Evidence-Based Means for Promoting Independence and Enjoyment Among People With Autism

1. Evidence-Based Means for Promoting Independence and Enjoyment Among People With Autism Dennis H. Reid, Ph.D., BCBA Carolina Behavior Analysis and Support Center

2. Agenda Importance of evidence-based strategies Importance of promoting enjoyment and independence Strategies for promoting enjoyment Strategies for promoting independence (rapidly and naturalistically)

3. Importance of An Evidence Base Increases likelihood of success Decreases likelihood of time and effort spent on ineffective interventions and supports Decreases likelihood of having detrimental effective

4. Why Focus on Enjoyment? Pursuit of happiness is a fundamental right Happiness a primary concern of family members Reductions in problem behavior

5. In Some Ways, Happiness a Risky Venture A private event Usually measured by verbal report – can be risky Verbal reports very difficult for people who lack vocal communication Still, happiness is viewed by society as important . . . For people with autism, it should not be taken for granted; it should be targeted and addressed like any other desired outcome

6. Qualifications Happiness on day-to-day basis vs. major lifestyle changes Focus on happiness and personal growth That is, not in place of personal growth Life, liberty, and the pursuit of happiness

7. Evidence Base LITERATURE REVIEWS Dillon & Carr (2007). Assessing indices of happiness and unhappiness in individuals with developmental disabilities. Behavioral Interventions, 22, 229-244. Reid & Green (2006). Life enjoyment, happiness, and antecedent behavior support. In J.K. Luiselli (Ed.), Antecedent assessment & intervention. (pp. 249-268). Baltimore, Brookes Publishing.

8. Critical Aspects of Increasing Happiness Identifying valid indices of happiness and unhappiness Evidence-based means of increasing happiness (and reducing unhappiness) Importance of relationships

9. Developing a Relationship Spend time doing things that the person likes to do Fun Time Program Help the person avoid disliked events Learn to communicate with the person Occurrence of happiness indices during interactions suggests a good relationship

10. Identifying and Validating Indices of Happiness and Unhappiness among Nonvocal Adults with Autism L. Perry Lattimore J. Iverson Riddle Center Dennis H. Reid Carolina Behavior Analysis and Support Center Marsha B. Parsons J. Iverson Riddle Center

11. A critical component for increasing happiness among people with severe disabilities is a valid means of identifying happiness To date, behavioral definitions of happiness for people with severe disabilities have been similar to happiness indices for people without disabilities These definitions may not be applicable to adults with autism who are nonvocal and have difficulty expressing affect in ways that are readily apparent

12. Purposes Primary purpose: Evaluate a means of developing and validating individualized indices of (un)happiness among nonvocal adults with severe autism

13. Participants: adult men with autism and severe intellectual disabilities Responded to simple gestures Expressive communication consisted of leading support persons to desired objects Exhibited a variety of stereotypic behavior History of challenging behavior Attended the same supported work setting on a part-time basis Two with severe hearing loss

14. General Evaluation Process Identified individual indices of (un)happiness and situations likely to occasion the indices Validated the happiness and unhappiness indices

15. Primary Target Behaviors To identify happiness and unhappiness indices: Identified 3 support staff who were very familiar with participant (had worked with him at least weekly for 6 or more months) The staff completed a questionnaire about behaviors the participant exhibited when happy and unhappy Behaviors listed by at least 2 staff were identified as target indices of happiness and unhappiness, respectively

16. Identification of Happiness and Unhappiness Situations

17. Evaluation Conditions and Design for Mr. Marr Happiness situation – swinging on a swing at his home Unhappiness situation - doing unfamiliar tasks at his work site To evaluate the reported happiness situation: Observations during a routine neutral situation (having a snack), followed by the happiness situation (swinging), and then another neutral situation (watching television) within an alternating treatments format To evaluate the reported unhappiness situation: Observations during a neutral situation (doing a familiar work task), unhappiness situation (doing an unfamiliar work task) and then another neutral situation (doing a familiar work task) within an alternating treatments format

19. Choice Validation participants were given opportunities to choose between situations (happiness situation vs. unhappiness situation or neutral situation) participants consistently chose the happiness situation over the unhappiness situation or a neutral situation

20. Conclusions The process for identifying individualized indices of happiness and unhappiness appeared effective Results suggest considering individualized indices for nonvocal adults with autism and severe intellectual disabilities

21. Summary: Identifying Valid Indices of Happiness Obtain consensus opinion of familiar caregivers re what an individual does when happy and unhappy Obtain consensus opinion of familiar caregivers re in what situations an individual is happy and unhappy Observe and compare reported indices across reported situations Provide a choice of situations with more and less indices of happiness and unhappiness

22. Note Focus of Interventions to Increase Happiness Must be on situations accompanied by happiness indices, not exclusively on the indices themselves

23. Evidence-Based Ways to Increase Happiness Providing choice opportunities Accessing preferences Making undesired routines more enjoyable for consumers Preference-based teaching Reid & Green (2005). Preference-Based Teaching. www.behaviordevelopmentsolutions.com

24. Importance of choices Personal examples . . .

25. Providing Choices For people with functional communication skills (LICS) For people who are nonvocal Two-event choices One-event choices

26. Accessing Preferences Role of systematic preference assessments Role of caregiver opinion For very strong preferences For more mild preferences Must be built into daily routine

27. Making Undesired Activities More Enjoyable Rationale Increase happiness by decreasing unhappiness Reduce challenging behavior during certain activities How to . . . Remove unnecessary activities where possible Make activities more enjoyable

28. Making Undesired Activities More Enjoyable: Example Preference-Based Teaching Rationale Some learners engage in challenging behavior to escape or avoid teaching programs If teaching programs are fun, no need for challenging behavior

29. Preference-Based Teaching Application of ABC Model to teaching Antecedents (A): what to do before a teaching session Behavior (B): what learner and instructor do during teaching session Consequence (C ): what to do after a teaching session

30. To Effectively Promote Happiness . . . Happiness should be a goaled, desired outcome just like more traditional outcomes Must have behavioral objectives for monitoring and increasing/maintaining happiness (indices) Informally, how often do we see individuals happy and unhappy?

31. Don’t Forget Support Staff It is unlikely staff will effectively promote consumer happiness if staff are frequently discontented with their work environment Reference: Reid, D.H., Parsons, M.B., & Green, C.W. (2012).The supervisor’s guidebook: Evidence-based strategies for promoting work quality and enjoyment among human service staff. www.behaviordevelopmentsolutions.com

32. Increasing Independence Focus on: Rapid increases in independence Promoting independence during naturally occurring situations

33. Why Concern with Teaching Rapidly: Slow Progress on Teaching Programs is Common SOCIAL VALIDITY SURVEY Included 51 professionals who taught or supervised the teaching of people with severe disabilities, including autism Represented teaching professionals in 16 community programs and 2 center-based progams from 4 states Survey questioned if any of the respondents’ adult learners had been taught the same objective for specific periods of time without mastering the objective (3 months, 6 months, 1 year)

34. Social Validity Assessment: Results 82% of teaching professionals reported they had taught (or supervised the teaching of) a learner with severe disabilities or autism on the same program for over 1 year without the learner mastering the program Results suggest slow progress on teaching programs is an issue faced by many support staff

35. Two Common Reasons for Slow Progress Parsons, Reid et al. (2008). Remediating minimal progress . . . Behavior Analysis in Practice, 1, 59-67. Lack of a powerful reinforcer Add a stronger reinforcer (SPAs, reinforcer assessments, etc.) Insufficient number of teaching trials Teach more intensively Ensure naturalistic teaching

36. Additional Concern with Teaching Rapidly Some skills needed quickly (e.g., for a supported job)

37. Issues for Providing Rapid (Intensive) Teaching Focus on enjoyment (because it is effortful) For staff For learners Likely problem behavior (early intensive teaching research)

38. Lattimore, L.P., Parsons, M.B., Reid, D.H. (2009). Rapid Training of a Community Job Skill to Nonvocal Adults with Autism: An Extension of Intensive Teaching. Behavior Analysis in Practice, 2, 34-42.

39. Background 4 adults with severe autism Job in small publishing company One-day, intensive training of new work skill (preparing book mailing boxes) prior to beginning new job task Based on early rapid teaching protocols (e.g., multiple sessions interspersed with preferred activities) Generalization training component Baseline assessment, intensive training, post-training (on-the-job performance)

41. Conclusion Quickly prepare adults with severe autism for new job task with intensive (one-day) training in simulation No indices of unhappiness and some indices of happiness

42. Naturalistic Teaching to Increase Instructional Trials Current support paradigm Naturalistic vs. circumscribed teaching Infrequent instructional opportunities Problems Doing for vs. teaching Promoting dependence vs. independence Promoting passive vs. active participation in communities Impact on dignity

43. Parsons, Reid, & Lattimore (2009). Increasing independence of adults with autism in community activities: A brief, embedded teaching strategy. Behavior Analysis in Practice, 2, 40-48.

44. Background 3 adults with severe disabilities Community settings (work breaks, grocery store) Observe what tasks staff do for participants SWAT intervention

45. SWAT Not: Special Weapons And Tactics Soil & Water Assessment Tool Southern Women Aiding Tourism

46. SWAT An on-the-spot way to teach in community settings Contrasted with formal community-based instruction SWAT: Say Wait/watch Act out Touch through

47. Study 1 3 adults with severe autism working in community job Focus on work-break activities . . . Seemingly simple activities . . . Performed by job coach for supported workers

48. Baseline observations (what job coach did for supported workers) 3 tasks identified: get drink, turn on radio, get sketch pad Worker performance categorized in 1 of 5 mutually exclusive categories (“0” – “4”) SWAT intervention across participants and tasks

50. Study 2 Study 2: grocery shopping 1 participant from Study 1 (Mel) 2 tasks identified: get item, push cart

52. Summary Happiness and independence are critical for quality of life Happiness and independence are best promoted by relying on evidence-based strategies Every bit of improvement in happiness and independence helps