Tessa Swiger

FIELD PLACEMENT OBSERVATION

Clelian Heights
Documentation of behaviors

STUDENT: C, Female, 20 years old, autism, anxiety, spatial and visual processing
issues. C is very smart with very good manners. However, because of her spatial
anxiety, C tends to hit if people get to close to her. Similarly, C will hit to avoid doing
work. C has trouble beginning tasks, but once she has started she does very well.

1. 8:30 AM-3:00 PM
5/16/16, 5/17/16, 5/24/16

Class/Time Antecedent Behavior Consequenc Notes

e
Treadmill/Opening (5/16/16)
8:30 AM-9:30 AM Staff Student Staff told I could tell
escorted refused, student she that staff was
student to would not was going becoming
gym area move, hit to call frustrated,
where treadmill teacher but after
treadmill is with hand and walking away
located, multiple student and coming
and times. climbed up back they
prompted onto handled the
student to treadmill situation
step up without better.
onto further
treadmill. incident.

(5/17/16)

Students C leans over Other Since C has

were sitting and hits the student did spatial issues,
around the knee of the not react, it seemed that
front of student however the the student
room during next to her. teacher sitting next to
the opening intervened her was to
sequence. by close, but is
redirecting still no excuse
the students to hit.

1
 attention
back to the
front.
Teacher
addressed
the incident
with the Before
student handwriting,
after student fills
opening out Good
sequence. Day chart.
Student
refused and
scribbled on
paper. Staff
retrieved a
new paper and
used hand
over hand to
assist student
with staying
on task.
Staff Student Staff then
escorted refused to redirected
student to move closer student Student was
gym area to treadmill. towards the usually
where When staff treadmill compliant
treadmill is walked and student about doing
located. around C to stepped onto the treadmill,
walk behind the device. however would
her, C occasionally
turned and display
hit staff on avoidant and
arm. aggressive
behaviors.

Handwriting Staff set out Student Staff When staff

9:30-9:45 handwritin cleared her verbally walked away,
g desk with a redirected student took
worksheets swipe. Staff student a few seconds
for student asked behavior. before
to student to Staff gave C independentl
complete. pick up the a new y starting
pencil and worksheet task.

2
 papers. and walked
Student away.
complied.
Student
then
scribbled
on papers.

Staff set out Student Staff gave

worksheets scribbled on student a
for student. papers. new
worksheet
and walked
away.
Student
took a few
minutes
before
starting
task,
eventually
completing
it.

There were no
behaviors on
5/24/16.

Spelling Student went

9:45-10:00 to OT on
5/16
No behaviors

3
 5/17

Staff gave Student kept Staff set the

student an flipping guided
iPad with corner of access on
spelling app iPad, and the iPad to
exiting out prevent
of further
application exiting, and
verbally
reminded
student that
she needed
to do her
work. Staff
did give
verbal
praise for
completed
work.

Reading Staff Student Staff

10:00-10:15 presented tried continued
dolch swiping to repeat
words to cards from the dolch
student to staffs word,
read hand. student
eventually
began task.
Staff gave
verbal
praise for
completed
work.

Staff Student Staff gave C

presented began task verbal
on dolch without praise for
words and issue. completed
sentences. work.
Student also
received
play time on

4
 the iPad.

No behaviors
5/24

Sensory/Snack/Hygie After Upon Staff Most days

ne receiving entering redirected student
snack, the student seemed
student bathroom, behaviors reluctant to
and staff student verbally. complete this
went to refused to Staff used task after
bathroom complete hand over receiving
to do hygiene hand to snack
hygiene. tasks. assist (reward).
Student student in
threw completing On 5/24
tooth tasks. student
brush, completed
smacked task without
tooth issue.
brush off of
sink, threw
deodorant.
Math Staff set Student Staff
touch point would redirected
cards out become negative
for student frustrated behaviors,
to practice if she verbally
addition. miscounte praised for
d, which task
lead to completed.
desk
pounding
and
attempting
to clear the
desk.
No behaviors
5/17

5
 Staff set out Student did Staff
dry erase not pretended to
clock to participate take turns
practice in telling with
time time, and student,
concepts refused to which
select the worked and
correct student
answer. completed
her task.

5/16 Phonics (group) Student went

to speech
5/17 and 5/24 Music therapy on
5/16 and
5/24.

Staff Student Staff

presented threw relocated Later on into
student with maraca at students class, student
a maraca classmate seat from was more
during her peers, willing to
music class. had student participate in
apologize to short bursts of
classmate, movement
and student activities than
lost music making
instrument ones.
playing
time.

Lunch/Recess Staff Student Staff

escorted refused to verbally
student to open lunch prompted
lunch. box. student
multiple
times to
open lunch

6
 box, when
she
continued to
refuse staff
opened
lunch for
her. Student
sat for
another
minute then
began
eating
lunch.
5/16 Home Ec Teacher Student Staff Student went
passed out swiped prompted to PT on 5/17
5/17 and 5/24 Art bingo cards card off of C to pick up and 5/24
to entire the desk. her card.
class. Student
picked up
card and
participate
d fully in
class
activity.
5/16 Social Skills Students When Staff
sat at student sat intervened,
5/17 and 5/24 Health center next to C, redirecting
table at she leaned behaviors
assigned over and and using
seat. hit student de
in arm. C escalation
began to techniques
cry such as
because breathing,
she saw the counting,
teacher and
was mad at eventually
her. C separating
began to her from
try and rip group.
her shirt, Student
while eventually
hitting self calmed
in head. down.

7
 Student
participated in
both Health
activities. The
class begins
with yoga in
which student
seems to enjoy.
Dismissal Student While Staff went
walked out waiting for out into
to hallway. bus to be hallway,
called, C hit redirected
a peer with student to
her back
backpack. hallway to
board onto
the bus. Staff
checked
other
student and
student self
reported
they were
fine.

Tally of behaviors

DATE -- 5/16 5/17 5/24

Behavior (below)

Aggressive XXXX XX XXX

behavior
(hitting,throwing)
Avoidant behavior XXXXXX XXX XXX
(scribbling, clearing
desk, refusal)
Tantrum/Meltdown X

8
STEP 1: FBA INTERVIEW

Student Name: C Date: 5-25-16

School: Clelian Heights Grade: 11 (developmentally and work wise preK-K)
DOB: February 1996
Educational Program Description: Autism Support Classroom, Life Skills

I. Description of the Behavior of Concern (specifically describe what the behavior

looks and sounds like): Before beginning some tasks, C may hit, pound, clear desk,
scribble, and display various aggressive or avoidant behaviors. Although C is
aggressive at times towards others, only becomes aggressive with self during times
of extreme anxiety (meltdown). When C is having a good day, however, she is polite
and productive.

Instructions: When the answer is YES, add details on the lines provided.
II. Physiological and Medical Factors:
1. Could the behavior be the result of a medical or psychiatric condition or any form
of physical discomfort?
X NO
YES
2. Could the behavior be related to a side effect of medication?
X NO
YES
3. Could the behavior be the result of some physical deprivation condition (thirst,
hunger, lack of rest, etc.)?
X NO
YES

III. Antecedent Events:

1. Are there circumstances in which the behavior ALWAYS occurs?
NO
YES Before tasks, when a peer or staff is in too close of proximity to student

2. Are there circumstances in which the behavior NEVER occurs?

NO
YES Behaviors are lessened if teacher works with student versus staff at times.

3. Does the behavior occur only (or more often) during particular activities?
NO

9
 YES all work related activities. If it is a leisure activity she is less likely to have a
behavior.
4. Does the behavior occur only with( or more likely with) certain people?
X NO
YES

5. Does the behavior occur in response to certain stimuli?(demands, termination of

preferred activities, tone of voice, noise level, ignoring, change in routine,
transitions, number of people in the room, etc.)
NO
X YES All of the above

6. Does the behavior occur only (or more likely ) during a certain time of
day?(morning, afternoon, end of school day, evening)
X NO
YES

.
IV. Skill Deficits Related to Behavior of Concern:
Could the behavior be related to any skill deficits? (check* all that apply)

X Academic Skills: Task requirements as presented are not at the students

instructional level in the core areas of Reading, Math, or Writing.
Sometimes student becomes frustrated during work.

X Participation Skills: The student has difficulty with participating in non-directed,

semi-directed, teacher-directed, or peer-directed activities. The student has
difficulty in small or large group instruction.
Student answers in one to two word responses. If the teacher asks C a
question, and C responds with an irrelevant answer, when the teacher asks again
the student becomes frustrated.

X Social Skills: The student has difficulty acquiring and/or maintaining peer
friendships. The student often withdraws from social interaction. The student is
often verbally and/or physically aggressive in social interactions.
Only if proximity is too close. Student thrives on social interaction when
doing good work and have positive behavior.

Communication Skills: The student has difficulties with requesting what they need,
including items, activities, attention, information, changes in the environment, or
help. He/she has difficulties in conversational skills and answering questions,
understanding non-verbal or verbal language, or following directions.

10
Organizational Skills: The student has difficulty with organizing school supplies,
study area, time, or projects, organizing class notes, or dividing assignments into
task.

X Self-Regulation Skills: The student has difficulties with staying on-task, completing
work assignments, handling stressful situations, calming self when agitated,
following rules, or difficulty transitioning between activities/places or people.
Difficulty with problem solving.

Study Skills: The student has difficulty with studying for tests, taking tests, taking
notes from lectures, or using studying techniques.

Motor Skills: The student has difficulty with gross motor skills (e.g. running, raising
arms, putting feet together, squatting, bending at waist, etc.) or fine motor skills (e.g.
pointing, counting with fingers, holding a pencil/pen, holding a fork/spoon, pressing
a computer key, using a mouse, etc.). S/he has difficulty with imitating others
actions.

X Functional Skills: The student has difficulty with performing activities of daily
living (e.g. eating, dressing, toileting, grooming).
Student is able to successfully complete task, however occasionally refuses to
complete task.

Play Skills: The student has difficulty with actively exploring activities/toys in their
environment (inside or outside) to play with during leisure time, playing with the
items as designated, or engaging in interactive play with peers during activities.

*If checked, please refer for further assessment (i.e. Speech & Language evaluation,
Occupational Therapy evaluation, curriculum-based assessments, specific skills
assessments)

V. Consequence Factors:
1. Does the behavior allow the student to gain something? A. Preferred activities or
items?
Indicators: The behavior often occurs when the student sometimes or always
regains an item or activity that has been taken away or terminated. The behavior
often occurs when the student sometimes or always gains access to an activity or
item that he was told he couldnt have. The behavior rarely occurs when the student
is given free access to his or her favorite items or activities.
NO
X YES When staff walks away after student has behavior, student is content sitting
and people watching. Also is receiving attention from teacher and staff

B. Peer or adult attention?

Indicators: The student frequently approaches others. The student frequently
initiates social interaction. When the behavior occurs, someone usually responds by

11
interacting with the student in some way (i.e. verbal reprimand, redirection,
comforting statements). The behavior rarely occurs when the student is receiving
attention.
NO
X YES Staff and teacher attention with redirection or de-escalation.

2. Does the behavior allow the student to postpone, avoid, or escape something such
as task demands, social interaction, etc.?
Indicators: The behavior often occurs when the student sometimes or always
postpones or escapes the task demands placed upon him. The behavior rarely
occurs when few demands are placed on the student or when the student is left
alone. The student is often noncompliant when asked to complete tasks and the
student sometimes or always postpones or escapes the tasks. The behavior often
occurs prior to predictable demands and the student sometimes or always avoids or
postpones the tasks.
NO
X YES-for the time being. Staff will try to return to task later on if time allows.

3. Does the behavior provide stimulation as an alternative to the student's lack of

active engagement in activities?
Indicators: The behavior occurs frequently when the student is alone or unoccupied.
The student seems to have few known reinforcers or rarely engages in social
interaction activities. When the student engages in the behavior, others usually
respond by not attending to the behavior.
X NO
YES ______________________________________________________
_____________________________________________________________
_____________________________________________________________

STEP 2: DIRECT OBSERVATION

The FBA interview results in a measurable description of the behavior of concern
and information that leads to direct observation with data collection and analysis.
Direct observation
Serves to clearly define the behavior
Supports or refutes interview information
Allows for assessment of behavioral events in the students natural environment
Leads to an hypothesis regarding the function(s) of the students behavior of
concern
Serves as a baseline to measure the frequency, duration, and/or intensity of the
behavior prior to intervention
Provides information that is necessary to build a Behavioral Intervention Plan
Supplies the team with progress monitoring data to evaluate the implemented
interventions and guide adjustments to the BIP.
Data collection
Define the behavior in observable and measurable terms.
Determine the purpose for data collectionthe type of information needed from

12
each data collection session (i.e. frequency counts, identifying antecedents and/or
consequences).
Outline the schedule including where, when, how often, and who will collect data.
Design tools that will result in the collection of the type of data needed and that
are
functional with clear coding systems.
Transfer the data to a visual representation (graph) and analyze it for trend, level
and variability.
Data collection methods (Appendix A)
Record frequency and/or duration indicating time of day, location, activities
occurring, and people present.
Write a description of the students behavior as well as the antecedents and
consequences using an Antecedent - Behavior - Consequence (A-B-C) format. This
type of data must be collected multiple times across settings when the behavior of
concern occurs as well as when the behavior of concern does not occur.
Appendix A contains sample data collection tools for use during direct observation
followed by a graphic (visual) representation of the data to facilitate data analysis.
Appendix B contains blank data collection forms for you to use directly or adapt to
fit your needs.

STEP 3: SUMMARY
History of interventions for Current Behavior of Concern
Antecedent (prevention) strategies: Verbally prompt student before next task, use
visual schedule, use reward chart to track tasks completed

Consequence strategies: Redirection, if refusal to do a task, complete the task at a

later time during free time such as recess, if student earns reward by earning all
pieces of snack bag/reward picture, student will receive reward. If the student does
not earn all pieces of snack bag/reward, then student will not receive reward.

Direct Observation Summary (attach graphic representation of observation data

collected) PAGES 1 and 2
Antecedent strategies:
Use more motivating techniques as well a visual representation of the task.

Consequence strategies:
Either receive reward or not depending on student behavior during assigned
tasks.

1. Describe how often the behavior of concern occurs, how long it lasts, and at what
intensity it occurs?
Varies in length, but no more than 5-10 minute intervals.

2. Describe any patterns to the occurrence of the behavior of concern.

Task and work oriented, spatial concerns.

13
Antecedent and Consequence Factors
1. Describe the antecedents that are present when the behavior of concern occurs.
Lack of prompting, attitude of staff, presentation of materials

2. Describe the consequences that appear to be maintaining the behavior of

concern.
No real consequence, only verbal redirection or warning. Praise is also
verbal.
Hypothesis Regarding Function of the Behavior of Concern
(The team may identify more than one hypothesis.

1. When starting a task, C displays aggressive behaviors (hitting, throwing) because

of either sensory issues or avoidance.

2. When starting a task, C displays avoidance behaviors (swiping desk,

scribbling, refusal) in order to not begin/complete the task.

3. After a negative behavior, C throws a tantrum/meltdown in order to deal with

prior anxiety that is building.

I have chosen hypothesis number two when describing this student. When

starting a task, C displays avoidant behaviors in order to not begin or complete the

task. I feel that this is an issue that can be helped in some way. With the aggressive

behaviors, it usually starts with the hypothesis I have chosen, and then gradually

builds up to hypothesis one, and then eventually hypothesis three depending on the

situation. With her aggression, she does hit when people are too close to her

because she has severe spatial anxiety. At her age now, there is not much to do that

would really eliminate this behavior. Overstimulation and anxiety are bound to

happen as well, so I choose number two because with avoidance behaviors, a

reward system as well as behavior of the aide or teacher can change. C feeds off of

others energy and emotions. Part of the issue is that C does not have any significant

motivators. She does enjoy our snack time, as well as playing on the computer. As

14
an intervention, I would like to use a behavior chart that she helps control to keep

track of her progress in order to earn a reward. She also thrives on social interaction

with her favorite staff and peers. In one study researchers observed the brain

functioning in participants with autism during the anticipation and receiving phase

of monetary and social rewards. Researchers suggested that using monetary

rewards, participants would have hypoactivision during anticipation and reward

outcomes. This was a similar hypothesis when using social rewards. Researchers

also suggested that social rewards have a decreased salience and did not hold

motivational properties (Dichter, 2012). During the study, there was a significant

difference in patterns of activation in the brain when recording reactions to social

rewards. This outcome determined that the faces held motivation relevance

(Dichter, 2012). This study further proves how interaction with students on the

spectrum and how you interact are important. Although it is common with those

diagnosed with ASD to struggle in social situations, there is significance to them. In

regards to completing work, C displays avoidance behaviors. It is hard to decipher if

the behaviors are happening because it is anxiety/stress, no understanding the task,

lack of caring (does not want to do work), or a sensory issue. Because C has

limited verbal skills, there is no way to self report on why she does or does not want

to do an activity. A research study was done using graduated exposure combined

with positive reinforcement to assist in increased participation in activities within

the given setting (Schmidt, 2013). The study was done on a sixteen year old boy who

avoided three areas of the school, the music room ,gym, and gross motor exercise

room. Through the study, there was one task to be done in each setting. During the

15
research it was only the participant and one staff member that entered the room. If

the student displayed aggression, the staff would remind him it is time to go back

into the classroom. After researchers conducted an FAI, they concluded that he

disliked these areas due to minimal exposure (Schmidt, 2013). For the

intervention, one staff member stood a certain distance from the door. If the student

made it that far without a behavior, positive reinforcement was given. Eventually if

he crossed the threshold, a food reward was given. A timer was used to prompt

student to engage in the specific activity, and after the timer was done the student

was allowed to exit the setting. By using physical guidance, verbal instructions and

demonstrations, the participant was eventually able to do the task actively

independently. Within the study there were staff trainings as well. By combining

positive reinforcement and graduated exposure, I feel that an intervention similar to

this would assist C in decreasing her avoidant behaviors.

Dichter, G.S., Richey, J. A. , Rittenberg, A. , Sabatino, A., & Bodfish, J. (2012). Reward

circuitry function in autism during face anticipation and outcomes. Journal of

Autism and Developmental Disorders, 42 (2). Doi: 10.1007/s10803-011-

1221-1.

Schmidt, J. , Luiselli,J., Rue, H., & Whalley, K. (2013). Graduated exposure and

positive reinforcement to overcome setting and activity avoidance in an

16
 adolescent with autism. Behavior Modification, 37(1). Doi:

10.1177/0145445512456547.

For my behavior plan intervention, I have planned to use a visual

task/reward chart. Combined with the chart, certain techniques will be used while

communicating with student. For example, instead of simply explaining the task

(which becomes too much talking), using a system of taking turns. Staff will

demonstrate the task in a positive manner, then offering a turn to the student. Not

only will turn taking assist in task completion, it will improve her appropriate

socialization skills with her peers. In a study done in 2014 researchers found that

students that had language age equivalents above 60 months indicated a need for

modeling and contingency to occur within the same exchange for optimal

responding (Reith, 2014). The type of turn taking is also dependent on the

developmental level and target skill for the students (Reith, 2014). In the book

Communicate With Your Child, it states Adults who use directive, controlling style

with their child may inhibit the child from learning to control him/herself and

encourage the child to be passive and expect others to do hi/her life work for them

(Macdonald, 2002). The author suggests to let the child have a say in what they want

to do, and approaching situations in a more open manner. Using comments more

than questioning or commands and show the child the communication rather than

testing him (Macdonald, 2002). Keep this in mind, staff while working with C can

ask her, Which activity should we do next, handwriting, reading, or spelling? Then,

the student will have control over which work she chooses to do, then implementing

17
the positive verbal prompting and using the reward chart. With the reward chart, it

could be a piece of decorated carboard (with Cs interests on it) with 7 pieces of

Velcro. On piece of Velcro on top to show the current task, then the rest of the pieces

underneath to place the pieces of the reward picture. Four will be used to create the

snack bag (given the time of day and the schedule set up), and six pieces of the easy

bake app or YouTube link for the end of the day computer time. A basic visual

representation is attached on next page of what a reward chart would look like is on

the next page.

Macdonald, J. , & Mitchell, B. (2012). Communicate with your child. Columbus, OH:

Communicating Partners Center.

Reith, S., Stahmer, A., Shrheinrich, J., Schreibman, L., Kennedy, J., & Ross, B. (2014).
Identifying critical elements of treatment: examining the use of turn taking in
autism intervention. Focus On Autism and Other Developmental Disorders,
29 (3). Doi: 10.1177/1088357613513792.

18
19
POSITIVE BEHAVIOR SUPPORT PLAN (PBSP)
STUDENT NAME: C. D.

Positive Behavior Support Plan

Student Name_______C.D.__________________ Date of Plan_____06/11/16___________

Team Signatures: _____________________________

_____________________________
_____________________________
_____________________________

20
POSITIVE BEHAVIOR SUPPORT PLAN (PBSP)
Student Name: C.D.

Antecedents to the Behavior of Consequences Perceived function

behavior of concern maintaining the of the behavior of
concern behavior of concern
concern
Presenting task at Avoidance Verbal warnings
To avoid, escape,
hand or current behaviors that and redirection,
or post pone
activity include but not loss of motivating
current work task.
limited too desk factor (snack,
pound, desk clear, computer time,
scribbling, ripping club time)
paper, refusal,
throwing writing
utensil or any
tangible objects,
and aggression
towards staff or
peers.
When starting a task, C displays avoidant behaviors in order to not begin or
complete the task.

Identify educational (skill) deficit(s) related to the behavior of concern:

Academic skill deficits, communication and or social skill deficits, sensory processing skill deficits.

Refer for further assessment: (Check here and describe plan for assessment if skill deficits
have not previously been assessed and identified.
Describe: ________________________________________

Educational deficits addressed in other areas of IEP: (check here if deficits have previously
been assessed and identified and addressed in the IEP).
Describe:_________________________________________

21
POSTIVE BEHAVIOR SUPPORT PLAN (PBSP)
Student Name: C.D.

V. GOALS AND OBJECTIVES Include, as appropriate, academic and functional goals.

Use as many copies of this page as needed to plan appropriately. Specially designed
instruction may be listed with each goal/objective or listed in Section

VI. Short term learning outcomes are required for students who are gifted. The short
term learning outcomes related to the students gifted program may be listed under
Goals or Short Term Objectives.

MEASURABLE Describe HOW the Describe WHEN Report of Progress

ANNUAL GOAL students progress periodic
Include: Condition, toward meeting this reports on progress
Name, Behavior, and goal will be will
Criteria (Refer to measured be provided to
Annotated IEP for parents
description of these
components)

C will reduce the Teacher checklist Daily reports

number of and observation through
avoidant behaviors documentation,
before a task to and progress will
three or less be monitored
incidents in a day. every nine weeks.

SHORT TERM OBJECTIVES Required for students with disabilities who take
alternate assessments aligned to alternate achievement
standards (PASA).

Short term objectives/Benchmarks

1. C will reduce the number of times she displays avoidant behaviors to two with
75% accuracy.
2. C will complete two out of three activities in any given subject with 75% accuracy.
3. C will reduce the number of objects she throws to zero with 75% accuracy.

22
POSITIVE BEHAVIOR SUPPORT PLAN (PBSP)
Student Name: C.D.

VI. PROGRAM MODIFICATINOS AND SPECIFICALLY DESGINED INSTRUCTION FOR

THE POSTIVE BEHAVIOR SUPPORT PLAN:

A Antecedent Prevention Strategies

Supply visual representation of what the next task will be

Verbal prompting to student of what action to do next with positive tone of
voice
Remind student of reward of what they are working towards
Have worked example done and ready
Place day work material out into visible area so student can have a choice as
to what subject to work on next.
Staff can also try taking turns with student. Staff would essentially
demonstrate the task, offer it to C as her turn, and then continue with task.

B Replacement Behavior
Student will begin task with displaying minimal to zero avoidant behaviors.
Student will eventually begin tasks independently.

C Consequences (reinforcement) for when the student performs the replacement

behavior

When student begins task, staff will offer immediate verbal praise for good
work.
Whenever task is successfully completed, student will earn one piece of reward
picture. Once the reward picture has completed the student will earn the reward.

23
C Consequences (including procedures to follow) when student performs the
behavior of concern.

Student will receive no puzzle piece for the incomplete task, or the task that
involved avoidant, aggressive behaviors.
If there is a missing piece, student will complete another task successfully to
earn it.
Redirection of task and behavior through verbal prompts will be given.

Note: In developing the Positive Behavior Support Plan (PBSP) the IEP team must
consider Program Modifications and
Specially Designed Instruction, Related Services, and Supports for School Personnel
Provided for the Child. These items
should be described within Section VI of the IEP.

VI. SPECIAL EDUCATION / RELATED SERVICES / SUPPLEMENTARY AIDS AND

SERVICES / PROGRAM MODIFICATIONS Include,
as appropriate, for nonacademic and extracurricular services and activities.

A. PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION (SDI)

SDI may be listed with each goal or as part of the table below.
Include supplementary aids and services as appropriate.
For a student who has a disability and is gifted, SDI also should include
adaptations, accommodations, or modifications to the general education curriculum,
as appropriate for a student with a disability.

Modifications Location Frequency Projected Anticipated

and SDI Beginning Duration
Date
Student will Classrooms At all times 6/11/16 6/06/17
have large
enough desk
to reduce
spatial anxiety
triggers.
Student will
also have a
seat distanced
a bit from
peers to avoid
aggressive

24
behaviors due
to spatial
anxiety.
Student will Classroom, During work 6/11/16 6/06/17
have visual with aide or time
aides to help teacher
maintain a
schedule
during her
morning work
and afternoon
class schedule.
Student may Classroom, During work 6/11/16 6/06/17
physically be transitions times.
in charge of between
her own classes and
reward chart tasks.
as long as no
destructive
behaviors are
visible.

B. RELATED SERVICES- List the services that the student needs in order to benefit
from his/her special education program.
Service Location Frequency Projected Anticipated
Beginning Duration
Date
Speech Room 201 Twice a week, 08/18/16 06/06/17
Therapy half hour
sessions
Occupational Room 106 Once a week, 08/18/16 06/06/17
Therapy forty five
minute session
Physical Room 108 Once a week, 08/18/16 06/06/17
Therapy half hour
session

C. SUPPORTS FOR SCHOOL PERSONNEL- List the staff to receive the supports and
the supports needed to implement the students IEP.
School Support Frequency Location Projected Anticipated
Personnel Beginning Duration
to Receive Date

25
Support
Classroom In service Twice a Conference 08/18/16 06/06/17
104 Staff trainings school year room
with (more if
behavior needed)
specialist
All PCAs Online Once a School or 08/18/16 12/31/16
and TAs autism school year home
trainings (must be computer
(Computer completed
program) before
December
of current
school
year).

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 Self Management Plan

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

I HAD NICE HANDS

I COMPLETED MY WORK

I RESPECTED MY
BELONGINGS

This week, I had nice hands ____________ out of ________________ days

This week, I completed my work _______________out of _______________days
This week, I respected my belongings ____________ out of ____________ days

I AM WORKING FOR:

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 Since C is lower functioning, developing a self management plan was a bit

difficult. So, I created a chart (which I would prefer was laminated so notes could be

written with marker, or else on a marker board), and the student would use Velcro

picture cards of the above images to place on each day they successfully master that

skill. At the end of the week, the student can count the number of pictures they have

which will determine if they receive the reward at the end of the week (possibly a

special club activity, or set aside iPad time to play with an app). The student will self

monitor everyday and consult with the teacher who will administer the picture card

that C will put on herself. In a study done by _________, students during a self

management intervention were able to successfully self record their behavior. Since

Cs behaviors are aggressive, it is important to work on socialization as well and not

just task avoidance. Also stated by the researchers, that without appropriate social

skills in their repertoire, children with autism or behavior problems have

significantly greater difficulty being socially integrated into their schools and

neighborhood communities (Koegel, 1992). By using Velcro pictures that C would

place on the chart herself, she would also be rewarded with interaction and

attention from the teacher by going to receive the image to place on the chart as well

as verbal praise. In another study that used pictures to record self management,

authors found that with the introduction of the pictorial self management package,

engagement in these daily living behaviors increased and inappropriate behavior

decreased (Pierce, 1994). Hopefully a similar chart could be used at home with

chores or even just when behaviors arise there.

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Koegel, L. Koegel, R., hurley, C. & Frea, W. (1992). Improving social skills with
disruptive behavior in children with autism through self management.
Applied Behavior Analysis, 25 (2). Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1279715/pdf/jaba00016-
0107.pdf.

Pierce, K. & Schreibman, L. (1994). Teaching daily living skills to children with
autism in unsupervised settings through pictorial self management. Journal
of Applied Behavior Analysis, 27(3). Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297828/pdf/jaba00009-
0053.pdf.

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