the basic premise - the epic school · 2016. 2. 12. · 2/12/16 1 transition to employment &...

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TransitiontoEmployment&LifeintheCommunity:TargetingSkillsandCompetencies

PeterF.Gerhardt,Ed.D.TheEPICSchool

TheMatthewReardonCenterConferenceonAutism.February11-12,2016.Savannah,GA

FYI

AcompletecopyofthehandoutsforthistalkcanbeonthewebsiteoftheEPICSchool.

www.epicschool.org

TheBasicPremise

SometimesIthinkIamanautismprofessionalwhoworksinPieldofappliedbehavioranalysis.AtothertimesIthinkIamabehavioranalystwhoworksinautism.ThetruthisthatIamboth.

TheneedtobeageneralistIfyouworkwithyoungkidsyougettobeaspecialist.Whetheryou’reaspecialeducator,speechpathologist,occupationaltherapist,orboardcertiPiedbehavioranalyst,yougettobeaspecialist.Whenworkingwithadolescentsandyoungadultsyoudon’tgettobeaspecialistand,instead,needtobesomethingofgeneralist.Inotherwords,youneedagoodworkingknowledgeofABA,EducationLaw,LaborLaw,MentalHealthconcerns,medicationsideeffects,sexuality,menstrualcare,jobdevelopment,jobcoaching,community-basedinstruction,generalizedsystemsofcommunication,stafftraining,communitytraining,andthat’sjusttostart.

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Sowehaveaverycomplex,challenging,yetinevitableoutcomecalledadulthood.Andwhileweknowmuchofwhatconstitutes“bestpractices”inthetransitiontransitiontoadulthood,wekeeprepeatingthesamemistakeswehavebeenmakingforthepast30years.Forexample…

Skill Taughtforthelast30years

Occasionallytaughtforthelast

15years

Theskillsweneedtoconsidernowandlookingahead

Purchasing Cash CreditorDebit ApplePay

TravelTraining Momdrivesyou Momdrivesyou Uber,Self-DrivingCars

Organization Velcropictureschedule

Velcrotextschedule IncreasinglysophisticatedSmart

PhoneApps

Sex “Never” “He/shecanmasturbateifthey

haveto”

Dating,relationships,sex,breakups,heartaches,etc.

CompetenceDe<inedAs…

Safeandwellcaredform

90%accuracyacross3consecutivesessions

Whatistheactualcommunitystandard

fortheskill

Safety “Neverlethimoutofyoursight”

InclusionandSupportedEmployment

IndependencetaughtviaVirtualRealityandmonitoredelectronically

Whatdoestheresearchsay?

Roux,etal(2013)Thereisgeneralacknowledgementthatpost-graduationoutcomesforadultsontheautismspectrumare,underwhelmingatbest.MostrecentlyRoux,etal(2013)reportedthatonlyhalfofyoungadultswithASDhaveeverworkedforpay[emphasisadded]sinceleavinghighschoolandwhentheydoworktheyearnsigni<icantlylowerwagesthanthoseofage-referencedpeers.OnanannualbasisgrowingnumbersofindividualswithASDarecompletingtheir18+yearsofpublicallyfundededucationandgraduatingintounemployment,underemployment,orintopoorlyfundedadultprograms.Outcomessuchastheserepresentanationaleconomicandsocietalcrisisofimmenseproportions.Roux,A.M.,etal.(2013)Postsecondaryemploymentexperiencesamongyoungadultswithanautismspectrumdisorder.JournaloftheAmericanAcademyofChildandAdolescentPsychiatry52(9),pp.931-939.

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Shattuck,etal(2012)  Shattuck,etal,(2012)conductedacomprehensiveliteraturereviewregardingoriginalresearchonservicesandinterventionsaimedatsupportingsuccessinwork,education,independence,andsocialparticipationamongadultsaged18andolderwithanASDpublishedbetween2000and2010.

  TheyconcludedthattheevidencebaseaboutservicesforadultswithanASDisunderdevelopedandcanbeconsidereda<ieldofinquirythatisrelativelyunformed.

Shattuck,P.,etal,(2012).Servicesforadultswithautismspectrumdisorders.CanadianJournalofPsychiatry,57,284-291.

q  Howlin,etal(2004)surveyed68adultswithautismwithanIQofabove50andfoundamajority(58%)wereratedashavingpoororverypooroutcomes.Withregardstoemploymentstatustheyfoundq  8werecompetitivelyemployedq  1wasselfemployedearninglessthanalivingwage

q  14workedinsupported,shelteredorvolunteeremployment

q  42had“programs”orchoresthroughtheirresidentialprovider.

“Amajordif,icultyconfrontingthoseinterestedinadolescentsandadultswithautismisalackofempiricaldata.”

Mesibov,G.B.(1983).Currentperspectivesonissuesinautismandadolescence.InE.Schopler&GMesibov,(Eds).AutisminAdolescentsandAdults.Springer:Philadelphia.p.37

Sadly,over30yearsafterGaryMesibovsaidthis,itremainstruetoday.

Soitseemstheonlywaythingswillbebetterforyourson,daughter,orstudentthantheywereforthosewhoalreadytransitionedtotheadultworldisifwecollectivelydosomethingtomake“better”happen.Andthatmeansthinking10-yearsdowntheroad,movingfromtheclassroomtothecommunity,promotingindependenceandacceptingreasonableriskallwhilemeetingtherequirementsoftheIEP,usingevidencebasedpractices,andaddressingstatestandards.Easy,right?

Sothenlet’sallagreeonafewthings…

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Everyoneiscapableoflivingandworkinginthecommunitywiththe

propersupports.

Nobodyhastoearntherighttobeinthe

community.

IfindividualswithASDtendnottogeneralizewellthenweneedtoteachwheretheskillismostlikelytobeusedandthatNOTinthe

classroom.

ThepotentialofindividualswithASDtohavefulPilling,includedandemployedadultlivesislimitedmorebyourvisionthantheirskill

dePicits.

Lastly,therearesomebehavioralbarriersandinviolablecommunitynormsthatneedtobeaddressedifthePirstfourstatementscanbefullyimplemented.Theseare:•  Highratesofseverechallengingbehaviorcanlimit

communityparticipation.•  Poorhygieneandageinappropriateclothingrestricts

socialinclusion.•  Pooreatingskillsrestrictsinclusiononmanylevels.•  Inappropriatesexualbehaviortendstofallunder

communityzerotolerancepolicies•  Notbeingbowelorurinetrainedpresentsanoverall

challenge.

Butanyway,thisishowthistalkdevelopedoverthepast

fewyears.

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PartI PartII

Havingworkedwithalargenumberofadolescentsandadultswhocouldidentitythesightword“poison”butwouldstilldrinkthepoison,itdawnedonmethatnomatterhowevidence-basedyourinterventionmaybe,usingittoteachthewrongskillisnobetterthanteachingtherightskillpoorly.

Howcomenooneevertaughtyouthis?

PartIIIMYQUASI-EXPERIMENT

q  Location:Aprivate,behaviorally-basedschoolforindividualswithautismlocatedinNYC.

q  Twoclassroomseachwith5adolescentswithautismeachstudentprovidedABA-basedinstructionina1:1ratio.

q  Atimerwasplacedintheclassroomandallinstructorsweretoldtomoveawayfromtheirstudentswhenitrang.

q  Datawerethencollectedonwhatthestudentsdidintheabsenceoftheinstructor.

q  Whatdoyouthinkthestudentsdid?

NothingTheydidnothing

Sowhatdoesthistellus?q  Everythingweweredoingwasteacherdirected.Inotherwords,allstudentbehaviorwasprompted,mediated,andreinforcedviatheinstructor.

q  Studentengagementwasmaintained,atleastinpart,bynegativereinforcement(i.e.,IfIdothisyouwillstopbadgeringme).

q  Noneoftheskillswewereteachingwereviewedasbeingofuseofvaluebymystudents.

Yetatthesametimeindensandbedroomsacrossthecountry

  TheaverageAmericanspends142hoursperyear(3.5standardworkweeks)playingvideogames.Worldwide,thetotalissomewherearound3.2Billionhoursannually.IPindthisfascinatingasgameplayershaveaccesstomultiple,competingschedulesofreinforcementthatmaintainedanalternativebehaviorsetpriortoaccessingtoMMPGs.

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“Whenyoustripawaythegenredifferencesandthetechnologicalcomplexities,allgamessharefourde<iningtraits:

q  Agoal,q  Rules,q  Afeedbacksystem,andq  Voluntaryparticipation.”

JaneMcGonigal(2011,p.21) RealityisBroken:WhyGamesMake UsBetterandHowTheyCanChange theWorld

Why? The7DimensionsofABAq  Applied:Dealwithproblemsofsocialimportance(Agoal).q  Behavioral:Dealwithmeasurablebehaviororreportsiftheycanbe

validated(Rules).q  Analytic:Requireanobjectivedemonstrationthattheprocedures

causedtheeffect(SystemofFeedback).q  Technological:Aredescribedwellenoughthattheycanbe

implementedbyanyonewithtrainingandresources(Rules)q  ConceptualSystems:ArisefromaspeciPicandidentiPiable

theoreticalbaseratherthanbeingasetofpackagesortricks(Agoal,feedbackandrules).

q  Effective:Producestrong,sociallyimportanteffects(Feedback)q  Generality:Designedfromtheoutsettooperateinnew

environmentsandcontinueaftertheformaltreatmentshaveended(PerhapsthisiswherevoluntaryparticipationPitsin)

Baer,D.M.,Wolf,M.M.,&Risley,T.R.(1968).Somecurrentdimensionsofappliedbehavioranalysis.JournalofAppliedBehaviorAnalysis,1,91-97.

Soweclearlyhavegoals,rules,andasystemoffeedback

Somaybeweneedtoconsidergenerality,(voluntaryparticipation)withadolescents/adultswithASDifwearetoteachskills&skillsetsthatareinitiatedindependently,generalizable,andmaintainedacrosstime&environments.

ABAasEvidence-basedPracticeThetermevidence-basedpractice,asusedinASD,isanevolvingconceptinvolvingbothempiricallysupportedinterventionsandtheclinicalexpertisebywhichsuchinterventionsareselected,applied,andanalyzedononcasebycasebasis.Smith(2013),forexample,hasdePinedevidence-basedpracticeisaserviceofferedbyaprovidertohelpsolveaproblempresentedbyaconsumerhighlightingtheroleoftheclinicianinanevidence-basedprocess.Evidence-basedintervention,ontheotherhand,generallyreferstoasetofproveninterventionsindependentofone’sabilitytousethem.

Smith,T.(2013).Whatisevidence-basedbehavioranalysis?.TheBehaviorAnalyst,36,7-33..

Todayweareexpandingourknowledgeof,andexpertisein,ABAforuseinthecomplexareaofadulthoodandASD.Amajor

challenge,however,isthatwestillviewadultswithASDiverysimplisticterms.

Antecedent(yelling)

Behavior(crying)

Consequence(R+comfort

ORR-yellingstops)

Butalladultsarecomplex

“Let’sgotowork”

MOs/SettingEvents• Learninghistory• Adolescence&itsimpact• Communicationchallenges• Socialchallenges• Mentalhealthchallenges• Physicalhealth• Medicationsideeffects• Environmentalstressors• Curriculumconsiderations• Boredom• Sexuality• Sleepissues• Agingin&ofitself• Yada,yada,yada…

“Huh?”

{ }Aggression

Professional

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“Thesechildrenoftenshowasurprisingsensitivitytothepersonalityoftheteacher[]Theycanbetaughtbutonlybythosewhogivethemtrueunder-standingandaffection,peoplewhoshowkindnesstowardsthemandyes,humor[].Theteacher’sunderlyingattitudeinPluences,involuntarilyandunconsciously,themoodandbehaviorofthechild.”

-HansAsperger,1944

HansAspergeronComplexityandASD

UnderstandingABAbeyondtheclassroomandinsupportofolderindividuals

Forourpurposestoday,ABAis:q  Analytical–Effectiveinterventionrequiresustounderstandpointsofviewotherthanourown.

q  SociallyImportant–Effective,generalized,andmaintainedinterventionrequirestheselectionoftargetsthatofvaluebeyondtheclassroom.

q  Contextual/Generalizable-Effectiveinterventionrequiresustoteachwheretheskillismostlikelytobedisplayed.

The2015BehavioralScienceInsightPolicyDirective

OnSeptember152015PresidentObamaorderedgovernmentagenciestousebehavioralscienceinsightsto“betterservetheAmericanPeople.”Inhisexecutiveorder,thePresidentdirectedfederalagenciestoPindprogramareaswherethebehavioralsciencescouldimprove“publicwelfare,programoutcomes,andprogramcosteffectiveness.ThisorderrePlectstheevidencethatpeopleoftenfailtomakerationalchoices.Suchdeviationsfromrationality,welldocumentedinthedecision-makingliterature,areconsistentacrosstimeandpopulations.Forexample,thetypicalpersonwoulddislikelosing$50morethanhewouldenjoygaining$50,whichwouldnotbethecaseifhewerefullyrational.Andwhenmakingdecisions,peopletendtogivedisproportionateweighttoinformationthatreadilycomestomind(arecentdiscussion,forexample)andoverlookmorepertinentinformationthatishardertoretrievefrommemory.Again,thisshouldn’thappentoso-called“rationalagents.”

WhyIsBehaviorAnalysisRelevanttoImprovingQualityofLife?

“Whendonecorrectly,thereisnotaPieldofinterventionthatismorepersoncenteredthanappliedbehavioranalysis”

-GinaGreen,Ph.D.,BCBA-DPersonalCommunication

WhyIsBehaviorAnalysisRelevanttoImprovingQualityofLife?

InstructionbaseduponAppliedBehaviorAnalysisdoesnotrepresentarigid,unyielding,andunalterablesetofinstructionsand/orinteractions.Infact,goodbehavioranalystsmodifytheirinstructionalinterventionsinresponsetoaslewofconditions,settingsandcontingencieswhilemaintainingacommitmenttodata-baseddecision-making.Yoda,wasprobablyabehavioranalyst.

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Andlastly“…happinessamongpeoplewithprofoundmultipledisabilitiescanbedePined,reliablyobserved,andsystematicallyincreased”supportingthefactthat“thecontributionsofbehavioranalysisforenhancingthequalityoflifeamongpeoplewithprofoundandmultipledisabilitiesmaybeincreasedsigniPicantly.”

C.Green&D.Reid,1996

AFewChallengestoEvidence-based

PracticewithOlderIndividuals

TheprevalenceofpseudoscientiPicorsimplyunproveninterventionsleadinguptoadulthoodcompeteswithevidence-basedpractice.

Sadly,ASDisabitofafadmagnet

Thereare,however,avarietyofchallengestoevidence-basedpractice

q  Seeingisnotbelieving.q  Correlationdoesnotautomaticallymeancausation.Weknow

thisbutwegenerallydon’tactaccordingly(thesay/dophenomena).

q  ThereisatendencytomakethefactsPitourpersonaltheoriesratherthanmakeourpersonaltheoriesPitthefacts.

q  Thereiswellestablishedtendencytooptforlowresponseeffortinterventions(e.g.,meds)overhighresponseeffortones(e.g.,ABA).Whileatthesametime,evidencefromsocialpsychologyindicatesthathowwellweperceiveanoutcomeis,atleastinpart,relatedtohowdifPicultitwastoachieve.

q  Withapopulationof310,000,000people,oneinamillionoccurrenceshappento310Americanseachdayjustasamatterofchanceandcoincidencesosuperstitiouslearningis,tosomeextent,inevitable.

Ifyouwanttotryanunprovenintervention,thisisthebestwaytogoaboutit(Kay&Vyse,2005)

1)  ClearlydePinethetargetoftheintervention.

Whatexactlyisitthatyouexpectthisinterventionwilldo?

2)  Developdecisionrulestohelpyoudecideif,orwhen,theinterventionworked.

3)  Getsomebaselinedatabeforeyoustart.Forfamilies,theyshouldtrytogetanhourortwo(in“random”15-minintervals)ofvideooftheirson/daughter

48

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Butifyouwanttotrysomeunproveninterventions,hereisareasonablewaytogoaboutit(e.g,Kay&Vyse,2005)

4)  Implementtheinterventiontothebestofyourability(i.e.,withPidelity)

5)  Collectdataonbothpositivechanges(i.e.,yourdePinedexpectations)andnegativechanges(i.e.,sideeffects).

6)  Evaluateobjectivelyusingyourdecisionrules.

49 Kay,S.,&Vyse,S.(2005).Helpingparentsseparatethewheatfromthechaff:Puttingautismtreatmentstothetest.InJacobson,J.W.,Muliek,J.A.,Foxx,R.M.(Eds.),Controversialtherapiesfordevelopmentaldisabilities:Fad,fashion,andscienceinprofessionalpractice(pp.265-277).Hillsdale,NJ:LawrenceErlbaumAssociates.

TimeIsNotOnOurSideq  SchoolDays/Year(NJ) 211.0q  Hours/day 6.0q  Hours/dayactualengagement4.5q  Totalhours/yearengaged 949.5q  Totalhours17to21-years 4,747.5q  GoalsinaverageIEP 30.0q  Totalgoalsacross5years 150.0q  Hours/goalavailable 31.65

ButthatreallyisbestcasescenariodePinedas:

q  Studentfullyengaged4.5hours/day;q  NOstafforstudentabsences;q  NOholidayorbirthdaypartiesq  NOPieldtrips;q  NOchallengingbehaviorq  NOweatherclosures,and;q  NOlatearrivalsorearlydismissals…

Sincewedon’thavebestcasescenariowecanincludea“fudgefactor”of.3

whichmeansweactuallyhave

5schooldaystoteacheachgoaltomasteryandgeneralizetountrainedenvironmentsand

novelpeople.

Whichmeans,timeisnotonourside.

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Nobody,itseems,goestocollegetoworkwithadultswithautism.Kidswith

autism?Sure.Adultswithautism?Notsomuch.

*Source: The Supply of Direct Service Professionals Serving Individuals with Intellectual Disabilities and other Developmental Disabilities. Report to Congress (2004). Department of Health and Human Services;

Washington DC. Available on line at http://www.ancor.org/issues/shortage/aspe_dsp_11-09-04.doc.

Direct Service Turnover in Residential/In-Home and Vocational/Day Services, 1998-2003*

Setting Type Number of Studies Average Rate

Residential/In-home 11 53.6%

Vocational/Day 6 46.0%

Both 9 48.1%

Combined Average 26 50.0%

Whichisfurther“complicated”bythefactthatnoonestaysinthePield.

So what do we do?

*Actually,thisisaparaphraseofaconversationAlicehaswiththeCheshireCat.IfIweretobeaccurate,thisquotecanactuallybeattributedtoGeorgeHarrison.

“YouCannotMakeaTransitionPlan

withoutDePiningtheOutcomeofyourPlan”

-PeterGerhardt

“TransitionServices”UnderIDEA:Theterm“transitionservices”meansacoordinatedsetof

activitiesforachildwithadisabilitythat:(1)Isdesignedtobewithinaresults-orientedprocess,(2)thatisfocusedonimprovingtheacademicandfunctionalachievementofthechildwithadisability(3)tofacilitatethechild’smovementfromschooltopost-schoolactivities,includingpostsecondaryeducation,vocationaleducation,integratedemployment(includingsupportedemployment);continuingandadulteducation,adultservices,independentliving,orcommunityparticipation;(4)Isbasedontheindividualchild’sneeds,takingintoaccountthechild’sstrengths,preferences,andinterests;andIncludesinstruction,relatedservices,communityexperiences,thedevelopmentofemploymentandotherpost-schooladultlivingobjectives,and,ifappropriate,acquisitionofdailylivingskillsandfunctionalvocationalevaluation.[34CFR300.43(a)][20U.S.C.1401(34)]

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SostartwithanoutcomestatementUpongraduationAwillbelivinginasmallwell,supervisedresidentialsettinginNYCwith24-hour,1:1support.Hewillhaveparttime(nomorethan20hours/week)employmentatajobheenjoys,wherethereissocialinteractionandsupportfromajobcoach.Hisfreetimewillbespentshopping,walking,exercising,etc.SocialopportunitiesareimportanttoAsohewillhaveaccesstobothtypicalandadaptiveevents(e.g.movies,religiousservices,Metsgames,etc.).AspartofhisleisurelifeAwillhaveregularbreaksduringwhichhecanchooseapreferredactivity(e.g.,leaPingthroughamagazine,books,doingpuzzles,usinghisI-Pad/Touchscreencomputer,etc.).ThisshouldbeconsideredveryimportanttoA’semotionalstability.Theimportantpeopleinhislifewillconsistofhisfamily,extendedfamilyandclosefriends,atleastonegoodfriend,andavarietyofacquaintances.

AndthenthereareacoupleofwaystoPigureoutwhatyouneedtodotohelpyourstudentgetthere.

PrioritiesofInstructioninTransitionProgramming

q  Solicitstudentandfamilyinputastodesired1year,5year,10yearoutcomes.q  ButyoureallyneedtotryandbespeciPichere.

Notjustthatheshouldhaveajobbutajobdoingwhat?Whendoeshedothisjob?Whodoeshedothisjobwith?Whatmightmakeemploymentworthwhiletohim?

q  Andthendothesameforwhere/howhewillliveandhisleisureskills,publicsocialcircleandprivatesocialcircle.

Adaptedfrom:Wehman,P.(1992).LifeBeyondtheClassroom:Strategiesforyoungpeoplewithdisabilities.Baltimore:PaulH.Brookes.


q  Solicitstudentandfamilyinputastodesired1year,5year,10yearoutcomes.

q  Surveycurrentandpotentialfutureenvironmentsbasedupontheseoutcomes.q  Youneedtothengetoutofyourclassroomsand

homesandseewhatskillsarereallyneeded.q  Arethereanyconnectionsyoucanusetogiveyou

sonordaughteramoreexpandededucationalexperience?




q  Surveycurrentandpotentialfutureenvironmentsbasedupontheseoutcomes.

q  Assessskillneedsintheseenvironmentsintermsofproduction,socialandnavigationskills.q  Remember,productionskillsareeasy.Socialand

navigationskillsarereallydifPicult.





q  Assessskillneedsintheseenvironmentsintermsofproduction,socialandnavigationskills.

q  Prioritizeskillsthatoccuracrossmultipleenvironmentsq  Moreoftenthannotthesewillfallintothecategoryof

SocialorNavigationskillsbutnotalways.


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q  Prioritizeskillsthatoccuracrossmultipleenvironments

q  Attendtosafetyskillsq  SigniPicantlyoverlookedbutveryimportantto

consider.






q  Prioritizeskillsthatoccuracrossmultipleenvironments

q  Attendtosafetyskillsq  Attendtoskillsthatreducedependence

q  Sometimesjustbeinglessdependentisanexcellentgoal.






q  Prioritizeskillsthatoccuracrossmultipleenvironmentsq  Attendtosafetyskillsq  Attendtoskillsthatreducedependenceq  Attendtoskillsyou,orthestudent,willneedtoprovide

theNTcohort.q  Thebestwayforotherstohelp,support,orjustgettoknow

yoursonordaughter.Adaptedfrom:Wehman,P.(1992).LifeBeyondtheClassroom:Strategiesforyoungpeoplewithdisabilities.Baltimore:PaulH.Brookes.

AShortCut

WhenspeakingaboutskilldevelopmentalwaysrememberthatforaspeciPicskill

Ifyoucanteachtheskill,teachit

Ifyoucan’tteachtheskill,adaptit

Ifyoucan’tadaptit,,igureoutsomewayaroundit

Ifyoucan’t,igureoutsomewayaroundit,teachtheNT’stodeal

“Ifthestudentdoesnotlearntodothetask,willsomeoneelsehavetodoitforthem?”

LouBrown,1985

AShorterCut

Whichleadstosomethinglikethis…

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PeterGerhardtAssociates,LLC

Student’sTransitionStatementAt23yearsStudentwillbelivinginasmallwell,supervisedresidentialsettinginNYCwith24-hour,1:1support.Hewillhaveparttime(nomorethan20hours/week)employmentatajobheenjoys,wherethereissocialinteractionandsupportfromajobcoach.Hisfreetimewillbespentshopping,walking,exercise,etc.SocialopportunitiesareimportanttoStudentsohewillhaveaccesstobothtypicalandadaptiveevents(e.g.movies,religiousservices,Metsgames,etc.).AspartofleisurelifeStudentwillhaveregularbreaksduringwhichhecanchooseapreferredactivity(e.g.,leaPingthroughamagazine,books,doingpuzzles,usinghisI-Pad/Touchscreencomputer,etc.).ThisshouldbeconsideredveryimportanttoStudent’semotionalstability.Theimportantpeopleinhislifewillconsistofhisfamily,extendedfamilyandclosefriends,atleastonegoodfriend,andavarietyofacquaintances.

Student–CenterofallInstructionalDecision-making

Family–Parenttraining&Support;Goaldevelopment

Neighborhood–Communitytrainingtodevelopnaturalsupports

ExtendedCommunity–Awareness,support,andacceptance

TransitionProPileRecommendedAreasofIntervention

Career

Home

Leisure Public Lives

Private Lives

TransitionProPileAreasofFocus

Jobdevelopmentbaseduponsuccessive

jobmatches

Abilitytomanagerequirementsofdaily

living

AccesstopreferredactivitiesdesignedtopromotehappinessActivememberofa

socialcommunity(s)

Establishedrelationshipsofvalue

andequality

SphereofIntervention:CareerInordertobegainfullyemploymentStudentneedsthefollowingprograms/skillsshouldbetargeted.

Skill Challenge Recommendation

Studentneedstobeabletotransitiontowork(busortaxi)withoutanydisruptions

Acommunitysetting,Restrictedcommunication,Changesinbusschedules/trafPic.Externalvariables

Listentomusiconbus?Giveabook/magazine.Sittinginthebackofthebus.OrientselfawayfromStudentasvolumeincreases.Adjustphysicalproximity

Studentneedstoincreasehisenduranceatworkfromcurrent8.5hours/week

IncorporateNegotiable-àNonnegotiableand5timerule

Studentneedstoincreasethevarietyofworktasksheabletocomplete(clearonset/offset)Studentneedstobeabletoworkwithsupportstaffupto20feetaway.

Sizeoftheworkroom.


Studentneedstobeabletotransitiontowork(busortaxi)withoutanydisruptions

Acommunitysetting,Restrictedcommunication,Changesinbusschedules/trafPic.Externalvariables

Listentomusiconbus?Giveabook/magazine.Sittinginthebackofthebus.OrientselfawayfromStudentasvolumeincreases.Adjustphysicalproximity

Studentneedstoincreasehisenduranceatworkfromcurrent8.5hours/week

IncorporateNegotiable-àNonnegotiableand5timerule

Studentneedstoincreasethevarietyofworktasksheabletocomplete(clearonset/offset)Studentneedstobeabletoworkwithsupportstaffupto20feetaway.

Sizeoftheworkroom.

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SphereofIntervention:HomeWithinhishome,Studentshouldbeabletoindependently(orwithminimalsupports),accomplishthefollowing.


Continuepreparingandeating3meals/day,checkingmail,takingourgarbage,etc.

NoneforstaffSystematicallyassessefPicacyofGF/CFdiet

Continuationofcurrentprograms.

Studentshouldbeabletorequestaccesstoleisurepreferences.

Developingcommunicationskillstorequest.Ensureaccessduringdowntime.

Seeleisuresection

Studentwillbeabletoshower/shampoo/drywithminimalstaffsupervision.

Longstandingchallenge.Understandingcompletioncriteria.

Considerincreasedistanceofparentorstaffandseeifreducespromptcueing.

Studentwillbeabletowipeeffectivelyafterabowelmovement.

Longstandingchallenge.Understandingcompletioncriteria.

Considerincreasedistanceofparentorstaffandseeifreducespromptcueing.

Studentwillmanagehisownsleep/wakecycle.

Purchaseandusealarmclock

Studentwillbeabletorespondtoaknockand“CanIcomein”wheninbathroom/bedroom.

Willrequirerepeatedpractice

ProvidesufPicientopportunitiestorespond(nolessthan5Xday)

Studentwillbeabletotakehislaundrytothecleanersandpickupwhendone.

Generalpurchasing,navigating,carrying,etc.

Selfexplanatory

SphereofIntervention:Leisure


IncreasethevarietyofleisureskillsStudenthasaccesstoandenjoys(clearonset/offset).

Leisureskillsneedtofunctionassuch.Studentisanexperientiallearner.

Introduceanactualjigsawpuzzlewithageappropriatethemes.Leisuresample5Xperactivity

IncreaseStudent’sindependentdurationatavarietyofleisureactivities.

Findingnew,ageappropriateactivitiesthatwillholdStudent’sattention.

Baselinecurrentengagementatnewactivities.Leisuresample5Xperactivity

IncreaseStudent’sexerciseopportunitiestoincludemoregroupactivities(aerobics).

Continueweightlifting.Locate/startintegratedaerobicsclass.Walking.

StudentwillhaveregularaccesstoYouTubeandmusicviaI-Pod

Soasnottointerferewithotherliferelevantactivities

Studentshouldbeabletoindependently(orwithminimalsupports),accessandutilizethefollowingleisureskills.

SphereofIntervention:PublicSocialStudentneedstobeabletoaccess,orutilize,thefollowingskillswithminimalprompting.


Studentneedstobeabletotransitiontocommunityactivities(busortaxi)withoutanydisruptions

StructureandpredictabilityareimportanttoStudentbutcontrarytomanytransitions

Provideaminimumof1suchtransition/day.IdentifyareasonablypowerfulR+fortransitions.

Studentwillmastertheexchangeprocessofpurchasing.

Frequencyofpracticeneedstobehigh

Studentwillpurchaseanitem2-3Xday.ConsiderintroofStudenttoCashier

Studentwillfollowashoppinglistatasmallgrocerystoreordeli.


Studentwillshopforallitemsheneedstomakehislunchand,uponreturn,makelunchwithpurchasedagreement.

Basicsocialcourtesiesinc.Thankyou,excuseme,Hello,Goodbye,socialdistancing,waitinginline


Prioritizethankyou,socialdistancing,andwaitingforinstructionanddatacollection.Incidentalinstructionforrest

BehavioralExpectations ThisneedstobeclariPiedbyteam

Safety,Publicmen’sroomuse,crossingstreet,personalinfo.

HighprioritybutverydifPiculttoteach

Prioritizehighfrequencyskillsinc.stopatallcurbs.HaveStudentALWAYScarrywalletwithofPicialphotoID,andGPSSmartPhone.

SphereofIntervention:PrivateSocialNotdirectlyapplicableinthiscaseasthenecessaryskillsaresubsumedunderthefourotherareasofintervention


Studentneedstomoreeffectivelycommunicatehiswants,needs,fears(dogs),concerns,etc.

Motivationtocommunicateneedstobeestablishedtopromotecommunication

Considersystematicdesensitizationprotocolfordogphobia.Increasenumberofcommunicativeopportunitiesacrosstheday

Transitionfrompajamastot-shirtandsweatpants.

Studentneedstowearsleepwearthatismoreageappropriate.

Makeandreinforcechange

FamilyResponsibilityinSupportofTransitionPrograming

AREA RESPONSIBLITY

Career •  Usepersonalcontactstoidentify3-5potentialemploymentorjobtrainingopportunitiesforStudent

•  Identify3-5adaptiveskillsathomewithclearonset/offsettoworkonwithStudent.

•  Continuecoordinationofteammeetings.Home •  Instructioninmanagingownsleep/wakecycle

•  Generalizationandmaintenanceofallotherskillsinthissection.Leisure •  Identifyaminimumofonenewleisureopportunity/month.

•  Promoteincreasinglylongerdurationsinpreferredandnon-preferredactivities.

PublicSocial •  Coordinate“ShoppingList”program•  Generalizationandmaintenanceofallotherskillsinthissection.•  CoordinateResourceMapping

PrivateSocial •  Provideagreaternumberofcommunicativeopportunities.•  Transitionofage-relevantsleepwear(i.e.,shortsandteeshirt).

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ProfessionalResponsibilityinSupportofTransitionPrograming

AREA RESPONSIBLITY

Career •  DevelopinstructionalprogramsandreasonabledatacollectionsystemsforidentiPiedgoals.

•  Ensureahighandconsistentfrequencyofinstruction(i.e.,opportunitiesforStudenttolearnskill)forallidentiPiedgoals.

Home •  DevelopinstructionalgoalsandreasonabledatacollectionssystemsforidentiPiedgoals.

•  Manyofthesegoalshavealimitedopportunityforinstruction(e.g.,onlyshower1Xday)soitisessentialtheeveryopportunityisseenasateachingopportunity.

•  Considertheuseofadaptivedevicesormodify,ifappropriate,masterycriteria.

Leisure •  Identifyaminimumofonenewleisureopportunity/month.•  Workwithfamilytopromoteincreasinglylongerdurationsinpreferred

andnon-preferredactivities.

Public •  DevelopinstructionalgoalsandreasonabledatacollectionssystemsforidentiPiedgoals.

•  Prioritizehighfrequency/highriskareasofintervention.

Private

DesiredcommunityResponsibilityinSupportofTransitionPrograming

AREA RESPONSIBLITY

Career •  Provideopportunityforemployment•  Providefrequentperformancefeedbacktojobcoach•  Provideforabrief“training”ofco-workersonwhoStudentisasapersonandhowhebestcommunicates.

Leisure •  Provideaccesstoavarietyofactivities•  AcceptanceofStudentasafullpartofleisurecommunityassociatedwithanactivity

Public •  AcknowledgementofStudent’sautismandrelatedchallengeswhile,atthesametime,bewillingtolearnabouthisstrengths

•  Providesimpleaccommodationsasnecessaryandpossible•  RespectStudent’sprivacywhileinteractingwithStudentinanageappropriateandrelevantmanner.

ResourceMappingResourceMappingisaprocessofidentifyingandlinkingcommunityresourceswithagreeduponindividualgoalsandpreferences.Resourcemappingcanbeusedto:q  Identifyavailablecommunityresourcesq  Enhanceservicesq  Identifyadditionalfundingsupportsq  Alignyoungadultwithavailablecommunity

supportsq  Usedatatomakeinformeddecisionsq  Cultivatenewpartnershipsandrelationships

overtimebysupportingor“givingback”totargetedorganizations.

AreasofInterestinResourceMapping

AREA POSSIBLE SOURCES

Leisure YMCAs,Movietheaters,JCCs,TownshipSponsoredAdaptiveSports,Musicclassesorconcerts,SNACKetc.

FinancialSupport

SocialorganizationssuchasLionsorElksClubs,CommunityFoundations,Communitiesoffaith,etc.

Career RetiredSeniorVolunteerPrograms,ChambersofCommerce,RotaryClubs,LocalBusinesses(particularlythosewithwhichyoudobusiness),VolunteeropportunitiessuchasMealsonWheels,GoodWill,SalvationArmy,FoodPantries,etc.

Social Neighbors,friends,highschoolseniors(communityservicegraduationrequirement),Communitiesoffaith,Collegefraternitiesorsororities,CommunityCollege,LocalArtsorganizations,SNACK,etc.

Transition,AdaptiveBehaviorandAdult

Outcomes

TheUniverseofSkillsatAge5

(andthoseskillsthatweusuallyteach)

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TheActualUniverseofAdultSkillCompetencies Theprimarydifferencebetweenthetwoviews,andbetweenindependenceanddependenceisadaptivebehavior.

SocialSkills

NavigationSkills

ProductionSkills Independence

Communication

Safety

DecisionMaking

AdaptiveBehavior“AdaptiveBehaviorisdePinedasthoseskillsorabilitiesthatenabletheindividualtomeetstandardsofpersonalindependenceandthatwouldbeexpectedofhisorherageandsocialgroup.Adaptivebehavioralsoreferstothetypicalperformanceofindividualswithoutdisabilitiesinmeetingenvironmentalexpectations.Adaptivebehaviorchangesaccordingtoaperson’sage,culturalexpectations,andenvironmentaldemands.”(Heward,2005).

AdaptivebehaviorisnotconsideredoneofthecoresymptomsofASDand,assuch,receivessigniPicantlylessattentionintermsofeffectiveinterventionandcurrentresearch.

Inagroupof20adolescentswithAspergersyndrome,Green,etal(2000)foundthatdespiteameanIQof92onlyhalfwereindependentinmostbasicselfcareskillsincludingbrushingteeth,showering,etc.Nonewereconsideredbytheirparentsascapableofengaginginleisureactivitiesoutsideofthehome,travelingindependently,ormakingcompetentdecisionsaboutselfcare.

Matson,Rivet,Fodstad,Dempsey,&Boisjoli,(2009)evaluated337adultsusingtheVinelandAdaptiveBehaviorScaletoassessthedifferentialimpactofhaving1)anIntellectualDisability(ID),2)anIDplusASD,or3)anID,ASD,andanAxisImentalhealthdiagnosis.AdaptiveskillsweregreatestfortheIDgroupfollowedbytheIDplusASD,andIDandASDpluspsychopathology.Thus,thegreaterthecomplexityofdiagnoses,thegreatertheskillsde<icitsobserved,particularlywherepsychopathologywasconcerned.

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Matson,Hattier,&Belva,(2012)notedthatwork,self-help,leisure,andhygieneskilldePicitsareoftenassociatedwithadiagnosisontheautismspectrum.Anumberofinterventionshavebeenestablishedtoassistindividualswiththeseimpairmentsthemosteffectiveofwhichareinterventionsbaseduponappliedbehavioranalysis(ABA)

AdaptiveBehaviorCompetencies:q  ArenotsimpliPiedcurriculargoalsq  ArenotcharacterizedbyADLskillsq  Aremorecomplicatedthaninferentialcalculus

q  Involvebothsimpleandcomplexdecisionmakingskills

q  Centraltoapplicationofacademiccompetencies

q  Arenotalwayshighlypreferredskillsbut,thenagain,someare.

Adaptivebehaviorisimportantbecausetheworlddoesnotalwaysplaybytherules Chores(ADLs)thattypicalchildrencando.

AGE CHORE

2-4yearolds Helpdust,Putnapkinsontable,Putlaundryinhamper,Helpfeedpet

4-7yearolds

Set(orhelpset)thetable,Putawaytoys,Helpmakebed,Helpputdishesindishwasher,Helpcleartable,Helpputawaygroceries,Waterthegarden

8-10yearolds

Makebed,Set&cleartable,Dust,Vacuum,Helpwashcar,Helpwashdishes,Takeoutthetrash

11yearoldsandolder

Abovepluscleanroom,Mowlawn,Feedpets,Startdoingownlaundry,Makesmallmeals,Shovelsnow,Helpwithyardwork,Emptyandloaddishwasher,etc.

AdaptiveBehaviorInterventionTheparametersofeffectiveinterventioninadaptivebehaviorinclude:1.   Context–Whereinstructiontakesplace2.   Intensity–Howofteninstructiontakesplace3.   Ef,iciency–Whatistheresponseeffort/

equivalenceassociatedwithinstruction4.   Transferofcontrol–Wheredoesstimuluscontrol

lie5.   Value–Whymightthisskillbeimportanttothe

student

Contextq  Theprimaryruleintheprovisionofeffectiveadaptive

behaviorinstructionis,“Teachwherethebehaviorismostlikelytobedisplayed.”Ithasbeenlongdocumentedthatmostindividualswithautismdonotindependentlygeneralizeskillstonewenvironmentsormaintainskillsthatareoflittleuseintheirprimaryenvironments.Thisagainhighlightstheimportanceofcontextasaninstructionalvariable.

q  Further,eventheyoungestindividualsintransitionwillremaininaclassroomenvironmentfor,atmost,thenext7years.Upongraduation,however,theywillneveragainbeinasimilarenvironmentand,instead,mustbepreparedwithskillsandcompetenciesthatworkintheenvironmentswheretheywillspendtherestoftheirlives(i.e.,theirneighborhoods,communitiesoffaith,home,etc.)

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Intensityq  Intensityreferstotherateofinstructionacrossagiventimeperiod;day,week,ormonth.

q  Thereisanextremelylargebodyofresearchsupportingthatfactthatacertainlevelofintensityisrequiredifskillmasteryistobedemonstratedwithallofus.

Intensityq  Bywayofexample,considerthe5-yearoldwithASDwho

required1,000trials(50setsof20trials)ofcoloridentiPicationtoconsistentlyidentifyall64colorsintheCrayolaboxacrossallteachersandallenvironments.

q  Nowtakethesamechildatage15withthegoalbeingthatofbuyinglunchatBurgerKing.Ifheisprovided1(one)instructionalopportunity(i.e.,trial)/week,itwilltakemorethan15yearstoprovidethe1,000trialsthatwerenecessarytoacquirearelativelysimplediscriminationskill(colorID).

q  Assuch,alackofskillacquisitionisoftennotafunctionoflearningabilitybutratherinsufPicientintensitywithinourinstructionalprotocols.

EfPiciencyq  Directlyrelatedtobothskillgeneralizationandmaintenance

isresponseeffortandequivalence.Thiscombinationconstitutesresponseef,iciencywhichistheeasewithwhichatask(desirableornot)canbeaccuratelyaccomplished.

q  IncorporatingtheconceptofresponseefPiciencyininstructionalprogrammingcanbeillustratedbytheexamplebelowoncellphoneuse.q  Asafunctionoffunctioninglevel,differentresponseefPicient

interventionsmayinclude:q  Teachingtoinitiatecalling,dialnumbersfrommemory,orlook

upintherelevantdirectory,or;q  Teachingtodialby<indingafamiliarfaceoriconinthephone’s

contactdirectory,or;q  Teachingtodialbypressingasinglefaceoricon,outofasmall

numberofsuch,onthephone’shomescreen,or;q  Teachingsimplytoretainphonewithhim/hertoallowfor

answeringofthephoneand,asappropriate,GPSmonitoring.

TransferofControlq  AgeneralgoalofmanyABA-basedprogramsisfor

teacherstodemonstratestimuluscontrolovertheirstudentsandclassroom.

q  However,theultimategoalofanytransitionprogramistotransfersuchcontrolfromtheteachertoboththeenvironment(e.g.,stopattheredlight)andtheindividualthemselves(e.g.,viaselfmanagement).

q  Pragmatically,asindividualsageandmovefromaratioof1:1instructionalsupportto,atbest,aratioof4:1,theimportanceoftransferofcontrolrapidlybecomesclear.

Valueq  Skillsthatareofgreatvalue(i.e.,highlypreferred

orhavesigniPicantfunctionalutility)totheindividualtendtobeskillsthat,onceacquired,aremaintainedovertimewithlittleadditionalintervention.

q  Conversely,skillsthatareoflittlevaluegenerallyrequiresigniPicantinstructionalintensitybothduringskillacquisitionandmaintenancephases.

q  Anyeffectiveandappropriateprogramofinterventionneedstocombinebothhigh-valueandlow-valuetargetsinsuchawayastosupportengagement,competence,maintenance,enjoyment,andpersonalsafety.

q  Functionality:thedegreetowhichaskill,ifacquired,canbeappliedacrossmultipleenvironments,domains,ortowardaccessindividualpreferences,interests,ordesires.

q  DegreeofIndependenceGranted:thedegreetowhichtheacquiredskillreducesdependenceuponanotherindividualacrossmultipleenvironments.

q  AcceptableErrorRate:theleveloferrorthatwouldbeexpectedundertypicalconditionsforaskilltobeconsidermastered.

q  AcceptableLevelofRisk:thelevelofrisktoselforothers,iferrorlevelisexceededORthemaybepresentduringtraining.

q  IndividualEnjoyment:theextenttowhichanindividualwillbeabletoaccessreinforcementthroughtheparticipationin,ordemonstrationof,theskill.

q  RelationshiptoCommunityInclusion:Theextenttowhichmasteryoftheskillallowstheindividualtonavigateincreasinglydiverseandcomplexenvironmentsorcommunities.

UsingthefollowingdePinitions

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Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1 (>20%)

(>15%) - 2

Moderate – 3 (>10%)

(>5%) - 4

Near 0 – 5 (< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Degree of Independence

Granted

Acceptable Error Rate Level of Risk Enjoyment

Community Inclusion

Functionality:thedegreetowhichaskill,ifacquired,canbeappliedacrossmultipleenvironments,domains,ortowardaccessindividualpreferences,interests,ordesires.

DegreeofIndependenceGranted:thedegreetowhichtheacquiredskillreducesdependenceuponanotherindividualacrossmultipleenvironments.

AcceptableErrorRate:theleveloferrorthatwouldbeexpectedundertypicalconditionsforaskilltobeconsidermastered.

AcceptableLevelofRisk:thelevelofrisktoselforothers,iferrorlevelisexceededORthemaybepresentduringtraining.Theriskofnotprovidinginstructionmaybeconsideredasseparatelevel.

IndividualEnjoyment:theextenttowhichanindividualwillbeabletoaccessreinforcementthroughtheparticipationin,ordemonstrationof,theskill.

RelationshiptoCommunityInclusion:Theextenttowhichmasteryoftheskillallowstheindividualtonavigateincreasinglydiverseandcomplexenvironmentsorcommunities.

TestingtheApplicationoftheFunctionalityIndexWithAdolescentsandAdultsWithAutism

PeterF.Gerhardt,Ed.D.,ABAIConference,Minneapolis,MNMay,2013

RatedIEPGoalsq  Toothbrushingq  Sightwordsq  StreetCrossingq  Readingforinformationq Mathfacts–Addition&Subtractionq  UsingaCredit/DebitCardq  Playingavideogameq  Sortingbycategories

Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1 (>20%)

(>15%) - 2


(>5%) - 4

Near 0 – 5 (< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1


Granted Acceptable Error

Rate Level of Risk Enjoyment Community

Inclusion

ToothBrushing

Range Range Range Range Range Range 4-5 1-4 4-5 1-2 1-2 1-4

Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1 (>20%)

(>15%) - 2


(>5%) - 4

Near 0 – 5 (< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1




Inclusion

SightWord


Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1 (>20%)

(>15%) - 2


(>5%) - 4

Near 0 – 5 (< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1




Inclusion

StreetCrossing

Range Range Range Range Range Range 3-4 4-5 4-5 5 1-2 2-4

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Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1 (>20%)

(>15%) - 2


(>5%) - 4

Near 0 – 5 (< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1




Inclusion

ReadingforInformation


Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1 (>20%)

(>15%) - 2


(>5%) - 4

Near 0 – 5 (< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1




Inclusion

MathFacts


Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1 (>20%)

(>15%) - 2


(>5%) - 4

Near 0 – 5 (< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1




Inclusion

UsingDebit/CreditCard


Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1 (>20%)

(>15%) - 2


(>5%) - 4

Near 0 – 5 (< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1




Inclusion

PlayingaVideoGame


Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1 (>20%)

(>15%) - 2


(>5%) - 4

Near 0 – 5 (< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1




Inclusion

SortingbyCategories


FunctionalityIndexCombinedScoresFunctionality Ranking Risk

Street Crossing 12 Very High 4.9

Credit Card 14 Moderately High 3.6

Category Sort 17 Very Low 1.5

Tooth 18 Moderately Low 2.6

Sight Words 18 Very Low 1.6

Reading 4 Info 18 Very Low 1.2

Math Facts 25 Very Low 1.4

Video Game 25 Low 1.5

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DiscussionOfparticularinterestwasthatthetwoskillsratedhighestoverallinfunctionality(i.e.,streetcrossingandusingacreditcard)werealsoratedhighestinpotentialrisk.Thiswouldindicatethatskillsorskillsetswiththegreatestpotentialtodirectlyimpactthelivesofadolescentswithautismmayalsobethosewherefeweroftheassociatedvariablesarecontrollableor,forthatmatter,evenknown.Theseare,however,theconditionsunderwhichthePieldofABAmayhaveitsgreatestpotentialimpactwithreferencetoQOL.Unfortunately,thishasnotbeenanactivefocusofresearchorpracticeand,assuch,ourknowledge-baseislacking.

RiskRisksthreatensthingsthatwevalue.Whatwedoaboutthemdependsontheoptionswehave,theoutcomeswevalue,andourbeliefsabouttheoutcomeswevaluethatmightfollowcontingentoneachoptionwemaychoose.Theoutcomescanbecertainoruncertainandourchoicessimpleorcomplex.(Fischhoff&Kadvany,2011)Risk,itseems,isunavoidable.Howeverignoringrisk,undertheguiseofsafety,wouldonlyseemtoinvitegreaterriskfortheindividualinquestion.

(Fischhoff,B.,&Kadvany,J.(2011).Risk:AVeryShortIntroduction.NewYork:OxfordUniversityPress

Discussionq  Amongtherespondentsthereseemedtobeatendencytorateskillsaccordingtotheirunderstandingof“functional”ratherthanbythedePinition(s)provided.Goingforwardthisisapotentialchallengeifthistoolistobeofuseindetermininginstructionalpriorities.

q  Inaddition,withtheexceptionofplayingavideogameandreadingforinformation,acceptableerrorratesassociatedwithskillacquisitionwereatnear“0”levels.Thistoopresentsachallengeinthatwemaybeholdingindividualstohigherstandardsthandoesthecommunityoutsideoftheclassroom.

Afutureimplication?q  ItisgenerallyacceptedthatindividualswithASDdemonstrate

challengesinthegeneralizationofmasteredskillsfromoneenvironmenttoanother(e.g.,Handleman&Delmolino,2005)

q  YettherearethosechildrenwhogeneralizetheoperationoftheDVD/BlueRayplayerfromunittounit,fromhousetohouse,andfromhometoschoolwithoutanyadditionalintervention.

q  Thequestionthenbecomestowhatextentafailuretogeneralizeaparticularskillisdueto:q  AneurologicalchallengeassociatedwithaDxofautism.q  Ourfailuretoattendtocontextasacriticalvariable?q  OurfailuretoprovidesufPicientopportunitiestorespondthatmaybe

necessaryfortruemastery?q  Ourfailuretoconsidertherelationshipbetweenskillvaluetheeffort

neededtocompletetheskill?q  Ourfailuretotransfercontrolfromtheclassroomenvironstothe

worldoutside?

•  LowValue+HighEffort=SlowRateofSA&NoGeneralization

• HighValueandHighEffort=ModerateRateofSA&SigniPicantGeneralization

•  LowValue+LowEffort=ModerateRateofSA&PoorGeneralization

• HighValue+LowEffort=HighRateofSA&SigniPicantGeneralization

High Value Skill

Low Value Skill

Low Effort Skill

High Effort Skill

Whatotheradaptivebehaviorsarecriticalinterventiontargets?

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Whatisacriticalinstructionaltarget?q  Anyskillthat,whenacquired,enablestheindividualtoindependentlycompleteavarietyofrelevanttasksandengageindesiredactivities,AND

q  AnyskillthatisusedwithsufPicientfrequencytoremainintheindividual’srepertoire.Theexceptionherearesafetyskillswhich,ideally,arelowresponsefrequencyskillsAND

q  Anyskillthatcanbeacquiredwithinareasonabletimeframe*.

Sothiswholetransitioningthingisverycomplex.Arethereanysimplerwayswemightbeabletoobtainsimilar,ifnotthesame,outcomes?

CurbCuts

“CurbCut(n)-Asmallrampbuiltintothecurbofasidewalktoeasepassagetothestreet,especiallyforbicyclists,pedestrianswithbabycarriages,andphysicallydisabledpeople.[sic]”

SowhatwouldconstituteacurbcutforsomeonewithASD?

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#1DecentChoiceMakingInstruction

Effectivechoicemakingiscentraltomanyofthecompetenciesofadulthood.However,mostofusmastersimpleeither/orchoices

prettyearlyinlife.

IthinkImightlikeanapple

Apple

GrannySmith

Whole Sliced WithCheese

MaybeApplesauce?

RedDelicious Macintosh Yellow

Delicious

Ifyouhavenothingelse

ForExample: #2

Resilience/ProblemSolving

(or,asabehavioranalyst,resistancetoextinction)

Resilienceisanindividual’sabilitytoproperlyadapttostressandadversity.Resilientbehaviordevelopsovertimeandisiscomposedofavarietyfactorswhichprescribethemannerinwhichwerespondtochallenges.Behavioralcompetenciesassociatedwithresilienceinclude:q  Perseverance,ortheabilitytocontinuewiththe

behaviorinquestionintheabsenceofhighratesofpositivereinforcement.

q  Flexibility,ortheabilitytogeneratenewstrategiestosolveaparticularproblem.

q  AlearninghistorythathasincludederroridentiPicationandcorrectionasaspeciPicinstructionalgoal.

q  Theabilitytomanageimpulsivebehaviorand/orignoreenvironmentaldistractors

InbehavioranalysisWehavelongacknowledgedthephenomenaoflearnedhelplessness(Seligman,1975).Learnedhelplessnessarisesfromrepeatedexperiencewithunpredictableanduncontrollableevents(oftentraumaticevents)andresultsinareducedabilitytocopewithlifechallengesacrossmultipledomains.

Seligman,M.E.P.(1975).Helplessness:OnDepression,Development,andDeath.SanFrancisco:W.H.Freeman.

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Inbehavioranalysis

Yetwehavenotprovidedthesamelevelofinterestorunderstandingtophenomenaoflearnedoptimism(Seligman,1990).Learnedhelplessnessarisesfromrepeatedexperiencewithunpredictableanduncontrollableevents(oftentraumaticevents)andresultsinareducedabilitytocopewithlifechallengesacrossmultipledomains.

#3 Train the Typicals

“Ifyouneurotypicalshavealltheskills,whydon’tyouadaptforawhiledammit!Whyisitalwaysmefault?

DonnaVickers

#4Teachtherightskillsintherightcontext(i.e.,

wherethebehaviorismostlikelytobedisplayed.

Whatyoudoeverydaymightinclude

1.  Waketoalarmclock2.  Morningroutine

1.  Shower,dress,hygiene,etc.3.  Coffee/Breakfast4.  Rememberkeys&lockdoor5.  Gettoworksomehow6.  Followverbal/writtenprompts7.  Userestroom8.  Takeabreak9.  Purchaseandeatlunch10.  Fixmistakes11.  Askforhelp12.  Usecomputer/smartphone13.  Gethomesomehow

14.  Getthemail15.  Unlockthedoor.16.  Changeoutofworkclothes17.  Getsomethingtoeat18.  ADLs19.  Preparedinnerandeat20.  Cleanup.Usedishwasher21.  Goon-line22.  Home/OfPicework23.  Shower24.  Prepforbedinc.meds25.  Reviewnextdayschedule26.  Setalarmclock27.  Sleep

#5

Theabilitytoselfmonitoronesschedule,behavior,workoutputgoesalongwaytosupportingindependentfunctioningacrossmultipleenvironmentsandskilldomainsinadulthood.

#6Acceptthatlifeisnotperfect

q  Forexample,arecentstudyfoundthat15%ofmenand7%ofwomendidn'twashtheirhandsatapublicrestroom.Whentheydidwashtheirhands,only50%ofmenusedsoap,comparedwith78%ofwomen.Further,only5%ofpeoplewhowashedtheirhandsscrubbedlongenoughtokillgermsthatcancauseinfections.

q  Inarecentstudyoncasualsexduringspringbreak,researchersfoundthat15%ofmenand13%ofwomenhadsexwithsomeonetheyjustmet.Further77%ofcollege-agewomenand83%ofmenreportedhavinghadcasualsexatleastonce.

q  Errorsandmistakeshappenallthetime.Thetrickisminimizebigmistakeswhileacceptingacertain,“non-dangerous”errorlevel.Soiscompetencetobeaverage?Betterthanaverage?What?Acceptsomevariabilityfromtimetotime.

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EmploymentDevelopmentand

Support

Employmentisaboutmorethantheactualjobtask.Infact,thejobtaskisusuallytheeasiestpartofemploymentforindividualsonthe

AutismSpectrum.

EmploymentisnotapipedreamWehman,etal.,(2014)presentedtheresultsofarandomizedclinicaltrialcomparingamodiPiedProjectSEARCHmodelofinterventionwithacontrolgrouponemploymentoutcomeswithyoungadults(ages18-21years)withASD.ProjectSEARCHisahighlyspecializedschool-to-workprogramthattakesplaceentirelyintheworkplaceandfocusesonhands-on,orexperiential,instructiononarotatingnumberofactualjobs.AsProjectSEARCHisnotautismspeciPicmodiPicationsweremadetobettermeettheneedsofyoungadultsonthespectrum.ModiPicationsincludedsystematicinstructionutilizingtheprinciplesofAppliedBehaviorAnalysis(ABA),on-sitesupportfromabehaviorspecialist,andintensivestafftraininginASDandtheProjectSEARCHmodel.Membersofthecontrolgroup,ontheotherhand,attendedtheirassignedhighschoolandreceivedtransitionservicesasoutlinedintheirIndividualizedEducationPlan(IEP).Followingintervention87.5%ofthoseinthetreatmentgroupwereemployedwhileonly6.25%ofthecontrolgroupwereemployed.Further,theyoungadultsinthetreatmentgroupachievedhigherlevelsofindependence(asmeasuredbytheSupportIntensityScaleEmploymentActivitiesSubscale)thandidthoseinthecontrolgroup.

ImportantconsiderationstowardsuccessfulemploymentforlearnerswithASD

q ThereisaneedtoredePineworkreadiness

q  ThereisaneedtoredePineworkreadinessq JobsamplingneedstoprovidedwithsufPicientinstructionalintensitytodevelopcompetenciesiscritical

q  ThereisaneedtoredePineworkreadinessq  JobsamplingwithsufPicientinstructionalintensitytodevelopcompetenciesiscritical.

q AserviceeconomyrequiresonetobeproPicientatjobcarvingorcustomizedemployment.

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q  ThereisaneedtoredePineworkreadinessq  JobsamplingwithsufPicientinstructionalintensitytodevelopcompetenciesiscritical

q  AserviceeconomyrequiresonetobeproPicientatjobcarving

q Promotecompetenceoverdisability



q  Promotecompetenceoverdisability

q Attendtothesocialandnavigationcomponentsofjobtrainingandsupport



q  Promotecompetenceoverdisabilityq  Attendtothesocialandnavigationcomponentsofjobtrainingandsupport

q Jobmatch!

WhatisJobMatch?

JobMatchistheextenttowhichaparticularjobmeetstheindividual’sneedsintermsofchallenge,interest,comfort,camaraderie,status,hours,pay&benePits.Ideally,aswemovethroughthejobmarket,wegetcloserandclosertoouridealjobmatch.

Wecan'tgetnojobsatisfaction.q  (AP)EvenAmericanswhoareluckyenoughtohaveworkin

thiseconomyarebecomingmoreunhappywiththeirjobs,accordingtoanewsurveythatfoundonly45percentofAmericansaresatisPiedwiththeirwork.ThatwasthelowestleveleverrecordedbytheConferenceBoardresearchgroupinmorethan22yearsofstudyingtheissue.[]workerdissatisfactionhasbeenontheriseformorethantwodecades.”ItsayssomethingtroublingaboutworkinAmerica.Itisnotaboutthebusinesscycleoronegrumpygeneration,"saysLindaBarrington,managingdirectorofhumancapitalattheConferenceBoard,whohelpedwritethereport,whichwasreleasedTuesday.Workershavegrownsteadilymoreunhappyforavarietyofreasons:q  Fewerworkersconsidertheirjobstobeinteresting.q  IncomeshavenotkeptupwithinPlation.q  Thesoaringcostofhealthinsurancehaseatenintoworkers'take-

homepay.

SOURCE:http://www.cbsnews.com/stories/2010/01/05/national/main6056611.shtml

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AlpineLearningGroupJobMatchAssessments

Intheend,effectiveemploymentdevelopmentandsupportrequiresare-conceptualizationofwhoourconstituentsaretoinclude:q  Individualonthespectrumq  Theirfamilyq  Theiremployerandcoworkersq  Thecommunity-at-largewhobene<itsfromtheirwork.

Physical Match

Navigation Match

Social Match

Family Match

Production Match

Co-workers

Employer Match

Society at Large

TheIndividualq  Wasthereadequateandintensivetransitionprogrammingprovidedpriortograduation?

q  Whataretheindividual’sinterests?q  Whataretheindividual’sareasofstrength?OfdePicit?

q  Whataretheircurrentcommunicativecompetencies?

q  Whatlevelofsupportwilltheindividualneedintheareasoflife,social,andnavigationskills?

q  Whatsafetyskillsdotheypossess?q  Whatjobexperience(ifany)doestheindividualpossess?

q  Whatwastheexperienceoftheemployerandtheindividualpriortograduation.

ThePhysicalMatchq  Isthespaceaccessibleandotherindividualswillingtoaccommodate

q  Challengingworkthatis,ineffect,doable.q  Physicallocationthatwillnotmaketheindividualanxioussuchasloudnoises,smell,lightsetc.

q  Doesthejobrequiretheindividualtostandortosit?Walkorremaininoneplace?Startearlyorstartlate?

q  Isthejobenvironmenttoohot,cold,loud,dark,etc.?

q  Arethephysicaldemandsofthejobcompatiblewiththeabilities/preferencesoftheindividual(i.e.heavylifting,etc.)?

TheSocialMatchq  Whatsocialskillsneedtobeassessedpriorto

employment(baseduponon-siteobservation)?q  Willtherebeampletimeforsocialinteractionswith

otheremployees?q  Doesthejobrequiretoomuchsocialinteraction

withco-workers?Customers?q  Doestheemployerofferafterhourssocialactivities

suchassoftball,bowling,etc.q  Whattypeofdresscodedoesthejobrequire?q  Howmightthephysicalenvironmentaffectthe

socialdemandsofthejobandcantheybemodiPied?

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TheNavigationMatchq  Physicallymanageableenvironmentq  Closeproximitytohomeoraccessiblebyreasonabletransportationoptions.

q  Cantheindividualnavigateallcomponentsoftheenvironment(elevators,stairs,cafeteria,restroomsetc.)?

q  Safetyprotocolsandrequirementsmatchedtoindividualskillsets

TheFamilyq  Familiesarefullpartnersintheprocessq  Whatisthefamily’soverallvisionofemploymentfortheindividual?

q  Maintainhigh(yetreasonable)expectationsfortheirsonordaughterintermsofemployment

q  Supportandencouragetheindividualtoremainemployed

q  Keepchannelsofcommunicationopenq  Istheresomeoneinthefamilywhohasan“in”atapotentialplaceofemployment(ex.Familybusiness)?

TheEmployerq  Willingtocommittotime&sensitivetoaccommodationsq  Doestheemployerhaveexperienceofemploying

individualswithdisabilities?q  Iswillingtobepartoftheteamonaregular,butlimited,

basisq  IsabletodePineclearexpectationsanddutiesfor

employee.q  Abletopromoteequalityandfairnesstoallemployees.q  Doesnotlookatthisjobasa“token”orfavor(i.e.,

Realisticandneededjob,notonemadeupfortheindividual)

q  Iswillingtoallowtrainingforco-workers?q  Canidentifyareasofneedfortheemployer/business?

Co-workersq Willingtoparticipateintrainingq  Arethereco-workerswhocanbecountedonforsupportifneeded(i.e.“naturalsupports)?

q Willingtotreatallcoworkersthesameq Willingtobehonestandcandidq  Sensitiveto,andacceptingof,anyspecialaccommodations.

Society-at-Largeq  Needstoaccepttheindividualasacontributingmemberofthecommunity

q  Needstostopfeelingsorryfortheindividualasa“victim”oftheirdisability

q  Needstoacknowledgethestrengthsthepersonhastoofferandaccepttheir(minor)behavioralidiosyncrasies.

q  NeedstorespectthepersonasanyemployedadultinajobthatisjobsociallysigniPicant,ofvaluetothecommunity,andpersonallyfulPilling/signiPicantfortheindividual

Accordingtoansurveyofactualemployers,themostimportantjobskillsare:

q  Endurance/timeontask–e.g.,Workingmorethan15minutesataclip-PRODUCTION

q  Qualitycontrol–e.g.,CompletingtheirspeciPicjobcorrectly-PRODUCTION

q  Rateorproduction(Fluency)–i.e.,TheraterelativetothatofotheremployeesforthatspeciPicjob-PRODUCTION

q  Knowingwhentoseekassistance–e.g.,Theabilitytoselfcorrect–SOCIAL

q  Breakskills–i.e.,whattododuringscheduledworkbreaksorwhenwaitingforhelp–SOCIAL/NAVIGATION

q  Selfcontrol/selfmanagement–i.e.,Minimalexternalstimuluscontrol-SOCIAL

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Accordingtoanemployersurvey,themostimportantjobskillsare:

q  Acceptsandrespondstofeedback–i.e.,Followsdirectionsfromsupervisor–SOCIAL/NAVIGATION

q  Ageappropriatedressandhygiene–i.e.,Relativetocultureofthebusiness–SOCIAL

q  Timeliness–Theabilitytoarriveontimeandadheretoascheduleofassignmentsorappointments–SOCIAL/NAVIGATION/PRODUCTION

q  Eatsneatlywithco-workers(yes,theysaidthat)–Thisgoeshandandhandwithappropriatetoileting.–SOCIAL/

NAVIGATION

The Social World

\\

Whatdowemeanbytheterm“SOCIALSKILLS”?

Socialskillsmightbestbeunderstoodasaccessandnavigationskills…theyarehowweacquiredesirablesandavoidnegativesbysuccessfullynavigating(andmanipulating)theworldaroundus.Theyarecomplex,multilayeredskillsthatareboundbybothcontentandcontext.

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Walton&Ingersoll(2013)notethatmostworkonsocialskillinterventionshasbeenconductedwithyoungchildren,andthatanumberofpotentiallyeffectiveinterventionshavebeendeveloped.Whilesocialskillsinterventionneedsbebeginsoonafterdiagnosis,socialskillinterventionremainsimportantacrossthelifespan.ThisisofparticularimportancegiventhatthesocialdePicitsassociatedwithASDdonotresolvewithdevelopmentandmay,infact,bemorepronouncedgiventhenormativesocialrepertoireoftypicalpeers.

Watson,K.M.&Ingersoll,B.R.,(2013)Improvingsocialskillsinadolescentsandadultswithautismandseveretoprofoundintellectualdisabilities:Areviewoftheliterature.JournalofAutismandDevelopmentalDisorders.43,594-615

TheIncreasingDemandsoftheSocialWorld

q  Yoursocialdemandsareoftenlowestwithinyourhome.Why?Becauseyousettherulesofacceptablebehavior.

q  Yoursocialdemandsatworkarehigher.However,workisasomewhatscriptedsocialenvironmentandonewithasecondarymeasureofcompetence(i.e.,production).

TheIncreasingDemandsoftheSocialWorld

q  Nextcomesthecommunityatlarge.Why?Becauseinthecommunityyouhavelesscontrolovereventsandactionsthatimpactyou.

q  Lastlycomestheworldbeyondyourcommunity.Whetheradifferentsocialcircleordifferentcountry,chancesareyousocialskillrepertoiremaybelessthanadequate.

Thesocialcontextofurinals

TheUrinalGame

Whatthismeansthen…

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SocialSkillsareNOTLinear

Hi! What's Up?

Not Much. You?

Not Much

Butratherlogrithmicinnature

Hi!

Hi!What’sUp?Yo!

Howyadoing?What’s

happening?Sup?

How’sithanging?

Notmuch?You?Nada.You?

SameoldsameoldWhereyoubeen?Justwork,really.

You?Hanginglowmy

brother

Notmuch.Nada.

SamethingmanBeenaround.Busy.Justbusy

Aslongastheyarehanging

Soremember

"Agreeting...isasocialskillthatisthoughttobesimple.However,furtheranalysisshowsthisskill,whichmosttakeforgranted,tobeextremelycomplex.Howachildgreetsafriendintheclassroomdiffersfromthetypeofgreetingthatwouldbeusedifthetwometatthelocalmall.ThegreetingusedthePirsttimethechildseesafrienddiffersfromthegreetingexchangedwhentheyseeeachother30minuteslater.Further,wordsandactionsforgreetingsdiffer,dependingonwhetherthechildisgreetingateacherorapeer....[G]reetingsarecomplex,asaremostsocialskills.”

Myles&Simpson(2001)

QualityofLifeisNotaNewConcept

Notlifebutgoodlife,istobechiePlyvalued. Socrates (469 BC - 399 BC)

QOLasahumanrightAllpersonsenjoythe“righttobeleftalone,[]theprivilegeofanindividualtoplanhisownaffairs,…toshapehisownlifeashethinksbest,dowhathepleases,gowherehepleases[]thefreedomtowalk,strollorloaf.”

SupremeCourtJusticeWilliamO.Douglas(1973)

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ButinASD,whiletheconceptofqualityoflifehasbeenusedforover30yearsinthePieldofintellectualdisabilities,thefactorscontributingtoqualityoflifeofpersonswithASDhavereceivedrelativelylittleattention(Renty&Roeyers,2006)intheliteratureandinpractice.

Renty,J.O.,&Roeyers,H.(2006).Qualityoflifeinhigh-functioningadultswithautismspectrumdisorder:Thepredictivevalueofdisabilityandsupportcharacteristics.Autism,10,511-524.

Theindividual’sperceptionofhisorherpositioninlifeinthecontextofthecultureandvaluesystem,andinrelationtoone’sgoals,expectations,standardsandconcerns.Itincorporatestheindividual’sphysicalhealth,psychologicalstate,levelofindependence,socialrelationships,personalbeliefsandhisorherrelationshiptosalientfeaturesoftheenvironmentinacomplexway.(TheWorldHealthOrganization,1995)

TheWHOhasdePinedQOLas…

WorldHealthOrganization(WHO)(1995)WorldHealthOrganizationQualityofLifeAssessment(WHOQOL):positionpaperfromtheWorldHealthOrganization.SocialScience&Medicine41:1403–1409.

ButamoreusefuldePinitionis…

Qualityoflife(QOL)isatermusedtodescribeatemporalconditionofpersonalsatisfactionwithsuchcorelifeconditionsasphysicalwell-being,emotionalwell-being,interpersonalrelations,socialinclusion,personalgrowth,materialwellbeing,self-determination,andindividualrights.(Wehmeyer&Schalock,2001)

Wehmeyer,M.L.&Schalock,R.L.(2001).Selfdeterminationandqualityoflife:Implicationsforspecialeducationservicesandsupports.FocusonExceptionalChildren,33,1-16.

ComponentsofQOL1.  Physicalwell-being–Personalhealthstatus2.  Emotionalwell-being–Personalmental

healthstatus3.  Interpersonalrelations–Valued&

reciprocalfriendships4.  Socialinclusion–Valuedsocietyrole5.  Personalgrowth-Continuedopportunities

tolearnandacquirenewskills/knowledge6.  Materialwellbeing–Financialliteracy7.  Self-determination–Decision-makingrole

inonesownlife8.  Individualrights–Life,liberty,happiness,

etc.

MuchoftheresearchonQOLandASDhasfocusedonalimitednumberofaspectsofadultlife(e.g.,employment)andprimarilyonquantitativeaspectsofthesefewdomains(e.g.,employedv.employmentsatisfaction).QOL,however,ismuchmorecomplexstateofbeing(VanHeijst&Geurts,2015).

VanHeijst,B.FC.,&Geurts,H.M((2015).Qualityoflifeinautismacrossthelifespan:Ameta-analysis.Autism:TheInternationalJournalofResearchandPractice,19,158-167.

VanHeijst&Guerts,(2015)recentlycompletedameta-analysisonthetopicofQOLandadultswithASD.Anextensiveliteraturereviewidenti,iedatotalof10peerreviewedstudiespublishedon2004-2012.TheresultsindicatedthatthequalityoflifeissigniPicantlylowerforpeoplewithautismwhencomparedtotheirtypicalpeers.Age,IQandsymptomseveritydidnotpredictqualityoflifeinthissample.Acrossthelifespan,peoplewithautismexperienceamuchlowerqualityoflifecomparedtopeoplewithoutautism.

VanHeijst,B.FC.,&Geurts,H.M((2015).Qualityoflifeinautismacrossthelifespan:Ameta-analysis.Autism:TheInternationalJournalofResearchandPractice,19,158-167.

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However…Parsons(2015)conductedanonlinesurveydesignedtosolicittheviewsofadultswithASDaboutcurrentlifesatisfaction.Fifty-Piverespondents,mostofwhomattendedmainstreamschoolsandwerediagnosedlaterinlife,completedthesurvey.RespondentswereleastsatisPiedwiththeircurrentemploymentsituationandmostsatisPiedwithpersonalrelationships.Therewassubstantialindividualvariationinresponsesdemonstratingtheimportanceofrespectingpersonalviews,circumstancesandaspirations.ThisissigniPicantaslittleisknownabouttheactualviewsofadultswithASDonQOLandthat,ingeneral,"goodoutcomes"inadultlifeareoftenjudgedaccordingtonormativeassumptionsofquality.Parsons,S.,(2015)."WhyAreWeanIgnoredGroup?"MainstreamEducational

ExperiencesandCurrentLifeSatisfactionofAdultsontheAutismSpectrumfromanOnlineSurvey.InternationalJournalofInclusiveEducation.19,397-421

Choice,controlandcompetenceinQualityofLife

CHOICE

Theabilitytomakeun-coercedchoicesandhavethosechoiceshonoredisintegraltoone’sperceptionofQOL.Fromthemomentwewakeupeachdaywearepresentedwithchoicemakingopportunitiesthatmayimpactourlives.ShouldIhitthesnooze?ShouldIhavebreakfast?WhatshouldIweartoday?Andsoon…Howwellwemakethesechoices,andhowfrequentlyourchoicesare,ifnotgranted,atleastacknowledged,greatlycontributestoourpersonalsenseofwellbeing:ourQualityofLife

CONTROL

Wealldesiresomedegreeofcontroloverourfates.Muchofthissenseofcontrolwegetbymakingor,atleast,participatingindecisionsthatdirectlyimpactus.Themorecontrolweexhibitoverdecisionsrelevanttoourlives,themoresatisPiedwefeelasapersonandthegreateroursenseofwellbeing:ourQualityofLife.

Everyonestrivesformorecontrolovertheirlives

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COMPETENCETheinterplaybetweenchoiceandcontrolisanareacalledcompetence.WegenerallychosetoengageintaskswherewehavesomedemonstratedoremerginglevelofproPiciency.Wemaycontrolthesituationalongsuchparametersashowlongweworkonatask,whetherweworkinpublicorinprivate,orwhetherwegiveuponataskalltogether.Thebetterweareatsomepersonalandpublicassortmentoftasks,thebetteroursenseofwellbeing:ourQualityofLife.

Thecommunityunderstandsautismbuttheystillwontaccept

incompetence.

Choice Control CompetenceChildhood Simple“either/or”

choicesLimited Accesstotangibles

MiddleSchool

Developmentofchoicemakingskills&repertoire

Intermittent Accesstotangiblesselfscheduling&monitoring

Transition “DignityofFailure”becomesissue

Intermittentacrossmultiplesettings

Jobsamplingoutcomes,accesstotangiblesxsettings,selfsched.

YoungAdult

Wheretowork,live,eat,vote,etc.Risk/BenePitAnalysis

Moderateacrosssettings&routines

Jobw/careerpath,accesstotangiblesxsettings,selfsched.,desiredsociallife

Adult Wheretowork,live,worship,eat,vote,sleepwith,etc.

SigniPicant Alife

“Improvingthequalityofpeople’sliveshasbeenoneoftheimplicitgoalsofserviceprovisioninrecentdecades,andremainssotoday.[]Movingfromqualityoflifeasanimplicitorexplicitgoaltoqualityoflifeasahelpfulconceptandsetofpracticalstrategiestoimprovepolicy,practice,andlifeforindividualsorgroupsofpeoplehasbeenastrongthemewithintherichpanoplyofqualityoflifeworkinthePieldofintellectualdisabilities.Thisworkhasbeenconsiderablymorechallengingthanmightbeexpected.”(p.316)

Brown,I.,Hatton,C.,&Erickson,E.(2013),QualityoflifeindicatorsforindividualswithIntellectualDisabilities:Extendingcurrentpractice.IntellectualandDevelopmentalDisabilities,51,316-332.

Some closing thoughts…

Butwhatishappinessexceptthesimpleharmonybetweenamanandthelifeheleads.

AlbertCamus(1913-1960)

That'sthedifferencebetweenmeandtherestoftheworld!Happinessisn'tgoodenoughforme!Idemandeuphoria!

Calvin,speakingtoHobbs

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IfIhadtolivemylifeagain,I'dmakethesamemistakes,onlysooner. TallulahBankhead(1903-1968)

“Oscar,youknowthat’snotgoodforyou!”“Felix,whenIlookbackonthebesttimesonmylife,noneofthemweregoodforme!”

FelixUngerandOscarMadisonTheOddCouple

Don’tdreamit.Beit!

*Stolen, without permission, from the University of Houston, Clear Lake ABA Program Website.

*

SummaryPoints:�  InterventionsbasedontheprinciplesofABAareapplicableacrossskilldomainsandacrossthelifespan.

�  Itiseasytobesuccessfulwhenyousetthebarlowsothinkbigandhavehighexpectations.

�  Startplanningearlyand,certainly,nolaterthanage16years.

�  Tothemaximumextentpossible,workcooperativelywithallinvolvedintheprocesstothebenePitoftheteen/youngadultwithASD.

�  RememberthattransitionplanningisaprocessandPirstdraftsofITPsarerarelythePinaldraft.

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�  Keepyoureyesontheprizeofyourlongtermtransitiongoalsforemployment,livingorpostsecondaryeducation.Frameallyourdiscussionswithreferencetothosedesiredoutcomes.Involveextendedfamilyandfriendsintheprocess,particularlyintheareaofemploymentastheymayhavecontactsandresourcesyoudonot.

�  Remember,youareacriticalpartofthisprocessnomatterwhattitleyourhave(parent,speechpathologist,transitionspecialist,etc.).

�  Withreferencetocommunityskills,remembertoteachwheretheskillsaremostlikelytobeused.Itismoreeffectivetoteachgroceryshoppingatanactuallysupermarketthanitistoteachitintheclassroom

�  Identifythelevelof“risk”withwhichyouarecomfortableandthenworktomaximizeindependencewithinthatframework.(Forexample,whileyoumaybeuncomfortablewithhimorhercrossingtheparkinglotofsupermarketwithoutclosesupervision,heorshemaynotneedthesameintensityofsupervisioninthesupermarket)Astheteen/youngadultgainsgreaterindependenceacrosstasksandenvironments,reassessyouacceptablelevelofrisk.

�  Good,effectivetransitionplanningiseffortfulandtimeconsuming.Thereare,sadly,noknownshortcutsbutwhenitisdonewell,theoutcomesarewellworththeeffort.

RecommendedFollow-upActivities1.  Theprinciplesofappliedbehavioranalysisworktoshapeour

behavioreveryday.Overthenext24hourstrytonotice,anddocument,aminimumof25instanceswhereyourbehavior,orthebehaviorofothers,wasmodiPiedviapositivereinforcement.

2.  Spend30minutesobservingaspeciPic,yetcommonplace,communityskill(e.g.groceryshopping,diningout,purchasinggas.Writeataskanalysisfortheteachingtheskillincorporatingproduction,social,andnavigationskills.

3.  Identify,foroneofyourstudents,aminimumof3jobcarvingopportunitiesatplacesyoumightfrequentacrossthecourseofaweek.WhatwouldthenbeyourPirststeptowardgettinghimorherhired?

SelectedReferencesBrown-Lavoie,S.M.,Viecili,M.A.,&Weiss,J.A.(2014).Sexualknowledgeand

victimizationinadultswithautismspectrumdisorders.JournalofAutismandDevelopmentalDisabilities.44,2185-2196.

Cederlund,M.,Hagberg,B.,Billstedt,E.Gillberg,C.,&Gillberg,C.,(2008).Aspergersyndromeandautism:Acomparativelongitudinalfollow-upstudymorethan5yearsaftertheinitialdiagnosis.JournalofAutismandDevelopmentalDisorders,38,72-85.

Glennon,T.J.,(2001).ThestressoftheuniversityexperiencewithstudentswithAspergersyndrome.JournalofAssessment,Prevention,andRehabilitation,17,183-190.

Green,J.,Gilchrist,A.,Burton,D.,&Cox,A.(2000).SocialandpsychiatricfunctioninginadolescentswithAspergerSyndromecomparedwithconductdisorder.JournalofAutismandDevelopmentalDisorders,30,279-293.

Hagner,D.,&Cooney,B.F.(2005).“Idothatforeverybody”:Supervisingemployees

withautism.FocusonAutismandotherDevelopmentalDisabilities,20,91-97.

Ivey,J.K.(2007).Outcomesforstudentswithautismspectrumdisorders:Whatisimportantandlikelyaccordingtoteachers?EducationandTraininginDevelopmentalDisabilities,42,3-13.

SelectedReferences

Lattimore,L.P.,Parsons,M.B.,&Reid,D.H.(2006).Enhancingjob-sitetrainingofsupportedworkerswithautism:Areemphasisonsimulation.JournalofAppliedBehaviorAnalysis,39,91-102.

Lee,H.J.,&Park,H.R.,(2007).AnintegratedliteraturereviewontheadaptivebehaviorofindividualswithAspergersyndrome.RemedialandSpecialEducation,28,132-141.

Mazefsky,C.,Williams,D.,&Minshew,N.(2008).Variabilityinadaptivebehaviorinautism:Evidencefortheimportanceoffamilyhistory.JournalofAbnormalChildPsychology,37,921-928.

McClannahan,L.E.,McGee,G.G.,MacDuff,G.S.,&Krantz,P.J.(1990). Assessingandimprovingchildcare:Apersonalappearanceindexforchildrenwithautism.JournalofAppliedBehaviorAnalysis,23,469-482.

SelectedReferences

Mesibov,G.B.,Currentperspectivesandissuesinautismandadolescence.InE.Schopler&G.B.Mesibov(Eds),AutisminAdolescentsandAdults,(pp.37-56).NewYork:Plenum

Myles,B.S.,Lee,H.J.,Smith,S.M.,Tien,Y.,Swanson,T.C.,&Hudson,J.(2007).AlargescalestudyofthecharacteristicsofAspergersyndrome.EducationandTraininginDevelopmentalDisabilities,42,448-459.

Okuda,K.(2001).Toilettrainingforanadultwithautism,severelydisturbingbehavior,andmentalretardation23-31.JapaneseJournalofSpecialEducation,39,23-31.

Quinn,M.M.,Rutherford,R.B.,Leone,P.E.,Osher,D.M.,&Poirier,J.M.(2005).Youthwithdisabilitiesinjuvenilecorrections:AnationalSurvey.ExceptionalChildren,71,339-345.

Sobsey,D.(1994).Violenceandabuseinthelivesofpeoplewithdisabilities:Theend

ofsilentacceptance?Baltimore:PaulH.BrookesPublishingCo.

Smith,M.D.,&Belcher,R.(1985).Teachinglifeskillstoadultsdisabledbyautism.JournalofAutismandDevelopmentalDisorders,15,163-175.

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SelectedReferencesStokes,M.,Newton,N.,&Kaur,A.(2007).Stalking,andsocialandromantic

functioningamongadolescentsandadultswithautismspectrumdisorder.JournalofAutism&DevelopmentalDisorders,37,1969-1986.

Sullivan,P.M.&Knutson,J.F.(2000).Maltreatmentanddisabilities:Apopulation-

basedepidemiologicalstudy.ChildAbuseandNeglect,24,1257-1273

Topper,K.,Bremner,W.,&Holmes,E.A.,(2000).Socialcompetence:Thesocialconstructionoftheconcept.InR.Bar-on&J.D.A.Parker,(Eds.),TheHandbookofEmotionalIntelligence,(pp.28-39).SanFrancisco:JosseyBass.

Taylor,B.A.,Hughes,C.E.,Richard,E.,Hoch,H.,&Coello,A.R.(2004).Teachingteenagerswithautismtoseekassistancewhenlost.Journal ofAppliedBehaviorAnalysis,37,79-82.

Watanabe,M.,Uematsu,T.,Kobayashi,S.,(1993).Teachingcommunityskills(busriding)tostudentswithautism.JapaneseJournalofSpecial Education.31,27-35.

Watson,GrifPiths,Richards,&Dysktra(2002).SexEducation,InGrifPiths,Richards,Federoff,&Watson(Eds.).EthicalDilemmas:SexualityandDevelopmentalDisability.(pp175-225).Kingston,NY:NADDPress

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