Expanding Assessment and Programming into the Community

No matter how enlightened the therapist and family, a LOT of instruction in home-based ABA teams occurs in the confines of the home, usually in a therapy room. This is often because of the comfort level a therapist may have with leaving the therapy room and relinquishing instructional control, but there are other issues that logistically make it difficult to leave: responsibility of the child without parents present, timing of therapy sessions, availability of parents and other children to join on community outings, etc. Things come up.

However, I had an experience this weekend that really struck home with me regarding generalization of skills with a five-year old little boy with autism. It was a beautiful day and I wanted to go to a local pool with this child. As coordinator of his team, my role had been predominantly organizing his programs and monitoring his progress. As we went out, I was surprised at the disconnect between the language production in the home and the language production in the community. I know I shouldn't have been surprised, but I was. This little boy that has been producing 50-70 mands/requests per hour in his home, and within his yard decreased mands to less than 20 in one hour. While the therapists work with him all around the house and in his yard, going out into the community happens less often. This raised a red flag for me and program modification is now necessary.

What to do with this information?
- Modification of program assessment. In order to identify his level, frequency, and functional usage of language/verbal behavior, we need to change how we assess this. It needs to occur in novel environments. When he can produce the same high level of language in novel environments, only then is that his true level of language. After all, what is the point of language if it isn't used when he needs it in school, out with his parents, at the beach.

- Increase of parent reporting on community language. This isn't that difficult to do. Yes, data collection can be cumbersome, but simple measures can be taken that will give feedback regarding level of generalization of skills. For example, if expressive language is the target, the parent can take a language sample of how many requests/mands a child makes in an hour. This can be done by the parent having a clicker (the same kind of clicker that baseball games, bars, concerts, use to count how many people are attending and can be found at any sports store) in their pocket and clicking away for an hour each time the child produces a request. This will give the parents and the ABA team feedback regarding generalization of language.

- Increasing the environments therapy occurs. This may be more challenging to schedule, but clearly is necessary. Outings should be scheduled with families, that are functional for a family. Therapists can easily accompany a family to family gatherings, birthday parties, the beach. You need a flexible therapist, but these events are very important and planning for outings like this that will be learning opportunities for the child and program planning opportunities for family and therapist are invaluable to program development.

- Changing criterion for mastery. When programs are written, there is usually a set goal that is acknowledged that the child has mastered a task. This criterion should include mastery in the community. Meaning, can the child produce the same response in novel and community settings?

- Listen to parents...I mean, really listen to parents. When a parent says, "yes, he does it with you guys, but not with us" this needs to inform intervention. It is the teams responsibility to identify "why". Why does the child decrease his level of responding and language production when he is out of therapy session. This usually has implications for parent training. Are there less opportunities created by the parents? OR, is the therapy session not a good measure of language production generalization. It could be that the level of manding in a therapy session where a therapist contrives the environment in multiple ways is NOT the best measure. In this situation, language should be measured in non-contrived comfortable environments (playing with siblings at home) versus novel environments (the beach, new playground, relative's house).

The bottom line is for parents and therapists to attend to the discrepancy of skills produced in different environments. These are probably concerns that we already attend to, but often a refresher or boost is needed to remind us to maintain this generalization as a level of programming.