Insight on Autism 
Issue: #6Spring 2012
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 Kentucky Autism Training Center

University of Louisville Autism Center

Kosair Charities Center

1405 E. Burnett Ave.

Louisville, KY 40217

 

katc@louisville.edu 

(502)852-4631

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In This Issue
2012 Autism Institute
Upcoming Trainings
Consulting in Schools Poll
Library Featured Book
Ask KATC
End of the School Year
Choosing a Summer Camp
Learn the Signs Act Early
Medical Home Study
Reinforcement
 
Child blowing dandilion
2012 Autism Institute

 June 18, 19 and 20

 

Putting the Pieces Together through Collaboration:  Bridges to a Brighter Future  

 

University of Louisville Shelby Campus
Louisville, KY

Upcoming Trainings

 

Webinars

 

MAY 2012  

5/31/12 at 12:00 (EST)  
Puberty

 

JUNE 2012

6/5/12 at 12:00 (EST)
Advocacy  

 

6/7/12 at 12:00 (EST)  

How to Start and Sustain a Support Group!

 

6/13/12 at 12:00 (EST)  Writing Goals to Inform Practice

 

6/26/12 at 12:00 (EST)  

Transition to Adulthood

 

JULY 2012

7/10/12 at 12:00 (EST)
Engaging Conversations (Part One) 

 

7/11/12 at 12:00 (EST) 

Basics of Positive Reinforcement

 

 7/17/12 at 12:00 (EST)  Engaging Conversations (Part Two)

 

Registration and more information about each training is available online here.

Past archived webinars can also be viewed online here.

KATC RESOURCES

 




 

 

 

KATC Family Guide

KATC Poll
 
 Please answer the short poll questions and let us know if you would you like to learn more about consulting in schools

 


Featured KATC Resource Library Book
 
 
Helping Your Child with Autism workbook for families 


Helping Your Child With Autism Spectrum Disorder: A Step-By-Step Workbook For Families
 
Stephanie B. Lockshin, Jennifer M. Gillis, Raymond G.Romanczyk 
New Harbinger Publications, 2005 
227 pages


With this workbook, parents learn the latest and most effective ASD management techniques for their children, including the use of the family enhancement treatment model designed by the authors-a program that provides step-by-step guidelines for fostering children's abilities and enhancing the health of the whole family.

The book encourages parents to seek a balance between child-centered and family-centered goals. Parents learn how to assess their children's needs and create a personalized intervention plan compatible with the family's resources, goals, and priorities. Worksheets guide parents through the assessment and decision making process.

The family enhancement plan shows how specific family needs can suggest specific child-centered target behaviors. When accomplished, these behavior goals-like the accomplishment of certain chores or the ability to go with the family on an outing or errands-will benefit both child and family.

You can request to borrow this book or other books from the
KATC Resource Library . We will mail the book to you upon receiving your request.  

Featured Article



Laura Ferguson, BCBA,  KATC Field Trainer 


Question: 
My child has a very difficult time waiting. If I tell him to wait, he screams and has tantrums. How can I work on this?
 

  

Answer:  

Often times children equate the word wait with the answer of no. What happens is that we all get busy, our child approaches us and asks us for something. We then tell the child to wait and then forget about what they wanted and what they ask for is never given to them.

 

With several instances of this happening the child begins to pair the word wait with the response of no. So, it is important that we teach them the concept of wait. Begin in very small periods of time. For example, the child approaches you and asks for a movie. You tell the child 'wait' then have them wait for five seconds. Tell them 'nice waiting' then give them the movie.

 

Gradually increase this time, while always pairing it with the word 'wait'. This will teach them the concept of wait. 

 

Do you have a question to ask the KATC Field Trainers?  Send your question to katc@louisville.edu.  The question and answer could be featured in our next newsletter.

Diandre Glover Thomas

Insight on Autism, Editor


 

The end of the school year is a busy time for teachers, parents and children.  Parents begin looking for summer activities for their children and teachers begin transitioning their students for the next school year.  In this issue both parents and teachers will find tips to help prepare students for the summer and the next school year.

 In addition, this issue of Insight on Autism contains information about using reinforcement, dealing with tantrums and the results of a medical home study of Kentucky parents.
 
KATC also has several upcoming trainings including free informative webinars throughout the summer and 2012 Autism Institute next month. Space is still available for all of these trainings so sign up to attend the trainings today.
Preparing Teachers and Students for Next Year   

Tips to Create a Smoother Transition for Students and Teachers 

 

by Laura Ferguson

 

The end of the school year is an exciting time for both students and teachers. This time of year brings parties, and the beginning of summer activities. The students are eager to start their summer break. Though this is a fun transition, it can be a difficult transition for individuals with autism. The end of the school year marks new transitions and the beginning of a lot of unstructured time. These changes can be very difficult for our students, so we need to make sure we are preparing them in advance. 

 

Preparing the Next Teacher
As the end of the school year approaches, make sure you have all your documentation prepared for the new teacher. Meet with that teacher individually if possible. This will allow you to give the teacher tips on working with the individual. The documentation is critical as well. Have the Individualized Education Program (IEP) completed along with behavior plans, Functional Behavior Assesments (FBA's), reinforcer assessments, visual supports and any other crucial paperwork. This will allow for a smooth transition into the next school year.  

 

Preparing the Student
Now, that you have the next teacher prepared. Prepare the individual student. If they are transitioning to a new school, see if you can take him to that school. This will allow him to see the new environment. Video modeling is always a good strategy to use. Video what the new school transition will be like from the point of view of that student. Videotape the student walking down the hall; pointing out key teachers, places, and information. Send the video home with the student and have them watch it over the summer months.

If the student is remaining in the same school, have them transition several times to the new classroom. Video modeling, again may be beneficial in this situation. You can also take pictures off the new environment, teacher, and other staff. These pictures can be put into a social narrative that can be used to explain the new environment for the next school year.

Transitions are always difficult, but if you prepare both staff and the students it will be a smoother transition for everyone involved.

Have a great summer!

Choosing a Summer Camp
Three Tips to Help You Select the Right Camp for Your Child

by Jennifer Bobo
 

Choosing a summer camp can feel like a difficult decision because there are so many factors to keep in mind when selecting the right one for your child. Don't let these choices dissuade you, we know there are many great benefits of our children being involved in community activities and maintaining social contact with other peers their age!

Include Your Child
First things first, always include your child in the camp selection process; make sure you have a good understanding of their hopes and fears and what they want to get out of the camp experience. Make sure the camp can accommodate the needs, interests, and expectations of both you and your child.

What Type of Camp Should You Choose?
Secondly you will want to look at what type of camp: Do you want a camp that serves only children with autism? Do you want an inclusive camp that welcomes children with and without disabilities? Do you want an overnight camp? A co-ed camp? There are many different types of camps your child can participate in, make sure you choose the best option for your family. Before enrolling your child in any program do your homework and talk with a camp representative to be sure that your child's interests, skills, talents, and needs can be met in the program.

Don't Forget to Ask 
Lastly, don't forget to keep practical factors in mind such as cost, length of camp and location. When speaking with a camp representative make sure to ask about things like supervision, medical issues, meals and communication-(how will you get updates about your child), health and safety, accessibility, staff training, staff to camper ratio, and programs and activities offered. Regardless of what camp is chosen we want to make sure that the camp will provide a positive experience for your child! Attached is a list of camp opportunities across the state, I hope this helps!

Need more help? Check out these links that all provide great suggestions, packing tips and questions to ask when screening potential summer camps:ACA Camps.org, Autism Speaks, Care.com

2012 Summer Camp List

AUTISM CENTER NEWS

Promote "Learn the Signs. Act Early." in Kentucky  

Free Materials and Public Service Announcements

by Rebecca Grau

A child's growth is not just physical; the milestones that mark a child's development also include social, cognitive, language, and motor skills. CDC's "Learn the Signs. Act Early." campaign shows the familiar milestones of physical growth, such as height and first tooth, and explains that there are other important signs to watch for, like using pronouns and engaging in pretend play.

Every parent needs to know the developmental milestones - not just because something might be wrong with a child, but because knowing how a child learns, speaks, acts, and plays is simply a basic aspect of knowing a child's developmental health.

Child health care providers need to be proactive in conducting developmental screenings and referring children with potential delays for more tests or treatment. A "wait-and-see" approach to diagnosing developmental delays can lead to missed opportunities for providing needed care.

If parents have concerns about their child's development, they should consult their child's doctor. If the doctor recommends a "wait-and-see" approach and parents are still concerned, they should seek a second opinionfrom a developmental pediatrician or other qualified professional, and they can contact their local early intervention agency or public school.

Materials developed to promote the "Learn the Signs. Act Early." campaign in Kentucky are available here

These materials are research-based, free, easily accessible and available for distribution. If you have any questions, please contact Rebecca Grau at (502) 852-7799 or by e-mail at rebecca.grau@louisville.edu
 

Medical Home Study in Kentucky   

Survey Results of Parents of Children with ASD and Pediatricians in KY 

 

by Dr. Patricia Gail Williams, Associate Professor of Pediatrics, University of Louisville, Weisskopf Child Evaluation Center

 

The medical home model of care is widely accepted as the ideal for children with autism spectrum disorders (ASD). As defined by the American Academy of Pediatrics, the medical home provides accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally sensitive care for children. The medical home model may be particularly difficult to implement for children with autism due to the complexity of the disorder, the often associated emotional and behavioral concerns, and family stressors and financial difficulties which frequently occur in conjunction with having a child with ASD. Several studies have documented that children with ASD's are more likely to have difficulty accessing health care services, receiving family support services and obtaining referrals. 

 
A recent survey study of parents of children with ASD and pediatricians in the state of Kentucky yielded insights into the implementation of the medical home locally. Parent surveys were distributed to the list serve of the Kentucky Autism Training Center and completed via Survey Monkey. Physician surveys were distributed to members of the Kentucky Chapter of the AAP and completed via Survey Monkey. A total of 114 parents (32% response rate) and 25 pediatricians (4% response rate) completed the Likert-type questionnaires.


The results of the parent surveys can be summarized as follows. The majority of parents reported that their pediatricians provided adequate time and caring atmosphere and helped them feel competent. They also rated their doctors as excellent or very good in performing routine physical examinations and had not changed physicians based on concerns about the doctor's care of their child. However, most parents reported that they did not receive written information on ASD from their physicians and were given inadequate information about community resources and treatment options. A majority of families whose children presented with sleep, gastrointestinal, feeding problems, toileting concerns, sensory issues, aggression, and anxiety/depression expressed dissatisfaction with their pediatrician's treatment of these problems.


For their part, most physicians rated their ability as excellent or good in providing routine preventive care for children with ASD and making referral s for ASD diagnostic evaluation. However, only 58% of pediatricians routinely administered an autism specific screening test at the 18 month visit and only 47% at the 24 month visit; the recommendation to perform ASD specific screens at these well child visits was made by the AAP in 2007. The majority of physicians reported their ability to provide advice about alternative/complementary treatments for ASD and knowledge of community resources as fair to poor, but felt that their willingness to address concerns about vaccinations and ASD and ability to address early developmental concerns related to a possible ASD diagnosis was good or excellent. The majority of physicians felt comfortable dealing with associated problems such as sleep disruption, ADHD symptoms, and feeding difficulties, but felt uncomfortable treating anxiety, depression, aggression and sensory issues.

Most parents and physicians expressed satisfaction with the routine health care provided for children with ASD, a fact that should not be taken for granted given the anxiety that many children with ASD have in the doctor's office. The areas where physicians fell short, according to parents, were in providing specific information regarding educational, behavioral and complementary treatments for autism, as well as information about community resources. This can perhaps be correlated with the large number of physicians (41%) who reported never having attended a Continuing Medical Education session on autism. Autism is a complex neurodevelopmental disorder which has undergone dramatic changes in terms of treatment, resources and research; without ongoing training in this area, it is doubtful that physicians will be able to meet the needs of their patients. Both parents and physicians expressed concern about the ability of pediatricians to address comorbid conditions such as anxiety, aggression, depression, and sensory issues. It very well may be that general pediatricians should not be expected to be proficient in treating all these conditions. The medical home concept does not suggest that the pediatrician must treat all a child's medical needs, but rather serve as the individual who helps access and coordinate this care. Of note in this study is the fact that only 25% of children had accessed specialty care from developmental/behavioral pediatricians and only 44% had received psychiatric consultation. In large part, this may be due to the very limited number of developmental pediatricians and child psychiatrists in Kentucky.


In conclusion, the medical home model is optimal for providing primary care services to children with ASD, but is often difficult to achieve. The current survey study indicates significant need for improvement in providing comprehensive and coordinated care to the population of children with ASD in Kentucky. Effective change will require willingness on the part of physicians to educate themselves regarding this disorder, increased utilization by pediatricians of national resources available for autism (AAP Autism Toolkit, Act Early-Learn the Signs materials, Autism Speaks, etc.), and expansion of local resources for autism. This will likely require use of innovative models of providing health care, such as use of co-location models with developmental/mental health specialists available in the pediatrician's office. Collaboration between pediatricians, families, social workers, therapists and educators will also be needed to optimize the quality of care. Pediatricians can also team with families to advocate for services which support the needs of children with developmental and behavioral health issues.  

 KATC TOOLBOX 
Evidenced Based Practice --Reinforcement

by Heidi Cooley-Cook

 

As a preface to the webinar The Basics of Positive Reinforcement scheduled on July 11, 2012 at noon lets take a moment to review the evidence based practice (EBP) of Reinforcement. The American Heritage Dictonary of the English Language (2000) defines reinforcement as an event, a circumstance, or a condition that increases the likelihood that a given response will recur in a situation like that in which the reinforcing condition originally occurred. Reinforcement is used in conjunction with several of the other EBPs as it increases the likelihood that the behavior or response will occur again. There are two types of reinforcement - positive and negative. Positive reinforcement involves adding a reinforcer immediately after an individual has exhibited the target behavior/skill. Negative reinforcement entails removing an aversive (object or stimuli) immediately following the target behavior/skill being performed.
As you look at the examples below - ask yourself 1)is the target behavior increased - if yes it is reinforcement 2) is something was added (Positive Reinforcement) or taken away (Negative Reinforcement) after the target behavior/skill was exhibited.

 

  1. With key in the ignition, your car makes beeping noises until you buckle your seatbelt - because you find the sound annoying, you put your seat belt on more quickly or prior to putting key in ignition.
  2. Upon eating the food on his plate, a child is given dessert - at the next meal, he eats his food without needing to be asked to do so.
  3. After walking into a busy store, a child throws a tantrum - parent takes child out of store - the next time the child walks into a busy/loud environment she throws a tantrum.


Example A: behavior is putting on seatbelt - it is increased so this is an example of reinforcement. The annoying beep was removed upon buckling seat belt , so this is Negative Reinforcement.  

 

Example B: behavior is eating food - it is increased so this is an example of reinforcement. The dessert was given/added upon eating meal, so this is Positive Reinforcement.  

 

Example C: behavior is tantrum - it is increased so this is an example of reinforcement. The child was removed from the store (removal of the crowed/aversive environment), so this is another example of Negative Reinforcement.

Let's take Example C for a moment because no one wants to encourage or reinforce tantrum behaviors - instead of taking the child out of the store when the tantrum occurs - have the child calmly ask to leave and then escort the child out - that way you are reinforcing the communication vs. the tantrum. You could also use a social narrative (another EBP) prior to your visit to the store. This too may help with the tantrum behavior.  

 

We'll review Social Narratives in the next newsletter.

Tom Goes to Lunch and the Intervention that Supported Him    

A Story About Using Reinforcement

 

by Julie Stewart

 

motivaiderMeet Tom, an eighth grader who has spent all of his years in school in a self-contained classroom.  Meet Sarah, a junior high teacher with high expectations for her students.  When Tom entered junior high his teacher, Sarah supported him to be fully included in general education and participate in lunch with his same-aged peers.  Tom was allowed to spend lunch in the resource classroom until Sarah was challenged to intervene and support him to change his behavior. 

 

Using a MotivAider® for Tom to self-monitor how many minutes he stayed in the lunchroom, Sarah provided 1:1 reinforcement in the form of one minute of computer time for every minute in the lunchroom.  After Tom began selecting to leave after a specific number of minutes, Sarah changed the reinforcement schedule, making computer time available after twenty minutes of lunch and then providing two minutes of computer for every one minute after twenty minutes in lunch, with a total of ten minutes available. 

 

Currently Tom is staying in the lunchroom for the entire duration.  Way to go Sarah! Way to go Tom!  This is just an example of one student, one behavior, and one intervention.  All elements are distinctly individualized and worked for this teacher and student.  It is important for teachers to collaboratively think through interventions for teaching new behaviors with other professionals and make data-based decisions.  Changes in expectations for Tom will impact both his educational experience and his future transitions. 

I'll Try Cartoon Strip


 The mission of the Kentucky Autism Training Center is to strengthen our state's systems of support for persons affected by autism by bridging research to practice and by providing training and resources to families and professionals. KATC is committed to improving the quality of life for those affected by ASD.