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Welcome

Welcome to a forum dedicated to applied behavior analysis. The purpose of this blog is to provide a forum for students, parents and professionals to access information and discuss timely concerns regarding the science of applied behavior analysis in a reader-friendly manner.

I have fallen off the blog recently, mostly due to the completion of my dissertation and spending time with my daughter. As I delve back into the home-based and consultation world, topics to discuss and share with those interested in applied behavior analysis appears endless. I hope to take this blog in a direction of bridging the gap across the various orientations towards working with and teaching children with autism and related disorders...I'm a behavior analyst through and through, but we can do better in various domains that we have been hesitant to discuss in the past. My interests are veering into the realm of self-regulation, problem-solving, relationship development in addition to working with children with substantial interfering behavior. Comments and discussion is both welcome and desired.

Tuesday, February 22, 2011

Relationship Development and ABA using DTT

The world of social and relationship development and ABA appear to always be at odds with each other, with each world poo-pooing the other. I find this unfortunate and want to bridge this gap. It goes without saying that my perspective is behavioral and therefore feel that in order to develop relationships with children that have difficulties in this arena, a behavioral approach must be utilized; however not how it has been in ABA programs in the past. This is a huge topic to undertake so rather than addressing the entire arena of relationship development, I would like to highlight the pitfalls of Discrete Trial Training (DTT) and relationship development.

I'll preface this discussion by saying that I am a strong believer in DTT and that it is incredibly effective at getting skills rammed into our little guys heads so that they can develop fluency with the mundane and save their precious cognitive energy for more taxing behaviors (i.e. problem-solving, conversations, playing, self-regulating). That being said, how DTT is used in most DTT programs seems to damage rather than support relationship development. Take the following example:

A child sits 1:1 with a therapist. The therapist implements multiple programs (verbal imitation, category sorting, labels/tacts, manding/requests) and the child receives praise and reinforcement or corrective feedback for each of these tasks. After the child has completed a set number of tasks, and has earned their time off of the table-work, they get their break, and the teacher steps back to organize her data, give the child a break, and prepare the materials for the next set of targets.

In this scenario, one that is incredibly typical across DTT programs, there is no relationship development. The child complies, gets their reinforcer, enjoys it for a limited amount of time, and then returns to the therapist and work. There are several problems here.

1. During the trials, the teacher moves quickly and rapidly in order to use momentum and establish fluency and quick responding. However playfulness is often sacrificed. The teacher maintains that the reinforcer is motivating enough and the child will complete the tasks and the tasks are paired with rewards and therefore will be positively associated. However, the teacher becomes negatively associated. Interactions with the teaches are work related, and therefore the child learns that anything involving the teacher is demand-based. The child will never want to seek out this teacher whom they may interact with the most because this is the person that places the most demands on them. The teacher becomes a stimulus/signal of "worsening events".
Solution: During the trials, non-contingent reinforcement, play, tickles, affect, and variable breaks should be incorporated. The child should giggle or smile during these sessions as should the therapists. Tokens should be paired with hugs, tickles, surprise additional reinforcement such as a surprise break with the teacher. Movement should also be included in these sessions. The child that gets fidgety will not be controlled by a token nor should they. It is the teachers job to incorporate all of their needs into these sessions. Play, affection, movement, paired beautifully and incorporated into the strict criteria with which they are presented. Some therapists do this quite well, and it is no surprise that these therapists get better responses and higher rates of acquisition from the children. Implementing technically beautiful trials may work for modeling "how to run discrete trial training" however in order to build up this relationship, the entire thing must be fun. Many of our kids spend most of their time with therapists, thus these are the people that MUST focus on establishing relationships, or else children are learning that "people" place demands. Always.

2. The teacher's agenda: In these DTT sessions, usually the teacher has a goal and an agenda. The goal may be for the child to label a set of fruits, and she/he will work diligently to get the child to label these fruits by providing cues/prompts, reinforcing approximations, and giving feedback on incorrect responses. Another observation in many schools and homes is that if the child digresses from this goal, even in an appropriate way, the child is redirected to the agenda of the teacher. This can either result in the child engaging in problem behavior because they are frustrated that they weren't heard, or the child again associating people as those who won't identify that their behavior shows interest in something else. One example is the child that while labeling his fruit, picks it up and licks it or tries to eat it. Rather than redirecting the child to replace it and label it, this is a learning opportunity that SHOULD interrupt the DTT and the skilled teacher will take this learning opportunity and expand on it. The child is showing an interest and may also be telling you in a very friendly way where you can put your trials. Another example is the child that begins staring at a toy or object in the room during the trial. They may be interested in something as a reinforcer and telling them "we aren't looking at that now" is not going to stop them from looking at it or thinking about it or wanting it. Halt the trial, and figure out what is distracting them. Either incorporate it as a reinforcer, or in play, or in the trial. If it isn't it can lead to interfering behavior, or worse, pairing the teacher (people) as someone who doesn't understand them and is not worth communicating with. Go with the child. I'm not saying "follow the child's lead" in a Greenspan manner where you join them in the stim (though i think there is some validity to that as well), but rather, use your skills as a behavior analyst and analyze behavior. What is the child communicating with their disinterest and how will you intervene so that their disinterest is abated? That is our job as teachers to figure out. If you miss this, and the child engages in a problem behavior, your DTT session is shot anyway, so it is much better to be proactive, identify the precursor to frustration and boredom and find a way to make it functional. Running a DTT session is NOT ABA. Analyzing a child's behavior while you are running a DTT session and identifying methods to improve it, what the child is communicating, and where you might be failing is...and this is a skill reserved for true behavior analysts. Anyone can run a DTT session. Not everyone can fluently analyze behavior and act accordingly to make the most out of each minute you are with a child.

Solution: use your skills as a behavior analyst and observe all of the child's behaviors, not just the ones you are targeting, and identify how you can improve this interaction by attending to their behavior. When a child sees that the person they are interacting with understands them and acts accordingly, they will pair that person more positively. I am NOT saying that if a child is tantrumming you should stop the trial and have them escape. That would be reinforcing escape motivated behavior. i AM saying that we can do better before it gets to that level, analyze what the child is communicating across all domains, and modify your agenda. You will get more out of the session, and the kid will like you more, because you "get" him.

3. Break from work: In most DTT sessions, what this means is you have earned your allotted tokens/time/tickets etc., and you are now free to roam, get your reinforcer, etc., while the teacher steps back. Here what the teacher is doing is actually pairing herself/himself as a punisher. The child is learning that FUN= No TEACHER. When getting away from the teacher is a reward, there is no relationship development. Clearly this is a time when most teachers will graph their data, organize materials, etc., but the damage is being done, in which the child gets to off on their own and not experience interaction with the person that is supposed to be covering this area as well.
Solution: Take breaks with the children, and find a way to make their break MUCH more fun through your participation. This means if they like jumping on the trampoline, you help them jump higher. This will pair you as a positive reinforcer. They will learn that jumping is cool, but jumping with you is cooler. You will know that this has happened when the child starts to take your hand and lead you to the trampoline. This is the start of a positive relationship where he needs you to have more fun (like Streisand says, people who need people are the luckiest people...:). Find a way to make yourself indespensible to the child's play and you are building a relationship. And for heaven's sake do NOT turn this into what YOU consider a learning/teaching moment where you question the child repeatedly "what are you doing? jumping!" Leave your questions/learn units/SDs out of this play. But make no mistake, this is a learning and teaching opportunity. The child is learning that you are fun. As they learn that, they are associating you as positive and not as someone that is going to put constant demands on them, and this will strengthen your relationship which will then help you get more from him in the future. They will need you to have fun, and will start manding/requesting for you. When the child can't wait to get away from you, you have done something wrong. Get creative with how to organize your materials and collect your data so that you don't need to do this on the break. During the break play, and know that you are still teaching. Challenge yourself to interact and play with the child and NOT present questions. Comment all you like, but don't demand reciprocation. Let the child play and have fun with you and they are learning people=fun, and a lot more fun than i can have on my own.

4. Time for work: When the child and teacher/therapist return to work, the therapist gets serious quickly. Yes, you want to have instructional control, but this abrupt switch from play to work, only pairs the activities at the table as more negative, necissitating more escape. Transition slowly. Use a visual support to show the child what the expectations are and what the "flow of the session" is. Let the child bring their toy to the table for a bit to pair the table more positively. Get playful and re-establish rapport at the table. Be clear as to the expectation. And please give the child the break while they are ON. All too often we "break" children when they are getting distracted, or "off". Now they have shaped our behavior, and we are reinforcing their fidgety distracted behavior by giving them a break. We should be stopping work in the middle of a fantastic trial! This way we are reinforcing fantastic responding and attention, not the opposite. It also allows the therapist MORE instructional control as she can end it on a positive note, not on an inappropriate behavior or tired child. Often teachers want to keep the child going because they are doing so well. All this becomes is "no good deed goes unpunished" Imagine this scenario with a teacher and her boss: she has a great day with her student and is now told that she did so well she has to say an extra hour. It is counter-intuitive, yet we do this to our children all the time, and this also damages our relationships.

In a nutshell, have fun, play with the kids, pair yourselves with breaks, listen to and attend to all their behavior, and end sessions on positive notes. Our children interact more with teachers, therapists and their parents than anyone else, so it is our responsibility to make these interactions as fun as possible, for them to WANT to interact with us because we are signals of "improving" not "worsening" conditions.

More to come

Tuesday, January 5, 2010

Don't under-estimate the beauty of the visual schedule

Although my last post has been long overdue, I felt the need to share my current experiences. First, I want to address the visual schedule as a behavior support. As mentioned before, one of the frustrating things about our field is the need for every speciated version of applied behavior analysis refusing to admit that their effective practices are behavior strategies and not something else. As a behavior consultant I incorporate visual schedules into a behavior support plan, i have been often told that ABA didn't invent visual schedules. But it doesn't matter who invented what. A visual schedule is an environmental modification that supports a child's understanding of their day, week, month, etc. If it is used to support appropriate behavior, it is appropriate in a behavior support plan.

Visual schedules can be incorporated in a child's day as pictures, words, symbols, etc. I currently have my typically developing 20-month daughter on visual schedules, and this is what I wanted to talk about today. Over the holidays, I noticed that with jumping around to the different houses and families all over the five boroughs and long island, that she didn't have a good understanding of what was going on. Although verbal, she was having a tough time with the travel and lack of predictability.

I purchased a dry-erase board, and created visual flow checklist for her of our day. EAch morning during breakfast, i brought out the board, and sketched one picture per activity of her day (e.g. for grandmas house it was a pic of a house and two people that i called grandma and grandpa), and included about 6-8 things that we were going to do that day. With each picture, i gave her buzz words to remember them. As the day went on, i referenced the checklist with her and we checked off the things that we had done (i didn't erase them as I wanted to reference them and refer to things that we had finished that day). She didn't understand all of it the first couple of times, but by the third or fourth day, we caught her referencing it and referring to the symbols.

Did it work? DAta indicates yes. Prior to using the schedule, i noted how she was able to retell what we did in a day and the number of correct utterances referring to our day. Following the implementation of this schedule, this number increased as did the comments in our car rides about where we were going, what we were going to see and who we are going to see.

The point is, visual schedule are not just for children with significant impairments or children with disabilities, although very important for these children as well. Recently at a team meeting i was told "but he is high-functioning and very verbal so he doesn't need a visual schedule." This statement is completely false.
1. All of us need visual schedules. Looking at our lives, how would we fair without a blackberry, planner, outlook etc to know what is coming up in our lives and in our day. That being said, it seems unrealistic and unreasonable to assume that our children wouldn't need a visual schedule as well.
2. For children with inhibition difficulties, autism, etc., predictability in their day is difficult to manage and fully understand. Although verbal ability may be high, maintaining a flow of the day covertly is another challenge that is an unnecessary requirement to place on our children. A visual schedule is a support that removes yet another task and allows the child to focus on more important tasks at hand (i.e. accessing learning and social opportunities)
3. When a child is anxious, although they may be verbal, the state of arousal takes over and makes it difficult to focus or retrieve information that under normal circumstances would be fine. Think of a typical adult in a fight with their significant other. While we may not have autism or a disability, and are fully verbal, in the state of anxiety and arousal of a fight, we may be inclined to yell and scream and throw things, forget chores that should have been done and forgotten events that we needed to attend. A visual support for a child in a state of anxiety and frustration will help direct them to what is going on.

One of the uses in the schools for high functioning children as well, is to keep that dry-erase board handy so that schedules can be mapped out as needed. When a child begins to get frustrated and seems confused, this is when a visual schedule can be used as a support for not only de-escalation but also as a proactive strategy.

Schedules do not have to map out the entire day or with the use of pictures. Words, symbols, sketches, photos can all be used. Uses can include:
- the entire day
- the school day or the afterschool day
- the events at a special event (birthday party, dentist, etc.)
- the big events over the course of a week (monday is dance, tuesday speech, etc.)
- holidays
- the weekend
- the month with pictorial cues of where the child will be,
- vacations
- the previous activity, the current activity, and the next activity
- the next few activities
- choices of activities

Tuesday, October 7, 2008

Goal: To become a living, breathing functional behavior assessment.

Functional behavior assessment (FBA) often carries a mysterious aura. Many professionals have an idea about FBA, think that they basically know what it is, but don't know how to begin to conduct an FBA, and nor do they want to. My goal in my consultation and teaching is to de-mystify functional behavior assessment. Teachers should become walking, living, breathing functional behavior assessors. FBA should not be something that is always formally conducted; rather, we need to keep the key questions of FBA constantly available to us and become fluent with asking ourselves these questions, so that when we observe a behavior, we can fluently functionally assess the behavior on the spot. 

In our classrooms and homes, a full functional behavior assessment is not always possible. But it is important for teachers and therapists to learn to ask ourselves the key FBA questions to try and identify what is going on in order to inform intervention. So, some questions to keep on your mind....always...

1. Why do I think he is engaging in this behavior? A simple question, but at the crux of FBA. Function=Why. Why is the child engaging in this behavior? To escape the task? To get something he wants? To get my attention? Breaking it down and asking the question in the moment, helps us to think analytically about the behavior not only will help inform intervention, but helps the teacher take a step back and see the behavior for what it is, communicative, and not personal. 

2. Is there a setting that appears to occasion this behavior? Does it occur more during certain activities? AFter a transition? When leaving a preferred activity for a non-preferred activity? When there are more or less people in the room? After a long weekend or break? Identifying patterns in when the problem behavior occurs informs intervention as we can then develop a plan to work within that setting or activity. For example, if we identify that a problem behavior occurs during writing workshop, we can target writing workshop by a) breaking down the activities into smaller mini-activities within he workshop to make it more manageable, b) we can pair the environment positively and use the child's preferences incorporated into the workshop, c) we can make sure that writing workshop does NOT follow a preferred activity, but rather is followed by a preferred activity to act as a natural reinforcer, d) provide additional support during this activity, e) teach functional communication to replace the inappropriate behavior in this context. 

3. Is there a consistent antecedent to the behavior? Meaning, what usually happens just before the behavior? Identifying this pattern may also help to inform intervention. 

4. Is there a consistent consequence to this behavior? What usually happens after the behavior that may be maintaining the behavior? Is my behavior as a teacher maintaining the inappropriate behavior? How can I change my behavior while teaching my student/child a new behavior. 

These questions should be asked of ourselves as teachers with fluency when observing behavior. This is not to say that formal functional behavior assessment is not necessary; however it isn't always feasible. Working in a busy and active classroom, it isn't possible for a teacher to stop, complete every data sheet necessary, and observe behavior taking note of antecedents and consequences. It is however possible, with practice, to think FBA all the time. 

Saturday, July 5, 2008

Off Topic: My Baby Girl

Hi Everyone,

I haven't posted in several months, but haven't forgotten the blog. I had a baby girl on April 14th. Her name is Ioanna (joanna but with an "I" instead of a "J") and she was born 5 pounds 15 ounces. She is now almost 12 weeks, smiling, laughing and giggling and is a joy.

I am however amazed at the social skills that she exhibits at this young age. Sustained attention for long periods of time, referencing, babbling, reciprocal babbling, and some precursors to joint attention. At 2.5 months, she is exhibiting these precursors to spoken language and it is amazing to watch.

As a behaviorist, it is also interesting to see how she has shaped my behavior and how my perspectives on some strategies have shifted somewhat. I wonder if as she grows, I would change as an ABA therapist, and if some of the techniques I have employed in the past (waiting out a tantrum, crying, etc.) would be acceptable now. We'll see.

I'll get back to posting soon.

Angela

Sunday, March 23, 2008

Stereotypy in Children with and without Autism

A research review by Michelle Rodgers (CUNY Queens College)

Authors: MacDonald, R., Green, G., Mansfield, R., Geckeler, A., Gardenier, N., Anderson, J., Holcomb, W., & Sanchez, J.

Title: Stereotypy in young children with autism and typically developing children

Purpose of this study: The purpose of this study was to compare motor and vocal stereotypy in 2-,3-, and 4-year old children with autism and typically developing children within the same age group.

Participants: A total of 60 children participated. 30 were diagnosed with autism or PDD-NOS and 30 were considered typical. Each group was broken up into three subgroups, 2-, 3-, and 4-year olds, each with ten children.

Settings: The setting was a small testing room at the New England Center for Children. The testing room had books and toys as well as a table and chairs.

Target behaviors: The behaviors that were measured were vocal and motor stereotypy across the two groups of children and across the 3 age groups. Some examples of vocal stereotypy were: non-contextual giggling, vocalizing non-recognizable words and echolalia. Examples of motor stereotypy were rocking, hand flapping, tapping objects, more than 2 times in a row, spinning, and finger flicking.

Procedure: Children were administered portions of the NECC Early Core Skills Assessment battery. These components covered motor and vocal imitation, matching, receptive and expressive communication, as well as instruction-following skills. Only a ten minute sample of the assessment was used, even though each student was given the entire battery. During the play portion, children were told to play with the toys but were allowed to move around the whole testing room. They were not prompted after the first directions were given. During the structured component, the children were administered tests for motor imitation, vocal imitation, and social questions. If the children engaged in stereotypy, it was not redirected.

Results: The results indicated that as the age increased for children with PDD-NOS, the mean percent duration of total stereotypy (vocal and motor) increased from 12% at 2-years old, 23% at 3 years old, and 39% at 4 years old. For typically developing children, the mean percent duration of total stereotypy decreased from 5% at 2 years old, to 3% at 3 years old and 2% at 4 years old. The children with PDD-NOS started with a higher mean percent duration than the typically developing students. The 4 year-olds with PDD-NOS displayed even higher rates of stereotypy than the 2 year-olds.

Implications: The study has several implications.

First, the optimal age for early intervention would be 2 years-old or earlier. Stereotypy is still relatively low at 2, that there may be more opportunities to teach appropriate behavior without having to compete with stereotypy.

Also, the fact that the four-year olds had higher rates of stereotypy implies that more should be done to limit the practice of stereotypy so that there is not much of a reinforcement history attached to these behaviors.

The types of stereotypy observed in the typical children and the children with PDD-NOS were also of interest. Children with autism tended to emit repetitive noises or non-contextual phrases, while rarely making eye contact. Typically developing children emitted contextually appropriate and identifiable words as well as made eye contact.

Tuesday, March 11, 2008

Stereotypy and social engagement : A Research Review

A research review by Jennifer Morrison (CUNY Queens College).

Lee, S., Odom, S. L., & Loftin, R. (2007). Social engagement with peers and stereotypic behavior of children with autism. Journal of Positive Behavior Interventions, 9, 67 – 79.

Purpose of the study: The relationship of social engagement and stereotypic behavior for children with autism, which looked particularly at if increased social engagement lead to decreases in stereotypic behavior, and finally if these decreases in stereotypic behavior generalized to other settings as well.

Participants:
Three children diagnosed with autism who engaged in frequent stereotypic behavior. One child was 8 yrs old with moderate to severe mental retardation with severe delays in language. Another child was 7 hrs old and engaged in a variety of oral/vocal stereotypy and also would sometimes engage in self-injurious behavior to himself and also others. The other boy was 9 years old and had profound mental retardation; he could follow simple verbal commands from adults but also engaged in high rates of vocal and motor stereotypy. In addition to the three children diagnosed with autism, 12 (6 pairs) of children without disabilities also participated that were all in third grade classes that the three children that were part of the study were in.

Setting: The study was done in a 5 m x 4 play area in a special education classroom. The area was full of several different types of toys and objects that they could play with.

Target Behaviors: The behaviors that were mainly investigated in this study were initiations with a peer or stereotypic behavior. Initiations were defined as: any vocal/verbal or gestural behavior that a participant/peer directed to another peer and that was not preceded by a socially oriented behavior from that peer. Stereotypic behavior was defined as topographically similar behaviors that were performed repetitively. These could include vocal which was when children used their mouths or made vocalizations or sounds. Motor stereotypy was defined as when children used any of their body parts except vocal with or without manipulating objects (eg finger flipping, wiggling fingers, banging head, etc.)

Procedure: The experimenters used a multiple baseline across participants and settings. After the first participant had a stable baseline they then introduced the intervention. Once the first participant reached stable responding at intervention, the intervention was introduced for the next participant…so on. During the baseline phase, each child with autism was observed during structured free-play sessions with two peer buddies. No instructions were given to the children and lasted approximately 5 minutes. During training, the trainer taught the peers four social skills concepts (sharing, suggesting play ideas, assisting and being affectionate). Each training session began with a verbal discussion of the importance of playing with friends and/or a review of the previous day’s play. After this the teacher then modeled appropriate and inappropriate responses. In the using skills intervention the teacher reminded the peer to use the skills they had learned to get their friend to play, and the peer then got the child to play in a structured activity with them.

Results:
During baseline, all three children did not engage with peers at all in any type of play situation. After training with peers, the mean percentage of social engagement increased to, 69%, 79%, and 56% for all three children. More importantly, this behavior continued through the reimplementation period and also for generalization probe trials with children that were not trained. At the same time, the participants’ engagement was more variable during the generalization phase which took place at snack time. In addition, during baseline each of these three children engaged in high rates of stereotypy (87%, 47%, and 89% respectively). When the peer initiation intervention was introduced not only was social engagement increased but stereotypic behavior decreased in all three children.

Implications: This study had several important findings. First of all, this study showed the importance of training peers to initiate social interactions with children diagnosed with autism. This study also showed how effective training with a peer model can be in increasing social engagement in a child on the autism spectrum. More importantly it was shown that the percent of self-stimulatory behavior also decreased with all three children. This shows the importance of the relationship of a set of social skills in comparison to stereotypy. If a child is engaging in a conversation with another child, this gives them less of a chance to engage in vocal stereotypy especially. The other really nice thing about this study is that it was naturally done with peers of the children that were their age. This study ultimately shows the importance of peer modeling and peer assistance to children diagnosed on the autism spectrum. One thing I thought was a strong point of this study was that they also used children that were not on the high functioning side of the autism spectrum. When reading studies similar to this, there are a lot of studies done with children with Asperger’s or related symptomology, but very little with children with more severe deficits and higher rates of self-stimulatory behavior.