2009/09/01/Behavior Plan for Josh Smith

About

This is a transcription of the behavior plan produced by Geoffrey Zeger for Josh on September 1, 2009. The format has been modified for improved readability, and some links have been added for clarity. (It had to be re-typed by hand because Zeger apparently could not send us the output file, even as a PDF; some sort of special software was involved that apparently can't save to any common format.)

• /comments: our comments on Zeger's plan, towards producing one that is both accurate and usable

Behavior Plan

Indicating Need

• Target Behavior: Indicating need through verbal or gestural communication as opposed to crying or shouting or pacing
• Goal: Josh will be indicating need 70-80% of the time through verbal communication or actions (pointing, signing) by November 2009

Interventions

• Josh's caretakers including parents, PP, QP, and school workers will reinforce a specific interaction style with Josh so that he will be able to communicate without resorting to behaviors that indicate frustration to overstimulation
• It is highly recommended that all caretakers use the same type of communication so that there is consistency between Josh's home, community and school
• It is highly recommended that basic tacit words be made as a standard lexicon for Josh and that these words have accompanying actions - for example:

  YES - head nod

  NO - head shake

  PLEASE - hands together

  EAT/HUNGRY - gesture towards mouth

  BATHROOM - hand on stomach

  TIRED - hands together on side of head

  HOT - wave

  COLD - hold self

• In the evaluation it was mentioned that Josh can echo back words when given choices but it is unclear if Josh's mimicking is truly what he needs/wants or if this is echolalia
• For most individuals with autism visual processing is more intact than verbal/auditory and if verbal interaction leads to frustration more emphasis should be placed on gestures.
• It is unclear if Josh can write but if he can then a white board (erasable) with a magic marker can be brought with him wherever he goes and made available so he can write down his needs
• Similarly, a small portfolio with pictures can also be brought with Josh so that he can point to the things he wants/needs (i.e. - pictures of a burger/fries, drink, toilet, pillow, person walking, etc.)
• It is highly recommended that anytime Josh is becoming agitated and making loud noises the caretaker ask Josh to get eye contact and then communicate via the above mentioned strategies
• Another strategy is for the caretaker to give Josh choices (i.e. - "Josh, do you want food or to go for a walk")
• This can be used along with the above mentioned pictures by saying "Josh, do you want this (point to picture of food) or this (point to picture of person walking)"
• When Josh uses the appropriate communication positive verbal reinforcement should be given by saying "GOOD Josh, thank you"
• It is likely that during the retraining period Josh may become frustrated and caretakers should try to encourage Josh to use the appropriate communication strategy even if he struggles to find the right picture/gesture

Toilet Paper

• Target Behavior: Using excessive amounts of toilet paper or other household items
• Goal: Josh will use the appropriate amount of toilet paper or other household items 90% of the time by November 2009

Interventions

• In the evaluation it was mentioned that Josh can "use the whole roll of toilet paper" when he is using the bathroom
• This behavior can be targeted with one of 3 methods: 1) repetitive retraining over and over of the appropriate amounts of toilet paper (although this may not be entirely successful), 2) supervision when in the bathroom (but this is intrusive of his privacy) or 3) making structural changes in the household (which is the easiest strategy)
• The idea behind structural changes is the same as removing knives from group home kitchens or putting foam rubber cushions on the corners of furniture in the house of a toddler
• It is recommended that a specific amount of toilet paper be rationed out per day or per event in the bathroom
• It is unclear if Josh hordes food or over consumes drinks from the refrigerator but if he does then limiting access to these items is the easiest way to target this behavior
• Since a multitude of objects in the environment will be distracting and possibly can cause over stimulation it is highly recommended that Josh's living environment be free of clutter and be organized

Reluctant to Go with Paraprofessional

• Target Behavior: Josh has been reluctant to go out of the house with his paraprofessional since June 2009
• Goal: Josh will increase his compliance to redirections from/guidance of the paraprofessional from approximately 10% to 40% by November 2009

Interventions

• In the 8/21/09 evaluation it was discussed how Josh has refused to go with the paraprofessional worker into the community since June 2009
• It may be necessary for the goals with the paraprofessional to be adjusted down - in other words, rather than trying to go out in the community the paraprofessional can try spending time with Josh alone in the house. If this is solidified after a few days then spending time outside of the house engaged in an activity is the next goal. If this is solidified after a few days the paraprofessional can proceed to going for a walk alone (no parents) with Josh in the neighborhood
• This is slow behavioral acclimation that proceeds slowly over time.
• Individuals with autism are extremely sensitive to people, tone, physical gesture, volume, environment, heat/cold, noise and it may be a set up for Josh to go from 0 to 100 by expecting him to go into the community with a new person until he becomes acclimated to that person
• If it turns out that no matter what intervention is tried Josh still refuses to comply with community based activities with the paraprofessional then another paraprofessional may need to be assigned. This is no reflection on the worker since Josh's preferences are difficult to understand and are based on a sensorial level

Pacing in the Classroom

• Target Behavior: Pacing in the classroom
• Goal: Josh will be able to sit in his classroom chair and engage in activities without spontaneously getting up from his chair for 8-10 minutes

Interventions

• In the evaluation it was discussed how Josh can have difficulty sitting for any extended period of time in the classroom
• It is a set up for failure to expect Josh to sit for an extended period of time and also to sit without engaging in an activity
• If Josh is unsupervised and unengaged it is highly probable that he will begin to pace - this is part of his condition
• It is therefore recommended that in the school setting time limited periods be designated for 8-10 minutes where Josh will sit engaged in a specific activity
• During this time Josh will be more successful with frequent monitoring and supervision
• Upon completion of the time frame Josh can be allowed to get up to dispel pent up energy