A Foundation and Framework for Providing Sexuality Education to Individuals with Autism

Jason Travers Author

03/22/2021 Added

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[00:00:01.710]Hi, I'm Jason Travers,
[00:00:03.650]Associate Professor of Special Education
[00:00:05.340]at Temple University.
[00:00:06.970]I'm grateful for the opportunity today to present
[00:00:09.490]to you a foundation and framework
[00:00:11.610]for individualized sexuality education for learners
[00:00:14.550]with autism.
[00:00:16.310]Students with autism may engage
[00:00:17.620]in socially unacceptable sexual behavior
[00:00:20.100]but also express interest
[00:00:21.870]in relationships and other aspects of sexuality.
[00:00:25.610]Unfortunately, special educators
[00:00:27.450]and related service providers
[00:00:29.490]as well as other professionals receive little or no training
[00:00:31.940]in how to support sexuality education related needs
[00:00:34.480]of their students with autism.
[00:00:37.090]This presentation will provide a framework
[00:00:38.840]for using evidence-based practices to provide
[00:00:41.640]an individualized sexuality education
[00:00:43.720]to students with autism.
[00:00:46.250]As the title indicates my presentation provides a framework
[00:00:48.720]for preparing and implementing an individualized approach
[00:00:51.950]to sexuality education.
[00:00:54.420]Although the evidence-based practices I will describe
[00:00:56.580]are supported by a large body of experimental evidence,
[00:01:00.010]there's truly not much intervention research
[00:01:02.460]specifically focused on sexuality
[00:01:04.400]education related knowledge and skills for this population.
[00:01:08.010]Nevertheless, I believe you can rely on
[00:01:09.570]special education approaches to meet your students' needs.
[00:01:13.690]My goal is to share with you the process
[00:01:16.370]as applied to sexuality education to address a wide variety
[00:01:21.270]of educational or treatment goals and objectives.
[00:01:28.800]Sometimes the biggest barrier
[00:01:30.020]to providing an individualized sexuality education
[00:01:32.880]is just convincing people that it's important.
[00:01:37.010]Here I have several reasons why you might justify
[00:01:39.730]or explain to somebody who needs convincing
[00:01:42.830]that an individualized sexuality education is appropriate.
[00:01:46.590]The first thing to notice
[00:01:48.010]is that individuals with autism often have limited
[00:01:50.750]or absent communication skills
[00:01:52.450]and that contributes to a risk
[00:01:54.670]of sexual abuse because they're not able to report it.
[00:01:58.010]Some individuals who are less impaired
[00:01:59.510]by their autism and are capable of reporting sexual abuse
[00:02:04.260]might not recognize when it's happened to them
[00:02:07.100]or they might not recognize that it's wrong.
[00:02:10.250]Others who recognize that abuse is happening
[00:02:13.700]and that it's wrong may sometimes tolerate abuse
[00:02:16.440]in order to maintain relationships.
[00:02:18.930]In other words, they may seek out bad actors
[00:02:21.540]because they're desperate to have friends
[00:02:23.360]or they may keep harmful people in their lives
[00:02:26.340]or social circles
[00:02:28.120]in order to feel like they have some important relationships
[00:02:31.350]or friendships.
[00:02:33.150]So sexuality education is justified
[00:02:35.760]for preventing, detecting and reporting sexual abuse.
[00:02:40.910]People with autism often express an interest
[00:02:43.510]in platonic relationships,
[00:02:45.570]close friendships and romantic relationships
[00:02:48.160]including life partnerships and parenthood.
[00:02:51.500]We and others may presume
[00:02:53.200]that individuals with autism often prefer to be alone
[00:02:56.460]but it's important to remember that
[00:02:58.260]lack of social interaction skills
[00:03:00.150]shouldn't be mistaken for a preference to be alone.
[00:03:05.930]Individuals who have milder forms of autism
[00:03:08.240]may not know how to initiate,
[00:03:09.830]develop and maintain intimate relationships.
[00:03:12.110]They may want to have them
[00:03:13.740]but lack the skills and therefore failed to engage in them
[00:03:16.890]and we mistake those as an indication
[00:03:18.890]of their preference for being alone.
[00:03:23.000]Sexuality education is largely about relationships.
[00:03:25.950]it's about access to interactions with others
[00:03:29.690]that enrich our lives in meaningful ways.
[00:03:32.840]And access to sexuality education may contribute
[00:03:36.730]to better satisfaction with various social aspects of life.
[00:03:42.250]Sexual education is often considered
[00:03:44.120]after socially inappropriate behavior has begun to occur
[00:03:47.840]and is usually aimed at reducing specific behavior
[00:03:50.620]like disrobing, touching others
[00:03:52.210]or inappropriate masturbation.
[00:03:55.100]Sexuality education that begins early
[00:03:57.310]and includes instruction about social norms
[00:03:59.580]may effectively prevent or reduce the probability
[00:04:02.328]that some of these inappropriate sexual behaviors occur
[00:04:05.230]while also increasing the probability
[00:04:07.100]that socially acceptable sexual expression
[00:04:11.157]and behavior occurs.
[00:04:14.380]In most sexuality education programs are aimed specifically
[00:04:17.020]at promoting health and hygiene in adolescents
[00:04:19.550]and that's good
[00:04:20.720]but students with autism may not have access
[00:04:23.040]to that content and if they do
[00:04:24.490]the instructional methods that are used
[00:04:26.580]may not be adequate for ensuring meaningful benefit.
[00:04:30.190]So individuals with autism need instruction and supports
[00:04:33.740]oftentimes to complete
[00:04:35.550]routine preventative healthcare, for example
[00:04:39.630]like getting a pap smear or a breast exam or a hernia exam.
[00:04:43.870]And by initiating conversations with IEP teams
[00:04:46.670]about sexuality education
[00:04:48.570]that is focused on health and hygiene,
[00:04:50.620]you might be able to later gather support
[00:04:52.970]for more broader applications or goals
[00:04:56.300]in other areas of socio sexual development.
[00:05:00.640]Finally, self-determination is a philosophy
[00:05:03.470]and framework for organizing
[00:05:05.040]and providing supports to individuals with disabilities.
[00:05:08.460]Students with autism may be taught to always comply
[00:05:10.930]with adult directions and never disobey.
[00:05:14.000]They may be taught to rely on others to make basic decisions
[00:05:17.080]or solve problems for them.
[00:05:19.250]Self determination is focused on teaching individuals
[00:05:21.620]with developmental disabilities
[00:05:23.010]including autism to make choices
[00:05:25.530]and to experience the negative
[00:05:26.925]and positive consequences associated
[00:05:29.320]with some of those decisions.
[00:05:31.000]It's about teaching them to problem solve
[00:05:32.530]and set goals and self monitor their progress
[00:05:34.990]and practice self-advocacy skills.
[00:05:38.260]Sexuality and sexual expression in particular,
[00:05:41.290]including choosing friends, setting relationship goals
[00:05:44.860]and monitoring one's own behavior to ensure that it conforms
[00:05:48.680]with some social norms
[00:05:51.710]as well as protecting oneself
[00:05:53.100]from abuse or exploit exploitation
[00:05:55.590]through self-advocacy can promote self-determination
[00:05:58.630]and probably improve overall satisfaction with life.
[00:06:07.070]Now, there are some misconceptions about what sexuality is
[00:06:09.870]and what a high-quality sexuality education should lead to.
[00:06:14.020]Sexuality education is often thought of
[00:06:15.950]having to do with sexual anatomy, hygiene and physiology
[00:06:20.460]but sexuality education is mostly about relationships
[00:06:23.590]with other people.
[00:06:25.280]Because people with autism have difficulty
[00:06:27.040]with social development and interactions
[00:06:29.260]it makes sense that sexuality education
[00:06:31.260]for these learners should focus on
[00:06:32.960]various aspects and types of relationships.
[00:06:36.430]Now, this is a list of outcomes
[00:06:38.290]for sexually healthy adults that can serve
[00:06:41.450]as a guideline of guiding points for the development
[00:06:44.488]of goals and objectives in IEP or a treatment plan.
[00:06:49.625]Our intentions should be to help students with autism
[00:06:53.396]achieve as many of these goals as possible
[00:06:56.830]and will likely need to operationally define
[00:06:58.580]what constitutes, for example
[00:07:00.330]respectful and appropriate interactions with others
[00:07:03.020]regardless of gender and do that in different contexts
[00:07:07.440]and there's no doubt that appropriate expressions
[00:07:09.960]of love and intimacy require development
[00:07:12.560]of numerous other skills in various contexts
[00:07:15.990]but all of these outcomes are relevant
[00:07:17.560]to individuals with autism.
[00:07:19.630]And though I've emphasized some with bold font
[00:07:22.870]to justify how relevant those goals are.
[00:07:25.710]The vast majority of people want to develop
[00:07:27.880]and maintain personally meaningful relationships.
[00:07:32.290]Although it's commonly believed that individuals
[00:07:34.530]with autism prefer to be alone, that's probably inaccurate
[00:07:38.530]and reflects a need for interventions and supports
[00:07:42.140]rather than an assumption about a person's preference.
[00:07:46.730]We often miss mistaken need
[00:07:48.130]for instruction as a preference
[00:07:49.930]and I think that extends to relationships.
[00:07:53.160]The list of outcomes serves as way points to a destination.
[00:07:57.210]There are goals for our instruction,
[00:07:58.908]our interventions and supports.
[00:08:02.130]Getting there requires some knowledge about
[00:08:03.860]what constitutes sexuality education
[00:08:06.870]and making decisions about what to teach.
[00:08:12.630]If you're being asked
[00:08:13.830]or intend to provide sexuality related instruction
[00:08:17.320]or address sexual behavior.
[00:08:19.780]I suggest reading and learning
[00:08:21.180]about comprehensive sexuality education.
[00:08:24.490]Like any reading teacher
[00:08:26.070]or mathematics teacher or history teacher
[00:08:28.140]one must have knowledge about the subject matter
[00:08:30.640]to conceive, design and deliver instruction.
[00:08:34.820]I suggest using the Sexuality Information
[00:08:37.210]and Education Council of the United States
[00:08:40.110]as a starting place for learning about sexuality education.
[00:08:44.640]However, it's likely you'll need to consult
[00:08:46.560]with professionals who are more knowledgeable
[00:08:48.380]about sexuality, including sexuality education
[00:08:51.330]and sexual expression and behavioral interventions.
[00:08:54.520]So professionals should be aware
[00:08:55.760]of the limits of their own knowledge,
[00:08:58.120]the limits of their own skills
[00:08:59.310]to design the delivery instruction and seek support
[00:09:02.090]when tasked with responsibilities that might fall
[00:09:05.120]just outside their scope of competence.
[00:09:11.100]Comprehensive sexuality education emphasizes ongoing
[00:09:14.300]and developmentally appropriate education.
[00:09:17.280]The Sexuality Education and Information Council
[00:09:20.010]of the United States published in 2004
[00:09:22.230]the guidelines for comprehensive sexuality education.
[00:09:26.090]The guidelines focused on six key concepts
[00:09:28.890]they are, human development, relationships, personal skills
[00:09:34.150]sexual behavior, sexual health and society and culture.
[00:09:40.160]Getting familiar with these guidelines will help you
[00:09:41.940]prepare an individualized sexuality education program.
[00:09:46.290]The guidelines function very much like the curriculum guides
[00:09:49.230]or maps that are similar to those used by educators.
[00:09:53.640]The guidelines are freely available at the SEICUS website
[00:09:56.450]along with many other helpful resources.
[00:09:59.820]Let's take a closer look
[00:10:00.760]at the guidelines for comprehensive sexuality education.
[00:10:07.370]The SEICUS guidelines are organized by six key concepts.
[00:10:10.950]Each key concept is comprised of six or seven topics
[00:10:14.510]and each topic has a developmental message for children
[00:10:17.680]adolescence or early adolescence or late adolescents.
[00:10:23.010]For example, key concept one focuses on human development.
[00:10:28.210]There are six topics associated with human development.
[00:10:36.930]Similarly, key concept two has to do with relationships.
[00:10:41.300]There are six topics associated
[00:10:43.890]with relationships, including families, friendship
[00:10:48.260]love, romantic relationships and dating,
[00:10:52.590]marriage and lifetime commitments and raising children.
[00:10:57.160]Key concept four has to do with sexual behavior.
[00:11:00.580]Topic two deals with masturbation.
[00:11:03.000]within that topic, one developmental message
[00:11:05.800]that is appropriate for early adolescent children
[00:11:07.840]is to understand that most people have masturbated
[00:11:11.740]at some point in their life.
[00:11:17.300]Let's look at each of the key concepts, topics
[00:11:19.870]and developmental messages in a little more detail.
[00:11:25.390]As I mentioned,
[00:11:26.223]key concept one has to do with human development.
[00:11:28.610]The guideline states that human development is characterized
[00:11:31.450]by the interrelationship between physical, emotional
[00:11:34.710]social and intellectual growth.
[00:11:37.580]Individuals who are competent about human development
[00:11:40.220]appreciate their own body
[00:11:42.150]and seek information about reproduction as needed.
[00:11:45.360]They interact with people
[00:11:46.520]of all genders in respectful and appropriate ways.
[00:11:49.570]They affirmed their own sexual orientation
[00:11:52.320]and the orientation others
[00:11:54.330]and they affirmed their own gender identity
[00:11:56.200]and respect the gender identities of others.
[00:11:59.910]Here again, you'll notice
[00:12:00.890]that topic one has to do
[00:12:01.980]with reproduction and sexual anatomy and physiology.
[00:12:07.900]What you'll also notice is a sub concept
[00:12:10.210]associated with this topic.
[00:12:13.870]Many of the topics for each key concept will have
[00:12:16.630]sub concepts that further break down the topic.
[00:12:20.340]And finally, notice that there are levels
[00:12:22.370]of understanding broken down by age groups.
[00:12:25.930]There are specific skills to be mastered
[00:12:27.740]by children ages five to eight years old
[00:12:30.200]or level one middle childhood,
[00:12:32.700]pre-adolescence for nine to 12 year old children,
[00:12:36.550]early adolescents for 12 to 15 year old children,
[00:12:39.880]and finally late adolescents
[00:12:42.590]for children 15 to 18 years old.
[00:12:46.380]So, there are six key concepts
[00:12:48.870]each with the respective topics and sub concepts
[00:12:52.330]that are further broken down
[00:12:53.680]into specific developmental messages
[00:12:55.590]based on age ranges or levels.
[00:13:00.130]For example, instruction in human development topic one
[00:13:02.830]which focuses on reproductive
[00:13:04.500]and sexual anatomy and physiology
[00:13:07.720]includes these and other developmental messages
[00:13:09.890]for each group.
[00:13:11.570]Level one, body parts have names and functions
[00:13:15.110]head, shoulders, knees and toes.
[00:13:17.730]Level two bodies change during puberty
[00:13:19.910]and sexual reproductive organs mature.
[00:13:23.090]Level three, there are differences
[00:13:24.430]between the sexual response system
[00:13:26.000]and the reproductive system.
[00:13:28.200]And level four, sexual differentiation is largely determined
[00:13:31.400]by chromosomes in early prenatal development.
[00:13:36.490]These are just the four of the 16 developmental messages
[00:13:39.290]across all groups specifically
[00:13:41.250]about reproductive and sexual anatomy and physiology.
[00:13:44.930]Any of these might be useful
[00:13:47.120]to inform an individualized sexuality education
[00:13:49.580]with goals and related objectives based on
[00:13:52.200]the learners specific needs and interests.
[00:13:55.690]Keep in mind that there are six other topics
[00:13:57.930]in this key concept each with subtopics and sub concepts
[00:14:02.290]as well as developmental messages.
[00:14:06.270]Let's look at some of the other key concepts.
[00:14:09.250]Key concept two focuses on relationships.
[00:14:12.220]There are six topics associated with this key concept.
[00:14:15.700]They are families, friendship
[00:14:18.070]love, romantic relationships and dating,
[00:14:22.690]excuse me, marriage and lifetime commitments
[00:14:25.250]and raising children.
[00:14:27.410]You'll notice the life behaviors are also listed
[00:14:30.540]in the upper right corner of the slide.
[00:14:32.740]Those with those goals that we found
[00:14:34.290]about healthy outcomes for sexuality education.
[00:14:40.330]Topic one has to deal with families
[00:14:41.920]and the sub concept is that most people are raised
[00:14:43.980]in families and live in families as adults.
[00:14:47.920]Level one developmental message for this topic
[00:14:50.600]which would be for middle childhood ages
[00:14:52.920]five through eight years or early elementary school
[00:14:55.370]is that a family consists
[00:14:56.431]of two or more people who care for each other in many ways.
[00:15:05.500]There are several developmental messages associated
[00:15:07.950]with each level of this topic.
[00:15:10.330]A level two developmental message about families
[00:15:12.870]emphasizes that family members sometimes disagree
[00:15:15.330]but continue to love each other.
[00:15:17.600]The developmental messages advance with maturity.
[00:15:20.670]Notice that level three focuses on love, cooperation
[00:15:23.670]and mutual respect is necessary for good family functioning
[00:15:27.510]and that 15 to 18 year olds also learn
[00:15:30.190]that one purpose of a family is to help its members
[00:15:32.250]reach their fullest potential.
[00:15:34.420]Now, these are just some of the developmental messages
[00:15:36.620]associated with topic one and the relationships key concept.
[00:15:45.040]Key concept three is about personal skills.
[00:15:47.530]There are six topics in this key concept
[00:15:50.090]they include values, decision-making,
[00:15:52.550]communication
[00:15:53.810]assertiveness,
[00:15:55.000]negotiation and looking for help.
[00:15:57.990]You'll notice that topic one deals with values
[00:16:01.420]and a level one developmental message for this topic
[00:16:03.640]is that values are strong feelings
[00:16:05.640]or beliefs about important issues.
[00:16:12.220]Key concept four has to do with sexual behavior
[00:16:14.640]and has seven topics,
[00:16:16.400]sexuality throughout life
[00:16:18.270]masturbation,
[00:16:19.430]shared sexual behavior,
[00:16:21.140]abstinence
[00:16:22.180]human sexual response,
[00:16:23.840]fantasy and dysfunction.
[00:16:26.330]Notice the related life behaviors that are suggestive
[00:16:29.070]of understanding or mastery.
[00:16:42.130]Key concept five has to do with sexual health
[00:16:44.710]which includes reproductive health
[00:16:46.570]contraception,
[00:16:47.450]pregnancy and prenatal care,
[00:16:48.910]abortion
[00:16:49.790]sexually transmitted infections,
[00:16:51.650]HIV and AIDS,
[00:16:53.160]sexual abuse assault,
[00:16:55.230]and violence and harassment.
[00:16:57.940]Some of these sexual life behaviors may be priorities
[00:17:00.980]while others may not be immediately relevant
[00:17:03.610]and that's a decision that you make with the team members.
[00:17:06.030]What are the specific goals that the team wants to work
[00:17:08.910]towards that are relevant for this particular learner?
[00:17:13.610]Finally, key concept six has to do with society and culture
[00:17:17.730]and entails teaching about sexuality in society
[00:17:21.870]as well as gender roles,
[00:17:23.810]sexuality and the law,
[00:17:25.470]sexuality and religion,
[00:17:27.710]diversity,
[00:17:29.080]sexuality and the media and sexuality and the arts
[00:17:42.440]Now, some folks may decide to seek out curriculum manuals
[00:17:44.820]to inform their sexuality education programming
[00:17:47.430]rather than relying solely on the SEICUS guidelines
[00:17:49.860]for developing an individualized comprehensive
[00:17:52.720]sexuality education program for the individuals
[00:17:55.370]with autism that they serve.
[00:17:58.180]Despite being a prominent and important topic
[00:18:01.360]there are relatively few options for curriculum manual
[00:18:04.520]specifically for teaching sexuality to individuals
[00:18:07.520]with autism and other developmental disabilities.
[00:18:10.440]The slide includes a few options that are worth considering
[00:18:14.730]but in making your consideration
[00:18:17.060]you should remember to evaluate them
[00:18:21.130]compare to each other to see
[00:18:22.280]if the content is appropriate, sufficient and accurate.
[00:18:29.100]Now, after you've decided what to teach
[00:18:32.080]you can begin delivering instruction.
[00:18:41.898]I recommend relying on an approach that involves assessment
[00:18:46.040]operationally defining skills
[00:18:47.540]that need improvement or mastery,
[00:18:49.660]intervening with evidence-based practices
[00:18:52.380]and evaluating instruction based on student responding.
[00:18:57.440]Assessment should include measures
[00:18:59.240]that indicate an individual's strengths,
[00:19:01.890]preferences and interests.
[00:19:04.600]Now, this is important
[00:19:05.433]because materials, procedures,
[00:19:07.140]rewards and other elements of instruction
[00:19:09.210]that reflect a person's strengths, interests
[00:19:11.360]and preferences often influence
[00:19:13.330]how they respond to that intervention.
[00:19:16.060]But also will be important
[00:19:17.180]to understand what the individual's current
[00:19:19.140]sexuality related knowledge and skills are.
[00:19:23.775]Knowing what a person already knows
[00:19:26.100]and what they need to know is a foundation
[00:19:27.770]to any educational intervention.
[00:19:31.020]It also will be important to understand
[00:19:32.910]what resources are available
[00:19:34.500]to support instructional delivery.
[00:19:38.320]Of course, with any specialized instructional programming
[00:19:41.250]specific skills must be defined
[00:19:43.030]in observable and measurable terms
[00:19:45.430]with explicit conditions and a clear criteria for mastery.
[00:19:49.240]This is to ensure accurate measurement
[00:19:51.120]of student responding to your specialized instruction.
[00:19:54.640]If outcomes are described in general ways
[00:19:57.340]then we'll have difficulty planning
[00:19:58.760]and providing relevant instruction and supports
[00:20:01.550]but we'll also be unable to determine
[00:20:03.560]whether our efforts are objectively working
[00:20:05.910]and whether the desired outcome is being achieved.
[00:20:09.900]These aspects of individualized interventions are important
[00:20:13.360]but they're not the focus of the remainder
[00:20:15.340]of this presentation because it's assumed
[00:20:17.600]that you already know this foundational information.
[00:20:22.620]The third step involves intervening.
[00:20:25.540]This of course includes your knowledge
[00:20:27.280]or your team's knowledge
[00:20:28.310]of comprehensive sexuality education standards,
[00:20:31.040]content and curriculum
[00:20:33.290]as well as evidence-based interventions
[00:20:34.750]for individuals with autism and developmental disabilities.
[00:20:38.530]This also involves your knowledge
[00:20:39.950]about the learner and the context of instruction.
[00:20:43.490]Now, the rest of my presentation will focus specifically
[00:20:45.870]on step three, but before I on I'd like to just point out
[00:20:48.160]that step four involves evaluating the effects
[00:20:50.250]of your intervention on learner preference.
[00:20:53.360]Mastering can be predicted
[00:20:54.540]by a specific date and allows for database decision-making.
[00:20:59.740]Very important to evaluate the effects
[00:21:01.730]of your intervention, collect ongoing data
[00:21:03.870]and project progress into the future to determine
[00:21:06.410]whether goals will be met on time.
[00:21:10.700]As I mentioned, step three involves having knowledge
[00:21:13.520]about sexuality education related curricula.
[00:21:17.190]I've given an overview of the SEICUS guidelines
[00:21:19.530]for this reason and I expect you will need
[00:21:21.790]to become more familiar with those guidelines
[00:21:23.920]before designing and delivering
[00:21:25.460]an individualized sexuality education.
[00:21:29.550]But I've also described the importance
[00:21:31.180]of understanding what the learner needs to know relative
[00:21:34.190]to sexuality education, be it personal skills
[00:21:37.040]or relationship skills or changes in sexual behavior
[00:21:40.520]consistent with social norms and so on.
[00:21:44.040]But what about intervening?
[00:21:45.600]What evidence-based interventions can you use?
[00:21:49.660]Let's look a little bit closer
[00:21:50.750]at the evidence-based interventions in step three
[00:21:53.520]as applied to teaching sexuality
[00:21:55.890]related knowledge and skills.
[00:22:01.550]I have identified here preventative strategies
[00:22:05.030]specialized instructional strategies
[00:22:07.700]and reactive strategies
[00:22:08.940]that are all evidence-based practices.
[00:22:12.530]All describe how each of these can be used
[00:22:14.530]to deliver individualized sexuality education
[00:22:17.850]but I'll not be delving deeply into the specific procedures
[00:22:20.390]for each of these listed practices.
[00:22:23.510]And that's because each of these practices
[00:22:24.960]could require an entire webinar
[00:22:26.880]or keynote presentation in their own way.
[00:22:31.570]However, there are freely available resources
[00:22:34.140]at the National Professional Development Center
[00:22:36.160]on autism spectrum disorder.
[00:22:38.130]They have modules for each of these practices
[00:22:40.280]that can be accessed without cost
[00:22:42.720]and many professionals can acquire
[00:22:44.750]continuing education units
[00:22:46.310]or professional development credits that are often required
[00:22:49.150]for licensure and certification maintenance.
[00:22:53.370]I strongly recommend this resource
[00:22:55.480]and encourage you to check them out.
[00:22:57.640]That's the National Professional Development Center
[00:23:00.090]on autism spectrum disorder.
[00:23:02.460]They have excellent online modules
[00:23:04.850]that are freely available
[00:23:06.050]and describe in detail the procedures
[00:23:09.010]for each of these interventions.
[00:23:14.100]In some cases preventative strategies might be conceived
[00:23:17.650]as focusing primarily on preventing unwanted
[00:23:20.280]or unacceptable behaviors
[00:23:21.840]such as disrobing or touching others
[00:23:24.810]but prevention strategies are also about
[00:23:26.760]increasing the probability of appropriate
[00:23:28.560]or desired behavior.
[00:23:31.060]Some evidence-based prevention strategies
[00:23:33.000]which are sometimes called antecedent strategies
[00:23:35.330]or antecedent based interventions include
[00:23:38.180]incorporating preferences into instruction,
[00:23:41.190]embedding demands into preferred or reinforcing activities,
[00:23:45.350]increasing the predictability of the environment,
[00:23:48.750]teaching functionally relevant or valuable skills
[00:23:52.450]and modifying the instruction.
[00:23:55.080]Let's look at some examples
[00:23:59.940]Consider a student who is engaging
[00:24:01.470]in inappropriate sexual behavior caused
[00:24:03.540]by motivation to escape or avoid tasks or people or places.
[00:24:08.630]For example, you have a functional behavior
[00:24:10.670]assessment results that reveal a student disrobes
[00:24:13.770]or puts their hands in their pants or on their genitals
[00:24:15.970]during non-preferred tasks in order to escape that task.
[00:24:20.240]So how might we prevent that?
[00:24:22.630]Well, our goal
[00:24:23.750]for prevention should be to decrease motivation to escape.
[00:24:28.050]If we decrease motivation to escape
[00:24:29.780]then the student will be less likely to attempt disrobing
[00:24:32.430]or inappropriate touching.
[00:24:35.790]To do that we can alter tasks and incorporate preferences.
[00:24:39.980]So if a student very much enjoys
[00:24:42.130]a particular movie character
[00:24:43.590]then we might prepare materials
[00:24:45.230]that include that movie character.
[00:24:47.610]We can also decrease the difficulty of the task
[00:24:49.870]or the demand, make it easier to complete.
[00:24:53.160]And by completing it,
[00:24:54.660]more likely to access a preferred activity
[00:24:56.700]or a reward that typically follows it
[00:25:00.340]we could also embed therapy tasks
[00:25:02.410]into reinforcing activities, such as labeling a favorite TV
[00:25:06.980]or movie characters and their actions
[00:25:08.720]rather than looking at line drawing or stock photography.
[00:25:12.130]We might have a student describe a social problem
[00:25:14.880]and the solution could be presented
[00:25:17.199]in a comic book form, some sort of hero dilemma for example.
[00:25:22.930]We can also modify the pace of instruction.
[00:25:25.870]Sometimes people think that instruction ought to be slower
[00:25:28.670]but there's good evidence to show
[00:25:29.900]that faster paced instruction to build momentum
[00:25:33.040]along with strategic prompting can increase responding
[00:25:37.170]to intervention, compliance with the task,
[00:25:39.610]task completion and decreased motivation to escape.
[00:25:43.620]Fast paced instruction is sometimes more effective
[00:25:46.060]than slow paced instruction.
[00:25:48.400]We can also allow the student to choose
[00:25:50.370]between the different types of materials
[00:25:52.410]that are used during the task.
[00:25:55.550]We can also work to decrease
[00:25:57.560]the opportunities available to escape.
[00:26:01.070]A task that's 30 minutes long
[00:26:02.730]will have lots of opportunities to escape
[00:26:05.200]whereas a task that is only 10 minutes long
[00:26:07.330]will have far fewer opportunities to escape.
[00:26:16.110]Some socially inappropriate behavior
[00:26:18.060]including inappropriate sexual behavior may be caused
[00:26:20.870]by a need for social interaction.
[00:26:24.600]Consider an FBA that reveals a student
[00:26:27.000]grabs peers body parts in order to get their attention.
[00:26:30.980]So what might we do in those situations?
[00:26:33.530]I think our immediate response would be
[00:26:34.960]to increase the distance and separate those individuals
[00:26:38.210]but that fails to recognize
[00:26:39.610]the need or the function of that person's behavior.
[00:26:42.230]They engage in that inappropriate touching
[00:26:44.560]because it reliably produces a social interaction.
[00:26:48.060]And by separating the students we amplify
[00:26:50.530]that student's need for social interaction
[00:26:53.000]we decrease their opportunities to interact
[00:26:55.580]and cause high motivation for more inappropriate behavior.
[00:27:00.160]Instead, what we wanna do is teach functionally
[00:27:02.510]relevant skills to get the peers attention.
[00:27:05.220]We wanna use functionally relevant instruction.
[00:27:07.930]Maybe we wanna teach the student to say the name
[00:27:09.940]of a peer when shown their picture
[00:27:12.980]but that might not generalize
[00:27:14.530]to saying the peer's name to get their attention.
[00:27:16.960]Lots of students learn to say the names of their peers
[00:27:19.810]but they don't learn to say the names
[00:27:21.350]of their peers to get that peers attention.
[00:27:24.170]So maybe we need to teach them social scripting
[00:27:27.760]to get the peer's attention.
[00:27:29.670]Maybe we need to then provide structure
[00:27:31.740]for authentic opportunities to use the script consistent
[00:27:34.630]with the procedures of that intervention.
[00:27:37.350]We could then arrange frequent opportunities
[00:27:39.190]for peer interactions to ensure
[00:27:40.830]that those students' attention needs are met
[00:27:43.920]and with those needs met, he's less likely to engage
[00:27:47.120]in inappropriate behavior that is serving a function
[00:27:50.080]of positive social reinforcement.
[00:27:57.980]This table includes five prevention strategies
[00:28:00.700]that may be useful for providing sexuality education.
[00:28:04.830]The incorporation of learner preferences
[00:28:06.840]during instruction can increase attention
[00:28:09.350]decreased motivation to escape
[00:28:11.360]and facilitate acquisition of functional irrelevant skills.
[00:28:15.220]This might involve incorporating Pokemon characters
[00:28:17.690]into instruction about body parts
[00:28:19.460]or dressing up as a favorite music performer
[00:28:23.650]to practice problem solving or decision-making skills
[00:28:27.160]or maybe creating comic strips that feature
[00:28:29.150]a favorite superhero to teach what to do when experiencing
[00:28:32.940]or witnessing abuse.
[00:28:36.320]Instruction may also be embedded into daily routines
[00:28:39.490]making the provision of sexuality education
[00:28:41.470]more readily accessible
[00:28:42.640]without necessarily requiring large chunks
[00:28:45.010]of day to set aside
[00:28:46.300]or reserve specifically for that instruction.
[00:28:50.610]For example, it might be best to teach negotiation
[00:28:53.360]and compromising during the video game earned
[00:28:56.480]as a reinforcer for task completion
[00:28:59.360]or maybe during a preferred outdoor activity
[00:29:01.990]while at recess rather than while seated
[00:29:04.530]at a table in a therapy room or a classroom.
[00:29:08.950]And providing consistent routines
[00:29:11.110]during each day may reduce the probability
[00:29:13.450]of inappropriate sexual behavior.
[00:29:16.350]For example, if a specific time is allocated during the day
[00:29:19.960]for masturbation in the individual's bedroom at home
[00:29:24.570]then the individual may be less likely to engage
[00:29:27.120]in masturbation at school or in the community.
[00:29:32.610]Similarly, consistent instructional delivery
[00:29:35.080]can increase the acquisition of skills
[00:29:37.930]When novel instructional methods
[00:29:39.770]are used to teach novel skills,
[00:29:42.190]this may delay acquisition until both aren't understood.
[00:29:45.980]When instructional procedures are consistent
[00:29:47.980]and familiar students can more readily attend
[00:29:50.640]to the content that is being taught.
[00:29:53.880]I frequently emphasized the importance
[00:29:55.700]of teaching functionally relevant skills.
[00:29:58.870]I think teaching skills that are going to likely result
[00:30:02.490]in frequent and consistent reinforcing consequences
[00:30:05.110]is important for making meaningful progress
[00:30:08.040]and enhancing quality of life.
[00:30:10.460]Skills or behaviors that have a naturally
[00:30:12.320]occurring maintaining consequence will likely
[00:30:16.040]be more readily acquired and maintained
[00:30:18.870]than those that are dependent
[00:30:20.670]on contrived reinforcement.
[00:30:25.070]Finally and perhaps most importantly,
[00:30:27.440]consider changing how you teach the skill
[00:30:30.440]this might include behavioral momentum
[00:30:32.180]or high probabilities success sequences
[00:30:37.020]could also be incorporating choice-making opportunities
[00:30:39.670]into an instruction
[00:30:41.020]or making the task shorter if the learner prefers
[00:30:45.230]and altering the speed of instruction.
[00:30:56.510]As mentioned previously,
[00:30:58.440]earlier provision of sexuality education may contribute
[00:31:01.320]to a culture of collaboration that can grow
[00:31:03.620]and evolve as the children do.
[00:31:05.980]It's plausible that sexuality education
[00:31:08.140]in earlier years may reduce the emergence
[00:31:10.260]of sexually inappropriate behavior that manifests due
[00:31:13.490]to poor understanding of social conventions
[00:31:16.280]as well as legal implications and lack of opportunity
[00:31:19.230]to safely engage in normal sexual expression.
[00:31:23.670]Earlier sexuality education may also increase opportunities
[00:31:26.960]to learn socio sexual skills
[00:31:29.730]in incidental ways in later school years
[00:31:32.310]due to high levels of social competence
[00:31:34.950]in turn relationships may be improved
[00:31:37.570]as well as education and predictors
[00:31:39.580]of better quality of life.
[00:31:42.120]Individuals who receive early
[00:31:43.800]and ongoing sexuality education
[00:31:46.140]may experience greater wellbeing,
[00:31:48.420]advance the health and safety of their community
[00:31:51.100]and promote a more inclusive society.
[00:31:53.840]I think it also reasonable to presume that early access
[00:31:57.560]to sexuality education may also challenge those attitudinal
[00:32:01.520]and logistical barriers that prevent access
[00:32:06.060]to sexuality education for future generations.
[00:32:10.030]I do not recommend waiting until a specific age
[00:32:12.680]or an event to begin teaching the socio sexual skills
[00:32:18.440]that individuals with autism need
[00:32:20.370]in order to live safe, healthy and enjoyable adult life.
[00:32:24.390]I think early prevention by provision of education
[00:32:28.530]starting in childhood
[00:32:29.950]is an ideal way to prevent problem behavior
[00:32:33.290]and increase the probability of satisfaction later in life.
[00:32:41.070]Well, prevention strategies are important
[00:32:43.070]but they're not likely going to be sufficient
[00:32:45.620]for ensuring students with autism learn what is important
[00:32:49.760]for their immediate and distal futures.
[00:32:52.870]Also, prevention strategies are not likely going to result
[00:32:56.050]in meaningful instruction in various key concepts
[00:32:58.850]and topics of comprehensive sexuality education.
[00:33:03.020]This means professionals must also specialize
[00:33:05.590]instruction to teach specific skills.
[00:33:08.950]There are five evidence-based practices
[00:33:10.620]you can use when preparing
[00:33:12.070]and delivering instruction, including visual supports.
[00:33:17.910]Now visual supports have been found useful
[00:33:19.580]for addressing a variety of social,
[00:33:21.310]communicative, behavioral, academic and daily living skills.
[00:33:25.330]In many cases, visual supports are combined
[00:33:28.250]with various other interventions
[00:33:29.960]in ways that amplify the beneficial effects
[00:33:33.340]for example, photographs for steps in a chain to behaviors
[00:33:37.620]such as washing your body or changing a maxi pad
[00:33:40.810]maybe matched with steps into task analysis
[00:33:43.140]to help the learner understand what to do.
[00:33:46.370]A visual support might also show the steps necessary
[00:33:49.320]to recognize and distinguish between safe and unsafe people
[00:33:53.280]and who a student can hug and not hug.
[00:33:57.230]Let's look at some different examples
[00:33:58.520]of how visual supports can be useful
[00:34:00.250]for teaching sexuality related knowledge
[00:34:02.700]and skills to students with autism.
[00:34:07.970]Visual supports might be useful for supporting
[00:34:10.950]important skills like recognizing the name
[00:34:13.380]and private nature of the buttocks,
[00:34:15.230]penis, vagina and breasts.
[00:34:17.910]These images help support an understanding
[00:34:20.220]of where private body parts are located
[00:34:22.750]usually covered by an underwear.
[00:34:24.840]The technical appropriate name for the body part is included
[00:34:27.610]on the symbol as well as an indication of who is
[00:34:32.340]and is not allowed to touch that body part.
[00:34:37.810]Similar visual supports might be developed to teach
[00:34:41.200]that a doctor sometimes needs to check
[00:34:43.607]private body parts for healthcare reasons.
[00:34:47.320]These symbols come from the picture communication
[00:34:49.760]symbols software by Mayer Johnson,
[00:34:52.130]a commonly used software program for creating symbols
[00:34:55.570]and visual supports for students who have disabilities,
[00:35:02.520]Well more complex skills such as teaching a person
[00:35:04.950]to rely on past experiences to help avoid making mistakes
[00:35:08.090]in the future could also be taught using visual supports
[00:35:12.070]for example, photographs or images of
[00:35:14.780]an if then decision-making model
[00:35:16.580]sometimes called a consequences map
[00:35:18.550]may help the person recall undesired results
[00:35:20.860]of previous decisions.
[00:35:23.900]In this example, the top row shows an event that occurs
[00:35:27.020]in the student's environment
[00:35:28.730]and the top row represents what the student might do
[00:35:32.010]his or her behavior,
[00:35:33.840]whatever he or she might engage in
[00:35:35.820]would lead to consequence X
[00:35:37.700]which is an undesired consequence.
[00:35:40.470]Alternatively, the student may engage in behavior B
[00:35:44.320]which leads to consequences Y, a desired consequence.
[00:35:51.700]The lower example is illustrates two different responses
[00:35:54.900]and consequences for responding to an attractive woman.
[00:35:58.560]A person with autism might see an attractive woman
[00:36:00.840]and stare at her breasts
[00:36:02.680]if so the woman might get angry or feel scared.
[00:36:06.140]She won't want to be friends
[00:36:07.370]and the person with autism might get
[00:36:08.790]into trouble with law enforcement.
[00:36:11.695]However, if the person
[00:36:13.460]with autism looked at the woman's face and said, hello
[00:36:16.450]then she might smile and say, hello back.
[00:36:19.220]She might be interested in becoming a friend
[00:36:20.980]and you probably will not get into trouble.
[00:36:24.140]Consequence maps can have more than two responses
[00:36:27.160]and responses can have multiple negative
[00:36:29.600]or positive consequences.
[00:36:31.950]The behaviors and consequences
[00:36:33.590]could be communicated using photographs
[00:36:35.440]or pictures if the student
[00:36:36.540]doesn't understand written language.
[00:36:39.570]Using visual supports may help learners with autism
[00:36:42.330]understand the different behaviors that are associated
[00:36:45.070]with different functions or consequences.
[00:36:47.740]And that relationships with others depends on knowing
[00:36:50.030]how your behavior affects other people.
[00:36:53.190]It also helps them understand what might happen
[00:36:55.550]if you make mistakes when interacting with other people.
[00:37:02.210]Official representation of various relationships
[00:37:04.940]and appropriate behavior might be communicated
[00:37:07.530]to a learner by using a model of concentric circles.
[00:37:13.310]This model includes placeholders
[00:37:14.950]for photographs of strangers, casual friends, acquaintances
[00:37:19.250]close friends, family and romantic partner.
[00:37:23.660]The learner could place photographs of individuals
[00:37:25.660]in the appropriate circles and explanations
[00:37:28.170]of appropriate behavior for each circle can be taught.
[00:37:32.660]Consequence maps as illustrated
[00:37:34.230]on the previous slide could be used
[00:37:35.960]for clarifying behavior associated
[00:37:37.790]with consequences for each circle
[00:37:40.100]for the individuals in each circle.
[00:37:43.420]For example, specific behaviors that are acceptable
[00:37:45.700]for individuals in the smallest circle
[00:37:47.890]romantic partners are not acceptable for interacting
[00:37:51.000]with family, close friends, acquaintances and strangers.
[00:37:55.390]Making clear what behaviors are acceptable and unacceptable
[00:37:59.610]as well as the desired and undesired consequences for each
[00:38:03.580]is critical for ensuring social competence in society.
[00:38:07.820]Without this knowledge,
[00:38:09.020]individuals with autism may frequently violate social norms.
[00:38:12.740]They may fail to develop various relationships
[00:38:15.427]and they may experience dissatisfaction
[00:38:17.960]with their quality of life.
[00:38:25.370]Now, here are some examples
[00:38:26.250]of visual supports that can be used to teach a variety
[00:38:28.700]of skills across the key concepts
[00:38:30.580]and topics of comprehensive sexuality education.
[00:38:34.970]For example, body awareness skills
[00:38:36.850]are part of the human development key concept.
[00:38:40.350]Children with autism
[00:38:41.340]or other developmental disabilities
[00:38:42.726]likely will need instruction
[00:38:44.470]to learn body part names and functions.
[00:38:47.410]Visual supports could be used
[00:38:48.970]in several ways to teach that skill.
[00:38:51.700]Instructional materials and methods
[00:38:53.320]might involve matching images to a poster of the body,
[00:38:57.090]matching written names of body parts
[00:38:59.020]to pictures of body parts,
[00:39:01.430]asking the student to point
[00:39:03.110]to the parts of their body when shown a photograph
[00:39:05.330]of themselves or using pictures of photographs
[00:39:09.000]to show the different tasks the body part performs.
[00:39:15.610]Similarly, teaching about friendships
[00:39:18.380]to older children is consistent
[00:39:20.270]with the relationship's key concept.
[00:39:23.040]This might be taught by sorting photographs
[00:39:24.960]of family, friends, acquaintances, and strangers.
[00:39:28.640]You might also ask the student to match images
[00:39:31.070]of close friends with favorite activities or games.
[00:39:35.160]Images also could be used to teach relationship skills
[00:39:38.360]by focusing on emotional recognition
[00:39:40.790]and appropriate response to perceived emotional states.
[00:39:46.150]Visual supports can be helpful
[00:39:47.450]for teaching a person to evaluate past decisions
[00:39:51.130]or experiences that they've had
[00:39:54.060]so that mistakes are not repeated in the future.
[00:39:57.500]This is consistent with the decision-making topic
[00:39:59.840]of the personal skills, key concept.
[00:40:02.760]You might use images to convey if then relations
[00:40:05.660]from previous events and apply them to current
[00:40:08.560]or prospective situations that are similar in the future.
[00:40:13.840]Teachers could use photographs
[00:40:16.390]of events or outcomes associated with important decisions.
[00:40:20.640]More advanced students might be taught
[00:40:22.650]to chart their own behaviors
[00:40:23.980]to see how often and when desired
[00:40:26.970]or undesired consequences follow the decision.
[00:40:43.290]Individuals with developmental disabilities
[00:40:45.130]like autism often depend on explicit instruction
[00:40:49.020]that includes graphic drawings, photographs
[00:40:53.110]and manipulatives or objects to learn abstract concepts.
[00:40:57.760]Advances in mobile and multimedia technology have made
[00:41:01.920]feasible the rapid development of video based instruction
[00:41:05.000]that includes explicit instruction
[00:41:07.010]with images, animation and film or video
[00:41:11.120]that can improve students skills.
[00:41:13.840]Video based instruction is an evidence-based practice
[00:41:16.500]and is supported by a very large body
[00:41:18.370]of experimental research.
[00:41:20.870]Video based instruction represents an ideal way
[00:41:23.160]of providing comprehensive sexuality education
[00:41:25.470]to learners with autism
[00:41:26.840]because it can enhance attention to relevant stimuli
[00:41:29.830]and provide consistent instruction
[00:41:33.360]irrespective of repetitions used.
[00:41:37.420]However, video-based instruction requires the learner
[00:41:40.230]to be able to see the content on the screen.
[00:41:42.840]In other words, have good visual acuity as a prerequisite
[00:41:46.720]and have what's called a generalized imitation repertoire
[00:41:50.900]which is an ability to imitate the behavior of others.
[00:41:55.230]Video based instruction can be an effective way
[00:41:57.670]to teach social and relationship skills
[00:41:59.790]to learners with autism.
[00:42:02.780]For example, MacManus colleagues used
[00:42:05.640]video based instruction to teach interactive play skills
[00:42:08.740]and increase peer communication in young children
[00:42:11.240]with autism.
[00:42:13.500]Grossberg and Charlop in 2014
[00:42:16.210]used video based instruction to teach learners
[00:42:18.560]with autism to persistently ask typical peers
[00:42:21.700]to join a playground game
[00:42:22.960]after being rejected by those peers.
[00:42:27.000]Accordingly, professionals will need to rely on
[00:42:29.510]a four step approach described previously
[00:42:32.320]to provide video based instruction.
[00:42:40.210]These are the steps for using video modeling.
[00:42:43.550]Step one, involves identifying and defining
[00:42:46.100]the sexuality related target behavior
[00:42:48.810]in observable and measurable terms.
[00:42:51.790]The next step is to obtain the necessary equipment
[00:42:54.850]whether it be a tablet computer
[00:42:57.420]or a mobile phone to take images
[00:43:01.440]or record video and to acquire video editing software.
[00:43:07.570]The third step is to prepare and produce the video
[00:43:10.480]to script the video
[00:43:12.120]to write out what should happen.
[00:43:14.140]What should it be said by whom and when
[00:43:17.210]much the same way that a film producer prepares a script.
[00:43:23.410]Step four entails collecting baseline data
[00:43:25.670]on the sexuality related target skill
[00:43:30.170]and then preparing to show the individual the video.
[00:43:34.780]Step six involves documenting the student's performance
[00:43:37.720]of the sexuality related target skill
[00:43:40.620]using either frequency, percent of opportunities
[00:43:43.550]rate of responding, duration, latency and so on.
[00:43:49.200]Step seven involves evaluating the interventions effects
[00:43:52.390]by graphing the data and looking at the trend
[00:43:54.978]to see if the student is progressing
[00:43:56.680]in a way that results in achievement of the goal
[00:43:59.200]by the pre identified timeline.
[00:44:03.670]And finally, step eight
[00:44:04.940]is adapting the intervention according to the results.
[00:44:09.850]In other words, making database decisions.
[00:44:15.720]Individuals with autism often struggle
[00:44:17.500]to communicate with peers
[00:44:19.130]friends, coworkers,
[00:44:21.130]family members and romantic partners.
[00:44:24.210]Scripting may help them improve interpersonal communication
[00:44:27.000]and relationships.
[00:44:28.790]A scripting intervention requires a determination
[00:44:31.280]that the learner has the verbal and motor imitation skills
[00:44:34.770]needed to acquire a scripting repertoire.
[00:44:38.640]If the learner is not able to imitate
[00:44:40.720]then scripting is most likely not going to be effective.
[00:44:44.370]Professionals need to consider the learners language ability
[00:44:46.810]when developing the script
[00:44:47.940]in order to ensure he or she understands
[00:44:51.030]and can use the script or pronounce the words
[00:44:53.800]in the script effectively.
[00:44:58.230]Ganz 2007 provided seven steps
[00:45:00.830]for implementing scripts as an intervention.
[00:45:04.330]First is choosing activity.
[00:45:06.040]Step two is observed typically developing peers.
[00:45:08.960]Step three is operationally defining the target behavior.
[00:45:12.260]Step four is writing the script.
[00:45:14.520]Step five is teaching the script.
[00:45:17.500]Step six is implementing the script during the activity.
[00:45:21.200]So teaching the script is first
[00:45:22.460]in the contrived teacher student's situation
[00:45:24.930]and step six is delivering the script
[00:45:26.910]or practicing the script in the actual activity
[00:45:30.090]with peers, for example
[00:45:31.730]and step seven is fading the script.
[00:45:35.200]Perhaps the most likely skills amenable
[00:45:37.180]to scripting interventions relate to
[00:45:38.850]the SEICUS key concept of relationships
[00:45:41.160]including aspects of families
[00:45:42.850]such as communicating with siblings and parents
[00:45:45.530]as well as friendships like when playing video games
[00:45:47.990]or resolving a disagreement and dating
[00:45:50.950]and romantic relationships like asking someone out on a date
[00:45:54.100]or rejecting an unwanted sexual advance.
[00:45:58.060]Scripting also can be helpful for professional relationships
[00:46:00.740]like making small talk or giving appropriate compliments.
[00:46:07.550]Here are some examples of scripts topics.
[00:46:10.670]Professionals should identify situations
[00:46:13.250]where they will teach the relationship skill of concern
[00:46:16.860]and develop appropriate scripts.
[00:46:20.360]For most of these questions, scripts also can be created
[00:46:23.380]for responding to similar questions.
[00:46:25.810]Also, a script about a special interest may help the person
[00:46:29.110]with autism share their interest
[00:46:30.600]in a socially appropriate way with family, friends
[00:46:33.610]or coworkers or acquaintances or others
[00:46:36.230]while also avoiding lengthy monologues
[00:46:38.420]and nuances about their special interest.
[00:46:42.060]You can also consider including reminders
[00:46:44.080]in scripts to smile or use an appropriate facial expression
[00:46:48.000]when reading the script.
[00:46:51.630]Reciting the script in the appropriate situations
[00:46:54.480]is most important.
[00:46:56.520]Memorization and recitation of the script is insufficient.
[00:47:00.810]Instead, the learner must memorize
[00:47:02.860]and recite the script when the appropriate antecedent
[00:47:05.660]or situation occurs.
[00:47:08.260]Achieving this may require role-playing
[00:47:10.240]and repeated practice in the actual environment
[00:47:12.700]before generalizing to novel settings and people.
[00:47:16.530]For example, a familiar question
[00:47:18.200]from an acquaintance, friend or coworker may be taught
[00:47:21.710]as the antecedent for using a script.
[00:47:24.680]Also seeing a particular person in their office
[00:47:27.300]or witnessing a friend crying
[00:47:29.240]maybe the antecedents for using a particular script.
[00:47:32.760]Indeed, knowing what to say is usually not enough.
[00:47:36.450]The timing of a statement
[00:47:37.830]or a question asked is equally important.
[00:47:42.410]Additionally, the learner may require a visual support
[00:47:46.040]such as a laminated card
[00:47:47.530]with specific phrases to support interacting with others.
[00:47:51.560]Ideally, the printed script is faded
[00:47:53.380]after the person demonstrates mastery
[00:47:55.970]and teachers can gradually shrink the text size
[00:47:58.480]of one keyword at a time until the person can say the script
[00:48:01.630]without the written prompt.
[00:48:04.160]Other prompts might also be needed to teach the person
[00:48:06.560]to recognize the condition when the script ought to be used.
[00:48:10.800]The number of situations and scripts taught at one time
[00:48:13.630]should be based on the learners acquisition rate
[00:48:16.090]as well as the priorities of team members.
[00:48:24.510]These examples scripts are associated
[00:48:26.510]with the different categories of relationships,
[00:48:29.300]acquaintances, friendships,
[00:48:31.700]dating and romantic relationships
[00:48:33.770]and professional and work relationships.
[00:48:37.220]You can see that for acquaintances
[00:48:38.620]some examples scripts might involve formal
[00:48:40.820]and informal greetings of various kinds,
[00:48:43.150]talking about the weather,
[00:48:44.780]complimenting a person's clothing or hairstyle,
[00:48:47.660]asking for help, telling a benign joke
[00:48:51.310]responding to humor and talking about
[00:48:53.660]local events like sports teams.
[00:48:56.980]For friendships
[00:48:57.813]it might involve inviting a friend to play a game
[00:49:00.220]or asking peers to if they can join
[00:49:02.300]into a game already happening,
[00:49:05.270]it could involve inviting a friend over
[00:49:06.860]after school or telling a friend when you're happy
[00:49:10.040]or unhappy or angry or frustrated.
[00:49:14.130]You could also have scripts
[00:49:15.030]for encouraging a friend to make the right decision
[00:49:18.130]or scripts that use appropriate jokes and other humor,
[00:49:23.130]scripts that teach questions are also helpful
[00:49:26.910]as well as follow up responses to those questions.
[00:49:29.910]Like my favorite color is blue too
[00:49:31.760]or cheese pizza is my favorite food as well.
[00:49:36.010]For dating and romantic relationships,
[00:49:37.650]you might have scripts that focus on complimenting
[00:49:40.670]the person's appearance, their clothing or perfume
[00:49:43.260]or something similar.
[00:49:46.060]There might be scripts about asking the person
[00:49:48.110]where they grew up and where they went to school.
[00:49:51.110]They might have a script prepared about a funny
[00:49:53.010]or exciting moment in their life or questions
[00:49:55.880]about a person's preferences or favorite things.
[00:49:59.810]You might also prepare teach scripts
[00:50:01.740]specifically about a person's daily routines.
[00:50:06.480]I like to drink coffee in the morning
[00:50:08.960]maybe we can grab a cup sometime.
[00:50:11.730]Questions and responses about family members
[00:50:13.960]or best friends, how to wrap up the date.
[00:50:19.420]Work relationships and related scripts
[00:50:22.100]can be very valuable.
[00:50:23.870]Initiating response to greetings is very helpful
[00:50:26.730]especially because you see people
[00:50:28.280]in many different situations throughout the day
[00:50:30.300]when you work in an office, for example
[00:50:32.904]you might ask the person who has children
[00:50:35.040]about their day, about their family, about their hobbies.
[00:50:37.870]You might teach scripts
[00:50:39.190]about to talk about the person's weekend or their plans.
[00:50:47.490]You might also use a task analysis
[00:50:49.500]to teach a person a variety of socio sexual skills.
[00:50:53.960]A task analysis involves identifying each specific behavior
[00:50:57.310]that is part of a larger
[00:50:58.660]more complex chain of behaviors associated with the task.
[00:51:03.170]Many things we do involve following steps
[00:51:05.430]of a broader behavior, such as making a sandwich
[00:51:07.950]or brushing our teeth or solving a long division problem.
[00:51:12.000]Breaking down more complex skills
[00:51:13.830]into smaller steps and systematically teaching each step
[00:51:17.920]is supported by a large body
[00:51:20.320]of high quality experimental evidence.
[00:51:23.520]Task analysis has been useful for teaching learners
[00:51:25.900]with autism to a variety of social skills
[00:51:29.910]including those related to play,
[00:51:33.140]language and communication,
[00:51:34.910]hygiene and self care,
[00:51:36.170]adaptive daily living skills and others.
[00:51:39.560]In many cases, task analysis is combined
[00:51:42.300]with other instructional and reactive strategies
[00:51:44.930]including visual supports, video modeling
[00:51:48.040]time delay and differential reinforcement.
[00:51:52.750]Task analysis is an ideal instructional intervention
[00:51:55.750]for this population because many sexuality
[00:51:58.250]related skills involve complex behavior.
[00:52:01.740]For example, sexual reproductive health in general
[00:52:04.360]hygienic care often involve numerous skills composed
[00:52:07.760]of discrete behaviors
[00:52:09.040]including bathing, showering,
[00:52:10.870]shaving,
[00:52:12.510]following medical and dental visit routines.
[00:52:15.670]Task analysis also may be helpful for instruction
[00:52:18.850]on how to masturbate,
[00:52:19.980]how to put on a condom,
[00:52:21.250]how to engage in consensual intercourse.
[00:52:28.820]Specific behaviors consistent with dating
[00:52:30.950]and relationships can be tasked analyzed
[00:52:33.000]and explicitly taught to individuals with autism.
[00:52:36.490]Such skills might include planning a date,
[00:52:39.600]escorting your date to the car
[00:52:41.480]and helping her into the passenger seat
[00:52:43.610]dining etiquette and similar behavior.
[00:52:46.660]Other complex sexuality related skills
[00:52:48.920]might involve teaching steps
[00:52:50.240]to resolve a conflict with a friend or a romantic partner.
[00:52:53.750]Might involve providing care to infants or young children
[00:52:56.310]or rejecting unwanted sexual advances
[00:52:58.850]or identifying options for decision-making.
[00:53:03.920]Numerous other task analysis
[00:53:05.580]for various sexuality related skills can be easily developed
[00:53:08.840]and used for instructional interventions
[00:53:11.530]but they should follow a prescribed protocol
[00:53:13.670]to maximize the probability of effectiveness.
[00:53:16.770]Here are two examples of task analysis.
[00:53:20.030]One for escorting a date to the car
[00:53:21.930]and the other for changing a maxi pad.
[00:53:24.920]Each step is clearly identified
[00:53:26.800]and is taught independently using forward
[00:53:29.330]or backward chaining.
[00:53:31.340]Forward chaining involves teaching the person the first step
[00:53:34.020]in the task analysis until mastery and supporting them
[00:53:37.410]through the remaining steps or doing the remaining steps
[00:53:40.470]with them for the learner.
[00:53:42.790]Backward chaining involves teaching the person
[00:53:44.930]the final step in the task analysis until that is mastered
[00:53:48.550]and supporting him or her
[00:53:50.330]through the initial steps are doing them for them.
[00:53:55.520]Prompting procedures usually are integrated
[00:53:58.000]in all steps with specific attention
[00:53:59.840]on fading the prompt for the current step
[00:54:03.050]as that's being targeted for independence.
[00:54:13.400]Consequence strategies are essential
[00:54:15.000]for improving appropriate responding
[00:54:17.060]while decreasing inappropriate responding
[00:54:19.990]and are critical for teaching most skills
[00:54:22.810]including those related to sexuality.
[00:54:26.400]Differential reinforcement is a strategic means of reacting
[00:54:30.120]to different behaviors to make desired behavior
[00:54:32.110]more likely to occur and undesired behavior
[00:54:34.860]less likely to reoccur
[00:54:36.800]without relying on punishment procedures.
[00:54:41.020]There are several specific forms
[00:54:42.520]of differential reinforcement that are important
[00:54:44.530]for ensuring comprehensive sexuality education instruction.
[00:54:49.420]These include differential reinforcement
[00:54:51.520]of lower rates of behavior,
[00:54:53.470]differential reinforcement of zero rates of behavior
[00:54:57.140]and differential reinforcement of incompatible behavior.
[00:55:02.470]Extinction refers to the cessation
[00:55:04.480]of a behavior because it no longer results
[00:55:06.098]in a reinforcing consequence and is best used when combined
[00:55:10.220]with differential reinforcement strategy.
[00:55:14.380]Finally, response interruption
[00:55:15.950]and redirection involves using verbal
[00:55:17.950]or physical response blocking procedures followed
[00:55:20.780]by redirection to a more appropriate behavior.
[00:55:23.890]Let's talk about each of these on the following slides.
[00:55:28.970]Differential reinforcement of lower rates of behavior
[00:55:31.480]is the strategic delivery of a reinforcing consequence
[00:55:34.980]based on a lower occurrence of behavior.
[00:55:38.360]For example, data may indicate a student picks
[00:55:40.680]his nose 17 times per hour.
[00:55:43.900]The use of differential reinforcement of lower rates
[00:55:46.830]of behavior to reduce this behavior
[00:55:49.120]might include making access to a reward
[00:55:51.840]such as a five minute period with a favorite video game
[00:55:55.490]contingent on picking his nose less than 12 times per hour
[00:55:59.440]rather than 17.
[00:56:01.650]Upon achieving the criteria
[00:56:03.000]for mastery such as 12 times or less per hour
[00:56:06.610]for a total of four hours on three consecutive days
[00:56:09.940]the rate might be then adjusted to eight times per hour
[00:56:13.670]then four and eventually one or zero.
[00:56:18.850]The differential reinforcement of lower rates
[00:56:21.620]of behavior strategy may be helpful when the behavior
[00:56:24.600]of concern can be tolerated at some level
[00:56:27.320]until it's reduced to a lower, more acceptable rate
[00:56:30.770]or eliminate it entirely.
[00:56:33.940]Differential reinforcement of zero rates of behavior
[00:56:36.930]is the strategic delivery of reinforcing consequences
[00:56:39.500]based on the absence of behavior.
[00:56:41.770]The DRO procedure is appropriate in circumstances
[00:56:44.450]where the behavior of concern cannot be reasonably tolerated
[00:56:47.910]like public disrobing or touching others.
[00:56:53.220]Data may indicate that a student disrobes
[00:56:55.300]at school about one time per hour
[00:56:57.910]but never during a highly preferred activity.
[00:57:01.410]The use of DRO to reduce disrobing may include making access
[00:57:05.310]to a highly reinforcing activity
[00:57:07.410]such as five minutes watching favorite YouTube videos
[00:57:10.640]contingent ongoing 15 minutes without disrobing.
[00:57:14.490]Upon achieving a criteria for mastery
[00:57:17.170]such as zero occurrences
[00:57:18.970]of disrobing for five consecutive school days
[00:57:22.420]the team might adjust the interval
[00:57:23.940]to 30 minutes without disrobing and eventually 60 minutes
[00:57:28.170]or 90 minutes and so forth until a limit has been detected.
[00:57:34.440]A differential reinforcement of incompatible behavior
[00:57:38.020]entails delivering reinforcing consequences
[00:57:41.020]based on the students' engagement
[00:57:42.380]in the behavior that is incompatible
[00:57:44.370]with the inappropriate behavior.
[00:57:47.180]For example, data may reveal that a student mouths his hands
[00:57:50.570]at least once in 50 of 61 minute intervals.
[00:57:56.060]A differential reinforcement of incompatible behavior
[00:57:58.940]strategy might involve increasing the students' engagement
[00:58:02.810]in tasks that require both hands
[00:58:05.320]and reinforcing the student for engaging in those tasks
[00:58:08.650]and using both hands like holding an object
[00:58:10.830]for 10 consecutive one minute intervals.
[00:58:14.270]And upon reaching that criteria
[00:58:15.690]for mastery can increase the number
[00:58:18.250]or length of required intervals
[00:58:19.980]in order to access a reinforcing consequence.
[00:58:23.470]Now, the DRI procedure is appropriate
[00:58:25.680]when the incompatible behavior has an acceptable educational
[00:58:30.070]or social value.
[00:58:33.280]Extinction refers to the elimination
[00:58:35.240]of a previously reinforcing consequence
[00:58:37.430]from a person's environment.
[00:58:39.650]If functional behavior assessment results
[00:58:41.620]reveal a student engages
[00:58:43.040]in tantrum behavior to escape a demand, for example.
[00:58:46.300]An extinction procedure for tantrums that occur
[00:58:49.280]during the demand would entail continuing
[00:58:51.590]to enforce the demand so as to not allow escape.
[00:58:56.570]If FBA reveals tantrums also sometimes occur
[00:58:59.600]to escape teacher attention
[00:59:01.870]then extinction would involve
[00:59:03.160]the teacher's continued delivery
[00:59:04.570]of attention when the tantrum occurred.
[00:59:06.460]So it was to not allow escape
[00:59:07.680]from attention contingent on tantrum behavior.
[00:59:11.570]If FBA reveal tantrums sometimes occurred
[00:59:13.780]to obtain a preferred item
[00:59:15.220]then extinction would involve not allowing the person
[00:59:18.650]to access that pervert item contingent on tantrum behavior.
[00:59:23.630]Importantly, extinction depends
[00:59:25.970]on knowing the function of behavior
[00:59:27.670]and should be informed by functional behavior assessment.
[00:59:31.890]Also, extinction does not result
[00:59:34.720]in skill improvement because it reduces problem behavior
[00:59:38.050]and it does not teach a replacement behavior.
[00:59:41.610]So that means extinction should be
[00:59:43.636]at least used in conjunction with other types of strategies
[00:59:47.750]like a differential reinforcement strategy
[00:59:50.300]but is perhaps most ethical when using prevention
[00:59:53.444]and specialized instructional strategies.
[00:59:57.070]So extinction alone is discouraged.
[00:59:59.480]I wouldn't recommend doing that.
[01:00:03.740]Response, interruption and redirection
[01:00:05.740]involves using a verbal
[01:00:07.580]or physical response blocking procedure
[01:00:09.880]followed by redirection to a more appropriate behavior.
[01:00:13.660]The procedures of response interruption
[01:00:15.780]and redirection begin
[01:00:16.960]with completing a functional behavior assessment
[01:00:19.270]to confirm the behavior caused is caused by self stimulation
[01:00:22.750]like touching or rubbing the genitals.
[01:00:25.720]Importantly, disrobing or touching others
[01:00:28.470]or touching one's own genitals
[01:00:30.530]maybe caused by consequences other than self stimulation.
[01:00:35.730]For example, if an individual
[01:00:36.930]with autism learns that high quality
[01:00:39.220]and the media attention is available
[01:00:42.150]immediately upon putting his hands in his pants
[01:00:44.800]then you'll be more likely to put his hands
[01:00:46.550]in his pants when he needs or wants attention.
[01:00:49.670]Also, a public disrobing
[01:00:51.440]or public masturbation very likely will result in a variety
[01:00:54.680]of consequences that may inadvertently be reinforcing
[01:00:58.360]such as attention or access to preferred items
[01:01:00.760]or activities.
[01:01:02.870]The FBA is an important first step
[01:01:04.780]for using response interruption and redirection
[01:01:06.930]because the method for stereotypical behavior that is not
[01:01:12.230]because using the method for stereotypical behavior
[01:01:15.070]is not primarily or exclusively caused
[01:01:17.600]by self stimulation may actually worsen the behavior.
[01:01:21.890]In other words, if you use response interruption
[01:01:24.280]and redirection for behavior that's not caused
[01:01:26.810]by self-stimulation or automatic reinforcement
[01:01:29.960]then it's possible that response interruption
[01:01:32.290]and redirection will exacerbate that behavior.
[01:01:36.660]The team should identify alternative behavior
[01:01:38.480]that is incompatible with inappropriate behavior
[01:01:40.810]after the FBA has revealed the target behavior
[01:01:43.700]is self stimulatory in nature.
[01:01:46.260]An incompatible behavior is a behavior
[01:01:48.230]that if occurring cannot simultaneously allow
[01:01:51.220]for the problem behavior to occur.
[01:01:53.600]For example, sitting and standing are incompatible behaviors
[01:01:56.520]because they cannot be done at the same time.
[01:01:59.110]Similarly, folding arms and masturbating
[01:02:01.570]with one or two hands are incompatible behaviors.
[01:02:05.830]After identifying incompatible behavior
[01:02:07.890]the team should specify what blocking procedure to use.
[01:02:11.640]Blocking requires the interventionists
[01:02:13.270]to interfere with the person's stereotypical behavior
[01:02:16.400]using physical or verbal strategies.
[01:02:19.440]Physical blocking is used when the stereotypy
[01:02:22.090]is physical in nature like hand flapping
[01:02:24.500]or inappropriate masturbation
[01:02:26.260]and verbal blocking is used for vocal stereotypy
[01:02:28.790]and may include requiring the student
[01:02:30.170]to verbally answer a question or repeat a sound
[01:02:33.720]that the teacher makes or simply say the student's name
[01:02:36.330]in a neutral voice to get their attention.
[01:02:40.180]The blocking procedures should be combined
[01:02:41.890]with differential reinforcement
[01:02:43.890]probably of incompatible behavior and maybe useful
[01:02:46.760]for addressing various stereotypical behaviors.
[01:02:50.060]For example, a student may engage
[01:02:51.470]in persistent hand flapping for prolonged periods of time
[01:02:54.650]which interferes with sexuality
[01:02:57.700]and other instruction designed to improve relationships
[01:03:00.800]or other topics.
[01:03:02.630]Use of response interruption and redirection as part
[01:03:05.690]of a comprehensive intervention plan with preventative
[01:03:08.740]and specialized instructional strategies
[01:03:11.310]might require redirection of hand flapping to place hands
[01:03:15.330]on a table when seated or crossing the arms when walking
[01:03:20.070]or giving objects to another person.
[01:03:23.920]Additionally, the student might be provided
[01:03:25.600]with an object to hold such as a squishy ball
[01:03:28.590]or putty or a tablet computer.
[01:03:35.650]So wrapping up.
[01:03:37.860]Sexuality education for learners
[01:03:39.580]with autism entails deciding what to teach
[01:03:42.570]and for that, I suggest that you turn
[01:03:44.040]to the SIECUS guidelines or curricula that are available.
[01:03:48.130]It involves following a four-step process where we assess
[01:03:51.520]define, intervene and evaluate the effects of interventions.
[01:03:56.020]It involves the deployment of evidence-based practices
[01:03:58.790]that prevent inappropriate socio sexual behavior
[01:04:01.960]while increasing the probability that appropriate
[01:04:04.980]socio sexual behavior occurs.
[01:04:07.400]It improves using evidence-based practices
[01:04:09.730]to teach appropriate socio sexual behavior
[01:04:13.410]and it involves using reactive strategies
[01:04:16.760]and in response to appropriate
[01:04:19.510]and inappropriate socio sexual behavior.
[01:04:24.170]Finally, it's important to remember that
[01:04:25.940]more complex interventions
[01:04:27.230]may produce more immediate effects
[01:04:29.330]but they may be more difficult to apply
[01:04:31.720]and that you need to understand the context
[01:04:33.990]in order to plan appropriately.

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A Foundation and Framework for Providing Sexuality Education to Individuals with Autism

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