AT/AAC Session 5

Upcoming Assignments

• Date Change…July 16th- Ecological Inventories Assignment• Remember this is with a group

• July 16th… Critique of Research Article is due• This is an individual assignment

• July 18th… Technology Selection/Design Assignment is due

• IPAD applications for communication and other low-cost apps• Talk to Me 100-Sydspeak, Inc. (Free, but $5.99 to upgrade)• Tap to Talk- Free, customizable (photos)• Talk 4 Me- Free, customizable (English, Spanish, Chinese • iCommunicate- $39.99, can upload pics to make storyboards for

activities• getsatisfaction.com/grembe

• Verbally, Free, For readers, word prediction• My Talk (lite version is free)- customizable via web “workspace”• Alexicom AAC- free- pre-made boards, customizable• First Then- $9.99, • Story kit- Free, You can record reading of a book and play back• Sounding board-$49.99, create custom boards with symbols or

photos, • Proloquo2Go-$199

IPAD Applications

How to establish baseline skills student already has?• Significant other interviews

• Ecological Assessment

• Direct observation in natural environments• Interrupted chain procedures

• Interrupt a routine that student has to complete and see how student communicates

• Assess student in interactions with other students• Provide direct assessments to determine if student

understands words, pictures, symbols, etc.

Take Typical Language Samples

• As we talked about last class, take an inventory of the vocabulary used in the settings student’s are in or will be going to.

• Conversation inventories with same age peers• Could use audio recorder if allowed.

Research on Comm. Assessment• Standardized Tests may provide age-equivalencies in receptive

& expressive language, but often fail to recognize the unique characteristics of students with severe disabilities (Cress, 2002; Ross & Cress, 2006; Snell, 2002).

• Recommendation is interviewing significant others (Bailey, Stoner, Parrette, & Angelo, 2006)

• Analyze Communication Environment (Blackstone & Hunt Bert, 2003; Downing, 2005); Use of Video recordings (Suarez & Daniels, 2009)

Reference for Gathering Info/Assessing Communication

• Blackstone & Hunt-Berg (2003). Social Networks: A Communication Inventory for Individuals with Complex Communication Needs and Their Communication Partners

• Guides team in efforts to collect info on student’s skills & abilities, various modes of expression used by the student, and who the typical communication partners are for the student.

• Targets info concerning how the student selects a message, typical topics of conversation, supportive strategies

Resistant student and/or Refusal to learn to use his device

• This may mean that the device/system is not meaningful or does not meet a communicative need (OR BOTH)

• Re-evaluate student’s opportunities to communicate.• May need to manipulate the environment in such a

way that necessitates the student use the device/system (Reichle, 1997; Snell, 2002)

• May be too difficult in comparison to other communicative means…think of some unaided means of communication (facial expressions, gestures, etc.) OR different symbols, colors, etc.

How to select communication devices?

• Conduct person-centered ecological assessment on communication

• Team approach- teacher, SLP, parents• Consider contextual-fit• Consider: durability, ease of use, transportability, flexibility,

cultural sensitivity, cost of device, & quality of speech (McCord & Soto, 2004; Mirenda, 1999).

• Ability of student to access an AAC system need to be assessed prior to purchasing system

Funding for AAC? • http://www.aacfundinghelp.com/• Low-incidence funding

• (property of school)• Health Insurance (property of student)• Medicare (property of student)• Department of Rehabilitation

• Dependent on potential for employability w/ device• In Oregon, Educational Service District (ESD) may have

guidelines for this.

Collaborating with SLPs?• Developing a communication system for a student is a team effort.• Speech/Language Pathologists will be your “go-to” person to

collaborate with when selecting system, designing instruction, implementing communication instruction

• Work closely with them. • Make sure you emphasize the ecological assessments and

preference assessments conducted with student.

Working with Parents? • Consider their home-language, culture, and long-term vision

for the student’s communication.• Want to build system so that you can bridge home and school

vocabulary, language, etc. • May be an issue when device is not allowed to go home. • Try to work with school to allow device to go home. Parents

may need to sign responsibility for device.

Research on Intervention Strategies

• Comm. Skills are best taught throughout the day where they typically occur or are expected to occur (Beukelman & Mirenda, 2002; Fox, 1989; Haring et al., 1985)

• Students without disabilities play a critical role in the development of communication for students with severe disabilities (Carter & Hughes, 2005; Kamps et al., 2002; Von Tetzchner et al., 2005;

Communication Skills Across Classes & Subjects• Greetings & Farewells

• Age-appropriate vocabulary, mannerisms• May not necessarily need a Speech Generated Device

(SGD)• Asking for Attention/Help• Comments of Approval & Rejection• Social Closeness

• Observe what typical students do to achieve this• E.g., admiring another’s hairstyle, telling secrets

• Communicative Skills specific to a class or an activity

Review for Quiz #4

Direct Observation is most reliable method for assessing preferences

• From list, directly manipulate potentially preferred items and observe to identify which items are actually preferred.

• Free Access or Forced Choice of reinforcing items

Free Access Steps (Ortiz & Carr, 2000)• Identify several potentially preferred items (checklist or

interview of others)

• Position items so that the learner has access to all items • Spread around the room in the learner’s reach/view

• Observe the learner on several occasions

• Document the first item (& successive items) the learner approaches and note the total duration of time the learner engages with each item.

Forced Choice Steps (Piazza, Fisher, Hagopian, Bowman, & Toole, 1996)• Identify several potentially preferred items • Present items in pairs.• Randomize the presentation of items in pairs and order of

pairs (to prevent the same item from being presented too many times in a row)

• Randomize the position of the items • Observe the item in each pair the learner selects.

Functional Analysis Experimental methodology in which (ANTECEDENTS) and

potential reinforcers (CONSEQUENCES) of a problem behavior are carefully arranged in a controlled manner to isolate the effects of potential sources of reinforcement that are often confounded through other observational methods

(Iwata, Kahng, Wallace, & Lindberg, 2000; Mace, Lalli, & Lalli, 1991).

Can lead to causal rather than correlational outcome data with respect to the relationships between environmental events and behavior (Cooper, Heron, & Heward, 2007)

Design of Functional Analysis Conditions

Individualized according to the functional hypotheses.The functional analyses for all students consist of at least three

conditions: control, attention, and escape.Control Condition: baseline condition in which student has

consistently exhibited little or no problem behavior. Reinforcement should be freely available and no demands placed on student

Attention Condition: will involve the contingent provision of attention following occurrence of the problem behavior.

Escape Condition: will examine the function of student behavior through the contingent removal of aversive tasks (e.g., difficult, long, or physically taxing tasks)

Control Condition

• Baseline condition in which student has consistently exhibited little or no problem behavior.

Procedure:1. Introduction: “I’ll help you while you do __________ task”2. Student presented with the _____________task.3. The researcher provides 1:1 attention with ongoing prompts every 3-5 seconds.4. Any occurrences of the problem behavior will be ignored and the student will continue to

receive attention every 3-5 seconds.

Setting Event Antecedent Consequence

Give attention for 1 minute

Preferred activity Ignore problem behavior

Attention Condition

• Involves the contingent provision of attention following occurrence of the problem behavior

1. Introduction: “I want you to do this activity.”2. Researcher will present the activity and then move 10 ft away from student3. If student engages in target behavior, the researcher will approach the student and provide

the student with 5 seconds of adult attention4. Following the 5-second interval the student will be directed to return to the activity, the

researcher will walk away, and the next trial will begin.

Setting Event Antecedent Consequence1 minute break—walk around…limited attention on break

Easy worksheet (from table above) no attention—adult 10 feet away

Contingent attention. If exhibits target behavior(s) (5 seconds of adult attention)

Escape Condition• Examine the function of student behavior through the

contingent removal of aversive tasks

1. Introduction: “I want you to work on this activity, if I think you are having trouble, we’ll take a 10-second break. During that break you need to sit quietly and count to 10 seconds.

2. The researcher will provide 1:1 attention with ongoing prompts related to completion of the assignment every 3-5 seconds throughout the condition.

3. Any time the student engages in the target behavior , the researcher will say, “Let’s have a 10 second break” and remove the worksheet for 10 seconds without providing the student any further attention.

4. The next trial will start following the 10-second break after the student is directed to get back

to work.

Setting Event Antecedent ConsequenceDesired activity on break Difficult activity (less than

60% accurate from table above) with 1:1 attention

Remove task for 10 seconds with no attention

Gain Object ConditionSetting Event Antecedent Consequence

Desired object, toys, activities, etc. on break

Remove preferred objects , give a neutral task and stay in close proximity of student.

Give student object for about 10 seconds

Sensory Condition (similar to control condition)

Setting Event Antecedent Consequence

Student given attention for 1 minute

Leave the student alone without demands, neutral or no activity

Ignore problem behavior and allow student to receive sensory input (use judgment for safety)

Example:

The student is a 5th grade student in a general education classroom with 29 students.

His strengths are: likes computers, great gross motor skillsRoutine: Reading (9:00) OR Math (10:00-10:30)

Setting Event Antecedent Behavior Outcome/Consequence

Unknown Unstructured time when not given an individual task to do (e.g.,. Listening to teacher read aloud; waiting for transition)

Pinches self or peers (in close proximity)

Peers or adults will respond to his behavior and give him attention by saying “stop that”

Function: Access attention from the adult (and peers to ultimately get the attention of the adult)

Activities for Conditions:

Activities for Control Condition

(Preferred activities)

Activities for Attention Condition

(Easy activities >90% accuracy)

Activities for Escape Condition

(Less preferred/difficult activities <60%

accurate)1. Using computer

2. Completing letter or number tracing activities

1. Matching numerals with a given number of manipulatives

2. Matching sight words with objects

1. Matching letters with letter sounds

2. Writing CVC words from dictation.

What would you use for the conditions to test this hypothesis?

Antecedent Behavior Consequence

Unstructured activity (e.g., listening to teacher read aloud, transition--waiting)

Pinches self or others Gain adult attention

Control Condition?

Attention Condition?

Escape Condition?

Preferred Activity during read aloud

If Problem behavior occurs:

Ignore

Alone during read aloud (peers & adult 10 ft away)

Adult close to him during read aloud or waiting period.

Provide him w/ attention

Stop read aloud and give him “easy activity”

What would you use for the conditions to test this hypothesis?

Antecedent Behavior Consequence

Writing/typing task (e.g., writing name, words, numbers)

Loud pitched scream/screech

Escape the writing task

Control Condition?

Attention Condition?

Escape Condition?

Preferred Activity If Problem behavior occurs:

Ignore

Alone with Easy “writing/typing” task (e.g., coloring)

Adult close to him with “regular writing task”

Provide him w/ attention

Take away writing/typing task/sheet

Quiz #4

Discussion• Pragmatic Organization Dynamic Display Communication

Books (Porter & Burkhart)• http://www.youtube.com/watch?v=S5Yrmm5mKzw• http://

www.youtube.com/watch?v=XSvY4jdKMxk&feature=related

Functional Communication Training (FCT) is based on…..◦ Based on notion that problem behavior may function as a

means of communication

1. Conduct a Functional Behavioral Assessment (FBA) to determine when, where, what, and why problem behaviors occur for a student.

2. Complete a competing behavior pathway to outline alternative/replacement behavior (way of communicating)

3. Design interventions to teach student new communication mode while not allowing problem behaviors to pay off for student.

3 steps to FCT

FBA: Summary of Behavior

Maintaining Consequence & Function

Problem Behavior

Antecedent

FUNCTION

FUNCTION is where student behavior intersects with the environment

Function = Learning

Student learns…. When (A), if I (B), then (C)… Function = how I benefit so I keep doing B

Targeted Routine

Competing Behavior Summary

Typical Consequence

Maintaining Consequence

Desired Behavior

Problem Behavior

Alternate Behavior

AntecedentSetting Event

Summary of Behavior

Function Based Interventions

Maintaining Consequence & Function

Problem Behavior

Antecedent

FUNCTION

Function should guide selection of prevention strategies

Function should guide selection of alternative/ replacement behaviors

Function should guide selection of consequences: (+) and (-)

When generating interventions we use Function to develop ideas to change A, B & C

Targeted Routine

Function Based Interventions

Maintaining Consequence & Function

Problem Behavior

Antecedent

FUNCTION

Function should guide selection of alternative/ replacement

behaviors

When generating interventions we use Function to develop ideas to change A, B & C

Targeted Routine

Understanding Alternate/ Replacement Behaviors

• Alternate Behaviors are:• an immediate attempt to reduce disruption & potentially dangerous

behavior in the classroom

• designed to actively begin breaking the student’s habit of using problem behavior to meet their needs, by replacing it with a more acceptable alternate behavior

• AAC device can be means for a student to use replacement behaviors

Essential Characteristics of a Replacement / Alternate Behavior

• An appropriate Replacement Behavior:• Serves the same function as the problem behavior

• Is easier to do and more efficient than the problem behavior• Alternate Behaviors require less physical effort &

provide quicker, more reliable access to desired outcome/response than problem behavior

• Is socially acceptable

Which of the Following are Appropriate Replacement Behaviors?

• Leslie is 12, has severe intellectual disabilities, does not use words, and hits her head. Head hitting is maintained by adult attention during work periods.

• Which is the best Replacement Behavior• hide under her desk and be ignored• sign for “more” to another student• take completed work up to show the teacher• move to sit by another student• Use picture communication system to request teacher

help

Start w/ the Function

1. Serve same

Function? Does it provide

adult attn?

2. Is Behavior easier to do than problem

behavior?

3. Is Behavior socially acceptable?

Which of the Following are Appropriate Replacement Behaviors?

• Jason is nine and cries when asked to do difficult tasks. The crying is maintained by avoiding or escaping difficult tasks.

• Possible Replacement Behaviors:• More rewards for doing tasks• Asking for an easier task/ worksheet• Asking to play w/ his Gameboy• Requesting adult attention• Asking to have soda after tasks are done

Start w/ the Function

1. Serve same

Function? Does it provide

adult attn?

2. Is behavior easier to do than problem

behavior?

3. Is Behavior socially

acceptable?

Competing Behavior Pathway: Alternative Behavior

• Example: Jason (from previous example)

Antecedent Problem Behavior Consequence

Avoid/Escape Difficult TaskCrying

Asking for an easier task/ worksheet

Asked to do difficult tasks

NOTE: This antecedent is not specific enough

Communication Replacements for Problem Behavior

Function Possible ReplacementGain attention/social interaction Recruit attention (“come here”)

Request affection (“Hug please”)Solicit Praise (“How am I doing?”)Initiate greetings (“Hello”)

Escape or avoid an object or activity Reject/protest (“No thanks”)Request assistance (“Please help”)Request alternative (“Any others?”)Request a break (“Can I have a break”)

Gain access to an object or activity Request objects (I want a drink)Request activity (I want to take a walk)Indicate preferences (I prefer tea)Make choices (I want that one)

Obtain direct sensory consequences Request stimulating objects/activities (Can I watch a movie?)Request attention/social interaction (Let’s talk)Indicate boredom (I’m bored. Let’s do something)

Function Based Interventions

Maintaining Consequence & Function

Problem Behavior

Antecedent

FUNCTION

Function should guide selection of prevention strategies

Function should guide selection of alternative/ replacement behaviors

Function should guide selection of consequences: (+) and (-)

When generating interventions we use Function to develop ideas to change A, B & C

Targeted Routine

Consequence InterventionsReinforcing Behavior

• Reinforcement should focus on 2 different sets of behaviors Alternative Behavior & Desired Behavior

1. Reinforcing the Alternative Behavior When the student engages in the alternative behavior, quickly

provide the student with an outcome that matches the outcome/ function of the problem behavior

E.g. if student raises hand to request an easier, substitute assignment; in order to escape difficult tasks then quickly provide the student with the easier assignment

Consequence InterventionsReinforcing Behavior

• Considerations for Reinforcing Desired BehaviorThe reinforcer must be valued by the student

• The function of behavior is a good place to start when identifying valued reinforcers

• e.g. If the function of behavior is to Gain Peer Attention, the reinforcer should give access to Peer Attention

• e.g. if the function of behavior is to Avoid Difficult Task the reinforcer could be a “Free Homework Pass”

Consequence InterventionsResponding to Problem Behavior

• Responding to Problem Behavior should focus on 2 things:• Redirecting to the Alternative Behavior• Active Extinction of the Problem Behavior

• Do NOT let the problem behavior be effective in giving the student what they want

1. Redirecting to the Alternative Behavior When the student engages in the alternative behavior, quickly provide

the student with an outcome that matches the function of the problem behavior • This should also help to prevent escalation

E.g. if student raises hand to request an easier, substitute assignment; in order to escape difficult tasks then quickly provide the student with the easier assignment

Consequence Interventions Responding to Problem Behavior

2. Active Extinction of the Problem Behavior Make sure the problem behavior no longer works for the student… If

using a consequence as a response to negative behavior, make sure the consequence is not providing the desired function for the student

Function Based Interventions

Maintaining Consequence & Function

Problem Behavior

Antecedent

FUNCTIONAVOIDING DIFFICULT TASK

Prevent

Make task less difficult

to avoid difficult task

Alternate behavior

Must allow student to

avoid difficult task

Consequence

(+) Reinforce (a) alternate behavior w/ oppt’y to avoid task & (b) desired behavior

(effort on task)

(-) problem behavior should not result in avoiding task;

redirect to Alt. behavior

When generating interventions we use Function to develop ideas to change A, B & C

Targeted Routine

Function Based Interventions

Maintaining Consequence & Function

Problem Behavior

Antecedent

FUNCTIONGETTING ADULT ATTENTION

Prevent

Provide adult Attention in advance &

often

Alternate behavior

Must give student

access to adult attention

Consequence

(+) Reinforce both alternate behavior & desired behavior

w/ adult attention

(-) problem behavior should not result in adult attention;

redirect to Alt. behavior

When generating interventions we use Function to develop ideas to change A, B & C

Targeted Routine

General Case Design— Why?Determine what to teach and features need to vary to increase generalization.

1. Define the Instructional Universe

2. Define the Range of Relevant Stimulus and

Response Variation

3. Select Examples for Teaching & Testing

4. Sequencing Teaching Examples

5. Teaching the Examples

6. Testing with Non-trained Probe Examples

1. Define the instructional universe (IU).---How?-Person-Centered Planning/ File Review/ IEP

2. Define the range of relevant stimulus & response variation within that IU.—-How?

-Task Analysis

3. Select examples for the IU for use in teaching and probe testing.—How? Positive & Negative Examples

4. Sequence teaching examples.---How? Juxtapose maximally different, then minimally different examples.

5. Teach the examples.---How? Using Antecedent & Consequence Strategies

6. Test with non-trained probe examples— How?

Programming Generalization

Functional Routines InstructionCue(opportunity to respond)

Response/Behavior

Consequence Pause

FR Environment provides a natural cue

Student does each step needed to complete the activity

Student gets natural outcome of activity

Student focuses on next routine

EX Student’s bus arrives and door opens.

Other students get off bus

S gets off bus, goes in the correct direction, enters building, goes to class, puts away materials

Student is now inside with other students and has inviting activities to do. Teacher offers praise

Student transitions to next routine

Discrete Trial TrainingCue(opportunity to respond)

Response/Behavior

Consequence Pause

DTT T provides instructional cue (prompting may be needed)

Student Responds

Teacher praises and give child a positive reinforcer

There is a pause

EX 1. Student indicates interest in chips

2. Teacher says “Give me a car”

Student gives car to teacher

Teacher praises student and gives student a chip

Student eats chip and teacher waits a few seconds before next cue

Discrete Trial Training Videos• http://www.youtube.com/watch?v=2afb4i7LMJc• http://www.youtube.com/watch?v=cp_gzUTCm8g&feature=m

fu_in_order&list=UL

1. It is not overly distracting for the child2. It is never the correct response3. In the same classification (object or picture)4. Not an item you are currently teaching

Arick et al., 2004

Rules/ Suggestions about the Distractor

• Stop & restart trial• Repeat Cue• Prompt with just enough assistance to get correct response.• R+ with social praise only or very little reinforcer (not the big

R+)• Repeat trial (with big R+ available)

Arick et al., 2004

If the student makes an error…

• For a correct response• 1:1 tangible reward or token (Big R+ for this student and 1:1

social praise.

• For a prompted response• 1:1 Social praise and (only if needed with this student) 1:1

little reward (not big R+)

• Arick et al., 2004

General Reinforcement Procedure

• Considered Naturalistic Intervention• Teaches Language and Social/Play Skills• Creates “Teachable” Moments in Context• Follows ABA Format• One Component of an Individualized Program

What is Pivotal Response Training?

Pivotal Response TrainingCue(opportunity to respond)

Response/Behavior

Consequence Pause

PRT 1. S indicates interest

2. Teacher withholds access to desired item/activity

Student Responds

S gets desired item There is a pause

EX 1. Student reaches for car.

2. Teacher withholds and says, “Car”

Student imitates the word car.

Teacher gives student access to car

Student plays with car

Video Examples• http://www.asatonline.org/intervention/videos.htm

• You can take it with you• Can be used by parents/ peers/siblings• Increases motivation• Decreases frustration• Increases generalization and maintenance of intervention

gains

Advantages

• If Grabbing Objects/toys• Avoid by teaching “hands down” and reinforce teaching “my

turn” and block/withold to encourage verbal language• If Throwing Objects/toys

• Avoid by teaching “do this” and show the student what TO DO; teach them to say “no ______” for rejecting an object (have other reinforcing items to choose from)

• If Crying/Screaming• Avoid by having highly reinforcing items; ignoring behavior if

possible; waiting till quite then reinforce; ending session on a positive (maybe start with shorter session)

Arick et al., 2010

Work on Behavior Throughout the Session

Picture Exchange Communication System (PECS) • Frost, L. A. & Bondy, A.S. (1994). The Picture exchange

communication system: Training manual. Cherry Hill, NJ: Pyramid Educational Consultants.

• Picture Exchange Communication System (PECS)• Six Phases

• http://www.youtube.com/watch?v=ZP48lxnNdHM• http://www.youtube.com/watch?v=tr3lQXNEcps&feature=rela

ted• http://www.youtube.com/watch?v=ZrELOVWnp28&feature=re

lated