Therapist/Aide Training Guide

Aide Training Week 1 (trainings are about 1 hr per day)



DAY 1:

What is autism: (15 min)

  1. Autism Spectrum Disorder
    is a neurological disorder which according to the DSM 4:
    1. A total of six (or more) items from (1), (2), and (3):
    2. Qualitative impairments in reciprocal social interaction, as manifested
      by at least two of the following:
    3. Marked impairment in the use of multiple nonverbal behaviors such as
      eye-to-eye gaze, facial expression, body postures, and gestures to regulate
      social interaction.
    4. Failure to develop peer relationships appropriate to developmental level.
    5. A lack of spontaneous seeking to share enjoyment, interests, or achievements
      with other people (e.g., by a lack of showing, bringing, or pointing out
      objects of interest)
    6. Lack of social or emotional reciprocity.
    7. Qualitative impairments in communication as manifested by at least one
      of the following:
    8. Delay in, or total lack of the development of spoken language (not accompanied
      by an attempt to compensate through alternative modes of communication
      such as gesture or mime).
    9. In individuals with adequate speech, marked impairment in the ability
      to initiate or sustain a conversation with others.
    10. Stereotyped and repetitive use of language or idiosyncratic language.
    11. Lack of varied, spontaneous make-believe play or social imitative play
      appropriate to developmental level.
    12. Restricted, repetitive, and stereotyped patterns of behavior, interests,
      and activities as manifested by at least one of the following:
    13. Encompassing preoccupation with one or more stereotyped and restricted
      patterns of interest, abnormal either in intensity or focus.
    14. Apparently inflexible adherence to specific, nonfunctional routines
      or rituals.
    15. Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping,
      or twisting, or complex whole body movements.
    16. Persistent preoccupation with parts of objects.
    17. Delays or abnormal functioning in at least one of the following areas
      with onset prior to age 3 years: (1) social interaction, (2) language
      as used in social communication, or (3) symbolic or imaginative play.
    18. The disturbance is not better accounted for by Rett's Disorder or Childhood
      Disintegrative Disorder.
  2. The Good News:



    Family-centered intensive (30-40 hr/wk) intervention strategies by trained/certified
    providers can "recover" 35-47% of the children as shown by the research
    of Ivar Lovaas and others.

Discuss Calvin's IFSP goals and Needs
to Learn/Knows (45 min) with question and answer

DAY 2:


VB
Training

#1 BUTTONS

#2 ABA procedures

#3 Components

#4 Transfer Procedures

#5 Behaviors

#6 What to do/not

#1 Buttons

Button #1 Sr- - Negative Stimulus Response (Unwanted response)

Button #2 Sr+ - Positive Stimulus Response (Good response)

Button #3 Sra - Stims (rolling car, ears/mouth, holes)

2 Worlds (not Tarzan)

1. Good things/good world/fun

2. Bad things/bad world/work/take away from fun

#2 ABA Procedures

What
are discrete trials?

Sd ----> R----->Sr

Sd
- discriminative stimulus - the instruction, question, relevant item
or materials, etc.

R - response

Sr - stimulus response - consequence - Consequences can increase
rates of behavior (reinforcement) or decrease 
rates of behavior (punishers or extinction)

discriminating stimulus is a particular stimulus that evokes
a particular response
due to a history of reinforcement.

Antecedent

Behavior

Consequence

Instruction

Response

Consequence

FBA-Functional Behavior Assessment

Date/time A B . C



Dyslexia

Dyspraxia

Dysteachia

Prompt / Prompt dependence

Types of prompts

Reinforcers

Killing reinforcer

Pairing

1.People

BEFORE
LANGUAGE TRAINING SESSIONS START

What
is "pairing"? "Pairing" refers to associating
yourself with the delivery of reinforcing items and events. Through pairing
you establish yourself
as a reinforcer.

A
reinforcer is any item
or, event that increases the rate of a behavior when it is presented
following the behavior. Anything that is consistently a reinforcer will become
reinforcing itself (a conditioned
reinforcer).

How
do you pair yourself with reinforcement?

  • have
    a number of reinforcing items and activities that are currently effective
    for your child
  • present
    yourself or your words with or immediately before the delivery of reinforcement
  • offer
    ways to access other reinforcers that your child could not access independently
  • ensure
    that you are not associated with the termination of ongoing reinforcing activities
    or other negative events
  • don't
    place demands upon your child initially
  • gradually
    increase demands once the training relationship has been established
  • set
    up playing so that you are required to make things fun (car goes down slide,
    you control car and don't give it to child until mand)
  • establish
    yourself as a reinforcer
  • How do you know if trainers have paired
    themselves effectively?  Does
    your child run to them or from them?
  • Giving up reinforcer doesn't mean its
    gone forever.
  • Pairing should continue to occur at
    the beginning of and during each session whenever instructors
    interact with the student.
  • Pair every 20 minutes (per session)
    or at least the first and last 20 minutes.
  • Gradually increase expectations.
  • Give me beads (history of just touching)
    -> then pick up for 1 second -> then hold -> then remove for longer
    periods
  • PAIRING -> EASY TASK -> HARD TASK
    -> EASY TASK -> HARD TASK -> EASY TASK -> PAIRING


DO:

Do

Don't

  • Narrate
    (vs instruct)

  • Use
    natural language
  • Present
    yourself and words followed by reinforcer
  • Reinforce
    engagement & interaction
  • Wait
    for interaction before reinforcement (don't do a whole bunch of stuff)

    Reinforcers
    During Pairing

    • Follow
      child's motivation
    • Control
      access to reinforcers (deliverable in small amounts, go away by themselves)
    • You
      are critical for activity

    Types
    of reinforcers

    • Edibles
    • Tickles
    • Praise
    • Bubbles
    • Squirt
      guns
    • Wind
      up toys
    • Videos
    • Balloons
    • Blankets/pillows
    • Swinging
    • Trampoline

    No
    demands - depends on child's capability - lots of reinforcement

    Don't
    turn reinforcer into task (read book "what's this?")

    Be
    silent, play next to child w/o engaging child



    2.Pairing Items (table, chair, flashcards)

    3.Pairing Actions (auto window in car)

    Backwards chaining

    To learn door lock combination number at Kindercare: 4641*

    You enter 4641 and teach *

    You enter 464 and teach 1*

    You enter 46 and teach 41*

    You enter 4 and teach 641*

    You enter nothing and teach 4641*

    EO-Establishing Operations->reinforcer

    Data Taking P+ + - NR

    Program Trial 1 Trial 2 Trial 3 Trial 4 Trial 5 Trial 6 Trial 7 Trial 8 Trial 9 Trial 10
      NR P+ P+ - + + + + + +

    Maintenance

    %-90% over 2-3 days with 2 people

    #3 Components

    Components of Verbal Behavior

    Motor Imitation

    Echoic

    Manding

    Tacting (expressive)

    RFFC (receptive feature, function, class)

    TFFC (tacting feature, function, class)

    Intraverbals

    #4 Transfer Procedures

    Transfer Procedures

    1.Receptive/tacting

    l

    v

    2.RFFC/TFFC

    l

    v

    3.Intraverbal

    l

    v

    4.No prompts/spontaneous

    #5 Behaviors



    SUMMARY OF THE PROCEDURES TO REDUCE
    DISRUPTIVE BEHAVIOR

    1. HE/SHE WANTS SOMETHING AND THEY CAN'T
      HAVE IT AT THIS TIME.
      • WALK AND PEEL PROCEUDRE (HOME
        VERSION)
      • Say no and if accepts it reinforce
      • If problem behavior occurs, walk
        in opposite direction
      • DO NOT REDIRECT TO FUN ACTIVITY
      • Return only to protect the child
        or property with no talking, walk again
      • If child grabs you, peel and go
        about your business
      • When child stops problem behavior
        for 1 minute return and redirect.
      • Use Data sheet# 1 during practice
    2. CHILD WANTS SOMETHING AND THEY CAN
      HAVE IT BUT NOT FOR DISRUPTIVE BEHAVIOR.
      • COUNT AND MAND PROCEDURE
      • Tell the child to stop behavior
        or "quiet" and begin counting by showing fingers counting off to 10 at
        first
      • If problem behavior continues during
        count, re start the count.
      • If child runs off, stop count and
        go about your business, don't follow the child.
      • When you reach 10 with no problem
        behavior prompt child to request desired item or activity with acceptable
        form of communication.
      • Deliver item for proper communication
        and then use the motivation at the moment for that item to run mand trials.
      • Use data sheet #2 when practicing.
    3. CHILD IS INSTRUCTED TO DO SOMETHING
      BUT REFUSES COMPLIANCE TEACHING PROCEDURE
      • After placing a demand allow about
        3 seconds for compliance
      • When compliance occurs reinforce
        and be prepared to do so.
      • If compliance does not occur guide
        the child to complete the task
      • Do not give reinforcement for completion
        if guided
      • In some cases you may want to use
        the promise technique of showing a strong reinforcer before placing the
        demand on the child to reduce the motivation to escape your request.
      • If the promise is ineffective than
        remove the promise and physically guide with no reinforcer after physically
        guidance.
      • When practicing this technique make
        demands easy at first.
      • Use data sheet #3 when practicing.
    4. HE/SHE WANTS SOMETHING AND THEY CAN'T
      HAVE IT AND THE CHILD IS IN SCHOOL OR OUTSIDE THE HOME.
      • WALK AND PEEL OUTSIDE THE
        HOME OR IN SCHOOL.
      • Say no and if accepts it reinforce
      • If problem behavior occurs, place
        a compliance demand on the child specific to the setting. If in school
        direct to next activity or run some contrived compliance trials. Provide
        no reinforcement for compliance within the trials.
      • DO NOT REDIRECT TO FUN ACTIVITY
      • Use the promise procedure within
        school and outside the home as well.
      • Use data sheet # 3 when practicing.
        Be sure to mark that data sheeting indicating that the practice started
        with the denial of a child request for something they could not have at
        this time.

    #6 What to do/not

    TEACHING
    COOPERATION DURING INTENSIVE TEACHING

      • Do I need to change teaching procedures
        to produce greater cooperation and a higher rate of responding in intensive
        teaching situations? IF YES, CONTINUE TO ANSWER QUESTIONS BELOW.
      • Do I need to Identify Stronger reinforcers?
      • Do I need to make a determination
        as to how the child learned the task avoidance, e.g. function is socially
        mediated positive, negative or automatic positive reinforcement?
      • Do all the teachers need to pair
        themselves with reinforcers until my child is approaching them to receive
        the reinforcers and their voice is paired with reinforcement?
      • Do we need to stop interrupting my
        child's reinforcers to present demands?
      • Are we ready to begin requiring my
        child to just mand reinforcers since we are paired with reinforcement sufficiently?
      • Are we ready to begin or should we
        return to requiring very easy and infrequent demands that result in immediate
        reinforcement before requiring more difficult tasks?
      • Are we prompting immediately to insure
        successful responding so that correct responding contacts reinforcement?
      • Are we using the extinction procedure
        based upon the function only if we moved the response requirement
        up too soon and therefore the child becomes task avoidant or resistant to
        the teaching?
      • After we use extinction are we re-adjusting
        the instructional demands to prevent using extinction again?
      • If my child is now ready for intensive
        teaching have we paired the intensive teaching situation (table) with reinforcement
        so that my child comes to it readily because it is associated with receiving
        of reinforcement and not removing of reinforcement?
      • During intensive teaching are we interspersi
        mastered - new tasks at a high rate,e.g. 80-20%.
      • During intensive teaching are we using
        errorless teaching procedures?
      • During intensive teaching are we mixing
        and varying tasks across the skill areas, e.g, motor imitation, tacting,
        intraverbals, RFFC, etc.?
      • During intensive teaching are we teaching
        all skills to fluency ?
      • During intensive teaching are we maintaining
        an appropriatel fast presentation of demands?
      • During intensive teaching are the
        demands low, easy and infrequent at least initially?
      • During intensive teaching are arranging
        for my child to mand at the end of each sequence of tasks?
      • How much direct teaching time will
        be spread across intensive teaching and NET?
      • What skills will be targeted in Intensive
        teaching sessions and what reinforcers will be used and how many responses
        before a reinforcer?
      • What skills will be targeted in NET
        situations: (Manding, VB Modules)?
      • In three (3) months what will my child
        being doing differently, e.g number of responses per minute, number of responses
        before a reinforcer, number of spontaneous mands per day?

    DAY 3:

    • General Classroom routines (show schedule
      and discuss different activities Calvin will be involved in)
    • Motivators
    • Stims
    • Rewarding
    • Pairing
    • Prompting
    • Prompt Fading

    DAY 4:


    Optional: HOW TO TEACH PIVOTAL BEHAVIORS
    TO CHILDREN WITH AUTISM: A TRAINING MANUAL


    DAY 5:



    • Answer questions, do basic written test

    Aide Training Week
    2 (trainings are about 1 hr per day)


    DAY 1:

    • NET at table

    DAY 2:

    • NET at table

    DAY 3:

    • Model how to ID motivators & stims
      in classroom and outside. Model prompting of teacher instructions and basic
      classroom routines.

    DAY 4:

    • Model peer interaction

    DAY 5:

    • Model & have aide do some interacting
      with child


    Aide Training Week
    2-3 (trainings are about 1 hr per day)


    DAY 1-5:

    • Have aide do work but with comments
      on technique from modeler.