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Intervention Strategy Wheel

A Partnership for Success By Pete Marcelo, LCSW, Ph.D

Over 50 years ago, when Leo Kanner first characterized autism, his descriptions of the impact or manifestations of the disorder were different than our current views. Today, we know that autism is a neuro-biological disorder or spectrum of disorders characterized by a complex interplay of biology, genetics and environment. Individuals with autism spectrum disorder (ASD) may be affected by different combinations of symptoms. Today, most experts agree that there is no magic cure for ASD and that no two children respond to treatment in the exact same way. Assessing and treating ASD can be very complicated, but it does not always have to be so. Whether you are the parent of a child who was just diagnosed, a teacher, physician, day care provider or member of child-study team, questions about assessment and treatment are the same: Where do we start and what constitutes a comprehensive evaluation and treatment plan? Is there any structured format to use when planning an evaluation or developing comprehensive intervention plans for individuals with ASD? In an effort to address the above concerns, a multi-disciplinary, inter-agency partnership was formed in Illinois and developed the Autism Wheel, an easy-to-use assessment/intervention strategy tool. It provides families and professionals with areas to assess as part of a comprehensive evaluation for an individual with ASD. It also details points to consider when developing an effective, individualized intervention plan for these same individuals. The Autism Wheel was developed by an inter-agency partnership comprised of a multi-disciplinary team with members from: the Pfeiffer Treatment Center/Health Research Institute in Warrenville, IL

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Asperger’s Digest

(Physician/Parent and Executive Director); Niles Township District for Special Education 807 in Morton Grove, IL (Psychologist/Assistant Principal, Administrator of Special Education/Psychologist/Social Worker, and Behavior Specialist/Autism Consultant); Niles Township High School District 219 in Skokie, IL (Special Education Teacher and Individual Student Assistant); and Northwestern Illinois Association in Sycamore, IL (Autism Consultant/OT, Autism Consultant/Speech Pathologist, and Autism Consultant/ Special Education Teacher). The common mission of all members of the partnership, which remains active today, is to serve students and their families within the framework of a coordinated, effective inter-agency service model. Our formula for success is to assess all areas and then match strategies to the individual needs of the student. The Autism Wheel that follows describes areas, associated strategies and interventions that may be considered for use beginning with early intervention through adult services. These lists, while comprehensive, are just a starting point since there are many other strategies and interventions available.

Program areas, strategies and interventions to consider: TEAM MEMBERS • Child • Family • Peers • Paraprofessionals • Educators • Community Liaisons • Social Worker • Physical Therapist • Speech Language Pathologist • Occupational Therapist • Psychologist • Psychiatrist • Pediatrician • Pediatric Neurologist

SOCIAL

Team Members

Family Support Collaboration

Motor

Social

• Teach structured play skills • Develop an understanding of perspective • Use social stories • Teach stages of relating • Teach coping skills • Educate peers • Teach leisure skills • Use comic strip conversations • Address bullying and teasing • Use role-playing • Support relationships

Communication

COMMUNICATION

• Support and enhance effective modes of communications • Use augmentative/alternative methods and picture exchange • Teach and shape gestures • Shape expressive communication (i.e. echolalia) • Teach verbal scripts • Develop receptive language • Assess and teach pragmatics of communication • Teach social conventions • Sign language • Choice cards and boards • Teach functional communication (i.e. phone skills, safety works, etc.)

Behavior

Sensory Processing

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BEHAVIOR

FAMILY SUPPORT

• Use process of functional analysis • Identify communicative intent of behavior • Identify what individual seeks and avoids • Identify environmental and internal factors • Use positive programming interventions • Develop reactive plan • Create functional alternative for restrictive and repetitive behaviors • Increase coping and relaxation skills • Teach waiting and turn taking • Identify meaningful motivators • Reduce verbal prompts and add visual supports • Teach functionally equivalent skills

• Family sensitivity • Respite opportunities • Sibling support • Counseling • Support groups • Network with other families and professionals • Early intervention • Home-school communication • Visual supports for daily routines • Behavioral support • Guardianship • Legal advice • Estate planning

SENSORY PROCESSING

(see wheel #2)

• Understand the importance of sensory processing • Assess sensory needs and sensitivities (oral, olfactory, visual, auditory, tactile, proprioceptive, vestibular) • Assess registration, orientation • Determine area of breakdown in the sensory processing chain (registration, orientation, interpretation, organization of response, execution of response) • Develop choices of sensory regulation activities • Develop a sensory diet to establish sensory regulation • Assess sensory impact on diet, sleep and behavior

ASSISTIVE TECHNOLOGY

TEACHING STRATEGIES

MOTOR • Assess fine and gross motor components (postural stability, range of motion, strength, endurance and flexibility, balance, coordination, grasp, dominance, and motor planning • Develop motor abilities • Shape fine and gross motor skills • Adapt for motor challenges • Provide acceptable alternatives for sensory-based behaviors • Teach imitation skills • Increase practice and repetition of motor skills • Provide repeated physical prompts to improve motor initiation • Provide adaptations for handwriting

COLLABORATION • Build a team and meet frequently • Provide opportunities to communicate with other team members • Provide ongoing training • Facilitate opportunities for team problem solving • Make data-based decisions • Develop goals, set priorities, and review regularly • Plan for transition across environments 34

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• Consider low to high tech options • Implement across environments • Alternative /augmentative communication • Computer-based instruction • Adapted books • Alternatives for handwriting • Adapted worksheets • Writing templates

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• Use liked activities as motivators • Discrete trial format • Task analysis • Prompting, shaping and chaining • Forward, backward and global chaining • Visual cues • Within stimulus cues • Time delay • Direct instruction • Age appropriate materials • Planned generalization

VISUAL SUPPORTS • Individual and group schedules • Mini schedules • Appropriate visual labels (words, picture, icon, object) • Visual timers • Definite start and finish • Choice boards • Defined personal boundaries and space

VOCATIONAL

Assistive Technology

Teaching Strategies

• Assess and develop vocational skills early • Develop transition team • Develop transition plan and review on regular basis • Use special interest for job development • Provide information for community awareness • Supported employment • Assistive technology • Teach functional life skills • Teach required social skills • Teach communication skills • Conduct ecological assessment of work environments • Develop natural supports

Curricular Adaptations

Visual Supports

Self-Help

Work Systems

SELF-HELP

Vocational Complimentary Elements

• Develop independence in: dressing, grooming, toileting, meal preparation, safety, daily living skills (i.e. chores & routines) • Address health and sexuality

CURRICULAR ADAPTATIONS • Written scripts and directions • Organizers • Color coding

WORK SYSTEMS • Teach independence • Develop structure to define work environment tasks • Use individualized work system • Teach system and vary content • Teach top to bottom, left to right • Use containers/organizers (i.e. folders, boxes)

COMPLIMENTARY ELEMENTS • Consider proper nutrition especially if diet is limited • Supplement imbalances with vitamins and minerals • Consider medication to reduce symptoms • Identify food sensitivities • Exercise regularly • Common ailments (allergies, constipation, colitis)

• Environmental manipulation • Inclusive education • Preferred activities as motivators • Systematic instruction • Direct instruction • Discrete trial format • Planned generalization • Visual supports • Adapted instruction • Countdowns for work completion • Individual and small group instruction Dr. Pete B. Marcelo is the Director of Special Education at Niles West High School and the Off Campus Learning Center in Niles Township High School District 219 through the Niles Township District of Special Education 807. Dr. Marcelo is also a clinical and school psychologist and clinical and school social worker who practices in Freeport and Warrenville, Illinois.

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