Understanding Transition to Adulthood Using Reverse Engineering

May 16, 2019

ID186

CreditsPeter F. Gerhardt

To CiteDCA Citation Guide

00:00Sure.
00:05Alright so, so it's my enormous pleasure to introduce to you, Peter Gerhardt. Peter is director of the epic school and also founding member of the Autism Organization for autism research which is probably one of the oldest.
00:27Organizations founding research in autism.
00:31Back in the 1990s, nineteen 90s and some of us here. The child study center remember very fondly apply and getting funding from or to start the very, very, very first studies on young children with autism so we were talking a little bit about the role of parents in spearheading important life changing opportunities for individuals with autism and Peter is director of this school that has.
01:02That was started by 8:00 parents right 8 parents would, in the late 1990s were dissatisfied with educational care of children with autism and they started a school for small and now a very large and extremely comprehensive program for individuals with autism and so I'm Peter is a marvelous speaker and looking forward to be stopped up more country.
01:36Thank you very much a conscious and thank you for having me here. I'm quite honored to be part of this fabulous panel. I feel a little out of place, though I have to tell you I'm a practitioner.
01:48Like I'm I'm kind of in the trenches. I consumed the research that everybody here does and informs Maine, but I'm going to talk a lot about practice and how we're doing what we're doing like things I'll point out a couple things relative to Loris talk. It also the cautious and this is sort of a very, very short version of a full day workshop. There's little genius and I did last year of the Association behavior analysis.
02:18It was called adulthood begins in preschool.
02:21And it really is the fact that we need to start looking at developing those skills necessary for adult competence.
02:29Much earlier than we are, and I'll talk about that because if you continue to wait to 16.
02:35We have a bit of a problem and we get the results that we're seeing now. Also, Jesse know my school tends to focus on individuals who today would get a diagnosis of autism 2 or 3 individuals with some cognitive challenges. The majority of my students have some significant behavior challenges.
02:59And my most recent student the district gave me a 3:00 to 1:00.
03:04To work with him.
03:06Which I'm quite sure we'll be able to fade but I couldn't resist a challenge as I told my staff. That's about a life and if we don't do it who will.
03:17So it's a lot of bragging point, 'cause we might fail, but it's that's how I see this job. The other thing is I get much of my life, philosophy from pop culture, which just tells you not really very deep at all.
03:36But I'm kind of a geek.
03:39And if you go back into the 70s. You might know Robert Crumb, who had some underground comics called zap comics.
03:47An exact comments, he had 2 drug dealing brothers called the freak brothers.
03:52And their mother was drugs will get you through times of no money better than money will get you through times of no drugs.
04:00And what I do and let Laura does, I say adaptive behavior will get you through talks with no academic skills better than academic skills will get you 3 times and no doubt to behavior because every single one of you has fake your way through some situation about what you knew nothing but even if you had that information. If you didn't have the skills to get into that conversation to participate are useless.
04:25So it is the core of really what we're looking at boobs.
04:34How do I do this?
04:41There we go.
04:51Not change it on the screen.
05:02You haven't.
05:04Windows 10 Wizards here.
05:08So same situation that we've seen this.
05:14When is?
05:25Norway OK fingers crossed.
05:31OK.
05:34Can you see the changes no wait wait wait? I'm gonna go into the nose?
05:43OK thanks.
05:51OK.
05:55Just there we go.
06:00Now usually I know, but
06:05My own disclaimers organization with his research. I've been involved with them. Since the beginning. We fund intervention research founded by a bunch of parents? Who are well tended please come out. I was looking at bio medical ideological issues, they said. My kids 20. It's not going to help them sell their sound with this group additional space in juvenile but none of that has anything to do with.
06:29I said, I did this talk with Angela but here's what I mean.
06:35About reverse engineering, we started a process about 4 years ago, when we started at age 12.
06:44And we sat down with Patterson said. Where do you see your son or daughter in 5 years?
06:48And think big.
06:50Give me a vision that when your iep doesn't help me anymore. 'cause it supposed to be achievable goals. I don't need achievable goals.
06:58I need goals that are slightly outside my grasp in order to do this well.
07:04Today we now do their starting at age 8.
07:07But it ain't we don't do 5 year goals. We do 3 recalls. We sit there and say he's 8. Where is he at 11?
07:15Tell me what you see in across multiple domains across family living skills about community activity about socialization about friendship and we do a whole plan based upon that then informs our IP.
07:30But this is one students.
07:33Opening statement in 5 years. Time spent 20 years old, and will be ready as if he's transitioned into live on his own this includes independent self wakening showering dressing toileting toothbrushing laundry cooking. Another general life skills. However, play follow schedule activities for 8:00 consecutive hours. Spencer will demonstrate personal responsibility related containers were immediately purchasing correct size clothes, keeping inventory for food shopping, etc.
07:57In terms of the community, Spence will be able to shop for himself, including meals and other necessities.
08:03And preferences they'll be able to independent navigate increasingly greater distances to participate in your living expenses will be able to distinguish good versus bad touch or discriminating different relationship roles. Mom versus friend versus Stan Fischer Stranger. Maybe is a smart phone to make receive calls and text contact for help describes location to another person or use the same location function and when appropriate kill some time playing a game.
08:28Spencer will be in turning a job requiring attention to detail. We just at assembly motherboards can think of anything else at the time help you have to work for 90 minutes independently and check us completed work for accuracy will respond to directions from supervisors and socially interact with our degree program with coworkers will make lunch for work or purchase lunch at work can be able to initiate independent choices with regard to leisure, which may include team, bowling going to arcade playing mini golf.
08:53Or hanging at the mall.
08:56You see young men were significant challenges.
09:00Dismiss tested IQ is some around 30.
09:03I don't buy the IQ score for this group.
09:07Because it doesn't tell me anything.
09:09It tells me this is the worst that can do one of the worst possible conditions.
09:13That's kind of what it tells me.
09:16But this tells me where I need to go.
09:19And although I don't know if I'll be able to do this.
09:25If I don't try he definitely won't do it.
09:29That's the problem. I think we often say, well, we don't know how to do. We can't do that? He can't do that one of my larger Flagstaff that they ever say? Well, he can't do that. I say you don't get to say that he gets to say that.
09:41Until he gets a chance to do it.
09:43We don't know 'cause I know so many individuals who can actually do things that we never thought they could with that.
09:52One of the things that I really focus on.
09:55Is it after 40 years of doing this?
09:58I started in 1980, when it was the prevalence rate is one out of 10,000.
10:04I'm really bored with deficits.
10:09Like I I really I'm just nobody ever talks. About me that way. Nobody says a Peter Gerhardt is good behavior analyst but he can't speak German.
10:18You know, nobody ever like says well we gotta crackle like they accept me for who I am and build upon my skills.
10:27And the deficits that I'll talk about today have nothing to do with the neurological underpinnings of autism. They have to do is stuff that we failed to teach.
10:37That we didn't prioritize so.
10:44Number I said, we have individuals level 2 or 3 autism.
10:50Our goal when they graduate employed a minimum of 20 hours a week.
10:5420 just an arbitrary term that number, but they want a social community outside her home contribute on regular basis family functioning have functional effective communication skills and independent independent basic self care skills can self manage their own behavior across multiple environments and have a medical reasonable transition plan.
11:13Awesome but I have no idea how I'm going to do that.
11:17I have 240 days a year 6 hour days.
11:22How I'm going to do that there was by partnering?
11:25By partnering with parents by partnering with the community by other resources in the community.
11:31One of the things I do know that I think is a strength of mind today is that the 40 years of doing this, I know what I don't know.
11:38So I'm very comfortable, reaching out to get assistance if there are things that I do not know.
11:44I'm Laura talked about Mike Chapman and support employment and the question about job coaches.
11:52Job coaching is a tough job.
11:55But you know it's really hard.
11:57The fact that nobody goes to college to work with adults.
12:02If you want to work with little kids. You gotta get your teaching certificate to be CPA. You gotta be in OT out of the license. Key you got to talk with adults at least in Jersey, you know by criteria is the higher.
12:14Drivers license.
12:19And a criminal background check.
12:22Guess what your life is supposed to get more interesting more enjoyable more engaging more difficult more risky work challenging more fun.
12:32We're bringing people with the least raining now. I'm not knocking at all. Adult services staff 'cause. There are some great people out there and I've worked in adult services for a very long time.
12:41But nobody gets into that field in college, I said, I wanted one daughter.
12:47They sort of wandered into it somehow.
12:50And that's a problem for us 'cause we have professionalized the field of services for adults with autism.
12:57You're at somewhere and someone says So what do you do for living using your job coach and they're like oh so that's kind of those and things is everything you're looking to ask right is that it's like. No, it's like we don't even know what job titles.
13:11I do point out.
13:13American behavior analyst so I'm not going to go over. All this, but I don't get into other theoretical. Yeah, we also see him. I'm looking at simple things I will talk about some positive reinforcement. I think is the most complicated thing we try and M.
13:27And the sponsor for help difficult in this task relative to the payoff for this task.
13:33I love watching reruns of The Big Bang theory when I get home.
13:38I have a tough job when I get home. I'm tired. I want to be entertained for 30 or 60 minutes depending? What channel am on.
13:47Somebody could say oh that's reinforcing Peter likes to do that. Let's say he can do that, after he mows the lawn.
13:53Do you think I would know the law?
13:57Because that response efforts, too high for the reinforces that you're think you're going to give me.
14:03But then we say we don't want to the one that's like. No, it doesn't work like that at all, so.
14:09There's the problem this is how we can understand transition, and we just accepted it.
14:15So we have very little follow-up data out of the public school systems. 'cause once kids are out of the systems. They're gone. The only data. We have teachers of public school system. But in other states. We have public public school theater.
14:29And that's really because we're not taught to do this and we talked at 16.
14:36Is the age maybe 14 under I DEA?
14:41That's too late to think about these things.
14:44As Laura Point are don't outcomes.
14:47At.
14:48They're not really worth bragging about.
14:51Especially when you consider the amount of money that we spend on education.
14:59I work in New Jersey my school is a fairly high tuition wait everyone school.
15:04If someone enters my school work 3:00 and leaves at twenty one that's 1.8 million dollars.
15:12I damn well better come up with better outcomes than that person who's in the public school program for 1/3 of that.
15:20So, but complicating this.
15:24Again is Laura mentioned we don't know about adult.
15:28Call Shatika to Drexel 2012 literature review all the research on adults with autism ages 18 and over published between 2000 and 2010.
15:39They concluded that the evidence base for services for adults with autism is underdeveloped and can be considered a field inquiry that's relatively uninformed.
15:47Now there were pockets of brilliance around the country during the good stuff with adults.
15:53In residential services and employment services out there, they're just not writing about Ish.
16:00They're not publishing. I know some people who do it who don't want to do that. 'cause they don't want more people to come to them.
16:06Because they're already kind of overburdened and what they're doing.
16:10But that's what the system reinforces.
16:12Is that you don't talk about it so there there? Is there are people doing really great stuff out there?
16:20Play my most important epiphany over the last 38 years.
16:24Is that if you want to look at adults? You basically don't get to be a specialist anymore?
16:30Identifiers behavior analyst sounds like it's all about gender identifies the behavior and bathroom and I'm fine.
16:43Little kids you got to be the specialist you. Give me a speech path. You could be the OT you be the CBA. You could be the special education teacher and kids.
16:53If I'm going to work with older individuals, though.
16:56I need a good working knowledge of ABA Positiva Sport Government Services and resources mental health concerns medication side effects. Sexuality medical care. I know more about medical care than any adult male should.
17:09Job development job coaching community based instruction generalize systems of communication staff training community training and that's just the start.
17:17I don't get to just focus on one part of a person's life.
17:21I have to focus on a life.
17:25And what this means is it does take a village right. But I think the racing with autism, it takes that village plus two small towns or midsize city of chapter. The Hells Angels 3 communes. An international coalition on call medical team seven. Lawyers for government officials, a fleet of vehicles and some alcohol.
17:42In order to do this.
17:46And as I mentioned earlier a lot of parents. I work with their kind of tired of advocating by their time it's twenty one and then I have to start all over again.
17:54You know they've been made into a new system, and also they have to learn all new people and all new rules.
18:00And that really kind of sucks.
18:02There's no other way to put it.
18:05But my point is no one could do this on their own.
18:08My name is the epic schools, Educational Partnership for clues for for educating children. Yeah.
18:14For something the structure children, I should know that right.
18:21But it has to be a partnership. I know my role in this or my role is temporary.
18:25I am not going to be there for the rest of his life.
18:28Or her life, but who is.
18:30Parent.
18:32So I have to work with the parents after incredibly cooperative and really partner with people to make sure that this happens and a big part of that.
18:42As I have to understand context.
18:44Now do you have any behavior analyst here today?
18:48A couple of you cool OK do you know Gina Green is?
18:53Yes, Jenna Green is the the end of its social pressure. Analysts been around. It used to be a New England Center. I was talking to Gina one time and she said.
19:05When done correctly there isn't a field of intervention that's more person centered applied behavior analysis.
19:10Think I need to know who this person is and what they want.
19:12And where they want to go and how they want to get there, you know, I need to sort of follow their lead. I can teach them a lot of stuff that that they need to know that they don't wanna know when it comes to actually changing a life.
19:25I really have to figure out what they do, and we're talking about employment. We look a lot at job match? What is about this job that this person would like?
19:34And not just the task itself that's the smallest part actually.
19:38Now it's more important.
19:40Is that they work in a big room or a small room to work with music on music off for a lot of people walking around a lot of people walk around do they get to stare deputy they get to sit down? Do they will get to walk around. While they work. The job task is the easiest part.
19:54All of you here if I had multiple jobs in your life doing relatively the same thing.
19:58But you change me for more money or you don't like people, you work with or you didn't like.
20:02That's what makes a job more than just a job.
20:06And that's what we want to look at.
20:08But why context is important.
20:13As we talked about kids with autism don't generalize well right people don't generalize well by the way their kids with autism. They have more challenges interlock system than their typical peers.
20:26Well, I learned back in 1980s. Generalization is concerned to teach with behavior is most likely to be displayed. We learned along time ago. Stop teaching purchasing purchasing at the fake grocery store in the classroom.
20:38You know back when I started there were schools that would make school buses out of cardboard to teach kids how to ride the school bus think that worked.
20:50No if you want to teach the scale teach the skill where it's supposed to be displayed.
20:55Because everything occurs in context, but one of the real problems is.
21:02Much of our research is done at a context.
21:05Lessons like intervention research, it's not done in a real world setting.
21:09And I did a literature review.
21:13On community based intervention an assessment and challenging behavior with people that if I want to see what was out there.
21:22Not surprisingly, there's nothing.
21:24It is a matter fact in the literature community based means regular classroom.
21:31So it's still with any structured environment.
21:34It is not at the supermarket is not, outside so we don't really very little about how to support people in less controlled invite for really good at supporting people in controlled environments.
21:47What are my basic principles at the school is that we should be successful in our classrooms?
21:52We're really smart well funded were 1:00 to 1:00. We control the variables. We say what you work on how long you work on it, what your enforcement schedule is.
21:59We play music on music off lights on lights off where is like we control everything?
22:04We should be successful, the only real measure anymore is how well this kid does outside the classroom.
22:10Am I doing anything else is just a waste of time.
22:14Because I don't care to do this going to class merchant home.
22:18I haven't done much of anything.
22:24I don't talk about that which we talk about Generalization Donburi Grand Old men in the field learning. One aspect of anything never means you know the rest of it doing something skillfully now never means that you will always do it well, resisting one temptation consistently never means that you would have character strength and discipline. Thus, it's not the learner who was dull learning or disabled or amateur because all learns are like in this regard no one learns a generalized lesson.
22:55Unless a generalized lesson is taught.
22:59If I was the king of the world.
23:01Which is what my lifetime goals it's on my bucket list?
23:06I would standardize 2 things.
23:09Public bathrooms.
23:11I would make all the same 'cause I'm really sick and tired put my hands under the faucet and not knowing how to turn on me realize I gotta press the button to turn it on.
23:19And microwave every time my students how to use that freaking microwave.
23:27I don't have to teach him how to use a new refrigerator. They know how to use a neural surgeon.
23:32The every microwave that's a generalization challenge I can sort of figure it out. 'cause I could read the buttons or not, but, for my students.
23:41Unless I work on generation that becomes a problem.
23:48But one of the problems is 2016 study, a meta analysis looking at generalization maintenance and functional living skills teaching functional living skills to individuals ASD.
23:5843% used training hope.
24:02Esther generalization striped OK what's more interesting.
24:09Yeah, actually it's sad isn't only 9 of 30 studies focus on teaching functional living skills were taught in a natural environment.
24:18How do you consider the functional living scale then?
24:21I'm kind of a bug on language in our field sometimes.
24:26I I my staff are not allowed to say job placement.
24:30I said, I was replaced in my life.
24:33They can't say job site and less around construction work.
24:37Yeah, it's a job see the job is not a job.
24:40Like that thing I stopped using very functional.
24:44Under now called applied.
24:47Because reading can be a really functional really good skill if you can apply it.
24:53I have taught a lot of kids how to read.
24:56Very few kids to use it out in the real world.
25:00So is the the functional door applied.
25:04And it was a waste of time.
25:07Unless I can make that leap.
25:11Excited to talk about positive reinforcement because it's so important, even into adulthood.
25:17That we look at this and it governs earlier Skinner didn't work with kids with autism.
25:22OK, like a lovely research wasn't done with people with disabilities.
25:27It is a large body of research.
25:32But I think the best thing, that I bought for my school.
25:36That vending machine at the end.
25:39You wanna do a nice preference assessment by yourself a vending machine like that. Now, my students work for money actual money?
25:46And then go and buy stuff out of the vending machine, or really fascinating those kids, who had a whole lot of difficulty with letter and number of unification can do. Y2 really well to get the Swedish fish right away.
25:59And some things cost more and some things cost less so we had a whole be able economy going.
26:06Based on what this is, but it's their choice. It's under completely under their control, but they get didn't get something they don't want.
26:15That's how you guys reinforce yourself.
26:18You say after I write that report I'm going to glass of wine?
26:23You may not see this reinforcement, but that's how you do it.
26:30Really sort of I don't sin work with older individuals do not hand deliver the reinforcer. I could ever. It is, don't. You said, like token boards, I get rid of all your token boards.
26:40Likely abandoned them along time ago, do not less absolute necessary is a timer anything. You want to use a smart phone that has a program message on it.
26:51Um.
26:52Do I do not a behavior analyst here like we hate verbal prompts right?
26:58We don't like verbal promise supposed to not use verbal prompts verbal promise. I suppose be hard to fade.
27:03In the community everything is done with reference.
27:07If not believing that are at the grocery store and that person is blocking me out with their cart gesturally prompt them to move and see what happens.
27:16Physically.
27:20But say excuse Maine.
27:22Which is a verbal prompt?
27:25They move plus I don't want anybody else, modeling that they can touch my students are my adults.
27:33So that's why I use verbal in the community.
27:37And really the last thing is like don't stop thinking about how to do this better wonder. Things I'd love. It hate about my career, so far.
27:45Is I get to look? How far we've come and I get to look at all this and I hate the fact I put all this stupid stuff, I've done.
27:53At one point I taught sex adults classical autism.
27:58Kind of disabilities to make their bed using hospital corners.
28:03And I will go home at night and made.
28:06Just maybe if I was going out that night and I thought I might Get Lucky pull the comforter up on like that, like that. That was the only reinforce or powerful enough for me to even do that I'm asking them.
28:21To do something different in my rapid.
28:27If you ever find yourself, saying, I tried reinforcement, but it didn't work. You didn't try reinforcement. It's not easy.
28:33Nothing reinforces that student something reinforces everybody.
28:36I don't know what happened. I just reinforce the men, hitting that's 'cause somewhere along the line became a 60s Dorito with the morning.
28:43And because you forgot to interspersed drinks by 8:00 and became a conditioned Punisher and the only way he could stop you from engaging repetitive annoying test of force feeding him Doritos must hate you and it worked.
28:58Don't have reinforce that behavior.
29:02I did reinforce I said good job.
29:05My friend joined balancer.
29:08At into
29:11She says it really want understanding complexity of reinforce with adults positive reinforcement. Adults take the statement that's a really slimming outfit.
29:19I'm crying now that said to you by someone like your good friend with you respect you have a good relation with you think? Why thank you. That's really nice. I'm going to wear this again. That was reinforced. But if it's said by someone who you don't like you think goes behind your back is a bit smarmy, you think are you, saying I'm fat, bitch is that what you're saying.
29:47And you won't wear that again. Same statement same condition. Wanna reinforce are going to Punisher. That's how complicated this is, do not think this stuff is simple.
29:57Don't think it's just praise don't think it's just candy.
30:00OK reinforcement is the most complex thing that we do.
30:06And I love this they give you a lot of troops while you're training you so play dumb for as long as you can.
30:11I cannot tell you how many students. I have worked with an shoot I and then one day realize they can tie their shoes all along. They could Tiger shoes. They just played me for cookies that's all so.
30:33The way positive reinforcement carried out is more important than the amount that's but I also want to talk about and this is an important very important part skill mastery? When is a skill mastered?
30:44Now in my field ABA we look at percents, you know, so like 80% accuracy 90% accuracy.
30:52Well recently I've been thinking you know in my life.
30:56On a good day, I maybe 80% after it like that's a good day and I get by 80%.
31:03I used to think I was a very good driver. I really used to think that.
31:08I don't know 2008 Toyota Camry that I drove for 10 years to 225 thousand miles and just this year. I traded it in for $100 and I bought a new Toyota Rav 4 that beeps if you go over like the white line. I suck at driving now that I mention collecting data on my ability to stay in the lines like my overall percentage went down to like 78 like I am laid.
31:40So we hold people with autism spectrum disorders to higher standards we hold ourselves.
31:45And in some ways that we need to do that will get safety skills that can be a good reason.
31:50But for other things like will talk about we may not may not have to.
31:56Sometimes you need to be 100% St Crossing Safety Skills Ballin. Yearning continent continents. Medical care dressing before leaving the House juggling trained chainsaws. Whatever you want they can be at 100%.
32:08I still see at least once a year. Somebody gives me a proposal to teach St crossing at 90% accuracy.
32:15And I said that means 110 times, he gets hit and you're good with this is another 100% skills.
32:25Other skills need rape to be this is actually appropriate skill icy keyboarding being taught a lot is a vocational school in other words, I hate it's an employment skill or it's not the work location was only used in the disability community.
32:40Like it's not used outside you don't get there, somebody in place so what's your location.
32:45To say what your job.
32:47You know, so if a keyboarding that's great. But the employment standard for data entry on keyboarding is 11,600 keystrokes per hour at 99.9% accuracy.
32:57So if your student is doing 100 keystrokes an hour at 90% accuracy. It's not a job skill.
33:05OK.
33:06For some skills mercies the function of ability to access accepting better prompts if you've ever done complex. LEGO projects or better yet, put together IKEA furniture.
33:17Other skills can be inserted messages about 80% around most academic skills. Most social skills variety of loser skills. Some skills can be considered 30% like if you get a curveball, 3 out of 10 times. You'll make it $18,000,000 a year like you're good.
33:37For some skills who do look at this 900% but we also teach it and most complex by pasa.
33:42A technology is making our lives easier and it should be making the lives of our students and our children and our adult easier to.
33:49But we're not accessing this stuff I still see people be taught mopping instead of Swiffer Ring.
33:56Play by a damn swift nobody should have anymore.
34:02But this is just my little thing for laundry like it used to be retrieved laundry baskets sort laundry by color put my loan machine measure detergent software start washing machine. You don't you doing, real well real life. The change laundry basket. I don't sort laundry.
34:15I don't own any clothes that are going to lead.
34:19Well, I actually do sort laundry, but I do it by like the type of clothes so all shirts go together because.
34:26I don't know I'm a laundry guest. I don't know I segregate, according to function. I guess I don't know.
34:35So don't just alone cold put the loading machine. You don't need to measure anything to type on and I like typical kids. None of my students have ever eaten at iPod so we're good there.
34:50And it started the simplest fastest way you can do this.
34:56And once people get doing that coming back to the old ways really hard.
35:01Do you know I have lost all rating skills because of this thing?
35:07OK, if I'm ever at line in the grocery store and I realized I left my phone in my car.
35:13I have a little panic attack.
35:15'Cause that means I have nothing to do except read their frequent star. I have complete completely lost. All waiting skills. Some skills have a gender component. This is not our graphic. This is off the Internet as a Bell curve, not private and water does the rest?
35:47Women as a rule shower Lecter going into surgery.
35:54But what is the goal of showering the goal is to not smell and look presentable.
36:02An I don't want somebody in that shower with you. I don't want to be in that bathroom with you.
36:09So I can get you the 6 days out of 7 doing this first one.
36:14So you hairless thing you don't that's great.
36:18I'm not going to lose sleep over that 90% accuracy for his toes and you know why that's important.
36:25Because it's not just a life skill to safety skill.
36:29That's why 'cause that means that for the rest of his life is independent. It that no paid staff ever has to be in that bathroom again when his shower.
36:39And you know, we do stranger danger stuff.
36:42OK, throwing area.
36:45The perpetrator of sexual abuse is former likely some of the person knows.
36:49Now again 99.999% of staff are great.
36:53But I have to target for that .001.
36:57So that's why we focus on a lot of things we focus on.
37:01And does he look good when he comes out that's all I care does that make sense. I'm not going to spend the next 4 years, making sure.
37:10As I said, we hold higher standards, but there is no one master criteria program for schools across all environments. All the time defining skill nursery is like everything else. Highly individualized So what we've done and what I have like 15 minutes left.
37:27I'm going to zip through this 'cause I want to get to the point of this.
37:32We've developed a set of critical skills.
37:35Which are all adaptive behavior skills this is from Pat Mcgreevy's essential 8 make request waiting after making requests accepting removal is completing 10 consecutive task, accepting know following directions, completing daily social skills daily living skills and tailoring situations.
37:53We do a lot now looking at social validity.
37:56How valuable is this skill to the community? Are we teaching in the way that the community values?
38:02Really really cook this app. It worked in Manhattan for 3 years with kids on the spectrum and we would go to the grocery store 2 or 3 times a day 'cause we could we just walk down to the corner and we did surveys of customers say are we teaching the right skills or teaching skills in a right way. What are the skills we should be targeting and now we're all thinking? Well, we should get fixed and quality in line.
38:22That they they put their stubs neatly on the thing they don't talk to themselves. They don't get a child you have the most important skill was.
38:29Pay quickly for your Purchas.
38:32Because if you don't you're holding up everybody behind you in line.
38:38So we changed the whole task analysis to assume she put everything on the conveyor belt. That's when you took out your credit.
38:43So you can pay right away.
38:45We decided that New Yorkers understand autism.
38:48But they won't accept incompetence in New York by the way is the greatest place in the world with kids allowed him 'cause. You don't need a car and nobody even notices anything so.
39:01We do have our 20 questions, which are just a list of everything up. We have to do in our analysis on this still but it's like stuck in this will be acquired by student original time frame will still be useful in 3 to 5 years.
39:13OK, this comment lends itself is kept to be instructional intensity black.
39:20What we also did is we said you know what?
39:24If we could break this down for early intervention to adulthood, where the 10 most important skills.
39:30Not surprising number one is toiling but lookout it's defined.
39:34It is independently, leaving going to the bathroom, knocking on the door, making sure nobody is undergoing an waiting there. Polar sheet before you sit down, pulling your best. I'm going to the bathroom wipe yourself and then coming back to where you want. It's not just me taking you to the bathroom.
39:48And you're going to be waiting outside.
39:51That's the entire chain.
39:53And in my field in behavior analysis. We've somehow accepted that compliance with ESD is mastery.
40:00So if I say John do your laundry doesn't laundry we sex master.
40:04That's not master.
40:07That's prompted.
40:09Really being answer is that it's in the schedule that you set up and you know you have to do it or you know that actually the logic. Messrs full so you do in the laundry basket that's mastered so.
40:20But then we look at.
40:22This is an easy one looking at Preschool Elementary.
40:26Going into middle school and then transition getting into gender bathrooms.
40:31If we look at some of the research in sexuality, there seems to be more gender diversity within autism and there is in a typical population.
40:38So for not addressing this we're missing a big factor.
40:43Obviously dressing.
40:46We do a lot with teaching kids to pick their own clothes why.
40:50Can you look around? You you're all dressed the same way but your dress different and it's really important to you.
40:56The best way to address that I work with that also challenges mom plays out there closed form.
41:01And they never get to sort of pick what they want.
41:04So we go out to the store and we say pick out some shirts, we go to weather sizes and they pick out 2:00 or 3:00 and then we distract them and put those 2 or 3 back and bring him back and say pick up some shirts if they pick the same 3 they like those shirts.
41:20And we are finding that actually kids dress a little faster.
41:23They're putting on clothes that they like some, but again we break it down.
41:29Starting very early to up to shop for your clothes.
41:33Independent eating this will restrict your social life more than almost any other skill.
41:40If you put 40 in French fries in your mouth at once. If you steal French fries from somebody else. If you're up catch up. Nobody wants to sit down with your lunch.
41:48It is that he chill with your mouth open if you talk wait like this makes it really hard for me to get you so sick degraded at work.
41:57So if we start early enough again.
42:01We can build this skill up to the point where they really can do all these skills.
42:06Bathing self care this is a whole array of things. But I considered so important. That last I had a small fundraiser and raise $28,000 just to install a teaching shower in my school.
42:18Because I thought it was so important for us to start teaching and by the way it's much easier to teach a seven-year-old to shower.
42:25Then a 16 year old to shower.
42:28I have seen more naked adolescent boys than anybody ever should and I'm tired of it. There's no reason.
42:36Plus, we're unlearning 16 years of not having to do this.
42:41But we started 7.
42:43We actually by the time you're older, you can do this so again.
42:48This is kind of my favorite. This is another big one. And this is something for behavior analysis. It like makes a mistake. We often say like mom will say well. I wanted to learn to set the table, we said. We have to write up a task analysis for this. Let's do the task analysis, so I never really learned to set the table.
43:07Uh because wait till he's 12 to do it.
43:09'Cause it probably there's some some genetic characteristic. That means at 12, you can set table.
43:16But temple kids learn to set the table how.
43:19By doing it by helping mom, they're not good program like there's nothing wrong with just helping initially.
43:26So we start to look at things like that that you're helping around the House and this.
43:32I got the Internet so you know it's accurate OK.
43:36But this is a different ages? What typical kids could do 2 before they basically help and they like to help like 47. They basically still help the less happy about helping but they do.
43:47ETA 10 they can make their bed, Sinclair table dusted vacuum help wash car. By 11 years old, they can do everything I'm not saying they do everything.
43:56But they can do everything and it's at that point that we say, Well, let's start teaching his brother has autism how to do.
44:02Which by definition now 11 years behind his brother?
44:06Like if we started early and built upon these skills, we wouldn't be in this predicament.
44:12Group learning.
44:14To acquire the skills representing a diet or triad at a rate of skill, acquisition, similar that and one on one. We want you to keep learning stuff that you sit quietly when you're working with your wine.
44:25We want to have acquire skills, which is the big point here.
44:28And again we can build an app.
44:31When the more complex skills were trying to start early enough is self management.
44:36My job is to put myself out of a job.
44:39Like I said, I don't want you to ever talk important. I don't want you to have like all this, you need to self manage their own behavior.
44:46You need to be able to say. I need a break and walk away. When it gets too tense. You need to build or user. ACS or do some other thing you need to go to self calm yourself reinforce.
44:56So again we're working on all of these things starting very early.
45:02Problem solved.
45:04Most of the kids that I work with historically across my life.
45:07Close mycareer have been taught that there's only one right answer to a prom.
45:13And we talk to Matt.
45:15And only one right answer get to the reinforce are and then you get the positive then you get the plus on your skill acquisition chart.
45:22A lot of things in life have multiple answers that are correct.
45:27Right you can call me. Pete didn't call me. Peter and call me doctor Karen call me Mister Gerhardt.
45:32You can call me when you're all correct.
45:35There is no single one in real life.
45:38But what happens is we see this sort of learned helplessness phenomenon that if they don't have the one answer, they do hug.
45:44Stop arrest for help.
45:46And we teach them self and that's really important.
45:49But now they've learned that if I ask for help all the time I don't have to do the really hard stuff.
45:54So we don't see persistence developing.
45:57So we have to understand what they can do, but they can't do what they really need help doing and build upon that as they start to get older.
46:07Or one of our big goals right now is.
46:10Health care transition.
46:13The research some of the research indicates majority of adults with autism get at least some of their healthcare from emergency rooms.
46:23Not good so some of the primary healthcare from merging rooms, not could use emergency resources and stuck with primary health care.
46:29There's a many adults stay with their developer pediatrician.
46:34Well, past the age that they should because they can't get an adult provider.
46:39Because you don't provider doesn't accept Medicaid and doesn't have autism, and so it doesn't want to bother of doing it.
46:47So we're doing a lot of work with Englewood Hospital to try and change some of those things.
46:51We have a lot of this come into our program once a week to teach kids how to take blood draws every kid knows how to get the blood pressure taken every kid knows they haven't darling.
47:00All of these things that you just need.
47:03In life.
47:06Safety skills, the one thing just want to point out with this very quickly. But we have a body of research and behavioral skills training.
47:14But.
47:15We all learn their safety skills by screwing up.
47:19But we learn, not to touch the hot stove by not touching the hot stuff by touching a hot stove.
47:25Right just go their parents that don't touch the stove.
47:29Yeah, just like all of you like you at the restaurant in the weight person puts the plate down. It says be careful. The plate is hot? What do you do you touch the please 'cause I have to see how hot it really is?
47:43But it's gotten so bad when I first got to epic.
47:48I said IP meeting Anna teacher said. We need to focus more on his environment. 'cause if you don't move that if you don't move the chair who walked right into the chair.
47:57And I said, Stop moving the chair that's how you learn to focus on your environment.
48:04Is that don't want to like walk off a Cliff for fall into a manhole? But like those little things we so overprotected kids on the spectrum.
48:13That they never learn any of the skills necessary.
48:17They develop other safety skills, obviously communication.
48:22That's a very big list.
48:26But we're also focusing a lot.
48:28On self advocacy and having a functional node.
48:32Being able to say no, I don't want to do that. No, you shouldn't come with Maine.
48:37Uh if I'm going to the bathroom. You can't come into the bathroom with Maine.
48:41All of those things my friend Amy on the spectrum taught me that no is a complete sentence.
48:47You if you don't have to add more to it quickly and we often run over, there knows of kids on the spectrum. We say John do you wanna do math? He says now? When we say to better math time and that way we just hit no doesn't mean anything.
49:00But no is probably the best adult skill you have.
49:05Same thing I feel about noncompliance we often teach kids to be very compliant.
49:09The best adult safety skill, you have is an adult is that your non compliant.
49:14You will not do certain things.
49:16We have a hell of a time teaching kids to be like young adults to be non compliant after they had 18 years of being taught to be compliant.
49:22Have you ever thought that every person who comes into that class and take him to the bathroom.
49:27That's really a bad skill.
49:29So we worked very hard on that, but then at the end of that.
49:34It's just adaptive behavior. This is billiards definition, the skills are abilities that enable individuals mean standards of Independence are expected in his or her age of Social Group. Adaptive changes corner purses age, culture expectations and environmental demands.
49:49I'm a city kid put me in the city at 3:00 o'clock in the morning drunk probably high am I being recorded now just getting drunk.
50:03Put me on the little the country that same way and I'm going to freak out. I think Leatherface lives there. I am like cities. I can handle it's about how well is there environmental match with you and then now we're back.
50:19To where we started in our last 5 minutes.
50:23So we have our students transition statement.
50:28First thing we do is define independence.
50:32Because of that iep goals says will end up early purchase 10 items at the grocery store.
50:37I think that means I stay outside of the store.
50:41Very few parents think that off the back.
50:44They think that means I'm 10 feet behind him and I said that's not independent.
50:48That's very prompted so we sit down and we say what's the worst is going to happen.
50:53So we get him independent systematic. We're just not abandoning him. We're just not like we do it systematically what's the word second? Well Hello Open, the bag of Doritos and start eating him before it pays for?
51:02I said, like what are the 10 customers I said that's OK?
51:06Yep.
51:07Um he might pull the fire alarm well, we'll make sure doesn't know where the fire alarm is.
51:13So we don't have to worry about that.
51:17You might spend too much time in the bathroom well, we could work on found on that.
51:21I'm not doing that, we can target those skills that you're afraid of.
51:24So we can make sure 'cause I again what his independence possible.
51:28And when we do things like that, you know what also happens.
51:32Everybody else who works at that grocery store get to know this kit.
51:36And you are your most safest in the community when people know who you are.
51:42Because if I was outside and somebody did try to walk away with one of my students somebody else would say John where you going.
51:48Because they know all my staff, they don't like.
51:51Their their best line of Defense.
51:55But if they don't know them. It doesn't happen, but so we take that first page that we had, and then we look OK well. Then the skill that we need is ability to work production for 90 minutes? What does the challenge going to be?
52:07Spencer follows an activity schedule, but the extent which is fully engaged on it is not documented. So he'll do stuff and then like go to the next thing but like he does like 10 minutes of work in an hour.
52:19So it's not really engaged time need to locate training task. It was targeted detail and complexity.
52:24And then the recommendation is going forward.
52:28We do the same.
52:30For home life, Spencer needs to independently wake himself up in the morning and complete his am routine? Why is waking himself up independently morning important?
52:40For job way off.
52:42It's a safety skill. That means nobody else has to go into your bedroom if you can wake yourself up in the morning.
52:51When I brought this up to one of my parents, they said. But he hates loud noises and I said that's the definition of an alarm clock put it on the other side of the room. She has to get up to turn it off.
53:01That's it.
53:03We look at leisure participating in Special Olympics. Spencer may participate in enter ABA school. Bowling league starts will expand his repertoire preferred video games will use a smartphone to kill so we identify all the tasks that we have to teach all the skills.
53:19In the period will purchase his own clothes by size and color and definitely navigate increasingly greater distance and then we build our instructional programs based upon these now we do this plan.
53:33Every year.
53:35More 5 years out again.
53:37But in terms of graduation.
53:40When we first do it will review it every year.
53:44As you get closer and closer graduation starts getting reviewed 3 times a year and 4 times and then every month. 'cause I'm running out of time.
53:52And time is my enemy.
53:54'Cause I need to do as much as I can in a very limited amount of time, but then we do with all of this 'cause I said, this as a partnership.
54:03We say mom and dad this is your job.
54:06This is all the stuff we set important that you picked.
54:11So this is your responsibility.
54:14Will help you will do whatever you need but we will help you?
54:19This is our responsibility.
54:22So address over the next, however long it's going to be.
54:27But then we also say this is the community's responsibility, 'cause That's my 3rd partner.
54:32OK, Laura said that the employer is is actually the client. You know, I have a number of consistency's constituencies. What is my student who is their family 3? Is my board floors the community?
54:45Thank I work for all of them.
54:48If I do this right.
54:51Couple quick closing thoughts.
54:54About the future, it happens? Is there's a lot of what we do.
54:58Um.
55:02That's all I want to say anything else about that.
55:04If you've never read it. Please read this article. It actually changed my professional life. It's balancing the rate of 2. Little Tation with the right people with developmental disabilities. Just adult book developmental disabilities to eat, too many Donuts and take a nap.
55:20We focused on appropriate behavior.
55:23I have to tell you the best times in my life when I was inappropriate.
55:27The most memorable times in my life when I was doing something with supposed to do.
55:31OK, a life lived just following the rules is kind of dull I think so.
55:38Billy's 32 pieces of bacon. He's 28. What does he have now happiness Billy has happened.
55:46And don't tell me you never had ice cream when you know you shouldn't.
55:51Don't tell me you didn't have that second glass of wine when you know you shouldn't.
55:56OK, we all do this.
56:00Please teach tunes to wipe after about movement.
56:04Very pragmatic thing.
56:09And like I said, I don't know how I'm gonna do all this, but I go with this. A failure is never mistake. It may simply be the best one could do it in the circumstances. The real mistake is to stop trying behavior analyst but I don't consider myself changing behavior I consider myself changing locks.
56:28That's gotta be my goal. I'm not that's not a broad point that's just my goal.
56:32And I think that's how we all need to look at this as we move forward teaching individual skill is great.
56:39But how does that play in a person's life if they're not going to use it in some functional appropriately so thank you for your kind attention.