Dr. Chris’ Autism Journal

In our teaching and learning endeavors with children, we often are driven by the ultimate outcome and functionality of a skill without even realizing it. Behind this motivation for teaching is the value and importance of generalization, we want our students to be able to learn something in an instructional setting and apply it in a functional setting. Think back to the days when you learned the alphabet. Now think of how easily you were able to learn that A is A, no matter what color it is, how tall it is, what kind of paper it is on, if it was on the fridge or in a book, or who might be asking you about it. And notice how you did not forget that A is A once you mastered the skill. This is generalization.

            Difficulties with generalization of skills are well-known in individuals with autism spectrum disorders (ASD) and to those who work with them. These difficulties often will mean that generalization will not just occur, but rather will need to be explicitly programmed and planned for in educational and therapeutic settings.  Thus, it is important to think of generalization issues as being the responsibility of the teacher, rather than as a deficit in the child.   Individuals with ASD frequently cannot functionally use what they have learned in a structured teaching situation and be able to apply it to other similar settings or with different materials and people. Often times children with ASD will need specific planning for maintenance of a skill and programming that can naturally embed learned skills into functional activities so that the skill is constantly and systematically reinforced over time.  It is absolutely essential to program and plan for generalization, the “train and hope” approach (just teaching the skill and hoping it will generalize), is not sufficient.

            If you are interested in more information on generalization, start with this article: Stokes, T. F., & Baer, D. M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10, 349-367, available for purchase at http://seab.envmed.rochester.edu/jaba/. Please note that this website has lots of full text articles available as well as abstracts for their articles going as far back as 1968. They have a great search feature so that you can get right to the information you are looking for. For example if you search for autism, you will get a list of links to abstracts and full text articles having to do with studies conducted relating to autism all the way back to 1968.  Here are some strategies for programming for generalization from the Stokes & Baer article:
1) Use naturally reinforcing and occurring materials - Seek to change behaviors that receive reinforcement in the student’s natural environment. For example - learning colors because the child has a favorite color of Popsicle, M&Ms, and ice cream flavor is likely to be more maintained and generalized than learning colors by sorting colored blocks into color bowls.
2) Train Loosely - Adding variety to skills being taught. This will include using a variety of materials in a variety of ways and in a variety of situations. Ideas and approaches used in incidental teaching or naturalistic ABA tend to foster better generalization because these instructional environments more closely resemble the ultimate outcome. Studies have shown that the more naturalistic instructions and presentations of SDs tend to have better learning outcomes to intensive instruction.
3) Train Sufficient Exemplars - Providing many examples of the target response. An example of this is the computer-assisted instructional program, TeachTown: Basics , which has many examples incorporated into every lesson.  You will notice many examples of one particular vocabulary word. You will also notice that pictures used in the pretest and posttest are different from the pictures used in the training lessons. Additionally, in the off computer activities there are many ideas that include the use of materials found around the house or classroom.
4) General Case Programming – Use many examples of stimuli, use many teachers, try different settings, and lots of materials.
-Using a vending machine at local community center, using similar vending machine at school, using another similar one at the grocery store…
-When teaching car, you would consider pictures of cars, different cars, toy cars, riding in family’s cars, labeling cars on the street, etc.
-When teaching social skills like saying hi, saying hi to people where you know a name for them, saying hi to people when you don’t have a name for them, pretending to say hi to stuffed animals, pretending to say hi to pictures of friends, having dolls say hi to each other, etc.
 

            Generalization should not only be planned for in the teaching situation, but measurement of generalization is critical so plans should be made up front for how to assess it.  This can be done by taking a skill that was taught and try it with new materials, go on an outing into the community (the zoo, park, beach, grocery store, etc.), and most importantly try it with mom, dad, and/or siblings. It is critical that generalization is assessed everyday with each newly acquired skill. If the child isn’t showing functional use of the skill in naturally occurring activities and routines, stop adding new programs and goals and focus planning and programming for generalization for his/her recently acquired skills.  If the skill has not generalized, the skill cannot be considered truly mastered!

            Although the term “generalization” is often heard in the ABA (Applied Behavior Analysis) literature, there is no intervention in which generalization is not important, regardless of the philosophy.  In seeking interventions for a particular child, it is essential to ask the treatment providers how they will program for and measure generalization, or real outcome.  Regardless of the impressive statistics of a treatment program, if the children do not demonstrate generalization in the real world, the results of the treatment program may not be as impressive as they seem.  A good resource for learning more about generalization, the research, and strategies for various interventions is Real Life, Real Progress for Children with Autism Spectrum Disorders: Strategies for Successful Generalization in Natural Environments (Whalen, 2009). 

I attended the Geneva Centre for Autism conference last week and saw many interesting presentations and one that I found inspiring was a talk by Brenda Smith Myles.  She is the author of a book called The Hidden Curriculum: Practical Solutions for Understanding Rules in Social Situations.  There are a great deal of good books on autism and several with pracial information for intervention.  Few of these books, and few interventions, focus on what is not obvious but what might be extremely important. 

“The hidden curriculum refers to the set of rules or guidelines that are often not directly taught but are assumed to be known (Garnett, 1984; Hemmings, 2000; Jackson, 1968; Kanpol, 1989)” (from Brenda’s book on page 5).  This curriculum includes things like unspoken rules, slang, metaphors, body language, etc.  Most of us pick up on these things instinctively but it is often difficult for those with autism and other special needs to do this.   

In her talk, Brenda spoke of obscure social situations such as using a public restroom or shower, using an elevator, and everyday conversations.  To many of us, these are situations that we have become accustomed to and we accept the social rules, even though we may not always think about them or discuss them.  She gives practical tips for teaching these hidden social rules to children and to adults and stresses the importance of making these a part of everyday life.

Another good resource for learning about the hidden rules in social situations is a book that I have finally started reading by Dr. Temple Grandin and Sean Barron (click here for a very interesting podcast with Sean) called Unwritten Rules of Social Relationships: Decoding Social Mysteries Through the Unique Perspectives of Autism.  This insightful and intelligent book helps you see into the minds of people with Autism Spectrum Disorders and how they perceive these strange social situations and rules, and how they cope with these situations.  This book is helpful for professional, families, and those with a diagnosis themselves - fascinating book that I will probably recommend to many of my friends that are not in the field, it really demonstrates how different brains process information from various perspectives and that we can not take any knowledge for granted.

The only thing that is missing from this perspective is how to measure success, how to take data and assess what the child or adult has learned and what they have left to learn.  If anyone knows of a good hidden curriculum type of assessment or measurement, please post here, I would be very excited to take a look at something like that! 

From looking at these 2 books and listenting to Brenda talk (and Temple on several occassions), I am reminded how important it is for us to look beyond the obvious in education.  This awareness of hidden information in our world can only advance the science of interventions and assist us with developing programs that result in real-world success.

The winter holidays can be a difficult time for children with ASD and their families. Difficulties may arise from too much free time, changes in routine, and gift giving.

Most school-age children are off school for two to three weeks for the winter holidays, leaving six to eight hours of unstructured time for families to fill each day. You’re not alone if you dread the school holidays; past experience has taught you that a lot can go wrong in two or three weeks. If you haven’t already done so, now is the time to plan how you will structure that free time for your child with ASD. Plan activities for each day of the vacation, and create simple visual supports (e.g., print a picture of a park from the Internet if you will be taking your child to the park) to prime your child about the activities you have planned. If possible, allow your child to help decide on the activities you are planning. During the vacation, review the schedule for the day the night before and on the morning of the day to which the schedule refers. Of course, you can’t plan for everything, and you will invariably have to make changes to the schedule. Let your child know of any changes as soon as possible, and provide visual supports to make the changes concrete for your child. If your family will be traveling during the vacation, changes to the schedule such as flight delays are even more likely. Prepare your child that more than likely, there will be changes to the schedule, perhaps through the use of a social story. Don’t forget to bring an assortment of things for your child to do such as coloring, books, games, or a laptop computer.
Where your child will go and what he or she will do in a day are not the only changes that may be upsetting during the winter holidays. Many people visit with friends and relatives during this time that they rarely see during the rest of the year. These people may feel like strangers to your child, and he or she may behave accordingly. Forcing your child to hug Aunt Mary because “She came all the way from Boston to see us,” is likely to induce challenging behaviors from your child and to make Aunt Mary very uncomfortable. Aunt Mary insisting on a hug may produce similar results. Inform Aunt Mary that your child may view her as a stranger and she should not be offended before Aunt Mary arrives at your home (or you at hers). If possible, show your child pictures of friends and relatives you will visit and review the names of these people before the visit.

Many people exchange gifts during the winter holidays. This can be a source of great disappointment for family and friends of a child with ASD. As a behavior therapist, I once special ordered a beach magnet set for a child I worked with one-on-one, three hours a day, five days a week. I was sure he would love it. I imagined all the exciting language he would produce when we played with those magnets. I heard in my mind spontaneous comments he would make and squeals of delight he would emit. As you probably guessed, the boy opened the magnet set, said nothing, put it down, and picked up another toy. I tried to engage him with the magnets through my enthusiasm. Nothing worked. I have heard similar stories from parents and educators time and again. Even when the child showed intense interest in a toy when it belonged to someone else or requested the toy, the same toy is often of little interest to the child when received as a holiday gift.  As a parent, there is nothing you can do to prevent this. If you have a neurotypical child, you may have complained that he or she only played with a new toy for a day and lost interest. This is part of being a parent, but it is especially disheartening when your child is on the Autism Spectrum, has limited interests, and you worked so hard to find that special gift. Remember that your effort is special regardless of the immediate reaction to the gift. And time may reward your effort. I heard that the beach magnet set became a preferred toy for the boy I worked with over a year later.

I recently had the pleasure of interviewing Krista Schultz, who works in Alberta, Canada with children with autism.  She is an ABA and developmental specialist and a frequent user of TeachTown with her clients.  I love her philosophy for teaching children and her passion for making a difference in the autism community.  I also really enjoyed her responses regarding technology and her feedback on TeachTown.  I hope you enjoy this as much as I did! 

Interview with Krista
May 2, 2007

1) Please provide us with a brief background about your education and credentials:

I am originally from Northern Alberta, Canada and received my first degree (Bachelor of Education) from the University of Alberta.  During teaching and then school counseling, I worked through a Master of Science degree in Educational Psychology with a Specialization in Developmental Psychology.  Since that time I have become a Registered Psychologist in the Province of Alberta and have continued to work in educational systems as well as home environments supporting children with special needs.

2) When and why did you start working with children with autism?

To be honest, it was quite unintentional.  Behavior has always been my key interest and I had been working with severe behavior disorders in children and adolescents. I am an avid proponent of the position that although we live in very rural areas, we should be providing children with services and professionals to the best of our abilities.  I received a call from a colleague who had a referral for an adolescent with autism and she asked if I would consult.  It was then that I realized that the area of autism and the families in our communities were sadly being under represented.  At that time, autism was not widely recognized.  Due to many factors, media included, I find there to be far more interest from the general public on the area of autism and thankfully, more recognition from service providers and educators to broaden their own knowledge of the diagnosis.

3) What positions have you had in the past and where do you work now?

I have been a teacher of many subjects, gifted students, educable mentally handicapped and those with severe behavioral disabilities.  As a Psychologist, I have a private practice and contract to school divisions, multidisciplinary teams and family agencies to provide assessment, support and programming for children with a variety of needs including those with medical conditions, FASD, severe behavioral disabilities, Autism Spectrum Disorders and learning disabilities.  I am also a workshop facilitator on several subjects surrounding special needs children and learning. 

4) What is the best part of your job?

Watching my clients successfully meet objectives and seeing the joy on the faces of parents.  AND, having clients whom other professionals cannot pick out of the classroom as the child who has the autism diagnosis!

5) What part of your job is most difficult?

Supporting families while waiting for services to be put in place.

6) What is your approach to using ABA? 

I believe that ABA incorporates many different teaching methods.  It is flexible and transitions between developmental stages as well as changes that a child presents during the course of their programming.  It is that flexibility - and the knowledge and openness to accept and embrace those times - that allows ABA programs to meet the needs of the individual child and address behavioral teaching.  Generalizing to natural settings and a comprehensive interventionist program that eventually fosters the fading of reinforcers is my key approach with my primary work being in school settings.

7) Other than ABA, what other treatment approaches do you incorporate into your practice?

My treatment practices in my work with autism have largely been guided by the science of ABA and the writings of Lovaas, Fenske, etc. 

8) Do you find that many children you work with benefit from using visual strategies?

Absolutely.  Given the difficulties with self regulation and auditory “overload”, many of the children I work with can build increased independent and functional skills from incorporating the visual modality.

9) How do you think that computers can help children with autism?

Computers are tools in our society.  Working with children with autism and using computers allows behavioral teaching and independence with skill building.  While the face to face, social component of interactions is certainly important, there are many aspects of teaching that can be completed by the use of computers.

10) Do you think computers can help parents, in what way?

Often the parents with whom I consult are eager, interested and motivated but they are not therapists or teachers.  They are not autism specialists or experts.  Having the technology and support of a good program that is effectively addressing the unique needs of their child(ren) with autism is empowering and motivating.  It also allows parents to be parents and not have the worry of appropriate programming or seeking out multidisciplinary teams to do, essentially, similar work.  Given our shortage of professionals in many areas and the factor of rural living, computers also “shrink” and sometimes eliminate barriers to effective programming.

11) How can computers help schools?

In our province, technology in schools is priority and for children with autism we find that while teachers want to offer similar experiences, they are often at a loss to make these times meaningful and functional.  In several situations this year, I have been exploring the use of TeachTown in a variety of settings in schools.  Again, non-expert facilitation and the preparation time that computers offer teaching professionals has been invaluable.

12) How do you use computers in your position and how can other clinicians benefit from technology?

I have been far more open to using technology and computers as tools for increasing functionality, independence and skillstreaming.  We are fortunate in this day and age that assistive technology devices and technology such as TeachTown has vastly reduced barriers that would have otherwise made appropriate and beneficial teaching very difficult or unrealistic.

13) What aspects of TeachTown: Basics are most helpful for you?

The non-expert model has been very motivating for those unfamiliar with autism.  The ease of setting the program up and moving parents and para-professionals through the trials has been excellent.  As an educational psychologist working with Individual Program Plans, the data, ease of collection and simplicity of results (graphs, etc.) have provided solid evidence of progress for clients.  Teachers have been thrilled with the explanations of objectives for sessions as it has allowed more meaningful short and long term goals to be added into the child’s program plan.

14) If you were on the design team at TeachTown, what would you do next to improve or enhance TeachTown: Basics?

Expand the developmental levels to promote additional training for older children!

15) What future directions should TeachTown take for developing other products?

I would like to see TeachTown work with assistive technology professionals to address the needs of children with autism who may present with additional impairments such as hearing impairments, visual problems or severe fine motor skill deficits. 

In a recent About: Autism Spectrum Disorders posting, the top 10 treatment approaches for autism were listed along with helpful links for each of these approaches.  The top 10 were determined by popularity, research, and most effective overall.

The top 10 listed were:

1) Applied Behavior Analysis (ABA)

2) Speech Therapy

3) Occupational Therapy

4) Social Skills Therapy

5) Physical Therapy

6) Play Therapy

7) Behavior Therapy/Positive Behavior Support

8) Developmental Therapies

9) Visually-based Therapies

10) Biomedical Therapies

I would like to see a similar list, in order, of those that are the most research-based and have evidence of effectiveness with the largest number of children with autism.  Organizations such as the National Autism Center are dedicated to coming up with good ways to make these kinds of lists and to develop rankings for treatment approaches which will be based on research and effectiveness for ASD.  This project is called the National Standards Project and the expert panel and conceptual reviewers include a prestigious group of autism researchers including several of our TeachTown science advisory board members including Dr. Ilene Schwartz, Dr. William Frea, and Dr. Aubyn Stahmer.

I would also like to see more studies on technology and which programs are effective and which ones are not.  It won’t be long before Computer-Assisted Instruction is added to the list above, I just hope that developers, and perhaps more importantly, university researchers continue to conduct the necessary research to keep improving these programs.

**Please see comments from the author of the ABOUT blog, she makes some excellent comments and I completely agree with her!**