Autism Society of NH Message Board

Pediatricians in Manchester

Becky — Tue, 02 Sep 2008 17:48:13 GMT

My children have been going to Hampshire Pediatrics in Manchester for their whole lives. They have recently been taken over by Elliot Pediatrics and the 2 doctors in the practice are leaving, so we need to find new doctors. I have 2 typically developing daughters and my son, Ryan, is almost 14 and is high functioning on the Autism spectrum. He is in the Autism program at Parkside. I am really dismayed that after this amount of time we are in search of new pediatricians. While my girls are happy they get to pick a woman to see, I am very concerned about finding adequate care for my son. He has seen the same doctor for his whole life and the change I'm sure will be traumatic for him. I am wondering if anyone out there has a recommendation for a pediatrician in the Manchester area with ANY knowledge at all in dealing with patients on the spectrum. While Dr. Schuman was no expert on ASD, he has known Ryan his whole life and watched him grow. He knew how to talk to him and that he needed special treatment. I dread having to educate another office on how to deal with a child that has Autism. Thanks for any help anyone can give.

Article on Behavioral approaches

Cheri — Mon, 01 Sep 2008 21:09:16 GMT

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Supporting Children and Youth with ASD Who Exhibit Challenging Behavior

By Rob O'Neill

Patterns of challenging behavior have long been associated with the diagnosis of Autism Spectrum Disorders (ASD.) Anyone with experience with such children has likely observed problems with toileting, sleep, excessive activity levels, self-stimulatory or stereotypic movements (e.g., rocking, hand flapping), and more serious behaviors such as aggression towards others (e.g., hitting, kicking), destruction of materials and the physical environment, and self-injury (e.g., hand biting, head hitting and banging). Consider Randall*, a 7-year-old student labeled as having an Autism Spectrum Disorder. Randall has been diagnosed as also having severe intellectual disabilities, and does not exhibit any functional verbal communication. He exhibits a variety of challenging behaviors, including forcefully smacking the backs of his hands on table edges, dropping to his knees on hard floors, and a variety of aggressive behaviors such as hitting, pinching, and scratching others. He spends most of his time in a self-contained classroom for students with disabilities, working on a variety of pre-academic and functional skill training activities (e.g., toileting, dressing, communication skills). Such behaviors can have a variety of negative physical, social, educational, and economic consequences. They can result in significant pain, injury, and emotional distress for children and families, and for teachers providing support to them. Participation in schools, residential programs, and other community settings may be jeopardized and there is an increased risk of readmission to public residential facilities. Providing necessary support results in greatly increased costs (e.g., $100,000 or more per year for persons with severe self-injury ). Such behaviors may place children with ASD at greater risk for abusive treatment by support staff. It is clear that challenging behavior is frequently exhibited by children with ASD, and that without intervention they are at much greater risk for a variety of negative outcomes.

Interventions for Challenging Behaviors

The two primary intervention approaches for such behaviors have been behavioral intervention and the administration of psychotropic medications; this article focuses on the former. For many years behavioral strategies predominantly focused upon reinforcement of appropriate behaviors and punishment or extinction for challenging behaviors. In recent years, concerns with such procedures have led to a more positively oriented and comprehensive approach, typically referred to as positive behavioral support (PBS). This approach includes a broader perspective on outcomes, an emphasis on careful functional assessment as a basis for selecting and implementing intervention strategies, comprehensive programs involving multiple components, and consideration of needed skills and systems that need to be in place to support students (e.g., Koegel, Koegel, & Dunlap, 1996).

A Broader Perspective on Outcomes

PBS has its roots in the field of applied behavior analysis. However, along with specific and important reductions in the frequency of challenging behavior, PBS approaches also emphasize that behavior change should result in broader positive changes in educational and community settings for students receiving support. This includes where they spend their time (e.g., more inclusive vs. more segregated classrooms), with whom they spend their time (e.g., more time with typical peers vs. paid support staff), and what they spend their time doing (e.g., engaged in more typical educational, domestic, leisure, and community activities). In thinking about Randalls situation described above, it would be critical to achieve reductions in his problem behavior, but if that is not accompanied by broader changes in what Randall is doing, where hes doing it, and with whom, we will not have done the best we can by him.

Functional Behavioral Assessment

A seminal research report by Iwata et al. (1982) is credited with sparking a resurgence of attention to the need for conducting systematic analyses as a basis for implementing interventions. Iwata et al. collected data on the occurrence of self-injurious behavior (SIB) of persons with developmental disabilities while systematically manipulating various environ- mental conditions. These functional analysis manipulations attempted to determine the reinforcement contingencies that were responsible for maintaining the SIB. Since the publication of the Iwata et al. report there has been an increasing frequency of pretreatment experimental and nonexperimental analyses (collectively known as functional assessments) reported in the literature, as well as an increase in the implementation of successful treatment strategies based on such analyses (Johnston & ONeill, 2001). The success of such approaches led a National Institutes of Health Consensus Conference panel to recommend that interventions for severe challenging behaviors be based on pretreatment assessments (NIH, 1991).

In recent years a number of states have adopted regulations that explicitly call for a functional assessment to be conducted prior to significant behavioral intervention. Along with state level standards, the last two enacted versions of the federal Individuals with Disabilities Education Act (IDEA) explicitly mandated that a functional assessment be done in situations involving serious challenging behaviors. Conducting a functional assessment of challenging behaviors prior to intervention has become an expected professional standard (ONeill et al., 1997).

Coming back to Randall, school consultants and staff working with him conducted functional assessment interviews, and also conducted structured functional analysis manipulations in his classroom setting. These sessions involved systematically responding in various ways to Randalls challenging behavior to determine what antecedent and consequence events were setting off and maintaining it. The results indicated that the vast majority of his challenging behavior was motivated by escaping and/or avoiding when he was asked to complete various pre-academic activities. This assessment provided a solid foundation for identifying intervention strategies.

Comprehensive Multi-Element Behavioral Support Plans

It is clear that students with complex histories of challenging behavior require a comprehensive approach including (1) responding to broader setting events such as sleep, diet, medication or social interaction issues (e.g., making sure a child has breakfast before coming to school); (2) more immediate antecedent strategies (e.g., changes in levels of task difficulty); (3) strategies to teach students more appropriate alternative behaviors (e.g., teaching a child to sign break when frustrated with a task or activity); and, (4) providing reinforcing outcomes for appropriate behavior (e.g., honoring requests for breaks, providing preferred activities contingent on task completion), minimizing or preventing reinforcement for challenging behavior (e.g., not allowing a child to escape a nonpreferred task), and, in some cases, providing appropriate punishing events contingent on challenging behavior (e.g., blocking aggressive hitting).

In Randalls case, assessment data indicated that he frequently was allowed to stay up very late at night, increasing problem behavior on subsequent days. Classroom staff worked with Randalls parents to implement an earlier bedtime routine. Classroom staff also modified curricular activities to more gradually lead to the eventual desired performance (e.g., providing easier tracing activities prior to moving on to more difficult printing activities). They began to provide Randall with choices about which academic or functional skill activities he would work on during a given period. A communication disorders specialist began to teach Randall some basic sign language to communicate his wants and needs in difficult situations (e.g., signing break, help). Randall was provided with some graphic picture cards signifying break and help, and received training in how to use those in situations likely to evoke challenging behavior. Classroom staff frequently and consistently provided desired outcomes when Randall exhibited appropriate communicative behavior (e.g., pointing to his break card), and provided breaks and preferred activities contingent on periods of problem-free task completion. Staff attempted to minimize or prevent reinforcement for problem behavior by attempting to keep him engaged in task activities. Even if Randall did escape task activities for a brief period, he was redirected to complete them as soon as possible. This comprehensive approach to Randalls situation produced reductions in problem behavior and an increased frequency of appropriate communicative behavior and engagement in desired tasks and activities (ONeill & Sweetland-Baker, 2001).

Skills and Resources Needed for Providing Effective Support

We need to think about the broader systems issues that need to be addressed to enable school personnel to support a broad range of students. Support may come either from within the building, or from external resources such as district consultants, but requires some person or persons with significant behavioral expertise who can take the lead in conducting assessments and helping to develop intervention strategies (Sugai et al., 2000). Such schoolwide efforts include (1) strategies for all students in a school as a whole; (2) group strategies for the smaller portion of students at-risk for more significant challenging behavior; and (3) strategies for those requiring more intensive individualized support (e.g., students such as Randall labeled as having ASD exhibiting severe challenging behavior).

In a recent review, Horner et al. (2002) concluded that the literature does not identify any types of behavioral support interventions that are uniquely effective with children with Autism. Providing support for students requiring intensive individualized strategies is best accomplished in a broader schoolwide context. Schoolwide efforts typically involve team-based approaches which should include (1) personnel familiar with the student, including teachers, paraprofessionals, parents/family members, and in appropriate cases, the student him/herself; (2) administrative personnel who can make decisions about resource allocation; and, (3) personnel with behavioral expertise who can conduct functional assessments and develop and implement behavioral support plans. Ideally, someone on the team would also have expertise in the characteristics and performance of students with ASD; however, given the lack of unique behavioral support interventions identified for such students, this may not be critical.

Summary

School-age students with ASD who exhibit challenging behavior may require a variety of behavioral supports to maximize participation in typical classroom and community settings. Perhaps the most critical issue is to focus on the needs of individual students, as opposed to assuming various support needs based on whether or not a child has an ASD label. It is hoped that this article provides some guidance to those school personnel and families providing such support to children and adolescents exhibiting challenging behavior in school and community settings.

*Pseudonym

References

Horner, R.H., Carr, E.G., Strain, P.S., Todd, A.W., & Reed, H.K. (2002). Problem behavior interventions for young children with Autism: A research synthesis. Journal of Autism and Developmental Disorders, 32, 423-446.

Iwata, B.A., Dorsey, M.F., Slifer, K.J., Bauman, K.E., & Richman, G.S. (1982). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 2, 3-20.

Johnston, S., & ONeill, R.E. (2001). Searching for effectiveness and efficiency in conducting functional assessments: A review and proposed process for teachers and other practitioners. Focus on Autism and Developmental Disabilities, 16, 205-214.

Koegel, L.K., Koegel, R.L., & Dunlap, G. (Eds.) (1996). Positive behavioral support: Including people with difficult behavior in the community. Baltimore: Paul H. Brookes Publishing.

National Institutes of Health (NIH) (1991). Treatment of destructive behaviors in persons with developmental disabilities. Washington, DC: National Institutes of Health.

ONeill, R.E., Horner, R.H., Albin, R.W., Sprague, J.R., Storey, K., & Newton, J.S. (1997). Functional assessment and program development for challenging behavior: A practical handbook (2nd ed). Belmont, CA: Wadsworth.

ONeill, R. E., & Sweetland-Baker, M. (2001). An assessment of stimulus generalization and contingency effects in functional communication training. Journal of Autism and Developmental Disorders, 31, 235-240.

Sugai, G., et al. (2000). Applying positive behavior support and functional behavioral assessment in schools. Journal of Positive Behavior Interventions, 2, 131-143.

Rob ONeill is Professor in the Department of Special Education, University of Utah, Salt Lake City. He may be reached at 801/581-3913, or at roneill@ed.utah.edu.

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Retrieved from the Web site of the Institute on Community Integration, University of Minnesota (http://ici.umn.edu/products/impact/193/default.html). Citation: Cadigan, K., Craig-Unkefer, L., Reichle, J., Sievers, P., & Gaylord, V. (Eds.). (Fall/Winter 2006/07). Impact: Feature Issue on Supporting Success in School and Beyond for Students with Autism Spectrum Disorders, 19(3). .
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Behavioral issues

cyndy — Fri, 29 Aug 2008 16:08:13 GMT

Hello parents,
My son has screaming, jumping and grunting bouts! Any idea how this can be maintained or resolved? The school keeps saying he will change, but they're getting frustrated. Lots of tantrums esp when he doesn't get his way! I though a behavioral therapist would help, but so far, nothing seems to work!
Any ideas will suffice!
Thanks again!

North Conway Menu Help GF/CF

Michelle — Fri, 29 Aug 2008 02:08:14 GMT

Anyone have any luck with restaurants in N. Conway and food choices? We are heading up to Storyland and would love to go out to eat (who wants to cook on vacation). I found a couple places that have gluten free menu's Rafferty, Bellini's, Yankee Smokehouse. The first two looked good but I didn't know if anyone had any luck elsewhere. They love pizza/hot dogs and I would love to go some where where they could get it. The three I mentioned didn't have anything to substitute for cheese (such as soy based).

Candidates and Austim

ASD Mom — Thur, 28 Aug 2008 22:42:26 GMT

Anyone care to share their thoughts on who they are casting their votes for? Where do the candidates lie when it comes to autism?

Need Contact Info

Andrea — Thur, 28 Aug 2008 12:09:02 GMT

Does anyone have the contact information to set up an evaluation at either Boston University or Dartmouth Hitchcock? I think I am going to set up another Evaluation of Ethan to get a second opinion.

Frustrated Already, help!

Kerri — Wed, 27 Aug 2008 14:50:38 GMT

Hello all, just needed to vent and ask for suggestions.

My daughter started 1st grade yesterday and this morning I found out the para in her room is only going to be part time! I was livid. At our last IEP meeting my husband and I asked about a one on one aide and the team told us that they did not think it was necessary since there would be a para in her new class. We agreed to test out how she did with the para thinking the para would be full time.

Last year she had a para full time in Kindergarten and my dd needed her help all the time. I just sent off an email to her team leader trying to find out the reason for this.

Any suggestions on what to do next?
FYI- DD's diagnosis is PDD-NOS, Sensory Integration disorder

Sep 9th, training....free

Cheri — Wed, 27 Aug 2008 00:43:08 GMT

Hi all, Don't miss this one.......cheri

Not Just One Autism

http://www.notjustoneautism.com/index.htm
September 9, 2008
Nashua North HS Auditorium

7:30am 8:20am	Continental Breakfast
8:30am 9:15am	Robert Greenleaf - Keynote Speaker
9:15am 10:00am	Not Just One Autism Teresa Bolick, Ph.D.
10:00am 10:15am	Coffee Break
10:15am - 11:00am	Autism and the Family Kirsten Murphy
11:00am 12:00pm	The Wider Spectrum Treating the Whole Person Jeff Q. Bostic, M.D., Ed.D.
12:00pm 1:00pm	Lunch
1:00pm 2:15pm	Panel Discussion: Autism Spectrum Disorders in Everyday Life

Volunteer Advocate Training

Cheri — Wed, 27 Aug 2008 00:27:41 GMT

Hi all,

I wanted to let you know that PIC's Volunteer Advocate Training is coming to Manchester. This 11 week training starts 9/23, Tuesday, and will be at SNHU. The program is really about training family members and others in the special education process so that they can help provide information and support to parents who may be new to the process or don't really understand it.

Some of this support is informal, just as most of our interactions are, but our goal is to train others who might be available on occasion to help a family that has called into PIC for support.

It's very rewarding, but also helpful if you have a child in with an IEP. The group is dynamic and really becomes a support network for you. You learn great communication tips and strategies while also learning about the law and rights for children with disabilities.

If you are interested or want to learn more, please email or call...
tcjcsullivan@yahoo.com 603-224-7005, ext. 19

Take care....(SNHU is also offering graduate credit for the course for a fee)

MRI Results

cyndy — Tue, 26 Aug 2008 20:41:02 GMT

Getting positive MRI results is great right! What does normal mean? I know that sounds crazy, but what's normal for a child with ASD?

Learn with Me

Bridget — Mon, 25 Aug 2008 20:11:41 GMT

We are a new program based out of Londonderry that provides individual and group services for children with disabilities. Our programs range from ABA services under the direction of a BCBA, social skills groups, preschool program, playgroups, respite care and music and movement groups. Our website is www.LearnwithMeInc.com and can be reached 421-9944. We are currently in the process of enrolling at our office in Londonderry and the North Country, as we are planning a location to open before the end of the year.

Daily activity sheets

Kerri — Mon, 25 Aug 2008 15:24:13 GMT

Hello,
My daughter will be starting 1st grade and I was wondering if anyone has any ideas for finding out about your child's day? My youngest is in preschool where they fill out an daily activity sheet designed to let us know what our daughter did that day. My 1st grader is verbal, but no enough to let me know a whole lot about her day.

Has anyone made their own daily activity sheets for your child's teacher? If so, how did the teacher react? I'm just not sure how to approach this since it's not just a few hours of preschool they'd have to report on like my younger daughter.

I want to start the new year off by building a good relationship with my daughters teacher. I also would like a better idea of what she is doing during the day and what therapist she worked with, etc. so that I can reinforce the things she is learning at home.

Any ideas/suggestions are welcome, thank you!

social skills training

ma — Sun, 24 Aug 2008 17:41:52 GMT

Hi!
I was wondering if anyone was familiar w/a social skills training program or DVD that has been successful
My son, now 12 has very limited speech & inappropriate social skills
Any info would be appreciated
Thanks!
ma

Need some vendors

stephanie — Sat, 23 Aug 2008 02:22:26 GMT

I am putting the call out there to see what everyone has to offer for Autism Family Weekend, October 9-13th at Gunstock Inn, Gilford, NH. I was trying to find someone who makes and sells PECS for people to take home that day, OT/sensory items, guest speakers on IEP's, funding, insurance ins and outs.........let me see what is out there.

Autism Family Fun Day in Dover

Viki Gayhardt — Thur, 21 Aug 2008 22:02:27 GMT

http://fosters.com/apps/pbcs.dll/article?AID=/20080821/GJCOMMUNITY_01/1200

First Autism Awareness Family Fun Day set Saturday

User Submitted News

Article Date: Thursday, August 21, 2008

DOVER - The first Autism Awareness Day will be held Aug. 23 from 10 a.m. to 4 pm at the McConnell Center, 30 Saint Thomas St.

This is a day meant to unite families with autism, to enjoy each others company and to celebrate our children.

There will be many free games and prizes, lots of music and fun. A raffle full of donations will be from local business.

Most activities will be completely free for all families. Food will be available for a small price at lunchtime.

All proceeds from the event will be donated to Easter Seals Dover Chapter and The Birchtree Center.

This event will take place rain or shine.

Contact Erica at (603) 651-8320 for more information, to donate or to volunteer.