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a powerpoint presentation regarding why kids

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This “PowerPoint” slide show was used in one of Dr. Mac’s workshops
regarding youngsters with PDD (Pervasive Developmental Disorder…Autism,
Aspergers Syndrome, etc). Certain “notes’ slides (like this one) have been added
to help to explain the slides.
Understand, however, that there was three hours of narration accompanying
this slide show. The notes provided will certainly not provide the detail and
explanations provided during the workshop.
There is also a “code” to running the slide show. The slide show will run by
itself unless you see a red or green punctuation mark. A red question mark,
colon, or period indicates that the show has stopped and that you must click
your mouse to continue. A green punctuation mark means that you have
reached the end of the material on a particular slide. You must left-click on
your mouse to advance to the next slide. (click to advance to the next slide)
.
“Defiance”
(failure to comply)
from Kids with Pervasive
Developmental Disorders
(Autism, Aspergers Syndrome)
Understanding It, Assessing It, &
Doing Something About It
(in effective, respectful & professional ways)
Tom McIntyre, Ph.D., www.BehaviorAdvisor.com
.
Our Kids: A Review
What is IT that brings out the
“autistic-like” actions that our kids
display
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?
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Demanding sameness
Displaying odd rituals
“Stimming” (self stimulation actions)
Uttering impolite remarks
Resisting assistance or direction
Refusing to comply
Aggression against others…push, bite, hit, kick, grab hair, etc.
Self abuse
etc.
IT’S ALL ABOUT A
N X I E T Y.
Anxiety? From What?
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Life being experienced as
a series of random events.
The student remains in a heightened state of
tension and alertness, not knowing what
might happen next.
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Unlike most youngsters, our PDD kids’ brains are
unable to:
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organize the world effectively
learn quickly from experiences
recognize repeating patterns in life.
Life is uncertain & it’s happenings unpredictable.
Unstructured environments, and adults who are
“emotionally unpredictable”, add to our
students’ problems with organization.
Stress develops from being unsure of what will
happen next & defenses against the building
anxiety are employed.
Which Common Traits
(the appearance of which lead to the diagnosis of PDD)
Make Them Prone To Stress?
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Difficulty interpreting events accurately
Difficulty adapting to change
Limited ability to self soothe
Limited expressive language to tell us what
they are thinking & feeling.
Limited receptive language skills to make
sense of the words spoken to them.
Life as a Series of Random Events
пЃ®
Imagine that you’re the rat in a “shock box”, a walled-in floor with a
center line dividing the two halves.
 You move across the center line of the box to other side when you’re
electrically shocked on the side where you were placed. You’re certainly
“on edge” and wary after this event (and subsequent shocks to
whatever side you are currently on), but your coping strategies allow you
to escape punishment and continue functioning well.
пЃ® Imagine then an electrical shock periodically and suddenly administered
to your side. Sometimes you can escape to the other side of the box. At
other times, the other side is also electrified. Might you develop odd
rituals (much like some sports professionals who engage in certain actions
previous to engaging in the event), “withdraw” (just like some rats that give up
trying to figure out the system, lie down, and endure the pain), and/or strike
out at the approach of others (because we’re tense, afraid, and unsure of their
пЃ®
intentions…especially when they react differently at different times).
Sorry for the comparison, but we’re mammals too, and react like others
of our ilk.
Rats & Other Mammals (Like Us)
пЃ®
“Odd” reactions are best understood as an
expression of the “fight-or-flight” dynamic in the
face of a threatening situation.
(real or imagined)
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Inconsistent environments create confusion
and anxiety which lead to:
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Agitation
Aggression
Ritualistic behavior & other ways to withdraw from
the “real world”.
Reactions to This
Granite Planet’s
“Shock
пЃ®
Box”
For psychological defense in the face of profound
anxiety (caused by randomness), our PDD kids:
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Retreat into isolated worlds of fantasy or
“soothing” self stimulation (rocking, chanting, head banging, fingerplay)
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Aggress toward themselves or others
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Perseverate in soothing rituals, adhere to
rigid rules of behaving, or turn conversation
to favorite topics.
Antecedents To “Fight-or-Flight” Responses
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Unfamiliar settings/experiences
(even if nearly identical to one with which they are familiar)
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Experiences in a familiar environment that are
inconsistent with the student’s expectations. Like?
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Same-time exposure to multiple familiar stimuli
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New bulletin board, student, or seating arrangement
Asst. teacher didn’t park his/her car in the usual space.
Former teacher visits the present classroom
What else?
Intermixing of reality and fantasy worlds
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From subtle magical beliefs
 (“It’s only safe to drink from red smiley-faced cups.”) OTHERS?
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To gross auditory and visual hallucinations.
Shutting Out This World
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What “benefits” result from using social isolation?
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Cuts off overwhelming anxiety and confusion
Unfortunate consequences to withdrawal?
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Undermines caretakers’ ability to gather information
from youngster that would help us to understand the
situation and respond effectively.
Allows the student to ruminate in his/her own confused
thoughts without input from others to help him/her
perceive reality more clearly.
Purposes of Aggression?
пЃ® Protection
against a (perceived) threat
пЃ® Make the source of anxiety withdraw.
Obsessions, Rituals & “Stimming”
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Can be personal “quirks” or major interferences in one’s
life
What are some common rituals seen among your
kids with autism, Aspergers, and other PDDs: ????
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Head banging (to sooth oneself after being touched softly by you)
Rocking
Finger play
Repeating verbal utterances
Turning all conversations to topics in which one is learned/interested
Rigid adherence to idiosyncratic rules
Required procedures for “setting the stage”.
Linked to a “neuro-cognitive tendency for perseveration”
(locking into a repetitive thought or behavior, like a skipping record).
Purposes of Repetitive Behavior?
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Familiarity is soothing and self-reinforcing
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(Although the actions may also have been unintentionally reinforced by others)
Rituals give a sense of:
пЃ® Accomplishment
пЃ® Mastery
пЃ® Safety from anxiety
пЃ® Security
пЃ® Control over a situation.
Extreme things that many “normal” people do might include:
пЃ® Vacuuming several times a day (keeps the environment looking
unchanged)
пЃ® Excessive care of pets (one feels worthwhile & nurturing when
treating the animal like a child in one’s care)
пЃ® What things do you return to that give your solace, comfort, or sense of
accomplishment?
пЃ® Re-read a book, watch a movie again, visit familiar places
 Me: At night; visit with daughter and wife, watch “West Wing” on TV
with glass of wine while holding hands.
Surrounding the sleep experience, this infant
experiences the same routine (just like there are routines
for dressing in the morning, preparing to enter the car,
preparing for a meal): Soft piano music, reading of a
book (or two), singing “Good night ladies”, and a kiss
goodnight. Accompanied by the same loving statement.
Awakens to the “Good morning” song and tour of house
(in the same order of rooms as the previous day).
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Routines & consistency give kids comfort in a
world that can seem random. It gives them
respite from trying to comprehend the what they
experience.
General
Reasons for
Defiance in
Kids with PDD?
Misunderstandings due to a
weak ability to organize life’s
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Misperceives the situation:
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Misinterprets approach as having hostile intent
Displays inappropriate behavior because of difficulty
generalizing what has been learned about the world and
appropriate behavior to similar settings/events
OR has formed rigid models for understanding how
the world works
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Exceptions to their expectations, even minor discrepancies
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Produce anxiety
Bring about the fight-or-flight reaction
.
Because They Are Confused
& Uncomfortable
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They remain in a constant state of hyperarousal to possible threats
OR
Retreat (when overwhelmed) into social
isolation, rituals, or a fantasy worlds in
order to minimize confusion, obtain
comfort, and limit his/her psychological
vulnerability.
Show Time!
In this video clip, imagine that the student has a form of PDD
Phil is a kids with Asperger’s Syndrome.
пЃ¬ In this situation, what is the stressor?
пЃ¬ How does he react to the anxiety?
пЃ¬ How might teachers other than this one react?
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пЃ¬ Unproductively
пЃ¬ Productively
How Anxiety Due to Randomness Affect
STAFF Who Work With Kids With PDD
Because our students react in unpredictable
ways, we have a career equivalent of a
“shock box”.
 We experience “random” reactions to our
interventions, often developing strategies
similar to those of our students.
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The Staffs’ “Shock Box”
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Student actions seem inexplicable, unpredictable,
personally charged, or random. Student behavior
may be viewed as a threat (to our authority,
professional self image, physical safety). We often
respond in “shock box” ways to the “random” or
“threatening” environment (just like our kids react to
these stressful circumstances).
пЃ® Hostility (verbally or physically)
пЃ® Rejection (refusal to work with the student)
 “Flight” (pull back or leave when feel ineffective/threatened)
 Withdrawl (avoid approaching students who cause us “pain”)
 “Odd” rituals to prevent behavior or make it go away
(because it worked once or twice before).
? What are some examples of:
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Staff hostility when agitated?
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Withdrawal when unable to influence the situation?
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Angry words
Physical attack (pinching, pushing, restraining)
Threatening postures/gestures/facial features
Punishment without instruction in how to behave in new ways
Ignoring/walking away from head banging
Failing to intervene in a developing situation because of uncertainty as
to what to do (or fear of experiencing “professional pain”)
Ineffective reactions/rituals to unpredictable situations?
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Telling a student to “Be good.” or “Be careful.”
Rituals (holding up finger to warn to stop, saying “Don’t be getting all huffy
now.”)
So What Do Responsible Staff Members Do?
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True professionals are in control of their emotions.
In stressful situations with students, they stand
back and say to themselves:
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“Here is a kid in crisis who needs help. What would a
caring and competent professional do in this situation?”
We need to be consistently calm, gentle, and
supportive in our interactions with kids with PDD.
Staff members who become irritated or skittish
create a non-consistent stimuli (a shock box) for the
student with PDD.
Consistently calm, gentle, and supportive staff have
their effective interactions sabotaged by colleagues
who are unable to manage their emotions well.
Effective Staff Demeanor
пЃ±
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Emotionally, verbally, and physically calm &
consistent (inter)action, even when under stress.
This consistent, restrained approach reduces
anxiety in the student, and thus the likelihood of
inappropriate behaviors.
However, the chances of us engaging in (continued)
inappropriate, unprofessional, & ineffective
behaviors are increased, unless we search out:
пЃ® New models for understanding our students
пЃ® Better intervention strategies for reducing
and handling stress.
We are calm and tolerant of young children because we realize that
they are doing their best to function and communicate given their
developmental level.
As professionals, we are paid to be tolerant, supportive, and
nurturing to youngsters who are doing their best, under difficult
circumstances, to function and communicate. Consummate
professionals do it because they believe that all individuals are
deserving of dignified & respectful treatment.
Is it defiance? What common traits
might account for these behaviors?
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In a staff member’s absence, the student refuses to respond
verbally or give eye contact to the replacement person (substitute
teacher, supply teacher, person from other part of facility).
пЃ® (Withdrawal from overstimulation; Not yet done with a ritual when the
new staff member intervenes)
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Laughing at other’s misfortune.
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Your direction brings a destruction of materials or self abuse.
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(Receptive language problem; Literal interpretation of your language —
”What’s shaking?”)
Refusal to sit down immediately upon entry to room.
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(Misinterpretation of an event; paranoid thinking that others are
conspiring to harm him; Your voice and image were distorted by an
hallucination and was threatening to the youngster)
Looks at you blankly after your direction or question.
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(Unusual affect found in kids with PDD)
(The direction is contrary to the youngster’s ritual of touching all handles
on drawers before sitting in an environment)
Barks rude order at you.
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(A social skills deficit evidencing the need for us to instruct in new ways)
Interventions
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Any attempts to replace anxiety-reducing behaviors
must involve:
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Assessing the circumstances surrounding the behavior in
order to determine the…?
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stimuli, reinforcers & other variables that contribute
(see www.BehaviorAdvisor.com page titled “Figuring out why kids misbehave” & “FBA”)
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Reducing ___________in the environment?
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Building a ______________ relationship with student?
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unpredictability (via consistency which reduces stress/anxiety).
a supportive & trusting (see www.BehaviorAdvisor.com page titled “nice ways”).
Teaching alternative behaviors that do what?
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serve the same function in a more socially acceptable manner
(see www.BehaviorAdvisor.com page titled “Differential Reinforcement.”)
.
Questions to Ask Before Intervening
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Is the anxiety-relieving behavior
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Quirky and socially odd, but non-harmful? Examples?
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Rocking
Turning conversation to a favorite topic
Repeatedly asking questions without having listened to the
responses of the previous ones
Uttering repetitive phrases
Debilitating enough to justify denying it to a student with
limited adaptive capacity to develop alternative useful
strategies. Examples?
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Self-abuse
Physical aggression directed toward others
SHOWTIME : A VIDEO
пЃ¬
Your students have been given the task of . . .
and you notice that one young lady is “off task”.
What might be the reason for her behavior?
What setting events and stimuli might have
sparked the behavior? What consequences
maintain this behavior?
пЃ¬
Behaviorist view: All behaviors have a
benefit…so what is it in this case.
Our Continuing Role(s)
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Identify the often counterintuitive, highly idiosyncratic
dynamics driving many of the problematic behaviors. Create
environments that are?:
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Scan new environments for?:
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possible sources of change and stress.
Be attuned to early indicators of student’s quality of thought
and affective state, because?:
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highly predictable, so they don’t require kids to use own internal
resources to create structure.
if they get anxious, their ability to think and learn is impaired.
Chances for “defiance” increase.
Apply support early. Once agitated or confused, it is often
difficult to calm the student.
Discovering Counter-Intuitive Dynamics
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Conduct an “Environmental Assessment”
пЃ® A-B-C and FBA for sources of stress (e.g., transition, new staff member)
for lower functioning (it’s one part of analysis for higher functioning)
(see www.BehaviorAdvisor.com pages by these titles)
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Is the soothing ritual’s quality more kinesthetic (movement oriented) as is
likely with low-functioning kids, or more symbolic (need to touch drawer
handle in room before sitting) as is more typical of high-functioning
youngsters?
For higher functioning kids, follow the “E-A” with psychological testing and
analysis of the child’s inner experience to determine the quality and
character of the:
пЃ® thought processes
пЃ® affective profile
Determine if the child in need of medication for?:
пЃ® anxiety disorder
 distractibility (see www.BehaviorAdvisor.com page titled “ADhD”)
 hyperactivity (see www.BehaviorAdvisor.com page titled “ADhD”)
пЃ® depression (see www.BehaviorAdvisor.com page by this title)
пЃ® psychotic thought processes
Scanning New Environments
for Possible Stressors
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How would you prepare students for a trip to the
firehouse so that it is a “familiar” experience when
the day arrives to visit?
Consider the student’s knowledge base,
transportation, familiarization with the site and
equipment, preparation for frequent events at the
firehouse, & preparing the student to handle
anxiety if it develops.
Field Trip Prep
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Mark on calendar 7 days in advance
Review on calendar each day
Show photos of firehouse & ask to draw what he thinks it will look like
when visits.
Meet bus driver. Visit bus on day before to?
пЃ® Select a seat
пЃ® See where teacher and others will sit
пЃ® Look at map of route & identify things will see on way to firehouse.
Have students draw them.
Describe what will probably be seen at firehouse.
Discuss rules for behavior in this unfamiliar setting
Discuss events that might happen while there (emergency call, jovial humor
uttered).
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Discuss what will do if feel anxious or confused.
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Who to tell about the emerging and escalating feelings
How to express them.
Review the plan several times prior, and again before leaving. Give
students a copy of plan (pictures/words)
Building Student Capacity to
Accept & Seek Out Our Support
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Trust and reliance upon relationships during times of stress
depends on matching the student with skilled, caring, and
persistent professionals who create a predictable environment.
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How can we reach the goal of becoming an empathetic & trusted
guide?
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Build a history of positive interactions/events
 Even though making mistakes, believes we’re trying hard
Be predictable by being:
пЃ® unswervingly calm, positive, supportive, understanding & nurturing
Create “a symphony”…get everyone on the same note on the same line of
music
Realize that disallowing an established strategy is generally
a slow, difficult, and to some degree, traumatic process.
Be highly attuned to the student’s emotional state so that we
are there when needed
Speak in an effective and positive manner.
Building & Maintaining Relationships:
The way we talk to kids is important
Right now, pull the
“Nice Ways…”
packet out of your folder
(for those of you viewing the slide show on your
computer, this material can be found at
www.BehaviorAdvisor.com inside the page titled “Nice
Interventions that build self discipline in kids” )
Trading In Old Behaviors for New
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Use our understanding of the student and the
stressors, and the inappropriate ritual’s soothing
quality to identify possible alternative responses.
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Teach new soothing behaviors while reducing
the inappropriate ritual through
strategies such as negative consequences
or removal of reinforcement.
Teaching
пЃ¬ Visit www.BehaviorAdvisor.com and check out the links titled:
п‚Ў The practices of ABA (8 links under this section)
п‚Ў What is ABA? (Applied behavior analysis)
п‚Ў Contracts
п‚Ў Differential Reinforcement Procedures (reducing misbehavior in positive ways)
п‚Ў Overcorrection
п‚Ў Response Cost
п‚Ў Schedules of Reinforcement (Deciding how often to give rewards)
п‚Ў Self monitoring (Students keep track of their behavior, thus building self-control)
п‚Ў Shaping (Building a desired behavior that the student doesn't show at present)
п‚Ў Task Analysis
п‚Ў Time Out
п‚Ў Token Economies and Point Systems
п‚Ў Managing behavior with your teaching style
п‚Ў Autism
п‚Ў Aspergers Syndrome
 Take a look at the handout you’re about to receive that will offer lots of
tips for various scenarios.
General Principles for Intervention
пЃ± Go
positive!
Punishment does not teach new behavior!
Use the least intrusive intervention possible.
пЃ± Be predictable. Always follow through.
пЃ± Hate the behavior, but stay attached to the
child.
пЃ± NEVER give up on a kid.
пЃ±
The Future (at present)
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Our kids will live their entire lives within the
supportive structure provided by others.
They measure the quality of their lives by their
capacity to obtain security and remove fear.
That optimal state is largely influenced by the
ability to accept and trust in the support and
structure created by others.
THE END
• Feel free to contact me at
Thomas.McIntyre@Hunter.cuny.edu
• And check out www.BehaviorAdvisor.com
where you can post your concerns on our bulletin
board and receive help from teachers around
the world.
Stop Here . . . . Unless time
remains in the session. In that
case move on to “Social Skills”
Assessment of Social Skills
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Assess adaptive functioning
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Capacity for appropriate social behavior
Ability to manage social anxiety
пЃ® Understanding of social conventions
пЃ® Ability to read social cues
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Capacity to use relationships as a source of
emotional support
Social Skills
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Facilitate their ability to establish an accurate
perception of social behavior. How so?
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Provide consistent and simple patterns of social
experiences from which to learn.
Create school environments in which social
interaction is predictable, consistent, and
governed by explicit rules.
Once established, promote the student’s
effective use of this understanding to make
decisions with the social arena.
Examples of Social Rules
(consistently applied and reviewed often with the student)
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Hands, feet & objects to self
(unless part of activity or have permission)
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Use only the real names of others
Ask permission to touch the food & belongings of
others
Raise hand and ask permission to leave seat
If another kid is having a difficult time, inform the
teachers and let them handle things
If you are feeling upset or angry, ask the teacher for a
time out or a chance to discuss the problem
So Why the Refusals or Retreats?
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Manage anxiety from
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Task complexity or volume
Situational inconsistencies
Staff (re)actions
пЃ® Misinterpretation of student behavior
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Take it personally
Unable to handle
Student perception of staff intent or threat potential
пЃ® Misinterpretations of intent
пЃ® Accurate perception of rejecting or hostile action
More Questions
пЃ®
Have we conducted an analysis of the child’s
environment to correlate inappropriate ritualized
behavior with specific events or environmental
dynamics? (We’ll need more than conventional perception or
empathic insight to determine the sources of stress when someone
views the world much differently than us).
пЃ®
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Do we have a procedure/plan?(DR, Shaping, Chaining)
Do we have the necessary
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permission
materials
staff
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