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7/30/2013

Autism, Adaptive Behavior, and Adult Independence:

Notes from the Forgotten Frontier

Peter F. Gerhardt, Ed.D. JPG Autism Consulting, LLC

[email protected]

This would seem a bit of shameless self promotion BUT all the proceeds go the Organization for Autism Research so it is really a shameless bit of fund raising.

Fact-O-Meter

Utter Nonsense

Absolute Fact

Teaching adaptive responding is difficult and complex yet we tend to think in overly simple

contingencies.

Antecedent

(yelling)

Behavior

(crying)

Consequence

(R+ comfort

R- yelling stops)

But in reality, life, in the form of adaptive behavior, is far more complex

Go take

a Shower

EO/MO •Learning history •Adolescence & its impact •Communication challenges •Social challenges •Mental health challenges •Physical health •Medication side effects •Environmental stressors •Curriculum considerations •Boredom •Sexuality •Sleep issues •Aging in & of itself •Yada, yada, yada…

“Huh?”

{ } Aggression

Professional

So the first rule here is

Not look for simple solutions to complex problems…

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Walking Two Blocks in NYC

Potential Error Points Which direction to destination (left, right, forward)?

Which side of the sidewalk to walk on (right side)?

Presence/absence of active driveways?

Identifying distant Walk/Don’t Walk icons (30-40ft)

If Don’t Walk icon lit then WAIT

Don’t follow prompt of other pedestrians

If Walk icon lit then CROSS BUT: Check for errant cars

Check for bicyclists

Move quickly; Avoid oncoming walkers

Start all over again

While not forgetting that sometimes simple solutions work best. Easy, right?

For example, at times mastery criteria can be tied to frequency which the activity is displayed

100% across all opportunities 2X per day

80% across all opportunities 3X per day

70% across all opportunities 5X per day

Activity Student Mastery So do it…

ABA & Adaptive Behavior

ABA is a field of inquiry dedicated to investigating and modifying behavior in a systematic way. ABA is:

Data-based

Analytical

Able to be replicated

Socially important

Contextual

Accountable (Sulzer-Azaroff & Mayer, 1991)

Behaviorally-Based Intervention is:

Analytical – Effective intervention requires us to understand points of view other than our own.

Socially Important – Effective, generalized, and maintained intervention requires the selection of targets that of value beyond the classroom.

Contextual - Effective intervention requires us to teach where the skill is most likely to be displayed.

ABA and Adaptive Behavior

 Behavior Analysis represents a teaching methodology with tremendous versatility beyond discrete trial instruction

Fluency/Rate-base instruction  Instructional Intensity Shaping & Chaining Task Analysis Functional behavior analysis/assessment PRT or NET Incidental strategies OBM, Precision Teaching, Verbal Behavior, Relational Frame Theory, PBS, Behavioral Economics, Healthcare, Safety etc.

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Instruction based upon ABA does not represent a rigid, unyielding, and unalterable set of instructions and/or interactions. In fact, good behavior analysts modify their instructional interventions in response to a slew of conditions, settings and contingencies while maintaining a commitment to data-based decision-making.

And lastly “…happiness among people with profound multiple disabilities

can be defined, reliably observed, and systematically increased” supporting the fact that “the contributions of behavior analysis for enhancing the quality of life among people with profound and multiple disabilities may be increased significantly.”

C. Green & D. Reid, 1996

Strengths/Challenges of ABA Strengths Challenges

Large and ever growing body of research Research generally has a small “N” which is a source of criticism.

A diverse cohort of interventions Most people think ABA = DTI

Effective across the lifespan Limited research with older individuals

When done properly, very effective When done poorly, far less effective

A comprehensive sub-field on Positive Behavior Supports (PBS)

Historically, there was an overreliance on punishment a disdain for function

Data, data, data, data, data, data, data. What can I say? Data are good.

Targets individual skills very well. Should be able to target complex, context-based skill competencies but research is limited.

Implementation of interventions can be taught to non-BCBAs

Supervision needs of non-BCBAs may be extensive

Has potential to significantly improve QOL

This is a difficult, time and effort intensive process. ABA is no silver bullet.

Demonstrations of the effective application of the principles of ABA in practice are pretty much everywhere

Before I go on, I would like to encourage all of you (if you have not already) to read Bannerman, et al, (1990).

Why focus on adaptive behavior?

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Person

Leisure

Safety

Social Competentce

Decision Making

Communication

Societal Norms

Employment

Sexual Safety

Self Management

Knowledge

Hygiene

Adult outcomes can, at least in part, be seen be seen as a function of adaptive behavior competencies (Mazefsky, Williams, & Minshew, 2008). It is not an overstatement to say that adaptive behavior competencies will get you through times of no academic skills better that academic skills will get you through times of no adaptive behavior competencies

In truth, the most desirable outcomes are in Adaptive Behavior

Adaptive Behavior is defined as those skills or abilities that enable the individual to meet standards of personal independence and responsibility as would be expected of his or her age and social group. Adaptive behavior also refers to the typical performance of individuals without disabilities in meeting environmental expectations. Adaptive behavior changes according to a person’s age, cultural expectations, and environmental demands. (Heward, 2005).”

“[Professionals] have the potential to improve the quality of life of adolescents with neurological disorders as they transition into adulthood by considering the “executive burden” posed to the individuals by various combinations of executive dysfunction and atypical adpative demand” ( Tarazi, Mahone, & Zabel, 2007, p. 196

Tarazi, R.A. , Mahone, E.M.., & Zabel, T.A. (2007). Self-care independence in children with

neurological disorders: An interactional model of adaptive demands and executive

dysfunction. Rehabilitation Psychology, 52, 196-205.

In other words… Adaptive behavior is everything you do that is not directly tied to academic responding. Yet adaptive behavior is not separate or distinct from academic responding. For example:

 Reciting a chemistry equation is academic but using that equation to pull a McGyver is adaptive behavior.

 Being able to identify the word “poison” is academic responding but not drinking from the bottle labeled poison is adaptive behavior..

 Getting CEUs for sitting through a lecture is academic responding but using the information obtained during the course of that lecture is adaptive behavior.

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Further… While all ADL skills are adaptive behavior not all adaptive behavior skills are ADLs.

Adaptive behavior competencies are more complicated than inferential calculus.

Adaptive behavior competencies involve both simple and complex decision making skills

Adaptive behavior skills are not always highly preferred skills (e.g. tooth brushing) but, then again, some are (leisure skills).

Adaptive behavior is important because the world does not always play by the rules

And with some undesirable consequences at times

Many bowling alleys and restaurants have ice in the urinals to keep them fresh so it is important to let kids know never to eat ice they find in the bathroom.

So generally, what are we talking about here?

Motor Skills Gross Motor Fine Motor Social/Comm Skills Social Interaction Language Comp Language Expression

Personal Living Skills Eating & Meal Prep Toileting Dressing Personal Self-Care Domestic Skills Community Living Skills Time & Punctuality Money & Value Work Skills Home/Community Orient.

Problematic Behavior

Adaptive behavior by way of Jersey

“.We learned more from a 3- minute record baby, than we ever learned in school“

Bruce Springsteen “No Surrender”

Early on in life

Adaptive behavior tends to signal the beginning of independence from parents Failure to address adaptive skills may hinder community integration, school functions, recreational activities, and eventually housing and job opportunities Challenging behavior and the absence of self help skills most are often associated with out- of-home placemen

Stephen Anderson, Ph.D. (2008) Summit Educational Resources www.summited.org

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Stephen Anderson, Ph.D. (2008) Summit Educational Resources www.summited.org

With young children we tend to focus too little on the development of self-help skills

Inadvertently, the emphasis on “recovery” may have resulted in diminished interest in teaching self-help skills.

And let’s face it, we all know that at times it is easier to simply do it for the child

In some cases this may also be an area where parents feel connected with their child (“I can do that for you honey.”) but the end result is fostering dependency

Early on in life Adaptive Skills (chores) that typical

children can do.

AGE CHORE

2-4 year olds Help dust, Put napkins on table, Put laundry in hamper, Help feed pet

4-7 year olds

Set (or help set) the table, Put away toys, Help make bed, Help put dishes in dishwasher, Help clear table, Help put away groceries, Water the garden

8-10 year olds

Make bed, Set & clear table, Dust, Vacuum, Help wash car, Help wash dishes, Take out the trash

11 year olds and older

Above chores plus clean room, Mow lawn, Feed pets, Start doing own laundry, Make small meals, Shovel snow, Help with yard work, Empty and load dishwasher, etc.

Adaptive behaviors are usual taught through a combination of

task analysis, shaping, and chaining with new, emerging, or

established behaviors strengthened by positive

reinforcement.

Basic Strategies for Teaching Many Adaptive Behavior Skills with Younger Children

Stimulus Control

Reinforcement

Chaining

Shaping

Task analysis

Prompting

Stephen Anderson, Ph.D. (2008) Summit Educational Resources www.summited.org

Transitioning Stimulus Control

Basically, what is the trigger that prompts the individual to engage in the behavior (e.g., cold weather prompts me to zip my jacket)?

While we are often able to establish stimulus control as parents or teachers that is only the first step. Effective stimulus control is environment-based stimulus control

This, however, requires instruction in attending to:

Physical environment (location and timing)

Natural signals or cues (a moving car)

Environmental prompts (positioning)

Contrived prompts (Velcro schedule)

Positive Reinforcement I believe that while R+ is the most powerful intervention tool we have in our repertoire it is also the most misunderstood and poorly utilized tool. There are many reasons for this such as:

The complexity inherent in identifying actual reinforcing stimuli;

In practice, preference assessments appear to be vastly underutilized;

We are biologically programmed to ignore the normative and recognize the aberrant; and

We live in a world where much of our behavior is maintained through coercion and punishment (e.g., Sidman, ----)

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Positive Reinforcement

The reinforcing value of any stimuli varies within an individual at different times of the day (tickles right after lunch may not be an R+) and across individuals.

The reinforcing value of any stimuli may vary according to schedule of delivery, immediacy of delivery, bootleg access, choice of stimuli, and the response effort associated with task at hand.

Adaptive behavior tasks tend to be more effortful than academic tasks resulting in an effective R+ for seat work not being an effective for an adaptive behavior task.

Reinforcement Effective reinforcement (R+) increases behavior.

Unfortunately, in practice the reliable identification and effective application of R+ is often poorly implemented. If you have ever said:

“I don’t know what happened, I just reinforced him and he hit me.”

Chances are pretty good that while your intent was to reinforce him, in actually you presented him with his 22nd Dorito of the morning and somewhere around his 13th Dorito he started to get thirsty thereby negating the R+ properties of the Dorito. So in effect his hitting of you was an attempt to punish an annoying, fruitless, and repetitive behavior that he could stop no other way.

Reinforcement

Or if you have ever said:

“She knows she is not supposed to do that.”

Chances are pretty good that what she “knows she is supposed to do” is far less reinforcing that what she has chosen to do. I know I am not supposed to drive above the speed limit, yet I do. Why?

Bottom line here, reinforcers compete for supremacy and you had better be aware of that

Potential Reinforcers Praise – May be most practical but also the reinforcing value of praise needs to be established early on through pairing with identified reinforcers. Effectiveness often variable between staff or family members

Primaries (food or drink) – often powerful but challenging to use (particularly as individuals grow up) and subject to rapid satiation.

Attention (verbal and physical) – See praise.

Activities – Can be difficult to identify and activity R+ is often implemented poorly and at too great a dosage thereby decreasing its effectiveness.

Natural – Skills that result in naturally occurring R+ are often the easiest to teach and both generalize and maintain well (e.g., using the Blue Ray player).

Almost Anything Else – If something increases behavior, it is a reinforcer.

Identifying Functional Reinforcers via

Preference Assessments

Slides developed by K. Peacock, K. Yurich (Vista School), P. Gerhardt (OAR) &

R. Kubina (Penn State University) and Presented at ABA 2005

Preference assessments… Allow for the quantification of stimulus preferences on a case by case basis

Allow for the a variety of stimuli to be “road tested” for potential effectiveness before incorporating them in daily programming

Allow for expansion of preference inventories and the ranking of stimuli contained therein

Allow for the assessment of the continued effectiveness of previously identified reinforcers

Can be done on an ongoing or regularly scheduled basis.

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Pace Preference Assessment

Single stimulus approach based assessment

Not powerful for producing a rank order

Is quick to administer

Cannot assess activities with no corresponding object

Can be used as a screening tool for other assessments

Pace et al (1985)

Do you want this?

Fisher Preference Assessment

Paired stimulus approach based assessment (forced choice)

Produces a highly reliable rank order

Time intensive

Cannot assess activities with no corresponding object like tickling.

Fisher et al (1992)

Which do you want?

DeLeon Preference Assessment Multiple stimulus without replacement approach based assessment

Forces the student to choose between an array of stimuli Each time the student chooses, the array decreases by 1

Produces a less reliable rank order than the Fisher Takes less time than the Fisher Cannot assess activities with no corresponding object The student must scan the array (7 stimuli)

DeLeon & Iwata (1996)

Which do you want?

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Hagopian Preference Assessment

Single stimulus engagement based assessment

Power to differentiate between highly preferred stimuli is limited

Flexible administration time

Can assess activities with no corresponding objects like tickling.

Hagopian et al (2001) How LONG do you want any of these?

Chaining Chaining is a method of linking relatively simple steps (task analysis) to form a more complex task (a chain)

Each step in the chain signals the next step to be completed and reinforces the previous step

Anecdotally, “working with” the student to establish the chain may allow for faster skill acquisition

Unknowns: How far can this simple procedure be taken? Could entire routines, days, weeks be sequenced? What happens when unintentional behaviors accidentally are incorporated (aberrant behavior)? Are more steps important – provides greater access to reinforcers/feedback? Are fewer steps better – reduced chances for error?

Chaining – Request to Put on a Coat (Cooper et al)

Discriminative Stimulus

Response Conditioned Reinforcer

Teacher request Obtain coat Coat in hands

Coat in hands Place one arm in sleeve

One arm in sleeve

One arm in/one arm out

Place second arm in sleeve

Coat on

Coat on Zip the coat Teacher praise

Three Methods of Chaining Backward, Whole, Forward

Establish a baseline of how the child completes the task without any assistance

If child can complete some steps and needs little physical assistance, use whole-chain If child cannot complete most steps but can respond to delayed reinforcement, use forward If child cannot complete most steps, needs physical assistance and/or needs immediate feedback, use backward

Unknowns - Do these rules really work? Is one approach always better than another? Does reinforcement magnitude need to shift in response to greater effort?

Stephen Anderson, Ph.D. (2008) Summit Educational Resources www.summited.org

Shaping Shaping requires the reinforcement of successive approximations of the desired behavior.

You can think of shaping as a game of “you’re getting warmer” but usually on a much smaller level.

Clicker training is a common way to shape the appropriate behavior of young gymnasts.

When used as part of Community Based Instruction (CBI) both shaping and chaining procedures may fall victim to our tendency to not let learners make mistakes and our desire not to “cause a scene”

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Now let’s talk a little about adaptive behavior

intervention and older individuals.

A Quiz In the following (brief) task analysis for grocery shopping which is the most important skill set with reference to social validity and inclusion?

A. Creating, reading, and picking items on a shopping list

B. Staying on budget/Money concepts

C. Fluently swiping your debit or credit card

D. Not engaging in stereotypy

E. Bagging your own groceries

F. Engaging in social courtesies (e.g., thank you)

G. A plus D

H. E plus F

Working in NYC for the past three years one thing became increasingly clear; New Yorkers could not care less about my student’s label or their behavioral idiosyncrasies. They did, however, significantly care about their competence when they were in front of them in line purchasing groceries. Odd behavior, it seems, did not impact their lives. Making them wait 90 seconds in the check out line did.

Adaptive Behavior is the Construct but Adaptive Competence is the GOAL

“It’s worse than I thought. They’re going to be

testing for competence.”

How Natural Reinforcers Can Support Behavior

“Appropriate” Behavior

Should lead to greater choices and increased

opportunities

To do things I like

To do things I don’t like

Which may serve as R+

Which may serve as P+

Holy adaptive

behavior Batman!

Your underwear is

outside your pants

The many, many moods of adaptive behavior.

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Adaptive behavior & adult outcomes

In a group of 20 adolescents with Asperger syndrome, Green, et al (2000) found that despite a mean IQ of 92 only half were independent in most basic self care skills including brushing teeth, showering, etc. None were considered by their parents as capable of engaging in leisure activities outside of the home, traveling independently, or making competent decisions about self care.

Howlin, et al (2004) surveyed 68 adults with autism with an IQ of above 50 and found a majority (58%) were rated as having poor or very poor outcomes. With regards to employment status they found

8 were competitively employed

1 was self employed earning less than a living wage

14 worked in supported, sheltered or volunteer employment

42 had “programs” or chores through their residential provider.

“A major difficulty confronting those interested in adolescents and adults with autism is a lack of empirical data.”

(Mesibov, 1983, p. 37)

There is a problem though…

Comparative Effectiveness Review Number 65: Interventions for Adolescents and Young Adults

With Autism Spectrum Disorders Agency for Healthcare Research and Quality

www.ahrq.gov

Available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides- reviews-and-reports/?productid=1197&pageaction=displayproduct

Objective: We systematically reviewed evidence on therapies for adolescents and young adults (ages 13 to 30) with autism spectrum disorders (ASD). We focused on the outcomes, including harms and adverse effects, of interventions addressing the core symptoms of ASD; common medical and mental health comorbidities occurring with ASD; the attainment of goals toward functional/adult independence; educational and occupational/vocational attainment; quality of life; access to health and other services; and the transitioning process (i.e., process of transitioning to greater independent functioning).

Results: We identified 32 unique studies, most of which were poor quality. Five studies, mostly of medical interventions, were fair quality, and none were good. In the behavioral literature, studies of group- and computer-based interventions reported short-term gains in social skills. [ ] Four small studies investigated disparate interventions addressing highly specific adaptive/life skills with some positive results in studies typically of short duration. Studies of vocational interventions, all of poor quality, reported that on-the job supports may promote employment in the community. Similarly, little evidence supports the use of allied health interventions including facilitated communication.

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Conclusions: Few studies have been conducted to assess treatment approaches for adolescents and young adults with ASD, and as such there is very little evidence available for specific treatment approaches in this population; this is especially the case for evidence-based approaches to support the transition of youth with autism to adulthood. Of the small number of studies available, most were of poor quality, which may reflect the relative recency of the field.

This paucity of age-specific research does not

diminish our responsibility as parents, behavior

analysts, and educators to better meet the needs

of our students and clients.

Testing the Application of the

Functionality Index With Adolescents

and Adults With Autism

Peter F. Gerhardt ABAI Conference, Minneapolis, MN May, 2013

A brief note here The research that follows would not be considered typical behavior analytic research and, as such, is unusual for an ABAI symposium and very preliminary.

However, if found to be both valid and reliable, the Functionality Index should prove to be a useful tool for behavior analysts working in autism, particularly adolescents and adults with autism.

For an excellent discussion on expanding the parameters of behavior analytic research I would refer you to Vyse (2013) and its subsequent commentaries.

So please bear with me here.

*Vyse, S., (2013). Changing course. The Behavior Analyst. 36, 123-135. (And subsequent commentaries)

Adaptive Behavior Intervention

The parameters of effective intervention in adaptive behavior would appear to include: 1. Context – Where instruction takes place 2. Intensity – How often instruction takes place 3. Efficiency – What is the response

effort/equivalence associated with instruction 4. Transfer of control – Where does stimulus

control lie 5. Value – Why might this skill be important to the

student

Context The primary rule in the provision of effective adaptive behavior instruction is, “Teach where the behavior is most likely to be displayed.” It has been long documented that most individuals with autism do not independently generalize skills to new environments or maintain skills that are of little use in their primary environments. This again highlights the importance of context as an instructional variable.

Further, even the youngest individuals in transition will remain in a classroom environment for, at most, the next 7 years. Upon graduation, however, they will never again be in a similar environment and, instead, must be prepared with skills and competencies that work in the environments where they will spend the rest of their lives (i.e., their neighborhoods, communities of faith, home, etc.)

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Intensity

Intensity refers to the rate of instruction across a given time period; day, week, or month.

There is an extremely large body of research supporting that fact that a certain level of intensity is required if skill mastery is to be demonstrated with all of us.

Intensity  By way of example, consider the 5-year old with ASD who

required 1,000 trials (50 sets of 20 trials) of color identification to consistently identify all 64 colors in the Crayola box across all teachers and all environments.

 Now take the same child at age 15 with the goal being that of buying lunch at Burger King. If he is provided 1(one) instructional opportunity (i.e., trial)/week, it will take more than 15 years to provide the 1,000 trials that were necessary to acquire a relatively simple discrimination skill (color ID).

 As such, a lack of skill acquisition is often not a function of learning ability but rather insufficient intensity within our instructional protocols.

Efficiency  Directly related to both skill generalization and maintenance

is response effort and equivalence. This combination constitutes response efficiency which is the ease with which a task (desirable or not) can be accurately accomplished.

 Incorporating the concept of response efficiency in instructional programming can be illustrated by the example below on cell phone use.  As a function of functioning level, different response efficient

interventions may include:  Teaching to initiate calling, dial numbers from memory, or look

up in the relevant directory, or;

 Teaching to dial by finding a familiar face or icon in the phone’s contact directory, or;

 Teaching to dial by pressing a single face or icon, out of a small number of such, on the phone’s home screen, or;

 Teaching simply to retain phone with him/her to allow for answering of the phone and, as appropriate, GPS monitoring.

Transfer of Control  A general goal of many ABA-based programs is for

teachers to demonstrate stimulus control over their students and classroom.

 However, the ultimate goal of any transition program is to transfer such control from the teacher to both the environment (e.g., stop at the red light) and the individual themselves (e.g., via self management).

 Pragmatically, as individuals age and move from a ratio of 1:1 instructional support to, at best, a ratio of 4:1, the importance of transfer of control rapidly becomes clear.

Value Skills that are of great value (i.e., highly preferred, have significant functional utility or provide access to R+) to the individual tend to be skills that, once acquired, are maintained over time with little additional intervention.

Conversely, skills that are of little value generally require significant instructional intensity both during skill acquisition and maintenance phases.

Any effective and appropriate program of intervention needs to combine both high-value and low-value targets in such a way as to support engagement, competence, maintenance, enjoyment, and personal safety.

• Functionality: the degree to which a skill, if acquired, can be applied across multiple environments, domains, or toward access individual preferences, interests, or desires.

• Degree of Independence Granted: the degree to which the acquired skill reduces dependence upon another individual across multiple environments.

• Acceptable Error Rate: the level of error that would be expected under typical conditions for a skill to be consider mastered.

• Acceptable Level of Risk: the level of risk to self or others, if error level is exceeded OR the may be present during training.

• Individual Enjoyment: the extent to which an individual will be able to access reinforcement through the participation in, or demonstration of, the skill.

• Relationship to Community Inclusion: The extent to which mastery of the skill allows the individual to navigate increasingly diverse and complex environments or communities.

Using the following definitions

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Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1 (>20%)

(>15%) - 2

Moderate – 3 (>10%)

(>5%) - 4

Near 0 – 5 (< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Degree of Independence

Granted

Acceptable Error Rate Level of Risk Enjoyment

Community Inclusion

Functionality: the degree to which a skill, if acquired, can be applied across multiple environments, domains, or toward access individual preferences, interests, or desires.

Degree of Independence Granted: the degree to which the acquired skill reduces dependence upon another individual across multiple environments.

Acceptable Error Rate: the level of error that would be expected under typical conditions for a skill to be consider mastered.

Acceptable Level of Risk: the level of risk to self or others, if error level is exceeded OR the may be present during training. The risk of not providing instruction may be considered as separate level.

Individual Enjoyment: the extent to which an individual will be able to access reinforcement through the participation in, or demonstration of, the skill.

Relationship to Community Inclusion: The extent to which mastery of the skill allows the individual to navigate increasingly diverse and complex environments or communities.

Method An on-line survey was distributed via Survey Monkey to 60 educators and behavior analysts working at a behaviorally based school in NYC.

Respondents were asked to use the Functionality Index (FI) to score 8 instructional goals randomly selected from an existing IEP developed for a 17 year old man with autism with an intellectual disability

Rated IEP Goals

 Tooth brushing

 Sight words

 Street Crossing

 Reading for information

 Math facts – Addition & Subtraction

 Using a Credit/Debit Card

 Playing a video game

 Sorting by categories

Results

Of the 60 surveys, 33 were returned. Of these, four were considered unusable as they were incomplete leaving 29 usable responses.

Rankings were totaled for each IEP goal and the averages were plotted on the FI. Results are presented in the following slides.

Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1

(>20%)

(>15%) - 2

Moderate – 3

(>10%)

(>5%) - 4

Near 0 – 5

(< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Degree of

Independence

Granted

Acceptable Error

Rate Level of Risk Enjoyment Community

Inclusion

Tooth Brushing

Range Range Range Range Range

Range

4-5 1-4 4-5 1-2 1-2

1-4

Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1

(>20%)

(>15%) - 2

Moderate – 3

(>10%)

(>5%) - 4

Near 0 – 5

(< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Degree of

Independence

Granted

Acceptable Error

Rate Level of Risk Enjoyment Community

Inclusion

Sight Word

Range Range Range Range Range

Range

4-5 1-4 4-5 1-2 1-2

2-4

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Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1

(>20%)

(>15%) - 2

Moderate – 3

(>10%)

(>5%) - 4

Near 0 – 5

(< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Degree of

Independence

Granted

Acceptable Error

Rate Level of Risk Enjoyment Community

Inclusion

Street Crossing

Range Range Range Range Range

Range

3-4 4-5 4-5 5 1-2

2-4

Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1

(>20%)

(>15%) - 2

Moderate – 3

(>10%)

(>5%) - 4

Near 0 – 5

(< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Degree of

Independence

Granted

Acceptable Error

Rate Level of Risk Enjoyment Community

Inclusion

Reading for Information

Range Range Range Range Range

Range

3-5 4-5 1-5 1-2 1-2

1-2

Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1

(>20%)

(>15%) - 2

Moderate – 3

(>10%)

(>5%) - 4

Near 0 – 5

(< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Degree of

Independence

Granted

Acceptable Error

Rate Level of Risk Enjoyment Community

Inclusion

Math Facts

Range Range Range Range Range

Range

1-4 2-4 3-5 1-2 1-2

1-2

Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1

(>20%)

(>15%) - 2

Moderate – 3

(>10%)

(>5%) - 4

Near 0 – 5

(< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Degree of

Independence

Granted

Acceptable Error

Rate Level of Risk Enjoyment Community

Inclusion

Using Debit/Credit Card

Range Range Range Range Range

Range

2-5 2-5 4-5 2-5 1-3

3-5

Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1

(>20%)

(>15%) - 2

Moderate – 3

(>10%)

(>5%) - 4

Near 0 – 5

(< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Degree of

Independence

Granted

Acceptable Error

Rate Level of Risk Enjoyment Community

Inclusion

Playing a Video Game

Range Range Range Range Range

Range

2-4 1-4 1-2 1-3 3-3

1-4

Functionality

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Large – 1

(>20%)

(>15%) - 2

Moderate – 3

(>10%)

(>5%) - 4

Near 0 – 5

(< 1%)

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

Somewhat - 2

Moderate - 3

Very - 4

Total - 5

None - 1

Somewhat - 2

Moderate - 3

Very - 4

Critical - 5

None - 1

Degree of

Independence

Granted

Acceptable Error

Rate Level of Risk Enjoyment Community

Inclusion

Sorting by Categories

Range Range Range Range Range

Range

2-5 2-5 4-5 1-2 1-2

2-5

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Functionality Index Score Distribution Functionality Independence Error Rate Risk Enjoyment Inclusion

Tooth 4.5 3.1 4.4 2.6 1.4 2.2

Sight Words

4.5 3.0 4.5 1.2 1.2 3.6

Street Crossing

3.6 4.5 5.0 4.9 1.4 3.0

Reading 4 Info

4.4 4.2 2.9 1.6 1.4 1.4

Math Facts 3.2 3.0 4.5 1.6 1.4 1.4

Credit Card

3.0 3.2 4.8 3.6 2.7 3.6

Video Game

2.6 2.6 1.5 1.5 4.1 2.5

Category Sort

4.0 4.1 4.4 1.5 1.5 3.2

Functionality Index Ranking

Functionality Independence Error Rate Risk Enjoyment Inclusion

Tooth Brushing

1 (tie) 4 3 (tie) 3 3 (tie) 5

Sight Words

1 (tie) 5 (tie) 4 (tie) 6 7 1 (tie)

Street Crossing

4 1 1 1 3 (tie) 3

Reading 4 Info

2 2 5 4 (tie) 3 (tie) 6 (tie)

Math Facts 6 5 (tie) 4 (tie) 4 (tie) 4 (tie) 6 (tie)

Credit Card

5 6 2 2 2 1 (tie)

Video Game

7 7 6 5 (tie) 1 4

Category Sort

3 3 3 (tie) 5 (tie) 6 2

Functionality Index Combined Scores

Functionality Ranking Risk

Street Crossing 12 Very High 4.9

Credit Card 14 Moderately High 3.6

Category Sort 17 Very Low 1.5

Tooth 18 Moderately Low 2.6

Sight Words 18 Very Low 1.6

Reading 4 Info 18 Very Low 1.2

Math Facts 25 Very Low 1.4

Video Game 25 Low 1.5

Results The results indicate that, in its current form, the Functionality Index may provide some fairly reliable information with regard to goal selection.

The results also indicate that the most “functional” goals are also those associated with highest risk.

An interesting result is that the only potential leisure skill on the list was rates a least functional. This may be more associated with respondents using a definition of functionality different for how it is defined in the Index.

Limitations  This is a very preliminary analysis of the utility of the

Functionality Index in goal selection by behavior analysts. As such, significantly more research is required before validity and reliability can be established for the instrument itself.

 Further, long term studies on the impact of the FI on skill acquisition, generalization, maintenance, and the direct impact of targeted competencies on quality of life will need to be completed before broad acceptance is possible.

 In addition, future studies should address the potential utility of the FI in assessing social validity of instructional goal. On way but which this might be accomplished for community members to complete the FI relative to a specific environment or task chain.

Limitations Future research should also investigate the relationship, if any, of demographic characteristics (e.g., Special Education Profession or Behavior Analyst, years in field, type of school program, etc.)

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Discussion A new tool, the Functionality Index, was investigated as to its potential utility in assisting behavior analysts in goal selection.

While very preliminary the results are promising and future research is warranted.

On area of research would be to assess the extent to which the Functionality Index can act to support a predictive model of rate of skill acquisition, generalization, and maintenance.

Discussion Of particular interest was that the two skills rated highest overall in functionality (i.e., street crossing and using a credit card) were also rated highest in potential risk. This would indicate that skills or skill sets with the greatest potential to directly impact the lives of adolescents with autism may also be those where fewer of the associated variables are controllable or, for that matter, even known. These are, however, the conditions under which the field of ABA may have its greatest potential impact with reference to QOL. Unfortunately, this has not been an active focus of research or practice and, as such, our knowledge-base is lacking.

A future implication?  It is generally accepted that individuals with ASD demonstrate

challenges in the generalization of mastered skills from one environment to another (e.g., Handleman & Delmolino, 2005)

 Yet there are those children who generalize the operation of the DVD/Blue Ray player from unit to unit, from house to house, and from home to school without any additional intervention.

 The question then becomes to what extent a failure to generalize a particular skill is due to:

1. A neurological challenge associated with a Dx of autism.

2. Our failure to attend to context as a critical variable?

3. Our failure to provide sufficient opportunities to respond that may be necessary for true mastery?

4. Our failure to consider the relationship between skill value the effort needed to complete the skill?

5. Our failure to transfer control from the classroom environs to the world outside?

•Low Value + High Effort = Slow Rate of SA and No Generalization

•High Value and High Effort = Moderate Rate of SA & Significant Generalization

•Low Value + Low Effort = Moderate Rate of SA & Poor Generalization

•High Value + Low Effort = High Rate of SA & Significant Generalization

High Value Skill

Low Value Skill

Low Effort Skill

High Effort Skill

Writing Adaptive Behavior Goals

Step 1: Start with a reasonable explanation as to why this is an important skill given individual’s overall profile and goals.

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Step 1: Start with a reasonable explanation as to why this is an important skill given individual’s overall profile and goals.

Step 2: Identify the context where the skills will be of greatest utility. If possible, spend a little time there to see how the skill is actually used.

 Step 1: Start with a reasonable explanation as to why this is an important skill given individual’s overall profile and goals.

 Step 2: Identify the context where the skills will be of greatest utility. If possible, spend a little time there to see how the skill is actually used.

 Step 3: Define your goal (and objectives) in a way that is most congruent with context and how the skill will be used. For example, “When at the grocery store John will, using cash or debit card, independently purchase up to 5 items (placing on belt -> waiting -> paying -> bagging and placing back in cart).

Step 1: Start with a reasonable explanation as to why this is an important skill given an individual’s overall profile and goals.

Step 2: Identify the context where the skills will be of greatest utility. If possible, spend a little time there to see how the skill is actually used.

Step 3: Define your goal (and objectives) in a way that is most congruent with context and how the skill will be used. For example, “When at the grocery store John will, using cash or debit card, independently purchase up to 5 items (placing on belt -> waiting -> paying -> bagging and placing back in cart).

Step 4: Describe instructional strategy and reinforcement schedule and related parameters.

 Step 1: Start with a reasonable explanation as to why this is an important skill given an individual’s overall profile and goals.

 Step 2: Identify the context where the skills will be of greatest utility. If possible, spend a little time there to see how the skill is actually used.

 Step 4: Describe instructional strategy and parameters of reinforcement schedule

 Step 5: Define intensity as number of opportunities to respond per interval.

Step 1: Start with a reasonable explanation as to why this is an important skill given an individual’s overall profile and goals.

Step 2: Identify the context where the skills will be of greatest utility. If possible, spend a little time there to see how the skill is actually used.

Step 4: Describe instructional strategy and parameters of reinforcement schedule

Step 5: Define intensity or number of opportunities to respond per interval.

Step 6: Determine mastery criteria inc. type of acceptable errors.

Step 1: Start with a reasonable explanation as to why this is an important skill given an individual’s overall profile and goals.

Step 2: Identify the context where the skills will be of greatest utility. If possible, spend a little time there to see how the skill is actually used.

Step 4: Describe instructional strategy and parameters of reinforcement schedule

Step 5: Define intensity or number of opportunities to respond per interval.

Step 6: Determine mastery criteria inc. type of acceptable errors.

Step 7: Determine steps necessary to prep community to support instruction.

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Step 1: Start with a reasonable explanation as to why this is an important skill given an individual’s overall profile and goals.

Step 2: Identify the context where the skills will be of greatest utility. If possible, spend a little time there to see how the skill is actually used.

Step 4: Describe instructional strategy and parameters of reinforcement schedule

Step 5: Define intensity or number of opportunities to respond per interval.

Step 6: Determine mastery criteria inc. type of acceptable errors.

Step 7: Determine steps necessary to prep community to support instruction.

Step 8: Implement, troubleshoot, etc.

My Thinking as to a Reasonable Transition of % Academic v. Adaptive IEP Goals as a Function of Age

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

12 13 14 15 16 17 18 19 20 21

Adap ve

Academic

Age in Years

% I E P G O A L S

An overly brief discussion of social skills

as adaptive behavior

A quick opinion here: I currently think that no other set of adaptive competencies relies so heavily on extremely subtle environmental cues for their correct display than do social competencies. So in this special case, the “Applied” is as critical as are the “Behavior” and the “Analysis”. Absent context, the vast majority of social competencies are meaningless. I would, therefore, point out that independent of how evidence-based your interventions may be, teaching social skills well but out of context is really no better than teaching these skills poorly, either in or out of context.

Minimally we need to understand social competence from a functional perspective

 Social skills might best be understood as access and navigation skills… they are how we acquire desirables and avoid negatives by successfully navigating (and manipulating) the world around us. They are complex, multilayered skills that are bound by both content and context. We are only social for a reason.

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The Increasing Demands of the Social World

 Your social demands are often lowest within your home. Why? Because you set the rules of acceptable behavior.

 Your social demands at work or school are higher. However, both are somewhat scripted social environments and ones with a secondary measure of competence (i.e., production or grades).

The Increasing Demands of the Social World

 Next comes the community at large. Why? Because in the community you have less control over events and actions that impact you.

 Lastly comes the world beyond your community. Whether a different social circle or different country, chances are you social skill repertoire may be less than adequate.

Adaptive Behavior In the Men’s Room. The Urinal Game: Please choose wisely

Two often ignored areas of adaptive

functioning in adults

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Adaptive Behavior and Incarceration

Professionals have been aware of high rates or learning and behavior disorders among incarcerated youth for some time (Moffitt, 1990) leading some professionals to characterize the juvenile justice system as a default system for special needs learners with more complex emotional and behavioral challenges (Quinn, et al, 2005)

Adaptive Behavior and Incarceration

Paterson, (2008) looked at two adults with Asperger Syndrome incarcerated in the U.K. Both individuals faced challenges understanding the complex formal and informal social hierarchies of prison life and accepting unfamiliar or non- preferred rituals and routines. Both were ultimately placed in a modified form of secure custody for their own safety.

And sexuality…

TV MA

The following part of this presentation contains language and imagery of a sexual nature and may be considered inappropriate for younger listeners and viewers.

Let’s then start at the start Puberty

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Puberty According to Medilexicon's on-line medical dictionary puberty is a sequence of events by which a child becomes an adult, characterized by the beginning of gonadotropin secretion, gametogenesis, secretion of gonadal hormones, development of secondary sexual characteristics, and reproductive functions. In girls the first signs of puberty may be evident after age 8 with the biological process largely completed by age 16. In boys, puberty normally begins at age 9 and is largely completed by age 18. Ethnic and geographic factors may influence the time at which typical milestones may occur.

Puberty Boys in the United States are starting puberty earlier than ever, according to a study published in the November issue of the journal Pediatrics. In the study, lead author Marcia Herman-Giddens from the University of North Carolina School of Public Health found that boys are starting to develop sexually 6 months to 2 years earlier than usual.

There has even been some discussion of ASD being associated with early onset or precocious puberty. In general, puberty can be thought of as a river being held in check by a dam. Negative or inhibitory impulses hold back puberty from starting early. Any "crack" in the dam can bring on puberty earlier by canceling these inhibitory impulses. Little data exists to support or refute this theory however.

Puberty and ASD

Not surprising, there is very little research on the impact/intersection of puberty and ASD. In fact, a quick search of the PsyScan database using “autism” and “puberty” as keyword search terms results in only 18 articles between 1979-2012. A similar search of the PubMed database results in 71 articles between 1963-2012. These results, while not unexpected, are still disheartening.

Puberty and ASD There is a tendency for parents and professionals to ignore or misinterpret:

The emotional impact of adolescence on growing individuals with ASD.

Reflex, or spontaneous, erections as being sexual in nature.

Genital stimulation is pretty much a universal phenomena.

That individuals on the spectrum are, by definition, sexual beings.

The importance of anticipating puberty and sexual development and planning for such.

Personal (i.e., sexual) safety and the 5-year rule

ASD, Puberty, and Adaptive Behavior

There is an ongoing debate regarding the impact of puberty on the display of challenging behavior. None of these discussions, however, have resulted in any general agreement or actual data. What seems to be true, however, is:

For some individuals the onset of puberty may be associated with an increase in emotional labiality and challenging behavior

This increase, however, may then be reinforced as a result of their newly realized increase in size and strength (i.e., the behavior is now more effective).

We, not surprisingly, do tend to see behavior challenges associated with menstrual cycles.

A new class of behavior maintained by R+ in the form of sexual stimulation may develop.

But other factors such as curriculum, boredom, staffing, restrictiveness of the environment etc. may also be related.

Why ABA-based interventions to teach

sexuality?

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Sex is just behavior. Whether a penis goes into a vagina, into an anus, or there is no penis involved at all, it is all just behavior.

-J. Bering, (2012)

Despite much discussion about decision making skills in the self-determination literature (e.g., Clark, et al., 2004), there continues to be “lack of evidence [supporting the] effectiveness of sex education and training for persons with developmental disabilities” (Duval, 2002, p. 453) which Behavior Analysis is able to provide.

Many of the basic instructional goals in sexuality education boil down to simple and complex discrimination skills. For example:

Boy or Girl

Men’s room or Lady’s room (or Blokes v. Shielas; Senors v. Senoritas; M v. W; Nuts v No Nuts, and so on…)

Where or with who you can/cannot:

Be naked

Masturbate

Curse

Help with toileting or menstrual care

Leave school with

Touch certain parts of your body

Now before you all start getting uncomfortable

 At it’s core, sexuality education is about safety and not about sex.

 There is no reason to believe that access to accurate information in the form discussed will lead to increased sexual behavior.

 Sexuality, as an area of intervention, needs to carefully coordinated with the family and in-line with family social norms, values, and religious beliefs.

 In fact, I would estimate that at least 80% of sexuality education should take place in the home and not at school.

 Sexuality education needs to be consider a core educational consideration and is particularly well suited for behavior analysts.

Sadly…

Sex and sexuality, as serious topics for discussion, are ones that many of us would rather avoid than address. This may be even more true when the issue is sexuality and learners with ASD.

Sexuality In two (somewhat) recent studies, (McCabe & Cummins, 1996; Szollo & McCabe, 1995) researchers concluded that individuals who have an intellectual disability have lower levels of sexual knowledge and experience in all areas except menstruation and body part identification whecompared to a typical student population.

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Sexuality

Stokes, Newton, & Kaur (2007) examined the nature of social and romantic functioning in adolescents and adults with ASD. What they found was that individuals with ASD were more likely than their NT peers to engage in inappropriate courting behaviors; to focus their attention on celebrities, strangers, colleagues, and exes; and to pursue their target for longer lengths of time (i.e. stalking).

But in reality sex and personal sexuality are just

components of adaptive behavior

A Couple of Good Reasons Why We Should Provide

Human Sexuality Education To Individuals With ASD

Number 4…

They Have The Same Hormones and Urges

and Need To Make The Same Choices As

Their Peers

Number 3…

The Internet and other readily accessible media

Internet Rule #34

If you can imagine it,

then it exists as internet

porn.

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From a new eboo friend

"Hey, I added you since you look familiar, but once I looked at your page I knew I was mistaken.. but hey, you seem like a good guy so i'll just introduce myself :) Im quirky, funny, and never afraid to have a good time.. I recently moved here about six months ago from a small town in Idaho for work and like it so far! Check out my profile.. if you want to I would love to meet sometime for lunch. Any way.. I wanted to attach more photos of me but its giving me some stupid error! If you give me your email addy I can send the pics to you that way. Hope to hear from you soon!"

From another new friend

How are you doing today?? you are a really cool and enchanting dude that's why i did opt for a message to you ok winks....Just want to know more about you with due respect that's if you don't mind. do take care and have a wonderful day feel free to reply ok.....with regards Fiona

Number 2...

Sexual Abuse

Self-Protection Teach that refusing to be touched is a right

Teach that secrets about being touched are not OK

Teach self-protection skills

Who can/can’t touch the individual and where on his/her body

How and when to say “No”

How to ask for assistance

How to recall remote events and convey where an individual touched him/her

(American Academy of Pediatrics, 1996; Nehring, 2005; Roth & Morse, 1994; Volkmar & Wiesner, 2004)

Number 1…

Because They Are People & Like All People Individuals with Autism Have The Right To

Learn All They Can To Enable Them To Become Sexually Healthy Persons

As you can tell by now, adaptive behavior competence is, in the final analysis, difficult to teach and difficult to acquire. So is there an easier way that we can can achieve this goal?

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Curb Cuts

“Curb Cut (n) - A small ramp built into the curb of a sidewalk to ease passage to the street, especially for bicyclists, pedestrians with baby carriages, and physically disabled people. [sic]”

So what would constitute a curb cut for someone with ASD?

#1 Decent Choice Making

Instruction

Effective choice making is central to many of the competencies associated with adulthood. However, teaching simple either/or choices is simply not sufficient.

I think I might like an apple

Apple

Granny Smith

Whole Sliced With Cheese

Maybe Applesauce?

Red Delicious

Macintosh Yellow Delicious

If you have nothing else

For Example:

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#2 Train the Typicals

“If you neurotypicals have all the skills, why don’t you adapt for a while dammit! Why is it always me fault?

Donna Vickers

Knowledge can be Powerful!

“… under appropriate conditions interpersonal contact is one of the most effective ways to reduce prejudice between majority and minority group members.” (Alpert, 1954)

Information that can be shared to great benefit

Let’s start with their name.

How other people can best communicate with him/her.

What his/her preferences, likes, and interests are so to better be able to engage them.

What makes him/her smile? What makes him/her unhappy?

What his/her relevant challenges might be.

What autism means in his or her life.

How open is the community to this level of training?

25% are very open

50% are open but nervous

25% are Untrainable!

Teach the right skills in the right context (i.e., where the behavior is most likely to be displayed.

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#4 Accept that life is not perfect

For example, a recent study found that 15% of men and 7% of women didn't wash their hands at a public restroom. When they did wash their hands, only 50% of men used soap, compared with 78% of women. Further, only 5% of people who washed their hands scrubbed long enough to kill germs that can cause infections.

In a recent study on casual sex during spring break, researchers found that 15% of men and 13% of women had sex with someone they just met. Further 77% of college-age women and 83% of men reported having had casual sex at least once.

Errors and mistakes happen all the time. The trick is minimize big mistakes while accepting a certain, “non-dangerous” error level. So is competence to be average? Better than average? What? Accept some variability from time to time.

Don’t Dream It, Be It!

Selected References

Stokes, M., Newton, N., & Kaur, A. (2007). Stalking, and social and romantic

functioning among adolescents and adults with autism spectrum

disorder. Journal of Autism & Developmental Disorders, 37, 1969-1986.

Topper, K., Bremner, W., & Holmes, E.A., (2000). Social competence: The social

construction of the concept. In R. Bar-on & J.D.A. Parker, (Eds.), The

Handbook of Emotional Intelligence, (pp. 28-39). San Francisco: Jossey

Bass.

Taylor, B. A., Hughes, C. E., Richard, E., Hoch, H., & Coello, A. R. (2004).

Teaching teenagers with autism to seek assistance when lost. Journal

of Applied Behavior Analysis, 37, 79-82.

Watanabe, M., Uematsu, T., Kobayashi, S., (1993). Teaching community skills

(bus riding) to students with autism. Japanese Journal of Special

Education. 31, 27-35.

Watson, Griffiths, Richards, & Dysktra (2002). Sex Education, In Griffiths,

Richards, Federoff, & Watson (Eds.). Ethical Dilemmas: Sexuality and

Developmental Disability. (pp 175-225). Kingston, NY: NADD Press

Selected References

Cederlund, M., Hagberg, B., Billstedt, E.Gillberg, C., & Gillberg, C., (2008).

Asperger syndrome and autism: A comparative longitudinal follow-up

study more than 5 years after the initial diagnosis. Journal of Autism

and Developmental Disorders, 38, 72-85.

Glennon, T.J., (2001). The stress of the university experience with students with

Asperger syndrome. Journal of Assessment, Prevention, and

Rehabilitation, 17, 183-190.

Green, J., Gilchrist, A., Burton, D., & Cox, A. (2000). Social and psychiatric

functioning in adolescents with Asperger Syndrome compared with

conduct disorder. Journal of Autism and Developmental Disorders, 30,

279-293. Hagner, D., & Cooney, B.F. (2005). “I do that for everybody”: Supervising employees with autism. Focus on Autism and other Developmental Disabilities, 20, 91-97.

Ivey, J. K. (2007). Outcomes for students with autism spectrum disorders: What

is important and likely according to teachers? Education and Training

in Developmental Disabilities, 42, 3-13.

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Selected References

Lattimore, L. P., Parsons, M. B., & Reid, D. H. (2006). Enhancing job-site training of

supported workers with autism: A reemphasis on simulation. Journal of

Applied Behavior Analysis, 39, 91-102.

Lee, H.J., & Park, H.R., (2007). An integrated literature review on the adaptive

behavior of individuals with Asperger syndrome. Remedial and Special

Education, 28, 132-141.

Mazefsky, C., Williams, D., & Minshew, N. (2008). Variability in adaptive

behavior in autism: Evidence for the importance of family history. Journal of

Abnormal Child Psychology, 37, 921-928.

McClannahan, L. E., McGee, G. G., MacDuff, G. S., & Krantz, P. J. (1990).

Assessing and improving child care: A personal appearance index for

children with autism. Journal of Applied Behavior Analysis, 23, 469-

482.

Selected References

Mesibov, G.B., Current perspectives and issues in autism and adolescence. In E.

Schopler & G.B. Mesibov (Eds), Autism in Adolescents and Adults, (pp. 37-

56). New York: Plenum

Myles, B.S., Lee, H.J., Smith, S.M., Tien, Y., Swanson, T.C., & Hudson, J. (2007). A

large scale study of the characteristics of Asperger syndrome. Education

and Training in Developmental Disabilities, 42, 448-459.

Okuda, K. (2001). Toilet training for an adult with autism, severely disturbing

behavior, and mental retardation 23-31. Japanese Journal of Special

Education, 39, 23-31.

Quinn, M.M., Rutherford, R.B., Leone, P.E., Osher, D.M., & Poirier, J.M. (2005).

Youth with disabilities in juvenile corrections: A national Survey.

Exceptional Children, 71, 339-345.

Smith, M. D., & Belcher, R. (1985). Teaching life skills to adults disabled by autism.

Journal of Autism and Developmental Disorders, 15, 163-175.