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The Elimination of the Asperger’s Diagnosis

There is a lot of confusion regarding the new Diagnostic and Statistical Manual of Mental Disorder’s (DSM-5) revision to exclude Asperger’s. Hopefully this post will clarify some things…

Taking into account the most up-to-date research, diagnostic criteria in the DSM are revised periodically by a team of professionals. Here are a few of the main changes in the DSM-5 that specifically apply to autism spectrum disorders:
  • Sensory behaviors are included in the criteria for the first time (under restricted, repetitive patterns of behaviors descriptors).
  • The terms used in the DSM-4 are autistic disorder, Asperger’s disorder, childhood disintegrative disorder and PDD-NOS (pervasive developmental disorder not otherwise specified). In the DSM-5, when people go for a diagnosis, instead of receiving a diagnosis of one of these disorders, they will be given a diagnosis of “autism spectrum disorder.”
  • The emphasis during diagnosis has changed from giving a name to the disorder to identifying all the needs someone has and how these affect his or her life.
  • The triad of impairments has been reduced to two main areas: (1) social communication and interaction; (2) restricted, repetitive patterns of behavior, interests, or activities.
  • Also, there are “dimensional elements,” which should give an indication of how much a person’s disorder affects him or her. This should help to identify how much support the individual needs.



The DSM-5 has eliminated Asperger’s as a separate diagnosis and weaves it into Autism Spectrum Disorders with severity measures within the broader diagnosis. In this revision, the individual must meet the criteria in sections A, B, C and D below to receive a diagnosis of Autism Spectrum Disorder:

A. Deficits in social communication and interaction not caused by general developmental delays (the individual must have all 3 of the following areas of symptoms present):
  1. Deficits in social-emotional reciprocity; failure to have a back and forth conversation
  2. Deficits in nonverbal communication (e.g., abnormal eye contact and body language) or difficulty using and understanding nonverbal communication, and lack of facial expressions or gestures
  3. Deficits in creating and maintaining relationships appropriate to developmental level – apart from relationships with parents (this may include trouble adjusting behavior to suit different social contexts, difficulties with imaginative play and making friends, and a lack of interest in others)

B. Demonstration of restricted and repetitive patterns of behavior, interest or activities (the individual must present two of the following):
  1. Repetitive speech, repetitive motor movements or repetitive use of objects (e.g., echolalia, idiosyncratic phrases)
  2. Adherence to routines, ritualized patterns of verbal or nonverbal behavior, or strong resistance to change (e.g., insists on eating the same food, repetitive questioning, or great distress at small changes) 
  3. Fixated interests that are abnormally intense or focus (e.g., strong attachment to unusual objects, restricted interests)
  4. Over or under reactivity to sensory input or abnormal interest in sensory aspects of environment (e.g., indifference to pain, heat or cold, negative response to certain sounds or textures, extreme smelling or touching or objects, fascination with lights or spinning objects)

C. Symptoms must be present in early childhood (although they may not become apparent until social demand exceeds limited capacity).

D. Symptoms collectively limit and hinder everyday functioning.

If your child currently has a diagnosis of Asperger’s – this will not change. In the DSM-5, people will get a diagnosis of “autism spectrum disorder” rather than any of the current DSM diagnostic terms.  The term “Asperger’s” may still be used colloquially by diagnosticians (e.g., for a diagnosis of autism spectrum disorder with similarities to Asperger’s). Also, many people identify closely with the term Asperger’s and may continue to use it in everyday language.

Overall, the changes to the diagnostic criteria are helpful. They are clearer and simpler than the previous DSM criteria. Including sensory behaviors in the criteria is very practical, because many young people with autism have sensory issues which affect them on a day-to-day basis. The emphasis on identifying the full range of difficulties that the person has during the diagnosis process is also convenient.

The DSM criteria are medically-based, and a diagnosis is given when “symptoms together limit and impair everyday functioning.” The criteria create the foundation for diagnostic tools, for example:
  • ADI (Autism Diagnostic Interview)
  • ADOS (Autism Diagnostic Observation Schedule
  • DISCO (Diagnostic Interview for Social and Communication Disorders)

These and other schedules are used to collect information in order to diagnose whether someone is on the autism spectrum or not. Therefore the criteria form the basis for the diagnosis, but the diagnostician’s judgment is very important.

The DSM-5 is an American publication. Most diagnoses in the UK are based on the International Classification of Diseases (ICD), published by the World Health organization. The current ICD (ICD-10) is virtually the same as DSM. The next version of the International Classification of Diseases (ICD-11) is due to be published in 2015. The authors of the ICD will consider the changes made to DSM-5, but their descriptions are often slightly different. Currently, there are no plans to change the label of Asperger’s during the next revision.

Diagnoses using the DSM criteria should always be based on a clinical decision about whether an individual has an impairment which has a disabling effect on his or her daily life. If a person gets a diagnosis of an autism spectrum disorder, it is likely to mean that he or she would benefit from support or services. However, the diagnosis is not directly linked to whether someone is eligible for support and services. Decisions over support and services are generally made by social service agencies and education professionals (often based in the local authority). The DSM-5 introduces levels of severity into the diagnostic process, to indicate how much support a person who receives a diagnosis may need. 

It is possible that fewer people – particularly at the higher-functioning end of the autism spectrum – will be diagnosed as having autism spectrum disorder in the DSM-5. However, the DSM team believes that this is not the case. Diagnoses should always be based on a clinical decision about whether an individual has an impairment which has a disabling effect on his or her daily life. Diagnoses will be given where symptoms cause impairment to everyday functioning. Many individuals with Asperger’s and high-functioning autism may continue to meet the proposed diagnostic criteria for autism spectrum disorder.

The removal of Aspergers Syndrome from the Diagnostic and Statistical Manual of Mental Disorders has been controversial, because it is commonly used by health insurers, researchers, state agencies, schools, and people with the disorder.  Many parents – and professionals – are concerned that eliminating the Asperger’s diagnosis will prevent mildly affected children from being evaluated for Autism, which may result in the ineligibility of much needed services.


Comments:

•    Anonymous said... I am in Liverpool uk, and I often find it really hard to get professionals to take his needs seriously, he can often seem very typical and many people tell me that there is nothing to be concerned about. It's not until they spend some time with him that they can see more of what's going on and how he finds little things so difficult.
•    Anonymous said... I found an autism "center" in monroe. Gonna try as and get info from them. My heart just breaks for parents and the autistic children who are in the dark about autism. Thanks to you, Stephanie  and Patrick, for making me see how awesome these kids are. I hope to at least be able to help the patients we have learn more.
•    Anonymous said... I found it hard having teachers and school psychologists get to have the final say (without going to due process, that is) on whether my son needed certain interventions. The people who deal with Asperger's and HFA every day can make suggestions, but the school doesn't have to follow them...never mind that they have seen fewer total aspie students than our medical providers, and studied asperger's less (or not at all...I met a special ed teacher once who found out my son had Asperger's and asked me to explain it to her). We need a new model of educational intervention.
•    Anonymous said... I have to say, I'm glad they have changed the diagnosis to ASD, I was so sick of people saying to me, "its only aspergers, or it's just aspergers" so I was kind of relieved when we got the diagnosis letter and it said ASD.
•    Anonymous said... I'm in BC and, while my guy has Aspergers, the diagnosis states ASD. It's hard with Aspergers isn't it, at first glance many seem neurotypical and hard to have their special needs taken seriously. I'm worried my guy will lose funding as seems so high functioning but a deeper look show his needs r actually quite high.
•    Anonymous said... Our local council in Cornwall UK are using DSM4
•    Anonymous said... sadly, many with Aspergers will no longer meet the criteria for Autism based on the changes. Boo.
•    Anonymous said... This scares me but knew it was coming.
•    Anonymous said... What is the difference if you dont mind me asking between asd and Aspergers
 
Post your comment below...

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Assisting the Peer-Rejected Student: Tips for Teachers of Kids of the Spectrum

Playing and conversing with classmates is a daily routine for school-aged kids. But children with ASD (Aspergers, High Functioning Autism) are often isolated and rejected by their peers. Their problems making and keeping a “buddy” are exacerbated by their poor social skills.

The sensitive educator should realize that kids go to school for a living. School is their job, their livelihood, and their identity. Thus, the crucial role that teachers play in the youngster's social development and self-concept should not be under-estimated. Even if a youngster is enjoying “academic success,” her attitude about school will be determined by the degree of “social success” she experiences.



There is much that the educator can do to promote social development in the special needs child. Kids tend to fall into four basic social categories in the school environment:
  1. Children who, although not openly rejected, are ignored by peers and are uninvolved in the social aspects of school.
  2. Children who have successfully established positive relationships within a variety of social settings.
  3. Children who “fit-in” with a peer-group based on common interests, but seldom move beyond that group.
  4. Children who are consistently rejected, bullied and harassed by peers.

Many children with ASD find themselves in the rejected/bullied subgroup. Their reputations as being rather “odd” plague them over the years. It is important for the educator to assist the youngster’s peers in changing their view of this boy or girl.

Discipline is a rather ineffective method of correcting bullying or rejecting behavior. For example, if the teacher disciplines Michael for insulting Ronnie, she only increases Michael's resentment of Ronnie. But, the teacher can increase Michael’s level of acceptance in several ways. Here’s how:

1. Assign the youngster to work in pairs with a “socially skilled” youngster who will be accepting and supportive. Cooperative activities can be especially effective in the effort to include the rejected youngster in class. These activities enable the youngster to use her academic strengths while simultaneously developing her social skills.

2. Assign the rejected youngster to a leadership position in class wherein his peers become dependent on him (e.g., line leader). This can serve to increase his status and acceptance. However, understand that this may be an unfamiliar role for the student, and he may require some guidance from the teacher in order to ensure success.

3. Attempt to determine specific interests, hobbies or strengths of the rejected youngster. This can be accomplished through discussions, interviews or surveys. Once the teacher has identified the youngster's strengths, celebrate it in a very public manner. For example, if the child has a particular interest in Indian wood carvings, find a ‘read-aloud’ adventure story in which an Indian plays an important role in the plot. Encourage the youngster to bring a couple of his Indian wood carvings to class and show how they were made. By playing the expert role, a rejected youngster can greatly increase his status.

4. Board and card games can be used to foster social development in class. These activities require children to utilize a variety of social skills (e.g., voice modulation, taking turns, sportsmanship, dealing with competition, etc.). These activities can also be used to promote academic skills. Since games are often motivating for children, this activity can be used as positive reinforcement.


 

5. Educators at the high school level must be particularly aware of the teen that is being rejected by peers. During the teenage years, it is very important that the youngster be accepted by his peers. The rejection suffered by teens with social skill deficits often places them at risk for emotional problems.

6. The child with social skill deficits invariably experiences rejection in any activity that requires children to select classmates for teams or groups. This selection process generally finds the rejected youngster in the awkward position of being the "last one picked." Avoid these humiliating situations by pre-selecting the teams or drawing names from a hat.

7. The educator can assist the youngster by making him aware of the traits that are widely-accepted and admired by his peers (e.g., when a particular child converses, extends invitations, gives compliments, greets others, laughs, shares, smiles, tells jokes, etc.).

8. The educator needs to recognize the critical role that the youngster's mom and dad – and even siblings – can play in the development of social competency. Ask the youngster’s mother or father to visit school for a conference to discuss the child’s social status and needs. School and home must work in concert to ensure that target skills are reinforced and monitored. Social goals should be listed and prioritized. Focus on a small set of social skills (e.g., making eye contact, sharing, and taking turns) rather than trying to deal simultaneously with the entire inventory of social skills.

9. The educator should demonstrate acceptance of - and affection for - the rejected youngster. This conveys the constant message that this youngster is worthy of attention. The educator can use her status as a leader to increase the status of the youngster.

10. The socially incompetent youngster often experiences isolation and rejection in his neighborhood, on the school bus, and in peer-group activities. The educator can provide this child with a learning environment wherein he can feel comfortable, accepted and welcome. Coming to school every day can become a helpless event for some kids on the spectrum – unless they succeed at what they do. Educators are shields against that helplessness.




 
 
Comments:

•    Mama said... I have always known this but getting teachers to get on board in public schools is nearly imposible. I'm so happy that Mark Hutten has brought this up. Sincerely, Marie Donily
•    Unknown said... Hello, this website has become one of our most informative sites for information. Our 13-year-old was just "transferred" to an alternative behavior school because of lack of understanding on teachers' parts. Now he is feeling punished because lack of understanding of his diagnosis
•    MartinKids said... I actually have the opposite problem- my 2nd grade son is receiving wonderful support and has plenty of 'playmates' at school. However, all of the children on our block have ostracized him and taunt him whenever he goes out in front(often in front of me!) The parents are either contributing to the stigma or are totally clueless. I would LOVE to read an article on how to handle this situation!
•    MartinKids said... I have the opposite problem with my 2nd grade son. He receives excellent support and has made several playmates at school. However, all of the kids on our block have ostracized him almost since we moved in. They ignore him and taunt him whenever he plays out front (even in front of me!) and their parents either seem to contribute to his stigma or are totally clueless. He seems to be handling this rejection well now, but I worry about how this treatment will affect him in middle school. I would LOVE to see an article offering tips for this situation!
•    Kelly said... You may not get this reply as I see you posted over three years ago but I'm having the same problem. Did you figure anything out?
•    MartinKids said... Unfortunately nothing ever resolved, just time went on, the two families we had the most issues with moved away and the new families have much younger children. My son does not interact very much with the kids that are left as he homeschools now and and they attend public school. Sadly, by the end of fourth grade he was already starting to be excluded and treated differently, so we pulled him out to homeschool him with his siblings. The kids in our main social group are more accepting of him, although he only has one good friend the others don't pick on him. Even more disappointing is his involvement with Boy Scouts, the adults were actually super caring and willing to accommodate his needs but the boys excluded him.:( I am incredibly thankful for our homeschooling friends who love him and have taught their children to be kind even if they aren't super close to him. :)

 
By

Obsessive-Compulsive Disorder in Aspergers Children

There are many conditions associated with Aspergers and High-Functioning Autism. In this video, we look specifically at obsessive-compulsive disorder, and its treatment:





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Identifying the Underlying Causes of “Difficult Behavior” in Kids on the Spectrum

"As a teacher, I would like to ask you what method you use to find the real reasons [or triggers] for behavior problems in students with high functioning autism?"

In order to identify the underlying causes of difficult behaviors in children with Asperger’s (AS) and High-Functioning Autism (HFA), a Functional Behavioral Assessment (FBA) must be performed. An FBA is an approach that incorporates a variety of techniques to diagnose the causes and to identify likely interventions intended to address difficult behaviors.

An FBA looks beyond the actual problem behavior, and instead, focuses on identifying biological, social, affective, and environmental factors that initiate, sustain, or end the problem behavior in question. The FBA is important because it leads the researcher beyond the "symptom" (i.e., the behavior) to the child's underlying motivation to escape, avoid, or get something (i.e., the cause of the behavior). Behavior intervention plans stemming from the knowledge of why a child misbehaves are extremely useful in addressing a wide range of issues.



The “functions” of behavior are not usually considered inappropriate. Rather, it is the behavior itself that is judged appropriate or inappropriate. For example, getting good grades and engaging in problematic behavior may serve the same function (e.g., to get attention), but the behaviors that lead to good grades are judged to be more appropriate than those that make up acting-out behavior.

As an example, if the IEP team determines through an FBA that a child is seeking attention by misbehaving, they can develop a plan to teach the child more appropriate ways to gain attention, thus fulfilling the child's need for attention with an alternative behavior that serves the same function as the inappropriate behavior. By incorporating an FBA into the IEP process, team members can develop a plan that teaches “replacement behaviors” that serve the same function as the difficult behavior.

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

Before an FBA can be implemented, it is necessary to identify the behavior that is causing problems, and to define that behavior in concrete terms that are easy to communicate and simple to measure and record. If descriptions of behaviors are vague (e.g., child has a “bad attitude”), it is difficult to determine appropriate interventions.

It will be necessary to observe the child's behavior in different settings and during different types of activities, and to conduct interviews with parents and teachers in order to identify the specific traits of the behavior. Once the difficult behavior has been defined concretely, the IEP team can begin to devise a plan for conducting an FBA to determine the functions of the behavior.

Since difficult behavior stems from a variety of causes, it is best to examine the behavior from as many different angles as possible. The IEP team should assess what the "pay-off" for engaging in problem behavior is, or what the child escapes/avoids/gets by engaging in the problem behavior. This assessment will enable the team to identify workable techniques for developing and conducting an FBA and developing behavior interventions.

When carrying out these tasks, the IEP team should find answers to a few critical questions. Addressing these questions will assist the team in determining the necessary components of the assessment plan, and will lead to more effective behavior intervention plans. Questions to ask include the following:
  • Are there any settings where the problem behavior does not occur?
  • Does the child find any value in engaging in appropriate behavior?
  • Does the child have the skills necessary to perform expected behaviors?
  • Does the child realize that he is engaging in unacceptable behavior, or has that behavior simply become a "habit"? 
  • Does the child understand the behavioral expectations for the situation? 
  • In what settings is the problem behavior observed? 
  • Is it possible that the child is uncertain about the appropriateness of the behavior?
  • Is it within the child's power to control the behavior, or does she need support? 
  • Is the behavior problem associated with certain social or environmental conditions? 
  • Is the child attempting to avoid a demanding task?
  • Is there a more acceptable behavior that might replace this behavior? 
  • Is there evidence to suggest that the child does not know how to perform the skill – and therefore can’t? 
  • What activities or interactions take place just prior to the behavior? 
  • What current rules, routines, or expectations does the child consider irrelevant?
  • What usually happens immediately after the behavior? 
  • Who is present when the behavior occurs?



Interviews with the child may be useful in identifying how he perceived the situation and what caused him to act in the way he did. Questionnaires, motivational scales, and checklists can also be used to structure indirect assessments of behavior. For example:

1. Hypothesis statement— Drawing on information that emerges from the analysis, school staff can establish a “working hypothesis” regarding the function of the behaviors in question. This hypothesis predicts the general conditions under which the behavior is most - and least - likely to occur, as well as the likely consequences that serve to maintain it.

2. Direct assessment— Direct assessment involves observing and recording situational factors surrounding a difficult behavior (e.g., antecedent and consequent events). A member of the IEP team may observe the behavior in the setting that it is likely to occur, and record data using an Antecedent- Behavior- Consequence (ABC) approach.

3. Data analysis— Once the IEP team is satisfied that enough data have been collected, they should compare and analyze the data. This analysis will help the team to determine whether or not there are any patterns associated with the behavior. If patterns can’t be determined, the team should revise the FBA to identify other methods for assessing behavior.

After collecting data on a child's behavior, and after developing a hypothesis of the function of that behavior, the IEP team should develop the child's behavior intervention plan. It is helpful to use the data collected during the FBA to develop the plan and to determine the discrepancy between the youngster's actual and expected behavior.

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

Intervention plans emphasizing the skills that AS and HFA children need in order to behave in a more appropriate manner will be more effective than plans that simply serve to control behavior. Interventions based upon “control” often fail to generalize (i.e., fail to continue to be used for long periods of time, in many settings, and in a variety of situations). Control measures usually only serve to suppress behavior, resulting in the youngster meeting unaddressed needs in alternative, inappropriate ways.

It is good practice for IEP teams to include two evaluation procedures in an intervention plan:
  • one designed to measure changes in behavior
  • one designed to monitor the accuracy with which the plan is implemented

In addition, IEP teams must determine a timeline for implementation and reassessment, and specify the degree of behavior change consistent with the goal of the overall intervention.

To be meaningful, plans need to be reviewed at least annually and revised as needed. However, the plan may be reviewed and re-evaluated whenever any member of the youngster's IEP team feels that a review is necessary. Circumstances that may warrant a review include the following:
  • It is clear that the original behavior intervention plan is not bringing about positive changes in the child's behavior.
  • The situation has changed, and the behavioral interventions no longer address the current needs of the child.
  • The youngster has reached his behavioral goals and objectives, and new goals and objectives need to be established.
  • The IEP team makes a change in placement.

If done correctly, the net result of an FBA is that school personnel are better able to provide an educational environment that addresses the special learning needs of the AS/HFA child.

CLICK HERE for an example of a completed Functional Behavioral Assessment (FBA) form…

CLICK HERE for a blank FBA and Behavior Intervention Plan (BIP) form…


More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

 ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

 ==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

 ==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

 ==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book
==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
By

Children on the Autism Spectrum and Problems with Perfectionism

“I'd like to ask you about a very big problem for our autistic son - his perfectionism! Can you give me some advice on what to do about this issue, because I believe it is a major contributing factor to his never-ending anxiety, especially when doing his homework?”
 
 ==> CLICK HERE for the full article...
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70 Tips & Tricks for Educating Students with Aspergers/High-Functioning Autism

 "I need to come up with some ideas for my son' teacher. My son is on the spectrum. The teacher is really struggling with his behavior as well as his learning style (he's a very visual learner, I know, and he doesn't do well with lengthy verbal instructions)."

Research has identified classroom characteristics that promote success for children with Aspergers and High-Functioning Autism (HFA: individualized instruction, interesting curriculum, positive reinforcement, predictability, short working periods, small teacher-to-student ratio, and plenty of structure.

Research has also identified optimal teacher characteristics: consistency, firmness, frequent monitoring of the child’s work, humor, knowledge of behavior management strategies for students on the spectrum, patience, personal warmth, and positive academic expectations.

Based on this research, here are 70 quick and simple – yet highly effective – tips and tricks to use in teaching your students who are on the autism spectrum:

1. Allow the child to change seats and places as long as she or he stays on task.
2. Allow the child to chew gum to reduce anxiety if needed.
3. Allow the child to stand or walk with a clipboard (if possible) as long as she or he remains on task.
4. Allow the child to use learning aides, computers, and calculators (for different parts of the task).
5. Allow the student to manipulate an object, doodle, squeeze a ball, bend a pipe cleaner or paper clip, or handle another non-distracting item as long as she or he attends and is on task.
6. Assign a capable "study buddy" who can remind and assist the active or disorganized child.
7. Assign another child to be a "support buddy" who works with the distractible student, and provides one-to-one attention to assist in completing tasks.
8. Assign duties that require self-control (e.g., line leader, materials distributor, etc.). Prepare the student for the duty, encourage the student, and reinforce the student during and after that activity/task.
9. Assign the child to a seat that best allows him or her to observe you while avoiding distractions (e.g., away from doors, windows, pencil sharpeners, etc.).
10. Assign the test grade based on performance on different aspects of the assessment (i.e., organization, writing mechanics, penmanship, subject knowledge displayed, etc.).

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism
 
11. Be sure you have the student's attention before you start.
12. Develop good rapport with the child. Aspergers and HFA students are more likely to respond to emotional connections than contingent consequences.
13. Devise interesting activities.
14. Eliminate excessive noise.
15. Eliminate excessive visual stimuli and clutter that might distract the student.
16. Employ study carrels or seat the child in the area of the class with the least distractions, and/or face the desk toward the wall. However, do not isolate the student for long periods of time because it may stigmatize the student. Allow the child to engage in group work too.
17. Encourage moms and dads to build physical activity into the student's out-of-school schedule.
18. Ensure that your style of presentation is enthusiastic and interesting.
19. Give a general overview first. Let the child know what will be learned and why it is important in life.
20. Give your attention to appropriate behaviors.





21. Have another child place carbon paper under the Aspergers and HFA student’s paper while writing down homework assignments. Give the carbon copy to the child to take home.
22. Have the child progress through the following steps while learning: See it, say it, write it, and do it.
23. Have the child underline or highlight directions.
24. If social rewards/reinforcement is insufficient to bring about the desired behavior, pair social recognition with earned activities or tangible reinforcers.
25. If you get a lot of defiant behavior, review how often you say negative things and give commands to the student. Children who hear too many negatives and commands will shut off the teacher they come from. Get positive, encourage the student, and focus on progress, however small.
26. Ignore as much of the negative behavior as possible.
27. In a multi-part task, provide visual cues that are written on the child's desk or on the chalkboard for each part. The child then engages in that next step.
28. In cooperation with the child, create a "secret cue" (e.g., tugging on your ear lobe, clicking your tongue, saying an odd word such as "huckleberry") that reminds the student to attend.
29. Incorporate movement into lessons.

30. Involve the child's interests into assignments.
31. Keep directions and commentary short and to the point. Avoid "overloading" the child with too much verbiage.
32. Keep unstructured time to a minimum.
33. Make a tube that the child uses as a telescope, keeping you in view and blocking out other distractions.
34. Motivate the student by having him or her "race against the clock" to finish the task (or part of it).
35. Move nearer to the child when she or he becomes restless. Offer verbal encouragement or touch. When misbehavior occurs (or threatens to occur), move closer and soften your voice.
36. Place instructions on an audio tape that can be replayed by the child as needed.
37. Play soft background music without lyrics.
38. Present the assignment in parts (e.g., 5 math problems at a time). Give reinforcement for each completed part before giving the next segment of the task, or have the student mark off his or her progress on a chart.
39. Provide "do now" activities for other children while you focus the child.

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism
 
40. Provide a "squeeze ball" for the child to manipulate if he or she becomes frustrated.
41. Provide a bouncy inflatable seat cushion. The child may put his or her energy into squirming on it, but he or she will stay in the seat.
42. Provide a grown-up to whom the child reports at the beginning and end of the day to organize his or her work and assure assignments are in-hand.
43.  Provide a laptop computer to children who lose papers (but not books).
44. Provide a second set of textbooks for the forgetful child to use at home.
45. Provide a special "transition object" (e.g., puppet, small stuffed animal, etc.) that accompanies the child to other classrooms, providing a sense of consistency and support.
46. Provide an individualized written schedule to which the child can refer.
47. Provide extended time to finish.
48. Provide opportunities for physical movement (e.g., erasing the blackboard, running errands, distributing and collecting materials, etc.), and build physical activities into the daily schedule.
49. Provide some choice or variation in assignments to maintain the child's attention.





50. Reduce the length of assignments so that child does not lose interest.
51. Repeat and simplify the directions.
52. Seat the child next to appropriate models.
53. Set expectations for behavior BEFORE an activity or event.
54. Set up routines that prepare the student for upcoming transitions.
55. Teach memory techniques and study strategies.
56. To block out distractions on a page, create a "window" in a piece of card board that exposes only one or two lines of print.
57. To ensure understanding, have the child repeat the directions in his or her own words.
58. To gain the attention of younger kids on the spectrum, give directions through a puppet.
59. To increase reflection and concentration, have the child identify the correct answer AND cross out incorrect answers on multiple choice tests. Inform the child that there may be more than one correct answer.

60. Use a clock to remind the impatient student that the next activity must wait until a certain time.
61. Use alert cues to get the child's attention before giving directions.
62. Use color and highlighting to accentuate certain important words or phrases on worksheets.
63. Use concrete objects to assist in keeping the child's attention.
64. Use examples that capitalize on the child's interests.
65. Use game formats to teach and/or reinforce concepts and material.
66. Use more than one modality when giving directions. Supplement verbal instructions with visual ones.
67. Use oral testing if that format will keep the child's attention and better assess his or her knowledge.
68. Use pantomime to capture the attention of the child to give instructions.
69. Use performance testing. Have the child do something or make something.
70. Use progress charts and other visual records of behavior to encourage more appropriate behavior. Use colorful charts and cards to motivate the student and recognize effort.


==> The Complete Guide to Teaching Students with Aspergers and High-Functioning Autism


More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
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How to Create an Effective Behavioral Intervention Plan for Kids on the Autism Spectrum

In this post, we will look at how to create an effective behavioral intervention plan for students with Aspergers and High-Functioning Autism…

Once the IEP team (including the parents) has conducted a functional assessment, the information obtained from that assessment should be used to develop a behavioral intervention plan. The purpose of this intervention plan is to spell out what behaviors are being targeted for change – and how change will be handled.



Certain items in the behavioral intervention plan are required by the Individuals with Disabilities Education Act, while others are simply good information to have included:
  • description of how the child’s behavior will be handled should it reach a crisis stage (called a “crisis plan”)
  • definition and description of the behavior being targeted
  • description of how the success of the interventions will be measured
  • description of previously tried interventions and how well they did - or didn’t - work in changing behavior
  • description of the behavior that will replace the inappropriate behavior (called the “replacement behavior”)
  • description of the interventions that will be used (e.g., who will be involved, specific procedures that will be followed, how data will be collected)
  • description of when and how information will be shared between the home and school
  • information about the child that could impact the intervention plan
  • list of the child’s strengths and abilities
  • measurable description of the behavior changes that all parties expect to see
  • schedule for when and how often the plan will be reviewed to determine its effectiveness
  • statement describing the function or purpose of the targeted behavior

When writing the behavioral intervention plan, make sure that everything is spelled out clearly and specifically so that the intervention plan can be used easily by all parties involved with the child. In most circumstances, the intervention plan should be less than 4 pages in length. If it is longer than that, it may be too difficult for all parties to remember and follow.

The IEP team should make sure that the interventions included are ones that they have the resources and ability to implement consistently (e.g., if “time-outs” are included in the plan, but a time-out space is only available 2 days a week, then it will be more effective to choose a different intervention).

Once the IEP team agrees on the behavior intervention plan, all parties involved must agree to implement it consistently. If even one team member thinks that he or she is unable to support the plan, it needs to be revisited. Inconsistent application of any intervention may result in an increase in the targeted inappropriate behavior, or in the appearance of a new inappropriate behavior.

Sample Behavioral Intervention Plan:

Name: Michael Jones
Grade: 5
Age: 10
School: Big City Elementary School
Date Written: 2/4/13

Strengths of the child:
  • enjoys praise and positive, social reinforcement 
  • likes science and hands-on activities
  • usually responds well to educators
  • wants to be in the general education classes
  • usually wants to do the same work as his peers
  • works hard and participates most days

Individualized information about the child:
  • Biological factors, medication interactions, and anxiety can cause child to react to situations/directions differently on some days. Child will have productive days and not so productive days. 
  • has difficulty with tasks necessitating writing
  • often works and moves more slowly than peers
  • Some behaviors associated with Obsessive-Compulsive Disorder and Tourettes are apparent (e.g., tapping, noises/verbalizations, some scratching/ rubbing hands and face, repetitive movements). These behaviors are made worse when child is anxious.

Previously implemented interventions:
  • Time-outs, negative reinforcement, and positive reinforcement with tangibles were ineffective interventions. There was some success with a token economy using concrete reinforcers.

Problematic behaviors:

Behavior 1— Incomplete assignments

Baseline: averaging 5 incomplete assignments per week for last 5 weeks

Function of the behavior:
  • allows child to express/feel in control of a situation when he’s uncomfortable with something 
  • relieves anxiety by avoiding a task he dislikes or finds frustrating

Replacement behavior:
  • complete assignments in study period or at home 
  • ask for help (e.g., asking for assistance, modifications or breaks)

Interventions:
  • Modify assignments by reducing the number/length of responses required for each concept.  Where possible, reduce the amount of writing required. 
  • Grading: Teacher establishes a minimum for each assignment. If child does more than the minimum number of responses required, he gets credit/extra credit for each extra response that is correct (no penalty for incorrect responses). If child doesn’t complete the minimum, he is counted off for the missing responses.
  • Child will have a scheduled study period each day. If he has all assignments completed, he can participate in other activities.

Documentation:
  • number of incomplete/missing assignments in each class 
  • assignment grades

Amount of improvement expected:
  • no more than 2 incomplete assignments per week for 3 consecutive weeks

Behavior 2— Unable/unwilling to work in class

Baseline: 20% of assignments completed and 35% completed in class

Function of the Behavior:
  • allows child to express/feel in control of a situation when he’s uncomfortable with something 
  • relieves anxiety by avoiding a task he dislikes or finds frustrating

Replacement Behavior:
  • at least attempt each assignment 
  • verbalize frustration and/or need for modification

Intervention:
  • Child is given 1 prompt to start assignment. After that, refusal is ignored (any behavior disturbing others will be dealt with according to classroom rules and consequences and child earns a 0 on that assignment). 
  • Child receives 2 points for every assignment he attempts (e.g., does at least 1/4th of the assigned task) and 5 points for every completed assignment. Points can be spent before lunch and before child goes home on items/activities on his reinforcement menu (child must have input on what’s on the menu).
  • Child will be given the option of completing an assignment in the resource room for full credit.
  • Child will receive instruction/guidance in how to express needs from the school counselor. Child will earn 5 points for appropriately (according to the guidelines taught by the school counselor) expressing frustration and/or need for help/modifications.

Documentation:
  • record % of assignments attempted and % of assignments completed 
  • record frequency and duration of time in the resource room for this behavior

Amount of improvement expected:
  • at least 60% completed and 75% attempted in class for at least 3 of 4 weeks

Behavior 3— Using profanity around peers

Baseline: average of 8 incidents per week for last 5 weeks

Function of the behavior:
  • vent anger/frustration in a situation less threatening than with teachers/peers 
  • relieving feeling of anxiety due to Tourettes or Obsessive-Compulsive Disorder
  • attention-getting

Replacement behavior:
  • recognize anxiety or anger/frustration and get help to vent appropriately (e.g., cool down time, removing self from situation, talking with teachers/peers) 
  • get attention by interacting appropriately with peers

Intervention:
  • when child is verbally inappropriate, he is directed to remove himself to a different location and is not allowed to participate in the activity (e.g., recess) for 5 minutes 
  • provide opportunities for child to practice interacting appropriately with peers (e.g., reading with them)
  • praise for appropriate verbal interaction

Documentation:
  • record number of times child asks for help with anxiety or anger/frustration
  •  record number of times child is verbally inappropriate with peers

Amount of improvement expected:
  • no more than an average of 4 incidents per week for 3 consecutive weeks

Schedule for review:
  • documentation review at least each nine weeks when grade cards are distributed

Provisions for home coordination:
  • On Fridays, a note will be sent home with weekly grade for each class number of inappropriate verbalizations toward peers and number of times child requested resource room and/or cool down. 
  • Assignment notebook sent home daily. Assignments will be marked as attempted, completed or not attempted.

Crisis management plan:
  • If an injury or property damage occurs as a result of Michael’s behavior, a police report will be made and he will be suspended according to district policy. The IEP team will meet as soon as possible within 10 days to review the behavior intervention plan and make modifications where necessary. 
  • If Michael endangers himself or others while in isolation, physical restraint will be used by staff members trained in Mandt procedures.
  • If Michael is not able to demonstrate compliance within 30 minutes, or if he has had more than 3 timeouts, he will be seen by support staff as soon as possible.
  • If Michael endangers himself or others, he will be isolated from his peers and mother or her designee will be called. Michael will remain in isolation until it is determined that he is no longer in imminent danger of hurting himself or others. He will finish his school day in the resource room.
  • Michael will be given a cue that he can use with staff to indicate that he is getting upset and needs to cool down. Once he gives the cue, he can choose from the following options: (a) ask to see a support staff member, (b) go to the resource room, (c) walk in the hall or outside (a staff member will accompany child, but will not talk to child). 
  • If staff sees that Michael is becoming upset and is not using his cue for help, staff will say, “You’re getting upset. I need you to see a support staff member, or go to the resource room, or take a walk in the hall or outside with a staff member.” If Michael is unable to cool down, he will be directed to go to time-out where he will remain until he can demonstrate compliance. 

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

 ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

 ==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

 ==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

 ==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book
==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
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