Applied Behavior Analysis: As reader friendly as possible

Relationship Development and ABA using DTT

2011-02-22T02:48:00.003-05:00

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

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

2010-01-05T19:37:00.002-05:00

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

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

2008-10-07T21:09:00.003-05:00

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.

Off Topic: My Baby Girl

2008-07-05T11:44:00.002-05:00

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

Stereotypy in Children with and without Autism

2008-03-23T11:38:00.002-05:00

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.

Stereotypy and social engagement : A Research Review

2008-03-11T07:10:00.002-05:00

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.

Research Review: Physical exercise as a Reinforcer

2008-02-24T20:37:00.002-05:00

Research Review by Michelle Rodgers (CUNY Queens College)

Azrin, N.H., Ehle, C.T., & Beaumont, A.L. (2006). Physical exercise as a reinforcer to promote calmness of an ADHD child. Behavior Modification, 30, 564-570.

Authors: Azrin, N.H., Ehle, C.T., &Beaumont, A.L.

Title: Physical exercise as a reinforcer to promote calmness of an ADHD child

Purpose of this study: This study had several purposes. One purpose was to determine if scheduled exercise could serve as a reinforcer for a child remaining calm for a certain period of time. Next, the authors wanted to determine if the exercise would result in calmness even if it wasn’t based on being a contingent reinforcer, if specific praise could result in calmness, or whether contingency was necessary to promote calmness.

Participants: The subject was a 4 year old boy that was diagnosed with autism and ADHD.

Settings: During baseline, the child was observed in his classroom setting. During the procedural component, the child was observed in a separate roomTarget behaviors: Calmness was the target behavior and was defined as sitting calmly and attentively and looking at the assistant.

Procedure: The procedure had several components. These procedures were given on separate days and alternated over the course of 5 days. The reinforcer would be 1 minute of play in an outside playground that contained gymnastic equipment and other climbing structures. The child would engage in activity for the full time and would not be prompted.

Shaping was the first component and the purpose was to attempt for the child to display calmness according to the definition. The time for the child to sit calmly increased from 1 second and after several trials eventually reached 60 seconds. Specific verbal praise was given throughout the session as well as after each successful session. After each successful session, the child was allowed to play.

The descriptive praise was the component in which only specific praise was given for the target behavior and the playground was not used as a reinforcer.

The noncontingent reinforcement phase allowed the child to use the playground every 60 seconds regardless of calmness and no praise was given.

The reconditioning phase allowed the child 60 seconds of playground activity contingent on 60 seconds of calm behavior. Descriptive praise was included at the end of each successful session.

The baseline component was the phase in which the playground was not given as a reinforcer and no descriptive praise was given. The child was seated in the chair and was returned to it when he arose from it.

Results: Prior to the intervention, the child was out of his seat for 100% of the time. The shaping and reconditioning phases had the most dramatic results. In these two phases the child was able to display 60 seconds of attentiveness which lasted for 50 minutes of the session. Descriptive praise, noncontingent play, and the baseline phase resulted in about 3 to 5 seconds of calm behavior.

Implications: Although this study was conducted on only one boy, it is interesting to see that vigorous activity served as a potent reinforcer. For children with ADHD, engaging in exercise at scheduled times may allow for more attentive behavior in the classroom. While the teachers noted how calm the boy was during the intervention, he was in a separate room. It would be interesting to see how attentive he would be in the classroom if he was able to “work” towards use of the playground as a reinforcer. This study offers another possible reinforcer that could be paired with the usual token economy that is often implemented in the classroom. A feasible schedule would need to be worked out to obtain maximum attentiveness in the classroom, while appropriately allowing for playground activity time.

Research Review: Scripted peer tutoring, social interaction and ASD

2008-02-23T16:48:00.002-05:00

A research review by Jennifer Morrison, CUNY Queens College.

Petursodittir, A. L., McComas, J., & McMaster, K. (2007). The effects of scripted peer tutoring and programming common stimuli on social interactions of a student with autism spectrum disorder. Journal of Applied Behavior analysis, 40, 353 – 357.

Purpose of the study: To explore the effects of scripted peer tutoring in reading activities, with and without programmed common play-related stimuli, on social interactions between a young student with ASD and his typically developing peers during free play situations.

Participants: A 5 yr old boy diagnosed with autism and a developmental delay. The study also included three typically developing peers from his kindergarten classroom that had no history of playing with him.

Setting: General education classroom in a kindergarten room.

Target Behaviors: The overall target behavior was to increase reading fluency by using peer influences. The reading behaviors that were included were: identifying letter sounds, decoding, reading sight words, and reading sentences.

Procedure: The boy diagnosed on the autism spectrum worked with each target peer for the reading activities for 15 minute peer tutoring sessions, four times per week, for 4 to 5 consecutive weeks. After this the participants could choose a 20 minute free play activity. The teachers that were present guided the children to play together in the same area but were also free to leave that area if they chose to do so. There were no explicit prompts or reinforcement for social interaction during any condition.

The design was a multiple baseline across peers with changing conditions, consisting of the following conditions: baseline, scripted peer tutoring, and scripted peer tutoring with common stimuli. During baseline sessions, he was given 20 min free play periods immediately following reading sessions. Scripted peer tutoring involved the same conditions as baseline, but was paired with a targeted peer. During the scripted peer tutoring with common stimuli condition, after the reading session, the play related stimuli were programmed into the reading activity itself. After the reading activity was over, the children were given other parts of the toy and encouraged to keep playing with it.

Results: The results indicated that when only peer scripted tutoring was implemented that there was no change in social interaction. However, once the peer tutoring and common stimuli condition was introduced, social interactions increased. Interestingly, when generalization probes were conducted before the common stimuli intervention, they did not see any generalization of social interaction. This could be because verbal interactions during the reading conditions were under tight stimulus control, and once common stimuli and peer tutoring were combined, generalization did occur.

Implications: This study has several important points that should be discussed. First and foremost, the importance of peer tutoring in academic situations with children diagnosed on the autism spectrum. This is something that all therapists need to keep in mind is the importance and usefulness of a typical peer model for any child with autism. A peer model not only serves as an appropriate model for academic behaviors but also appropriate behaviors in general. Instead of using adults constantly to teach children on the spectrum, we should seek out appropriate peer models that can also sit with the child and teach them various academic tasks, not to only teach them, but also to develop some type of social relationship with that given child since it is so important in building friendships, etc.

Another important point to touch on from this article is the importance of training common stimuli to promote generalization. This was first discussed in Baer, Stokes, and Risely (1968) of the importance of programming these common stimuli in the environment to promote generalization. If a child on the autism spectrum is never exposed to these common stimuli the chances of the generalization to happen in a new novel situation is slim to none. This study shows this point beautifully because there is no change in social interaction, and as soon as common stimuli are introduced the experimenter saw increases in social interaction across all three typical children. Generalization might quite possibly be one of the most important aspects in teaching children with autism academic and social skills, and if generalization is not programmed into the training program, it is much less likely to happen.

Queens College Conference: Positive Behavior Supports and Autism

2008-02-08T21:55:00.000-05:00

Queens College Center on Autism and
Related Disabilities
QC-CARD

1st ANNUAL CONFERENCE

CREATING PBS CONTEXTS AT SCHOOL AND HOME
FOR CHILDREN ON THE AUTISM SPECTRUM

MAY 3, 2008
9:30 – 1:00

KEYNOTE ADDRESS

Dr. Edward Carr
Leading Professor
Stony Brook University

“Repairing and Enhancing Quality of Life: Achievable and Hopeful”

Breakout sessions:

1. Thinking in PBS: Approaching Problem Behavior Through the Lens of PBS
Presenter: Christopher Oliva, Ph.D.
This training will focus on understanding and addressing problem behavior of children with autism in educational settings from the perspective of positive behavior support. General PBS strategies, as well as formal assessment based strategies, will be explored. Case examples will be used to demonstrate effective interventions.

2. Guidelines for a PBS Classroom: Lessons from the Field
Presenter: Angela Mouzakitis, MsEd, BCBA

The purpose of this workshop is to share classroom guidelines identified as necessary to create a "positive behavior supports" classroom. These guidelines have been identified through hands-on work, observation and consultation with classrooms that serve children with autism. Goals of the workshop are to provide guidelines for a PBS classroom, discuss and provide examples of the guidelines in action, and to provide professionals with a system for managing and monitoring guidelines, providing feedback to teacher, in order to improve classroom practice.

3. Parent Strategies for Supporting Language and Positive Behavior in Daily Family Routines
Presenter: Peishi Wang, Ph.D., BCBA
This session will explore a variety of parent-implemented interventions appropriate in natural environments with young children with ASD. Focus will be on teaching communication skills and increasing participation in family activities.

4. Friendships and Beyond: Developing Social Skills in Students with ASD
Presenter: Nicole Weidenbaum, MsEd., SAS
Success within home, school, and community settings, weighs heavily on the development of social skills. This presentation will focus on the social skills needed for students to be successful in an inclusive school setting, as well as teaching techniques that are applicable across a broad range of skill levels and settings.

5. Make It Fun and I’ll Show Up: Moving towards naturally occurring reinforcement
Presenter: Randy Horowitz, MsEd, SAS

This presentation will describe ways in which parents and teachers can establish (and maintain) themselves as reinforcing stimuli in the education of individuals diagnosed with an autism spectrum disorder. The use of antecedent based strategies to prevent problem behavior will be described in the context of designing effective behavior support plans.

6. “We’re all working really hard – but these PBS strategies are not working!”
Presenter: Sara Woolf, M.A

Does this sound too familiar? If so, come to this session to learn about team process strategies and skills that have been identified as critical in establishing successful home-school partnerships -- and developing lasting PBS outcomes. The session will focus on ways to apply “team best practices” as discussed by select school-family teams and in current literature from the fields of Special Education, Educational Leadership, and PBS/ABA.

Contact Me for Details.

The Effects of Calisthenics and Relaxation Training on Self-Stimulatory behavior: A research review

2008-02-06T19:44:00.000-05:00

A research review by Michelle Rodgers (CUNY Queens College)

Authors: Morrissey, P.A., Franzini L.R. & Karen R.L.

Title: The Salutary Effects of Light Calisthenics and relaxation training on self-stimulation in the developmentally disabled

Citation: Morrissey, P.A., Franzini, L.R. & Karen R.L. (1992). The salutary effects of light calisthenics and relaxation training on self-stimulation in the developmentally disabled. Behavioral Residential Treatment ,7, 373-389.

Purpose of this study: The purpose of this study was to determine if light calisthenics and relaxation could decrease self-stimulatory behavior. Light calisthenics was defined as 15 minutes of exercise, such as running, and bending to touch toes from various positions, such as standing and sitting.

In addition to decreasing self-stimulatory behavior, the authors also wanted to determine if light calisthenics and relaxation could also improve attention to toy tasks.
Relaxation and calisthenics were possible replacements for self-stimulatory behaviors because they were believed to provide the same type of proprioceptive feedback the inappropriate behaviors were creating.

Participants: The participants were four males ranging in age from 8-13. These males were diagnosed with the following developmental disabilities:
chromosomal abnormality with microcephaly, spastic quadriplegia with seizure disorder, chromosomal abnormality and fetal alcohol syndrome and the final subject was diagnosed with autism.

Settings: The treatment took place in a basement room located within the residential facility.

Target behaviors: The target behaviors were an increase in attending-to-tasks, through toy play, and a decrease in self-stimulatory behaviors such as hand flapping, hand mouthing, and other self-abusive behaviors such as hitting head with knuckles and body slamming.

Procedure: After a baseline of these behaviors were recorded over 5 days, treatment began. During treatment, the participants were engaged in light calisthenics as mentioned above. During the relaxation interval, they were asked to tense and relax various parts of their bodies, such as their legs, then arms, and then their hands. Free time was considered the control condition and the residents could play with various toys that were present during attention-to-task activities. The treatment sessions and control condition lasted fro 15 minutes each. After the treatment sessions, data were collected for 10 minute intervals and directly followed treatment. During this interval, the subjects were asked to play with the toys in order to measure their time on task.

Results: The light calisthenics decreased self-stimulatory behavior in all four subjects while relaxation had an effect on three of the subjects. Four subjects showed an increase in task attending after the calisthenics and only three of the boys exhibited on-task behaviors after relaxation. The only downfall to these techniques was that the effects were short-lived. The behaviors decreased immediately after the treatment sessions but had increased again later in the day.

Implications: Light calisthenics and relaxation may be good techniques to employ prior to a learning session or activity to have the most dramatic effect in increased attention and decreased self-stimulatory behaviors. The authors had mentioned that if the exercise had been directly related to each subject’s self-stimulatory behavior, the replacement exercise may have been effective and long-lasting. However, in this study, each subject, regardless of their self-stimulatory behaviors, received the same treatment. It was also noted that the effects of treatment weren’t realized until a few days after treatment. It is believed this was due to the time involved in learning some of these exercises. It was not until the subjects were more fluent with the exercises that the effects were noticed. This was speculated to be related to the amount of proprioceptive feedback that would be gained with proper exercise formation. The authors also made mention of the fact that the relaxation techniques were more laborious on the staff members because they had to help these subjects get into various positions, whereas the calisthenics were more easily implemented and feasible for a larger group.

Over-reliance on para-professionals

2008-01-26T13:19:00.000-05:00

A research review by Jennifer Morrison (CUNY Queens College)

Giangreco, M. F. & Broer, S. M. (2007). School-based screening to determine overreliance on paraprofessionals. Focus on Autism and other Developmental Disabilties, 22, 149 – 158.

Purpose of the study: The purpose of this given study was to describe a 16 item screening tool designed to assist schools in determining overreliance on paraprofessionals and from here to lead to action plan in how to fix this growing problem.

Participants: The study participants included a total of 244 screening and planning team members that were part of 27 different schools. These individuals consisted of special education teachers (n= 44), general education teachers (n=40), general education administrators (n=32), special education administrators (n=31), paraprofessionals (n=29), parents (n=23), critical friends (n=21), consumers (n=17) and others (n=7).

Setting: The setting of the study was at 27 schools in six states: California, Connecticut, Kansas, New Hampshire, Wisconsin, and Vermont. Out of these 27 schools eleven of these were primarily rural, eight as suburban, and eight as urban. 95% of the children in the study primary placement were at a general education classroom with supports.

Target Behaviors: The given target behavior was to look at overreliance on paraprofessionals in a classroom settings. This overreliance in some cases could lead to interference with the general education teacher engagement or even with peer interaction, decision making by under qualified personnel, and more importantly the development of unnecessary dependence on the paraprofessional.

Procedure: The school initially signed up for participation in field testing by submitting an application online. The schools joined the project in staggered cohorts over 3 academic years. Once the school agreed to participate, they had to submit their demographic information and were sent copies of guidelines of the research. From here each team had a 2 hour time block to meet and use the screening tool. After giving it to individuals in the school, it was then sent back and the number and percentage of schools answering each question was calculated and rank order was determined by looking at responses which included: happens too frequently, happens sometimes, or for some of the time.

Results: From the screening tool, it was determined that the biggest concerns across schools was that paraprofessionals provide academic support in subjects where they are underskilled, students spend most of their time in close proximity to para’s, students are very dependent on the para’s presence, others communicate through the para instead of the child, the child is physically separated from the rest of the class (eg back of the room) and finally that the classroom teachers are minimally or superficially involved with some students.

Other concerns included: that para’s make curricular or instructional decisions or adaptations without the classroom teachers input, the students receive their primary instruction from para’s, and when it is time to report the students progress classroom teachers rely on para’s because they know more about the student in general.

Implications: This study has several implications to special education and general education classrooms. It has become practice in the recent past to increase the number of paraprofessionals in schools in order to provide support for children with disabilities. This is ok, however, this option is one of the most restrictive supports that can be offered and should be looked at and thought about more closely without becoming the first and best option. The given school district could also look at other supports before choosing this option such as coteaching, peer supports, etc. I know that personally I have worked as a paraprofessional in the past and worked with other paraprofessionals, and these problems that are listed in the results section happen very frequently in any school setting. This screening tool could be very useful to many school districts in order to screen for overreliance problems so that an action plan can be made in order to decrease this overreliance in the future. This study brings up a lot of important concerns, being that first and foremost those children become too dependent on the para to do ANYTHING in the classroom. Another important concern is that the lack of interaction that the general or special education teacher has with the given student. This can very easily happen when the para spends 6 hrs of the day with the child and the classroom teacher does not. This is one thing that should be carefully observed in any classroom setting that the classroom teacher spends some time everyday with the student so this does not happen.

One of the most important things to keep in mind when employed as a paraprofessional is to provide support when needed but also to take a step back when the child can be independent at a given task, in order to ensure that the child will not form this overreliance on the para having to be there at all times. If this technique is used, it could be possible in the future that the child will no longer need the para in the general education setting and will just be able to use other supports in the classroom, which is the ultimate goal.

Decreasing self-stimulatory hand-mouthing behavior: Research Review

2008-01-21T22:03:00.000-05:00

Research Review by Michelle Rodgers (CUNY Queens College)

Title: Effects of providing sensory stimulation to decrease self-stimulatory behavior: using additional food to suppress hand-mouthing behavior

Citation: Yang, J.L. & Bruner, J.D. (1996). Effects of providing sensory stimulation to decrease self-stimulatory behavior:using additional food to suppress hand-mouthing behavior. Behavioral Interventions, 11, 119-130.

Purpose of this study: The goals of this study were three-fold:
First, the authors wanted to validate the functional relationship between sensory reinforcement and self-stimulatory behavior. Second, the authors wanted to determine what role sensory stimulation could play when provided as a treatment procedure. Third, the authors wanted to determine if food could serve as a sensory reinforcer to replace hand-mouthing behavior.

Participants: The participant in this study was a 30.5 year old nonverbal male with profound mental retardation.

Settings: The setting was the large dining room within the state care facility in which the participant resided. The participant typically sat with three of his classmates.Target behaviors: Hand mouthing was defined as momentary insertion of any finger covering the first knuckle between the lips.

Procedure: Data were collected twice a day during baseline and treatment conditions. The data were collected during a structured morning activity and during a less structured activity in the afternoon. During the baseline phase, the participant received his usual meals, with no additional food given. Any hand-mouthing that was observed and recorded were never stopped or interrupted. During the intervention phase, the participant was given his usual meals. However, he was also given additional portions of bread, fruit and milk. He was able to eat as much or as little as he wanted. Data was collected for three months after treatment was employed.

Results: The participant’s hand-mouthing behavior decreased from 67% in morning activities to 13% after treatment, His hand-mouthing behavior in the afternoon decreased from 47% to 17%. During the follow-up, the participant averaged 12.5% hand-mouthing behavior in the morning and 10.4% in the afternoon. The participants weight was also observed. The participant gained 19.5 pounds during this study and was within his ideal body weight. In addition to the behavior decrease, the participant’s hands healed and he was able to sleep longer throughout the night. He no longer needed insomnia medication or restraints to prevent tissue damage to his hands.

Implications: In this particular case, the functional analysis of the hand-mouthing behavior allowed the authors to conclude that food would be a viable replacement. This study is somewhat limited in its generality to other individuals engaging in hand-mouthing behavior because there was only one participant. Although increased food intake worked for this individual it may not work for others.

However, with that being said, increased food decreased the hand mouthing and was less labor intensive for the staff at the facility. Permitting extra food at meal times was an easy solution to the hand-mouthing behavior and was not aversive to the participant nor did it pose an ethical dilemma for the staff as the restraints had. On the other hand, with increased food comes weight gain. This particular individual happened to need to gain weight but other participants may end up with a health problem. It is therefore suggested that individuals undergoing this increase in meals to prevent hand-mouthing, get additional exercise and perhaps some foods that provide chewing sensations without significant calories, for example chewing gum.

Relationship of Self-stimulation to learning in Autistic Children

2007-12-12T11:35:00.000-05:00

A research summary by Jennifer Morrison - CUNY Queens College

Koegel, R. L. & Covert, A. (1972). The relationship of self-stimulation to learning in autistic children. Journal of Applied Behavior Analysis, 5, 381 – 387.

Purpose of the study: To complete a functional analysis of the relationship of self-stimulatory behavior to learning in children diagnosed with autism.

Participants: The study included three children diagnosed with autism. These three children engaged in a variety of self-stimulatory behaviors such as body rocking, hand play, gazing at lights and repetitive vocalizations that interrupted their learning experiences.

Settings: The setting of the two experiments was at the three children’s home.

Target behaviors: Rhythmic body rocking, waving of hands: or objects in front of the eyes, gazing: which included looking at the house light, hand gripping: between fingers on both hands, hair twirling, hand/arm flapping, and repetitive vocalizations.

Procedure: In order to treat the occurrence of self-stimulatory behavior, the experimenters used a suppression technique which in experiment one included saying “no” and using a physical prompt to stop the self-stimulatory behavior in experiment one.

In the second experiment, they did not use the suppression technique and instead used a discrimination training exercise with the children. So for example, they would do a typical discrete trial type of format and present the child with the colors yellow and green and teach the child how to choose between the two colors. The experimenters hoped that by doing this it would decrease the amount of self-stimulatory behavior.

Results: The results of this study show several interesting things. In experiment number one, they showed that the suppression technique decreased the amount of self-stimulatory behavior but there was no evidence to show an increase in the number of correct trials of discrimination.
In experiment two, however, it showed that for one participant that the amount of self-stimulatory behavior was decreased and also the percent of correct trials increased also.

Implications: This study has quite a few major implications. First of all, from the results of experiment two, this show that perhaps indeed a positive reinforcement procedure is more effective than a punishment procedure in decreasing the amount of self-stimulatory behavior. The nice thing about the discrimination training method is that it also increased the percent trials correct by this particular student. This is an important implication in the treatment of self-stimulatory behavior in children with autism. The use of punishment should be a last resort and only used when all other possible reinforcement strategies have been tried. It is also important to look at the relationship between the self-stimulatory behavior and learning. It has been shown in this study that when a child is engaging in self-stimulatory behavior that they have a hard time attending to other things in the environment. This is an important idea to keep in mind in school and home based programs, especially before teaching a given topic. It is very important that if a child that is engaging in self-stimulatory behavior they are engaging in appropriate attending behaviors before beginning a new learning trial, and also that they are attending to the correct stimuli in the environment in general. If these two things are not present, then the chances that learning will happen are less likely in some situations.

Research Summary by Michelle Rodgers

2007-12-11T13:54:00.000-05:00

I am mentoring several professionals for their BCBA accreditation. In this process, they are required to read and review evidence-based practice in the literature. We thought it would be helpful to disseminate these reviews with parents and professionals. These are overviews of specific articles, not comprehensive literature reviews. I will post them up periodically. Enjoy.

Authors: Koegel, L.K., Koegel, R.L., Hurley, C., and Frea, W.D.

Title: Improving social skills and disruptive behavior in children with autism through self-management

Purpose of this study: To determine if self-management could be helpful in increasing social interactions and responses for children with autism, within the community, home, and school settings.

Participants: Four children with autism. These children had been identified, by caregivers, as unresponsive to other’s social initiations, even though they had at least the social skills of a three-year old. These children were also reported to engage in disruptive behaviors as a result of interactions initiated by others.

Settings: As a result, a clinic and community setting was used for each, while a home and setting and a home and school setting were used for two others.

Target behaviors: Making an appropriate response to social interactions of others through a verbal response within 3 seconds. An inappropriate response was defined as no response within 3 seconds, a response unrelated to question, or an echolalic response.

Procedure: A small wrist counter and edibles were used for the procedure. In order to teach the children how to self-manage, a clinician modeled an appropriate response to a question for each child. Then the clinician modeled how to make the indication through the wrist counter. Inappropriate interactions were also modeled and the clinician showed the child that a point could not be counted on the wrist counter. Once the child was wearing the wrist counter the clinician continued to model the procedure until prompts were faded. The children were reinforced for appropriate recording and this schedule of reinforcement was gradually thinned.
The children were also taught to reinforce themselves after a certain number of responses were recorded on the counter. The prompts for this procedure were also gradually faded. After these steps were mastered by the children, they were able to use this method of self-management in the other settings.

Results: The children had high percentages for recording appropriate responses and not recording inappropriate behavior. In addition to learning the self-management procedure relatively quickly, the children’s level of social interactions towards others increased in all settings. Disruptive behaviors were also lower after self-management was employed.

Implications: Self-management can be a successful technique to increase appropriate social interactions and decrease disruptive behavior in children with autism, who are functioning at or above the typical benchmarks for three-year-olds. This is a valid technique to decrease the amount of adult support that would otherwise be needed. Obviously, increased social skills allows for more social a

Response to Intervention (RTI) and Applied Behavior Analysis (ABA)

2007-11-13T23:47:00.000-05:00

Response to intervention has been getting a lot of air time lately both in school psychology and special education circles. A explanation of RTI and how it relates to ABA I thought was in order.

Response to intervention is essentially a model of intervention and diagnosis. The current model for referring and diagnosing students with disabilities is to refer them for an evaluation, which can take months for the referral, another month for the eval, another month for the report, and may lead to a referral that will not work for the child (e.g. resource room). RTI aims to change this process.

Defined: “…RTI is an objective examination of the cause-effect relationship(s) between academic or behavioral intervention and the student’s response to the intervention”

Basically, to identify if a child is having difficulty learning, the way you identify the disability is by monitoring their progress and looking at how they respond to a particular intervention.

Core Elements:
- Intervention is organized into levels of intensity
- It is diagnostic…if a child doesn’t respond to an intervention, could be indicative of a disability
- Keeps teachers and schools accountable
- Ongoing data collection
- Pre-referral

Basically, you need to monitor a child's response to a program through data collection and use their response to give you information about how to proceed.

Three Tiered Interventions:
First Tier: What you do at the first sign that a kid is struggling…basic classroom modifications.
Need to answer the question:
- Are routine classroom instructional modifications sufficient to help the student achieve academic success?

Second Tier: Individualized interventions tailored to the struggling learner
- For students that have failed with Tier 1.
- Can the individualized intervention plan carried out in a gen-ed setting bring the student up to the academic level of his or her peers?

Third Tier: The most intensive academic supports available in the school
- Generally for students with chronic and severe academic delays or behavior problems
- Often only available through special education
- What ongoing supports does this student require and in what settings should they be provided to facilitate the greatest success possible?

As a teacher:
- Need to monitor struggling students
- Act quickly, and support them early on
- Collect data and monitor progress
- Have access to a pool of resources of evidence-based strategies
- Monitor and track what you have tried, how effective it was or wasn’t, and communicate this to your school-based support team.

RTI is essentially a system to begin intervening and monitoring progress immediately in a classroom. How is this different than what is done in ABA programs? Behavior analysts identify a need, or a struggle, and implement an intervention, monitor progress, and change the intervention as needed based on the data. RTI is bringing this to the regular education classroom: guidelines to use these methods to work with struggling learners in regular education settings.

It is great to see data-based decision making entering our schools and the mainstream. However, it was written into the law in 2004 and is still not universally accepted in most schools, but it is a start.

I would love to hear any experiences with the RTI model in schools.

NYSABA Conference: November 1st and 2nd

2007-10-28T11:39:00.000-05:00

On November first and second, the New York State Association of Applied Behavior Analysis (NYSABA) will be hosting a conference at Turning Stone Casino in upstate New York. It promises to be an exciting and informative conference with well known speakers including John Baily, Dennis Reid, Peter Gehrhardt, and many others for invited addresses and small group workshops. See the link below for additional information on the conference schedule.

http://nysaba.org/mn_downloads/2007NEWconference_schedule.pdf

I will be presenting two workshops:

1. An Introduction to Applied Behavior Analysis for Parents and Professionals.

2. Pre-K Inclusion for Children with Autism: How to merge ABA and "Just playing and learning with other kids"

It is a two day conference and offers an array of speakers. Hope to see you there!

Conference in NYC: Meeting the Needs of Young Children with ASD and Their Families in Everyday Life: Sensory and Behavioral Perspectives

2007-10-08T12:35:00.001-05:00

I wanted to share this presentation with readers. The purpose of this presentation is to address concerns that parents and professionals have working with their children in the community. This presentation is a little different than others in that it addresses community situations (e.g. restaurants, doctors visits, birthday parties) from both a behavioral and sensory perspective. The information is below and seats are limited.

CENTER FOR AUTISM AND RELATED DISABILTIES (CARD) at Hunter College

in collaboration with
Resources for Children with Special Needs, Inc.
and the
Early Childhood Direction Center/Manhattan
New York- Presbyterian Hospital
Presents a seminar for families and professionals

Meeting the Needs of Young Children
with Autism Spectrum Disorders
and Their Families in Everyday Life:Sensory and Behavioral Perspectives

Saturday, December 1, 2007 9:00 AM- 1:00 PMRoom 714 West, Hunter College (SW corner of E. 68th Street and Lexington Avenue)

Moderator: Professor Shirley Cohen, Director, CARD at Hunter College and author of the book Targeting Autism.

Presenters:
Lindsey Biel, M.A., OTR/L, pediatric occupational therapist and co-author of the book Raising A Sensory Smart Child

Jamie Bleiweiss, M.A., behavior specialist, consultant for the ASD Nest program, and advanced doctoral student at Stony Brook University

Angela Mouzakitis, M.S. Ed., BCBA, faculty member, Graduate Programs in Special Education at Queens College, consultant for the Intensive Kindergarten, and advanced doctoral student at The Graduate Center of CUNY

Admission is free. To reserve a place, register in advance by leaving an
e-mail message with your name and phone number at: hcard@hunter.cuny.edu or (if you do not have access to e-mail) by calling (212) 772-4822 before Tuesday, November 27, 2007.

Coffee and sign-in at 9:00. Presentation begins promptly at 9:30.
(Childcare will not be available at this conference.)

Classroom Management in Special Education, Pre-K and K: Notes from consultation observation

2007-10-03T09:42:00.000-05:00

(Before I start, my spell check isn't working so pardon the errors.)

In some of my consultation work, I see classrooms that are just getting started with children with autism. While they may not incorporate DTT in their instruction, the principles of behavior analysis are applied and are inherent in proper classroom management. I wanted to post some of the recommendations I have made across classrooms: these are simple changes that can be made to help the classroom run more smoothly, aid student transitions, and help students understand the expectations of the classroom and day. As the school year goes on, I'm sure more suggestions will come up.

Before I post the observations and recommendations, I want to be clear that working in a classroom with children with varying needs and disabilities while rewarding, is incredibly challenging. I have taught in these classrooms, and recognize that as a consultant, it is easier to identify ways to improve the classroom that may be difficult to see when you are in the trenches, on the floor, with a child that is frustrated and showing you how frustrated he is (to put it mildly). I give props to these teachers and the efforts they make to teach their students and work diligently to ensure that they progress over the weeks, months, and school year.

1. Follow the lead of the classroom teacher - Teacher assistants are not shadows for our children. They are essential members of the team, without which, these classrooms wouldn't work. But there is also a role that needs to be followed. Teacher assistants need to support the teachers lead, follow it, and ensure that the students are attending to the teacher. There should be no side converstations, or additional and possibly contradictory directions given. For example, if a teacher assistant says "time to clean up the blocks now" and then the teacher makes an announcement "Clean up in two minutes" the student(s) have just been given a contradictory message. Keep it consistent, and keep the big direction coming from one person.

2. Any activity can be turned into an instructional acitivty - Even clean-up. In many classrooms, adults are doing the clean up while the children are running around with the classroom teacher trying to get them to sit. Every part of the day can incorporate instruction and language. clean up can have a visual schedule that children need to follow and complete. Within this visual schedule, you are working on picture recognition, reading, following a sequence, communication, attention, and appropriate clean up skills. This will not only teach, but keep the children engaged during transition activities which decreases probability they will get more riled up while clean up is completed by someone else.

3. Length of time in group instruction - For many of out children, staying in a group is not a time for instruction, but rather a big "wait" program. Waiting is an important skill to learn, but should not be run this frequently. Group instruction in these class is often too long, and after 5-7 minutes, instruction is lost, children get antsy and problem behavior develops. Proactively, limit group instruction and after 5-7 minutes provide an interactive hands on activity that will apply the group instruction. This goes for circle, morning meeting, math lessons, writing, etc. Change it up before things get ugly.
Example: Break a lesson up with different activities that might address the same concept
Math – a math song, manipulatives at table, math and the computer, counting with blocks,
number hunt in the classroom (each less than five minutes)

4. Don’t push the children too far beyond what they are capable of – We want the children to continue to learn throughout the day, but it is everyone’s responsibility to ensure that we are pushing the children to their appropriate level and not to do something that is way beyond their ability level.
For example: A child that is using one-word requests, can be pushed to use a two-word
request, but if you take it further than that, frustration is inevitable.

5. Individual schedules – As the first couple of months of school are passing, attend to who would benefit from and individual schedule, prioritize and slowly introduce it with each child. See Krantz and McClannahan for information on creating visual schedules.

6. Respond to appropriate requests – Most of our kids have a difficult time with communication skills and behavior. Therefore, we want to ensure that when the DO use appropriate language, that we are responding to them quickly and appropriately.
Even if a request cannot be honored, acknowledge it and identify when it can be honored, or a replacement suggestion. Otherwise we will be encouraging perseverative requests.

7. Modify lesson on the spot – If you are engaging the students in a lesson, and it looks like it is not working, change it or modify it based on your student responses
Example: Observing that a game is becoming "tired" and children are losing interest,
change it and move on, or you might incur the wrath of problem behavior. Proactively,
identify what your students can handle.
Example: If children aren’t responding on the rug, get them off the rug and change it up.
You might address the same skill at the table, then move them back to the rug to break it
up, and then even to a different spot in the room to generalize the same skill.

8. Table top time – This is not a time for just independent play. We need to engage the children with: Language, Play models, New play ideas, Commenting
Example: Maybe create idea cards to keep in each activity bin to help each child come up
with new ideas on how to play with the activity.

9. OBJECTIVES – For each lesson plan, activity, song, manipulative, we need to have a “POINT” to the lesson. Look at your activities, and write out objectives of what you think and what you want you students to get out of the activity. Start simple, with one or two objectives for each activity, and maybe alternate them between days.
- Move on when the students have mastered the objectives
- Differentiate objectives depending on the students level
Having written objectives is the ONLY way to know if our students got something out of your lesson. It makes your lesson measurable.

10. Positive feedback – Children need to get not only corrective feedback about their behavior, but positive feedback about what they are doing correctly. This needs to be differentiated for each child and by each activity
For example, if we know a particular child has a hard time with writing, we need to
increase praise feedback during writing, while other times that he has an easier time, we
could decrease the positive feedback making it a little more natural and sporadic

If we see a child is not responding, it may not be a skill deficit, but no understanding the expectation and needed clearer reinforcement. Bump it up a notch to get them excited again.

11. Pre-requisite skills – When preparing a lesson, keep in mind the skills that are needed to perform the activity that might be unrelated to the goal of the program: You may need to teach them first before you implement your lesson:
- Waiting in line to jump in a bean bag and find a match
- Sitting on the rug appropriately in order to engage in a math lesson on the rug
- Holding a crayon properly in order to color and identify a rectangle

12. Identify when the activity should end – Sometimes an activity can be modified and maintain the children’s attention, other times it needs to end. We need to REALLY attend to the behavior of our students in order to identify when it is time to end the activity and move on to something else.

13. Pay attention to your staff ratios when lesson planning – Staffing is often a problem, and some lessons don’t work, no matter what, with only two staff in the room. Monitor and plan accordingly. Additionally, when you have high staff ratios, plan your intensive 1:1 academic time. These are opportunities to be capitalized on with no one on book on tape, long-term computer, or independent activities.

Hope some of these guidelines help. As always, feedback is requested and welcome!!

Prioritizing Behavior Goals

2007-09-18T08:12:00.000-05:00

The first month of school is now in full swing for most of us. I've been working in several schools as a behavior consultant, and while problem behaviors abound, none are particularly unique. What is especially abundant across all classrooms I have worked with is the urgent need to fix everything immediately so that the class can run smoothly. This is not possible and it cannot be understated that this "need" to get the class under control immediately will hinder actual progress.

Priorities need to be made. While all children in a class need to make progress and we want to help them all equally, there are several challenges that we face working in classrooms, and we need to prioritize what is feasible to target. Where do you begin?

First, I would recommend, do not go in with your arms swinging getting ready to change everything immediately. The first few weeks of school are challenging, and many of the challenges subside as children acclimate to their classrooms. The child that is engaging in tantrum behavior because Mommy is leaving, will most likely decrease this behavior as he learns that reinforcement is accessible at school as well. It is easy to feel overwhelmed at the beginning of the school year and that things will never calm down, but wait a few weeks, provide your class with the structure and consistency that you promised, and some of the challenges will subside.

Second, take data. These first couple of weeks will give you invaluable information about where your students have started for you to compare and measure progress come December, March, and finally June. Data doesn't always mean numbers and figures. At the end of the school day, a sentence or two on something eventful for each child in your class will give you an anecdotal record of the child's current level of functioning for you to compare. For example:

- Jonathan 9/13/07 - No verbal behavior today. He watched peers playing for two minutes but kept to himself and engaged in self-stimulatory behavior most of the day.
- Jonathan 10/14/07 - Initiated play with a peer by handing him a block. Said "help build"
- Jonathan 11/5/07 - Used subject object verb to ask for help "alison, open box"

A sentence for each student might give you more information than you thought, and is a nice anecdotal gauge of progress. It shouldn't be the only measure of progress, but in the beginning, when you aren't sure what to target and what areas of concern will be, this anecdotal record may help you to pinpoint some areas of concern or areas of a child's strength.

Third, after a week or two has passed, and you have taken some anecdotal notes, take a look at what some of the significant challenges may be. If you have a child that is tantrumming at high rates in your class, this is a priority. The disruption will hinder learning for other students, disrupt the flow of the class, and affect the atmosphere you may be trying to develop in your classroom. It is when this priority has been identified, that formal functional behavior assessment should begin, and a formal plan should be implemented soon. If five children are engaging in significant interfering behavior, pick ONE to start. You will be more effective putting your energy into one complete assessment at a time, rather than attempting to cover all the students in your class and not being comprehensive across any of the plans.

This is important, as it is more the norm that everything is tackled at once, with less precision and skill. A classroom may have many students engaging in problem behavior and all interferring behaviors are tackled at once in a half-assed manner, more out of desperation than out of carelessness. Take the time now, to work through each child comprehensively, and the benefits will be reaped later on.

Fourth, Communicate with the related service providers and your team on a regular basis. If you are working with a population that requires extra support, weekly meetings should already be in place. If not, make an attempt to touch base with the team members weekly. Priorities should be identified and discussed across a team, and all team members should be consistent.

Fifth, take data. As you identify your priorities, you should be taking data on the levels of interfering behavior before you intervene (baseline) and the levels of interfering behavior after you intervene. For example:

- September summary (baseline) - Jonathan averaged 45 instances of screaming per day
- October summary (intervention - behavior plan implemented) - Jonathan averaged 25 instances of screaming per day.
- November summary (intervention - same) - Jonathan averaged 10 instances of screaming per day.

This simple frequency data gives us information that our plan may be working.

To be clear, I'm not advocating that the rest of the children in the classroom be ignored while Jonathon is our focus, however, as data collection and functional behavior assessment starts for Jonathon, you can move on to identifying the next priority and preliminary data collection can begin on Kaitlin. I am admonishing, however, that to attempt to fix everything in the first month of school will not end in success.

Does it really matter what orienation a strategy comes from???

2007-08-23T15:17:00.000-05:00

I'm getting tired of defending the principles of behavior at different meetings and to colleagues. Frankly, I shouldn't have to defend them. Whether you like it or not, the principles of behavior are exactly that: principles. They aren't theories, they aren't underlying orientations. They are principles of behavior that explain learning. Period. It is not a religion. You can't choose to BELIEVE in behavior analysis. Behavior analysis doesn't ask you to believe in it. The principles are as concrete as the grass is green. The principles aren't debatable. They exist. That being said...

Any teaching strategy that includes these principles and uses them to teach a child is fair game. As long as you can measure it, gauge progress, use it. Did you know that Greenspan was the first guy to say "put it high up on a shelf so the child can't reach it, and that way he will be encouraged to ask for it..." Does any behavior therapist or analyst NOT do this??? Because Greenspan did it, and I disagree with other methods of his, does this preclude me from using this strategy because I am an ABA therapist? Of course not, and it is just as ridiculous to exclude effective strategies that may stem from other disciplines, as it is for the interventionists from these programs to pretend that their strategies are not behavioral in nature.

To be honest, I don't consider this an eclectic model either. I consider it a behavioral model. This is because I am monitoring effectiveness, using the principles of behavior, and teaching and shaping a behavior. The idea may have come from Greenspan, but this does not make me a Greenspan follower. I think it is a cool and good idea, and I will try it in my programs. This is the beauty of behavior analysis. You are not limited. Your role is to identify a goal, find a way to measure the behavior, find a way to teach it, apply the principles, and analyze your effectiveness. Not to shy away from a program that didn't first appear in The ME Book.

Eye Contact: ABA, DTT, and RDI

2007-08-14T08:39:00.000-05:00

Eye contact for children with autism is always a concern. Well, not always, but usually. I do work with one little boy that appears to love looking people in the eyes and teaching this skill took all of four days when he was two-years old. For the rest of our kids, it can be very challenging.

Different orientations go about teaching eye contact in various ways. While I've voiced my opinion on RDI in the past, I will discuss it as additional strategies here. But in summary of previous posts, behavior is behavior. If you want to teach a new behavior, like eye contact, it WILL be taught using behavioral principles, whether you are comfortable calling it that or not. RDI provides us with strategies that modify the environment and provide creative ways to elicit eye contact, but eventually that eye contact is reinforced (ABA) shaped (ABA) given differentiated reinforcement depending on quality of eye contact (ABA) elicited by modifying the environment (ABA) elicited by using a discriminative stimulus (ABA). It is all ABA.

Where ABA has fallen short on the eye contact issue, in my humble opinion, is by not exploring more creative methods to elicit eye contact, and to make giving eye contact important. I'll go over some traditional methods that have been used to elicit eye contact, and then how some RDI ideas can be incorporated into an ABA program (since they are all based on behavior principles anyway.)

DTT - Discrete Trial Instruction/Training programs tend to teach eye contact in very contrived situations. A child will sit opposite a therapist, and given the directive "look at me" or the child's name will be called. Depending on the level of the child, a reinforcer will be held at the teacher's eye to help the child understand where they should look. Contingent upon eye contact, the child will immediately receive the reinforcer, possibly providing a token, and providing praise. It make look like this.
Teacher: "Look at me" (while holding an M&M at her eye)
Child: Looks at M&M and glances at teachers eye
Teacher: "Excellent looking" and provides M&M immediately.

This is an effective method and will teach a child to look at someone at the eyes when a demand is placed, when their name is called, when a reinforcer is present. However it doesn't always generalize. Some children that I work with look at me beautifully in the eyes, but when their grandmother says hello, they are looking anywhere but her eyes. Why? Maybe because she is not holding an M&M or a reinforcer in her hand, so the MO (motivating operation) to look in her eyes is not there. The child has not generalized that looking at people in the eyes is reinforcing.

ABA - Applied behavior analysis will of course incorporate the strategies used above, slowly fading out the item at the eye, just like DTT, until the child looks at the teacher's/parent's eyes without have a reinforcer within eye sight. Other methods are always used. In my programs, I prefer not to demand eye contact, but rather to wait for the child to initiation eye contact and reinforce the spontaneous eye contact. An example of this is the following

Teacher: Holding Elmo toy that two-year-old child with autism clearly wants to play with.
Student: Pulling at the toy, while staring at the toy
Teacher: Teacher looking at child's face, not letting go of the toy
Student: Still pulling at toy
Teacher: Still holding toy....continues to hold on until child glances up at which point the toy is immediately provided with praise and excitement.

This method reinforces spontaneous eye contact as opposed to eye contact that is requested. What ABA therapists do is contrive the environment to elicit eye contact, and reinforcer the eye contact, assuring that future eye contact will occur at higher rates due to the reinforcement.

RDI? I don't think RDI strategies are inconsistent with applied behavior analysis (ABA). What I have learned by attending these seminars is how to be more creative with my children. How to give my a children cool reasons to look at me, give me eye contact and enjoy themselves while doing it. It is these cool creative ideas (reinforcing events) that when used in the environment (modifying the environment) will provide a stimulus (SD) to elicit eye contact (response). (Do you see how it all falls so nicely into behavior principles.

I tried some of these strategies with a child that I work with. RDI talks about doing the unexpected, getting creative, and making kids care about giving eye contact. Now, I don't know if I am making them care about giving eye contact as it isn't something that I can observe, but what I CAN do is note the response, which was fantastic, and it didn't include reinforcing objects, rather reinforcing people (myself). That is one of the core tenets of RDI: to keep objects out of it and build relationships with people, which is quite different from ABA and DTT which rely on tangible reinforcers heavily.

I sat opposite a five-year old child with autism, removed toys and reinforcers out of sight in the environment, I positioned myself in front of him and waited. He didn't look at me, save the occasional glance. When he would glance, I smiled. See below

Child: Glanced
Teacher: Smiled
Child: Glanced again
Teacher: Blew air in his face
Child: Giggled
Teacher: Waited for eye contact again
Child: Gave it much more quickly
Teacher: Pinged child's nose
Child: Giggled, and while maintaining eye contact, blew air in teachers face
Teacher: Giggled, and made a raspberry on his cheek
Child: Giggled, and laughed, and said "blow"
Teacher: Blew air in his face, then by his ear, then on his toes
Child: Giggled, and pinged teacher's nose.

This went on, while maintaining eye contact. This is not an RDI program, this is an ABA therapist, using some of the creativity from RDI, and reinforcing and shaping the eye contact behavior of the child. At the end of this interlude, before he got tired of the game (satiated) I laid down on my back and left him alone. Normally, he would have walked away and found a toy to stim with. This time, that didn't happen. He watched me lay down, walked over to my face, looked at my eyes, giggled, and blew air at my cheek. I had made my eye contact and interaction reinforcing to him, so much, that he was seeking it out.

Understanding the Speech Mechanism: Impact on teaching and program development.

2007-08-01T12:52:00.000-05:00

I was co-treating with a speech therapist on Monday working with a child with autism that also appears to present with severe apraxia. While I'm not ready to debate the diagnosis or what it means, what is clear is that the child has a very difficult time articulating. Now as an ABA therapist, what does this mean to me, and how can I teach or shape his vocal behavior?

Many ABA therapists and programs do not feel that certain related services are necessary and that all behaviors can be addressed in an ABA program. While I agree that using good teaching and analyzing behavior and shaping behavior this is true, I as an ABA therapist simply do NOT have the knowledge base that a speech therapist has and I feel that this role is imperative on a team. That being said...

The two of us were targeting the "eh" sound found in many words, and the therapist was talking to me about "jaw grading". I didn't know what this was, nor had I ever tried to monitor it or shape it. Getting into a discussion about articulation, we discussed all the components within communication and cognitively, that a child must be able to plan (motor planning) or rather coordinate in order to speak and more importantly, to articulate so that he can be understood. Below I will highlight the areas as I understand them, as a behavior analyst, not as a speech therapist.

Jaw grading - the child needs to open his jaw to an appropriate degree, and this requires planning. For example, a jaw almost completely closed (found in the 'eee" sound) or completely open (found in the 'ah' sound) are the easiest positions and easier to shape and teach. However, three positions in the middle (one of those producing the 'eh') are levels of jaw grading and requires skill to identify what level the jaw should be open to target a specific sound
Lip closure - in addition to the above, lips need to be shaped in a certain way in order to produce target sounds, paired with appropriate jaw grading. Another area that a child must gauge level of lip closure, opening, forming, etc. that is needed in order to produce the target sound.
Tongue placement - while all this is going on, the child needs to place his tongue in the correct position, which is also difficult to prompt. Therapists have become quite adept at prompting the lips and jaw, but the tongue presents quite a challenge, as evidenced in trying to teach a child with artic difficulties the "l" sound.
Breath and volume - how loud the child says the target. With kids that are low-tone, this presents as a unique challenge.
Tone - how appropriately is it said? This can be a problem for many children on the spectrum who sound robotic at times, or their voice fluctuation is off.
Retrieval - Cognitively, in addition to all of the above, the child needs to retrieve the target label, request, word, etc. when needed. Often children will imitate beautifully when presented a model, but the word falls apart when they have to label it with no model, or are requesting spontaneously.

All of this, requires a lot of work for some of our kids. It is amazing they find the energy to talk at all, given how much is involved and how much cognitive energy must be expended in order to get the target out.

What does this mean for our programs?

- Collaboration with speech therapists is necessary, and how to prompt the appropriate Jaw grading, lip closure, etc. is imperative. While as ABA therapists we are not PROMPT trained, there are techniques that can be taught to us to help us obtain the target sounds.

- Practice. Repeated practice in isolation and distributed practice throughout the day (sound familiar?) However the targets need to be clear and identified upon in a team fashion with the speech therapist input regarding the skills mentioned above and what the child is capable of doing at this point.

- What is difficult? When functional words you want to target encompass skill levels that the child is having a difficult time with. This is where speech and ABA butt heads a little. The speech therapists want to hold off on the words and sounds the child can't say until they can do so with fluency, and the ABA therapists want to get this kid communicating one way or another. A compromise has to be reached here. Functional words need to be targeted, while these sounds may need to be prioritized as speech goals. For example "I jump on trampoline" may be impossible for a child to say, but it is his favorite activity, and asks for it a hundred times a day, the articulation needs to be shaped, even if it appears he isn't ready for it.

Co-treating with speech therapists is always incredibly informative, this time more than others, and I felt like I had a stronger understanding of "why" a child may not be able to get a word or sound out. This also shows how collaboration is necessary in addition to informative and helpful. Any comments are appreciated. I do have a lot more respect for how touch it is for some of our kids to get these words out and give them props for trying.

Observation of a DTT Classroom: One example

2007-07-24T16:48:00.000-05:00

I had the opportunity to observe a classroom that followed a strict DTT model. The students in the class followed schedules, and were on half hour schedules of DTT work with instructors. The students were all on token schedules individualized to their own level of tolerance. For example, some students were on token boards that consisted of ten tokens, others of five tokens.

Each work session consisted of a particular program targeted. For example, a child would be presented with a picture I.D. program. He was presented with the materials and provided tokens for correct responding. Occasionally mastered social questions were intermixed.

When the child earned his reinforcer (after having earned all of his tokens) the instructor provided him with the reinforcer to enjoy on his own.

What struck me about this program was the lack of interaction between the teacher and students, let alone between the students with other students. All of the interactions between teacher and student were in the form of directions and praise. There was no act of developing a relationship, playing, or playful interaction. There was also little or no requesting on the part of the student.

While DTT is an effective strategy, I was taken aback by the lack of friendly, playing and relationship building time during this observation. My post was spurred by my urge to caution programs against this. I can't understand why DTT in this setting couldn't be implemented in addition to strategies that address rapport building and spontaneous language in the form of comments and requests. The students in turn responded by providing little eye contact or interaction with the teachers.

DTT will teach skills, but these skills are useless if they are not practiced in a functional manner throughout the day. Reinforcement from people should be built into these programs. If a child earns a toy as a reinforcer, a teacher or peer should be involved to help these kids find reinforcement from people, not just from things. Rather than standing back during periods of reinforcement, teachers and peers should be paired with reinforcers, breaks, etc.

In some models that incorporate a strict DTT strategy, spontaneous language is punished rather than reinforced. For example, if a child looks out a window and appears distracted, this is a learning and language opportunity. It may not be appropriate to automatically redirect the child to the task at hand; rather capitalize on this opportunity to prompt language "I want window" talk about the window, and then even incorporate it into reinforcement. Reinforcer assessment should be ongoing and dynamic. Reinforcers changed and constant analysis of this change is necessary.

Another observation was the immediacy of prompting if a child didn't respond. For example, if a child wanted to access a reinforcer, and did not provide the appropriate request within a matter of three seconds, the language was prompted. If the language is within the child's repertoire, I personally would have waited a bit, to see what the child would give me. Something motivating is already present. Waiting, might have gotten a more independent response and reinforced the independent request, rather than possibly encouraging prompt dependency. I'm not recommending waiting for minutes, rather just wait a bit longer for the independent mand/request.

While models differ, DTT, RDI, PBS, VB, ABA, I can't understand why there needs to be such a clear distinction between these programs. Some skills are effective taught in DTT, but there shouldn't be a reason to neglect strategies that develop relationship between our kids and people, nor should spontaneous language and manding be ignored. I don't see this as an eclectic model. I see this as ABA. The principles of behavior should be applied to any strategy, but across domains. The model I observed mentioned above, to me, seemed to be lacking. I'm not debating the effectiveness of DTT. I not only acknowledge it, I revel in it, and incorporate it when needed in my programs. But it isn't the only strategy, and I'm curious how social and relationship development domains are expected to progress when they aren't addressed in a functional manner with distributed practice over time and context.

The challenge becomes how to incorporate these evidence based practices into a program that addresses the whole child: social, behavior, academic, communication. These areas can be address in programs that follow the principles of behavior analysis and are monitored for effectiveness with changes made as necessary. They cannot all be addressed using one strategy and one strategy only.

To iterate, re-iterate, and re-re-iterate, DTT does not equate ABA. A program that follows DTT is doing just that, follows a DTT model, and doesn't necessarily follow all the principles that an ABA program would entail.

Teachers and Therapists: Reinforce the good ones

2007-07-19T09:28:00.000-05:00

I noticed after perusing my blog topics, that I talk a lot about parent collaboration, the need to include parents, and the tendency for some professionals to discount parent input. But there are so many dedicated teachers and therapists that go above and beyond for their families and children and they need some acknowledgment and discussion.

Working with children with autism is rewarding, but is also very challenging. In the programs where I teach, I am constantly reminded not only of the challenges that school and center-based classroom teachers face, but also the dedication that many of them exhibit to obtain information, resources, and support to work with these wonderful yet challenging kids. Some of the schools that they work in are incredibly under-supported and underfunded, and often, teachers will dig into their own pocket to purchase materials, snacks, and activities for their classrooms. This is not the case of all teachers, and we have all encountered the jaded and miserable teacher who is counting down the days till summer and breaks, but lets not forget about the dedicated teacher that is busting his/her hump to work with and teach children using evidence-based practice. It is a really difficult thing to be a good teacher, and they should be praised for it.

The home-based teacher/therapist has other challenges. It is difficult to find good home-based therapist because the job doesn't always reap the same benefits as a center-based program. At a center, all the kids are there, you drive to one place, have built-in paid prep times and breaks, and have a host of colleagues that you can trouble-shoot with, complain to, and chill out with in the faculty lounge. You have a guaranteed salary and supervision as needed. Health care is provided and summer breaks are also guaranteed, with the option to work should you so choose. Maternity leaves are included, and sick-days are provided without complaint.

The life of the home-based provider is very different, and not always coveted. While the pay (at least in New York State) is not-bad, there are many sacrifices that are made: living out of your car, paying for all your supplies and resources out of pocket, going into some one's home on a daily basis (essentially have no home-base of your own), limited interaction with other team members save monthly team meetings (if you are fortunate enough to be on a team that has monthly meetings), gas prices, last-minute cancellations, dead time between sessions, guilt over bathroom breaks, and guilt over therapists having to cancel and feeling the need to explain why. Additionally, the lines of responsibility of the home-therapist may blur at a much faster and more significant rate. Going into someones home on a daily basis has a very different dynamic than having a student enter your classroom and your domain. Travelling in your car five separate times in the snow differs greatly from driving to and from work one time in a day.

There are a lot of considerations to opt to be a home-based teacher versus a center-based teacher. Most of us opt for home-based because the perceived rewards are better. We see a LOT of progress, even in one session. We get to work with the child one-to-one, establish rapport, and grow to care about the entire family. We see the child in their natural environment and can use that to our advantage.

This post is by no means a rant. Rather pointing out that there are a lot of good teachers dedicated to the field and many considerations they need to address in order to choose their location mode of service provision. Lately a lot of complaints have been surfacing the list-servs about the salaries that are demanded, attitudes and arrogance, and while I think they are well-founded in many situations, I think some praise is due to the good ones out there.

ABA versus RDI

2007-07-15T11:09:00.000-05:00

Looking through the links that have referred people to this site, often the search words "ABA vs. RDI" come up. I have a couple of comments on this.

Well, nothing is out there at this time comparing these two approaches. In order to compare the two, you would have to have a set of children in an ABA program that incorporates NONE of the guidelines outlined in RDI, and find a set of children in an RDI program that incorporates NONE of the principles outlined in applied behavior analysis and compare progress and outcomes for both of them. This, in my humble opinion, will never happen. Mostly because it is almost impossible to extricate what is ABA from what is RDI to what is Verbal Behavior to what is natural environment teaching. All programs incorporate behavior principles, whether they care to admit it or not. Positive reinforcement, negative reinforcement, chaining, shaping, are intrinsic to good teaching. A good program incorporates all of the aforementioned teaching strategies and embeds the principles of behavior analysis within them, both to teach, monitor, and analyze effectiveness.

Rather than perpetually attempting to disprove the effectiveness of ABA and constantly criticize the flaws of an ABA program, lets take a look at some of the skills that programs based in applied behavior analysis are not as adept in (e.g. relationship development, joint attention, body language) and lets identify programs and strategies that will address some of these concerns. Admittedly, ABA programs usually do not have a goal that targets joint attention. It is neglected, I think mostly because a way to teach it hasn't been analyzed, researched and supported. But that doesn't mean it can't be.

What I would like to see in the searches is rather than "ABA vs. RDI", things like "how to incorporate RDI into an ABA program and measure the effectiveness of strategies outlined in RDI." This is more realistic. Analyze the effectiveness of the strategy. I see RDI as outlining strategies to teach skills that are difficult for children with autism, and for teachers of children with autism, to address. I'm intrigued by some of the strategies, and incorporate them into my home-based programs. The difference is, we measure progress.

How do you measure progress in an RDI program? Identify what the goal is that you want to teach, and measure it. If your outcome is "the use of nodding to communicate assent or agreement non-verbally" now you have an outcome, that can be quantified and measured. How independent in contrived settings? How independent in contrived settings in the community? How independent in novel environments, with novel people, etc. It isn't the programs that are at battle at each other. ABA therapists don't inherently dismiss other programs. Let's just measure it. I would love nothing more than to have another strategy identified as effective to teach some of these challenging skills.

ABA programs should embrace new strategies that show promise for efficacy, and it looks like programs are starting to open their arms to incorporating other strategies from "perceived" opposing domains. But they aren't opposing, which is important to remember. What is important to identify is not the orientation of the creator, but the effectiveness of the strategy.

Parent and therapist relationships in home-based programs

2007-07-11T21:04:00.000-05:00

When a family is running a home-based program for their child with autism, dynamics are very different between family and teacher than they would be if the child was in a school/center-based program, and from my experience, it appears to be a neglected topic of discussion in the research, on forums, and in training programs.

Home ABA programs usually have high mandates of hours per week. For example, children that I work with have anywhere from 28-36 hours of ABA services in addition to related services of speech, PT and OT. This may mean that a family may have streams of therapist in and out of their home ALL DAY LONG. This has an impact on the family. While this is a program that they probably fought for, it doesn't make it easy to manage. The home starts to feel like a center.
- Family members may feel like privacy is violated.
- Freedom is somewhat limited (freedom to say what you want, wear what you want, scratch where you want).
- They may have people coming into their home, that while they respect their skills, may disagree with their lifestyle, dress, attitude, and yet need to welcome them into their home.
- Parents may also begin to feel ineffective, as there is a stream of people who may be more effective engaging their children, in constant presence.
- Simple acts in the home, conversations among members, parties, meals, may lose their intimacy, coziness, and privacy, all of which impact the family.
- Siblings may feel neglected, or left out, when a therapist shows up with a big bag of toys for their brother or sister. Additionally, some siblings may not want to have their own friends over fearing the need to answer questions about the therapy occurring.
- The parent is the only constant in the home, and is often left the role of providing communication among the various therapists about what has occurred that day. This can be exhausting and confusing.

These considerations need to be taken by therapists, respected, and therapists need to act accordingly to minimize discomfort when ever possible.

There are many factors that I have left out, that parents would be better at outlining, but I wanted to put it out there, that it is important to consider what the family is experiencing within this context of service.

Another difficult area is the personal relationship between the parent and the therapist. When an individual is coming into your home on a regular basis, you get to know them. You may start asking personal questions about how their weekend was. If that person looks sad, you may ask if they are okay. This happens in the therapist/parent relationship as well, and it is a VERY DIFFICULT and SHADY area. How far this is taken may make or break this relationship. It has hurt teams that I have worked on.

We are human, and we care about other people, but at some point, a line can be crossed, and the child's progress may suffer as a result. If a parent feels pressure to "take it easy" on a therapist, because she knows said therapist is not feeling well, is having personal problems, or is undergoing a stressful even (divorce, buying a house, death in the family) it inevitably compromise the relationship and service that is provided. It is difficult to keep it professional when a person is coming into your house (or you are going into theirs) but this line needs to be carefully attended to.

Several problems can occur when the relationship is compromised. One of the most important, is that if you start liking your therapist "as a person" too much, you may not be able to see that you need the opinion or input from another professional. Your vision may be clouded by the relationship that has been formed.

Additionally, as a parent of a child with a disability, you have your hands full. The parent shouldn't be responsible for caring about what is going on in the life of therapist. They need to focus on their child, their family, and maintaining order in the household.

It is easy to say "keep it professional" but difficult to do. Also, how appropriate is it to stick to just the professional chatter and not inquire about someone who looks like they are feeling under the weather. Tough spot. But important to acknowledge and attend to the issues that may come up and how certain relationships may be compromised.

Feedback and possible suggestions are welcome. Post them up!!

Families as Partners (FAP): New Early Intervention Regulations

2007-07-06T18:26:00.000-05:00

I recently went to a training addressing recent changes in early intervention service provision, and was surprised by some of the new regulations. Not surprised because I disagreed; rather surprised because I have rarely seen them implemented appropriately. Here is a brief review of these regulations, changes, and comments (of course).

FAPs overall goals are to support families: to help them learn skills to support their child's needs, to help their child learn, and to help the parents feel and be more capable to help their children.

These new regulation may have sprung from teams of teachers and therapists excluding the parent from the collaboration of their child's programs. It is now in the law that this collaboration, training, and interaction is documented. While it adds to our paperwork (therapists and parents included) it is increasing accountability of parent training and collaboration, which is always (really always) a good thing. Remember, it is EASIER to come in, work with a child, and leave. It is more challenging to teach a parent new to the field how to interact and teach their child. But it is the latter that will have more of an impact on the development of the child.

The receiver of the services is the family, not just the child. Emphasis is on the use of daily and natural routines. (some of us do this anyway, but certainly not all and definitely not most. They may say they do, but they don't.) The child is the reason for the service, but the child must be viewed within the context of the family.

Goals: These are no longer called goals. They are outcomes. What is written on the individualized family service plan (IFSP) should be exactly what the parent wants, not what the therapist prioritizes. So for example, a parent outcome might be "to play with his brothers and sisters." While this may hurt the eyes and ears of the behavior analyst, or anyone interested in quantifying outcomes in a measurable way, this is what the requirement is now. What this also means is that "Child will laterize tongue in order to produce the /l/ sound" is NOT a family outcome. This is a jargon filled term that is not considered acceptable for the IFSP.

This is challenging for the therapist. We now need to identify what is important to the family, and identify a way to meet that outcome, but read on, because it is not the therapists goal to meet the outcome, but rather the therapists/teacher's goal to help the parents meet the outcome.

Outcomes must be written without jargon. The family member should be able to understand the goals, as they should have written them.

Goals are written to include the child, the activity, the context, the time, and the family/member. For example: "James will use language to communicate his preference during dinner with his parents so that he can participate in meal time."

Training: Parents are no longer observers of therapy. Regulations stipulate that parents need to be involved in the sessions and taught how to elicit outcomes from their children. Recommendations for parents are that they are involved in at least 70% of the sessions of service their child is receiving. For example, if a child has three sessions of speech, two of those sessions should involve a parent or family member.

Responsibility is on two parties: therapist and family member. It is both parties that need to make the effort to do what is right for the child. This is a challenge for both parties. The therapist may not be skilled at training, comfortable working with parents, fluent in the parent's native language, etc. The parent may not be comfortable in the session with the therapist, feel effective as a parent, have other children that he/she needs to attend to, not speak the language of the therapist. To these difficulties, the answer is unanimously "work it out". As the priority is working with the child in the most effective manner, in the natural environment, with the family as providers. The therapist becomes the coach.

Documentation: In addition to the changes, there is written documentation of the services/training, that is provided. This documentation is again the responsibility of the provider and the parent. The provider (now called interventionist) must collaborate with the parent in order to identify activities that will facilitate progress toward the outcomes over the course of the week. Over the quarter, parents will document the therapist training, and their own response to the training. This is one of the first times that parents have the opportunity to provide feedback in a written statement regarding the quality of service they are receiving, which in my opinion is long overdue.

This was a brief review of some of the changes, but this is not what I personally seeing implemented. Rather parents are excluded from the collaborative process. It may LOOK like collaboration, but rather, it is the therapists outlining goals for the child, and letting the parent know about it, and how they could try to carry them over. This is placing the family in the heart of the services, which is where they should be.

However, this should not be interpreted to mean that the interventionists do not provide guidance in how to meet these outcomes. It is the interventionists responsibility to develop a program that will hopefully attain the outcomes outlined by the family. Let's see how it works out.

New Blog: Speech, Language, and Applied Behavior Analysis

2007-07-01T10:14:00.000-05:00

In an effort to increase collaboration among ABA and related service providers, I have started a new blog with a colleague of mine focusing on collaborative and programming issues between ABA and speech therapists. The blog titled Speech, Language, and Applied Behavior Analysis hopes to focus on concerns and obstacles that are encountered between the domains on teams for children with autism.

Diana (certified speech therapist) and I are both completing our dissertations at The Graduate Center (CUNY) but do not directly work together on teams for children with autism. As a result, our experiences on teams of professionals working with children with autism vary and hopefully will lend themselves to interesting discussion. Feedback and ideas for topics of discussion are always welcome. We are hoping to generate concerns from parents and professionals that will be used to stimulate discussion.

Home-based Team Meetings

2007-06-28T23:33:00.000-05:00

I had a team meeting tonight for a child that is receiving almost 40 hours of services per week. I thought it might be helpful to provide guidelines or at least a broad format for a home-based team meeting.

Frequency: For a child with many therapists working together, monthly team meetings are advisable. We meet for this child once a month.

Attendance: Everyone who works with the child should make an effort to attend the monthly meetings. At our meeting, in attendance were myself, five therapists, two speech therapists, an occupational therapist and mom.

Purpose: The purpose of the team meeting is to review the student's progress, identify any difficulties that the entire team has encountered over the past month, to update programs, and identify if there are new areas that the child may be ready to develop. Additionally, it gives the team an opportunity to get together and discuss overall ideas. ABA teams in a home-based environment can often be very isolating for the therapists and the family. A team meeting gives everyone an opportunity to collaborate and rejuvenate the "team" feeling. This is important, as sometimes, getting excited about a program when you feel like you are on your own, is more difficult. I find that after a team meeting, everyone, family and therapists included, are a little more excited for their next few sessions. Its like a booster shot.

Agenda:

Overview: At the start of the meeting, a brief overview helps the team point out any major concerns. It gives the family an opportunity to give an overview "feel" for how the child is progressing. Do we feel he is overall progressing? Is there a regression? No progress? This will guide the program over the course of the meeting, and help focus discussion.

Pressing Concerns from Family: I like to ask the parent at the start of the meeting to share any concerns that are affecting the family. This is usually a behavior that is interfering, and is very important to focus. If there is a concern in the family, this should take precedence over the meeting. While academic programs may not get reviewed, this should be priority and a plan should be put in place to help the family.

Behavior: If it hasn't been brought up until now, a brief discussion of the students behavior and progress should ensue. This is important in order to ensure that not only the ABA therapists are implementing consistent behavior support plans, but that the related service providers are on the same page.

New programs to be added: Any new ideas from programs should then be discussed. For example, tonight, we discussed four new programs that were probed and added by the team coordinator (myself) over the week. I had probed programs, and identified if they appeared to be appropriate. At the meeting, I posed them to the team and we discussed the appropriateness of the programs.

Book Review: Programs and graphs are reviewed. If the program is moving along nicely, the point does not need to be belabored. If there is a concern, the team will discuss the program and identify if it needs modification or additional supports.

Occupational therapy Review: The ABA programs are reviewed first in order to give the speech and OT an opportunity to hear the programs run and to give input. The entire process is collaborated on by the entire team, however usually, the ABA programs review all of the domains and often touch on the other domains.

After ABA program review, the occupational therapist discusses how the programs can me supported to include an OT perspective, and what additional goals can be addressed. The OT at this meeting had created a list of strengthening activities that should be followed by the team and progress on these goals were reviewed.

Speech Review: Much like OT, speech therapists discuss the goals as well throughout the meeting and provide feedback. If there are areas of development and programming that hadn't been discussed, the speech therapists would address it and provide suggestions and modification for how the team could support pacing, articulation and additional language development. This is not the only time that the related service providers collaborate, but having an opportunity to "have the floor" provides the therapists with time to cover what may have been missed (and there is always something missed).

Re-cap: Highlight any changes that will be implemented based on the meeting.

Schedule Next Meeting: Scheduling over email and phone calls is all but impossible. The best way is to schedule it at the meeting to ensure a day and time that everyone can make.

Time: These meetings tend to run about 2 hours. This may seem a bit extreme, but it also allows for the occasional digression which happens, and breaks up the meeting a little. If there is a significant concern, the meeting may run longer, but this is usually not the case. It is also rarely the case that the meeting is short.

Food and drink: While it may not seem important, having a little something at the meetings helps, and goes a long way to make the therapists feel appreciated. Some families go overboard with a full meal and dessert ensemble, which is lovely, but parents shouldn't feel the need to cook. It also depends on the time of the meeting. Coffee is always good. Anything else is supplemental. If the meeting is at a meal time (like tonight, 7:30-9:30) I find parents want to provide dinner, but this can get expensive and difficult to prepare if you have a family to take care of.

I find that meetings are very important. In earlier years, I have worked with teams that said they were "so consistent" they didn't need to meet. I found this ludicrous and arrogant. Everyone is different, and the diversity should be embraced. Out of this diversity may come some great ideas and successful strategies.

An ABA Session

2007-06-25T21:08:00.001-05:00

I worked with two children today, and as I was working with each child, it struck me how different each session looked. The children were very different (as all children are) and their skills varied across domains. I thought it might interest some if I chronicled the "look" of these sessions today.

The first child I saw, diagnosed with ASD, has a lot of language. By a lot of language I mean he speaks in full sentences, comments, has conversational exchanges, and would be classified by some as high-functioning or PDD-NOS. He does however have significant social deficits and engages in high rates of self stimulatory behavior. This is what the two hour session looked like:

Greeting and Book review: I walked in, and after greeting the family, relatives and child, I guided the child to an independent activity. I explained to him that I needed to read a couple of things, and while I did this, he needed to find something to play with. This is a deficit, so I helped him pick something out. I needed to ensure that he was engaged while I read the notes and reviewed graphs from other therapists to minimize his opportunity to engage in self-stimulatory behavior. After he was set up with an activity, I reviewed notes, identified goals I wanted to target, identified programs that hadn't been targeted recently, and made a little schedule for myself to ensure that I accomplished my goals for that session.

Talk and play: I like to start the session by playing and talking. I find this keeps the child excited to see me as a therapist, as I do not begin presenting "work" demands immediately. During this play and talk time, I work on conversational skills, requests, syntax, manding, commenting, wh questions (about the day, what he would like to do, what ideas, etc.) eye contact, rapport building, and play skills. Because it is a play time, it does not necessarily lack data collection. Anecdotal recording, trial data from various targets, are all taken. One of the positive points of reviewing goals and preparing targets at the start of the session, is that it gives the therapist and opportunity to hone in on the targets for the day. In addition, this time makes for a great opportunity to probe maintenance and generalization.

WH-Questions: Today, I targeted a structured program that targets WH questions. While this is an incredibly structured program "Auditory Processing of WH questions", it is an excellent guide for program development. The trick is, not to stick just to the program, and rather to extend the program to the child's natural environment. One of the sets of WH questions addressed vacuum cleaner and a young girl vacuuming. However, we did not stay married to the curriculum. With the book as a guide, the child and I explored the vacuum, discussed how it was used, how it was plugged in, the purpose, who did it, where they did it, did they vacuum the floor or carpet...etc. It is necessary to extend the structured curriculum away from the book and into the functional environment. It was time-consuming, but was met with rewards. When I introduced the next picture of a boy sweeping, the child responded "picks up dirt....just like the vacuum!" Mission accomplished.

Silly/what's wrong: While we continued to work on WH questions throughout the session, the next structured activity was a "what is silly, or what is wrong" game. Again, this comes with a book and a structured curriculum, as many programs do, but the therapist needs to take the structured curriculum into the natural environment. The book provided examples of silly pictures (someone diving into a pool with their jacket, driving a bathtub, etc.). I love this program because it elicits some pretty interesting responses and really gives me the opportunity to work on expressive language and "explaining things" which is often neglected in programs. After using the sheets, we took turns engaging in "silly" or "wrong" behavior. He got a kick out of it, and increased his skill at explaining "why" it was wrong, and what the appropriate response would have been.

Play time again: This time play focused on us. Although I love to teach play skills with manipulatives, I find that playing with people is important (a tenet of the RDI philosophy as well) and building people as reinforcing is imperative. We played a nodding game (again from an RDI model). Each time he nodded and looked at me with eye contact (appropriate, not serial killer staring), I gave him an airplane ride. My target was using body language to communicate. It took a while, but toward the end of the game, he got it.

Snack time: During snack, targets include your basic appropriate chewing, etc. etc. A lot of therapists like to work on conversation skills during snack, but this really depends on the age. The best thing to do is watch other children eating snack, and listen to what they talk about. At this age group (four) it isn't much. They usually eat if they are hungry, and start becoming task avoidant when they aren't. So I don't push the conversation.

Reading: Using the 100 lessons to teach your child to read (reviewed in another post). This was a quick ten minute lesson targeting phonics. He is up to lesson four and progressing nicely. It is a structured SRA program, and I follow the structure, as it is with the structure that the research supports it.

Social stories: Next we worked on a social story together. As I mentioned earlier, this child engages in a lot of self-stimulatory behavior, so the team creates social stories that are used to target the behavior, and provide replacement behaviors that will hopefully take over for the inappropriate behaviors. Today's story targeting saying "because" with no response. Whenever asked a question, he consistently responds with because, and then drifts off to an unintelligible statement. We created the social story together and generate solutions for "because" when he doesn't know the answer.

Wrap-up, book review: This is similar to the beginning of the session. I reviewed what we did with together, prompting him to remember what we did, making it easier for him to recall it when mom reviewed it after session. Then as the beginning session, I set him up with an independent activity while I wrote in the communication book and graphed data. This is very important to do. Often, at the end of the session, there therapists lets the child go, and the child may engage in self-stimulatory behavior while the therapist is writing. This teaches the child that's it is okay to engage in this behavior in front of the therapist and people in general. At the very least, we want to teach the children we work with that it is not okay to engage in this self-stimulatory behavior in front of others to hopefully minimize opportunities to practice the behavior.

This post is longer than I anticipated, so I will review a different type of session later this week.

Autism Bulletin

2007-06-23T07:57:00.000-05:00

I recently was directed to a review of this blog linked to the Autism Bulletin site. As a result, I checked it out: http://autismbulletin.blogspot.com/. This site is run by Michael Goldberg, a parent of a child with autism spectrum disorder. Michael Goldberg has organized his site to provide weekly posts regarding topics in autism, but also to provide invaluable resources regarding autism and therapies that are used to support individuals with autism in the news, law, and reports.

The site, designed to be a resource for parents, can also be an incredible resource to therapists, related services providers, teachers, and professors of special education. Resources and links are provided to access information regarding insurance laws, news briefs, autism coverage in the news, suggested texts, research, guidelines for parents, court decisions, and relevant laws that either address or affect children with autism spectrum disorder and their families.

Michael Goldberg has organized this site in a viewer and reader-friendly manner, making it easy to navigate and find information.

Expanding Assessment and Programming into the Community

2007-06-21T08:32:00.000-05:00

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.

Inclusion? - Preliminary Guidelines

2007-06-19T21:24:00.000-05:00

Perspectives on inclusion vary from person to person, and implementation of guidelines for inclusive practices vary not only from state to state, but often from district to district and even from school to school. While there is a current push to include children with developmental disabilities and autism into the regular education curriculum, universal guidelines are lacking, as is an agreed upon definition of what inclusion is. While accessing typically developing students, age appropriate curriculum, and the most appropriate and natural setting are all important, appropriate supports and guidelines are needed, and rarely provided.

Many schools have "inclusion" programs in their schools, but inclusion is defined in different ways. Officially speaking, an inclusive classroom should have a distribution of students that looks like the general population in terms of disability. Technically speaking, the general population has a disability rate estimated at 12-13% (APA, 1994). This translates to a classroom of 30 students, that three students should be identified with a disability, in order for it to be a true inclusion classroom. The purpose is to include children with special needs and not exclude them from accessing the same social and academic opportunities and experiences that typically developing children have. However, this ratio is rarely seen in "inclusive" classroom, at least not in the classrooms I have observed in New York State.

Inclusion begins before a child ever steps foot into the class. Preparation for each child is needed, with experienced and trained individuals as part of the team to guide the less experienced. Supports that should be in place in an inclusion classroom should include but are not limited to:

- Proper training and education for any staff that will interact with this child. The child should not be the responsibility of one para, or the special education teacher. The classroom as a whole, and all the staff and children in the class should feel ownership of all the students of the class.

- A classroom para-professional is needed to help the teachers manage the classroom, instruction, and social opportunities for the class.

- A classroom management program with behavior goals for all the children should be in place. All children will at some point exhibit interfering behavior and require classroom guidelines.

- Inclusion goals should be identified. The team needs to identify what goals will be the target of this inclusion class. To gain academic goals, an inclusion classroom is not necessary. The team needs to identify, what more will this child gain for this inclusion program, how will this goal be attained, what are the strategies that will be implemented in order to attain this goal, and how will progress be monitored.

- Although more difficult to get as a service on an IEP, a one-to-one shadow should be in the classroom to support the identified child for success. This shadow should be specifically trained, and this is one of the more challenging positions to fill (Please see post regarding appropriate training for shadows).

- Ideally, monthly meetings with all teachers, related service providers, and family members should be held to review progress, generalization, behavior, and transfer of skills to the home and community environments. These meetings are imperative, but again, often difficult to mandate and coordinate. Often the coordination may fall on the parent.

- Teachers: Different models that I have observed have appeared effective. One model, as two teachers in the classroom, one as a regular education teacher, one as a special education teacher. Another is a special education teacher that is in the classroom for an hour or two a day, and splits her time between various classroom. Yet another model has the special education teacher acting as a consultant to the regular education teachers, and her roll is more to train and support the teacher and the para-professionals. However, whatever the model, training and experience of the teacher will have an impact on the success of the porgram.

- Related service providers - Participating in an inclusion classroom does not mean that a child does not receive related services. As a result, the related service providers need to be trained to provide service in an inclusion environment as appropriate. This requires training in how to push-in. Pushing in, does not mean, going into the classroom and pulling the target child to the side of the room and conducting therapy. It means that each therapist needs to identify naturally occurring opportunities in the classroom that will help the child practice and learn the target skill.

- Buying into Inclusion - While this may sound like a sales pitch, it is necessary for the school, classroom teacher, special ed. teacher, related service providers, principals, assistant principals, school psychologists, lunch aide workers, etc., need to want this to work, and buy into inclusion as an appropriate place for all children with disabilities. This is incredibly challenging. Even with the youngest and freshest first and second year teachers, a cool eye is turned when inclusion is mentioned. Because of this, it is important to explain inclusion, and get everyone excited about it.

Even if all these supports are in place, parents may decide that inclusion isn't for their child, and would prefer a more structured environment. Of the children's home programs that I supervise, only 3 out of the 5 are in inclusion settings. As a therapist, I support parents in the decisions they make regarding their child's placement. I also feel that it is more important to have a good program, even self-contained, rather than a poor inclusion program.

The "chair", "table" and Applied Behavior Analysis

2007-06-16T10:17:00.000-05:00

The past couple of weeks I have personally encountered several worrisome "ABA" situations. I put this in quotes because it is not therapy based on applied behavior analysis, although the people providing the services are claiming that it is.

These situations involve keeping a child in a chair under inappropriate circumstances. Here are the few examples that I have encountered either first-hand, or told to me by colleagues:

- Meeting a child for the first time, scooping them up by their elbows and sitting them in a chair.

- Placing a two year old child in a highchair, strapping them in, and let them cry for an hour while "therapy" is conducted.

- Having an 18-month-old child sit at a table and chair and begin identifying objects while crying.

These are troublesome because this is not how a child should ever be introduced to learning: by restraints, tears, and punishment. This will set a child up for building an aversion to teachers, therapists, and eventually people, not to mention that learning will not occur while a child is unhappy and screaming. It cannot be overstated how inappropriate these environments are.

Yes, in their therapy sessions, eventually a child will sit in chairs and work at the table, but this should not be done when a child is 2. The table and chair is not an appropriate environment for a two-year old child. The appropriate environment is the floor, their room, the playground, the backyard, etc., and sessions should be focused in these environments.

When a therapist first meets a child and family that they will work with, the most important thing to establish is a positive environment and rapport. This is usually done by bringing activities that might motivate and entice the child. The child will begin to associate the therapist with fun, play, and engaging activities. This will help the child associate the entire therapy environment, and learning in a positive manner.

Building and establishing rapport should take precedence over ANY structured programs. Much more will get accomplished if the child is in a positive environment that if filled with reinforcing people and activities. This might take several weeks, but it also might take longer and parents and therapists need to understand that this time is incredibly important and establishing this rapport is paramount.

Additionally, the focus of the first couple of weeks of session should be getting to know the child, performing assessments in the natural environment through observation of the child's interaction with family, people, and the environment. Language samples should be monitored. As the child becomes more comfortable and begins to get excited to see his therapists, more structured programs can be implemented. However, the majority of ANY session, with ANY age child, should not be at the table. This is a tool used in therapy, but not the only one, and certainly should not be the focus of an ABA program.

This is a challenge for many therapists and families. Many of us are married to the table, and find it challenging to pull away from the table and engage the entire environment that a child lives in. While challenging, it is necessary, and requires talented and creative therapists to be able to use all aspects of a child's environment.

Therapists will not leave the table on their own and may require training and coaxing to leave it. The table is easy. Sitting a child in a chair, once instructional control is established and running cards and programs, is easier than identifying learning opportunities in the natural environment. Training is necessary. Often natural environment instruction is perceived as playing in the natural environment and questioning a child on labels, colors and shapes in everyday objects. Natural environment teaching requires planning, programming, and data collection and monitoring.

The bottom line is that the child's instructional environment should from the beginning be positive and enjoyable. If the child is screaming when he sees a therapist, crying at the table, something has gone terribly wrong and must be changed. ABA therapy for children with autism does NOT equate discrete trial teaching in a chair at a table. The principles need to be applied to teach a child functional language and skills that will promote independence in his life. This should be done in any and all environments that a child will experience. Divorce the table.

Parent Anecdotal Records

2007-06-13T21:43:00.000-05:00

Data collection can be overwhelming for many professionals, let alone parents that are trying to manage a household, additional children, and careers. However, parent reports are essential for programming and retention of services. It is imperative that logs are kept by parents.

Data is information. It is not always numbers and figures. Data can be an anecdotal record or log kept by families to keep an ongoing record of a child's progress, response to certain events, behavior following a change in diet or medication, etc. Anecdotal records can be invaluable to program development and assessment.

There are different ways to take simple anecdotal data that will inform program development, change in medication, changes in environment and placement, etc. One of the biggest downfalls of anecdotal data collection that hits parents is the intensity with with data is collected in the first couple of days, to a level that cannot be maintained, and so it isn't. A long anecdotal isn't required, but keeping track of significant events i not only important to look back and see when a behavior was first evidenced, but will help program development, and may help hold onto services. For example, if several therapists cancel on a particular day, and your child goes without services, you need to attend to his behavior and identify if you see a change. Keeping an anecdotal record of his behavior change will help you fight for the services, because now you have a record of evidence to show that a lack of services results in regression. Cancellations, illness, and car trouble happen. At least a record will show how this lack of service affects your child.

Usually school districts are not prepared to have parents come in with logs of anecdotal data. No one can argue with an ongoing log and anecdotal record that has been maintained for the past year. If numbers can be thrown in, even more impressive (e.g. three tantrums, four episodes of aggression), but you don't need to go nuts with percentages, etc.

There are several simple methods and types of anecdotal data that can be taken without being overwhelming.

Calendar data - Keep a regular calendar on the refrigerator. At the end of the day, write a sentence about how the day went. Was it a good day? Was it a bad day? If something significant occurred (a new word/request was used, a three hour tantrum, initiating play for the first time) jot it down in the calendar.

Notebook log -Similar to the calendar, but a little more freedom to write if you are so inclined. Keep an ongoing log. If something significant happens, you can elaborate, if it was an average day, state it. If you are using vitamins or medications, logging this information is imperative, along with notes of any side effects that your child may be experiencing in regards to the meds.

Things to share list - If maintaining the log proves to be challenging, make it even easier. Tape a piece of paper to your fridge, and if something happens, jot it down. Then you have something to share at team meetings, or with the next therapists that comes in the door.

Positive and Not so Positive - Sometimes it gets difficult to see the positive things that happen in a day. Keep a list with two sides: on one side have something great that happened today, and on the other, something that is concerning. This will hopefully bring out positives in your child's day, and limit the negative to one. Try to prioritize the negative to one instead of listing everything that was upsetting that day.

While these methods appear "almost too simple to try" the data is important. It gives parents a way to analyze the generalization of certain programs. Many things happen throughout the day and with additional responsibilities, some important events may go forgotten. The good things may also be overshadowed by the less positive.

Parents have a lot to say, and need to contribute to data collection from the most important environments: home and community. More specific data collection would be great, however, anecdotal reporting is important. Writing a sentence a day is an easy way to start.

Reading Programs

2007-06-11T22:04:00.000-05:00

I am a huge advocate of teaching reading skills in children with autism at an early age. Once acquired, reading can be used to prompt language, teach social skills in social stories, incorporate self-management programs, contracting, teach categories, "wh" questions, etc. There are no limits to how reading can benefit a child's academic AND social skills. Fortunately, many children with autism take to reading rather quickly and it often becomes a strength. It then depends on the teachers and therapists to capitalize on these strengths and incorporate this skill into programs in order to augment skill acquisition.

Without exception, I introduce the Edmark Reading program to teach the children I work with sight word recognition. While this program is not particularly strong at teaching reading comprehension, I have had incredible success teaching sight word recognition. Edmark has components that incorporate stories, basic comprehension and following written direction. While all the components are helpful, the sight word recognition program appears to be the most effective from my experience.

Phonics instruction is a little more complicated, but still can be taught early in a child's programming. Typically I introduce phones by introducing sounds of letters discretely, and then generalizing the sounds of letter learned in discrete trial, to mastered sight words used in Edmark. However, lately I have begun experimenting with the SRA DISTAR (Direct Instruction System for Teaching Achievement and Remediation) Teach Your Child to Read in 100 Easy Lessons. Several months ago, a parent and I implemented this program with an 8 year old child on the spectrum and he is making incredible progress. Today I started using this program with a 4 year old child on the spectrum and saw progress in understanding sound-symbol correlation.

This program breaks reading down into small manageable incremental lessons that take 20 minutes a day. Rules for instruction are written out for anyone to follow in a manner that makes it easy to implement by a parent, grandparent, and therapist. The child learns sound-symbol, blending of sounds, and writing strategies that will help phonics instruction. Today I started lesson 1 with a 4-year old child, and his mother will continue with lesson 2 tomorrow. We'll keep you posted.

While these programs are not necessarily used in a DTT format, the principles of behavior apply. Reinforcement, and shaping along with antecedent strategies are combined to teach reading behavior. Additionally, data collection is required in order to identify the effectiveness of the programs. For example, each opportunity for the child/student to respond, a data point is collected. A percentage is then calculated by dividing the number of correct responses by the number of total possible responses. Data collection and monitoring the prohram effectiveness is essential. While these two programs have been successful with the programs I supervise, they may not be effective for every child. Therefore treatment monitoring is necessary without exception.

Certification in Behavior Analysis

2007-06-10T09:49:00.000-05:00

There have been many inquiries on this blog regarding certification in behavior analysis. While the Certification Board has a comprehensive web site (http://www.bacb.com/) that addresses questions and concerns, I wanted to briefly review my own experience.

I pursued certification in behavior analysis (BCBA) four years ago through Penn State. This was an on-line program and I felt it was the most feasible while completing my doctoral coursework. The program was one year long, consisted of three on-line courses with the fourth course provided in an abbreviated time frame for one week at Penn State. The on-line program was sufficient for my needs to become certified, however required discipline to keep on top of readings and assignments as there is no classroom to guide you.

Certification in behavior analysis is in my opinion necessary, but not sufficient for a behavior analyst. Hundreds of programs have cropped up that provide the coursework necessary for certification. However, many of these programs, while providing training and didactic instruction in behavior analysis, do not focus on working with children with autism. Rather the programs, as they should, focus on the principles and application of behavior analysis. A problem presents itself however, when professionals with their certification in behavior analysis are assumed to have the necessary experience and knowledge to work with and teach children with autism. The coursework, which depends on the program, does not target the specific instruction of children with autism, rather behavior change.

This is important for parents in particular who are looking to employ a BCBA. The credential is not enough. There needs to be a thorough review of the experiences of that professional and how their experiences relate to working with children with autism.

The certification does provide a safe-guard though. There is a minimum amount of knowledge and experience that a professional must have in order to complete the BCBA. Having a BCBA communicates to professionals and related service providers that a number of courses have been completed, a mentorship process has been complete, and an exam has been passed. It gives us information that at LEAST this set of requirements has been completed (within the limits of the institution that provided them).

Over the years, the requirements to obtain certification have become more and more comprehensive, which is necessary. I would argue that additional requirements are necessary. Licensure is necessary for a psychologist, and I don't see the difference between a behavior analyst and a psychologist. Depending on the orientation of the psychologist, the behavior analyst can be even more effective at effecting positive (and negative) behavior change. There is the potential to "do harm" in behavior analysis. The principles are effective, and used incorrectly or inappropriately (positive and negative punishment for example) can "do harm", and a board needs to be responsible. I see the certification in the next ten years growing into a licensure within a doctoral program. To separate behavior analysts from the work of a behaviorally oriented psychologist doesn't make a lot of sense. Behavior analysis is specific, but is no different than any other orientation in psychology that necessitates a license to practice it, except that it is more effective and evidence based. Some have argued that increasing the requirements will limit the number of BCBAs available for consultation to work with children on the spectrum, but the argument is intrinsically flawed.

Common Errors in Functional Behavior Assessment and Behavior Support Plans

2007-06-05T09:36:00.000-05:00

Once the team is on board and a functional behavior assessment is underway, there are several obstacles to sticking to the integrity of an FBA that may compromise the effectiveness of the FBA. Like with any other program, if it isn't implemented correctly and completed comprehensively, the FBA may not produce findings that will appropriately inform intervention. The following concerns have been adapted from Dan Crimmins "Positive Strategies for Students with Behavior Problems" (Crimmins, Farell, Smith, and Baily, 2007) and include some obstacles I have encountered consulting in schools.

Poor record review - If a team begins and FBA and completes a behavior support plan, a record review needs to have been completed. There may be other plans and strategies that have been attempted without success. This doesn't mean that these strategies should be ruled out, however a record review will inform intervention providing a complete history of the child. It is possible that a token economy had been tried with a child and the individual responded poorly. This may not be a strategies the team chooses to implement without ruling others out.

Not attending to the context - The variables in the environment, both classroom and school wide, need to be considered. Children don't live in a bubble, they live in a community, and often the context may not be an appropriate fit for the child. This needs to be considered in the FBA and BSP in order make appropriate modifications.

Poor definition of target - If the target behavior has not been identified and defined consistently across team members, the data resulting may not be appropriate and useful in identifying the function of the behavior. Prior to the FBA and BSP, the team needs to get together and define the target so that everyone on the team can identify the behavior and consistently measure it.

Lack of observations across context - While completing the FBA, the child needs to be observed in different context. The same behavior may function differently in different environments, thereby requiring interventions that vary by context. The same strategy might not be effective in different settings.

Limited inclusion of Family in process - As children don't operate in a bubble, or only in a classroom, it is imperative that families are included in this process. A problem behavior that baffles school personnel may be easily explained by a parent "he does that when he needs to go to the bathroom". Additionally, if the family is included and are participating members of the team, not only will more input be garnered, consistency and communication between home and school will be encouraged.

Failure to attend to the child's strengths - If the FBA and BSP process and final products become a laundry list of what the child cannot do, the team is limited to remediation and does not focus on strengths, the effectiveness of the plan may be affected. For example, when working with a child that has significant tantrum behavior, it is valuable information to know that the child can read. This skill may then be used as part of the supports in the behavior support plan (e.g. visual cues, social stories, script-fading).

Consequence-based plans - A plan that only focuses on reinforcing the absence of an interfering behavior, may not target teaching appropriate behaviors. There may be success and some argue that this is sufficient to target the behavior, however as reinforcement is faded, and there are no new appropriate behaviors to replace the interfering behavior, maintenance may be affected.

Lack of a system to monitor progress - Often, an FBA is completed and a BSP is generated, and it is forgotten. It may be implemented in the classroom, but without a system in place to monitor the integrity of which it is implemented, there is no way to identify the effectiveness or appropriateness of the plan. Research has shown that treatment integrity of behavior support plans is limited (Noell et. al., 2005). A system to monitor the effectiveness and integrity must be in place and stipulated as part of the plan. Or else "it doesn't work" "nothing can stop this behavior" "we've tried everything" will ring in the ears of the collaborative team, with no evidence to support these statements.

Who Completes the FBA and BSP?

2007-06-04T09:54:00.000-05:00

In the courses I teach to graduate students in special education, this question inevitably comes. Whose responsibility is it to complete a functional behavior assessment and subsequently a behavior support plan? There isn't an easy answer unfortunately. It depends on your school placement and the support network that is available to you. The easy (and correct) answer is to say that is it a collaborative effort. Everyone should meet as a team to complete an FBA and BSP. The team should get together, collect data, discuss setting events, antecedents, maintaining consequences, environmental factors, etc. After a discussion and brainstorming, (and of course tons of data collection) the team should collaborate on the behavior support plan. However, this is not always feasible and depends on many systemic variables: how much prep time is the teacher given? What does the school psychologist's schedule look like? Do related service providers have time set up for meetings in their schedule? Does the climate of the school welcome and respect the need for functional behavior assessment?

In some schools, the school psychologist is the leader of the school-based support team and has training and background in completing an FBA and generating a BSP. However, some schools do not have the resource of a school psychologist on the premises (e.g. the school district may employ a school psychologist for every school in their district, and their role may be limited to assessment).

A current trend is to educate and train guidance counselors to be more fluent in understanding and completing functional behavior assessment and behavior support plans. This is new at the time of this post, but I would argue that the more school professionals that are fluent at this skill, it can only benefit the child and the school. However, I have had limited experience with a school counselor that was competent at completing a functional behavior assessment.

Often, and in my experience with many school districts on Long Island, a behavior consultant is hired to complete FBAs and BSPs. This is expensive and gives responsibility of an individual that knows the child the LEAST, to guide the development of a behavior support plan.

Other schools hold the special education teacher as the resident FBA and BSP expert. This is the avenue that I push to graduate students. The classroom teacher has the most interaction with any given student, will be able to give the most information, and may identify nuances that will not be caught in an observation by a second party. It should be a collaborative process, but the classroom teacher should be FLUENT at FBA and generating a BSP. Additional supports and system changes would be required. Prep periods to complete this work, conduct the appropriate observations, analyze the data, and meet with team members should be available in order to complete a comprehensive FBA and BSP. While this may be overwhelming to add to the responsibilities of a classroom teacher, it should be part of her/his roles and responsibilities. Tha classroom teacher cannot be a passive member of this team. I would argue that interfering behavior should be the top priority over academic gains. The interfering behavior will prevent learning and creates an environment of chaos for the entire class. Additionally, a comprehensive behavior support plan will include many components of learning that are essential (e.g. functional communication training, skill-based goals, self-regulation, self-monitoring) and will contribute to the future academic and social growth of the child.

It goes without saying that parents are collaborative team members as well. Parents should learn about FBA, and carry the assessment into their home. Consequently, the BSP should be consistently implemented in the home as well. If the school is not educated in this process, the parent needs to become knowledgeable and insist the school does as well.

Systemically, completing a functional behavior assessment should be a pre-referral strategy in every school. This will encourage pupil personnel service providers to become competent in FBA, and by including it as part of the pre-referral process, it is a step that will be less likely to be over looked. Additionally, all staff would be encouraged to learn how to use this effective tool to generate much needed behavior support plans.

So for now, the person that would suggest the need for a functional behavior assessment and behavior suppor plan would most likely be the classroom teacher. It should then be identified who will be able to participate in the completion of the FBA and BSP. Hopefully someone knows how.

See other posts for reviews of the components of an FBA and BSP.

Baseline is Essential

2007-06-03T08:21:00.000-05:00

Baseline is the current level that a target behavior occurs prior to intervention. It is absolutely essential to obtain baseline information prior to the onset of an intervention. It is only with measure prior to an intervention compared to data collected after the intervention begins, that the effectiveness of the intervention can be determined.

In order to identify the effectiveness of an intervention, not only is baseline necessary, but a clear definition of what the goal of the intervention is, needs to be determined. In other words, you need to understand what change you are looking for, what behavior you want to increase or decrease, what you expect the intervention to accomplish.

Lack of these components, is what may lead individuals/parents/therapists to draw erroneous conclusions about what is an effective intervention. See the following examples.

A speech therapist wants to start floortime with a child on the spectrum to help him with his core deficits. After a month of this therapy, the parent is told "he is responding well". What does that mean? I have no idea what that means, and would be surprised if the speech therapist would know what that meant either. Whatever the therapy is, clear goals, and clear ways to measure progress are needed.

Take the same example, with floortime, and the speech therapist says "I want to start floortime, with your child, and I am targeting initiated play, commenting, and joint attention. At this time, he does not initiation ANY independent play when left alone in a half hour observation, comments one time in a half hour session when playing with a peer, and will referenced twice in half an hour when playing with a peer." Now the parent and therapist know what the child's baseline is, and following intervention, will be able to identify if the therapy/strategy was an improvement.

Baseline and measurement is essential to identify the effectiveness of any program. It is the corner stone of behavior analysis and can and should be used in the analysis of any strategy that is used with typically developing children as well as children with disabilities.

Social Stories

2007-05-30T16:59:00.000-05:00

Social Stories have been utilized in home and school programs for children with autism with increasing frequency. A social story is essentially a story that is simplified in order to explain a given event, sequence, setting, etc. for a child, usually a child with a disability (Carol Gray, 2000). Usually this story uses simple sentences that give a break down, or a task analysis, of an event. (e.g. riding in an elevator, going to the movies, taking a picture). The type of story or the focus of the story that is used is dependent upon the needs of the child.

Social stories can be created to work with the needs of each individual child. For example, I am currently working with a team and writing social stories to address the self-stimulatory behavior of a four year old boy with ASD. The sequence went like this:

His mother identified an interfering self-stimulatory behavior. The therapist sat with him that day, an with his input created a social story outlining the target behavior, and that included a replacement behavior. He read the story with the therapist, and with his family. Other therapists were encouraged to create several social stories within the same theme in order to promote generalization.

Some researchers have investigated the use of social stories to improve social skills (Delano and Snell, 2006). These research targeted the behavior of "playing with a peer" and showed increase of this target behavior following the social story intervention.

Kuttler, Myles, and Carlson (1998) used social stories to decrease tantrum behavior in a 12-year old child with autism.

Acosta, Greatz, Mastropieri, and Scruggs (2004) used social stories to decrease inappropriate screaming and increase appropriate replacement behaviors.

While the research isn't overwhelming (and this was NOT an exhaustive review of the research) Social stories is a very promising intervention. Like with anything else, data should be taken in order to assess the effectiveness of the social story. Goals should be created in order to guide the measurement of outcomes that are desired. Only with data collection and analysis can the effectiveness of the social story be determined. However, the possibilities for application are limitless.

Follow Through and Ignoring.

2007-05-24T08:42:00.000-05:00

Some parents and professionals that I have worked have ignored a behavior thinking that the behavior will go away. After follow up on "why are you ignoring the behavior" I was told, "because you told me to ignore it if I can't follow through." This may be where "ignoring" is over-used, used incorrectly or misinterpreted.

If you identify that a child is engaging in an inappropriate behavior, and you anticipate that if in fact you follow through on the redirection, possibly get a tantrum, and this process might take two hours, and you CAN'T follow through at this time....then ignore the behavior, or just give in. See the following example for clarification.

Example. A child is tantrumming, and mom thinks "I can hold out on not giving her what she wants" and mom does hold out...for ten....fifteen....twenty minutes. The tantrum continues, but Mom has to get to the bank, so she gives in, gives the child what she wants, and gets to the bank. Mom has just reinforced a 20 minute tantrum. Because this tantrum was effective for this child, next time, the tantrum will last a MINIMUM 20 minutes, probably more, because the child has learned that 1) tantrumming is effective at getting what I want and 2) I may have to tantrum for a long time, but eventually i will get what I want...cool.

However, if the same parent identified "I cannot follow through on this right now...I'll give in, and follow through when I have the time and availability" By doing this, the parent has ONLY reinforced a 30 second tantrum or a 1-minute tantrum. Next time, the child may have learned to tantrum to get something, but only for less than a minute. Next time, when mom has the availability to follow through, it will not take as long (well, it might, but it is less likely to. )

Example: Self-stimulatory behavior. Take the child that is flapping his hands in front of the television while mom is in the kitchen with her two younger children feeding them and trying to get dinner ready. Mom sees her son engaging in self-stimulatory behavior. What to do?

One option is to verbally direct him to stop. However, mom is not in a position to follow through, go over, redirect him to another activity and engage him. All she can do is call for him to stop and sit down. If he doesn't listen, she will call out for him to stop again. He has now learned that I don't have to listen, because she isn't going to do anything about it. This is a situation where I would advise "don't worry about it". If you can't follow through, you may do more damage than good by repeating the demand over and over. It isn't that you are necessarily "ignoring" the behavior as an intervention per se, rather, you CAN'T engage and redirect the child appropriately, so finish what you are doing, and wait until you can. Repeatedly telling a child to do something over and over again, with no follow through is NOT an effective intervention. If anything, it lessens your effectiveness as a teacher and parent.

Some might argue that the situation will NEVER be ideal for appropriate engagement and redirection. I agree, and that is why individualized programs are necessary. However, there must be some opportunities in the day where consistency and follow-through is possible, necessary and appropriate.

Ignoring

2007-05-23T12:51:00.000-05:00

In different settings, I have often heard teachers/parents/related service providers tell me "But I'm ignoring the behavior." While the etiology of "ignoring" as a method for all problem behavior is unclear, it is disconcerting how often it is used and mis-used.

To begin with, remember that all behavior has a function. That function can be due to a medical issue, to escape or avoid a task, to get attention, to obtain a tangible, or for a sensory effect. Given that, ignoring an inappropriate behavior, (not necessarily ignoring the child, just not responding to the inappropriate behavior) removes attention from the behavior, it will only be affective if the behavior is attention seeking. Therefore, ignoring a child when he is engaging in self-stimulatory behavior will NOT be an effective intervention, because you are not addressing the function of the behavior. He is escaping or getting sensory reinforcement from it, so ignoring it will be fine by him.

An intervention needs to speak to the function of the behavior in order to be effective. However, ignoring an attention-seeking behavior is not a sufficient intervention. A replacement behavior needs to be taught. For example, teaching the child to raise their hand, ask for attention, access attention in an appropriate manner from their family and peers, in addition to proactively providing attention throughout the day.

Ignoring is different from extinction. It may be utilized in extinction, but is not synonymous with extinction. Please see posts addressing extinction for a more comprehensive review of this strategy.

Treatment Integrity

2007-05-22T07:42:00.001-05:00

In order to properly evaluate a program, it needs to be implemented as intended. This is referred to as treatment integrity, and is necessary in not only programs in applied behavior analysis programs, but in all treatment programs. Parents and professionals will NEVER be able to identify the effectiveness of a plan without proper implementation. Without proper implementation, false conclusions may be drawn.

For example, take the example of a picture exchange communication system (PECS). This is a system that has a lot of evidence to support its effectiveness in teaching communication skills to students with severe disabilities (Bondy & Frost). Used properly that is. However, PECS has significant training that goes with it, and requires this training and knowledge of the research base to go with it. I have often heard parents say "we tried that but it didn't work". Why didn't it work? How was it implemented? How did you monitor the implementation of it? Was it implemented consistently? Across people? Across environments? There many factors that influence treatment integrity and they need to be accounted for.

In order to maintain treatment integrity, several supports are needed:
- Supervision (everyone observing each other, teachers, parents, school psychologists, etc.)
- The program should be clearly written out for all to implement correctly.
- Visual supports for staff and family should be in sight to provide cues about the steps of more complicated programs.
- Communication about the plan should be ongoing
- Feedback should be provided to the implementer consistently and frequently.
- Data collection is necessary in order to monitor the effectiveness of the program. Data collection should be conducted not only on the target behavior, but also on the steps implemented.

Treatment integrity is under-rated and under-discussed in most school and home programs for children with and without developmental disabilities. Important to consider is the complexity of a plan. It would be more effective implement a good plan or instruction intervention, that has fewer components, than to never be able to implement a phenomenal plan accurately.

ABC and Functional Behavior Assessment

2007-05-18T11:50:00.000-05:00

In response to searches about ABC analysis, I wanted to include a quick word about ABC analysis and the importance of it in an FBA.

In order to identify the function of a problem behavior, you want to look at the antecedent (what triggered the behavior), the behavior (what did it look like, what was the intensity, repeated frequency) and the consequence (what happened directly after the behavior and what may in fact be maintaining the problem behavior). In addition to ABC it is also important to identify any setting events that may be working to keep the behavior going. A setting event is anything that does not directly trigger the behavior but occasions the behavior to occur, and in many cases is much more significant than the antecedent. Below is more of descriptions of these terms with examples.

Setting Event - A setting event can be anything that increases the likelihood of the problem behavior occurring. Many professors and analysts will say that it is something that happened in the near distant past, but I take the explanation of Ted Carr. A setting event can be something that occurred in the near distant past (a fight last night, sitting on the bus to someone that was screaming, not getting enough sleep). A setting event can also include changes in the current environment (the lights are too bright, there are a lot of people in the room, it is noisy). Another setting event can be the person you are working with. For example, if my brother asks me to give him a ride to the store (the antecedent) I may do so willingly because he does things for me as well, and he is a generous and kind individual. However, if a cousin asks me to give him a ride to a store, and I have had nothing but negative interactions with this individual, I may yell, start a fight, or retaliate. Here it is clear to see that the antecedent (asking for a ride) is not the important factor in the analysis of the behavior. Rather "who" asked is the factor that is important to identify.

This can be the same with a child in a school or home setting. If a preferred teacher places a demand, the child may comply with no problem behavior. If a non-preferred teacher places the identical demand, this may trigger a tantrum. This is not due to the antecedent, but rather where the antecedent came from.

Setting events are not fluidly incorporated into FBAs at this time, but are factors that need to be analyzed and addressed. There is much more to discuss on SE, but I will leave it for another post.

Antecedent - This is the immediate trigger: usually in our programs, the demand, but can be anything that happens that directly triggers the behavior. Once antecedents have been identified, a behavior support plan can address the antecedents in order to modify the environment and help the individual attain success. For example, if a demand is an antecedent...how can we change that demand to make it less aversive.

Consequence - This is what happens directly after the behavior, and may be maintaining the behavior. For example, task is presented, child cries, task is removed. The removal of the task is making the child's escape-motivated behavior very successful. When looking at the consequences, you want to identify how can you stop making the inappropriate behavior successful for the child.

To complete an analysis, all these factors need to be taken into consideration. On a data sheet, you should have space for date, time, activity, person, possible setting event, antecedent, behavior, consequence, and a space for comment. When I analyze Se-ABC data, I like to highlight the rows by function to help me identify which function is maintaining each behavior.

Functional Behavior Assessment and Applied Behavior Analysis: How they fit together.

2007-05-18T08:07:00.000-05:00

Based on searches I have seen linked to this site, it appears that many people are curious as to how functional behavior assessment (FBA) links to/is incorporated into applied behavior analysis (ABA).

Applied behavior analysis follows the basic principles of learning and behavior (e.g. reinforcement, shaping, etc.) It is a data-based model and concerns itself with changing socially significant behavior, whether it be academic behavior like reading or writing, or life skills like brushing teeth or washing hair. So essentially it is the application of these principles to teach.

A functional behavior assessment is a tool used to identify "why" a problem behavior is occurring (see previous post regarding FBA for a full description). Although it is not a tool used by all behavior analysts, and not necessarily used in home-based ABA teams, I advocate its use and feel it is a necessary tool in order target an inappropriate behavior that may be interfering with a child's ability to learn. Through an FBA, a therapist can identify why the behavior is occurring and then use the principles of learning to shape the behavior, teach a replacement behavior thereby decreasing the inappropriate/interfering behavior.

A mistake made in some ABA programs, is NOT using a functional behavior assessment. Take the example of a child that is tantrumming during work time. A behavior analyst can put a plan in place to decrease the tantrum behavior, but this does not address the function of the behavior, which may be to escape. If the analyst can identify that the function of the behavior is for escape, a replacement behavior can be taught (e.g. asking for a break). Simply decreasing a behavior does not remove the communication the child was aiming for (which may be to communicate: I don't want to do this, I don't like it, I want to leave.) Based on an FBA, which will identify the setting the behavior is most likely to occur in, why the behavior is occurring, and what specifically triggers the behavior, an appropriate plan can be created to target the interfering behavior (e.g. teaching a replacement, and modifying the teaching to make it more engaging, enticing, and hopefully an environment the child will not want to escape from.)

All of this can and should be included in any program especially one that is modeled as an ABA program.

If it isn't working, make a change.

2007-05-16T09:19:00.000-05:00

A facet of applied behavior analysis that is difficult to conduct research on is the dynamic flow of an ABA program. It is ever-changing and ever-growing. Data collection allows for this. Because data is collected on all programs, either qualitatively or quantitatively, we can make data-based, data-driven decisions. Based on data, we can see if a program is causing an increase in skill acquisition, a decrease, or no change. Based on the interpretation, changes need to be made.

How long should a team wait to make a change for a program that looks like it isn't working? It does depend on the child and the history of learning for the child, but you shouldn't wait long. In the teams I work with, if I see no significant change over five data points (and this isn't attributed to illness, absences) a change needs to be made.

This is where the therapist/teacher/parent may need to get creative, do some research, and see what other strategies are available to teach a particular skill. This takes effort and it takes creativity. For example, if you are trying to teach a child "wh" questions, and your traditional program, that you have used for ten children isn't working, you need to find another way. There is always another way, but it will take some legwork to find it. As long as you find a method, and measure its effectiveness by clear and consistent data collection, it falls within the realm of data-driven instruction.

The concern is staying with an ineffective program too long, and running out of ideas to teach a skill. In the worst case scenario, the concern is giving up. I worked with one little boy several years ago, that could NOT receptively or expressively label anything. He was able to mand for milk with vocalization and sign, had five other expressive mands, gave wonderful eye contact, had over twenty receptive actions, followed directions, responded to his name, imitated, etc. But receptive and expressive labels showed no progress. The team of therapists that I was working with could not identify a program that worked to teach this child to understand that object, items and people, had labels. His mands stagnated and stayed at five.

However, the team kept going. Taking data on every program that was attempted, fifteen different strategies were attempted to teach this child receptive language. And the fifteenth worked. He sky-rocketed, learning 90 receptive objects in four months. He then generalized 75% of those objects into expressive labels and 50% of those objects in mands/requests. His articulation was poor (he was also diagnosed with apraxia) but this skill enabled him to move into other programs. The process to identify a program to teach him this skill took over a year, and it took the creativity of a team of five behavior analysts to figure it out.

At the time of this post, this child is using three word utterances (subject, verb, and object) to request his wants and to communicate with his family and teachers.

Data collection is imperative to make appropriate decisions in a child's program. If something isn't working, make a modification, collect data, and evaluate the effectiveness of the program.

What Do Typically Developing Children Do?

2007-05-13T09:54:00.000-05:00

As part of program development, it is important to observe typically developing (or neuro-typical if you prefer) children and observe what they do and how they play. Often, when developing programs in a home-based ABA program, this aspect is ignored. While behavior analysis is not a developmental model, there is something to be said for appropriate goals depending on the age of the child. A few examples from the programs I coordinate are discussed below.

Play with Little People
When writing play programs, we tend to write guidelines and scripts to teach a child, based on how we "think" children talk and comment when they play. Working with a four year old child with autism, this was the home-team's goal as well. We began to outline the script to teach. We included things like "come on guys, let's go" "what should we eat" "let's play hide and seek" Upon observing other children play, it was nothing like this. When other four-year olds play, they don't usually speak in full sentences, they don't have planned out stories of how they will play with the playschool little people, they don't comment and build on each other's ideas. This child, next to his typically developing peers, would stand out as odd.

As part of his program, teachers observe typically developing children, write what they hear, and watch how they play, and we try to incorporate this natural language in our programs. Four year olds don't say, "give me the horse please"....they say "gimme" "hey, I wanit." It is important to always have a gage for what is appropriate, what sounds typical, to maintain appropriate goals.

RDI "Follow My Eyes to the Prize"
One of the strategies to teach the "value" of eye contact, and to make eye contact reinforcing (from my interpretation of Gutstein's work) is this game. The premise is that an object is hidden in the room, and using only my eyes, I looked at the object and gave the instruction to the child that in order to find the toy, he would have to look at my eyes, to see where I was looking According to the steps in the RDI assessment, this is his level and the goal to be followed. I played the game with a four-year old child with autism spectrum disorder, and a bright four-year-old peer.

Neither child could perform the task. The peer was unable to understand that I was looking at the target object. She did get closer to the area, but upon not finding it, began looking all over the room, including behind me. If I hadn't had this typical peer to gage the appropriateness of the goal, I may have perseverated on teaching him this skill. I still may try to get the idea across, but having the typically developing peer as a measure, made the objective clearer.

Often in our team meetings, these issues come up. I recommend that as a measure of what is appropriate, observations of typically developing children at the playground, in schools, at the supermarket, need to be incorporated as part of program development. It is imperative that we know what we are working towards.

By the same token, to say that "inappropriate" behaviors that are often self-stimulatory are OK because typically developing kids do them also, isn't good enough. Many children tantrum, cry, whine, beg, hit, bite, but that doesn't mean we should use levels of inappropriate behavior as a measure. It is a luxury that children with autism do not have. Inappropriate behavior begets more inappropriate behavior.

Maintenance and Generalization

2007-05-10T21:30:00.000-05:00

These two very important components of teaching a new skill are often confused and omitted from programs.

Maintenance is the ability to keep the same skill over time. This means that if a child can ask for juice today, he will be able to ask for juice tomorrow, and the next day and a week from now and a month from now. The child has maintained the behavior.

Generalization is the ability to display the behavior across different settings. across different people and different times. This means that if a child can ask for the bathroom, he can do it at home, at school, at a diner, with dad, with grandma, when he is tired, in the morning and at night.

Maintenance and generalization should be built in to every step of every program. It should not be a special step or a special "day" that generalization and maintenance are run.

Many programs have a step built into a program called "maintenance" and a step called "generalization". For example, if a child learns to label objects, the child will learn all the different objects, and then after he has mastered the different labels, he will be brought to different environments to label. Instead of teaching this way, the appropriate way to teach generalization is by exposing the child to multiple exemplars in multiple environments to learn the labels. So if you are teaching a child to label "cup", they should learn it in a picture, as an object, in the kitchen, in the living room, etc., as one step, and then move on to other objects. This ensures that the object will have been learned and generalized without having to wait until the end of the program to generalize the skill.

Some programs have a day that "maintenance" programs are run. I would contend that good programs build on previously learned skills; therefore, a child is constantly practicing the skills that they need while they are acquiring new skills. In addition, if a skill is functional for a child, they will constantly be practicing the behavior. If a skill does not have the opportunity to be practiced enough, and the child does not retain it, the question should be asked "how functional was this skill for this child to learn"

For example, responding to the question "Tell me something that has numbers" may not be retained over time, because the skill does not have the opportunity to get practiced over time. It is not incredibly functional for the child, and maintenance may be low. At this point, I wouldn't be as concerned about the retention as I would be about the types of skills that we are targeting.

Bottom line: If maintenance and generalization have not been targeted and built into the programs, it doesn't matter what is taught to the child, because they may or will not be able to perform the skill in different settings and over time.

Punishment

2007-05-08T13:20:00.000-05:00

Punishment has been receiving a lot of air time lately in news, radio, hearings, etc. A quick discussion of what it is, the types of punishment, and side effects of punishment is warranted. To clarify, this is a description of punishment, not an advocacy of the use of punishment procedures.

A punisher is something that, when presented immediately following a behavior, it will cause the behavior to decrease in frequency (Martin & Pear, 2007).

We have Positive Punishment and Negative Punishment. (Just like we have positive reinforcement and negative reinforcement).

Positive Punishment: Adding something to the environment in order to decrease the probability of the behavior occurring in the future. So anything that is added to the environment when you want to decrease the behavior. This can range from a dirty look, a slap, extra homework, electric shock.

Negative Punishment: Taking away something from the environment in order to decrease the probability of the behavior occurring in the future. So if you take something away, because you want to stop a behavior from occurring, that is negative punishment. This can range from a loss of recess time, losing a favorite toy, taking a token off the board, losing attention from a teacher, etc.

Types of Punishment: Pain-inducing (un-pleasant stimuli), reprimands, time-out, response cost.

Side effects of Punishment:

1. Aggressive behavior: Punishment tends to elicit aggressive behavior. If an individual has been exposed to punishment, there is a higher probability that they will engage in punishing behavior (Berkowitz, 1989). For example, if you hit a child for running into the street, this is a new behavior that they are exposed to, and may learn to use it when they are frustrated.

2. Emotional behavior: Crying and fearfulness are common responses to punishment. This may/will pair the person delivering the punishment as negative. The child/adult may associate that person and that activity with punishment and this may damage any rapport.

3. Escape/avoidance behavior: Because the person delivering the punishment may have been associated adversely, the individual that has been punished may want to escape/avoid the punisher. This is not conducive to a learning environment.

4. No New Behavior: When you punish, you are not teaching a new more appropriate behavior to take the place of the behavior that you want to decrease. Hitting a child when they engage in self-injurious behavior, does not teach anything. All it does teach, is at best, not to engage in the behavior in front of the punisher.

Take the example of speeding. I have received many speeding tickets (punishers) but I continue to speed. However, I slow down at the spots where I have received the speeding tickets. I have learned not to speed there, but I haven't stopped speeding altogether.

5. Modeling punishment: You are modeling an inappropriate method of communication "I don't like what you did." That may and probably will get picked up by the student.

6. Continued use of punishment: You need to keep using it for it to be effective, and usually need to apply more of it. Just like children and adults satiate on reinforcement, they will satiate on punishment. Usually more punishment will be required to maintain the suppression. You may hit someone once, and it may work for a little while, but after a while it may not be enough. This may spiral into an out-of-control cycle.

Should you use punishment?

This isn't even a question I want to try to tackle here. However, looking at the facts, if an individual is engaging in an interfering or problematic behavior, there is a reason for it. Punishing the behavior does not help, teach, or show dignity and respect for the individual exhibiting the behavior. If a child is hitting his head on the table, punishing the behavior does not help us find out "WHY" the behavior is occurring. And without knowing why, we can't teach him how to use an appropriate behavior to replace the head-hitting.

There must be another way. Skinner has been quoted saying "Punishment is the tool of a weak teacher." There must be another way to teach an individual to engage in an appropriate behavior. Please see the post on positive behavior supports.

Real-life Application:

I had an experience with a response cost system with a child on the autism spectrum and self-stimulatory behavior. Response cost is when something is removed contingent upon the inappropriate behavior.

About four years ago, I worked with a child that was engaging in high rates (200 in a 2 hour session) of self-stimulatory non-contextual vocalizations. We (the team with his mom) were not able to redirect the behavior and were not able to identify competing reinforcers. (Knowing what I know now, I think I would have tried harder, but this was a learning experience.) The behavior was interfering with his learning, ability to make friends, and have a conversation with his family. Additionally, rates of self-stimulatory behavior were increasing.

We identified that the behavior appeared to function for escape, so we included several supports to make the environment one that he would not want to escape from (fun activities, lessons, dense schedule of reinforcement, more choices in his activities) but did not see a significant decrease in his self-stimulatory behavior. Additionally, he was engaging in high rates of behavior when not in demand environments.

The team, mom included, decided to implement a response cost system to help him manage his behavior. He was given a token board with fifty tokens on it. It was explained to him, that each time he engaged in the self-stimulatory target behavior, he would lose a token. If he had even ONE token left at the end of the day, he would be given half an hour of his video that was the target of his self stimulation verbalization. At the end of the day, he engaged in FIVE, compared to over 200. Significant decrease.

We faded the system out over the next couple of weeks, giving him reinforcement every two days, then every three days, then finally down to once a week. Very successful right?

Well...

We had a couple of side effects. For at least a year after the plan, the words associated with the perseveration elicited anxiety related behaviors: First, body tightening up, if he saw the words written down, he would scribble them out angrily, scribbling holes in the paper. Some anxiety-related side effects. Not terrible side effects, and it did eradicate the target behavior, but in retrospect, with more experience, I would have thought about it a little more before jumping into the response cost. I don't think I would have done it differently, but prior to the implementation, I hadn't considered possible side effects of a response cost.

Planning and CSE Meetings

2007-05-06T21:09:00.000-05:00

I was on a panel this weekend geared towards answering questions from parents about therapies for children with autism. Overwhelmingly, questions from parents were in regards to fighting for services for their children. As a result, guidelines and points of interest that I have accumulated in my experience with New York State CSE meetings are presented below. These guidelines are by NO means meant to replace advocacy or legal guidance.

Prior to the meeting, be prepared to fight for your child, and be your child's advocate, but don't walk into the meeting with hands flailing and screaming your demands. Work with board of education if you can, but do not sacrifice what you feel is appropriate for your child.

- Legal advice, and retaining a lawyer or an advocate is advisable. Services are rarely given to families without a battle, and usually families and parents are not aware of what services they are entitled to. What you will fight for depends on your child's needs in addition to the age of your child. For example, home-based services from birth to 3 (early intervention) are obtained with more ease than children that are over five years old.

Services in early intervention for a child with autism can range from 10 hours a week to 28 hours a week (ABA), 5 half hours a week of speech (SLP) and variable services of OT and PT.

Services in CPSE (3-5) range depending on the level of functioning of the child. At this point in a child's education, you may consider entering the board of education center-based programs. In my experience, the board of ed. is still a work in progress in terms of schools for children with autism. While there are some good programs, but they have wait lists. Often, parents prefer to maintain home-based ABA services for children in this age range. Ranges of hours that I have seen given WITHOUT a lawyer are anywhere from 24-33 hours a week. However, although a lawyer was not present for these meetings, the services needed to be demanded and fought for.

- Keep on top of all meetings and paperwork. Procedural violations are very common. If a procedural violation has been found in the CSE process, this strengthens your case against the board of ed and may help you get the services you need. So monitor the paperwork, keep copies, read what you sign, and make notes at these meetings of what you are told and who told it to you.

- Have data with you. If you are going in to fight for services, have data to support that the services are what your child needs. This means that you need to not only be knowledgeable about the services you seek and the research to support it, but you need to be able to talk comfortably about your child's current program.

- Do NOT ask for the "best" education for your child. Your child, as far as the law is concerned, is not entitled to the "best" education. Your child is entitled to a "free and appropriate education". If you start telling the district "this is what is best for my son" you have given them ammunition and grounds to say "yes, that might be best, but we don't have to provide the best" and they will automatically provide you with less than what you asked, and they are within proper legal boundaries to do so. Be careful with this language.

- Have a team member with you, if not more than one. The team that you have with you should be knowledgeable about the services and the CSE process. They will help you discuss a review of your child's progress and provide justification for the home-based services.

- Do not listen when they say "we don't give that program" meaning that they do not provide enough hours for parents to have a home-based program. They do. They will always, always, always push a center-based school, saying that they are concerned that your child will not have socialization opportunities. Don't fall for this. Socialization opportunities in a class with five other non-verbal autistic children does not make for socialization opportunities. In your home program, it is YOUR responsibilities to ensure that your child will have opportunities for play dates and accessing community resources (e.g. private pre-schools, libraries, sports, play groups).

I work with two children at the time of this post that have 30-33 hours of home-based services 5 hours a week of speech, OT and PT. Each child receives 9 of those hours on site at a local pre-school paid for by the parents, and he is shadowed by his ABA therapist.

- Be Prepared. Go into that meeting knowing the program you would LOVE to get, the program that you will take and tolerate, and what you will absolutely NOT accept. Some parents and professionals think that if they go into a meeting and ask for 40 hours a week, they will get 35 and will be happy with it. This is not a tactic that I advise. I have asked for the services that I think are appropriate, and that I can defend, but this is a family decision, and decision to made with the guidance of legal counsel.

- Know your rights. You have the right to refuse the services that they are offering, and you can seek an impartial hearing to fight the district. If you refuse to sign and refuse services, your child will STAY with the services that they have at the time of the meeting. Services will not be lost. Again, I would not recommend taking it this far without legal counsel. But to iterate, you cannot be made to accept services and an IEP that is not appropriate for your child.

- Know what your options are, and what recommendations the Board of Education may make. Often at these meetings, sites are recommended for visitation, and the education placement is slowed while you the parent, look at sites. This can be avoided if prior to the CSE meetings, you have researched available programs, called principals, and visited sites. This way, at the meeting, when a recommendation for a 12:1:1 is given, you have notes and data to say "no, I have seen that program, at this school (insert school name), on this day (date), and met with this principal (principal) and it is NOT appropriate for my child because....

If you haven't seen the programs, it is difficult to say they are not appropriate.

- Be careful what you say. Responses to questions can often be turned against you. For example, if you are asked "do you believe that your child will benefit from a structured program.." ask "what do you mean?" They may mean a 12:1:1, and you may mean inclusion with a trained para-professional.

- Ask them to explain themselves. What do they mean by eclectic program? What do they mean by ABA trained? How do they evaluate their programs effectiveness? These are all questions that you as a parent should be able to ask and have these questions answered.

This is just a handful of observations and hints on preparation for CSE meetings. It is not meant to be exhaustive, and there is a lot of preparation that has not been reviewed here. Seek support prior to going into these meetings, be clear with what you want, and discuss this with your family and support people/therapists.

The board of education is not out to do the wrong thing for your child. The people sitting at these meetings mean well, and often believe that they are doing right by your child and making the most appropriate educational recommendations. But they do not know your child, and usually do not fully understand the services you are requesting and the research that supports these requests. When you come armed and prepared with this information, you are strengthening your case and advocating for your child. It is not worth it at this point to debate "WHY MUST I FIGHT". It stinks, it is a given, but it is something that you have to do and must take responsibility for.

Replacement Behaviors

2007-05-03T10:10:00.000-05:00

If an individual is exhibiting a problem or interfering behavior (a behavior that interferes with learning, accessing the community and developing relationships), first we need to identify "why" the behavior is occurring (by conducting a functional behavior assessment) and create a program to help the individual be independent and develop an appropriate behavior repertoire. However, decreasing the behavior should NOT be foremost on our minds as parents and professionals. Rather, what behavior can be increased, that will make the interfering behavior irrelevant (doesn't work, has no purpose), inefficient (doesn't work as well as a more appropriate behavior), and ineffective. To do this, a replacement behavior must be identified.

Depending on the function of the target interfering behavior, and depending on the child (always individualized for the child). An important way to look at interfering behavior is as "purposeful". So we need to address the purpose, the function, the "why". Some examples for different functions are presented below.

Attention: What ways can you teach a child or adult to get attention appropriately?
- Teach Raising hand
- Provide attention throughout the day on a higher schedule, making it unnecessary to seek attention in inappropriate ways.
- Teach Asking for attention
- Build in a "talk time" where the individual gets attention for a set period of time and an opportunity to engage in whatever topic of conversation is necessary.

What about the co-worker that is always engaging you to talk about their various illnesses and aches and pains? This is a possible attention seeking behavior, so engage them in another conversation, providing opportunities for attention for positive behaviors.

With attention, an individual can't always have attention when the want it, clearly. But at first, each appropriate request for attention should be adhered to, and then can be faded out. For the child that wants attention every minute at first, give it, then give it to them every two minutes. Then give them "attention passes" where they can give you a pass to talk, maybe five in a one hour period. You want to fade the intervention out, because truthfully, waiting for attention is a very natural environmental situation.

Escape: What if someone needs a break? They want to escape a task. As neuro-typical individuals, we take escape breaks and no one questions it. As a doctoral student, I would leave to use the bathroom in the middle of a lecture, whether it was necessary or not. A natural escape that no one questioned. Escape is sometimes very appropriate, but through appropriate behaviors. Some example:
- Teach a child to ask for a break; verbally, by giving a break card, by signing break, etc.
- Provide breaks throughout the day and lesson at first (always need to have a plan in place to fade the breaks out). Some have argued that if you provide breaks all the time, the child will miss out on material, for example math class. However, if the child is generally getting sent to Dean's office during math, and missing the ENTIRE lesson, a ten-minute break already has you ahead of the game if it can get him through math.
- As with attention, escape can't always be granted, so a fading system needs to be in place. At first, every appropriate request should be reinforced with a break, but as the child becomes fluent in this behavior, the schedule of breaks should be thinned.

Tangible - This is similar to the two mentioned above. Teach a replacement for asking for or accessing the tangible, rendering the inappropriate behavior ineffective.

Sensory - In my humble opinion, the toughest behavior to teach an appropriate replacement, and to decrease in an environment that is incompatible with sensory stimulation. This is also very specific to each individual as self-stimulatory behaviors run a wide spectrum.
- Wheels - Some children we work with and love, also love wheels, things that spin, etc. We can teach them to access materials that provide the visual stimulation they crave (gears, tops, etc. )
- Teach more play behaviors - Children may be engaging in these self-stim behaviors because they lack other interests and activities. As part of any curriculum, appropriate activities should be taught in order to expose many activities and interests that can be expanded on.

The bottom line, is that if a behavior serves a function for an individual, decreasing the behavior will not eradicate the purpose or function that behavior originally served. In fact, to not teach a replacement behavior is self-explanatory....we are not teaching.

Applied Behavior Analysis and Postive Behavior Supports

2007-05-02T08:23:00.000-05:00

There is a rift between these two fields. I'm posting this NOT to attempt to mend the rift, nor to debate it, but rather, from an application perspective to teachers and professionals, how can both work together for a good program that addresses all necessary aspects of interfering behavior to promote success. Here is a BRIEF description/definition of each (not meant to be comprehensive).

Applied Behavior Analysis - The science in which procedures derived from the principles of behavior are systematically applied to improve socially significant behavior to a meaningful degree and to demonstrate experimentally that the procedures employed were responsible for the improvement of behavior. (Cooper, Heron, & Heward, 2007) There are assumptions that are made in ABA:
- Behavior is learned (if you can learn an inappropriate behavior, you can learn a replacement)
- Behavior is multiply determined (usually not just one reason for a interfering behavior)
- Principles that can be used to effect behavior change include reinforcement, punishment, extinction, antecedent control, modeling, shaping and chaining.

A brief discussion of punishment (as it is a topic of significant debate)
While punishment and the effect on punishment on behavior is evident, it is NOT necessarily a part of a program that follows the principles of ABA. Additionally, there are many forms of punishment, and degrees of punishment programs that are implemented. Punishment defined is simply something that is either added or subtracted from the environment in order to DECREASE the future probability of a behavior occurring. Let me clarify, that as I provide examples, I am not advocating for the use of punishment; rather explaining. Examples:

- A dirty look given contingent upon talking while Mom is on the phone (adding something).
- Taking away recess from a class that is yelling (taking something away to decrease yelling).
- Adding a painful stimulus to a child contingent upon self-injury (I DO NOT ADVOCATE)
- Assigning "I will not hit my friends in class" to be written one hundred times.

There are many concerns with punishment and side-effects that will be discussed in a future post.

Positive Behavior Supports - Focuses on changing the environment in order to decrease interfering behavior and promote success in life goals that include learning, accessing friends, accessing employment, and participating in the community. PBS is invested in understanding that each individual has strengths, and to shape these strengths to create and promote adaptive behaviors in order to function as independently as possible, while making interfering behaviors irrelevant, inefficient, and ineffective.

The focus of PBS is on antecedent-based procedures. In other words, pro-actively rendering the interfering behavior unnecessary in order to prevent the behavior from EVER occurring.

Functional Behavior Assessment comes out of PBS (Carr and Durand). This is a key assessment tool that is used to identify why a behavior occurs. While it stems from PBS, it is used by behavior analysts with vigor.

The majority of PBS folks do NOT EVER advocate the use of any punishment procedure, while many ABA folks will use forms of punishment punishment(e.g. response cost - losing something contingent upon a problem behavior). (although I do not have data on the figures, so will not claim majority)

How do these two areas work together? and what is the difference? This is an area of debate that I am not willing to get involved in. But what does PBS and ABA mean to the parent and to the classroom teacher?

To bottom line it, behavior principles change behavior. There is overwhelming evidence that all the principles of behavior can effect both positive and negative change in behavior. So, we have all these principles that are outlined in ABA. How they are applied to change behavior, and to create plans to promote higher quality of life is interpreted differently. In my perspective as a teacher, and as a staunch behaviorist, Positive Behavior Supports, and the guidelines of PBS guide the application of these principles to create positive environments and educational plans that will promote success for individuals that exhibit interfering behavior.

Below is an application. While ABA and PBS are used in parentheses to show with which orientation the strategy aligns more, it is not exclusively with that group. Rather, the focus is more a part of ABA or more a part of PBS, but not necessarily exclusive. For example, praise is used in both ABA and PBS oriented programs, but consequence-based procedures are more the focus of ABA. None of the strategies below are exclusive to one orientation.

The application below is meant to be a BROAD description of a program and strategies, not to address a debate of ABA and PBS.

Application:
A child in a class is exhibiting interfering behavior of hitting peers in his pre-school class. This behavior is preventing him from learning, developing friendships with peers, and prevents him from accessing community resources (concerns that guide ABA and PBS).

The teacher is not sure why the child is engaging in this behavior, so she wants to figure it out. She completes a functional behavior assessment (from PBS, but used in ABA).

Based on this FBA, it appears that the hitting behavior functions for attention (every time he engages in the behavior, he gets some kind of attention). Based on this function, a behavior support plan will be generated (this is more from PBS but not exclusively. Many ABA folks may say that a token system will decrease the behavior. I am an ABA folk, but I would create a plan based on the FBA).

As the major component of this BSP, antecedent strategies would be outlined that address attention. Some ideas might be 1) greet him early in the morning(PBS) and praise any positive behavior (ABA) evident. Provide opportunity at this time for one-one attention (PBS), a chance to talk about what he wants (PBS) 2) create a small group with one peer that can be monitored in order to promote positive social interactions (PBS). 3) Teach the child a replacement behavior of how to access attention through appropriate means (raising hand, asking for attention, showing teacher work completed to get attention) (PBS). 4) A star chart communication with home can be implement to reward a day with appropriate attention getting behavior (ABA). 5) Should the behavior occur, attention is not provided. Rather the child is redirected back to task and the hitting behavior is extinguished (more ABA). Treatment integrity and effect of plan is monitored by anecdotal and frequency data (ABA and PBS).

The breakdown in the above example might not be agreed upon by both sides of the debate, however as a teacher, and teacher of teachers, it is the application, and not the debate that is of interest. Hope this helps. Comments are welcome.

Functional Behavior Assessment vs. Functional Analysis

2007-04-30T18:20:00.000-05:00

Often these two terms are used interchangeably, when they are not interchangeable. As described in other posts, a functional behavior assessment is essentially a complete assessment as to "why" a behavior occurs: is it to escape a task? to obtain a tangible? As discussed before, information/data from various sources (scatter plot analysis, ABC sheets, interviews, direct observation) are collected in order to identify the function.

A functional analysis is different. A functional analysis can be part of a functional behavior assessment. Sometimes, after a full FBA has been completed, the function of the behavior is still unclear. The assessors may have narrowed down the function to two functions (for example escape and attention) but are unclear which function is really maintaining the behavior. In this situation, a functional analysis can be completed. A functional analysis involves manipulating certain variables in order to identify with more certainty what is occasioning the behavior. This is completed by implementing several different conditions and measuring the target behavior under those conditions. See the following example.

A teacher has completed a functional behavior assessment for a child's self stimulatory behavior (he follows lines with his eyes in the corners of rooms, lines in the wall paper, and lines in the furniture). She has narrowed down the two functions to escape and attention, as he often escapes but at the same time tends to receive attention from teachers to redirect the behavior. In order to identify the function of the behavior so that she may create an appropriate behavior support, she decides to analyze different conditions with a functional analysis.

She sets up four phases of data. The first phase is an attention conditions. Each time he engages in the self-stimulatory behavior, she provides attention. She takes frequency data on the self stimulatory behavior over a set period of time (ten minutes) while providing him with attention every time he engages in the behavior. The next phase, is the escape phase. Each time he engages in the self-stimulatory behavior, she allows him to escape, and continues to take frequency data on the self stimulatory behavior. She then repeats the attention phase and then the escape phase.

She then analyzes the data, to see under which condition he exhibited the behavior more. If he engaged in higher rates of behavior during the escape behavior. it would appear that the behavior functions for escape. If the behavior occurred at higher rates during the attention condition, it appears that the behavior functions to obtain attention.

ABA: A bad reputation?

2007-04-27T16:56:00.000-05:00

ABA has a bad rap. I attended a conference today, and ABA is often spat out of presenters mouths. It is such an effective treatment, and yet some groups of professionals, refuse to admit the success that ABA has attained, or only choose to point out the flaws, or the skill/domains that typical ABA programs do not incorporate. This infuriates me. But there are reasons for this. The Bad Rap didn't come out of the air.

One of the criticisms is that ABA programs do not address initiated language, spontaneous comments, social skills, joint attention, relationship development, and rather that ABA programs focus on responding. I would love to argue with this, but I can't. In many cases, this is true. Many of us that work with children with autism may incorporate these skills (and certain models of ABA, like ABA/VB) claim to incorporate them more, but it IS a weakness in our programs. The programs that do address these skills are not promoting or publishing research about their programs. Often in meetings, I will defend the home-based program stating that "we do have play dates, we address joint attention, we target development of relationships, we work in the natural environment..." but the proof is in the pudding. When I walk into a classroom that follows an "ABA" model and is advertised as such, I see discrete trial instruction. And why? I believe it is easier. It is easier to work out of a card box and teach labels/tacts and contrive environments. It is far more challenging to extract learning opportunities from the natural environment. The challenge is there, and while discrete trial instruction will teach discrete skills, it is the responsibilities of the ABA therapist to get out of the chair, away from the table and address functional skills that the child encounters daily in their environment.

Another reason that ABA may have this bad rap is the language and attitude that we ABA therapists have. Of course we have an attitude. We use an effective technology that effects behavior change. We know that what we do works. But we don't have all the answers, and it is okay to admit that. Other disciplines can offer strategies that will benefit our teams. Speech therapists have a lot to add on our teams and they may have strategies that we can incorporate. The lack of open-mindedness of some professionals may propagate this bad rap. It is unfortunate though, and the confidence we exude when we discuss our principles and programs may eventually hurt us.

Rather than defending our program, and defending our principles, I feel we should open up to other disciplines. Chances are (rather data supports) that if other effective strategies are identified, they have a behavioral base. We don't have to defend it...the evidence is there. I know that "follow my eyes to the prize (an RDI activity) is behavioral in nature, and SD and an establishing operation that occasions the target behavior, but when I have tried to debate this, I am shot down and referred to as "such a behaviorist". I guess the bottom line is, it doesn't matter what orientation the strategy falls under, as long as it is implemented correctly and monitored for effectiveness.

These points may be some of the contributors towards this un-loving attitude towards ABA. (How can ANYONE not love such effective principles???) But we have to engage the general public to see the connection, not debate them on it.

I will sit through the conference again tomorrow and bite my tongue as reinforcement strategies paired with SDs to elicit joint attention are called "developmental strategies" and ABA programs criticized for not incorporating them. These were just some observations.

Escape Motivated Behavior: Relationships

2007-04-25T18:36:00.000-05:00

Once familiar with functional behavior assessment, analyzing the function of a behavior is not limited to individuals with autism or developmental disabilities. When a behavior is witnessed, the same principles can be applied to analyzing the function of the behavior. This can then be applied to any relationship, including marital. The divorce rate of parents of children with autism is significantly higher than the going divorce rate (80% compared to 50%). Have a child with a disability adds stress to a marriage. Having a child with autism, based on this statistic (which is specific to autism) appears to add more stress to a marriage. Why? I want to address it from an "accessing reinforcement" perspective.

When an environment isn't positive or preferred, an organism will move away from it, (escape). When there is stress in the home, there are many escape behaviors that are evident: working more, substance abuse, drinking, illness (real or feigned), extra-marital relationships, sleeping, and leaving. Form a functional behavior assessment, these are escape motivated behaviors. So, why does an individual engage in these escape motivated behaviors? The environment is aversive or unpleasant, and these other activities are more reinforcing. The argument can be presented that "why should the environment be rewarding....this is the environment we live in, deal with it just like I am" However, this argument will not get very far. I may lead to more and more arguments, which will lead to more escape-motivated behaviors, and eventual separation. Divorce is an escape-motivated behavior in any situation. The divorcee may want to access stimulation elsewhere, but the main function is escape from the current situation.

The answer: the environment needs to compete with the escape environment. The trick is how to identify a reinforcer that will compete with escape. Further assessment is needed. Many children and adults engage in escape-motivated behaviors because of a skill deficit. Cursing is seen to increase during math lessons for some students, tantrums during work time, etc. This is again not unique to children with disabilities. There for, it must be identified what behaviors an individual is lacking in order to function in the current environment and experience reinforcement. When I work with a child, implement a strategy, and see the child learn a skill, I feel good. I'm happy for the child, for the family, and for myself. This is a reinforcing environment that keeps me going back. Often, in a family with a child with autism, one of the parents may not be as adept at interacting with their son or daughter, do NOT experience reinforcement, rather experience failure: failure to teach, failure to engage and thus failure to feel effective and good about themselves as a parent, spouse and person. I would begin with skill acquisition. Working with your spouse and teaching them how to interact, how to access reinforcement from their child.

Baby steps are needed here. Start with one simple strategy...one simple technique and see how far it goes. Teach someone to fish....

Monitoring and Parent Involvement in a Home-based ABA Team

2007-04-23T18:17:00.000-05:00

My posts tend to come from my current experiences. Something I want to stress that I have encountered is the need to monitor a home-based ABA team. While some may want to leave decisions and programming up to the professionals, I cannot stress enough how important parent involvement is. Most importantly, as a parent, you know your child the best. Everyone throws that statement around at meetings, sometimes in a condescending manner, but it is incredibly true. The parent/family is privy to a lot of information that individual therapists are not.

Communication
- what the other related service providers have been working on in a given day (maybe by the time the ABA provider gets there and works on verbal im, the speech therapist has been working on articulation for an hour and the child needs a change of pace for a bit)
- what has transpired in the day (events, parties, accidents, sleep habits, etc.)
- history with certain reinforcers, activities, that may elicit interfering behaviors
- perseverations - what a therapist that only sees a child twice a week considers appropriate, may be a perseverative behavior that the parent has been witnessing all day long, and is concerned that it is being reinforced in session.

These are only the day to day events that keep parents and families involved. A communication book only goes so far. Sessions that I work tend to flow a little better if the parent and I have taken ten minutes to talk prior to the session, and ten minutes to chat at the end of the session. It is more important to sacrifice ten minutes of session time in order to maintain open communication than to sacrifice the communication to squeeze in one more program.

Opportunity for practice
Another factor is opportunity for practice. A child is with their family for a significantly greater period of time than with the therapists. We do not teach children so that they will behave appropriately in their learning environments. We work with children so that they will extract learning opportunities from their day to day life, in the community and in natural settings. In order to do this, the family needs to know what goals are being target and provided opportunities for distributed practice throughout the day and week.

Input on Goals
What is important to a family and what is important to a therapist is not always the same, and there isn't necessarily a right answer on this. Some families value academics over social, and are more concerned with building academics. Others value social skill development and play dates over academics. The child's program should not only reflect the child's strengths and weaknesses, but should address the culture of the child's family and what is important to the family.

Keep an eye out
Monitoring a program is up to the family, the team, the team leader, possibly a consultant. However, it should not be left to one individual. It takes a team, and it takes a few sets of eyes on the team to keep things in check. Parents should get into that program book, ask questions, make comments, provide suggestions.
- Why hasn't this program been run consistently?
- This program isn't moving...what are we doing to improve progress on this goal?
- How can I enhance generalization of this skill? Is generalization addressed?
- What does this mean?
- What are these goals based on?

There are so many questions that should be posed. Especially if monthly team meetings are not occurring. But again, it IS up to the parent to get involved. The level of involvement that you are comfortable with is up for debate. Some will argue that a parent should be 100% involved, others want to be minimally involved. I work with each family and the level of involvement they are most comfortable with. However, the families that are more involved tend to have higher rates of progress and acquisition. This is clinical experience, but parental involvement does appear to correlate with progress. Thoughts?

Components of a Behavior Support Plan

2007-04-20T10:33:00.000-05:00

After the identification of an interfering behavior, and a functional behavior assessment has been completed pinpointing the function of the behavior, a behavior support plan based on the function of the behavior should be created and implemented by the parents and professionals who know the child and work with the child frequently. Below is a brief description of the components necessary in a comprehensive behavior support plan.

Identifying information: Child's name, age, setting, date of the plan.

Operational definitions of interfering behavior: The behavior should be defined in a way that ANYONE observing it would recognize it as the target behavior. It is not sufficient to say that the target behavior is "self-injury". Rather, a full description is necessary so all family and professionals can recognize the behavior: "...opens his mouth and bites the fleshy skin on his forearm with enough pressure to break the skin..."

Communication Skills: As interfering or problem behavior has a communicative function, a brief description of the child's current level of communicative ability should be stated to inform the reader of what abilities the child has.

Medical Concerns: Some interfering behavior have a medical function, or rather are the result of pain, trying to escape pain, and may increase in accordance with the concern (e. g. dental, allergies, skin irritation.) Therefore it is important to include a brief description of medical concerns.

Setting Events and Antecedents: A brief review on stimuli that occasion the behavior should be listed or briefly described (e.g. illness, unexpected changes in the schedule, loud noises, lethargy).

Hypothesized function of the behavior: The function identified from the functional behavior assessment should be clearly stated here. Rarely does a behavior occur only for one function, so multiple functions may be listed (e.g. sensory and escape motivated behavior).

Preference assessment: As reinforcers in the environment may occasion the behavior (child wants to access the reinforcer, and may engage in an inappropriate behavior to do so). Additionally reinforcing activities may be used proactively and should be listed here to keep family and teachers aware.

Proactive Strategies: This is the meat of the plan, and can be broken down into several components.
A. Environmental Modification: This section lists how the environment can be modified in order to help the child be successful. These are modifications that staff and family are responsible for (e.g. visual schedule, seating arrangement, prior notice of transitions, etc. )

B. Teaching Strategies: These are skills and strategies that are targeted to teach a skill that will help the child manage their own behavior, or replace the inappropriate behavior (e.g. functional communication training).

C. Reinforcement Strategies: In addition to the above, a reinforcement system may be put in place (e.g. token economy, etc.)

Reactive Strategies: While the child is learning to engage in appropriate behaviors, the interfering behavior will continue to occur, although hopefully at lower rates. However, there should be a consistent response that the family and professionals consistently follow when the behavior occurs (e.g. redirect the target behavior, block the inappropriate behavior)

Data Collection: A system of data collection and monitoring the plan should be clearly stated (e.g frequency of head-directed behavior daily)

Treatment integrity: A system for monitoring the correct implementation of the plan should be in place in order to ensure the plan is followed.

Signatures of team: Everyone that collaborated on the plan and that implements the plan should have met to review the final product, ask and answer any questions and sign the plan.

Follow-up: There should be a section that stipulates how often the data for the plan will be reviewed and data monitored.

Evidence-based Practice: Guidelines for Intervention Evaluation

2007-04-18T23:32:00.000-05:00

The New York City Task Force for Inclusive education, outlined four different levels for evaluating how "evidence-based" an educational program actually is.

1. Scientifically-based programs:
- Is there strong data to support the effectiveness?
- Were random trials used in the data that was collected?
- Is there generalization of findings across different sites?
- Is the setting that established support similar to the setting you want to try it in? In other words, is replication at your site possible?

Bottom line, are the programs that our schools claim to be scientifically-based, actually scientific? Have they been supported by a good research design? Is data published to support it? Ask your districts why they have selected a particular reading curriculum, and see what there answer is based on.

2. Evidence-based:
- Random controls, but some flaws
- Strong research design, but some flaws present.
- Groups that the intervention was compared to was closely matched to the setting you want to implement. For example, if you have a lower SES setting with predominantly minority population of students, was the intervention shown to be effective in a similar setting? or in an all-white upper class neighborhood with no second languages present?

Bottom line: On our way to a strong scientific model. The intervention hasn't conclusively been identified to be effective, but evidence is emerging and it looks good.

3. Emerging consensus:
- Informed by some studies, although the intervention did not come fro the study (e.g. studies show that a whole language approach may be effective...so the school implements a whole-language approach). May be informed by qualitative studies (not hard data, but some information), non-random studies (this means that the students selected may have come from a biased sample).

Bottom line: This type of intervention stems from non-scientific and usually non-quantitative research that seems to have the right idea, makes sense, and is implemented in the classroom. This usually happens when a new treatment or intervention blips on the radar, and some preliminary qualitative research starts to emerge, as "experts" come out of the woodwork. Doesn't mean the intervention isn't effective, just that the data isn't there yet (of course, it might be totally ineffective, but we would have to see. )

4. Expert-judgement:
- Field-based practices that look good, but haven't been studied. For example, there isn't research to show indices of anxiety in children with autism decrease through the use of social stories, but I have seen it clinically, through measures. I have monitored it, and while I have seen a positive effect, it is field-based and has not been subjected to the rigors of a scientific study.
- It is what appears to be effective in the field.
- Looks good with certain students in certain contexts.

Bottom line: This is what a lot of people do. However, these are essentially little studies that are run with individual children and generalizability is weak. This expert judgement and interpretation of what is happening with an intervention, I think is the kind of thing that needs to be researched. There are a lot of great interventions that stem from the field, where teachers are too busy teaching to publish their data. Not being scientifically based, doesn't make it an ineffective program. It just means it hasn't been supported by data to be effective across populations.

Essentially, these are four guidelines that are helpful to reference when trying to identify what level of rigor some of the interventions (academic and social) have been through in our schools, justifying their usage in the classroom. It is important to ask questions. "Why are you using this program???"

These guidelines are taken from the New York City Task Force on Inclusive Education
-

Inclusion, ABA, and Autism: Some questions to guide a program.

2007-04-18T22:53:00.000-05:00

“IDEA requires states to establish procedures assuring that students with disabilities are educated to the maximum extent appropriate with students without disabilities” (Osborne & Dimattia, 1994).

Below are some Broad guidelines from a presentation from one of the courses I teach. Information is bulleted off of the powerpoint presentation.

Inclusion: When a child with a disability is placed as a full member of a regular class with the provisions of supplementary aids and services.

Why do you want to include children with autism in a regular education class?
• Learn and generalize social, academic, and play skills
• To access natural environments and interact with typically developing peers.
• To gradually increase students independence in a regular education classroom.

Questions to ask and answer prior to an inclusion program.
- Is there a need for home supports with the school program?
- How can ABA procedures be incorporated into the school inclusion program?
- Is the site appropriate (e. g. how close to home)?
- What are the characteristics of the regular education teacher (openness of teacher, knowledge of disabilities and modification strategies, etc.)
- How large is the class?
- What is the climate of the school? Open to students with disabilities?

Questions to ask about a selecting a shadow.
- Training and education?
- Knowledge of disability
- Ability to convey methodologies to classroom and support staff?
- Experience (necessary)
- Clear knowledge of responsibilities in the classroom?
- Relationship with child? Rapport established?

What will the targets in the inclusion setting include?
- Language skills
- Social Skills
- Academic Skills
- Appropriate behavior and behavior management

How will we monitor goals?
- anecdotal data?
- baseline and intervention data
- peer data (needed to establish a comparison

Basic strategies that require fluency?
- Interrupt inappropriate behavior
- Provide non-verbal prompts to follow classroom teacher
- Prompts to begin work
- Systematically fade instruction
- Allow time for student to follow regular education teacher
- Prompt from behind
- Provide praise and reinforcement as appropriate (constant feedback).
- Prompt child to direct questions to regular education teacher
- Foster social interactions
- Extract learning opportunities from the environment
- On-the-spot curricular modifications

Eclectic Program Models for Children with Autism

2007-04-18T22:13:00.000-05:00

I was part of a CSE meeting today for a child transitioning from pre-school special education (CPSE) to special education (CSE). I had been coordinating this child's home program of 33 hours a week for three years. His program consisted of programs based on the principles of applied behavior analysis. While we weren't married to the table, and did not exclusively use discrete trial instruction, it was an ABA program and all educational programs followed systematic instruction, reinforcement, shaping, etc. He has made significant gains in his program.

After three years of this intensive home-based program, comprised of masters and above level therapists, prompt-certified speech therapists and certified behavior analysts, we were met with the CSE recommendation of an eclectic program. This was presented because "ABA isn't effective for all children with autism anyway"... I held my tongue. While I posted yesterday that not all children will become indistinguishable from their peers, an ABA program WILL effect a positive behavior change in a child with autism.

Now were met with an eclectic program. What is an eclectic program? I have no idea. Apparently it has a "little bit of TEACCH", "a little bit of ABA", "a little bit of sensory integration" "a little bit of Greenspan." Essentially a little bit of everything. This was not my first experience with situations similar to this. Often in the board of ed for New York, families are presented with this eclectic model as a replacement for the ABA program. This is advertised as having the components that ABA lacks. Throw in some RDI, some sensory integration, some TEACCH and you got yourself a good program....allegedly.

This becomes a concern in many home-based programs that start to incorporate different models. However, these is nothing to support that an eclectic model will be effective. Of the flawed data that we have, ABA is the strongest intervention out there with the strongest research to support its use. It is frustrating and disheartening when eclectic programs are presented as not only as effective, but more effective than ABA programs because they have something that the other programs lack.

I am not advocating that other programs or models not be incorporated into a home or school ABA program. However, if a component is to be added, it needs to be monitored and evaluated for effectiveness, as is the case with all programs that are implemented with our kids from Edmark to Sensible Pencil. Any program needs to be evaluated. We have good data to suggest that intensive behavioral intervention is effective. We do NOT have good data to suggest that an eclectic program is. Case closed.

Self-stimulatory Behavior

2007-04-17T23:13:00.000-05:00

This has to be the most challenging behavior to effect positive change. When targeting behavior for change, self-injurious and aggressive behaviors tend to rank high on the list of priority, and rightfully so. However, self-stimulatory behavior is incredibly self-injurious as well. Every time a child engages in self-stimulatory behavior, they are essentially practicing it. By practicing it, the inevitable result is that they will get better at it.

If a child were to practice piano for a set period of time every single day, the child would become a virtuoso. The same practice is applicable to self-stimulatory behavior. Practice makes perfect. And by practicing behavior, they will get better at it, and it essentially is brain damage. By practicing something over and over and over, a child's response in an inappropriate behavior is more fluent, which will lead to more self-stimulatory behavior, and a downward cycle spiral of less opportunities to engage in appropriate behavior. It isn't pretty.

However, the challenge persists on how to shape or decrease inappropriate self-stimulatory behavior. Very challenging. Incredibly challenging, bringing the most talented and creative behavior analysts to their knees, only to have some breakthroughs and mild decreases in one behavior while it is replaced by another. Several strategies have been outlined in the literature, some with more success than others. Some strategies that I have implemented in clinical and school-based environments are briefly outlined here.

Time and Place: This was attempted with a child that engaged in high rates of hand play. Due to the incredibly high rates, we attempted to teach a time and place. This meaning that we would allow him to engage in self-stimulatory behavior in certain areas and during certain times. The thinking behind this would be that he would learn that he had the opportunities to engage in the behavior, he would not feel denied the behavior, and would focus it during that time and place. We started out by allowing the behavior in frequent intervals and then planned to phase the intervals out. n
Result: Backfire. This particular child engaged in the behavior during his "time". Following this allotment, it was impossible to re-direct him back to task, nor was there any motivation for him to do so. He was engaging the behavior the entire time and didn't need to stop. We saw higher rates in self-stimulatory behavior, following the time and place procedure.
However: With another child that engaged in intense high rates of self-stimulatory behavior with a favorite movie, we were able to decrease time and Place to one time a week, and he learned he was allowed to enjoy that movie that one time a week. Success.

Timed-trials: This procedure involved starting with small increments of time (30 seconds) and reinforcing the absence of the target self stimulatory behavior (DRO, Differential reinforcement of other behavior). This was successful to a degree. We were able to build the increments of timed-trial to five minutes without engaging in self-stimulatory hand and vocal play, very successful compared to the less than five seconds without self-stimulatory behavior prior to the intervention.

Response cost: A token board was used with a child that engaged in high rates of perseverative vocal behavior. Baseline indicated that the child was engaging in over 100 perseverative statements in a four hour period. A token system with fifty tokens was provided to the child and he was given the contingency each time a perservative statement (specified for the child) was observed, a token would come of the board. As long as he had one token left at the end of the day, he would get to watch a tape that included his topic of perseveration.
Result: Success. Within a week the perseverations were down to less that six. At the end of two weeks, the contingency was faded to included watching the tape after two days of appropriate behavior, then three, then four, then weekly.
However: Response cost is a punishment procedure and as all punishment procedures, has side effects. In this situation, two years later, the child exhibits signs of anxiety when the preferred perseverative topic is mentioned. This anxiety related behavior (tensing of the arms, face) is common in the use of punishment procedures and not recommend.

Teaching an Appropriate replacement behavior: This is of the more preferred interventions, although it is less immediate than a response cost procedure and may not be as alluring to the parent or therapist to try. However, it results in the learning of a skill, which the other interventions mentioned above do NOT do. The challenge is to find an appropriate replacement behavior. For example, if spinning wheels is a child's behavior of choice, a building gears toy may be an appropriate replacement, giving the child an opportunity to spin, but to do so in an appropriate manner. Another example, is creating a scrap book of a topic that is a high perseveration topic. Clippings, pictures, stories of the child's preferred topic can be added to a scrap book, with guidelines (ex. no double pictures, items) and the child can have a set of time each day that he can talk about the section in his book, add to it, clean it up, etc.

Other replacement behaviors may included substitute sensory providers: squeeze balls for the active hands, a ball between feet for squeezing ankles together for the active feet, hands in pockets while walking for the wandering and flying hands and fingers, etc. The challenge here is usually to find the appropriate replacement behavior.

As more strategies are identified, I'll try to post them. However, I find the best way to prevent the self-stimulatory behavior is by not allowing the child to practice the behavior. This entails parents and teachers to be highly aware of new self-stimulatory behaviors as they crop up and nip them quickly, providing replacements, expanding on play ideas, and helping children tie these fascinating self-stimulatory behaviors to new ideas that may intrigue them more.

As with any intervention however, data is needed to identify the effectiveness of the intervention. Prior to start, baseline should be taken. How often is the behavior occurring without intervention? Then the intervention can be implemented and the team/family can identify if a change in behavior is observed.

ABA and Typical Functioning

2007-04-17T20:44:00.000-05:00

Applied behavior analysis, and interventions that incorporate behavior interventions, based on principles of behavior, are very effective at changing behavior. Any behavior. Some behaviors are more challenging than others, but a behavior change will be seen. ABA programs seek to change socially relevant behavior, generally focusing on academic, social, verbal, adaptive, and motor behaviors that will help an individual become as productive as they choose to become in our society. However.

An ABA program does not guarantee "recovery" or "normal functioning" or "typical functioning". This is something that needs to be addressed, as normal functioning becomes the goal of ABA schools, home teams, and parents. Recovery should not guide instruction. The child should guide instruction, and working with a child to reach his/her maximum potential should guide instruction. ABA does not guarantee normal functioning, and this is something that needs to be clearly stated, as to leave no one to mis-interpret what outcomes are expected from children that are even in the most intense ABA programs with 100 hours a week. As the quote says "you know one kid with autism, then you know one kid with autism." We don't know how every child will respond to our programs, even if the programs are based on sound and valid research. Children have different rates of acquisition, different abilities, different strengths and weaknesses.

Lovaas (1987) had a lot to add to our field and showed that some children with autism can indeed blend into the regular education classroom and appear indistinguishable from their typically developing peers. However, this study is often cited by parents and therapists who haven't actually read the study. They only report the figures "47% of children in the intensive group attained normal functioning." It is a great study, and a lot has been learned from it, but replication of this figure has never been attained and there are flaws in the study. Not to say that intensive instruction doesn't have incredible effects. However, it does not affect all children equally. 8 of the 19 students that received intensive instruction for an average of two years, were maintained in regular education classes (McEachin, 1993). However, we don't know how the children faired in these classes. Did they develop friends? Did they get jobs later? Did they go onto college? Possibly, but we don't have data on that yet.

I'm not looking to criticize the study, nor to imply that ABA shouldn't be sought for intervention. I whole-hearted accept the data that says it is the most effective intervention to teach children with autism, and continually advocate for its use. However, it will not solve all problems, and will have children responding differently. I recommend reading the article to further understand what the study actually entailed. Additionally, follow-up studies that attempted to replicate (unsuccessfully) the design. The purpose of this post, is to encourage consumers of ABA therapist, schools, consultants, to critically review the literature, and to be knowledgeable about the goals and outcomes of behavior intervention.

Lovaas. O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in
young autistic children, Journal of Consulting and clinical Psychology, 55, 3-9.
Original landmark study
McEachin, J. J., Smith, T. & Lovaas, O. I. (1993). Long-term outcome for children with autism
who received early intensive behavioral treatment. American Journal on Mental
Retardation, 97, 359-372. Follow-up of Lovaas sample
Attempted replications:
Eikeseth, S., Smith, T. Jahr, E. & Eldevik, S. (2002). Intensive behaivoral treatment at school
for 4- to 7- year-old children with autism. Behavior Modification, 26, 49-68.
Smith, T., Buch, G. A., & Gamby, T. E. (2000). Parent-directed, intensive early intervention for
children with pervasive developmental disorder. Research in Developmental Disabilities,
21, 297-309.
Bibby, P., Eikeseth, S., Martin, N. T., Mudfor, O. C. & Reeves, D. (2002). Progress and outcomes
for children with autism receiving parent-managed intensive interventions. Research in
Developmental Disabilities, 23, 81-104.
Boyd, R. D. & Corley, M. J. (2001). Outcome survey of early intensive behavioral intervention
for young children with autism in a community setting. Autism, 5, 430-441.
Scheinkopf, S. J. & Siegel, B. (1998). Home-based behavioral treatment of young children with
autism. Journal of Autism and Developmental Disorders, 28, 15-23.

Home-based ABA Programs

2007-04-16T10:47:00.000-05:00

For the past 20 years, predominantly since the Lovaas (1987) study showing the highest success rates for children with autism were children involved in an intensive ABA program, parents have been working to implement a home-based team in their homes in attempt to replicate the results that Lovaas attained with 50% of his sample (9 students). However, there are several components of a home-based ABA team and quality factors to consider. Unfortunately, evaluation of home-based ABA programs is difficult and the research does not report longitudinally on the effects of these programs. I will be reviewing the literature in this area over the next couple of weeks, and will present findings here, but in the meantime, there are some factors to consider when reviewing the quality of the home-based team.

Training of team and family: Quality of quantity always. Families will often fight their district for services, particularly here in New York, and retain expensive lawyers in order to obtain as many hours per week as possible. However, following award of these hours, it is a struggle to fill the services with qualified professionals. While a degree does not make an excellent, knowledgeable and creative therapist, training does, and intensive training in applied behavior analysis (as discussed in prior posts).

Supervision/lead of team: While the training of the entire team is of pivotal importance, there should be an individual that guides and supervises the team, monitors the implementation of programs, and provides feedback to the team members on the proper implementation of the programs. While BCBA alone again, doesn't guarantee an appropriate team leader, it does offer some certainty that training in applied behavior analysis has been formal. However, additional experience in supervising home-based ABA teams is necessary for an effective team leader. As also mentioned in previous posts, the team leader/supervisor, should work with the child 1:1 in addition to supervising the team.

Related service providers: The team, including the related service providers (Speech, OT, PT) need to be on board with the ABA team. Many ABA programs are generalist models. This means that they do not work directly with related service providers under the assumption that behavior analysis and programs based on the principles of ABA are sufficient to approach and effect a positive change in all skills. I disagree. As a behavior analyst, I do not have fluency with information regarding the development of the speech mechanism, occupational therapy strategies and physical therapy knowledge. As a result, the teams I work with include members from each domain. However, it is important that each team member understand the effectiveness of ABA and work with the ABA therapist in their program development and goal implementation. Collaboration among the domains is key.

Monthly Meetings: While this is difficult to manage in some home-based ABA teams, it is imperative that frequent meetings among the professionals occur. On smaller teams, communication may be sufficient through telephone calls with occasional meetings, however on larger teams, monthly meetings are recommended. Some of the teams I supervise have up to ten professionals in addition to parents and family, and monthly meetings are necessary to keep everyone on board, troubleshoot problems with programs, identify progress rates and discuss the child and new goals in a group. It cannot be understated how important this collaboration among family and professional can be for a strong program.

Family involvement: Family involvement is imperative. As many hours as service providers may be working with the child, the family is there more. While some family members may not be as involved, it is important to give information to families regarding the program, and how they can be consistent with the implementation and generalization of programs, and consistent with necessary behavior support plans, redirection strategies, etc. Often, immediate family beyond the child's parents may attend meetings in order to be more involved with the program. (At many meetings that I coordinate, grandparents and aunts are involved, sitting in on meetings and observing sessions).

Data-based Decision Making - Program development should spring from assessment results. Many assessments have been recommended for children with autism, but whatever the assessment, it should be valid and reliable. The assessment should also be used as a consistent measure. If it is given at the beginning of the program, it should be referenced periodically to gage progress and identify additional goals to work on.

Monitoring programs in order to make decision regarding the programs based on the data is necessary. Only with data collection and monitoring of the programs can progress be identified. Different methods have been identified for data collection (trial by trial data, probe data, anecdotal data), and while there is debate as to the best way to collect data, I would argue that as long as it is consistent and TAKEN, you can identify if progress is made on a goal and make decisions accordingly.

Community involvement: A home-based program that keeps instruction in a room in a home will be successful in that particular room, in that home. In order to have opportunities for generalization and maintenance, instruction must occur all over the house, in the community and in other environments appropriate for the child's age (e.g. park, community center, local pool, school, etc.).

Research-based programs: Programs selected for implementation should be based on research, assessments, and what has worked in the past. While many programs that are implemented may not themselves have research to support them, clinical experience has much to offer regarding programs, and can be an incredible resource. However, programs stemming from experience should be monitored with rigor as well.

Most importantly, ongoing program evaluation is necessary, not just by the team, but the family as well. The family/parents, are integral parts of the home-based team and should be regarded as such in meetings and interactions. On-going education is necessary for all members including family. Conferences, workshops, formal education and mentoring, should be part of a team. As new skills are developed, research should be completed to identify how to elaborate on these skills in order to maximize learning.

This is not an exhaustive list of factors that are important to consider when evaluating a home-based ABA team, but its a start. More to come.

Consultation: Home-based Programs

2007-04-15T16:06:00.000-05:00

The challenges in consulting in a school are not necessarily unique to that environment. Home-based consultation is difficult and presents with many of the same challenges: seen as an outsider from the home-based team, the team may feel that it is "easy to say it" but the implementation of certain strategies are challenging, and lack of knowledge of the child makes recommendations challenging. I have been on both sides of this consultation model.

As a home-based teacher receiving consultation services: As a home-based ABA therapist, working with children on the spectrum, I have worked with consultants that were hired by parents to support the home-based team. Suggestions were always valued and strategies were suggested, however without working with the child directly, it is challenging to fully understand what the implementation of the program is actually like, if it is feasible, and the logistics of implementation paired with data collection. In some consultation models, the consultant works with the home-based teacher on the implementation, but time limitation on both parties, prevents full observation and feedback on data collection, implementation, and monitoring child responses. In this respect, many consultation models are somewhat flawed. In my experience, the biggest challenge to overcome in these environments is lack of knowledge of the child.

As a consultant to home-based teams: This was frustrating, as I felt I did not have fluent knowledge of the child, and unable to fully make recommendations for the team and family, always left with questions "How do you think he will respond? Can you implement this?" Even on teams that I am a member of, I need to engage in the actual participation of the strategy in order to identify if it is applicable, if the data collection is feasible, and to provide support to trouble-shoot for problems that come up.

I try to avoid situations like this. Rather than maintaining a consultative role, it appears that certified behavior analysts should commit to teams, and have opportunities to work with the children on a frequent, if not weekly basis. The implications is that rather than having consultants come and observe teams, and make recommendations, the skill level and expertise of the team needs to increase. Decision making and strategy development should not be left to a consultant or a supervisor that works with a team once a month or bi-monthly. This leads to slower progress. Rather the expectations of the knowledge and skills of each therapist needs to increase.

This at first, may need to be guided by a consultant. It is possible that the more appropriate role for consultation is to guide the therapy provider with ways to increase their knowledge and skill base, thereby providing the teacher with the tools necessary to engage in decision making strategies independently. Essentially the focus of the consultation should turn from strategy development to staff training. Again, teach a man to fish...

At the time of this post, I am coordinating five home-based teams for children with autism and have the opportunity to work with four out of the five children on a weekly basis. For the little girl that I do not get to see on a weekly basis, I have weekly phone contact with her family and therapists. However, I have worked with this child for four years and have significant history as a therapist with her. This is the consultation model that I have found to be most effective at this point. The evolution of consultant from provider, to team leader, to consultant, with the same child.

My experience is certainly not exhaustive of consultation models that have been implemented in our field, but may be typical of many ABA providers and I would love to hear additional experience and comments.

Consultation in School Districts

2007-04-14T01:31:00.000-05:00

Consultation is common in behavior analysis. Professional become trained and certified as behavior analysis, and obtain consultation positions ranging from school programs for children with developmental disabilities, district schools that have self-contained and/or inclusion classrooms for children with disabilities, or for home-based ABA teams. I have worked as a consultant in each of these different environments and find them challenging.

Working in a district school a couple of hours a week is probably the most challenging environment. While a consultant has knowledge that can be applied, lack of in depth knowledge of the students in the classroom makes it challenging. For example, a consultant comes to the classroom, can provide suggestions, but without hands-on experience, it is difficult to make workable suggestions. In order to build up enough experience, it takes time, time that districts do not have the patience to wait for, nor the funds to pay. Districts want behavior consultation in the form of hard and fast functional behavior assessment and behavior intervention plans. This turns the consultation in a much less personal relationship, and more of an assembly line of behavior support plans. This becomes frustrating for the consultant who may feel pressure to complete plans as they are required by law, frustrating for the teachers who may feel that an "outsider" is coming in, who doesn't really know the situation, and telling them how to handle a child's problem behavior. This direction is not always received positively. Some ways to help the relationship are to:

Listen. value the input of the teacher. In order to get on board and act as part of the team, the classroom teacher needs to feel part of the team. The only way to do this is to sincerely value his/her input, incorporate input into assessments, data collection, and reports. Too often, a consultant will come in as the professional and not treat the teacher as a professional as well.

Be realistic: A consultant can come into a classroom, observe, and create an incredibly thorough and complex behavior support plan based on a functional behavior assessment, and this plan may be in line with best practice, but none of it will be effective it the plan is so involved that the classroom staff cannot implement it. Although 34 components may address all the needs of the child, if the teacher can only realistically implement ten, then ten is all that should be included. Prioritize the most significant components and focus on them. As I've mentioned before, treatment integrity is a huge issue and one of the factors that influence treatment integrity is plan complexity. Keeping it simple and realistic is a step in the right direction not only to foster a cooperative working relationship between the classroom staff and the consultant, but also for a plan that will have a higher probability of being implemented in the classroom.

Share information: In order to be an effective consultant that will have an impact in the classroom, sharing information is necessary. In the business models of consultation, often certain information is withheld from the employer in order to make the consultant necessary. However, in order for strategies to be implemented in the classroom, the classroom staff need to understand "why" the strategies are necessary and what effect they will have. However, in order to share this information and properly train classroom staff in behavioral strategies and techniques, some hands-on interaction with the children is necessary, which leads to another guideline.

Interact and work with the kids. While much valuable information may be very helpful in the classroom consultation model, working with students provides the consultant with more information on how to guide the classroom staff. This component however is usually the most challenging as time prohibits significant interaction.

This consultation is necessary, however, I am curious about the use of consultants in school districts are they are currently used, particularly in my area of New York. It goes back to the old maxim of "if you teach a man to fish...." Writing behavior support plans and completing functional behavior assessments may be a quicker solution to the problem of law compliance. However, I feel the appropriate role of the consultant is as a trainer and supervisor of the implementation, with the eventual goal of monitoring quality of program implementation. If the staff is taught, and significant time is spent on training, this will have a stronger impact on the classroom and the teacher who can then learn how to functionally assess behavior and have a more significant role in the development of behavior support plans addressing the function of interfering and problem behavior.

Imus: A Functional Behavior Assessment

2007-04-13T11:34:00.000-05:00

Taking off from my earlier posting on functional behavior assessment and the application to typically developing individuals, what was the function of the offensive comments made by Don Imus on the air. This can be explored from various functional perspectives, but I would argue that while a function was there, identifying it will be challenging, and without inside knowledge, impossible. From the perspective of each function:

Medical: Can there be some medical explanation of why he said it? It is possible. If he has been identified with a disorder, is having difficulty gaging what is appropriate and what is inappropriate to say on the air, or difficulty with his ability to identify future consequences? Possible.

Escape: Is there a reason for escape? Does Don Imus want to leave the position that he is in? Does he have a contract that he may want to break and decided that going the way of Howard Stern might be one way to break of this contract without lawsuit. Did he want to leave his job and literally escape to a vacation spot and retire?

Attention: Where has Imus been? He hasn't been in the news lately, hasn't said anything of interest to anyone in a while. This may have been an attention-seeking behavior. "no such thing as bad publicity" (while in this case, depending on the function of the behavior, may not be necessarily so). His behavior has been successful in gaining the attention of the media and advocates across the nation. His behavior has placed him on New York 1 daily for a large chunk of their broadcast. He has become the number 1 search on most search engines on the Internet. Talk show hosts will be fighting over having him on their show to give "his side" of the story, broad apologies to the general public in addition to special groups. If the function of the behavior is attention, success.

There may have been a smaller attention component involved, and that would be the attention of his peers, attention for being "funny", for maintaining the conversation, getting others to laugh. Although inappropriate, within his peer group, this may be expected. He may also have wanted to escape/avoid negative attention from his peer group if he commented that this talk was inappropriate.

Tangible: What could come of this that could have a tangible result? Although this had led to the loss of his job (a consequence he may or may not have foreseen) other monetary/tangible benefits may come of this. Books, magazine interviews, talk shows. It doesn't appear that Imus will suffer a financial crunch if he doesn't want to.

Sensory: Could be. Imus may like to just hear himself talk. This is probable. Based on his history (while a record review wasn't really possible) Imus does not have a history of practicing censoring his speech to a high degree. Saying what he said, to make his peer group laugh, to entertain himself, may have had a sensory component.

Most likely a combination of several of the functions listed above.

Functional Behavior Assessment: The Basics

2007-04-12T22:46:00.000-05:00

Behavior support plans go by many different names: Behavior support plan (BSP), behavior intervention plan (BIP), behavior plan (BP). Additional terms include positive behavior supports (PBS) but his term is not synonymous with BSP or BIP. Positive behavior supports will be discussed in a later post.This post is by no means a comprehensive review of a behavior support plan rather a guideline as to components that should be included in a BSP.A BSP/BIP is a plan that specifically addresses a behavior that interferes with a child's ability to learn and function in their environment.

There are several components that should be in place in a behavior support plan.

First, the target behavior needs to be identified. This target should be a priority behavior, meaning that it is the most important/most interfering behavior. A target behavior should not be chosen simply because it is irritating or annoying. A behavior should be prioritized by the interference with the child's ability to participate in his environment. The safety of the child should also be considered. For example, if you have a choice of a target of self-injury and self-stimulatory behavior, self-injury should be priority as it jeopardizes the student’s health and safety.

Once the target behavior has been identified, it is important to identify what the function of the behavior. This is done by conducting a functional behavior assessment. Function of the behavior refers to the purpose of the behavior, or "why" the behavior occurs. (See Carr and Durand for strong support on the need of a functional behavior assessment.)

They are generally five recognized functions of all behavior:
Medical: Behavior that occurs as a result of pain, trying to ameliorate or relieve pain
Escape: Behavior that occurs in order to escape or avoid non-preferred items/activities
Attention: Behavior that seeks to get attention from others.
Tangible: Behavior that occurs to get something (e. g. candy, activity, toys,)
Sensory: Behavior that occurs to fulfill some sensory stimulation (visual, auditory, tactile, gustatory, vestibular)

A functional behavior assessment is essentially system that accumulates information from various sources in order to develop a hypothesis of why (the function) the behavior occurs. While several tools are used as part of a functional behavior assessment, several are essential.
- Interviews: are conducted with individuals that interact with the child on a daily basis. Sometimes a structured interview can be used, but an un-structured can be helpful.
- Observations: Usually observations are done across environments and can give you information about how to take data on behavior (if you should use frequency, duration, what environments seem to have higher rates of behavior). Observations may help guide in the selection of tools to complete the functional behavior assessment.
- ABC analysis: An essential tool is a form that analyzes the antecedent to the behavior (what usually happens that appears to occasion the behavior) and the consequence (what consistently follows the behavior that may be maintaining the behavior). Analyzing the antecedents will give information about how to manipulate interventions to prevent the behavior from occurring (what supports can be put in place to prevent the behavior). Analyzing the consequences will give invaluable information about the function of the behavior (does a child consistently get sent to the dean's office during math class, then he is successfully escaping from math, function: escape).
- Scatter plot analysis: This tool looks at the frequency of the behavior over time, and is usually completed on a grid that has time on the left side and days across the top. This tool lets you see if the behavior is more likely to occur during a particular time of day.When information is gathered from the various informants (people) and environments (places, settings) hypotheses can be developed about why the behavior is occurring.

However, sometimes all of this information is not sufficient and an additional analysis needs to be completed. Functional Analysis (FA) is completed when variables in the environment are manipulated in order to narrow down the function of the behavior. For example, through FBA it is possible that two functions (attention or escape) have been narrowed down, but it is still unclear what the function of the behavior is. In a functional analysis, the therapist would set up two conditions, in one, providing attention, in the other providing escape, and measure which condition has higher problem behavior. The condition with the higher problem behavior will help identify the function. Functional analysis is a complicated procedure (it is briefly described here) and must be completed by a trained behavior analyst.

After all this is completed, and the function of the behavior has been identified, a behavior support plan can be created that directly speaks to the function of the behavior and outlining supports that will help the child be successful in decreasing the interfering behavior.

Functional behavior assessment is not just for students with autism or disabilities. Attempting to identify the function of anyone’s behavior is an interesting and insightful endeavor in our day-to-day lives. What maintains our day-to-day behavior? Why does a spouse pick a fight? Do they need attention? Are they trying to escape a work-related activity? Do they enjoy the sensory rush and adrenalin that gets pumped from arguing? Analyzing the function of the behaviors we encounter from people in our environment may give us new strategies for dealing with troublesome behaviors as we learn not to allow that person be successful in their function. Somebody gives you the finger on the road may want your attention. By ignoring them, you are preventing the success of their attention-seeking behavior.... etc. etc.

Treatment Integrity

2007-04-12T00:12:00.000-05:00

This will be a short post, with more to come, but I wanted to address the issue of treatment integrity. Research in the field of learning disabilities, applied behavior analysis, positive behavior supports shows that LIMITED information in these studies is provided on treatment integrity (Gresham, 1999, 2005). Treatment integrity refers to the level that an intervention is implemented as written. In other words, if a child is receiving a set intervention, (e.g. a behavior support plan, Wilson Reading Program, Discrete Trial Instruction) is the plan implemented the way that it is supposed to be implemented? This is the most important aspect of an intervention. If a plan is identified to target a particular skill, the ONLY way that we will know if it is an effective plan, or an ineffective plan, is if it was implemented accurately. Then and only then, can the team make an educated decision regarding the effectiveness of the plan.

An intervention can be excellent, but may fail because it wasn't implemented accurately. Then, school staff may feel that it "doesn't work" and give up, when in reality, it wasn't run correctly. On the other hand, an intervention may be ineffective, but teachers make accommodations without stipulating them, the child is successful, and it is wrongfully attributed to the plan.

It is up to teachers, parents, and school personnel to question treatment integrity of interventions that are implemented with our children, students, teachers, peers. It is important to ask questions regarding treatment integrity at meetings. How is treatment integrity monitored? Is it monitored? What is done after monitoring reveals poor treatment integrity? What level of training is implemented to increase treatment integrity? See research by Gresham for exhaustive reviews of treatment integrity in the literature across domains of behavior interventions, academic interventions, social skills interventions.

More on treatment integrity to come.

SUMMARY: Ferraioli, S., Hughes, & Smith, R. (2005). A model for problem solving in discrete trial training for children with autism. JEIBI, 224-243.

2007-04-10T15:11:00.000-05:00

The authors of this article propose and outline of how to trouble-shoot through glitches in DTT. While DTT is a strong tool used in many programs working with children with autism, sometimes families and teams are met with a challenge of a target that is not showing change. Several possibilities are proposed as reasons why progress may have halted in a particular program. Lack of progress is defined as 1) low rates of responding (responding stays at a certain level with no movement), 2) variability in performance (graph is going up and down consistently), 3) interfering behavior has increased making the program difficult to run (possibility that the target program is actually eliciting the problem behavior), 4) maintenance and generalization of the skill are not evident (in other words, the child cannot perform the target in different settings, and cannot perform the skill consistently over time).

This article presents flowcharts that are helpful for knowledgeable parents and professionals to follow in order to identify barriers that may be preventing progress. Provided as part of the analysis are key questions to ask when lack of progress has been observed. For example:
- Is the lack of progress specific to this program? or across all programs?
- Has there been ANY progress? a plateau?
- What is the trend? Is it variable ( data going up and down) descending (decreasing)?
- Are interfering behaviors present?
- Maintenance and generalization occurring?

Based on answers to these questions, this article provides basic hypotheses about why the program may not be indicating progress. While it certainly isn't an exhaustive list, it provides insightful suggestions on what modification can be made to a stagnant program. The article also provides models of graphs that depict no progress for a good visual example.

An additional resource in this article is a grid that outlines prompting procedures providing definitions, examples and advantages. See the link below for the full article.

http://www.behavior-analyst-today.com/JEIBI-VOL-2/JEIBI-2-4.pdf