Analysis of Behavioural Approaches for ASD

The NZASD Guideline recognises well assessed, behavioural interventions as being the best way to support behavioural challenges experienced by individuals with ASD. The Guideline appreciates the abundance of different behavioural assessments and interventions, but acknowledges the common foundations for these as being in the science of applied behaviour analysis. It defines applied behaviour analysis (ABA) as: the process of systematically applying interventions based upon the principles of learning theory to improve socially signif icant behaviours to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behaviour (Ministries of Health and Education, 2008, p.242). This artefact sets out to analyse and evaluate a range of interventions with their basis in ABA and categorise them according to the effective components in facilitating behavioural change. The aim is to provide breadth rather than depth, to be aware of some of what is available. The interventions chosen are listed below together with my personal rationale for selection. Key Component Positive behaviour supports Intervention Functional Behaviour Assessment (FBA) Individual Education Plan (IEP) Rationale for Selection The meta-analysis by Lord and McGee (2001) repeatedly provides many examples where ABA supported by FBA has the most favourable outcomes. An appropriate IEP developed around evidence-based effective, interventions produces the best results for modification of problem behaviours. (Lord and McGee, 2001) PBIS is an approach that can be used across the whole school with benefits to all children, staff and families. The NZ MoE have used this approach in their Positive Behaviour For Learning initiative (Ministry of Education, 2012). This offers an affordable intervention that is already used successfully by staff in our school. These staff could support others to develop stories for the children they work with. I would like to explore the idea of video modelling with a child who has behaviour problems relating to turn taking on a specific piece of

Positive Behaviour Intervention and Support (PBIS)

Social Stories

Video Modelling

Pivotal Response Training

Peer Mediated Instruction and Intervention (PMII)

Systems change

Adult Behaviour Change

Environmental change

Adapting Physical Aspects of the Environment

playground equipment. It is very easy for teachers, including myself to target academic skills in children with ASD, however, I have come to firmly believe that it is the pivotal skills, the key competencies, that we need to be teaching in order to truly help our children make changes that will last for live. With the increase in numbers of children with ASD in our classrooms it is important to actively involve peers in their interventions. This brings benefits to both the individual with ASD, the peer themselves and the teacher, who becomes free to deal with other tasks. This is something that could be explored in our school. Cartledge et al. (2008) report the importance of teachers looking at, and adapting, their own behaviours in relation to the behaviours of cultural and linguistically diverse students. I have clearly witnessed this need for adaptation in teachers approaches this year and feel this needs to be a focus for our school to prevent these negative situations arising again next year. This is something I would like to explore further with regards to 2 children in my current class.

The following tables consider each selected intervention with regards to theory, purpose, practice, research evidence, the individual with ASD and their family, and culture and the New Zealand context.

Functional Behaviour Assessment (FBA) Theory Purpose

All behaviours serve a purpose. Identification of this purpose can allow the problem behaviour to be replaced with something more acceptable whilst still allowing the child to fulfil the same purpose. To identify the antecedents of problem behaviours.

Practice

FBA is a systematic process involving: identification of the problem behaviour (interview and observations) forming an hypothesis about antecedents and consequences linked to the behaviour testing the hypothesis (observations of adaptations of the environment) developing an intervention based on results of this testing Lord and McGee (2001) reported that: Interventions based on FBA have a higher frequency of use of positive procedures than those not based on FBA Interventions based on FBA have a higher rate of reduction of problem behaviours than non-systematic assessments In some cases interventions based on FBA were not designed in accordance with the assessment data. It is important that information supplied by FBA is used accurately, to inform the selection and implementation of an intervention.

Research Evidence

The National Professional Development Center on Autism Spectrum Disorders (NPDC on ASD) reports that: FBA meets evidence-based criteria with five single-subject and one group design studies across ages, as well as in the domains of behavior and communication. Individual with FBA allows for identification of core characteristics and sensory issues in the individual with ASD including: communication deficits ASD and family social attention e.g. biting hands leads to adult soothing social avoidance escape from aversive situations access to desirable objects or activities sensory reinforcement including auditory, visual, tactile, olfactory, gustatory FBA can be used across school, home and community settings and the data collected helps to inform the ch ilds individual education plan and their families.

Culture and NZ Context

Assessments need to account for the cultural impact on behaviours and the cultural values of the family.

Individual Education Plan (IEP) Theory Purpose

No one intervention can address all the needs of a child with ASD. The child is an active, capable learner whose needs can be met by class and school-wide strategies. Collaborative decision making is key in supporting children with ASD IEPs offer a vehicle for adapting the school program to fit the needs of the child rather than changing the child. This is achieved through creating, implementing and monitoring a comprehensive intervention package in collaboration with the school, family, community and the child with ASD. It allows knowledge from different areas to be combined to produce better outcomes for the child. An IEP is: a plan of how the classroom or school program will be adapted to meet the child s needs combines knowledge about the childs needs, aspirations, goals and what is required to achieve these a plan to complement class learning and improve the childs participation in the class, school and community a future focused plan looking at strengths, next steps and how to facilitate these a brief outline of a few precise goals and steps to achieve these in the classroom setting a living document that should be updated and referred to by all the team In 2010 national and international literature around IEPs, from 319 sources was reviewed to inform their effectiveness and future use. The Review of the Literature on Individual Education Plans (Mitchell et al., 2011) was commissioned by the NZ Ministry of Education. The final conclusion from this review was: .in examining the role of IEPs we believe that they should ultimately lead to a high standard of education for students with special educational needs, as reflected in improved educational outcomes and the best possible quality of life for such students. (Mitchell et al., 2011, p.64)

Practice

Research Evidence

Individual with The involvement of the family at every stage of the IEP process is critical. If practical the child should be given a voice at ASD and family IEP meetings. IEPs address the specific needs of the individual with ASD and their families.

Culture and NZ Context

The NZ Ministry of Education document Collaboration for Success: Individual Education Plans (2011) offers strategies to ensure inclusion of Mori and Pasifika families in the collaborative IEP process. It emphasises that an IEP is designed for: .writing students into The New Zealand Curriculum rather than writing students out. (Ministry of Education, 2007, p.5) In accordance with the NZCurriculum Purpose and Scope this means that all students are included: .regardless of their sexuality, ethnicity, belief, ability or disability, social or cultural background, or geographical location. (Ministry of Education, 2007, p.6) This document acknowledges that Mori-medium schools may chose alternative options based on their kaupapa.

Positive Behaviour Interventions and Supports (PBIS) Theory

Positive behaviour interventions and supports comes under the umbrella of ABA, based on the learning theory concept that interaction with the environment is the process by which most learning takes place. However, unlike traditional ABA, PBIS has a strong family- centred foundation. PBIS supposes that there is a purpose to all behaviour and that, problem behaviour can be reduced if this purpose is identified and an alternative way of achieving this is taught. PBIS aims to reduce or replace problem behaviours by teaching functional skills and at the same time improving academic, communication, social and pivotal skills. A behavioural support plan for the child with ASD and their families or carers consists of: a medical assessment to ruling out physical illness as the cause of the problem behaviour a FBA is conducted using interviews and observations identify the purpose of the behaviour families and professionals design a plan to remove antecedents of the problem behaviour new skills and alternative ways of communicating wants and needs are taught

Purpose Practice

Research Evidence

Lord and McGee (2001) concluded that: PBIS was effective in reducing problem behaviours in at least 50% of all ABA studies involving children with ASD PBIS effectiveness doubled if it was informed by FBA for most children PBIS can be carried out in the childs natural setting PBIS had little effect reducing behaviour problems maintained by sensory inputs PBIS increased problems for a small percentage (6-8%) of participants Raising Children Network Australia rates PBIS as established.

Individual with Parents have a key role in the collaborative team working on PBIS for their child. Practitioners have a responsibility to ASD and family provide parents with training, information and support about this approach. PBIS improves pivotal skills for the
individual as well as eliminating the target behaviours. It can be used across school, community and home settings by being implemented by parents and teachers, who then provide feedback to the team. NZASD Guideline recommendation 3.2.5.2 states: Educational interventions should incorporate principles of positive behaviour support, particularly on understanding the functions of children behaviour. (Ministry of Health and Education, 2008, p.119) Many studies on PBIS have been conducted in America and so do not account for the cultural composition of New Zealand.

Culture and NZ Context

Social Stories Theory Purpose

The Social Stories approach was developed by Carol Gray in 1991. It is based on the theory that children with ASD often misunderstand or miss the social cues in body language, facial expressions, gestures and eye contact. To explain situations that the child may find difficult or confusing, increasing their understanding and teaching effective responses. This helps the child to feel more comfortable in these situations and to cope appropriately.

Practice

A social story can be in the form of a sheet of paper, a book, a video or a tape recording. It is developed by an adult who works with the child and shares it with them, allowing the child to learn about the target situation without actually being in that position in real life, therefore reducing anxiety. A successful social story needs to be relevant, reassuring and easy for the child to understand. It is usually written in the first-person and present-tense highlighting important social cues, the things that might happen and why, and how the child could respond. Social Stories usually include three kinds of sentences: Descriptive sentences: describing what people do in specific social situations. Perspective sentences: explaining the emotions and thoughts of other people to the situation. Directive sentences: stating the desired behaviour in a positive way. They can also include control sentences written by the child to aid recall and understanding of the story

Once the child is familiar with the story the adult helps the child apply the learning to a real life situation, reminding them of the story. When the child understands and uses the correct behaviour without adult support, the story can be faded out. Much evidence exits to support the use of social stories to address problem behaviours in children with ASD Research Raising Children Network Autism rates them as established. Evidence The NPDC on ASD considered 5 single subject studies that support the use of social stories. Research Autism rates social stories as having limited positive evidence. This is based on over 30 scientific, peer reviewed trials of Social Stories being used for children with ASD. Individual with Social stories are often written by parents as well as teachers and can be used across the home, school and community ASD and family setting. Parents understanding of their child often results in the most effective social stories. The success of social stories may lay in them being originally designed for children with ASD rather than borrowed from a broader field and adapted to the needs of a child with ASD. The interests and comprehension skills of the child need to be considered when choosing the form of the story. The individual nature of social stories and the involvement of the parents allows for cultural values, beliefs and Culture and practices to be reflected. NZ Context

Video Modelling Theory Purpose Practice

Viewing appropriate responses and behaviours via a video recording removes the anxiety of actually being in the social situation. To teach the child with ASD to replace problem behaviours with new skills including social, emotional and adaptive skills. It can be used to teach a wide variety of social, and functional skills. Video modelling teaches a target behaviour or skill through the individual with ASD watching it demonstrated on a video recording. It involves: the child with ASD or other models (siblings, parent, peer) are videotaped using the target behaviour the video recording is played back to the learner a number of times the learner is given opportunity to practice the behaviour in a real life situation

Different types of video modelling include: Basic video modelling: when someone other than the child with ASD is recorded demonstrating the target behaviour or skill Video self-modelling: when the child with ASD is recorded demonstrating the target behaviour or skill Point-of-view video modelling: when the target behaviour or skill is recorded from the perspective of the child with ASD Video prompting: breaks the behaviour or skill into steps, recording each step with pauses to allow the child to attempt each step before watching the next section. There is much positive evidence to support the use of video modelling for children with ASD. Research The National Standards Project rates video modelling as established. Evidence The NPCD on ASD reports that 8 single-subject studies confirm that Video modelling meets evidence-based practice criteria. Research Autism rates video modelling as having limited positive evidence, recognising that most research in this area to date has limited scientific reliability and validity. Autism Internet Modules list 9 studies providing supporting video modelling as an evidence-based practice. Individual with Video modelling can be implemented in the home by family and may include the child in the video or a sibling or peer. ASD and family This intervention is highly specific to the child with ASD and has a high motivational factor for many children with ASD. Video modelling can support children with ASD as young as 3 years of age. However, the success of video modelling depends on upon the previous elimination of behaviours that interfere with watching the video and imitation skills.

Culture and NZ Context

The individuality of the videos made allows for cultural values, beliefs and practices to be reflected.

Pivotal Response Training (PRT) Theory

PRT is grounded in the theory that there are four key areas of child development pivotal to later development: Motivation: encouraging learning through choices, varying tasks, combining previously learned skills with new skills, prompting and rewards Self-initiation: encouraging and rewarding the childs curiosity Self-management: teaching independence and responsibility for learning. Responsiveness to multiple cues: responding to different forms of the same prompt or instruction Establishment of these pivotal skills can then lead to the development of other skills. To improve social, communication and play skills, promoting independence and reducing the need for ongoing intervention. PRT occurs at school, home or in the community, and uses everyday activities to teach the child. PRT involves: 1. A focus on goals specific to the individual child 2. Using the childs interest to teach and help the child reach the goal 3. Positive reinforcement when the child makes an effort to reach the goal 4. Rewards are based on what the child likes. PRT always occurs in the childs natural environment and can be implemented by specialists, parents, teachers or peers. It can be very time intensive.

Purpose Practice

Research Rated as established by both Raising Children Network Australia and National Standards Project Evidence Individual with Active parent involvement is crucial to this approach, one source of parent training and support materials is the Koegel ASD and family Autism Centre in the US. The childs interests and strengths are used as a basis for PRT, making the program individual
for each child.

Culture and NZ Context

NZASD Guideline recommendation 3.1.7 states: Approaches should emphasis pivotal skills such as spontaneity, initiation, motivation and self-management. (Ministry of Health and Education, 2008, p.87)

Peer Mediated Instruction and Intervention (PMII)

Based on Vygotskys proximal zone of development, the peer uses their expert knowledge to move the child with ASD from what they know to what they need to know. To teach typically developing peers to interact with and help children with ASD so improving the childs social skills Purpose including: responding to others, reciprocity, understanding others, and interacting with others or in groups, Peers are systematically taught how to engage learners with ASD in social interactions. It can be used as part of the Practice daily curriculum with a balance of teacher-directed and learner-initiated activities. PMII can be used with pairs, or small groups of learners. In young children, 3 to 8 years of age, PMII can help individuals with ASD acquire communication and social skills. Social networking strategies can be used with older learners, 9 to 18 years of age. The NPDC on ASD classifies PMII as meeting the criteria for evidence-based practice within the early childhood and Research elementary age groups for promoting communication and social skills. They only identify one study meeting the criteria Evidence in the middle/high school age group. National Standards project rates PMII as emerging. Research has shown PMII to have positive effects on academic, interpersonal, and personal-social development. Individual with The individual with ASD will become more included in the class setting by developing relationships with their peers and ASD and family the increased understanding and tolerance of peers. This inclusion may generalise to outside the school setting, aiding the childs participation in the community, a goal for many families. NZASD Guideline recommendation 3.4.2 states: Culture and

Theory

NZ Context

Peers should be provided with information about ASD and given support and encouragement to foster relationships. (Ministry of Health and Education, 2008, p.127) When a child with ASD is paired with a peer from their own culture the beliefs, values and practices of this culture will have a better chance of being integrated into the learning. The Big Brothers Big Sisters program run in 15 location around New Zealand matches mentors for vulnerable children and young people from the age of 6-18, some of which have ASD.

Adult Change
Shift needs to be made in the thinking and the behaviour of adults working with the child rather than with the child themselves. All children with ASD are unique and need to be supported in the way that produces the best possible outcomes for them as an individual. To help adults examine and change their behaviours to produce positive, maintainable change to the behaviours of Purpose children with ASD Adults working with children with ASD can adapt their own behaviours in relation to the child through: Practice modifying the curriculum, daily routines, timings, spaces and places ensuring opportunities for social engagement altering their communication style implementing and monitoring planned interventions A crucial factor in achieving these changes is on-going professional development. Key findings from Goodall, (2008.) identified the link between: Research a teachers attitude and willingness to teach and effectiveness of their practice Evidence a teachers attitude towards ASD and how this effects the potential of the child with ASD. Individual with This change in teacher attitude and behaviour will foster a more effective relationship with both the child with ASD and ASD and family their family. This relationship will recognise and value the strengths of the child and acknowledge that they learn in a different way which needs to be accommodated in order to achieve positive outcomes for all involved. NZASD Guideline recommendation 3.4.1 states: Culture and

Theory

NZ Context

All school staff should be offered information about ASD and given opportunities for discussion with an aim towards understanding the needs and experiences of the child or young person. (Ministry of Health and Education, 2008, p.127) NZASD Guideline recommendation 6.11 states: Teacher aides, education support workers (ESW) and other paraprofessionals require professional learning and development for working with specific children and adults. (Ministry of Health and Education, 2008, p.187) Ministry of Education funded training is provided for professionals and families through a number of initiatives including the Tips for Autism program. A key consideration in an adults adaptation of their own behaviours is to ensure their cultural responsiveness to the child.

Environmental Change Theory Purpose Practice

Arranging the physical environment to ensure children with ASD know what is expected of them decreases problem behaviours replacing them with appropriate behaviours. To arrange the environment to remove specific antecedents to problem behaviours. This approach involves modifying the environment to meet the needs of the child with ASD. It involves: an assessment of the antecedents to the behaviour making adjustments to the environment. monitoring the effectiveness of these adjustments In a classroom setting adjustments may include: removing distracting stimuli incorporating calming sensory experiences into the daily routine changing physical arrangements e.g. seating providing a clear and predictable schedule scheduling calming down times or exercise breaks before difficult situations alternating demanding tasks with more enjoyable tasks providing choices providing access to favourite activities and peers having somewhere for the student to relax

Research indicates that the arrangement of the classroom environment influences the learning of children with ASD. Children in organized and structured classrooms show less off-task behaviours and higher levels of achievement (Hume, 2007). Individual with Environmental adaptations are equally relevant to home settings as they are to the classroom. Being in an environment ASD and family that reduces the stress of the child with ASD sets them up to be more compliant to social and academic learning and helps avoid challenging behaviours. Any environmental modifications need to take cultural preferences into account. The Ministry of Education Culture and Modern Learning Environments assessment process introduced in 2010 provides schools with the opportunity to NZ Context assess environmental needs for all learners, including those with ASD, and direct funding towards this.

Research Evidence

Conclusion
The interventions and approaches reviewed highlight the widely accepted notion that there is no one intervention that provides the solution to all problem behaviours for all children. It also reflects the shift in perspective away from the child being the cause of the problem behaviour and needing to change towards the more ecological perspective of the environment providing the antecedent to such behaviours and this therefore needing to be the focus of change. The research supporting these approaches varies in fulfilling the demands of criteria for evidence-based practice. However, EBP is not the only factor that needs to be considered in intervention choice, professional experience, family preferences and the ability to implement the approach in a given setting must also be taken into account. The section of this analysis which was least supported by international literature was that of culture. This can be attributed to much of the research coming out of America and some from the UK or other anglo-european countries. Little or no reference is made to the culture or ethnicities in most research studies. However, it is widely recognised by professionals within the field of ASD in New Zealand that cultural responsiveness is a key consideration for all ASD interventions. New Zealand is in a unique position with regards to its bicultural and multicultural nature. It has been noted in the research that behaviours considered as problematic by teachers and specialists are often developmentally appropriate within the childs culture. Misunderstandings of this form strongly point towards the need to increase the recruitment and training of Mori and minority culture professionals in the field of A SD. The shift towards a more holistic model of intervention is in line with Mori worldview and also the collectivist view of some other minorities. There is a growing body of NZ research around the modification of interventions and processes to provide a good fit to Mori culture and include practices and beliefs. As our knowledge in this area grows it will open doors for working with other cultures and ethnicities in New Zealand. Finally the growing body of research regarding ASD interventions, and the shifting perspectives informing these interventions, places a responsibility on all professionals in this field to remain informed of current issues and to keep pace with the second and third generations of behavioural interventions as identified by Meyers and Evans (2006, p22).

References
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