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Archive for the ‘Evidence Based Treatments’ Category

The field of special education and behavior analysis lost a great man last week. Stan Deno, Ph.D. served on faculty in the College of Education and Human Development at The University of Minnesota (commonly referreStan Denod to as The U) from 1970 (or so) until he retired in 2009. During that time, Stan developed a framework for monitoring student progress towards their academic goals. His work in Curriculum Based Measurement (CBM) is the foundation for DIBELS (Dynamic Indicators of Basic Early Literacy Skills; Good & Kiminski, 2002) which has been used in thousands of schools across the country.

Stan also trained many students including undergraduate, masters level, and doctoral level. Two of his students, Doug and Lynn Fuchs, have led the way in developing Response to Intervention (RTI) an evidence-based approach to identifying students with learning disabilities and behavior disorders.

If you don’t know Stan or haven’t read his work, you should make time to do so. Without a doubt, his work has influenced the way we monitor progress in schools and the way we address instruction for students with learning and behavioral needs.

I have many fond memories of Stan. I feel so lucky to have studied with him during my time at The U. He worked diligently to help me slow down when I spoke (I talk fast and southern and it was difficult for him to understand me). He also modeled for me the act of thinking carefully before speaking. If you know me, you know I still am working on this skill!

Stan trusted me to serve as his Teaching Assistant (TA) in the Intro to ABA class. He taught me how to teach adult learners and how to give meaningful feedback on their written work. During this time, he also taught me the importance of technology in the classroom to increase graduate student participation and responding. I am a much better teacher now because of Stan.

I took several classes from Stan. The most memorable included the course on Single Subject Design. In this course, Stan introduced me to the work of Alan Kazdin and he taught me to conduct experimentally sou
nd research studies as well as how to read research and interpret and apply it in my own work. His influence enabled me to write successful grants, publish my own science, and go on to teach my own students. Stan also served on my dissertation committee where he modeled for me how to help students improve their research ideas, study procedures, and how to interpret results accurately. I was so fortunate to learn so much from him.

In addition to our love of research, behavior analysis, and helping students learn, Stan and I both shared the diagnosis of cancer. I received my diagnosis in 2002 some time after he received his diagnosis and treatment. I stopped by the U to visit Stan while I was in town later that same year. We shared how hard living as a survivor can be and we shared how crushing the diagnosis can be. It was then that Stan shared with me the theory of the Sword of Damocles. It took some time for me to truly understand this concept as a new survivor. But oh do I understand it now, 14 years later.

My heart sank to my stomach last week when I learned of Stan’s passing. But, I have joy in knowing how much he taught me and how much he has taught the special education world. Stan will be missed.

The family asks that in lieu of flowers contributions be made in memory of Stanley Deno to: “Stan Deno CBM Research” fund #20003 at the University of Minnesota Foundation.

Online gifts can be made at:  www.give.umn.edu/giveto/standeno

Or mail this giving form to:

University of Minnesota Foundation
P.O. Box 860266
Minneapolis, MN 55486-0266

 

References

Good, R.H., & Kkaminski, R.A. (2002). Dynamic Indicators of Basic Early Literacy Skills (6th ed.). Eugene, OR: Institute for the Development of Educational Achievement. Available: http://dibels.uoregon.edu.

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Logo2012 was a great year for the Applied Behavioral Strategies blog. We had almost 100,000 visitors in total. Here is a list of the most visited blog postings last year. The great news is that I wrote some of the most visited posts in 2011. I am pleased that my posts remain relevant for readers.

#5. Early Morning School Routines. Who doesn’t need help with this? Seriously, it is THE most stressful time of the day for my house.

#4 Just Say No. I can see why this one has staying power. Almost daily, I hear myself saying “Parents need to learn to say no.” You don’t even have to state a reason. Just know that your child needs to learn to accept being told no. (And despite how it may feel or sound, it will NOT be the end of the world.)

#3 Autism Awareness Apps. I really need to update this link. I will be sure to do so in time for April give aways. Keep in mind that I’m also presenting on this topic at SXSW in Austin, TX in March, 2013.

#2. Do You Use Visual Schedules? Wow. I am pleased that this topic is still a hit. If you aren’t using visual schedules, you should! In my home, we use a homework whiteboard every day and it makes our afternoons a BREEZE!

#1. Using ABA to Teach Math. I had no idea when I wrote this post that it would become so popular. The great news is that ABA may be used for a variety of skills!

I cannot thank you enough for your readership! Keep the reading, following, sharing, ideas, feedback, and questions for Ask Missy Monday coming!

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Ginger rated her behavior during carpet time

Hi! and welcome to What Works Wednesdays where a success story from clinical files is shared. Today’s story is about a little girl named Ginger who happens to be a typically developing 3rd grade. Ginger’s teacher contacted Applied Behavioral Strategies to assist her with Ginger’s behavior because Ginger had difficulty paying attention during morning meeting, sitting quietly during group instruction, and staying on task during independent seat work.

Record Review

A review of Ginger’s academic records indicated that she was performing at grade level in all areas. While she had some struggles learning to read, with focused intervention, she has remained on a 3rd grade reading level. Ginger is also very active and has difficulty keeping her hands, arms, and legs still. Finally, Ginger is highly distractable. Her focus is disrupted by butterflies, peers walking by, and particles on the floor.

Ginger’s teacher felt overwhelmed because she had tried verbal reminders, notes home to parents, and seating arrangements. She felt that none of these strategies worked effectively.

Student Interview

The behavior analyst asked Ginger why she had difficulty sitting quietly, completing her seat work, and listening to teacher instruction. She responded that, “I try to sit still and listen but my friend talks to me” and “I try to do my work but I have to sharpen my pencil” and “I sit away from my friend but she comes to sit next to me”.

ABC Observation and Analysis

Direct observation revealed that a variety of consequences followed these target behaviors. Sometimes Ginger received a verbal warning, sometimes the class received a reminder, and some times, no consequence occurred at all.

Self-Management

The behavior analyst needed more time to complete the assessment

so she developed a brief self-monitoring plan for Ginger to use until the assessment and behavior intervention plan could be completed. The self-monitoring plan consisted of Ginger evaluating her own behavior following each instructional activity. Her teacher reviewed the evaluation and confirmed if the evaluation matched reality. Ginger received praise and positive feedback for desired behaviors and her parents provided additional positive attention each day when Ginger shared her rating at home.

Additional Tips

The form was printed and put onto Ginger’s favorite color of construction paper. Then it was laminated so that one side showed the seat work and the other side showed the carpet time. Using a dry erase marker, Ginger could self-rate each day and then the chart could be wiped clean for the next day.

Ginger rated her behavior during seat work

Success

After 2 weeks, the assessment had to be put on hold because Ginger’s behavior improved. As with any student, Ginger continues to have difficulty when substitute teachers are present. However, this simple intervention worked to focus on Ginger’s strengths by reinforcing desirable behaviors.

Readers, have any of you tried self-management? What worked? Parents, have any of your children been placed on self-management plans? Did you like it? Did your child?

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Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s post is in response to multiple requests and questions about social stories and visual supports. Common questions include:

  1. I thought the story had to be written in first person? (e.g., “I like” versus “Charlie likes”)
  2. I thought the story had to be just like Dr. Gray says (A specifically defined style and format: sharing accurate social information and affirming something positive about the child)
  3. Is there any research to support social stories or visual supports?
  4. We do ABA.  Social stories aren’t behavioral.
  5. My child cannot read so why should we have a story?

Overview

Social stories and visual supports serve a specific purpose of providing visual information to individuals so that they can be successful in difficult situations. Some examples of difficult situations include:

  • Non-preferred but required activities (e.g., shopping, haircuts, blood draws)
  • Changes to routine (schedule is disrupted, substitute teacher, different bus route, school cancellations)
  • Novel situations (first time to hospital, first time on an airplane, first time to a play or show, storms)
  • Special but routine situations (dr. appointments, dentist appointments, hair cuts)

 

Individualized

Social stories and visual supports should be individualized to the user. While it may  not be convenient for a teacher to create 12-15 stories/visual supports, what works for one person may not be appropriate for another. When developing stories and visual supports keep the following considerations in mind:

  • age of the individual (resources must be age appropriate for the user)
  • reading ability (adjust the text of the visual depending on the reading level)
  • visual acuity (content should be selected based on the individual’s vision and ability, 3D versus 2D, color versus black and white)
  • attention span (the length and detail of the story or visual support)

Content

While Dr. Gray has created a trademark, there are many options beyond what she describes. Because social stories and visual supports should be individualized, the content should be determined based on the individual’s needs. For example, a mom here in CT created a social story for her child regarding Hurricane Sandy. The story included information about the storm, how it would affect trees and power, and how power could be restored. The story was developed for her son because the issue of losing power is important for him. He becomes upset if he cannot turn on lights or play on computers. However, another child may be scared of the wind or scared of the heavy rain. That child would need a story that focuses on the wind and the rain and how to make the noise go away. And then another child may not fully understand why she cannot go to school. Because she cannot read, her story may show a picture of wind and rain and a picture saying “no school”. The story would end with a picture of the little girl at home working with her ABA therapist.

Research

We have written about visual supports before: here, here, and here. We recommend only evidence-based strategies for our readers. So obviously there is ample research to support social stories and visual supports. A research group has developed a list of evidence-based practices for individuals with autism. Social narratives and visual supports are both on the list. For additional information on those practices and to read the research visit here.

ABA and Social Stories and Visual Supports

ABA, applied behavioral analysis, is simply the application of behavioral principles, to everyday situations, that will, over time, increase or decrease targeted behaviors. For additional information on ABA, visit our website. Thus, the use of visual supports and social stories does not preclude someone from doing ABA. Similarly, implementing ABA does not preclude someone from using visual supports and social stories.

I hope this helps to answer the many questions about social stories and visual supports. If you have a behavioral question for me email me directly at askmissy at applied behavioral strategies dot com. Thanks!

 

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Hi! and welcome to What Works Wednesdays where we share a success story from our clinical files. Today, we are going to take a pause from our personal stories and share a resource with our readers. The resource is called the What Works Clearinghouse from the Institute of Educational Sciences (IES). the website for the resource is http://ies.ed.gov/ncee/wwc/.

 

Educators (special education and general education alike) are required to use evidence-based strategies in their teaching as required under the No Child Left Behind Act and the Individuals with Disabilities Education Improvement Act. Educators often find it difficult to determine what strategies have evidence.

As a result, the Institute for Educational Sciences (which also happens to hand out research money to educational researchers) developed the clearing house as a resource. The criteria used to determine if a methodology may be listed in the Clearinghouse is very stringent. However,  if you are ever in doubt about teaching methodologies and “what works”, their website is a good place to start.

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Here at Applied Behavioral Strategies, our mission is to improve the quality of life through effective intervention. One way we hope to do that is by reviewing research articles for our readers. Today’s article is titled, “Evolution of Research on Interventions for Individuals with Autism Spectrum Disorder: Implications for Behavior Analysts”. Dr. Tristram Smith (Tris) authored the article and he recently presented the paper at the Annual Conference of the Association for Behavior Analysts in Seattle.

This article is somewhat different from the other articles we have reviewed. In the past, we have reviewed research studies where authors gather data, analyze the data, and present the results. This article is a summary of the autism research that is ongoing today.

Historical Review

Over the past half-century, hundreds of papers have been published on the effectiveness of Applied Behavior Analysis (ABA) for individuals with autism spectrum disorders. Those interventions have been used to teach communication skills, play skills, self-help and those interventions have successfully addressed challenging behaviors such as self-injurious behaviors and tantrums.

Current Transformation

Today, scientists in fields other than Behavior Analysis are conducting studies related to autism. The Combating Autism Act  of 2006 and reauthorized again in 2011 was a declaration of the war on autism. This act resulted in hundreds of millions of dollars for research on autism with a large percentage of it focused on intervention efforts. Scientists can now apply for specific autism research money through Autism Speaks, the National Institute of Mental Health, the Institute for Education Sciences, the Maternal and Child Health Bureau, and the Department of Defense.

Priorities for this research focused on randomized clinical trials (RCTs) where participants are randomly assigned to treatments in order to determine which treatment is more effective. This means that some participants will be assigned to the “no treatment” or the waiting list control group. (I don’t know about you, but if my child had autism, I would not wait one minute to begin treatment.)

Types of Funded Studies

A number of studies have been funded. For example, two studies on psychotropic medication have been completed. Those studies resulted in the approval of the use of abilify and resperidone for treatment of children on the spectrum.

Several studies on ABA packaged interventions have been funded. However, the treatment is brief and often implemented by non-behavior analysts.

Studies on clinical behavior therapy and cognitive behavior therapy (CBT) have also resulted. Researchers examined social skills interventions, anxiety reduction strategies, and interventions for individuals with high functioning autism.

Implications for Behavior Analysis

Dr. Smith notably discusses the relevance of this to behavior analysts. Essentially, the money is available for research. If behavior analysts do not seek out the funding, other scientists will. He goes on to list areas of work where behavior analysts should focus.

Framework for Autism Research

  1. Dr. Smith encourages researchers to conduct careful tests of individual intervention packages before moving on to RCT research.
  2. Dr. Smith notes that some areas of ABA are ripe for RCT research, specifically comprehensive ABA interventions for school age children, youth, and adults.
  3. Dr. Smith suggests that we refine the defining features of autism through behavior research.
  4. Behavior analysts have long been successful in reducing stereotyped behaviors. This should be studied using RCT.
  5. Behavior analysts need to study intervention packages for behavioral feeding therapy.
  6. Dr. Smith encourages behavior analysts to develop thorough treatment manuals so that procedures may be replicated successfully.

In summary, we have a duty to ensure that research in autism interventions continues. If we want to continue demonstrating that ABA is effective, we must seek out this funding, design studies to demonstrate effective techniques, and disseminate our work so that others can implement successfully.

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Each week we try to review a research article. Though not intentional, several of our posts this week related to visual supports for students with autism and other disabilities. Thus, we thought it would be helpful to review a research study on the use of visual supports.

Today’s research article was published by researchers at the University of Kansas. However, the article is now over 10 years old and several of the authors have moved to other institutions. You are probably wondering why we would review an article that is over 10 years old. We have 2 reasons for doing so. First, while the article is old, many teachers and parents do not even know about visual supports. Sadly, research does not always result in translation to practice. Second, the authors completed a cool study with results that we found compelling to share with you. Finally, if it worked 10 years ago, it most likely will work today–especially if we augment the practice with a little technology.

The authors of this study included Sarah Dettmer, Richard Simpson, Brenda Smith Myles, and Jennifer Ganz. The study appeared in Focus on Autism and Other Developmental Disabilities in 2000 under the title, The Use of Visual Supports to Facilitate Transitions of Students with Autism. You may find a copy of the study (and many others) here.

Participants in the study included 5- and 7-year-old boys with autism. Both boys experienced difficulties transitioning between activities. The researchers used a withdrawal research design. Specifically, researchers observed behaviors and collected data in baseline. This was followed by intervention procedures and additional observations. The researchers then withdrew the treatment and continued observations. Finally, the treatment was reinstated while observations continued. A design such as this demonstrates experimental control and shows the effectiveness of an intervention if observed behaviors change as a result of treatment and treatment withdrawal.

For this study, baseline (or pretreatment) observations demonstrated the difficulty of transitions for each child. One mother physically removed her child from community settings due to challenging behaviors and refusals to leave. Both boys required 2-5 minutes of transition time combined with multiple verbal and physical prompts.

The intervention consisted of the use of visual supports. Researchers taught parents how to use visual schedules to communicate to their children upcoming events. If the intervention sounds simplistic to you, it is. The simplicity of the intervention adds to the quality of the study.

Both boys experienced decreases in total transition time. Specifically, one boy decreased from 5 minute transitions to 1.5 minute transitions. The other boy decreased from 2 and 3 minute transitions to transitions lasting 30 seconds.

The most surprising finding in this study (and the reason we still want to talk about it 10 years later) is the fact that one student verbally requested his picture book when it was removed. The other student went looking for the visual support materials. The students wanted their visual schedules.

So why 10 years later aren’t we all using visual supports for children who need them?

If you have a child or a student with autism who experiences difficulties with transitions. Consider using visual supports as a strategy to reduce transition difficulty. If the student has an iPad consider purchasing iPrompts so a visual schedule may be made in seconds.

Happy transitions everyone!

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