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

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

Upcoming Trainings

Webinars

MAY 2012  

6/5/12 at 12:00 (EST)
Advocacy  

6/7/12 at 12:00 (EST)  

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

6/26/12 at 12:00 (EST)  

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

7/11/12 at 12:00 (EST) 

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

KATC RESOURCES

KATC Family Guide

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. 

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!

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

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.  

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

Meet 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.