Autism Center at Childrens Hospital

Brief overview of the program:

In terms of a brief overview of our program - we are a relatively small program housed within a
larger Children's Hospital. All of our services are provided on an outpatient basis and include diagnostic
evaluations (conducted by two clinical psychologists and two postdoctoral fellows) and behavioral
intervention services provided by myself (a clinical psychologist) and a behavior analyst.

How does a child receive services through you?

For a child to receive services the child must be referred from a pediatrician for an evaluation. We
do not allow self referral services. It used to be all privately based, but a new law was passed in 2013 in
Louisiana, which requires medicaid to cover Applied Behavior Analysis (ABA) services. Therefore, now
we have about 80% on medicaid being referred to our program. This has created a very long wait list and
limits the services we are now able to offer.
We used to go into schools and make consults or visit our clients in their setting. However, with
the medicaid change we have no time to leave our clinic. It has made it a purely counseling based
program in house. The amount or type of services really depend on the specific diagnosis for each child.
Some are in group therapy, whereas others are in family counseling, individual therapy and group
therapy.

Do you have any help from other agencies?

We have had a little help from Tulane as we partner with them to help each other. We used to be
able to go into schools and consult, but with the new law the teachers no longer have our support in
classes. So, Tulane has developed a way for their students to come to us. It is an agreement between the
behavior interventionists at our facility and the behavior psychology and education directors at Tulane.
In the undergraduate program students volunteer through the Childrens hospital and this allows
us to avoid a HIPPA violation with non-licensed educator working in our facility. The undergrads volunteer
their time and it counts towards hours of observation time at Tulane. They will run a group social skills
class. However, they are always supervised by our clinical psychologist. They will learn how to

communicate with parents, students and pt practice prompting, responses, and rewards for students with
autism.

On the other hand, Graduate students are generally licensed educators so we can do more with
them. They are documented so it does not violate HIPPA to have them in the process. They earn
graduate hours and we have help in our facility as well. Graduate students actually help with evaluations
and can assist with individual and family counseling as well. They are of course, supervised or monitored
by one of us at our facility.
What do you practice here?
Only researched based and applied behavior analysis. (ABA) is positive reinforcement, teaching in small
steps, and repeated practice. We tackle one thing at a time, reteach, reteach, reteach, and practice,
practice practice.

ABA Fact Sheet

Working with Non Verbal students

If they do not start speaking by the age of 7 or 8, generally we do not make this part of

their programming any more. This age is our cutoff. They may begin to speak later in life, but it
no longer consumes us with the need to force them to speak. There are a lot of other ways to
communicate to be successful. We teach them sign language or other methods for
communicating like signs or ipads.
Sign language is actually something we suggest to use with all levels of
students on the spectrum. Even if they do not sign the educators who work with them or
their parents should be signing while speaking. At least the basics, because it can help
make more connections in their brains by activating visual and auditory neurons. This can
help to alleviate the overwhelming sensations a student can get when they are relying on
just one sense.
It also allows for students to release anxiety, communicate in a way,
which can be a sensory barrier, and it allows multiple parts of the brain to interact with

language
If they cannot or choose not to communicate you must provide them some way of sharing

their needs.

Breaks built in on a chart or schedule

A break card they can hand to an adult any time they need a break
These breaks should be documented and reviewed if

there is a pattern though because this could be a potential escape mechanism

from some stressor or anxiety trigger
FUNCTION OF BEHAVIOR
We must always look at the function of a behavior. Why is the student behaving this way. No
matter what the behavior is we have to look at the function. If the child is non-verbal it can be difficult fro
them to share what they are thinking or feeling and this may cause them to do things like hit, scream,
refuse to comply, fidget, rock, or throw a tantrum. But why should be your question
Inclusion or Pullout?

When the response to anxiety is interfering with school it is recommended to take the
thing that is causing the anxiety be taught in isolation, in manageable chunks and broken down
to meet a smaller number of objectives at one time. It is not the best situation to have no pull out
time during a day. These kids need supports beyond a classroom. The classroom with peers is
not the Least Restrictive Environment. They must have a place to work for small portions of the
day and should be attending an affective skills class. Especially at the ms/hs level.
Is it ESCAPE or ATTENTION SEEKING?
The best way is to observe the child in the classroom, and watch for indicators or antecedents to
behavior. Then note times, patterns, and behaviors. The first thing you do once a behavior is seen you
must determine the function of that behavior. For example if a child is in a small group and refuses to
work you can determine is it because they do not want to work in a group, do not know how to work in a
group, or is it a task that requires more developed social skills or a skill that brings the student frustration
like handwriting. Then decide if it is an attention seeking or escape behavior.
If it is attention seeking find other ways to provide that attention prior to a task that always brings
about anxious behavior, make a smaller group, or allow the student to work with the group for a set
amount of time and then break into a solo activity that will benefit the group.
If it is an escape then for tasks like writing a paper then the education team needs to determine if this is a
skill that the child needs to be pulled out of class to work in a setting more conducive to his or her learning

style. If so there needs to be an expectation that when they are pulled from the room to work they go to a
"work space" not a "fun space." Because if we give breaks from work that are fun they may begin to
correlate the fun with not having to work. Then there will be an increase in the behavior you are trying to
correct. So, it must be a "work space."
Then you need to look at the data collection and determine if there are patterns in the data. you
need at least three to four weeks (without any breaks or changes in between) of good data to really see if
there are patterns that truly mark a behavior as negative or a response to a stimuli. Kids who are
overstimulated respond well when they are given breaks and expectations are clear. You can also send
the student to a "calm down" area for five minutes, and note if the behavior changes.
The calm down area should be devoid of anything fun, bright or busy. It needs to be quiet, and if
at all possible not have fluorescent lighting. Some kids on the spectrum can actually hear the buzz in the
lights or it can be too bright. A desk in a room with a lamp would be appropriate. However, they are only
allowed in that space for a quick calm down session. Then they are to move to a work area. Setting the
expectations for each area is important. If the student continually refused to leave the calm down area
then this is a good indicator he or she may benefit from a "sensory safe" classroom. However, we must
decide again if it is an attention behavior or an escape behavior.

Escape :

If a student needs to escape where do they go?

There must be a specific place for them to go. The space should be
trigger free:

Darker- filtered or no fluorescent lights. Lamps or natural

Quiet (carpet is a plus)

soothing fountains or very light relaxing music can be a

light are best

plus, but it can trigger some overstimulation too.

Desks not touching others
Personal space allocated for individual students
No busy walls and absolutely no extra clutter or papers.
It must be very clean -not sterile, but overly organized. Cabinets should be shut
to hide visual things, and book shelves should be free of clutter, debris, trinkets,
and books need to be labeled or categorized.

There needs to be bins or categories for everything, and

everything needs to have a place.

The space should be separated into three categories and clear
expectations should be modeled, shared, and practiced.
Even having a room painted in three separate colors or
just using duct tape to label the different spaces is important
Work space- CLEARLY FOR WORK
ONLY

Fun Space - Sensory space- This is a

great place to put into a reward system for those behaviors you are trying
to reinforce like work completion, demonstrating positive social skills and
complying with teacher directives etc. It can include
Sensory blankets or lap
pads, ball pits, kinetic sand, playdough, stress balls or stretch
bands.

Calm Space- This is a space where they

go when they have tantrums or need to be removed from class for a

negative behavior

Set a timer for 5-10

mins and if they are calm at that point then you state the
inappropriate behavior and what you would like them to do next
time very CLEARLY. Do not overcomplicate by talking for hours
over something. It should be a 3-5 minute conversation or less.
Anymore and you are over stimulating them and they will need
more time to process. Some may even become confused about
what they are discussing in the first place after more than 3-5
mins. It should be stated something like:
Restate what they did:
When you were asked to go back to your seat you screamed and
threw a chair.

Share why it was not an

appropriate behavior and try to tie it to a social skill: Screaming is

disrespectful to your teacher and classmates because you

distracted them from their work. Throwing a chair was unsafe

because you could have physically injured another student or
yourself. Your actions made your classmates feel sad, and
scared.

State what you want

from him or her next time: A better choice would have been to
take a deep breath instead of scream, and taken a break instead
of throwing a chair.

If they

are extremely high functioning you might be able to ask

them to share their feelings, but it might be an
impossible task for some.

Positive Reinforcement

statement should be given at this time. It should be specific to

something they did well that day: I know you do not like to make
people sad because I watched how you let Johnny join your
group during reading. He was very happy that you let him join
you.

THIS IS IT! DO not over think, over

stimulate or over correct. It has to be clear, SHORT, and directly to the

point.

It is important to do the

same thing with parents. Teach them to not over think or to keep
talking about things. It is like beating a dead horse. It will not get
you very far.
FAMILY INTERVENTIONS
The institute holds a once a month class for parents. They provide childcare and give the parents time to
work together with trained staff and support each other. There is an agenda, where the staff teaches
something specific. Then they have time for direct questions and time for parents to mingle. It helps them
feel less isolated, and the training assists the parents in being a partner with the school in the education
of their child.

Parent Resources

Reading Material from May Institute

Parent Manual
http://youtu.be/ajDvUk4f4Wo

Educator Resources

Educator Resources
http://www.chnola.org/autism
Aspergers Employment Workbook
Getting Started with the Verbal Behavior Approach

Childrens Friendship Training (2-6) Elementary training on social skills (8-10 weeks)
P.E.E.R.S. Treatment Manual (7-12) Training for MS/HS on social skills (14 weeks)
Aspergers Employment Workbook
Verbal Behavior Approach by Barbera BUY THIS ONE!

Books

Affective Skills classes:

Use the curriculums

Childrens Friendship Training (2-6) Elementary training on social skills (8-10 weeks)
P.E.E.R.S. Treatment Manual (7-12) Training for MS/HS on social skills (14 weeks)

And any information from Jed Baker Social Skill Instruction

TEACCH curriculum / model has good components, but not the entire model is evidence

based

WOrk station model

Folder Tasks
Bin Schedule

Can we put BD/ED and SPECTRUM KIDDOS IN THE SAME ROOM FOR AFFECTIVE SKILLS

At the elementary that is fine if it is very structured and BD/ED are not

Not at the ms/hs level

safety concerns for spectrum students and low social

too extreme

skills they can learn inappropriate behaviors to earn friendships

Easily manipulated by other BD/ED
Transition
Life Skills Class Requirement for any student on IEP last year of school

Resources:

Must meet objectives for meeting their own needs

Aspergers Employment Workbook
Guide for Transition to adulthood

May Institute
Peter Gerhardt
Virginia Institute of Autism
Chartwell Center - school for kids with autism
FINAL ADVICE

When you see one child with autism you have seen one child with Autism. They

are all different and do not follow the same patterns.

Be realistic in your expectations
Most challenging behaviors are communicative in some way