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Diagnostic and Assessment Findings: A Bridge to Academic Planning for Children with Autism Spectrum Disorders

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Abstract

Increasing numbers of children diagnosed and treated for autism spectrum disorders (ASDs) has impacted both neuropsychologists and educators. Though both play key evaluative and treatment roles, there is no available method or process in place enabling the translation of the neuropsychological report recommendations into a format educational teams can easily use, leading to a gap between neuropsychological recommendations and educational planning. In the following, we review the areas evaluated by a neuropsychologist when assessing a child with an ASD, discuss the domains targeted by educational teams when designing an educational plan, and then present a process that has met with some success creating a “bridge” between the diagnostic/assessment process and the subsequent academic planning. Though presented in the context of ASD, the process described can be used by neuropsychologists for various populations to facilitate partnerships with educators that result in improved care for the child.

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Correspondence to Stephen M. Kanne.

Appendix: Case example of Bridge Document

Appendix: Case example of Bridge Document

CCC was 6 year old boy referred for an evaluation to a multidisciplinary team to confirm his prior diagnosis of an ASD, to assess his cognitive and behavioral functioning, and to make treatment recommendations. The multidisciplinary team consisted of an occupational therapist, a speech/language pathologist, a special education specialist, and a pediatric neuropsychologist. The team concluded that CCC continued to meet the criteria for an ASD.

To provide some background, CCC did not walk independently until 15 to 18 months of age. His early speech/language developmental milestones were significantly delayed. CCC demonstrated minimal babbling and used only a few single words until 4 years of age. He was diagnosed with Autistic Disorder at the age of 4. Educationally, CCC did not receive Early Intervention or Early Childhood Special Education services. He had significant behavior problems (e.g., hitting) while in Kindergarten that prompted a change of school. Due to his parents’ and educators’ concerns regarding his lack of progress, he was retained in Kindergarten.

At the time of the evaluation, CCC had an IEP under the special education eligibility category of Autism. Services included occupational therapy and speech therapy. He was included with typical peers for several classes. Teachers had significant concerns about his behavior (e.g., striking a teacher).

Multidisciplinary evaluation

Results of the cognitive testing from the multidisciplinary evaluation indicated that CCC’s nonverbal intellectual ability was in the borderline range (Leiter International Performance Scale, Revised). Although he knew his colors, his other pre-academic skills were in the impaired range (Bracken Basic Concept Scale—Revised). His speech was severely impaired with frequent substitutions and reduction processes, and his overall language was significantly below average (Goldman–Fristoe Test of Articulation 2; Khan–Lewis Phonological Analysis 2). His visual–motor skills were in the borderline range (Peabody Developmental Motor Scales; Developmental Test of Visual Motor Integration). Parents rated his adaptive skills in the impaired range overall (Adaptive Behavior Assessment System-II).

The recommendations from this evaluation were separated by domain, including speech/language, occupational therapy, education/school, medical, social/behavioral, and general resources (e.g., autism support groups, websites, and books). We have omitted the recommendations having to do with resources in the interest of brevity.

These recommendations were targeted for receiving the highest priority:

  1. 1.

    Speech/language:

    CCC would benefit from intensive speech and language therapy due to the severity his disorder.

    1. a.

      Remediate speech using a phonological or cycles approach to intervention. Begin with eliminating final and medial consonant deletion, consonant harmony and velar fronting.

    2. b.

      Pair speech production with printed graphemes to facilitate early literacy skills and sound–symbol correspondence.

    3. c.

      Continue to build vocabulary through frequent exposure to books and activities. Caregivers should use short sentences when talking with CCC. New concepts and words should be spoken with slightly increased amplification.

  2. 2.

    Occupational therapy

    1. a.

      CCC would benefit from Occupational Therapy services to address fine motor skills and functioning in school based activities, as well as to address his sensory differences.

    2. b.

      CCC would benefit from strategies to address his toileting difficulties.

  3. 3.

    Education/school:

    1. a.

      With regards to CCC’s challenging behaviors, teachers should look for ways to structure the environment to promote success and anticipate problem situations in order to avoid them. Punitive feedback should be limited as much as possible as punishment does not facilitate skill development. Instead, positive reinforcement strategies should be used to promote wanted behaviors. Formal functional behavior assessment should be conducted to identify situations that are particularly problematic for CCC and to aid in the development of appropriate behavioral supports.

    2. b.

      CCC will benefit maximally from strategies that are used consistently across home and school settings. CCC would benefit from collaboration between his educators and other service providers to facilitate exchange of information and implementation of effective interventions.

    3. c.

      CCC would benefit from continued opportunities to interact with typically developing peers in order to facilitate learning and socialization, as well as give him the opportunity to use language for functional purposes in a natural context.

These recommendations followed the high priority recommendations above:

Medical:

  1. 1.

    It is recommended that CCC follow-up with Dr. XXX regarding his medical needs.

  2. 2.

    CCC’s parents are encouraged to consult with Dr. XXX regarding the possible risks and benefits of medication management to address CCC’s difficulties with attention, hyperactivity, and impulsivity. Research indicates that medication, behavior management strategies, and environmental accommodations are the most effective means to address difficulties with inattentiveness, distractibility, and impulse control.

Speech/language:

  1. 1.

    CCC would benefit from intensive speech and language therapy due to the severity his disorder.

  2. 2.

    Remediate speech using a phonological or cycles approach to intervention. Begin with eliminating final and medial consonant deletion, consonant harmony and velar fronting.

  3. 3.

    Pair speech production with printed graphemes to facilitate early literacy skills and sound–symbol correspondence.

  4. 4.

    Continue to build vocabulary through frequent exposure to books and activities. Caregivers should use short sentences when talking with CCC. New concepts and words should be spoken with slightly increased amplification.

  5. 5.

    Increase the use of auxiliary verbs and articles through structured tasks.

  6. 6.

    Improve syntactic development through increasing CCC’s variety of sentence types. Pictures plus sight words can be used to build sentences visually. Physical manipulation of the pictures can be used to facilitate question formation. For example: The (printed sight word) boy (picture) is (sight word) jumping (picture) can be changed to a question form by moving the sight word “is” to the beginning of the sentence to formulate, “Is the boy jumping?”

  7. 7.

    Provide opportunities for peer interactions. Guided play would facilitate success.

Occupational therapy:

  1. 1.

    CCC would benefit from Occupational Therapy services to address fine motor skills and functioning in school based activities, as well as to address his sensory differences.

  2. 2.

    CCC would benefit from intervention to improve his scissor skills:

    1. a.

      Begin by teaching the child the action of the scissors using tweezers/tongs before they begin cutting.

    2. b.

      When first introducing scissors, have the child practice opening and closing the scissors. Using the concept of an alligator, verbally instruct the child to imitate opening and closing of the alligator’s mouth (the scissor blades).

    3. c.

      Have beginning cutters cut across small pieces of heavy paper (i.e., magazine inserts, old greeting cards, index cards).

    4. d.

      Progression for cutting shapes—Wide straight lines, Narrow lines, Wide curved lines, Narrow curved lines, Cutting around a corner, and Cutting a circular shape

    5. e.

      The best scissors have short (3.5 or 4.5 in.), sharp blades, rounded tips, and small finger loops for the thumb and middle finger to promote better control of finger movements.

    6. f.

      When teaching children to cut, encourage them to properly hold the scissors with their middle finger and thumb in the finger loops and the index finger supporting the scissor blade.

    7. g.

      Encourage children to cut with their thumb up by putting a sticker or smiley face on their thumbnail to look at while cutting

  3. 3.

    CCC would likely benefit from an assistive technology evaluation to identify resources to assist him in areas of difficulty (e.g., letter recognition).

  4. 4.

    The following strategies may be effective in addressing CCC’s toileting difficulties:

    1. a.

      Use visual and verbal cues to sequence the task. For example, use a storybook with concrete pictures to show the steps of toileting and what will happen when finished with toileting.

    2. b.

      Make the toileting experience as pleasant as possible by using relaxing music, allowing CCC access to certain toys only when he is sitting on the toilet, or including other elements that CCC enjoys.

    3. c.

      Immediately reward CCC when he has a bowel movement on the toilet.

    4. d.

      One strategy that could be used to wean CCC from reliance on pull-ups, is to begin playing with him in the bathroom during target times (i.e., the times bowel movements usually occur). When his behavior suggests that he needs to have a bowel movement, initially sit him on the toilet in his pull-up and reward him for voiding in his pull-up while sitting on the toilet. Then gradually cut increasingly bigger holes in his pull-up over the next few weeks, so that eventually, he is having bowel movements on the toilet, with only the waist of the diaper around his waist. The final step is completely eliminating the diaper.

    5. e.

      A seat insert could be used to minimize splashing water.

    6. f.

      A desensitization program is the most appropriate way to address anxiety of discomfort related to toileting. A brief list of some of the gradual steps this could involve follows, but it is important to discuss this type of program with a professional so that it can be tailored to meet your child’s individual needs. Do not move from one step to the next until your child is completely comfortable at each stage:

      1. 1.

        Allow your child to have a bowel motion in his diaper or pants, then show him how you empty it into the toilet. At this stage it may be best not to flush it away until the child has moved away.

      2. 2.

        Next, do the same as above, but flush the toilet while he is nearby.

      3. 3.

        If your child is regular, have him sit on the toilet, keeping his diaper on, and do his bowel movement in the pull-up while sitting on the toilet. Once he is done, empty into toilet and flush.

      4. 4.

        Place a pull-up or cloth diaper across the toilet bowl, held in place by the seat, so the child has no pants or diaper on, but can defecate onto the pull-up. Finish up as above.

      5. 5.

        Gradually lower the diaper until it is virtually hanging in the toilet

      6. 6.

        Remove diaper, but put a bit of toilet paper into the toilet before the child goes so that there is still something for his bowel motion to land on.

      7. 7.

        You may want to teach the child to do this last step himself to stop water splashing.

Education/school:

  1. 1.

    CCC continues to demonstrate a need for special educational services based on his diagnosis of Autistic Disorder. Individual Educational Planning should incorporate curriculum modifications, environmental modifications, and behavioral management strategies. CCC’s parents are encouraged to share the results of this evaluation with CCC’s educators to assist in educational planning.

  2. 2.

    With regards to CCC’s challenging behaviors, teachers should look for ways to structure the environment to promote success and anticipate problem situations in order to avoid them. Punitive feedback should be limited as much as possible as punishment does not facilitate skill development. Instead, positive reinforcement strategies should be used to promote wanted behaviors. Formal functional behavior assessment should be conducted to identify situations that are particularly problematic for CCC and to aid in the development of appropriate behavioral supports.

  3. 3.

    CCC will benefit maximally from strategies that are used consistently across home and school settings. CCC would benefit from collaboration between his educators and other service providers to facilitate exchange of information and implementation of effective interventions.

  4. 4.

    CCC would benefit from continued opportunities to interact with typically developing peers in order to facilitate learning and socialization, as well as give him the opportunity to use language for functional purposes in a natural context.

  5. 5.

    It will be of benefit to CCC to participate as much as possible in the regular classroom. He will likely need a personal aide to assist him with the specific material presented as well as in helping him to modulate his focus, shift from activity to activity, learn to interact appropriately and play with other children, and assist with his other needs. This aide should be a person who knows about autism with specific training regarding the disorder. The role of this person is not to serve as the student’s shadow to “put out fires.” Instead, the aide is most helpful when she or he assists in developing and implementing the structure (schedules, modifying assignments, checklists, etc.) that will be useful in increasing the child’s independence.

  6. 6.

    The following strategies may be helpful in addressing CCC’s inattention:

    1. a.

      give directions one step at a time

    2. b.

      use a physical prompt (e.g., touch arm) if necessary to get his attention

    3. c.

      limit instruction complexity

    4. d.

      eliminate distractions (e.g., seat in front of class, near quiet students, fold worksheets in half, not by windows)

    5. e.

      keep desk/table clear of materials not essential to immediate task

  7. 7.

    The following strategies may be helpful in addressing CCC’s overactivity:

    1. a.

      allow CCC to stand at times while working

    2. b.

      provide opportunities for activity

    3. c.

      give CCC many short breaks

    4. d.

      provide recess even if work is not complete

    5. e.

      during some tasks, have a defined “spot” for CCC to stay in if needed

    6. f.

      keep CCC close to a teacher or aide so physical prompts can be used if disruptive or inattentive

Social/behavioral:

  1. 1.

    CCC’s family is encouraged to continue to pursue available resources through Dr. XXX regarding structured behavioral programs, such as Applied Behavior Analysis (ABA) therapy to promote more adaptive behaviors at home and at school.

Bridge Document

Below is the Supporting Document for CCC from his Bridge Document. The Summary Page for CCC’s Bridge Document is shown in Table 5:

Supporting document

Section 1: Environment

  1. 1.

    Structured/predictable daily routine. A structured, predictable, routine can reduce anxiety and increase behavioral compliance. Using concrete visual supports and predictable transitions may be beneficial for CCC.

    1. a.

      Concrete visual supports

      • – Daily schedule—CCC should participate in setting up his daily schedule at the start of the day so he has an overview of what to expect. Prior to changing activities, CCC should check his schedule and label where/what is next. After the completion of the activity, CCC should remove the picture of the activity from his schedule and put in a designated “task completed” container.

      • – If–then (reward) board—For more difficult activities in CCC’s daily routine, if–then boards can be utilized to visually show the positive outcome of task completion. For example, if during speech CCC tended to protest working, an if–then board could be used to show CCC the behavioral expectation and the reinforcement he was working for: A picture of him sitting with his hands in his lap or on the table with an arrow drawn to a picture of a preferred, highly motivating, reward. Prior to beginning the activity CCC would be shown the if–then board and told as the pictures are pointed to, “If you work, then you can have ____.”

        • To initially teach this concept, the activities should be short in duration of time so CCC could be successful in meeting the behavioral expectation and obtaining the reinforcement (for example, the if–then board could be shown for a 5-min activity with an opportunity to be reinforced as opposed to expecting CCC to maintain the behavior for an entire 30-min session)

        • In order for the use of an if–then board to be successful, CCC must have a clear understanding of the beginning an end of an activity. For example, working a puzzle has a clear beginning and end, but playing with cars does not. It would be beneficial to only have the items that are being worked on out and visible, and to put them away as he completes the expectation so he can see that he is getting through the task. For tasks that do not have a clear beginning and ending, a timer may be useful.

        • It should be noted that it is not appropriate to put pictures on an if–then consequence board that are not contingent on the desired behavior. For example, if you have safe hands, then you get to go to lunch is not appropriate, because lunch is not a consequence that could be withheld if he did not have safe hands.

    2. b.

      Predictability of transitions

      • – Transitions may be difficult for CCC, both between activities, and between physical locations. This may to be due to a couple of reasons such as: (1) not wanting to stop a preferred or familiar activity, and (2) due to anxiety over not knowing what to anticipate next. To best support transitions consistent structure and routine is recommended.

        • To transition away from preferred items and activities, set a structured routine that allows CCC to predict how long he has with his preferred item/activity, and that he will have access to it again.

        • To transition away from a preferred activity or item, a timer may be set to indicate that CCC has 2 min left with a preferred item or activity. CCC’s attention should be directed to the timer being set, and it should remain in his eyesight. Once the timer does off, CCC’s attention can be redirected to the timer and he can be told, “You are all done.” (or “time to clean up”, etc.) to obtain control of the item. It is important to note here that the chosen amount of time the timer is set for (2 or 5 min etc.) should be consistent each time so CCC can predict how much longer he has left (as opposed to setting the timer for the entire amount of time he has access to am item which will vary throughout the day, and not allow him to predict when the transition will occur).

  2. 2.

    Prompting. Provide the least level of prompt necessary to assist CCC to complete a task. Prompt dependency occurs when the prompt itself becomes part of the routine. The use of prompts should be faded as quickly as possible. Be conscious of what level of prompt is being used to get through daily routines, to assist with communication attempts, motor skills, etc. and try to fade back prompts for tasks that he is capable of doing himself. The following are prompts listed in order from least intrusive to most intrusive.

    1. a.

      Latency—Using wait time in before or instead of providing assistance or a higher-level prompt CCC to do something.

    2. b.

      Intonation—Using the inflection of your voice to prompt CCC to do something.

    3. c.

      Explanation—Providing further information to prompt CCC to do something.

    4. d.

      Verbal—Providing a specific verbal directive to prompt CCC to do something.

    5. e.

      Visual—Having a picture(s) to show CCC what to do.

    6. f.

      Positional—Placing yourself or the instructional materials in a proximity which prompts CCC to do something

    7. g.

      Pointing—Pointing at the item or first step to prompt CCC to begin, give, etc.

    8. h.

      Gestures—Using a non-verbal sign to prompt CCC to do something.

    9. i.

      Modeling—Showing CCC exactly what you want him to do

    10. j.

      Physical—Physically guiding CCC to do something.

Section 2: Instruction

Based on CCC’s evaluation results, it was determined that goals for the development of critical communication and functional skills that promote independence are of primary importance. The following recommendations were purposefully written without a criteria or setting. These specifics should be defined by service providers (i.e. school IEP teams and home or complimentary service providers).

The following goals are broken down by the sub domains identified as essential components of programming for children with autism by the National Research Council for Autism in 2001:

  1. 1.

    Academics/cognitive skills goals

    Although the focus of CCC’s educational programming should be on promoting functional communication and life skills, functional academic and cognitive skills should be incorporated into CCC’s educational programming. The Evaluation Report indicated that CCC’s visual motor performance was of particular concern. Activities to promote visual motor skills should be incorporated throughout CCC’s daily routine. It was further identified that CCC could identify colors and shapes, but was not yet able to identify letters, numbers, etc. Further functional academic assessment is necessary to identify appropriate academic targets. If local resources are not available to conduct a comprehensive functional assessment, services are available through the XXXX.

  2. 2.

    Self-management goal

    1. 1.

      CCC will comply with adult directed activities.

      Suggestions for goal implementation

      • The time in which CCC is expected to comply with adult directed activities should be in short segments at first, (taking baseline data on the amount of time CCC currently cooperates with adult directed requests, and then increasing the expected time by only a couple of minutes initially will help set an achievable goal.)

      • Break tasks into smaller segments, and interspersing reinforcement to promote CCC’s motivation to comply with adult directed tasks.

      • Initially, present preferred tasks to teach the structure and expectation.

      • Once CCC is successful meeting the goal criteria with preferred tasks, introduce neutral tasks (tasks that he does not prefer or dislike), being sure to reinforce heavily for cooperation with the task.

      • Use task completion momentum to embed non-preferred task, alternating with preferred tasks into the structure. For example, start with preferred tasks, reinforcing for cooperation with each of the tasks, once he completes a couple of preferred tasks (momentum is built) quickly introduce a less preferred task and reinforce heavily for cooperation with the task, then return to a more preferred task. This structure will increase the likelihood of his cooperation.

      Suggested data collection

      • Data should be collected by tracking the duration of time in which CCC complies with adult-directed requests.

  3. 2.

    Communication goals

    Increasing intelligibility of CCC’s communicative attempts is a recommended primary focus of intervention. It is most important to note, that working on these goals should not be isolated to his time with a speech language therapist. Communication goals should be worked on throughout CCC’s entire day with the consultative support of a speech/language therapist. Furthermore, CCC demonstrates frustration with not being understood, by not repeating attempts to communicate once he has tried to say something. For this reason, it is important that attempts to communicate are reinforced and expanded, and structured repetitive practice is implemented throughout CCC’s day.

    1. 2.

      CCC will produce medial and final consonant sounds.

      Suggestions for goal implementation

      The purpose of this goal is to focus on CCC’s articulation difficulties to better enhance intelligibility of communications to the listener. CCC’s Evaluation Report indicated that CCC has difficulty with velar fronting. Velar fronting refers to the substitution of sounds produced in the front of the mouth (t,d,n) for sounds produced in the throat (k,g). Other difficulties noted included omissions of medial and final consonants and consonant harmony.

      • Target sounds include, k, j, l, z, bl, dr, kr, kw, sw

      • Initially, begin by targeting the above listed sounds through imitation in isolation, and in the final word position. Begin with simple sounds in one-syllable words. Target the same sounds, as CCC is successful with their production, in the medial word position. As CCC is successful in the medial position, practice should include multi-syllable words with the target sounds in varying positions.

      • The use of visual cues, such as having CCC look at the therapist’s mouth and his own mouth in a mirror during repetitious practice may be beneficial.

      • It may be beneficial to teach CCC to discriminate the sounds he is producing by pairing words with velar fronting patterns with the correct word pronunciation (i.e. having him produce tar and then car, tan and then can.)

      • Printing graphemes to show CCC as he works on sound production will facilitate early literacy skills.

      • All adults working with CCC should be taught how to encourage appropriate sound production CCC is learning to imitate so the target sounds/words can be incorporated throughout his daily routine and not isolated to use with the speech therapist and within the home setting.

      Suggested data collection

      • Data should be collected by tracking the number of opportunities CCC is given to produce target sounds in each word position, and the number words he correctly produces.

    2. 3.

      CCC will expand his sentence structure to three to four word utterances.

      Suggestions for goal implementation

      As indicated in the Evaluation Report, CCC currently uses an average of two to three word utterances, and omits articles and auxiliary verbs.

      • Initially, begin with imitation of sentence expansion.

      • Using simple, beginning level reading books that have one sentence per page, with repetitious patterns, and three to four words per sentence is a good way to facilitate early literacy skills while working towards this goal. The expectation should not be on having CCC “read” the book, but on having the adult model reading the sentence, and then having CCC imitate.

      • To encourage imitation utilizing three to four word utterances within naturally occurring, highly preferred activities, model the desired utterance while holding back a preferred object or action until CCC makes an attempt to imitate the sentence production.

      • Encouraging initiations with expanded sentence structures can easily be incorporated throughout CCC’s day, by having him use pre-taught expanded sentence structures to get his needs and wants met (i.e. May I have the ______? I want to play with _______, etc.)

      Suggested data collection

      • Data should initially be collected on the number of opportunities CCC correctly imitates an expanded sentence structure in an isolated setting.

      • Data should also be collected to length of spontaneous utterances, utilizing language samples within naturally occurring environments.

    3. 4.

      CCC will identify objects/actions/people by labeling pictures and objects upon request.

      Suggestions for goal implementation

      The purpose of this goal is to expand CCC’s vocabulary.

      • Initially, items taught should be familiar to CCC until a repertoire of at least 100 items is obtained.

      • Opportunities for label expansion can easily be incorporated throughout CCC’s day with the use of books, toys, etc.

      Suggested data collection

      • Baseline data will need to be obtained to identify objects/actions/people that CCC can and cannot yet identify.

      • Data should be systematically collected on each of the items CCC is not yet able to label to track the number of new labels CCC obtains.

      • Data should be collected on the number of opportunities CCC is presented with a particular request to label and the number of opportunities he correctly responds to the request. Progress can be measured as the percentage of correct labels he makes increases. Opportunities in which CCC is prompted to respond should not count towards his percentage of labels.

  4. 3.

    Motor development

    CCC should have opportunities throughout the day to work on fine motor strength and accuracy. Consultation from an occupational therapist can identify opportunities to incorporate fine motor practice into pre-existing routines. The specific motor goal addressed focuses on cutting. Once CCC has enhanced control to accurately cut, he will concurrently have more motor control to target imitative writing.

    1. 5.

      CCC will increase his ability to independently cut simple shapes.

      The following activity suggestions are also outlined, along with others, in the Evaluation Report on p. X.

      Suggestions for goal implementation

      • Initially, teach CCC the action of scissors using tweezers and tongs before targeting cutting.

      • When first introducing scissors, have CCC practice opening and closing the scissors. Begin with simple snips in paper.

      • Once mastered, move on in the following progression to cut: on wide straight lines, then narrow straight lines, wide curved lines, narrow curved lines, cutting around a corner, and cutting a circular shape.

      • Heavier paper will add in better control initially.

      • Suggested scissors should have short (3.5 or 4.5 in.), sharp blades, rounded tips, and small finger loops for the thumb and middle finger.

      Suggested data collection

      • Data should be collected on the number of opportunities he has to practice cutting and the level of prompting required to complete the task. Mastery criteria should be based upon a predetermined percentage of opportunities in which CCC is independently performing the skill (without prompts).

      • It is helpful to keep data collection sheets in the area the skill is being performed so data can be collected each time he is presented with an opportunity to cut.

  5. 4.

    Daily living goals

    1. 6.

      CCC will increase his ability to independently manipulate fasteners and clothing including buttons, snaps, zippers, belts, and gloves during daily routines of toileting, and getting ready for and coming in from outside. As indicated in CCC’s Evaluation Report. He was able to manipulate buttons, but not on his clothing

      Suggestions for goal implementation

      • Embed the instruction within his naturally occurring routines to make it meaningful, and increase the likelihood of generalization to other environments.

      Suggested data collection

      • Data should be collected on the number of opportunities he has to practice the skill and the level of prompting required to complete the skill. Mastery criteria should be based upon a predetermined percentage of opportunities in which CCC is independently performing the skill (without prompts).

      • It is helpful to keep data collection sheets in the area the skill is being performed (in the bathroom, or in his personal cubby) so data can be collected each time he is presented with an opportunity to work on the skill.

    2. 7.

      CCC will independently care for his toileting needs.

      Suggestions for goal implementation

      The following activity suggestions are also outlined, along with others, in the Evaluation Report on p. 13.

      • Use visual and verbal cues to sequence the task (with a storybook, or pictures of each step in the task analysis)

      • Make the toileting experience as pleasant as possible for CCC. Relaxing music, and access to certain toys only when he is on the toilet may aid in his comfort and motivation to defecate in the toilet.

      • Immediately reward CCC with a highly desired reward when he has a bowel movement in the toilet.

      • If CCC experiences difficulty with soft/loose stools or constipation, consultation with her primary care physician or a dietician may be helpful in determining dietary supports to address these concerns.

      • See p. 13 of the Evaluation Report for specific information on weaning CCC’s reliance on his pull-up, and on instituting a desensitizing toileting program.

      Suggested data collection

      • Data should be collected on whether CCC was wet, soiled, or dry at each interval he is taken to the bathroom, and whether he voids in the toilet or not. This information will provide structure for a schedule to take CCC on to “catch” him at times he is likely to have a bowel movement.

      • Data should also be collected on CCC’s independent communications that indicate his need to toilet.

  6. 5.

    Social/play and leisure goal

    1. 8.

      CCC will cooperatively play simple turn-taking games with familiar peers.

      Suggestions for goal implementation

      • Initially, simple turn taking games should be taught in a very structured setting with a familiar adult.

      • Initially, it may also be helpful to use visual cues, or other prompting strategies to encourage CCC to turn-take following the rules of the game.

      • Once turn taking with a simple game is established with an adult, within the structure provided, the game should be introduced with a peer with adult facilitation and prompting.

      • Fade adult prompting as soon as possible.

      • Expand simple turn taking games to include a variety of games for CCC and the peer to choose from, by first teaching each game in a structured setting with a familiar adult.

      • Use games that are reinforcing to CCC.

      Suggested data collection

      • To measure progress towards this goal, “turn-taking” must be operationally defined. Suggested components of the definition should include, taking his turn independently, waiting for his partner to take his turn before going again, and attending to his partner while it is his partner’s turn.

      • Data should be collected on the number of opportunities provided for turn taking and the percentage of these opportunities in which CCC is able to met the criteria established for turn taking.

Section 3: Behavior

  1. 1.

    Positive reinforcement. If non-compliance is an issue, or progress is slow or inconsistent, a lack of motivation is often the problem. Often, adults fade reinforcement too quickly and rely on intrinsic rewards of doing well, resulting in non-compliance with tasks. The following are some key points to remember when reinforcing:

    • Reinforce immediately. If possible, reinforce while the behavior is occurring.

    • Reinforcement should be based on individual preferences of the child. For example, adults often assume what will work as reinforcement, (i.e. stickers) instead of basing reinforcement on individual student choice.

    • Pair primary reinforcement with secondary reinforcement (i.e. praise with toy)

    • Vary reinforcers to avoid satiation

    • The most difficult tasks should get the most desirable reinforcement

  2. 2.

    Provide opportunities for choice making. A proactive strategy to promote CCC’s motivation to cooperate with learning activities is to offer opportunities for choice making throughout CCC’s day. Choices may include a choice between two activities targeting the same skill, the order to do activities in, what materials to use for an activity, even where to sit, etc.

  3. 3.

    Social stories. If there are times in CCC’s day that are predictably more difficult for him, the use of social stories may promote desirable behaviors. Social stories identify appropriate prosocial behaviors specific to the context the child has difficulty with. The story should be written at CCC’s receptive level of understanding and should include pictures of CCC performing the desirable steps to the task being targeted. Carol Gray’s, The New Social Story Book, published in 2000 may be a helpful resource for designing and formatting social stories.

  4. 4.

    Behavior support plan. A proactive behavior support plan should be implemented across environments. The above-mentioned environmental supports should be included in the plan. If further behavioral concerns interfere with CCC’s or other’s learning, a functional behavior assessment (FBA) should be completed to determine the, frequency, antecedents and maintaining consequences of undesirable behaviors for the purpose further defining the environmental supports necessary for CCC’s success. If local resources are not available to conduct a FBA, services are available through the XXXX.

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Kanne, S.M., Randolph, J.K. & Farmer, J.E. Diagnostic and Assessment Findings: A Bridge to Academic Planning for Children with Autism Spectrum Disorders. Neuropsychol Rev 18, 367–384 (2008). https://doi.org/10.1007/s11065-008-9072-z

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