1
Q
Autism Spectrum Disorder (rate 1/88)
definition
A
deficits in social-emotional reciprocity: ranging from abnormal social back and forth conversation through reduced sharing of interests to total lack of initiation of social interaction
2
Q
ASD
Abnormal social appriach
A
- unusual social initiations (eg. intrusive toughing or licking others)
- use of others as tools
3
Q
ASD
Failure of normal back and forth converstations
A
- poor pragmatic/social use of language (e.g. does not clarify if not understood; does not proivde backgound info)
- failure to respond when name called or when spoken to directly
- does not initaite conversations
- one sided conversation/monolugues/ tangential speech; train of though wanders/ lack of focus
4
Q
ASD
reduced sharing of interests
A
- doesn’t share
- lack of showing, brining, or pointing out objects of interest to other people
5
Q
ASD
reduced sharing of emotions/affect
A
- lack of responsive social smile (response to others’ smile)
- failure to share enjoyment, excitement or achievement with others
- faiure to respond to praise
- doesn’t show pleasure in social interactions
- failure to offer comfort to others
- indifference/ aversion to physical contact/ affection
6
Q
ASD
lack of initiaton of social interaction
A
- only initiates to get help/ limited social initiations
7
Q
ASD
poor social imitations
A
failure to engage in simple social games
8
Q
ASD defition 2
A
Deficits in nonverbal communicative behaviors used for social interaction: ranging from pooryly integrated verb al and nonverbal commmunication through abnormalities in eye contact and body language, or deficits in understanding a nd use of nonverbal communication to totoal lack of facial expressions or gestures
- impairments insocial use of eye contact
- impaireement in the use and unerstanding of body bosture ( eg facing away from listener)
- impairment in the use and understa nding of gesture (e.g. pointing waving nodding and shaking head
- abnormal volume, pitch intonation,, rate, rhythm, stres or prosody in speech
- lack of coordinated verbal and nonverbal communication (e.g. inability to coordinate eye contact or body language with words)
- lack of coordinated non verbal communicagtino (e.g. inability to coordinate eye contact with gestures)
9
Q
ASD abnomalitie s in use and understanding of affect
A
- impairment in use of facial expresion (may be limited or exaggerated)
- lack of warm, joyful expressions directed at others
- limited communication of own affect (inability to convey a range of emotions, via words, expressions, tone of voice, gestures
- inability to recognize or interpret others’ nonverbal expressions
10
Q
ASD defition 3
A
Deficits in developing and maintaining relationships appropriate to developmental leel (beyond those with caregivers) ranging from difficulties adjusting behaviors to suit different soical contexts through difficulties in sharing imaginative play and in making freinds to an apprents absence of interest in people
11
Q
ASD
deficits in developing and maintaining relationships appropreiate to developmental lev;el
A
- lack of “theory of mind” inablity to take anothers perspective
12
Q
ASD
difficulties adjusting behavior to suit socal context
A
- doesn’t notice anoth pe3rson’s lack of interest in an activyt or their distress/disinterest
- lack of response to contextual cues (eg. social cues from other indicating a change in behavior is implicity requested
- inappropriate expressions of emotions (laughing or smiling out of context)
- unaware of social conventions/appropriate social behavior; asks socially inappropriate questions or makes socially inappropriate statements (e.g. “oh great you’re here)
- doesn’t recognize when not welcome in play or conversational seting
- limitied recognition of soical emotions (e.g. doesn’t notice when being teased; doesn’t notice his/ her bx battern impacts others emotionally)
13
Q
ASD
difficulties in imagitative play
A
lack of imaginative play with peers, inclduin social role playing
14
Q
Difficulties in making friends
A
- doesn’t try to establish friendships
- doesn’t have prefferred friends
- lack of cooperative play, parallel play only (e.g. play next to each other but not interested in what other is doing)
- unaware of being teased/ridiculed by other children
- doesn’t play with children his/her age or developmental level
- has an interet in frienship but lack understanding of the conentions of social interactions (eg. extreemly directive or rigid; overly pasive)
- doesn’t respond to the social approaches of other children
15
Q
ASD
absence of interest in others
A
- lack of interest in peers
- withdrawn/ aloof in own world
- doesn’t try to attract attn of others
- limited interest in others
- unaware or oblivious to children or adults
- limited interactions with others
- prefers solitary activiites
16
Q
ASD 4 definition
A
stereotyped or repetitive speech, motor movoement, or use of objects (such as simple motor stereotypies, echoalia, repetitive use of objects, or idiosyncractic phrase
17
Q
ASD
stereoytped or repetitive speech
A
- pedantic speech or unusually formal language (eg speaks like little adlt or “little profesor”
- echoalia (immediate or delayed ); may inclue repition of words, phrases, or more extensive songs/ dialogue
- “jargon” or gibberish (mature jargoning after develpmental age of 24 months)
- use of “rote language” from ememory, without thought of the meaning
- idiosyncratic or metaphorical languae (language that only has meaning to those familiar with the indivudals communicatio style;
18
Q
ASD
stereotyped or repetitive motor movements
A
- repetitive hand movements (eg. clapping, finger, flapping, or twisting)
- stereotyped or complex whole body movements (e.g foot to foot rocking, dipping spinning)
- abnormailites of posture (e.g. toe waking); full body posturing
- intense body tensing.
- unusual facial griamcing
- excessive teeth grinding
- repetitively puts hands over ears, not in response to loud sounds
- perserverative or repetitive action/ play/ bx (if 2 or more components than considered a routine)
- repetitive picking
19
Q
ASD
stereotyped or repetitive use of objects
A
- nonfunction play with objects (eg. waving sticks, dropping items)
- lining up toys or items
- repetitively opens/ closes doors or turns ligths on/off
20
Q
ASD
definition 5
A
Excessive adherence to routines, ritualized paterns of verbal or nonverbal bx, or excesive resistance to change; such as motoric rituals, insistence on samw routine or food, repetitive questioning, or extreme distress at small changes)
21
Q
ASD
Adherence to routine
A
- routines: specific, unusual multiple step sequences of behavior (2+ components)
- insistence on rigity following specific routine
22
Q
ASD
Ritualized patterns of verbal and nonverbal behavior
A
- repeptitive questioning about a particular topic
- veral rituals: has to say one or more things in a specific way or requires other to say things or answer questions in a specific way
- compulsions (e.g. insistence on turning in a circle 3 times before entering a room)
23
Q
ASD
Excessive resistance to change
A
- difficulty with transitions
- overreaction to trivial changes (e.g. moving items at diner table or driving alternate route)
24
Q
ASD
rigid thinking
A
- inability to understand humor
- inability to understand nonliteral aspects of speech such as irony or implied meaning
- excessivily rigid, or rule bound in bx or thought
25
ASD definition 6
Highly restricted, fixated interests that are abnormal in intensity or focus; ( such as strong attachment to or a preocupation with unusual objects, excessively circumscribed or perserverative interests)
26
ASD
Highly restricted fixated interests that are abnormal in intensity or focus
- preoccupations/ obsessions
- interests that are abnormal in intensity
- narrow range of interests
- focused on same few objects, topics, or activities
- preoccupation with numbers, letters, and symbol
- being overly perfectionistic
- interests that are abnormal in focus
- excessive focus on nonrelelvant or non fucntional parts of objects
- attachment to unusual inanimate object (e.g. piece of rubber band)
- Having to carry around or hold specific or unusual objects (not common attachment objects such as blankets or stuffed animals)
- unusual fears (e.g. afraid of people wearing earrings or lion in the MGM ads)
27
ASD definition 7
hyper or hypo-reactivity to sensor input or unusual interest in sensory aspects of environement; ( such as apparent indifference to pain/heat/cold, adverse reponse to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects
28
ASD
hyper or hypo-reactivity to sensor input or unusual interest in sensory aspects of environement; ( such as apparent indifference to pain/heat/cold, adverse reponse to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects
- high tolerance for pain
- poking own eyes
- preoccupation with texture or touch ( includes attraction/ aversion to texture)
- -- tactile defensiveness: doesn't like to be touched by specific objects/ textures
- -- significant aversion to having their hair/nails cut teeth or brushed
29
ASD
unusual visual exploration/activity
- close visual inspection of objects or self for no clear purpose (e.g. holding things at unusal angles with no vision impairment)
- looks at objects/ peole out of corner eye
- unusual squinting of eyes
- extreme fascination with watching movoement of other things (e.g. the spinning wheels of toys, the opening/ closing of doors or an electric fan)
30
ASD
In all domains of sensory stimuli (sound, smell taste, vestibular, visual) consider:
- odd response to sensory input (e.g. becoming extremely distressed by the atypical sound)
- atypical and/or persistent focus on sensory input
31
ASD
Unusual sensory exploration with objects ( sound, smell, taste, vestibular)
licking or sniffiing objects
32
Severity Level for ASD
Level 1 Requiring Support
Social Communication
Without supports in place, deficits in social communication cause noticeable impairments. Has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccesful responses to social overtures of others. May appear to have decreased interest in social interactions
33
Severity Level for ASD
Level 1 Requiring Support
Restricted Interests and Repetitive Behaviors
Rituals and repetitive behaviors (RRBS) cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB's or to be redirected from fixated interest.
34
Severity Level for ASD
Level 2 Requiring substantial support
Social Communication
Marked deficity in verbal and nonverbal social communcation skills; social impairments apparent even with supports in place; limited initiation of csocial interactions reduced or abnormal response to social overtures from others
35
Severity Level for ASD
Level 2 Requiring substantial support
Restricted Interests and Repetitive Behaviors
RRBs and/or preoccupations or fixated interests appear frequently enough to be obvious to casual observer and interfere with functioning in a variety of contexts. Distress or frusturation is apparent when RRb's are interrupted; difficulty to redirect from fixated interest.
36
Severity Level for ASD
Level 3 Requiring very substantial support
Social Communcation
Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning; very limited initiation of social interatctions and minimal response to social overtures from others
37
Severity Level for ASD
Level 3 Requiring very substantial support
Restricted Interests & Repetitive Behaviors
Preoccupations, fixated rituals and/or repetitve behaviors markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted, very difficult to redirect from fixated interes or returns to it quicly
38
BX/ symptoms that may not be captures by DSM-5 ASD
Problems with Play/imagination
-problems with play/ imagination
--impairments in imaginaive/ symbolic lay
-- lack of functional play skills
-- difficulty distinguishing fantasy from reality
Shyness/ social anxiety
language and developmental delays
- milestone delays/ developmental delays
- speech delays (expressive or receptive)
- language disorder
behavioral difficulties/ temper tantrums
- poor imitation skills (poor SOCIAL imitation skills ARE captured)
39
Knowledge of research regarding treatment intensity
- one on one treatment : 30-40 hrs/week most intensive; 2 or more years is necessary optimal outcomes
- -- most recieve at least 3 years, some require longer others finish early
40
knowlege of early intensive behavioral intervention research
- 1970's Ivar Lovaas- treatment can be maximized if intervention is:
- - initiated early in child's life
- -intensive, encompassing most of child's waking hours
- - comprehensive
- - addressing all child's skill deficits and behavioral excesses
41
DSM 4 Criteria
Total of 6 criteria from three domains, minimum of:
2 criteria w/ social interaction
-- Failure to develop peer relationships - isolates self in group seting; when in proximithy of peers may not interact with others
-- impairment in use of non-verbal behavior - eye to eye gaze; facilal expressions; gestures
-- lack of seeking to share enjoyment interest or achievement with other people - not showing or pinting out objects of interest
- 1 criteria w/i communication
-- delay in total lack in development in spoken language, not accompanied by an attempt to compensate throguh alternative modes of communication (gesture or mime)
-- if individuals have language, deficient conversation skills (ex. doesn't initiate 'hello" when someone enters room)
-- repetitive use of language (ex. repeats sounds, phrases out of context)
-- impaired make- believe play (ex not engage in make beleive play, or only engage in make beleive play with a tea set where rep repeats same actions over and over
- 1 criteria for restrictive, repetitive and stereotypic bx patterns
-- inflexible adherence to routine or rituals (ex. take same route to park each day)
-- repetitve motor mannerisms (hand or finger flapping, or rocking back and forth)
-- persistent preoccupation with parts of objects (ex. toy car, only interest in the wheels)
1/88 children are affected
4-5 times higher in males than female
onset of symptoms must occur prior to age 3
42
Distinguishing between evidence based intervention svs. non evidence based interventions
- Ivar lovaas First EIBI effectiveness study
- 1987 experimental group
- - 19 kids recieving 40hrs/ week for 2+ years
- - control 1 ( young autism project) & control 2 (different provider) recieved 10hrs/ week for 2+ years
- -Results
- -- experimental group - 47% Normal function in general ed clas, 40% aphasia class, 10% special ed cls
- -- Control groups - 2% in general ed class, 40% in aphasia class, and 53% I special ed class
- 1993 follow up with experimental group:
- 8/9 kids in the general ed and score in normal range in IQ
- 1 participant had moved to general education placement
43
Principles of ABA
- Positive reinforcement
- Negative reinforcement
- Positive punishment
- Negative punishment
- reinforcer
- punisher
- conditioned reinforcer
- unconditioned reinforcer
- extinction
- deprivation
- satiation
44
positive reinforcement
when a behavior is strenghtened by the reciept, addition, presentaiton or increased intensity of any stimulus, following an occurence of the behavior* can be socially mediated and automatic: someone delives reinforcer vs. person doesn't present reinofrcer, problem bx produce preferred sensory stimuli
ex: social positive reinforceemtn = access to tangible
automatic positive reinforcement = sensory stimuli such as look finger waving
45
negative reinforcement
when a behavior is strengthened due to removal, termination, or avoidance of an aversive stimulus, following an occurence of bx * can be socialy mediated and automatic: problem bx is strenghtheded when someone removes following occurence of problem bx vs. problem snesory stimuli -
ex: social negative reinforcement = escaping from demands
automatic negative reinforcement = escape from sight ( pull jacket over head)
46
positive punsishment
a stimulus in which its presentation reduces the the likelihood of response that produce- ex: phone rings in class and you are reprimanded for not turning off phone
47
Negative punishment
stimulus in which its removal reduces the likelihood of responses that terminate it
ex: child yells at mom. gets allowance taken away
48
reinforcer
a stimulus that isprovided as a consequnce for a behavior that increases or maintains the strength of that behaivor - a preferred stimulus that immediately presented folllowing a response the - elimination of unwanted stumuls follow response
49
punisher
aversiv e stumulus or negative reinforcer that has the effect of decreasing the strenght (e.g of a behavior when it is presented as a conseuquence of (is contingent on ) that bheavior - a stimuls that the individual will actively work to avoid
50
Conditioned reinforcer
stimulus that acquired its reinforcing value by being paired with other reinforcers (ex praise or money)
51
unconditioned reinforcer
simulus whose reinforcing value is rooted bioligcall (natually food)
52
extinction
focus on eliminating mantaining reinforcer - processs in which previously reinforced behavior no longer result in reinforcing consequence and therefore stops occurin - terminatio of ccess to a function in order to extinguish the behavior - exc: when we use escape extinction = no longer letting client escame from task
53
deprivation
hunger, thirst, or zero attention - increases effectiveness of reinforcers
54
satiation
being too full, too much attn, and wants to be left alone, wanting something to cease - reduces effectiveness of reinforcers ex when acleint becomes satiated by music video that used to be an reinforcer
55
Contingency
What is used to determine the consequence of a particular behavior
56
contingent vs non- contingent reinforcement
Contingent-- a consequence that is contingent based on appropriate/correct responding
Non-contingent: delivering reinforcement regardless of action (without providing reinforcement to extraneous behaviors)
57
3 term contingency
example: folliwng through with ABC during down time
Antecedent SD = "play with these cars"
Behavior : child plays with cars
Consequence: TX provides verbal praise. The verbal praise is given contingent upon the correct bx in response to the SD
58
Motivating operation (MO)
Antecedent stimuli that may temporarily increase or decrease value of a reinforcer and evoke a response
59
Establishing Operatioion
MO that establishes effectiveness of some stimulus, object or event as a consequence
60
Abolshing Operation
MO that decreases effectiveness of a stimulus , object or event as a consequence (reinforce or punisher)
61
Evocative Effect:
increase in the momentary frequency of bx
62
Abative Effect
decrease in the momentary frequency of behavior
63
Both evocative and abative effects....
influence BEHAVIOR
64
Conditioned Motivating Operation
MO whose value-altering effect depends on a learning history
65
Antecedent
An environmental event (stimulus) that precedes a response
ex. the light changes (antecedent) you press on the brake (response)
- a response that comes before a response is not considered n antecedent
66
Behavior
anything an organism doesn
67
Critical Attributes of Behavior
- Bx is biological
- involves movement (actions)
- can only be done by a living organism
- observable
- measureable
- involves interaction with the environment
68
EIBI focuses on function of behavior
refers to circumstanes under which a behavior occurs
69
Dead man test
anything that a dead persona can do is not considered a behavior
70
Function of behavior
increases the possibility that a behavior will be used in all or most appropriate situatios and whetehr or not that behavior is likey to be evoked or abated in the future
71
Receptive Behavior
responding non-vocally to a given instruction, child doesn't have to say anything
-- eg. matching objects, identifying objects
72
Expressive Behavior
a vocal response, child responds by saying something
| - vocally identifying object in response to a question
73
Receptive/ expressive behavior topographies
description of what language behavior looks like
| - doesn't mean he/she can use it functionally
74
verbal behavior
any behavior for which consequences is mediated by the behavior of another person (bx reinforced by other person) includes gestruing and sign language)
75
vocal behavior
behavior that involves vocal output or speech (one speaks or produces souds with voice, can be type of verbal bx)
76
Other vocal vs verbal
behavior doesn't have to be vocal to be considered verbal bx
77
Consequence (AKA postcedent)
a stimulus that occurs after a response
| - ex i put on my hat (respone) the sun is no longer in my eyes (consequence
78
3 term contingency : Antecedent - Behavior Consequence importancee
consistency within consequnce is crucial for treatment with children with autism. It is used to increase appropirat behavior and decrease inappropriate behavior. We manipulate atecedents and consequences to increase appropriate behaviors (skill repetoier building) language skill - increase frequency and variety
ex- followign through with ABC during down time. Antecedent SD - "play with these cars"
Behavior: child plays with cars
Consequence: Tx provides verbal praise, "good playing with cars!" result child continues to play with cars. The verbal praise is gien contingent upuon the correct behaivior in response to the SD
79
Stimulus
- a change in the environment which can effect behavior
- includes environmental events outside of the observed individual
- involves an energy change
- two general types of stimuli (antecedent, consequence)
Examples: light turns on, music volume increases, a bug bites arm, an onset of a headache
non example
- object is not a stimuli, PRESENTATION of object is stimulus
80
S-R
refers to the Stimulus and Response relationship in which a stimulus is presented and a response occurs
81
Discriminative stimulus (SD)
- an antecedent that evokes discriminative control of a response
- the sd that has been continually reinforced in the past as a pairning with a particular response
- SD has discriminative conrol (stimulus control) over the behavior of interes
82
Stimulus control(AKA discriminative control)
- when a bheviaor is more likely to occur in the presnece of a partiuclar simulus because in the past, that behavior has been reinforced in the presence of that stimulus
- Antecedent stimulus EVOKES a response
- Established through differential reinforcement which leads to DISCRIMINATION
83
ENVIRONMENT and discriminative control
ENV exerts discriminative control, organism does not exert discriminative control
84
Respone
- a SPECIFIC INSTANCE of a behavior
85
Response vs. behavior
- typing is the behavior, pressing a key is a response
| - in a task analysis the bheaivor is tying shoes each step from beginning to end is a response.
86
Response Cycle
the beginning, middle and end of a response. It may be used to identify specific responses, but not all responses have clear responses cycles nor do they need to be clarified.
87
Discrete trial
- discriminative stimulus and stimulus control training
- pairing SD's with responses in order to create Stimulus Control (discriminative control) which will ultimately allow for discrimination by an organism
eg. discrete trial training, running bak to back trials in a controlled setting
88
Treatment Skill Acquisition
- Discrimination training: teaching child to respond to/tell difference between 2 (or more) SDs.
89
two types of discrimination training
Simultaneous and successive
90
Simultaneous discrmination training (7-step) ( T1 and T2)
```
MT t1 alone
MT t1 w/ unknown distractors
MT t2 alone
MT t2 w/ unknown distractors
MT t1 w/ t2 present
MT t2 with T2 present
RR T1 and T2
```
91
Simultaneous discrmintaion training
4 steps (T3 - T#)
MT T# alone
MT T# w/ unknown distractors
MT T# w/ known distractors
RR T# w/ previously mastered Ts
92
Simultaneous discrimination training
field of stimuli (target and disctractors items) presented at same time. Requires "pointing to, touching, or picking up item"
93
Successive
stimuli presented one at a time. requires verbal response
94
Successive
3 step (intro T1 and T2)
MT T1 alone
MT T2 alone
RR T1 and T2
95
Succesive
2 step : (T3 - T#)
MT T#
| RR T# w/ previously mastered Ts
96
Discrete trial training
Teaching technique method for skill acquisition
| - defninite beginning and end
97
3 compondents of discrete trial training
1) Antecedent
- - EO - establishing operation; internal
- - SD - discrimintation stimulus ; external
2) response
3) consequence
98
WHY 3 components?
- ASD kids don't learn by watching other kids
- allows multiple opportunities to be set up
- Lets kids know how they are expected to respond
- immediate consequence given
- assits tx with consistency
- decrease undesired bx, increase desired bx
- easy to take data and assess progress
99
Natural Environment training
- is child directed
- uses intrinsically motivating material and considers child's current interests
- is performed in natural settings
ex: tx joins child, initiated by child's expression of interest in item or topic. tx helps child engage in expanded resonse. Tx provides related consequence
- demos to successfully build wde variety of skill
- often use for teaching: initiation sills, skills that are intrinsically motivating
100
4 main characteristics of Naturalistic Teaching Strategies:
1) focus on use of learner's current motivation/MO
- child directed -- therapist follows learner's lead
- if learner's motivation charges, activites follow
- activites may be embedded within regular daily activities
2) Functional relationship between task and reinforcer
- reinforcers given are directly related to activity, not arbitrary
- natural consequences provided for responses
3) taught in child's environment in playful manner
- use of functional stimulus items
- more naturalistic transitions
- to untrained individual many appears as if the tx and learner are just playing
4) focus on reinforcing any appropriate attempt to respond
- shaping procedures lead learner to correct response
- less focus on "correct" versus "incorrect" responding
101
Fluency based training
- child is provided with several brief, times opportunities to practice the skill target
- timed training is continued until child can respond quickly and correctly
- targets taught in sequence: basic skills before complex skills
- useful when teaching skills in which speed of responding is just as important as accuracy
- easier to learn related more difficult skills later on
- children who perform fluently are able to stay on task and retain info longer
- tasks that can be performed well are less aversive and less likely to occasion problem bx
102
Fluency-based training
example:
- tx selects less, initiates teaching and tells child to perform skill quickly
- tx starts timer (up to 1 min); helps child to perform skill quickly and repeatedly throughout timing
- after timing, tx provides appropriate consequences ( may or may not be typical natural environment)
* some overlap with fluency based instruction and DTT (ex. forming letters)
* all approaches complement each other, each scientifically validated to build skills in cildren with autism
103
Generalization
| 1) setting/situation:
extent to which child engages in target bx w/o direct training in settings and situations that are different from those in which child originally learned t bx
- -environments
- - people
- - stimuli
104
Gerealization
| 2) response generalizaition
Child engages in bx that have not been directly trained and that are functionally equivalent to train t bx
105
Maintentance
continuation of bx change after all/part of intervention responsible for bx change has ben faded/ terminated
106
caregiver training
transferring control of who delivers SD to learner and learner responds the same/correctly
107
Premack principle
relativity theory of reinforcement -- more probable BXs will reinforce less probable bx
eg. getting to eat dessert (more probable bx) will be used as the reinforcer for when all vegetables are eaten (less probable bx)
108
preference assessment
caregiver reports:
parents and caregivers can be useful as you determine what groups of items may f(x) as SR+s (siblings, friends, teachers, family members are god resources to find out a clients's SR + s) ---> however, cannot rely solely on this info as the caregiver's ability to predict is not reiable
109
Preference assessment
RAISD
the reinforcer assessment for indivuals with severe disabities
- program supervisor/ BCBA will determine what tools will be used
110
Preference Assessment
Self- Report
depending on an individual's verbal skills, hyou may be able to ask them what they want: use open - ended questions, list of choices (ranking 1-10). Keep in mind that self-report is not always reliable
111
Preference Assessment
Free Operant Preference Assessment
during an observation, record the duration oftime the individual interacts with each item that is available. --> free access to predetermined set of items or activities; record the duration the individual engages with each activity/ item ( the longer the duration, the stronger the pref. is percieved to be ; this results in a hierarchy of the pref. bw the available items
112
Preference assessment
Structured Pre. Assessment
more reliable preference assessment--> condcuts an assessment tat provides the individual with opportunities to indicate their pref. though physical choice response. In order to assess what f(x) as a SR+ for the client, the Tx must conduct regular pref. assessments that indicate the preferred SR+ in that moment.
113
Multiple Stimuli w.p Replacement (MSWO)
a hierarch of pref. between multiple items; allows the individual to choose btw sever items simultaneously; there are as many trials as there are items; prior to the assessment, allow the individual; instruct the client to "pick one" -- allow him/her to access that item for 30 secs, afterwards, remove the chosen item from the array, then line up the remaining items and instruct the client to "pick one"
114
MSW ( multiple stimulus with replacement )
1) there will be as many Trials as there are items
2) prior to preference assessment, allow the individual to interact with item
3) Allow acces for 30 secs
4) After the 30 secs, place the chosen item BACK into the array
5) instruct the client to "pick one"
6) continue until all items are completed
115
Paired choice
Presenting only two items at a time -- useful for kids with scanning issues or difficulty choosing 2+ items in array. Must be done in RR
A. Stimulie are presented in pairs until each stimulus has been presented with every other stimulus
B. Predetermine the sequence of the pairings
C. tell the individual what you are presenting and tell him/her to make a choice
D. hold the stimuli or place on a table infront of a client
E. Give the individual the item that he chooses for 30 secs
F. if the individual attempts to take both remove both and present them again
G. repeat until all pairs are presented
116
Prompt
Supplemental stimuli presented in addition to SD that evokes the target response/correct response and is not a part of natural SD that will eventually control bx. A hint given before, during or after SD to assist learner to respond correctly
117
Types of Promts
```
Stimulus prompts
- movement cue: gestural
- Positional cue: proxomity
- redundancy: voice inflection, stimulus manipuplation
Response prompts:
- verbal direction: echoic, directive, textual
- modeling: model
- physical guidance: physical
```
118
errorless learning:
early stages of learning a new skill. Goal in this stage is to minimize/eliminate incorrect responses by prompting the child so they always get the correct answer.
119
Most to least prompting
- fading from one type of prompt to another going from most intrusive to least intrusive ( hierarchy
- new skill
120
Prompt fading
- transfers stimulus control from prompt to target SD
121
Simple fading
gradual removal/reduction of a specific type of prompt across successive trials
122
Most to least prompting
used when target is in early stages of acquisition (0-79% correct responses). Prompt intrusiveness gradually decreases as correct response occur. Decreasing intensity of one type of prompt OR changing type of prompt being used
123
Least to most prompting
using least intrusive prompt them moving to last effective prompt. Used when skill is in maintenance stage/ mastered. Amount of assistance increased until learner gives correct response. Start with "weak" prompt then increase intrusiveness to get correct response. heps avoid prompt dependency
124
Time delay prompt
increasing elapsed time between
1. ) presentation of target SD
2. ) across trials
125
Constant time prompt delay
start with no delay then move to fixed delay duration (3sec) before providing prompt
126
progressive time prompt delay:
start with no delay then increase dely by one second before providing prompt
127
stimulus fading
prompt been paired with stimuli are gradually reduced then removed ( made smaller , lighter, less salient
128
Chaining
complex behaviors comprised of multi single repsonses
129
behavior chain
sequence of SD's and respones where each response where each response in sequence procedures SD for the next response
130
task analysis
provess of breaking down behavior chain into a sequence of individual SD and response components
131
4 steps in Task Analysis
1) ID all responses necessary to perform behavior chain, list then in order in which they should occur
2) ID the SD associated w/ each response in behavior chain
3) ID initiating SD for chain
4) ID natural reinforcers that maintain chain in natural environment
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Procedures (chaining)
- Strategies used to teach behavior chains
| -
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Forward Chaining
(acquisition)
| begin with initial SD and response component. Continue in order of remaining steps
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Backward chaining
(acquisition)
| begin with final SD and response component. Continue targeting steps backwards, first step being taught ast
135
Total task presentation
all of the SD and response components are taught during every learning trial
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Shaping
behavior procedure in which one systematically reinforces successive approximations ( bx that become more similar to target) of target bx while extinguishing previous approximations (closer approximations reinforced only = no longer praise/ reinforce previous approximations)
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Shaping steps
1) ID target bx
2) ID initial behavior to reinforce
3) Reinforce initial behavior until it starts to occur consistent
* * 4) raise criterion for reinforcement to a closer approximation of target bx. No longer reinforce previous approximation
5) continue shaping until child acquires target bx
- - use shaping when child not currently engaging in target bx and target bx cannot be easily prompted
- - shaping is a slow process --> prompting procedures incorporated to increase acquisition rate of target
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Pacing (Time Delay)
- icreasing the elapsed time between the presentation of the target sD prompt across trials
- goal is for child to beat prompt and respond independently
* may be instructed to use both most to least prompting and time delay
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Alternative and augmentative communication
Use of augmentative device:
- these are devices that can be used for a client to communicate mands, tacts, wants and desires
1) sono flex on ipod
2) ploloquo application
3) sign language
4) typing words on ipad
5) PECS
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Functional approaches to teaching language skills :
| Teaching language
- receptive behavior
| - expressive behavior
141
Receptive behavior
responding nonvocally to a given instruction, child does not have to say anything
ex: matching objects
142
expressive behavior
a vocal response, child responds by saying something
| ex. vocally responding to a question
143
* receptive/ expressive bx are topographies
description of what language behavior looks like
| - doesn't mean he/ she can use it functionally
144
EIBI focuses on function of bx
refers to circumstances under which behavior occurs
145
Verbal Bx
| BF skinner
any behavior for which consequence is mediated by the behavior of another person (bx reinforced by other person) includes gesturing and sign language
146
Vocal bx
| BF skinner
bx that involves vocal output or speech (one speaks or produces sound with voice, can be type of verbal bx)
147
The mand
a verbal response that occurs when an individual is motivated for a particular item or event and results in the individual gaining said item; its a request (communication exchange in order to get someone from another person)
148
Mand and motivation
mand is controlled by a person's motivation; this motivation can increse/decrease one's desires -- waht are some of the common motivations that control manding ?
* deprivation < hunger, thirst, attn>
satiation )
149
MAND training
brief deprivation
tempting child and taking it away in order to mand
150
MAND training
interrupted chain
taking away something to get child to mand for whats missing (ex. give colording book to child but withhold crayons)
151
MAND training
incedental capture opportunities
EO in effect already, then hide something that is needed for activity or another aspect requires a man ( ex- thirsty but can't reach cupt; he/ she has to ask for someone to get the cup)
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Teaching Man BX (Card Curriculum)
1. teaching the child simple, one-word mands
ex. puzzle
2. teaching more complex mand frames
ex. i want puzzle
3. teaching softened mand phrases and sentences
ex. i want puzzle please
4. teaching disguised mands
ex. wow, that's a sweet-looking puzzle
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Response forms
1. vocal speech, icons, sign language or written words
2. what should the student be taught to request for?
3. how to prepare and implement teaching strag
4. howo will data be collected
154
Response forms (what the mand will look like) of Manding:
how are we going to teach the student to request for things? Looking for gestures? sign language? whwat i the most effective method fro the student to mand?
1. vocal speech
2. non-vocal speech (icons, proloquo, signing)
155
Establish motivation: tempting
| Step 1: impure mands
not motivated by own, but motivated through other means, like temptation
e. g pretending to lick a lollipop and saying "mmmm" ,, tempting client into wanting item- trying to get the interest of the client
ex. a lollipop is in view B.SD "waht do you want" C. Echoic P. Say lollipop
- sometimes, SD: what do you want, can be overused and may be difficult to fade; it may be easier to not just use this prompt and prompt client imediately to say "lollipop"
- may need to acept approzimations ot the word according to speech abilities
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Establishing operations
Step 2 Fading the echoic prompt (ie. say lollipop)
- fade the imitation prompt
- just like with any fading procedure this will happen gradually and carefully
e. g fade out 'lolli or "lo instead of fading out entire word
- RBT should femember not to fade too slowly as to prevent the child being depndent on prompt
- For some, fading the prompt take a long time and for others, it may happen sooner
- data will show how the client is progressing, then adjustment from SUP will come
157
Establishing operations
Step 3
Continuing fading verbal stimulus
in the example of lollipop tempting, the RBT is no longer asking "what do you want"
158
Establishing operations
Step 4
Fade nonverbal stimulus
- fade presence of lollipop (you can show the lollipop and then hide it to see if the client mands for lollipop)
- to ensure mands are product of self motivation
- teaching clients to mand for items that are not in view
159
Establishing operations
| Step 5 pure mands
- motivation is in place
- there are no prompts
- student requests because he or she is motivated by self
- student will learn because she/he is motivated by self
- student will learn when he wants something, he can mand for it spontaneously
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Generalizing mands in NET
- generalization can begin in early stages
- in initial training, ensure that the client is requesting that the client is requesting from several people to show hat manding can occur with other people
- have different team members or parents take turns holding and prompting to mand for an item
- mand training in different locations: school plyground home or car
- create manding opportunities within daily routines that is most functional, (lunchtime, playtime, self-care routines)
- one of the errors SUPS see that RBS do not work on manding often
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Promoting Multiple Intx
- RBT should provide multiple opportunities throughout session not just at the beginning of session
- Do multiple preference assessments and keep the patient interested in available items
- just because SUP implements mand training as a lesson does not mean client will start to mand indep.
- this takes lots of work and practicing in different situations
- SUPS will set goals for Tx in mand training (e.g aim for 20 requests/hr)
- RBTs should contrive motivation and to manipulate environment to promote requesting
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TACT training (making conTACT with environment) aka 'labeling"
tact definition
verbal bx controlled by nonverbal antecedent and followed by nonspecific consequence
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Tact training
- occurs when child sees, hears, smells, tastes, touches, feels then states but does not recieve it
- benefits listener with info from speaker
- aids in development of relationships and friendships
164
Teaching tacting bx
- starting with similar response forms
- building complexity of the response
* one of the most difficult verbal operas to develop, nonspecific consequences may not be meaningful to child, nonspecific consequence is paired with meaningful consequence
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Teaching tacting bx
| ex.
a child, preson has eaten for two hours. While outside with his ts, sharon he notices a dog and says "dog" sharon responds by saying "good job, preston" and gives preston acookie, Over time the primary R+ (cookie) will be faded out to the nonspecific social praise "Good job, Preston"
166
What two types of tacts are contained in the CARD curriculum
- simple tacts and complex tacts
167
Training echoic behavior
For CARD program, echoics follows 4 steps
- teaching child to vocally imitate sounds
- teaching child to vocally imitate sounds blends
- teaching child to combine sounds and blends to form words
- teaching child to link words to form phrases and sentences
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Intraverbal behavior
- (practicing conversation or answering questions)
- controlled by verbal antecedent and doesn't match the verbal antecedent
- consquence for intraverbal bx is non specific
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Intraverbal bx
- occurs whehn a child hears a question/comment , says something related to but different from what heard, does not receive item names
- enables child to talk about things that are absent
- difficult to develop in children with autism
- - maintained by social consequences
- - may be asked to pair nonspecific consequences with meaningful consequence
- - meaningful consequence is gradually removed
- -- things talked about are not physically present (nonverbal antecedent suchas visual can used then faded)
170
CARD curriculum on intraverbal bx
- mustic and movement
| - episodic memory
171
intraverbal bx example
Mom asks peter, "what's your favorite fruit?" Peter replies "Banana". Mom responds "me too!" Here, the consequence of mom agreeing with Peter is nonspecific. Peter's response does not match the verbal antecednet
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Pure verbal operants
For verbal operants with a specific atecedent and maintaining consequence
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Impure verbal operants
when only antecedent and consequent conditions for 2 or more operants are present
174
Pure and impure verbal operants
both are necessary to communicate effectively in natural enviornments
175
Teaching play skills (NET)
A. One of the best ways to teach play skills is at a playgroup, NET style
B. if playgroup is not appropriate, NET style is still recommended
C. Progression (interactive) ---> Imaginative, parallel, associative, joining, and initiative, cooperative
(IPAJ and I C)
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Imitative Play
observes and appropriately imitates the activities of peers; pre-req NVI, E.C following intstruction ( if prompt needed that's fine)
177
Parallel Play
plays in proximity to peers using similar toys, without engaging in or otherwise attempting to infleuce peer's play; basically near each other, playing similar things, but not interacting ---> might be good for kiddos who have a hard time tolerating other people's presence in the same rooml you see this in preschools
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Associative Play
begins to vocally and non vocally itneract w. peers while engaging in similar or identical activiites --e.g borrowing or lending toys from one another, possibly following the actions of another but continuing play as each wishes. Here, kiddos continue to play independently, but there starts to be more intx; floating back and forth beteen independent play vs. some intx
179
joining and intiating
kiddos approaches peers and either joins a play activity in progress or invites peers to play
180
Cooperative (coop)
play with one or more peer for the purpose of producing a material product, playing formal games,, or engaging in dramatic activity with SHARED goal: eg. building a fort, see-saw, building a sand castle
181
Teaching play skills
For many ASD clients, learning and using appropriate play skills can be difficult ; play not always be enjoyable; txs should strive to make each play activity as reinforcing and enjoyable as possible
182
Teaching motor skills
A. gros motor skills: catch balll, bit volleyball, run to mailbox
B. write name, cut shapes
183
Teaching adaptive skills
Includes daily like skills like brushing teeth, wiping, eating witha fork, May need to use a schedule board or PEC. Most of thee will be using otal Task presentation format with all of the steps listed. Can use partial task presentation or the use of backward chaining and forward chainig may be implemented continguent upon child's skill
184
Teaching safety skills
crossing the street, safety signs (poison, STOP, red light, etc)
185
Teaching social skiills
A. Eye contact
B. Greeting
C. end a conversation
186
Visual supports
use of a schedule. Child can help build a visual aide that determines what will come next. This helps with structure in a session. Eventually, it can help the child make his or her own schedule. Another visual can help with everyday taksks like "how to take a shower". The visual will outline each step that the child must complete showering.
187
Curriculum modification
teaching strategies and skill targets should be chosen based upon the specific needs of each indidvidul -- there is no one size fits all curriculum
- change the environment
add visuals with SDS use more natural occuring objects in the home
-modify an SD, use visuals
- modify responses
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1. Behavior Intervention Plan
- a detailed guied to what the behavior is. it has the ABCs of the behavior and shows that the goals are for reducing it
189
Target behavior
this is what the behavior looks like when it occurs
190
Functional behavior assessment
- to observe the initally the ABC of a bx.
- systematic evaluation of the atecedents and consequences of the target bx that determines why the target bx is occuring
1 indirect assessment
2 descriptive assessments
3 experimental functional analysis
191
automatic function
- atuomatically occuring. usually stimulatory bx. Voca/physical/ visual/ hand flapping, gazing/spinning/nonsensical utterances/ repeating words or phrases out of context are all examples of this
192
antecedent intervention
to modify the antecdent (pre bx) in order to change the occurence of the bx
193
Functional communicatino training
FCT teaching the individual to communicated in amore functional manner. SImilar to replacement bx
194
token economy
this is giving a set of reinforcement specifically (contingent) upond a bx or absence of one
195
High-p request sequence/ behavioral momentum
- to give a high probablility request in order to do lower probablity after eg high p- write your name , low p write a senence about your schoolday
196
Non contingent reinforcement
reinforcement that is not specifically or (contingent) of anything "free reinforcement"
197
replacement bx
replacing a previously undesired behavior with a more preferred one
198
escape extinction
behaviors maintained with negative reinforcement are placed on escape extinction when those behaviors are not followed by termination of the aversive stumulus. Emitting the target bx does not enable the person to escape the aversive situation
199
Attention exticntion
also known as planned ignoring. A strategy that doesn't give attention to an unwanted bx. this means not providing eye contact or interacting vocally with the child. Do not provide redirection that involves providing attention. Do not talk about the child's bx in fron tof him or her to another person. Use this strategy for bx that you know you are attn maitaned or for bx that you feel may become attn. seeking bx.
200
Access to tangible extinction
withholding the tangible item or activity the child is trying to get by engaging in the problem bx
201
continuous r+
provides reinforcement for each occurence of bx. CRF is mostly used when teaching a new bx or skill
202
intermitent reinforcememtn
a contingency of r+ in which some, but not all, occurences of bx produce reinforcement. INT is mostly used ot maintiain a previously mastered skill and is a natural form of R+
203
DRO differential reinforcement of other bx
behavior is reinforced whenever the problem behaviro has not occured during a scpecifict time. R+ is contingent on the absence or omission of target bx
204
Fixed interval DRO
a dro procedure in which reinforcement is available at the end of intervals or fixed during a duration and deliveed contingent on the absence of the problem bx during each interval
205
Fixed momentary DRO
a procedure in which reinforcement is available at specific moment of time which are separated by a fixed amount of time, and delivered contingenty on the problem bx not occuring at those moments
206
Variable interval DRO
a DRO procedure in which reinforcement is delivered contingent on the absence of the targeted problem bx DURING INTERVALS of VARYING UNPREDICTABLE DURATION
207
Variable momentary DRO
a dro procedure in which r+ is avaialbe is available at specific MOMENTS OF TIME in random sequence and delivered if the problem is not occuring at those times
208
response cost
a form of punsishment in which the loss of a specific amount of r+ occurs, contingent on an inappropriate bx and results in decreases probablity occurence of the bx
209
time out from reinforcment
the withdrawl of the oppotunity to earn positive r+ or the loss of access to positive r+ for a specified time, contingent on the occurence of abx the effect of which is to decrease the future frequency of the bx
210
exclusionary time out
the child is removed from a reinforcing environment for a pre-specified period of time
211
non exclusionary time out
the child is allowed to remain within the reinforcing environment but is not permitted ot engage in any reinforcing activiites for a pre-specefied perioed of time ; this form of timeout removes reinforcers from the individual ( ex sliding away from acivity table )
212
time out ribbon
each child wears a ribbon that can be taken off them to implement time out
213
time out planned ignoring
a time out where social attn is removed
214
contingent observation
the child has to sit and watch other engage in reinforcing activities
215
withdrawing a specific reinforcer
removing a positive reinforcer form a child engaging in a target behavior
216
spontantaneous recovery
the tendency for the bx to occur again in situation that are similar to those in which it occured before extinction. Sponaneous recovery is short lived and limited if the extinction procedure remains in effect and those implementing or involved in the extinction procedure are aware of this phenomenon
217
Data collection
Observation of a target bx orf skil, the measrement of that bx and a permanent record of the measured bx
- critical componenet
- allows supervisor to make data- based decisons on:
- - ID skill deficits (before)
- - monitor progres
- - determine mastery
- - ensure maintenace and generalization of skill (after)
218
Data must be accurate -- Guidelines
- data should be recorded immediately following the occurence of bx
- data should be complete
- - child's response
- - sd present
- - prompts
- - current step of discrimination training
- - data skill practices
219
Interobserver agreement (IOA)
measures data realiability by calculating the degree to which two people agree on a bx that they have both observed, measured and recorded
- 2 independent observations compared
- - similar = reliable
- - different = unreliable
220
Recording methods
| - observation period
specific time frame when bx is likely to occur
221
recording methods
| - continuous
record every instance of a bx
| - observe, meausre and record target skill each and every time it occurs
222
recording methods
| - latency
amount of time between SD and onset of bx
223
Recodring methods
| - trial by trial
recording child's response to a SD on a TBT basis
- OP = during lesson and targeting specific skill
- WR = end every trial (inter- trial- interval)
- types of responses
correct: target response
incorrect : and response different from a target response
No Response: no reaction to SD
prompt: SD + prompt/hint
224
Discrete trial data
A form used by the tx to record complete and accurate data on the child's responses during the discrete trial training
- 3 sections identifying info, description of current lession, trian by trial data
225
Summary Measures
Rate
Percentage
Average
226
Summary measures
rate
number of times bbx occurs in a specified amount of time
| - frequency of bx/tx
227
summary measures
percentage
comparison of two quantities
- percentage of opportunities : # observed/ #opportunies X 100 = %
- percent correct # correct responses / # recorded responses X 100 = %
- Percent of time: total target bx duration/ observed period duration X 100 = %
228
summary measures
average
described 'typical level' of bx observed
- Avg. duration: how long bx typically lasts
- total target bx duration/ frequency of target bx
- avg. latency : total latency/ number of responses
229
BX chain
a complex bx comprimised of multiple sing SD- response componenets that occur in a specific sequence
- data is recorded on accuracy and independence
- 4 sections on task analysis data sheet- identifying infor, lesson description, specific trial data, sumary measure info
230
conducting probes
probe method of assessing child's skill to determine what a chid know or doesn't know
231
2 types of probes
Pre instructional
| Post instructional
232
Pre instructional probes
"baseline probes" are conducted before teaching a new skill determine what needs to be taught
233
Post instructional probes
"mastery probes" conducting after a new skill determine if recently taught skill is known. Ensure skill is mastered, generalized, maintains in absence of r+
- only differ when they are conducted
234
Assessment environment
multiple settings, variety of stimuli , different people
- probes are designed to address natural environment needs with out delay in instruction
- done in RR
- looks like : distracter trial, distracter trial, probe, distractor trial, distractor trial
235
Probe data sheet
includes 4 sections n task analysis data sheet - identifying info, lesson despriction, specific trial data, summary measure info/ outcome info
236
Things on probe data sheet
hings on sheet - stimulus presented - details that are not included on SD portion of the form SD response componenet that is targeted for probing, child's response, tx initials and date five sections.
- there are 5 sections bc probe is comprised of 3-5 opportunities to determine is skill is known
- - if child scores correct in first 3 out of 5 trials additional trial are not required
- - if child scores correctly 2 out of 3 trials five trials are required
- - if child scored incorrectly in 2 or more of the 3 trials, skill is unknow and additional trials are not needed
- probe trials no SRT, just record no error correction procedure for incorrect response
- final probe trial is data summarized precent calculated
- last column is outcome pre instuction and post instruction - target is known circuled/ unknown
237
Task analysis probe data sheet
- identifies whether a child can accurately perform each step in the bx chain
- used when determining whether a child can perform - bx chain
- has 4 sections identifying info, lesson description, step by step data each probe trial, summary has measure info and outcome info
238
Thngs on task analysis data sheet
target bx, initiating stimulus, tx who conducted probe, date steps in bx chain, each chain is one trial
- there are 5 sections bc probe is comprimised of 3-5 opportunities to determine is skill is known (p1, p2,p3,p4,p5)
- - exact number of probe trials is determined by child
- - all trials correct 3 trials, child knows skill, p4, p5 blank
- - two trials correct additional trial needed
- p4 p5 used
- two trials incorrect
- three trials child does not know skills
239
Bx Management Data Collection
- program supervisor can make informed decisions regarding; how to treat the problem bx, when and where the BIP should be implemented when intervnetion is no longer needed
- extremely important to have reliable data must be accurate
- data should be recorded immediately following the occurence of bx
- data should be complete
- - problem bx
- - antecedent
- - consequence
- - date and time observed
240
recording method for bx management
an effective bx intervention plan must include adetailed descrption of the recording method used to collect data
241
inter- response time
- the time between the consecutive occurences of he target bx ( how much time passes from one occurenceof the target x to the next ocurences of the same bx
- to calculate mean IRT add up IRTS between each instance nd divide bhy total number of problem bx
242
interval recording
is used to measure the presence or absence of bx within the specific time intervals. The observation period is divided into equal time periods, such as 5 minute intervals. Interval recording is useful for estimating the number of occurences and/or duration of bx and can be used for high frequency bx
243
Partial interval recording or DRO
reocrds whether the bx was present or absent at ANY TIME during the interval (not concened with how many times the bx occured)
244
Whole interval recording
The bx is only recorded if it is present throughout the ENTIRE interval. This procedure tends to produce a slight underestimate of the presence of the target bx and should be used when the goal is to produce an increase in bx.
245
Duration recording
when it is improtant to know how long a bx occurs, either to tarted an increase or decrase in bx duration recording can also be used. It is more precise than momentary time sampling or interval recording. Duration recording records the total time or percent of time that a bx occurs within a specified time period.
246
A-B-C recording
during direct observation the operationally defined target bx is recorded along with the antecedent (stimulus that preceded/ triggered the bx) and consequence that followed/ was the result of the bx. Additionaly any bx that resulted form consequnce can also be recorded. Antecdents Bx and consequence are often recorded in narrative form
247
types of abuse
physical abuse
emotional abuse
sexual abuse
Neglect
248
Physical abuse
- non-accidental physical injury
- threat of physical injury
- risk of physical injury
249
Emotional Abuse
- injury to the psychologcal capacity or emotional stability
- evidence by ovserbable or subtantial change in
- - bx
- - emotional response
- - cognition
250
Emotional abuse
| -- rejection and ignoring
- Telling an individual in a variety of ways that he or she in unwanted
- Shame and humiliation
- - telling them they are stupid and worthless
251
Emotional abuse
Terrorizing
Threatening the individual with abandonment, physical harm or death
252
Emotional Death
Isolation
not allowing the indvidual to engage with peers, not exposing the indvidual to stimulation
253
Sexual abuse
- sexual intervouse
- sexual activity
- secual conduct with a minor
- - touching, ecouraging to touch
- - directly or through clothing
- - particular body parts
- specific sexual acts with aminor
- sexual exploitation allowing child to engage in
- - prostitution
- - production of pornography
254
neglect
- failure to provide
- - food, clothing, shelter
- - medical care
- - adequate supervision
- threatens the individual's health, safety or well-being
