1. How to Use Evidence-Based
Practices to Help Children with
Autism in Unknown or
Uncomfortable Settings
Christy Roybal, M.S.

2. 1 in 88 Children have an
Autism Spectrum Disorder
(CDC)
Individuals and families affected by Autism
Spectrum Disorders are part of every
community. 2
National Survey – Autism
prevalence at 1 in 50 school-age
children

3. What is Autism?
A developmental disorder of neurobiological
origin
– Developmental - Evidence of the disorder
sometime in the developmental period – typically
before 3
– Neurobiological – of or related to the nervous
system
– Lifelong – individuals will not “grow out of” or be
cured of autism
3

4. What are the Core Deficits of Autism?
Committee on Educational Interventions for Children with
Autism, National Research Council, Educating young children
with autism, 2001
Communication
• Joint Attention
• Symbol Use
Social Development
• Adults
• Peers
Cognitive Development
• Includes executive function (planning)
4

5. Core Deficits of Autism (continued)
Sensory & Motor Development
• Motor abilities
• Atypical sensory responses
• Motor stereotypies
• Sensory/Arousal modulation
Adaptive Behaviors
• Social responsibility
• Independent performance of daily activities
Problem Behaviors
5

6. Characteristics: Communication
• Language difficult to produce and understand
• Limited facial expressions and use of gestures
• Literal and concrete thinking and interpreting
• Unusual “melody” of speech
• Difficulty imitating sounds and actions
• Repeats (echoes) words and phrases

7. Characteristics: Communication
• “Children and adults on
the autism spectrum
have taught me that it
is imperative to
communicate most
clearly about things that
are the most difficult to
understand.”
• Understanding Death and Illness and
What They Teach about Life: An
Interactive Guide for Individuals
with Autism or Asperger's and their
Loved Ones
• by Catherine Faherty

8. Characteristics: Communication
“ When Bernard was told that he was scheduled for a CAT scan in
one hour, he became elated. Bernard loved cats and brought
many of his favorite cat books with him to the hospital. He had
even made a sign for the door to his room, writing his name in
cat letters….Realizing what she had said, the nurse explained to
Bernard that a CAT scan, now referring to it as a CT scan. Was
like a big x-ray, and that it had nothing to do with real cats. They
decided that it was a funny name for an x-ray and that Bernard
would be allowed to bring his favorite cat book with him to hold
and look at while he was having his scan.”
Prescription for Success: Supporting Children with
Autism Spectrum Disorders in the Medical Environment
• by Jill Hudson

9. Communication
What helps
• Keep language simple
• Use concrete, literal
language
• Use visuals to support
your communication
(visual prompts)
• Give instructions and/or
ask questions one time
only
• Use gestures, facial
expressions, tone of
voice
What gets in the way
• More than one person
giving instructions or
asking questions
• Repeating instructions
louder
• Repeating instructions
many times

10. Characteristics: Social
• Difficulty in relating to people
• Difficulty in understanding/using social
cues
• Greater focus on objects
• Lacks understanding of the perspective of
other people
• May appear to be
inflexible, argumentative, stubborn

11. Social
What helps
• Use social stories
• Give cues
(visual, demonstration
) to help the child
understand what to
do
What gets in the way
• Trying to get the child
to “look at me.”
• Trying to get the child
to use polite language
– “please, thank
you, excuse me”
• Taking the child’s
behavior personally –
it’s not about you

12. Characteristics:
Cognitive Development
• Delayed executive functioning
Planning
Organizing
Breaking down complex
activities/requests
• Transitions can be difficult
• Difficulty generalizing skills
• Difficulty with Theory of Mind

13. Cognitive Development
What helps
• Provide information that
can be seen, is organized
and as specific as
possible
• Pre-teaching activities
• Visual strategies –
schedules, mini
schedules, cue cards
• Easy-to-understand maps
of the hospital
What gets in the way
• Not preparing the child
• Rushing the child through
the process
• Using words/symbols the
child does not know

14. Characteristics: Sensory and Motor
Development
• Restricted interests
• Non-functional routines
• Stereotyped and repetitive motor mannerisms
• Delayed motor skills
• May be very sensitive or unaware of sensory
input (noise, smells, visual
stimulus, movement, touch)
• May explore by licking, smelling, etc.
• Often overwhelmed by sensory experiences
• May seek or avoid sensory experiences

15. Sensory and Motor Development
What helps
• Use special interests for motivation
/reinforcement
• Allowing the child to keep special
items or talk about special interests
when he/she is stressed
• Keeping things as quiet as possible
• Consider head phones to block out
sound or with music
• Notice what helps the individual to
be calm and alert
• Something in the mouth (that is
safe)
• Something in the hands (that is
safe)
• Thinking about alternatives to what
the child wants to do and can’t.
Example: Child wants to fling a stethoscope
around – is there a kid stethoscope or other
things that they can use?
What gets in the way
• Trying to take away items of
special interest (as long as
they are safe)
• Not addressing their sensory
needs
• Over/under simulating
environment
• Be patient when children are
navigating around– they may
feel unsteady on shiny
floors, steps, etc.
• Lots of things that you can’t
control
(smells, noise, unexpected
changes in the environment)

16. Characteristics:
Adaptive Behaviors
• Difficulty with executive functioning
• May need direct instruction in
– self-care
– leisure activities
– functioning in the community
– Self advocacy

17. Characteristics: Problem Behaviors
• Using inappropriate behaviors as a
means of communication
• Behavior may result from fear, sensory
overwhelm, anxiety or illness
• Behavior may be related to ritualistic
and/or stereotypical behavior
• Behavior can be related to social
difficulties

18. Characteristics: Problem
Behaviors
• Why do they do what they do?
Functions of Behavior
1. Escape – from a person, place or activity
2. Tangible – desire for a thing or activity
3. Sensory – feels good or meets a sensory
need
4. Attention – desire for attention from peers or
adults
Mark V. Durand, 1990

19. Problem Behavior
What helps
• Don’t take it
personally – it is not
about you
• Always consider
communication, visual
supports, antecedents
and consequences
What gets in the way
• Talking a lot to the
child
– Reasoning
– Telling the child what
he/she shouldn’t do

20. How do you change it?
Positive Behavior Supports
• Token Economy
• Video modeling
• Timer
• Boundaries defined
• Labels
• Reinforce, reinforce, reinforce
• Help them to understand what is being asked and what comes next
• Use few words supported by pictures/written words
• Say/show what you want, not what you don’t want
• Each activity has its own expectation – make sure the child understands
what they are being asked to do
• Expectations should be modeled, practiced & reinforced

21. Behavior – Effective Interventions
• Interventions should use highly supportive
and structured environments.
• Interventions should utilize predictability and
routine.
• Interventions focus on easing transitions
between activities.
• Interventions need to involve the family in
planning and implementation if possible.
* Adapted from Dawson & Osterling, 1997.

22. Evidence Based Practices
• Prompting
• Time delay
• Reinforcement
• Task analysis and chaining
• Shaping
• Differential reinforcement of other/alternative behaviors
• Discrete trial training
• Extinction
• Functional behavior assessment
• Positive behavior supports
• Response interruption/redirection
• Self-management

23. Evidence Based Practices Continued
• Computer-assisted instruction
• Functional communication training
• Independent work systems
• Naturalistic interventions
• Parent training
• Peer-mediated instruction/intervention
• Pivotal Response Training
• Social skills groups
• Social stories
• Video modeling
• Visual supports
• Voice output communication aids/speech generating
devices
• Stimulus control & environmental modification

24. Components of an Evidence-Based
Practice Brief
• Overview: A general description of the practice and how it
can be used with learners with autism spectrum
disorders.
• Step-by-Step Instructions for Implementation: Explicit
step-by-step directions detailing exactly how to implement
a practice, based on the research articles identified in the
evidence base.
• Implementation Checklist: The implementation checklist
offers a way to document the degree to which
practitioners are following the step-by-step directions for
implementation, which are based on the research articles
identified in the evidence base

25. Components of an Evidence-
Based Practice Brief
• Evidence Base: The list of references that
demonstrate that the practice is efficacious and meets
the National Professional Development Center’s
criteria for being identified as an evidence-based
practice.
• Briefs found here -
http://autismpdc.fpg.unc.edu/content/briefs
• Modules found here -
http://www.autisminternetmodules.org/

26. It’s time for an activity!
• Develop a social story for a typical routine at
the hospital.
and/or
• Develop a mini-schedule for an common
activity /procedure at the hospital.

27. References
Behavioral Intervention for Young Children with Autism, Catherine
Maurice (1996) Pro-ed
Choosing Outcomes and Accommodations for Children
Michael Giangreco (2011) Brookes Publishing
Prescription for Success: Supporting Children with Autism
Spectrum Disorders in the Medical Environment, Jill Hudson (2006)
Autism Asperger Publishing Co
Thinking about You Thinking about Me, Michelle Garcia Winner
(2007) Think Social Publishing
Understanding Death and Illness and What They Teach about
Life: An Interactive Guide for Individuals with Autism or
Asperger's and their Loved Ones, Catherine Faherty (2008) Future
Horizons Inc.

28. Thank You!