Thursday, May 25, 2017

What do you say when...

I am an introvert. I hate talking on the phone, talking to new people, and events where socializing is key. That being said, I am a teacher who calls the parents of every student I have in the beginning of the year. I was a PTA president and now have risen to the role as region director where I get to talk with new people all the time. It is intimidating and uncomfortable, but easier now than it was a dozen years ago. I also have a son on the spectrum who struggles with conversation. He's good with a monologue, but a conversation is so much more challenging. Therefore I was intrigued when I saw Florence Isaacs' book, What do You Say When... Talking to People with Confidence on any social or business occasion. This book is organized into four parts: the basics, social occasions, business and professional occasions and other times for conversations.

The basics normalizes social anxiety. We easily fall into the role of I am the only uncomfortable one here. I will embarrass myself. I know no one. Let me be a wall flower until I can leave. Getting out of that rut is hard but important. This book is more about starting a conversation than carrying it on. If your communication partner is not a great conversationalist, you will still struggle.

A few key ideas from the book.
  • If you are talking to someone you don't know: start with an open ended questions, or comment with a question.
    • I love the gardens here. What do you think? What is your favorite part?
    • What did you think of the speaker today?
    • Where are you headed? What is your favorite place to visit there? or What did you do that you would recommend to others?
    • How do you know Penelope?
  • If you are talking to someone you've met before:
    • I know I've met you but old age must be hitting because I can't remember your name. I'm Susan and you are...?
    • How are your children? Your youngest was practicing for a play (soccer tournament, recital,...), how did that go?
    • How is the house hunting/remodeling going?

The if you know ones are more challenging because you need to remember information about specific people. I liked the author's idea about keeping a rolodex (or maybe an electronic file) about the people you meet and reviewing it before you go to an event they might attend. An updated file helps keep track of things my mind at least struggles with. I suspect many a sales person, dentist and hair stylist does this to help keep track of clients.

Another idea she pitches that I've heard elsewhere is to wear or have something comment worthy on you to spark conversation. I have a rather large collection of statement shoes and earrings. They give people an opening that can help get things started. Other items might be a tie or pen that can be commented on. If you are doing it for that role, perhaps the potential conversational partner is as well. Commenting on the interesting colored stripes in someone's hair might be a great opener.

The author also points out something that I heard on Dr. Phil recently. Don't answer a thoughtful question without thinking. Give yourself a moment to process. In schools we call this wait time. We need to do it in serious conversations like job interviews and conferences as well. If you are formulating your response as the speaker is finishing a statement, you might miss a critical point.

While this book was an interesting read and there are pieces I might use with a student with extreme anxiety, it is not really meant to be read cover to cover. If I can get my son to read the first two chapters, he might have an easier time with starting to speak. This book is a soft text, not right for many, but did reiterate some good ideas that I know I will use, especially if I review pertinent sections prior to an event. That is really the ideal way to utile it.

Saturday, May 20, 2017

How did students with disabilities get to Harvard?

Thomas Hehir and Laura A. Schifter's book, How Did You Get Here? Students with Disabilities and Their Journeys to Harvard, was not what I expected. I thought I would read vignettes about the trials and tribulations of people with disabilities getting into a prestigious Ivy League school. Instead I read a book that was the analysis of a research project. The authors performed in depth interviews with 14 individuals, their families and, in some cases, service providers. Then they examined commonalities and differences between the tales. There is one narrative like I expected at the end, written by Wendy S. Harbour. The book also includes two essays by people with disabilities, one the co-author, Laura, and one a student, Nick. While these include more narrative than the rest of the book, they still both lean heavily toward meta-analysis rather than story. As a piece of research, this is a pretty readable text.

The book hit upon some interesting features. Of the 8 chapters (plus a hearty forward, preface and conclusion), 6 discuss aspects that helped young people make it to Harvard. They are as follows:
  1. Mom- These young people had a parent who was a powerful advocate for their child. She could have just held high expectations, but many were so invested they became active service providers for their children. In chapter 8, Tom questions how can we help more children succeed without requiring monumental efforts from their parents. His only suggestions is universal design for learning (UDL), a theme throughout the book. While I cannot imagine that being a universal panacea, it would help more students move forward.
  2. Teachers and or service providers who believed in the child. These passionate, highly talented professionals included a preschool teacher, a private speech and language pathologist, a special ed teacher and a general education teacher. These professionals provided  support, critical training, and advocacy for their students leading to positive outcomes.
  3. Asking for more. These young people wanted more than the education that was initially provided. In spite of the challenge of pulling information into their brains, they wanted more. Several students commented about being in self-contained programs and seeing them as academically undemanding. Switching to mainstream programs helped impart rigor, but often presented challenges of input. Other students saw their self contained programs as life savers. The authors caution that there is no single right placement. A spectrum of placements is essential so that the placement for every student can continually be examined to see how well it meets the child's needs. These exceptional youths requested more rigor themselves.
  4. Finding things outside of school to be successful at. If school is a challenge, having something in your life that you can be successful in with less work is important. Sports, music, and poetry are some of the interests that sustained these young people through their challenges.
  5. Drive to find a way. These students attended a mix of programs- public and private school, fully mainstreamed, separate schools for students with disabilities, self contained classes and resource room were all placements that were experienced. Students needed to figure out accommodations. Developing a bag of strategies to be successful was important to these students who were highly motivated to be successful and who were, it appears, intellectually gifted, in spite of their disability. Their disabilities were deafness, blindness, deaf-blind, anxiety, dyslexic, learning disabled and orthopedically impaired. (Interestingly, no ADHD, autistic, or emotional disturbed students were in the group interviewed.) In order to make it, these students needed work-arounds for their challenges, and many had to self-discover them. They brought with them indomitable drive to be successful, often in spite of people telling them they would not make it.
  6. Audio-texts. Since many of the students interviewed experience reading disabilities, audio books, screen readers and voice-to-text technologies were critical to their success. The last two decades have seen an explosion in technology to help students with disabilities. These tools help implement UDL in a way that was, perhaps, impossible years ago.
These students overwhelmingly came from upper middle class families where there was someone who saw through the challenges to a bright and capable young person. They received the benefits of private support, educated parents, and intact families. Interventions received mixed reviews. Being deaf or dyslexic did not mean the same intervention worked for all.

Interestingly two suggestions from the students were seen as important. If you are blind, learn braille. The notion that audiobooks replace self-reading was dismissed. Being able to independently read and write, regardless of the status of the power being up, was seen as important. Audiobooks impair the ability to fully create the story in your mind and that was seen as important. Another key takeaway from the audiobook area was the challenge of someone with dyslexia listening to an audiobook in which every picture, figure, chart and diagram is described, can be a serious waster of energy.

The other suggestion was that students learn organization. Most of these students needed to spend extra time on activities. Whether it was studying for the GEDs or writing a paper, students with disabilities needed to carefully plan their time to accomplish their goals. They needed to develop plans to keep track of materials and assignments. They needed to be good at initiating and persevering through challenge. These students did not exhibit classic executive function weaknesses that many with disabilities struggle with. In and of itself, this could be a reason for these students' success. So many students, with and without disabilities lack these skills. If we can teach students strategies to manage these challenges, many more would be successful.

Sunday, May 14, 2017

Supporting students with problem behavior- support plans

Chapter 9 in Lee Kern, Michael P. George and Mark D. Weist's book, Supporting Students with Emotional and Behavior Problems, discusses how to develop a support plan to address problem behaviors. I particularly like the format that is used to  create a plan. Many districts have formal protocols that they use. It would not be difficult to ensure that they contain all the elements of the plan that is in the authors' format.

First I want to emphasize a thought. Having a "complete understanding of the causes of problem behavior, including an appreciation that environmental events (i.e. antecedents) may trigger it and that skill deficits can limit a student from engaging in desirable alternative behavior ( p. 181)" provides a strong foundation for creating an intervention plan. I think back to reading The Curious Incident of the Dog in the Night Time by Mark Haddon. The main character, Christopher, has autism and knows what sort of day it will be based on seeing yellow cars on the ride in to school. We think this is odd, but this sort of thing can set students off and we need to understand these setting events so that we can respond in a way to facilitate appropriate behavior.

The authors describe 4 categories of intervention and then add a fifth later on in the chapter and a sixth later on in the book:
  1. After setting events- modify or ameliorate- Christopher needed to have his yellow car thing ameliorated.
  2. Modify or eliminate antecedents- modify task or mode of completion, increase relevance of task, offer choice, schedule attention, provide transitional activity, provide transitional warning.
  3. Teach alternative skills- replacement skills, general skills
  4. Respond without reinforcing- instruction, positive punishment, negative punishment, extinction
  5. Lifestyle interventions
  6. Mental health interventions
I was giving a workshop this spring on deescalating behavior where I was asked about a student who responded to adults appropriately until free time, at which point he grew too loud and used inappropriate language. Since the child had an ASD diagnosis, I speculated that he did not generalize well and needed to be taught how to interact with adults during free time. A theme during that workshop was teach don't tell. We often assume that students know how to do something- we told them, they can do it in some settings or at some times. Unfortunately that is not adequate for all students in all situations.

A note on lifestyle interventions. I really like these because they impact quality of life. Increasing the number or quality of relationships a student has dramatically impact his life. A student who finds academics very challenging or school very difficult needs to find something to have success in. Often students gravitate to sports, crafts or outdoor activities. Reinforcing these is essential for students. Lunch bunch- a strategy in which a trained adult interacts with a small group of good role models and target students during lunch time- is often used to build social skills and friendships. See here for additional information. An advantage of lunch bunch is that the intervention does not pull students out of mainstream instructional times. Peer tutoring and mentoring has also been used to develop social skills and friendships.

I slightly modified a form from the book as seen below. The chart format would be one or two pages. This format would be easy to stick in a sub folder so that people coming into the program could quickly get up to speed when dealing with challenging students. Such a summary is essential with high need students.

Support Plan
Team Leader
Team Members
Target Behavior                             
Behavior definition
End of Year Behavior goal
How will progress be measured?

Functional Assessment data collected ( how and from whom)
Antecedent or setting event strategies
Alternative skill instruction
Response to problem behavior
Lifestyle interventions
Who will implement Interventions? When will it be implemented?

How will plan be evaluated

If we look at the intervention portion here is what it might look at for a student.

Hypothesis: John exhibits disruptive behavior when he is frustrated, especially with inferential reading comprehension tasks or writing assignments, or is asked to switch from a preferred to less preferred activity.
Antecedent or setting event strategies
Alternative skill instruction
Response to problem behavior
Lifestyle interventions
Who will implement Interventions? When will it be implemented?
  • Break the task into smaller more manageable parts
  • Before the lesson identify potentially problematic tasks and ensure extra adult support during those tasks
  • Provide choice for long writing tasks- write, scribe, type or voice-to-text.
  • Provide 5 and 1 minute warnings
  • teach how to ask for a break
  • teach relaxation techniques
  • Role play transitions with positive self-talk
  • Provide additional instruction in reading comprehension strategies
  • Teach and provide practice in typing
  • Provide reminders of expected behavior
  • Have cards to remind about taking a break and use relaxation strategies
  • do not alter task upon disruption
  • Reinforce break taking to accomplish a task.
  • if he does not complete task because of disruptive behavior, assign afterschool detention in which to complete task
  •  na
  •  all staff will implement
  • Counselor will teach relaxation techniques
  • Special ed teacher will role play transitions and help identify potentially problematic tasks
Begin immediately

Saturday, May 13, 2017

supporting students with behavior problems FBAs

I am reading Lee Kern, Michael P. George and Mark D. Weist's book, Supporting Students with Emotional and Behavior Problems. The book is not an easy read because of the depth of information it contains, but it is an excellent resource for behavioral interventions. The chapter on FBAs (Functional Behavior Assessment) takes me back to my son's elementary days where there was an abundance of behavioral challenges to work with. Unfortunately his experiences highlight what not to do rather than what to do. This book offers advice, guidelines and supportive paperwork to help intervene in behavior appropriately.

The authors suggest that the first step of a tier three behavior intervention is to assemble a team. The team should include staff members with expertise in areas that the child is struggling- in my son's case, his special ed teacher, SLP, OT, PT, classroom teacher and 1:1 aide- someone with expertise in developing behavior plans, and his parents. Parents are often not consulted enough in researching behavior and developing interventions. They bring valuable insights from craziness at home (ex. divorce, late parental working hours, frequent sibling conflict) to issues around home behaviors (ex. does not sleep well, limited diet, homework difficulties) to home perspectives (ex. sees school as boring, cannot complete homework, hates the kids on the bus, is teased a lot). These things have a bearing on school behavior, just as events at school have a bearing on home behavior. Parents are in the unique situation to not have rigid school day time constraints (there is no appointed lunch half hour) and potentially have access to more positive reinforcement (ex. favorite tv/video show, ice cream cone, Friday night movie, night with grandparents). They need to be a part of the team. This may be challenging. Parents often work during the day when school staff want to meet. Not everyone can go in a hour late or participate in a phone conference when it is convenient for staff. Flexibility needs to be used to ensure participation.

In primary school my son's teachers put together a behavior plan around respect. His very caring special education teacher explained to me that what everything boiled down to was a respect issue and thus this focus was perfect for him. I expressed concern. The second step is to identify and prioritize problem behaviors. Lack of respect is not a problem behavior. Yelling at others, taking materials, physical aggression, throwing materials at people, and self-injury are examples of specific problem behaviors. When the behavior is not operationally defined, your opportunity to work as a team to eliminate the behavior is limited. Yes, there can be many problem behaviors, my son actually exhibited the entire list above and more, but you need to prioritize the most important one first. The authors identify three levels of behavior to guide prioritization:
  1. Destructive- harmful or life threatening. (My son picks at his skin. He has had open wounds for months at a time.)
  2. Disruptive- destroying materials, interfering with learning of self or others including mental health issues like depression or anxiety, causing problems with social relationships, preventing participation in events or activities or likely to escalate to destructive. (My son was known for standing up in class and loudly proclaiming that the assignment and the teacher were stupid in not so polite terms followed up by ripping the paper and throwing it or eating it.)
  3. Distracting- impeding social acceptance, affecting self-image, causing minor damage to materials, likely to escalate to disruptive behavior. (My son wrote on himself and his clothing.)  (p. 157)
As you would expect, interventions need to start with destructive behaviors and advance through disruptive ones and finally settle on distracting ones. Although the authors have not yet proposed a number, other sources I have used suggest focusing on no more than three behaviors at a time. My son's teachers picked respect because that was one behavior. Addressing each component would be mind boggling and the time frame for improvement was too long to contemplate. Perhaps, however they would have been more successful in changing behavior if they had defined the problem behavior more specifically and worked on a few aspects at a time.

After the behaviors have been targeted, the real work of the assessment begins. Start with interviews. Staff, parents and the student himself should be interviewed. Strengths and likes are identified and broad concerns are labeled: past trauma, health and physical concerns, academic problems, social problems and general quality of life issues. Attempts are made to pin point when the most undesirable behaviors occur. Suppositions are made regarding antecedents and consequences that trigger and reinforce the behavior. This guides when observations are made.

Observations. The authors recommend observing 15-20 occurrences of the behavior (p. 169). This can be less for highly consistent behaviors, such as every time the fire alarm goes off, he screams and covers his ears. The most my son was ever observed for was his last reevaluation when I specifically asked the psychologist to observe him in different settings- different classes, the hall, and around lunch. Oddly enough we got the most information from that activity than from any other, including the report from his 1:1 aide. A teacher doing teaching cannot perform an adequate observation. Someone else must be on hand to do it. This could be a trained paraprofessional, principal, guidance counselor, behavior specialist, or other staff. What the book does provide is a set of forms for the observation. One is a report form, one a checklist and one a results summary. The report form requires a narrative of events during the observation. The checklist includes a series of sections like the one below for each activity observed. I really like the checklist because it suggests areas to examine as possibilities when the behavior occurs. The summary combines information from the observations, interviews and other sources, identifies consistencies and inconsistencies, and recommends either the development of a hypothesis statement or suggests that further data collection is required. My favorite FBA done on my son said there was no known antecedents for behaviors and suggested that additional supports be put in place to meet his needs. Really??

o   Told to stop or start an activity
o   Working independently
o   Given a multistep direction
o   Denial of preferred item or activity
o   other
o   Noncompliance with stopping or starting an activity
o   Attempting to gain teacher/adult attention
o   Attempting to gain peer attention
o   Noncompliance with directions
o   Minor disruptive behavior
o   Aggression
o   other
o   Redirection
o   Preferred item or activity
o   Encouragement
o   No response
o   Help
o   Time out
o   other
ABC Checklist sample section from p. 171.

Hypothesis. The authors propose the following format to frame the hypothesis:

Given the circumstance when (setting event) _________________ when (antecedent) __________ the student does (problem behavior) ________________ in order to (function) __________________.

For example:
  • "When Jim is given an assignment that takes longer than 15 minutes to complete (antecedent), he engages in disruptive behavior (problem behavior) to escape the task (function)." (p. 178)
  • When Julie feels overwhelmed by her schoolwork (antecedent) she asks to leave the room and cuts herself (problem behavior) to relieve tension (function).

Then an intervention is engaged in. For Jim, at 13 minutes in we ask him to take a break and then return to the task that has been broken into 10-15 minute segments. (Slowly over time we increase the time he needs to work before a break.) For Julie, we teach her to use an anxiety rating scale and how to use a stress reduction technique to intervene without cutting, for example deep breathing paired with positive self-talk.

Then data is taken to see if the intervention is effective and when to start stretching the goal.

The process is long and extensive, requiring lots of staff resources to engage in. FBAs are not for everyone. The authors suggest that perhaps less than 5% of a school population should have an FBA done. This is consistent with the RTI concept of three tiers of intervention- the first is for everyone (good classroom management), the second for a small number who need a little more (ex. checking in paired with goal setting for success), and the third for very difficult behaviors and children who do not respond well to traditional management programs. Tier three is where FBAs fall. They should be the starting point of the intervention. Done well they should be an excellent guide to implementing an intervention and a great tool to determine if an intervention is effective.