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发表于 2003-10-9 13:13:49
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Re:Helping children with autism
在美国，公立学校要求为每一个有特殊需要的儿童制定一份个人教育计划(Individualized
Education Program), 简称IEP。IEP 包括学生目前的学习，智力，语言，自理，社
交，行为等能力；年目标和具体教学目标以及评估方法 ；教育和配套服务地点和项
目。
参加IEP制定的人员通常包括：学生家长，特殊教育老师，普通教育老师，语言培训
师，学校心理学专业人员，理疗师，学区特殊教育行政人员等。
IEP 通常由学校制定。家长只是被动地参与IEP讨论和签署。但是 由於老师素质，
经验，资金等因素限制，学校制定的IEP往往无法满足学生个人的教育需要。学生家
长的积极参与会有利于制定一份更为合理的IEP。由於autistic (自闭症)学生的教
育花费很大，学校，医疗保险公司，政府机构等都很难支持每周20-40 小时的应用
行为分析学(ABA)培训。但经过家长的努力(如请律师)也有家庭获得了ABA资金。我
们目前还不准备浪费时间和精力与学校据理力争。我们想凭自己的教育背景(我有教
育学博士学位，主攻特殊教育和教育技术)和经济能力为ALBERT提供大约每周25小时
的ABA。另外学校提供每周10小时的特殊学前教育。
现附上我为我儿， Albert， 制定的IEP。这份IEP包括目前能力的评估，拟定的教
育目标， 对应用行为分析学理论及应用的总结(美国流行的结构强化行为疗法-DTT，
自然环境疗法-NET，和最新的言语行为疗法-Verbal Behavior (VB) ). 这份IEP得
到自闭症专家Dr. Allen 的高度评价。希望能对中国的自闭症孩子和家长以及海外
华人的自闭症孩子和家长有所帮助。
全文都是英语。很抱歉，我打中文的速度实在太慢。每天都忙於孩子和教学工作，
时间真的很宝贵。如有不明白之处，可以通过EMAIL与我联系。我们或许可以通过MSN
Messenger 的语音交流。-JenJen
JenJen, Ph.D.
Albert, Son
09/20/03
Assessment
Instrument: The Assessment of Basic Language and Learning Skills (The ABLLS)- Dr. James Partington and Dr. Sundberg.
+ Curriculum-Based Assessment + Direct Observations.
Cooperation with Adults:
Albert has recently begun to follow instructions if given reinforcers, but if he does not want to do what adults want him to do he will scream, cry, and often fall to the floor. Albert will sit at a table and read one or two books (for about 5 minutes), and he will do language tasks for two or three trials (for about five seconds), but when he is ready to get up he will tantrum if he is not allowed to do so.
Request (Mand)
Albert is able to request three items and activities with the reinforcer present if you ask, “ what do you want?”. He can request “juice”, “cookie”, and “Mom, hug”. If the reinforcer is not immediately delivered, he will often tantrum.
Motor Imitation
Albert has recently learned to imitate the motor behavior of others, but often requires verbal prompting and the immediate delivery of reinforcement. He is able to imitatively clap his hands, kick a ball, and touch his body parts. He has difficulty with fine motor imitation such as pointing to items with only his index finger.
Vocal imitation (Echoic) and Articulation
Albert’s echoic skills are quite strong, however, when repeating words on request, he sometimes adds a “le” sound to the end of words.
Matching-to-Sample
Albert has recently learned to match pictures. When given a picture of an item and a display of four pictures, one of which is exactly identical to his pictures, Albert can place the pictures with the identical item. He can match approximately 48 pictures from an array of four pictures. He cannot match items and pictures to other items of pictures that are not exactly identical to his item.
Receptive Language
Albert has recently learned to follow instruction to do simple actions (clap your hands, touch parts of his own body, arch your back, kick your feet, turn your head, wave your arms, feed bear soup, kiss me, etc). Albert does not look at or come to a person when called by his name. He is unable to make choices between two items. For example, when you present juice and water, and ask him, “What do you want, juice or water?” He is not able to choose the one he wants.
Receptive by Function, Feature, and Class
Albert is unable to point to any objects or pictures when given verbal information about them but not their specific name (e.g., Touch the one you ride”).
Labeling (Tacting)
Albert can label approximately 10 common objects and hundreds of pictures. However, he cannot use pronouns, adjectives, or prepositions. He is unable to identify colors and ongoing actions.
Conversation (Intraverbal)
Albert can fill-in a few missing words from some favorite songs and books, and can give his name and age upon request. However, he is unable to answer many common “Wh” questions, or fill in any words from common phrases. He does not use any words to express his wants and needs. He does not call mommy, dad, or speak to us spontaneously. Albert engages in almost no conversation.
Letters and Numbers
Albert can identify about 10 different numbers. He could rote count to 10 in Chinese. Albert is not able to count objects. He was able to identify all letters.
Social Interaction
Albert does not socially interact with other children. Albert does not initiate social interactions with others. He actively avoids eye contact.
Play/Leisure Skills
Albert does explore some toys for a few seconds, however, he does not engage in any pretend play or extended interactions with toys.
Group Instruction
Albert does not attend well to group instructions. He has recently learned to sit at circle, but he does not respond to the teacher’s instruction nor imitate her actions. He does not interact with peers nor learns from peer models. His level of attention and participation decreases considerably compared to one-on-one instruction.
Self-Help Skills
Albert can remove his socks, and help with removing shoes. He is unable to put on and take off his clothing independently. Albert drinks from a cup. He cannot use spoon to eat without spilling. Albert is not able to independently wash and dry his hands and face. Albert depends on physical prompts and a schedule to use the toilet. He does not express his needs either verbally or nonverbally.
Gross Motor Skills
Albert can walk forwards and can jump and hop on the bed. He cannot throw/catch a ball. He cannot ride tricycle.
Fine Motor Skills
Albert can put puzzles together, stack blocks, and mark on paper with a crayon or pencil. He has difficulty with stringing beads, removing lids from jars, and cutting. He is unable to color within boundaries. He is unable to trace simple straight and curved lines. He is unable to copy any specific markings.
Some Suggested IEP Objectives
Visual Performance
1. When given a model of a visual pattern, Albert will be able to make a block design that matches a model or a picture using up to 5 blocks when given more blocks than are necessary to complete the task.
2. Albert will be able to put together a variety of eight-piece (or more) puzzles without frames.
Receptive Language Skills and Tacts (Labeling)
3. Albert will be able to take objects to a specified person or location within a room
4. Albert will be able to receptively identify and tack (label) a total of five prepositions (on, in, under, out, in front of).
5. Albert will be able to receptively identify and tack (label) at least three pronouns (mine, my, I).
6. Albert is able to receptively identify and tack (label) at least 10 adjectives (big, little, red, blue, yellow, green, cold, hot, wet, fast, slow).
Receptive by Function, Features, or Class and Tacts (Labeling)
7. Albert will be able to receptively identify and tack (label) at least 10 items when told either its function, one of its features, or given its class. (e.g., “Touch the one you eat”, “Touch the one you ride”, “Touch the one that says woof.”)
Imitation
8. Albert will be able to imitate a sequence of motor activities without additional prompts (i.e., “Clap hands, then thighs, then touch toes”).
Requesting
9. Albert will be able to mand for (request) desired items at least 30 times per day.
10. Albert will be able to request at least 10 different items and activities per day.
11. Albert will be able to ask for information using “what”, “where” questions.
Tacts (Labeling)
12. Albert will tact (label) 20 common actions (both ongoing and pictures).
13. Albert will tack (label) 100 common objects and animals.
Intraverbals
14. Albert will correctly respond to 25 intraverbal fill-ins (e.g. “ It’s time to wash your_______,” “You ride in a ______,” “You cut paper with _____” A dog says ______” You write with a ____, The name of your school is _____,).
15. Albert will be able to provide answers to 8 questions regarding personal information (name, age, address, phone number, school, teacher, parents).
Play and Leisure Skills
16. Albert will play at least 10 toys as designed with occasional prompts for up to 10 minutes.
17. Albert will participate in socio-dramatic play activities in which he pretends to be at least 5 different characters (e.g., cook, doctor, construction worker, animal, care-giver)
Social Interaction
18. Albert will initiate and return greetings with adults without prompting. He will initiate and return greetings with peers with partial prompts.
19. Albert will appropriately play with a peer for five minutes with prompts from adults. (e.g. Albert will roll/catch/throw a ball to another peer for at least 3 exchanges).
Group Instruction
20. Albert will follow instructions that are known by him (e.g., touch known items, imitate an action, etc.) presented to a group of 12 students.
21. Albert will appropriately take turns with three other students during small group instruction activities.
22. Albert will complete his classroom routine (e.g., hang up his coat, put away backpack), with no more than 2 verbal prompts.
Self-Help Skills
23. Albert will be able to pull up and down his pants and urinate in the toilet independently.
24. Albert will request to use the toilet as needed in familiar settings (home and school).
Math Skills
25. Albert will be able to count out objects given to him up to the amount of 10.
Writing Skills
26. Albert will be able to color within lined areas.
27. Albert will be able to trace and copy simple straight lines and shapes.
Fine Motor
28. Albert will be able to cut out simple shapes staying within ¼ inch of the line.
Gross Motor
29. Albert will be able to throw and catch an 8-inch ball four feet to a person.
30. Albert will be able to peddle a tricycle at least 20 feet.
Language and Basic Learning Skills Analysis and Recommendations
The most important areas to focus on for Albert at this time are (1) his manding (requesting) skills, (2) his conversation skills, and (3) social and play skills. Albert could also benefit from additional training on labeling and receptive language skills. In addition, Albert could benefit from some regular contact with non-handicapped peers in order to facilitate social interaction. Albert has great potential for acquiring more effective language skills, but his rate of acquisition will be directly related to the frequency and type of training provided. Parents, teacher, and therapists must require a high rate of responding from Albert, especially manding and intraverbal responding.
It is now well established that effective early intervention for young children with Autism centers on intensive behavior intervention. This intervention is characterized by high degree of engagement (usually one-on-one instruction), reinforcing, and errorless learning trials (Allen, K., 2003). Early intensive behavioral interventions are based on ABA principles and typically include intensive (usually 25-40 hours per week), individually administered treatment interventions (Jensen, V., 2002). Research shows that many children will do best with 30 or more hours per week of intensive behavioral intervention (Leaf, R., & McEachin, J., 1999). Providing intensive early intervention is critical to maximizing outcomes for children with autism (Woods, J. & Wetherby, A., 2003).
Though all guided by the principles of Applied Behavior Analysis (ABA), there are some variations in treatments and techniques. Two common approaches have been identified as discrete trial training (Lovaas, 1987, McEachin, J., Smith, T. & Lovaas, O.,1993), and the natural environment training (Koegel, R., O’Dell, M., & Koegel, L. 1987).
The main aspect of discrete trial training (DTT) is that language intervention is conducted in a highly specified and structured manner. The instructor chooses and presents a specific stimulus related to a target skill, and when the student responds correctly (perhaps with prompting) the response is reinforced with strong reinforcers. Training on a specific skill are divided into a number of independent tasks, and mass trial training typically occurs in a designated situation (e.g., at a table). Discrete trial training can be very effective (Lovaas, 1987, McEachin, J., Smith, T. & Lovaas, O.,1993), especially when compared to the indirect type of language intervention (e.g., large group and activity-based instruction common to many special education classrooms) (Sundberg, M., & Partington, J., 1998).
The essential features of natural environment training (NET) involve focusing on the child’s immediate interests and activities as a guide for language instruction. NET is conducted in the child’s typical daily environment (e.g., his home, a playground, the community), rather than in a formal teaching arrangement. Natural environments are defined to “include the home and community settings in which children without disabilities participate,” (PL 105-17) and would not include settings designed for treatments or therapy such as clinics, hospitals, or segregated special education programs (Woods, J. & Wetherby, A., 2003). Stimulus and response variation is stressed, and the consequences for correct verbal responses are specific to the child’s interest or activities, rather than consequences that are irrelevant to the response (e.g., giving a child the ball for identifying a ball rather than giving him an M&M). (Sundberg, M., & Partington, J., 1998). NET approaches use systematic teaching trials that have the following common active ingredients: (a) initiated by the child and focused on the child’s interest, (b) interspersed and embedded in the natural environment, and (c) use of natural reinforcers that follow what the child is trying to communicate (Woods, J. & Wetherby, A., 2003). There are only a few studies, all using single-subject design, that have reported that NET approaches are more effective than discrete approaches at leading to generalization of language gains to natural contexts.
Both DTT and NET have been shown to be effective, and each offers specific advantages for teaching certain types of verbal behavior. The exclusive use of only one of these approaches may be less effective then the combination of the two, guided by Skinner’s analysis of verbal behavior (Sundberg, M., & Partington, J., 1998).
Verbal Behavior approach is guided by the principles of Applied Behavior Analysis (ABA) and emphasize teaching Verbal Behavior to children with autism or other developmental disabilities. Analysis of verbal behavior using all of the information being published on discrete trial training plus Skinner’s analysis of verbal behavior. Verbal Behavior (VB) approach includes teaching in all settings throughout the day across persons and circumstances. In addition, Verbal Behavior’s emphasis is on teaching the function of language. A full and rich language repertoire of a child includes nonverbal responses to what someone says (receptive), verbal responses to his/her motivation or EO (mands,) verbal response that match exactly what someone else just said (echoic), verbal responses to nonverbal stimuli in the environment (tacts), and verbal responses to what someone else just said that don't match what was just said (intraverbal). To develop this repertoire it will be essential to teach a child to respond this way in the natural environment as well as in formal intensive teaching (Sundberg, M., & Partington, J., 1998).
Albert’s curriculum should focus on the development of functional language skills as a priority (Allen, K., 2003). The VB curriculum is based on B.F. Skinner’s analysis of verbal behavior (Skinner, B.F., 1957). The VB curriculum follows the manuals by Dr. Mark, Sundberg and Dr. James Partinton. Emphasis is on teaching the function of language. Teaching procedures focus on transferring the child’s ability to respond across all functional categories. VB program is featured with the following components: Intensive Teaching (DTT), Natural Environment Training (NET), and positive behavioral techniques to replace maladaptive behaviors (Peters, C., 2003). This intervention is characterized by high degree of engagement (usually one-on-one instruction), reinforcing, and errorless learning trials.
Some elements of a good VB program are as follows (Peters, C., 2003):
1. Learner makes constant requests for desired items, actions, information
2. Words are taught through all functional categories of language
3. Constant conversational dialogue occurs between teacher and learner
4. Situations contrived by teacher to create motivational conditions (EO’s) so the learner behaves in a desired way.
5. Errorless learning
6. Prompt fading 0-3 second delay
7. A high rate of correct responses
8. Skills generalized immediately
9. Mixed and varied tasks
10. Difficult tasks interspersed with easy tasks to keep level of reinforcement high
11. Transfer procedures to make learning easier
In conclusion, I believe strongly that Albert has great potential to make substantial progress or even mainstream to the regular school given an early intensive behavior intervention with focus on his functional language. This program can be conducted at home as well as in the school by arranging for high levels of engagement and intensive instruction (usually one-on-one instruction) (Allen, K., 2003). The most effective ABA programs provide 30-40 hours of intensive treatment a week (Lovaas, 1987, Jensen, V., 2002, Leaf, R., & McEachin, J., 1999, Allen, K., 2003). In addition to the intensive behavior intervention with focus on the development of functional language skills, Albert could probably benefit from one-on-one speech therapy.
References
Allen, K.D. (2003). Albert’s psychological evaluation/diagnosis report.
Lovaas. O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55 (1), 3-9.
McEachin,J., Lovaas, O., & Smith (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal of Mental Retardation, 97, 359-72.
Sundberg, M., & Partington, J. (1998). Teaching language to children with autism or other developmental disabilities. Behavior Analysts, Inc. Pleasant Hill, CA.
Sundberg, M., & Partington, J. (1998). The assessment of basic language and learning skills (the ABLLS). Behavior Analysts, Inc. Pleasant Hill, CA.
Woods, J., & Wetherby, A. (2003). Early identification of and intervention for infants and toddlers who are at risk for autism spectrum disorder. Language, speech, and hearing services in schools, 34, 180-193.
Peters, C. (2003). Implementing a successful verbal behavior program. http://mariposaschool.org/programs/
Jensen, V. (2002). Treatment of autism in young children: behavioral intervention and applied behavior analysis. Inf Young Children, 14(4), 42-52.
Leaf, R. & McEachin, J. (1999). A work in progress: behavior management strategies and a curriculum for intensive behavioral treatment of autism. New York, DRL Books, L.L.C.
-JenJen |
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发表于 2003-10-8 09:11:08
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