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Literature Review
1. Smooth Transitions: Helping Students with Autism Spectrum Disorder Navigate the
School Day (Hume, K., Sreckovic, M., Snyder, K., & Carnahan, C. R., 2014)
This article outlines several transition supports that can help students with autism
to successfully transition from various activities, teachers, and environments throughout
the school day. The article discusses how transitions can be filled with anxiety and
unpredictability for students with autism, and that transitions require a level of cognitive
flexibility that students with autism may lack. Therefore, it is important for teachers to
make these transitions more predictable for students with autism through simple
strategies that can be easily implemented in the classroom. These transition supports
include priming, social stories, cueing, power cards, and visual schedules. The article
also describes the process for determining which support will work best with particular
students.
2. The Clinical Application of Deep Touch Pressure With a Man With Autism Presenting
With Severe Anxiety and Challenging Behavior (Blairs, S., Slater, S., & Hare D.J., 2007)
This study looked at the systematic use of deep touch pressure for a man with
Autism who had severe challenging behavior. The man in the study would seek
physical restraint by staff members and would engage in aggression in order to receive
the restraint. The studys authors developed a program that was not contingent on the
man exhibiting challenging behaviors. According to a daily schedule, the man would be
brought to a quiet room and would have several sheets tightly tucked around him. An
alarm would be set for 15 minutes and a staff member would stay with the man at all
times, talking with him. At the end of the session, the man would receive a tangible
reinforcer, such as chocolate milk. The man could elect to end the session at any time.
The program led to a dramatic reduction in the use of physical restraint and medication,
and increased the individuals quality of life.
3. Using a Modified Social Story to Decrease Disruptive Behavior of a Child With
Autism (Crozier, S. & Tincani, M., 2005)
This study looked at the effects of a modified Social Story, with and without
verbal prompts, on the disruptive (talking out) behavior of a student with Autism in his
preschool classroom. A Social Story is a short, simple story that is written from the
perspective of the child. The story delivers instructions on appropriate social behaviors.
This study found that the use of Social Stories helped to decrease the childs disruptive
behavior with and without prompting. However, the behavior decreased to a greater
degree when coupled with verbal prompting. In the baseline phase, the student
averaged 11.2 talk-outs during one 30-minute observation. In the first phase of the
intervention (Social Story without prompting), the students talk-outs dropped to 2.3 per
30-minute observation session. In the second phase of the intervention (Social Story
with verbal prompts), the students talk-outs dropped further to 0.2 talk-outs per 30minute observation.
4. The Efficacy of Function-Based Interventions For Students With Learning Disabilities
Who Exhibit Escape-Maintained Problem Behaviors: Preliminary Results From a Single
Case Experiment (Burke, M.D., Hagan-Burke, S., & Sugai, G., 2003)
took handwritten notes, and I listed Carols behaviors as I saw them occur, as well as
staff reaction and intervention strategies over a 30-minute period of time.
In addition to the observations, I reviewed Carols file with my mentor teacher
and spoke to behavior support staff and her homeroom teacher. Anecdotally, when
Carol is not exhibiting disruptive behaviors, I found she is a joy to have in class; she is
smart and funny, and will often accept and complete work without complaint. She loves
to draw and color, and when I previously worked in the art room with Carol, I never saw
a hint of disruptive behavior. However, Carol is very affected by things that are
happening in her body. She has Celiac Disease and other digestive issues, and
recently had yeast in her digestive track that caused her significant discomfort. In
addition, she started her menses within the past year, and the additional hormones
have been very unsettling for her. These and other health issues have caused Carol to
exhibit severe behaviors more frequently. Carols medicine management is extensive
and includes drugs for seizures (Lamictal), stamina, cerebral folate deficiency
(Leucovorin), calming, and social engagement (Oxytocin). The introduction of new
medications can cause additional behaviors as Carol adjusts to the new drug. In
addition, when she is sick, Carol is sometimes allowed to stay at home, and then she
does not want to come back to school. She will say repeatedly that she wants to be
home with mommy. After a recent stretch of disruptive behavior, Carols mom
introduced an incentive toy at home, and this has proven very affective in motivating
Carol to participate at school, at least in the short-term.
St. Elizabeth Schools behavior support specialists have collected a great deal of
insightful data about Carol during the current school year. Every time that Carol is
referred to the counseling room for disruptive behavior, a form is filled out that includes
important information about the type of behavior, the function of the behavior, the time,
setting, and the day of the week that the behavior occurs. This data is entered into the
computer and tables are created that offer visual representations of Carols behavior.
Looking at the behavior support data on Carol, I see that Carols Minor Disruptions and
Major Disruptions occur with virtually equal frequency. She has had a total of 59
behavior referrals thus far in the 2014/2015 school year. The major function of the
behavior, as documented on the behavior referrals, has been to avoid the task. Carols
behavior spikes at 9:30 a.m., 10:30 a.m., and 12:45 p.m, but her behaviors are
generally spread throughout the school day. She has no referrals during lunch or
homeroom. Furthermore, all of her behaviors occur in classrooms, but almost never in
the art room, which is her favorite subject. Carol has the most behavior support
referrals on Monday, Tuesday, and Thursday. Wednesday, which is a half-day at St.
Elizabeth, and Friday have relatively few referrals. By month, Carol had a significant
spike in behavior in September and October, which her mother believes coincided with
Carols social worker being out for maternity leave.
During my two observations, I was looking for the two categories of behaviors
that are listed on Carols Functional Behavior Assessment. The first is Disruption Minor
and includes tearing worksheets and verbal protest. The second behavior is Disruption
Major and includes swiping objects from desk and shelves, crying, yelling, pushing,
kicking, disrobing, and urination. I was also hoping to determine the function of the
behavior through my observations, as well as the staffs response to Carols behavior.
Based on Carols recent Functional Behavior Assessment in 2014, a Behavior
Intervention Plan was developed for Carol. During my observations, I was also looking
to see which of the strategies listed in Carols BIP were being implemented in the
classroom and which appeared to be successful.
____________________________________________________________
Observation #1
Date: 2/2/15
Time: 12:35 1:20 p.m.
Class: English
Activity: Small Group Instruction
Behavior:
Carol did not want to come to class, so she was escorted into class by behavior
support staff
Carol yelled I dont want to do work and Mommys picking me up
Began tearing pictures off the wall, yelling, kicking, etc.
Staff Response:
One preferred staff member and one behavior support staff worked with Carol in
a corner desk, blocking her exit
Staff wrote down three tasks on a whiteboard
Staff asked Carol to read the tasks aloud
The teacher introduced each task
Carol checked the tasks off the whiteboard as she finished them
Carol began to calm down as she checked off each task
Tasks are very short; one or two questions
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When finished, Carol asked for a weighted blanket and is brought the blanket
Carol rests on the ground under the blanket with headphones on and is calm
____________________________________________________________
Observation #2
Date: 2/4/15
Time: 8:35 9:20 a.m.
Class: Science
Activity: Whole group instruction
Behavior:
Yelling
Staff Response:
Carols social worker entered the room and began to talk to her and soothe her;
this is calming
One behavior support staff and one preferred staff member blocked Carol into a
corner desk to prevent exit
Behavior support staff helped Carol to complete her worksheet
Staff offered Carol words of encouragement and praise for her good work
When Carol finished her worksheet, she was allowed to return to her quiet room
down the hall
____________________________________________________________
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Based on my two initial observations, I saw that Carol was exhibiting the
behaviors listed on her Functional Behavior Assessment. I did not witness any
additional behaviors beyond those listed on her FBA. Her behaviors appear to be
somewhat predictable for the staff, and they are experienced at responding to these
behaviors. During the week that I was observing Carol, she was experiencing a spike in
behaviors due to recent health and menses concerns. Despite this, I saw how effective
several intervention strategies were in helping Carol to deescalate and finish her work.
In particular, the staff used a 3-task system that visibly helped Carol to manage her
anxiety about class work. Carol checked off the brief tasks as she finished them, and
with each task she seemed to become calmer and less agitated. In addition, Carol
responded well to having a preferred staff member with her while she was in crisis. This
staff member helped to deescalate Carol by using humor and proximity control. Based
on these observations and other strategies I saw being used to help Carol, I developed
the Positive Behavior Supports detailed below.
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blocking her into a corner. That way, she does not avoid the task altogether, but
instead is offered the 3-task checklist of truncated tasks. Carols avoidance of tasks is
related to her anticipatory anxiety and generalized anxiety and her diagnosis of autism.
This anxiety is most visible during transitions during the school day, as well as during
less preferred subjects and activities. During Observation #1, I witnessed Carol
screaming, I dont want to do work and Mommys picking me up, which clearly
suggested that the behavior was caused by her desire to avoid the task. Similarly, in
Observation #2, Carol said that she did not want to go to class as she was walking
down the hallway. This would normally have led to an escalation in her behavior,
however, she saw that a preferred activity (Brainpop) was being offered in the
classroom, and so she decided to participate without incident. In addition, based on the
data from the Behavior Support Referrals from St. Elizabeth School, the vast majority of
Carols referrals were motivated by avoiding the task. This data gives further evidence
to support my hypothesis.
Replacement Behavior
1. What is it the student should be doing?
Carol should be safely and actively engaged in instruction. This includes
completing class work as it is assigned, and safely interacting with peers and teachers.
Carol should learn that school is not an environment filled with unpredictability and
anxiety, but is instead a place with supportive, familiar teachers and staff who want to
establish routines and therapeutic rapport with Carol.
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can ask to take a break in the Quiet Room, and she can use her weighted blanket
there as well.
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Disruptions
Dates
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The second chart details the days in which positive behavior supports were
utilized to assist Carol, and the frequency in which they were used. Again, due to the
lack of disruptions, there is little that can be gleaned from this data because the
interventions were needed infrequently during this period. You can see that the positive
behavior supports were used the most frequently on February 9, 2015, when Carol
exhibited minor and major disruptions. On the other days, the supports were used
mainly to help Carol maintain appropriate behavior.
6
5
4
3
2
1
2/26/15
2/24/15
2/22/15
2/20/15
2/18/15
2/16/15
2/14/15
2/12/15
2/10/15
2/8/15
2/6/15
0
2/4/15
Dates
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exhibited two incidents of behavior, both occurring on the same day. There is little that
can be concluded from this data, except that Carols recent health concerns improved
through medication. Therefore, she was experiencing less physical distress during my
data collection period. When Carol is feeling better, she is less likely to exhibit
disruptive behaviors and work avoidance.
On February 9, 2015, Carol had two class periods in which she displayed
disruptive behavior. The incidents were each 5 minutes or less, and the staff supported
Carol with the 3-task system, preferred staff, truncated work, and deep pressure.
During one of the incidents, Carol was brought to the quiet room so that she could
deescalate without disturbing other students. Carols staff reported that all of the
positive behavior supports helped to deescalate Carols behavior.
During the other 12 days that data was collected, Carol exhibited no disruptive
behavior and generally the positive behavior supports were not used. However, deep
pressure, in the form of a weighted blanket, was used on five other occasions. Carol
really enjoys the weighted blanket and finds it very calming. Staff will offer this blanket
to Carol when she has finished her work. It can be concluded that the weighted blanket
is an effective positive behavior support during class, and it helps to maintain Carols
appropriate behavior.
During the 13 days of observation, with the exception of the two periods of
disruptive behavior, Carol completed all her work as it was given to her. Therefore, her
staff did not use the 3-task system because it was not necessary. Often though, class
work is modified by teachers to prevent triggering Carols disruptive behavior. Teachers
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and staff at St. Elizabeth School do an excellent job of anticipating and mitigating
problem behaviors before they occur, and every teacher knows that a difficult or nonpreferred assignment can cause Carol to exhibit disruptive behavior. I believe much of
Carols success in recent weeks is due to the fact that teachers know precisely how
much to ask of Carol, and they know not to push an inch further.
Due to the unpredictable nature of Carols behaviors, it is difficult to say whether
the implementation of the positive behavior supports outlined in this plan had any effect
on the outcome as revealed by the data. Certainly, I cannot take credit for her excellent
stretch of good behavior, as I believe it had nothing to do with the behavior supports.
As I mentioned earlier in this report, Carol has had a total of 59 behavior referrals thus
far in the 2014/2015 school year, with spikes during certain months, but no clear
pattern. I cannot conclude anything definitely from my 13 days of data because Carol
may be experiencing a good stretch that may then be followed by another period of
increased disruptive behavior. Carols parents, teachers, and behavior staff try to
develop explanations and hypotheses for Carols behaviors because they can be
extremely disruptive and significantly effect Carols ability to engage in classroom
learning. However no explanation is entirely satisfying, and no behavior support plan
completely eliminates the behaviors, particularly if they are motivated by internal factors
such as health issues.
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Reflection
The completion of this project helped me to increase my knowledge, skills, and
dispositions in classroom management. I learned about the process of developing a
Functional Behavior Assessment and a Behavior Intervention Plan, and the
comprehensive data that is required to make this process successful. I also became
informed about some of the important studies that have been conducted to test the
effectiveness of various intervention strategies for students with autism. At St. Elizabeth
School, I witness many of these strategies being implemented on a daily basis, and it
has been a valuable process to explore the research basis of these intervention
strategies. In addition, if I was asked to develop an FBA or a BIP for a student in the
future, I would have the skills to do so in coordination with my school team. This team
effort is extremely important when developing a comprehensive view of student
behavior and how to mitigate maladaptive behaviors. Through this project, I learned
more about the important work of the Behavior Support Specialists at my school, and
their efforts to collect informative data about student behavior.
While completing this project, I have also become aware of the importance of
strong positive relationships with parents. Parents have excellent insights into their
childs behavior. Often the behaviors we see at school are related to something that is
happening at home, and having an open dialogue with parents can help reveal the
cause of certain behaviors at school. Carols mom regularly informs Carols social
worker and teacher about anything that is happening at home or issues related to
Carols health. She works together with the staff at St. Elizabeth School to help
reinforce school behavior plans with incentives at home. Carols mom is an excellent
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collaborator and team member and offers important pieces to the puzzle when
attempting to decipher Carols unpredictable behavior spikes. However, parents can
also have erroneous ideas about their childs behavior. Carols mother thought a recent
spike in behavior was due to her social worker being out on maternity leave, but now
that social worker found another job permanently, and Carols behavior has been better
than ever.
Many of the positive behavior supports I have outlined in this report are
interventions that Carols behavior support specialists have already been implementing
for Carol on a regular basis. My effort was to document their effectiveness. These
supports will continue to be provided for Carol as needed by her staff and teachers in all
classes.
One thing I might do differently if I were to repeat this project again is to take data
for a longer period of time. Taking data over several months or longer may have given
me a more useful picture of how certain positive behavior supports successfully
deescalate Carols problem behavior. However, recording data for my project, in
addition to Carols normal data sheet, is a burden for the classroom staff. I felt guilty
enough asking this of them for three weeks; I would hesitate to expect them to continue
this unless I could record the data myself. In addition, the behavior support team at St.
Elizabeth already records a great deal of data, and a Behavior Support Referral is filled
out every time Carol exhibits notable behavior in the classroom. This referral, however,
does not document the effectiveness of the interventions.
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References
Blairs, S., Slater, S., & Hare D.J. (2007). The clinical application of deep touch pressure
with a man with autism presenting with severe anxiety and challenging behavior.
British Journal of Learning Disabilities, 35(4), 214-220.
Burke, M.D., Hagan-Burke, S., & Sugai, G. (2003). The efficacy of function-based
interventions for students with learning disabilities who exhibit escape-maintained
problem behaviors: preliminary results from a single case experiment. Learning
Disability Quarterly, 26(1), 15-25.
Crozier, S. & Tincani, M. (2005). Using a modified social story to decrease disruptive
behavior of a child with autism. Focus on Autism and Other Developmental
Disabilities, 20(3), 150-157.
Homer, R.H., Sugai, G., & Anderson, C.M. (2010). Examining the evidence base for
school-wide positive behavior support. Focus on Exceptional Children, 42(8), 114.
Hume, K., Sreckovic, M., Snyder, K., & Carnahan, C. R. (2014). Smooth transitions:
helping students with autism spectrum disorder navigate the school day.
Teaching Exceptional Children, 47(1), 35-45.