Peer Mediated Instruction

Peer-mediated instruction is a strategy where peers of the target students are trained to provide the necessary tutoring in educational, behavioral, or social concerns (Chan et al. 2009). These peers are then able to mediate appropriate behavior by modeling it themselves, as well as prompting and reinforcing appropriate behavior when it occurs from the target student.

While I was teaching in a middle school, I worked with a general education colleague to construct a "Helping Hands" program. We assembled a group of neurotypical peers that volunteered to be "buddies" with our students. These peers participated in structured group discussions about the needs of our students and how they could best help them. Early activities included structured games in the gymnasium and art projects in our classroom as students began meeting and spending time with their buddies on a weekly basis. Later, our students began getting involved in after-school activities with their buddies, and the culminating activities included trips out into the community together.

Visual Support

Visual support refers to the use of pictures (which may be actual photographs or pictures taken from magazines or the internet) as a cue to help a learner perform a skill more independently. This may come in the form of a visual schedule that shows a sequence of activities or the steps to an activity. Many learners with autism respond very positively to visual cues, which can help to make an otherwise abstract concept significantly more concrete.

Picture Exchange Communication System

The Picture Exchange Communication System (PECS) is an augmentative communication that is designed to help nonverbal individuals communicate both functionally and effectively. It has also been shown to be effective in verbal students or in preschool settings. While the name may imply that it is only picture cards, a key component to using PECS effectively is that it is a communication system that goes beyond simply using picture cards to stimulate communication. A child is taught to exchange a picture of an item with a listener who will honor the request for the item in the picture. This is later expanded to convey requests or to express needs or emotions. PECS is child-initiated and is both easily understood and implemented, and can be individually tailored to be functional to the needs of a specific person. The portability of the system gives it a universal appeal (Ball 2008). PECS is also utilized in the software of augmentative devices, where the pictures can be touched and the device will speak the desired words.

Pivotal Response Training

Pivotal Response Training (PRT) is an Applied Behavior Analysis (ABA)-based behavioral intervention that suggests two behaviors are "pivotal" to the acquisition of other behaviors, those two behaviors being motivation (reinforcement) and the ability to respond to multiple cues. Children are taught in naturalistic settings and components include child-choice, turn-taking, and the reinforcement of all attempts. It is used to target language skills, play skills, and social behavior, and is child-directed and uses reinforcement directly related to the task (Ball 2008).

Computer Assisted Instruction

Computer-assisted instruction refers to situations in which an instruction is presented through a computer to a student, or the computer itself is a platform for an interactive learning environment. It uses a combination of text, graphics, sound, and video to enhance and facilitate the learning process, and it can be used to personalize instruction for learners with language limitations, physical limitations, or learning disabilities. For example, a screen-reading program may assist a learner whose sight is impaired, or an oversized keyboard may assist a learner with limited fine motor control.

However, the most effective strategy that I have encountered during my career is the utilization of video modeling. Video modeling is an instructional teaching technique that utilizes assistive technology and videos as the primary vehicle. It is a strategy that has applications regardless of ability or age. It has a growing research base and can be used to teach a variety of skills, including social skills, play skills, and more.

Video modeling typically has three core components:

1. Video recording the individual to be taught or someone else, or finding commercially made videos highlighting the behavior to be taught.

2. The video is used to teach the skills.

3. The individual is required to perform the skill.

Video modeling is by no means a new idea. Even in the 1980s, it was identified as a time-efficient and personnel-conserving teaching tool (Charlop and Milstein 1989). However, the technology available today makes this technique invaluable and essential in teaching going forward.

In this book, we will be discussing the process of developing, implementing, and assessing video modeling for learners with autism to increase independence, facilitate learning, and improve quality of life.

Getting Started

Technology has come a long way from the days of video cassette players, when it may have been cumbersome to record a video and a necessity to have a television available to play it back. Nowadays, it is possible to record an impromptu video in a matter of seconds with a cell phone, and with these advances in technology comes new avenues and opportunities for teaching and training using video technology. With the immediacy and ease of video capture technology, there has never been a better time to incorporate video modeling throughout programming.

There is a plethora of resources available now to create a video for the purposes of video modeling, ranging from traditional hand-held camera, to a webcam, to a cell phone camera. While the portability and ease-of-access of a cell phone can make it convenient to create a quick video for immediate use, there are times when the crisper presentation of a traditionally filmed video will be more appropriate. The context of the situation will dictate what is best to use.

Similarly, it is important to consider the perspective that will be most beneficial for a video to take. While sometimes we will want to use a video from a third-person perspective (in which the viewer is watching a person complete the targeted behavior), there are situations where it will be most beneficial to show a first-person perspective — or a "mind's eye" perspective — in which the viewer is seeing precisely what they will be seeing out of their own eyes when they perform the desired behavior.

While working with students to increase their independence in job skills, we created a series of videos showing vocational tasks — such as simple assembly work with nuts and bolts or wrapping hamburgers — being completed from the first-person "mind's eye" perspective. While watching the video, they saw a first-person perspective of my hands as I completed the task. However, we ran into the problem that some tasks required measuring with a ruler or cup, or filing according to a letter, and on the video it was difficult if not impossible to see these small details. This made it difficult to follow exactly what was being expected and performed. Our solution was to take still pictures or close-up video of the ruler being used, or the tab being filed, and splice this into the video at the appropriate time to look at it. It was then possible to fully follow and imitate the task being performed.

There is a misconception that a key component of this is that the learner needs to have the pre-requisite skills necessary to access and view a video, such as attending to the video or access skills (turning the device on, or swiping or otherwise manipulating a touch screen to access and view the video). This does not always prove to be true in practice. Even students who do not have a history of engagement in videos have been successful when video modeling is implemented in an appropriate manner. The true key components to having success with video modeling are repetition, exposure, and predictability, all of which can lead over time to successful engagement and positive behavior. The video should be accessible in a regular and predictable way.

Before creating a video, select a behavior to target. It is vital that the targeted behavior be measurable and observable. For example, the targeted behavior should not be "Danny will improve his social skills" or "Jamie will dress correctly." More appropriate goals may be "Danny will initiate appropriate social interaction by saying 'hello' to a peer when he joins morning group" or "Jamie will put on pants independently."

Collect baseline data on the skill before beginning the video process, as this information can inform the type of video that is created. As when teaching any skill, it is important to know what the learner is already able to do, particularly identifying specific steps that can already be completed without assistance. A video may not be necessary for steps that are already known, but may be needed to contextualize later steps depending on the skill.

When it comes time to actually create our video, determine who will be an appropriate person to use as a model. Ultimately, the video needs to display a person performing the targeted skill both appropriately and independently. If the learner will want to watch him or herself, record a video of them being prompted through the task, and then edit the video to remove the prompts. Would the learner prefer to watch a parent, teacher, sibling, or peer? If the learner will not show increased interest from watching a familiar person, it may be possible to save time by searching the web to see if a video model for this skill already exists.

Consider how best to prepare the environment in which the video will be viewed. Where and when should the video be watched? How many times, or how long should it be viewed for? Ideally, the skill should be performed in a natural setting in which it would normally occur, with the skill be used in a functional way. For example, a personal care skill such as brushing teeth would be performed in a bathroom, or a food preparation skill performed in a kitchen. Any materials being used should match the materials that appear in the video.

When it comes time to view the video, keep in mind the pre-requisite skill of being able to attend to a video for several minutes without exhibiting challenging behavior (Delano 2007). Even with this skill in place, prompts may be necessary to maintain attention to the video. Whenever possible, do not prompt performance of the actual skill, but rather prompt or redirect attention to the video. Allow the learner the opportunity to watch the video multiple times before attempting the skill. In some cases, particularly longer chain tasks, it will be appropriate to stop or repeat the video after individual steps. In other cases, viewing the whole video will work best — just as in task-analysis, when we consider whether to teach a skill total-task or in steps.

Additionally, it is important that the idea of watching the video is not presented as "work." Just let it play until it becomes second-nature in the environment, and the learner gets used to it and begins to gravitate towards it on his or her own. Put the video on a loop and let it run until the learner engages with it. For those learners that seem to not be interested in videos, again, just give them exposure until they begin to be interested.

While monitoring the program in progress, it is vital to collect data on both the performance of the skill as well as the viewing of the video so that informed and data-driven decisions can be made. Take note of the trend of the data being collected. While the learner may not necessarily have mastered the skill, they may be making smaller strides towards it. As long as data is trending towards success, alterations may not be necessary. However, if after three to five sessions progress is not being made or trending downward, it is time to troubleshoot.

At this point, it is best to assume nothing and consider each of the following:

• Is the video being used frequently enough?

• Is the video being utilized properly (whole-viewing versus partial viewing)?

• Is the learner attending to the video, or able to attend to the video?

• Has staff received sufficient training on how to properly utilize the video?

• Are appropriate and sufficient prompting strategies being utilized?

• Is sufficient and appropriate reinforcement being provided?

• Is the video appropriate for the learner or is to too complex?

Once success is achieved and progress has been made, begin the fading process. A video being viewed on a computer screen can be faded to a cell phone or a tablet. We may fade the length of a video, showing it fewer times or perhaps only showing the first few steps of a task to get the learner started, and shortening the length of time viewed or the number of steps shown.

It may not always be an appropriate goal to fade out a video entirely. Daily planners are, in essence, a visual schedule that many people utilize in everyday life with no intention of ceasing usage, nor would anyone think that they should. I readily admit to the fact that I have made it into my thirties and have no idea how to tie a tie. If the fate of humanity rested on my ability to conjure up a Windsor knot on the fly, humanity would be doomed. However, on an as-needed basis, I can use my computer or phone to access a video on how to tie a tie, and follow the model. Given the infrequent basis of which I actually need a tie around my neck, this works just fine.

Lights, Camera, Action!

Johnny's parents would like him to learn how to brush his teeth appropriately. A baseline assessment shows that while he can identify a toothbrush and toothpaste, he will not engage in the desired behavior of brushing his teeth. While Johnny will not consistently comply with parent requests, he takes interest in his older sister, Jane, and will often imitate what she does.

In the bathroom that Johnny uses, record a video of Jane completing all steps of the tooth brushing sequence. Record Jane as she puts toothpaste on the toothbrush, places the toothbrush in her mouth, brushes the left side, the right side, and her front teeth, rinses the toothbrush, rinses her mouth, and spits. We will want individual videos of each step, but if it is available to us we can use a video editing program to do this later.

Place a toothbrush and toothpaste identical to the ones used by Jane in the same place she retrieves them from in the video. Load the videos on a cell phone or tablet so that they are easily accessible and set them to loop continuously when played. Bring Johnny to the bathroom and say, "Brush your teeth." Play the first video. Do not initially prompt Johnny at all, simply let the video play. If Johnny does not attend to the video, non-verbally direct him to do so by pointing to it or physically directing his gaze towards it if necessary. If after three to five loops of the video Johnny does not attempt to imitate it, non-verbally and physically prompt him to perform the skill exactly as Jane does in the video. Play the next video and repeat the process. Once all steps are completed, reinforce with praise and a highly preferred item.

Record the amount of prompting required to attend to the video and to complete each step of the skill. Repeat this process once or twice a day (morning and night) until five sessions' worth of data is gathered, and review the data. If the amount of required prompting is decreasing, continue and review again after five sessions. If there are no signs of improvement, it is time to troubleshoot. Is the program being implemented consistently? Is sufficient time being given to view the video? Is Johnny attending to the video? Is the reinforcing item providing enough motivation?

Once the data shows the skill being completed independently and consistently, we can consider fading the video. If we notice Johnny is performing the skill and is no longer watching the video, switch to the original video showing the full task and play this instead, keeping it available for Johnny to refer to if he gets lost. If Johnny continues to perform the task independently without referring to the video, it can be removed entirely, but in the future if Johnny has trouble with the task or asks to see the video, it can be brought back.