The authors stressed the importance of parental attitudes in influencing the outcomes for their children. They quoted A.P. Turnbull and Winton (1983) who discussed the attitude of a mother of a child in a mainstreamed program:

You need to learn how to deal with this world the way it’s designed to run right now, which is toward the nonhandicapped. You cannot live in a sheltered environment, whether it be your own home, or a private school for the handicapped, and then all of a sudden come of age and be thrown out into the world and never learn to deal with it. (pp. 63-64)

This mother’s attitude mirrors my own. I have grown up among people with handicaps, and it is true that if you do not learn to cope at an early age, your life will be most miserable and pathetic, indeed.

A statement is made on page 164 by the authors that parents are not often named as service providers in the goals and objectives of the IEP. They further argue their point by citing studies that even though parents of children with learning disabilities work with their children at home, they do not distinguish between home activities carried out as objectives on the IEP.

According to Michael D. Powers, Psy. D., (ADVOCATE 1996) the most effective educational program of all for a child with autism has to have parental participation and involvement from the very beginning and at all levels. He states that parents are the essential element in their child’s education for the very reason that are well-suited to promote generalization of skills.

This report is a PROPOSAL of a Goal, Objective, and Interventions which can be implemented in the home and community setting for Christopher Lawrence, with his mother and father named as the service providers.

I. Identification and Description of the Student

Christopher Steven Lawrence celebrated his 8th birthday on March 6, 1998. When he was originally labeled with autism two years ago, IQ (MA) tests were deemed invalid because Christopher’s receptive language skills at that time were very poor. My best guess is that his IQ is “average,” which might be a bit optimistic on my part, but hey, I’m his mother!

Physically, Christopher is 4’3” tall and weighs 85 pounds. With the exception of chronic ear infections when he was two, Christopher has had few medical problems. There is continuous communication between home and school , so that when Christopher is not feeling well it is noted and he receives prompt medical attention. Vision and hearing screenings are inconclusive but parent/teacher observation indicate that Christopher responds to normal conversational tones and does not squint or appear distressed when viewing books, television, etc. He does avoid most social eye-contact, however. Christopher is fully toilet trained during the daytime and indicates verbally when he needs to go to the bathroom.

Expressive Language consists mostly of immediate as well as delayed echolalia, often phrases and “sound bytes” from various television programs and movies. He seems to rely on the “video library” in his head to determine an appropriate response to given situations. Expressive language that is not echolalic in nature is very difficult for him. He becomes anxious when he doesn’t know what is going to happen and has no way to ask. He will usually reserve spontaneous language for making requests, asking questions (“where is it?” and “what is it?”) , or getting his little sister to go away when she annoys him (“Go away! Leave me alone!”). He has to be verbally prompted to “use his words.”

He reads on a 4th grade level, with comparable comprehension skills. Picture cues are provided with written text to ensure that comprehension levels remain high. He seems to understand written language much better than spoken language. We take advantage of the Closed Caption capabilities of our television set at home.

Math skills such as Addition and Subtraction are very difficult for him, regrouping is far too abstract for him to comprehend. Progress is hampered by the fact that he has a tendency to throw math manipulatives when frustrated (he does not like to deal with sets and subsets). Currently he is working with “Touch Math” materials which are semi abstract in nature.

Christopher attends public school in a regular P3 (2nd grade) classroom, with pull out for Speech Therapy and Resource Room for Math. He has a one-to-one aide part of the day who supports his participation in the regular classroom environment.

I used the Vineland Adaptive Behavior Scales to measure Christopher’s adaptive skills, since these are the types of skills that his Father and I work on in home and community settings. These skills are easy to assess because they are based entirely on observation.

Based on the VABS, according to his Chronological Age, in the Communication Domain, Christopher has “Adequate” Receptive Communication, “Low” Expressive Communication, and “Moderately Low” Written Expression Skills. He received an overall score of “Low” in the Communication Domain.

In the Daily Living Skills Domain, Christopher has “Moderately Low” Personal Skills, “Moderately Low” Domestic Skills, and “Low” Community Skills. He received an overall “Moderately Low” score in the Daily Living Skills Domain.

In the Socialization Domain, Christopher has “Moderately Low” Interpersonal relationships, “Adequate” Play and Leisure Time Skills, and “Adequate” Coping Skills. He received an overall score of “Moderately Low” in the Socialization Domain.

All in all, these scores reflect the very nature of a diagnosis of Autism. However, the data collected using the VABS at least provides a starting point on beginning interventions at home and within the community.

His two most lowest scores are in the areas of Expressive Language in the Communication Domain and Community Skills in the Daily Living Skills Domain, so based on this data, these are the two areas I have targeted for home intervention.

RISK FACTORS Primary - Within person factors that put Christopher at risk for learning and competency:

Attention: Christopher can focus on things that are of interest to him, but not necessarily what instructor is teaching or what someone wants him to focus on.

Social Interaction: Christopher seldom interacts with family members reciprocally. Poor social use of eye contact.

Imitation Abilities: Christopher has delayed imitation. He can imitate things that he has seen/heard many times in the same format and sequence, i.e. Disney Movies. Usually when he imitates it is of adult actions. Immediate imitation is seldom seen at home.

Sensory Needs and Processing: Christopher is a highly visual learner. He tunes into all types of music (Rock and Roll, Classical, Jazz, Western). Distracted by too much visual and auditory stimuli. He may tantrum in situations that involve large crowds of people. Reacts to some noises (sirens, loud engines), some tactile stimuli, and avoids strong smells such as kitchen/bathroom odors- particularly in public places.

Preservative about some things : Christopher organizes his world by keeping things certain ways and following certain routines when he is at home.

Self Care Delays : picky eater, only wears certain clothes (soft and loose fitting), needs to have constant supervision (runs)

Some fine motor difficulties with paper and pencil exercises, clothing fasteners, and inability to tie shoelaces

Problems with transitions : not wanting to stop some things and not wanting to move to the next activity.

Inconsistent: some days Christopher does much better attending, following directions, and doing work than on other days.

Problems with Generalization: Christopher learns object and situation specific skills and doesn’t use them in other places unless taught. May also try to use an object in only one learned way.

Behavioral Concerns: Tantrums as refusal, makes noises, stares into space, paces in circles, screeches to avoid difficult situations, problems staying on task

Motivation: Christopher’s reinforcers need to be planned and designed for him. Typical social reinforcers may not mean much to Christopher.

Secondary - Environmental Factors that put Christopher at risk for learning and competency

*Not having the supports he needs in place which include
*Trained positive staff who are supported to meet his needs
*All of the above factors addressed in a proactive way
*Collaboration between home and school and between all school staff
*Individualized teaching strategies that address his learning needs
*Ongoing training and meetings for teachers and staff
*People who understand how autism affects Christopher’s learning and provide for those factors
*An enlightened and supportive community network

PROTECTIVE FACTORS

Primary - within person or Christopher’s preferences, interests, strengths (List needs to be constantly updated.)

These need to be used throughout his day as motivation:

Electronic Equipment, things with buttons and switches and knobs - tape recorder,computer
Latest Obsession is John Wayne Westerns - he likes cowboys and horses, is speaking phrases in Spanish
(Father teaches High School Spanish)
Music cassette tapes and radio (favorite station is FM 101.5)
Puzzles and shapes
Lego Blocks
Rocking
Routines
Photographs of familiar people and places
Watches what is going on around him
Reacts to environmental cues to know what to do
Likes watching his environment
Enjoys watching Aquariums full of fish
Usually enjoys puzzles and manipulative items with structure

Secondary - The individualized teaching strategies and supports to put in place to help assure that Christopher learns and becomes competent

Visuals : Christopher is a good observer and notices things in his environment in detail. He is better able to interact and know what to do with his environment when things are in a set place and/or follow a predictable sequence that Christopher has learned through seeing the same thing over and over. Materials that have a clear action to do with them, i.e. turn on, put in, place on are the easiest for Christopher to understand. Pictures, demonstrations, the environmental arrangement,calendars, and gestures are some examples of visual supports. Christopher needs visual supports used with most all verbalization that is directed to him. Visual processing appears to be a strength of his.

II. Identification of Specific Environment/ Activity

Every Sunday Morning, I go shopping to buy the weekly groceries and purchase a Sunday Newspaper at Save-A Lot Grocery Store. It is usually the quietest possible time of the entire week, which allows me to shop at my leisure, rummage through my coupons, and so on, with very few distractions. I have been taking Christopher with me on these shopping trips to help him become aquainted with the process of shopping.

Christopher used to throw terrible tantrums inside any store, until I learned that the best time to take him is on Sunday Morning when the store first opens up.

When I have taken Christopher to the store in the past, he has always either ridden inside the shopping cart or stood on the front of the shopping cart for a “ride.” Well, at 4’3” tall and 85 pounds, he is much too big for either one of those things now. People give us funny looks when they see this great big kid riding along in a shopping cart, not to mention that it is very bad for my back, too.

I want Christopher to become an actual participant in the shopping activity. When I was 8 years old, I used to go to the corner grocery store for my mother almost every day to buy milk or a loaf of bread. If there was enough change left over, I could buy a piece of candy or a soda pop. I became a smart shopper just by having to run to the store for my mother.

Even though life is not as peaceful and idyllic as it was back in those days, it is still an important and useful skill for Christopher to learn. Who knows - maybe in ten years he might work as a bag boy for Mr. Mitchell, the store manager.

III. Identification of Goals and Objectives

Rationale and Support From the Literature

My rationale for choosing shopping as an objective to meet the goal of increasing expressive communication and community skills is simply that I feel this objective articulates several of Christopher’s needs into one activity. Christopher enjoys going to the store. He is very motivated to demonstrate appropriate behavior in stores because I have spent several years teaching him manners. He feels that it is a special treat to get to go to the store with Mommy.

In the article Training Parents To Use the Natural Language Paradigm to Increase Their Autistic Children’s Speech (Laski, Charlop, Schreibman 1988), the authors stressed that once they had trained the parents to use NLP in the clinical setting, their goal was for the parents to then take the children home and use NLP in the home setting. The way in which the NLP was measured was in an arranged play situation and followed certain steps using a toy: Step 1) direct reinforcement of verbal attempts; Step 2) turn taking with the stimulus materials (the toy); Step 3) use a variety of tasks to illustrate the meaning of a given word and give multiple exemplars; Step 4) then share control by allowing the child to select a new activity at least five times during the session.

The beautiful thing about the Natural Language Paradigm is that it doesn’t have to occur in a clinical setting. It doesn’t have to occur at home in your living room floor surrounded by a bunch of toys, either. It can be used in normal day to day situations, such as shopping.

Here is an example, using this task of shopping : Christopher has read his list with the following items “2 Gallons of Milk, 1 Big Box of Cheerios, 1 Loaf of Bread” and holds it in his hand - these are some of his favorite foods, by the way. So we walk into the grocery store, he gets a shopping cart and begins to follow Mommy through the store.

When the weather is warm and sunny, we can walk to the store, and thus work on other community skills such as walking on the sidewalk, using signal lights to cross Main Street at the crosswalk and so on. I have yet to find a good, clear way to state an objective like crossing the streets.

Instructional modifications for the task “Going Shopping” are as follows :

One of the fundamental instructional techniques that I will use to teach Christopher shopping skills is through forward chaining (Anderson, Taras, and Cannon, 1996). Forward chaining begins by teaching the first step of the task analysis (see Appendix 1), while physically guiding the child through the remaining steps. This procedure is repeated for each step until the child can independently perform all of the steps of the task analysis. We will use the system of least prompts to fade our participation in the shopping activity - fading from physical prompting, to gestural prompting, to verbal prompting - using which ever prompting will achieve the desired results with the least amount of assistance, until all steps are completed independently and linked together in a single chain.

Task Variation to Motivate Christopher (Dunlap and Dunlap, 1987) In other words, we will not be going to the same store every time and purchasing the same items over and over again. That would be SO boring. Instead, I will allow him to experience shopping until he becomes familiar with the procedure, then we will practice our shopping skills in a variety of stores.

Environmental Supports include shopping lists, sale circulars, and a personal ID card (Quill, Ch. 10). Christopher is a good reader, so we can read the “junk mail” we receive when we go to the Post Office ( yet another community skill). The personal ID card is for Christopher to carry in his wallet with his shopping money. It will have his name, address, and telephone number on it, like a driver’s license. One of my worst fears is that Christopher will wander away some day and not be able to tell anyone who he is or where he lives. We will spend some time practicing that, but I will have peace of mind if he has an ID card in his wallet, just in case.

Other environmental supports will include Social Stories that explain appropriate behaviors in a store and the whole “purchasing concept” that we want him to learn. (Edelson, 1995).

Reinforcement/application of academic skills including reading comprehension and money skills (milieu teaching, Koegel & Koegel, Ch. 2). Christopher is working on reading comprehension and vocabulary skills, as well as counting money and numeration skills at school. Going on shopping trips provides a very rich opportunity to apply those skills in a natural environment and hopefully allow him to generalize those skills to multiple settings (Powers, 1996).

Behavioral Modifications

Behavioral modifications will include as many Natural Reinforcers as possible, such as shopping for the kinds of foods that he likes, or letting him use his own allowance money to select and purchase a toy or book (Koegel & Koegel, pg. 8).

As a part of providing Christopher with “no fail” behavior situations, we will select times for shopping when there are as few people in the store as possible, and not expect him to perform during “peak” store hours, such as Friday evenings or Saturday afternoons. We want to “set him up for success” as much as we possibly can. As he becomes more competent, we will allow him more shopping opportunities at various times throughout the week.

As I have mentioned earlier, Christopher used to pitch big tantrums whenever we went to the store. Therefore we will use photographs and sentence strips on a Velcro board to reinforce Who? What? Where? When? and Why? questions regarding the shopping trips prior to the actual event (Quill, Ch. 11). We are able to manage Christopher’s behavior much better by providing him with clear details about what is going to happen regarding future events.

Documentation and Assessment

The method that I have chosen to document and assess the effectiveness of this intervention is a task analysis data sheet. It is very simple to keep track of the types of behaviors that Christopher demonstrates during the intervention, how much assistance he requires to complete the task, and whether his degree of independence is increasing. Christopher’s Father and I will take turns implementing the intervention, using the data from the sheets to evaluate his progress and determine if he is more independent with one parent than the other, and so on.

V. Discussion

The desired outcome of this intervention is for Christopher to become a well mannered, 8 year old child who is able to walk into a local grocery store with a shopping list and a certain amount of money, select items from the store shelves, walk up to the counter and make the purchases and carry the sack out to the car, without too much hassle, fuss, or bother.

When I think of what skills that I need to target for Christopher, I try not too be too short sighted. I have to keep in mind the “BIG PICTURE” of what I want for Christopher when he is an adult. I have to work now for his future 10 and 20 years down the road. As his mother, I have to look at the kinds of things today that are going to either help him to become integrated into our community, or will create barriers to his integration for a lifetime. (Ruble & Dalrymple, 1996)

Christopher’s annual Admissions and Release Committee Meeting is due in May. I sincerely hope that they take this project proposal that I have written seriously enough to include it in his IEP with his father and myself named as the implementors of this particular goal and objective. Nancy Dalrymple, a leading expert in the field of autism, (Dalrymple, 1989) stresses the importance of coordination between parents and professionals to develop plans, monitor success, and and respond to concerns. The school is doing basically all that they can for my child, and I firmly believe that it is my parental duty to help my children as much as I am able, in as many ways that I am able.

All the while that I am teaching him self-sufficiency skills such as dressing himself , keeping his room neat, or even shopping, I have to keep in mind the attitudes of our community towards people who are different. It is my added duty to enlighten community members about autism and how it effects the person with autism. Not only does Christopher have a Physical Handicap, he also has an Unenlightened Community Handicap.

I have four children. My other children are 22 , 17, and 4, and all are bright and gifted young people. I did not have to convince anyone that my other children are worth knowing or worth including. I didn’t have to convince school personnel that my other children should be in their classrooms. I want Christopher to have as many of the same opportunities as they have.

Whenever I take Christopher into a store, I am giving all of the people in that store one of life’s little lessons: not all people are the same. I am teaching them that my son is a valuable human being and a great kid, once you allow yourself an opportunity to know him. I am not going to keep him hidden away in a sheltered environment, then expect the world to welcome him with open arms when he comes of age. He would be a complete stranger, and people are very wary of strangers around here.

VI. Appendices

Appendix 1. Task Analysis Sheet - Adaptive Behavior Skill : Shopping

Appendix 2. Social Story: Shopping

Appendix 3. Quality of Life Indicators to Consider in Judging Outcomes for People with Autism

VII. Bibliography

Anderson, S.R. , Taras, M., and Cannon, B.O. (1996). Teaching New Skills to Young Children With Autism. Behavioral Intervention for Young Children with Autism: A Manual for Parents and Professionals, edited by Catherine Maurice, co-editors are Gina Green and Steven C. Luce. Pro-Ed : Texas, Pro-Ed publishers, Chapter 6.

An Interview With Michael D. Powers, Psy. D. ADVOCATE, Vol. 28, No. 3 May-June 1996, pp. 11 - 15.

ASK THE EXPERTS: The ADVOCATE interviews Nancy Dalrymple. ADVOCATE, Vol. 21, No. 3, Fall 1989, pp. 13-14.

Dunlap, L.K. & Dunlap, G. (1987). Using Task Variation to Motivate Handicapped Students. Teaching Exceptional Children. Spring 1987, pp. 16 - 19. Edelson, Steven,Ph.D. (1995) Social Stories. Center for the Study of Autism, Beaverton, OR. article published on the World Wide Web.

Koegel, R.L. & Koegel, L. K. (1995). Teaching Children With Autism: Strategies for Initiating Positive Interactions and Improving Learning Opportunities. Baltimore: Paul H. Brooks Publishing Co.

Laski, K.E.; Charlop, M. H.; Schreibman, L. (1988). Training Parents to Use the Natural Language Paradigm to Increase Their Autistic Children’s Speech. Journal of Applied Behavior Analysis. 21:4, pp. 391 - 400.

Quill., K.A. (1995). Teaching Children With Autism: Strategies to Enhance Communication and Socialization. New York: Delmar Publishing Co.

Ruble, L. A. and Dalrymple, N. J. (1996). An Alternative View of Outcome in Autism. Focus On Autism and Other Developmental Disabilities. Vol. 11, No.1, Spring 1996, pp. 3 - 14.