Using Assignment Notebooks to Help Individuals with Autism in Classrooms and Other Settings

An effective organizational strategy for students with Autism Spectrum Disorder, especially those who are older and possess the prerequisite reading, writing, and organizational skills is an assignment notebook. All academic tasks and their due dates are listed in the notebook and the student will take it to school and home every school day. The most effective support would include a sample of how each assignment should look. Ideally, it should also contain examples of completed items (math equations, definitions, filled out problems, etc.) as these would function as visual examples of the correctly completed assignment. Although, simplified assignment books are certainly acceptable and can be effective depending on the particular student. The classroom teacher would need to check the notebook at school to make certain all information and expectations are included. At home, the parents or caregivers monitor the notebook to make sure the student has successfully completed all necessary assignments or activities to the level expected of them. A signature section for each day can provide an additional layer of thoroughness. This can include a signature section for the parent who monitors the assignment book and/or the student who completes the assignments. Essentially, these assignment books function as a visual checklist to help students stay organized and on-task. These are pretty standard in schools, yet it is imperative they are used to help students with ASD succeed.

As with most strategies for students on the spectrum, the specific skills required to effectively use an assignment book will need to be taught or should already be in the student’s repertoire. In addition, motivation needs to be taken into consideration. The teacher or support staff may need to provide additional reinforcement when the naturally occurring contingencies (i.e., assignment completion) are not sufficient. For example, if a student completes all daily assignments within a specified time frame, let’s say, homework that was assigned Monday through Thursday, then on Friday, they may receive access to a special activity or item. Another way to help students “buy-in” to the idea of assignment books is to individualize assignment books so that they include items, characters, colors, or designs that are preferable to the student. Students can customize their assignment books to increase the book’s value and help boost motivation.

We hope that you find the use of assignment books as a helpful organizational tool to promote homework and academic task completion!

How is Applied Behavior Analysis Different From Psychology?

The answer to this question is that while many people have historically viewed behavior analysis as a branch of psychology, the two disciplines take fundamentally different and antithetical perspectives to account for variability in human behavior.

In general, Behavior Analysis does not concern itself with mental states or inner thoughts when it comes to describing why we behave the way we do. Rather than focusing on “the mind,” behavior analysts look at behaviors, or in other words, what we do, as a consequence of things that happened previously. Simply put, we will repeat things when the consequences are pleasant and we will stop doing things when the consequences are unpleasant. Behavior analysis, as it suggests, focuses on treating behavioral problems from a purely behavioral perspective/lens. Functional analysis, gathering of data to establish trends, and then a subsequent intervention program or plan that utilizes various forms of operant learning are then applied.

Psychology focuses on the mind. Psychology as a discipline largely hypothesizes internal explanations (personality traits, mediating forces and other structures in the brain, etc.) explain differences in human behavior. Psychology looks to explain behavioral variability by appealing to internal causes that are typically seen as inside the mind (e.g., mood states, personality traits, hypothesized structures such as ego and/or drive states)

In short, the difference can be stated as follows: In the ENVIRONMENT (Behavior Analysis) versus inside the MIND (Psychology).

Can Autism Spectrum Disorders Get Worse?

A better way to rephrase this is “can the symptoms that define an autism spectrum disorder (ASD) diagnosis get worse?” Rephrasing the question this way makes us focus more on the specific difficulties that we can develop sound treatment for. Can ASD get worse? The answer is yes, but it also can get better.

For families that are just now starting their ABA-based services at home and/or in a school setting, it is crucial to identify what these symptoms or difficulties are exactly. Upon identifying, assessing, planning and implementing proper treatment programs, these symptoms can be either directly or indirectly addressed by the ABA services. With proper guidance of a BCBA, a sound comprehensive treatment plan may facilitate gains over a targeted amount of time.

That is not to say that once goals are met, “autism is cured.” No. What it means is that the ABA services that addressed the initial or more recent difficulties have been effective as the goals for that period of services have been met. How long that period of services is varies from one child to another. Some children may just need six to 12 months of ABA-based services while some children may need the services for a more extended period of time. Be the services for a short or an extended period of time, a crucial aspect of the services is to guarantee that parents/caregivers are given proper training in order for the family to maintain and continue to generalize their child’s learned skills from the services in the absence of the ABA team. Equally important are the parents’/caregiver’s ability to generalize their own skills when presented with similar situations that their child may face in the near future and again, in the absence of an ABA team.

As with any symptom, left untreated it will get worse. It is important then for families who have not yet received any prior ABA-based services to seek the services in order to get difficulties under some control. Families that previously received ABA-based services who find themselves unable to effectively address their now older child to seek once again ABA services in order for them to address their child’s more current needs.

Using Time Warnings To Help Students With Autism

 

Now is the time? Kid and clock: preschool child preparing for the school

Giving students warnings about time remaining in an activity can provide a helpful frame of reference. Time limit warnings should be paired with an auditory or visual cue, such as a bell or card. Towards the end of the work activity, the teacher should verbalize, ‘five minutes left, ‘two minutes left’. For students requiring additional support, the verbal que can be paired with the gestural pointing to the timer and manually signing ‘finished’ using sign language. When preparing students for the end of an activity that has a natural ending point, such as a game or a timed-test, the teacher should alert students that a transition is approaching by making such a statement as, ‘only a few more cards and the game is over’. Finally, time warnings or making transitional cards as part of the student’s routine can also help students with autism develop the capacity to be flexible for change. Additionally, teaching students to put away materials in the completion of an activity can function as a natural queue that one activity is ending, and that another is beginning. For example, the teacher can say, ‘once you finish that problem, you can begin to get ready for recess. All of these simple, yet very effective support strategies are easy to use, and help both students and teachers during everyday classroom activities.

Who Can Provide ABA Therapy?

Applied Behavior Analysis (ABA) therapy is typically provided by Board Certified Behavior Analysts (BCBAs), Board Certified Assistant Behavior Analysts (BCaBAs), Registered Behavior Technicians (RBTs), and paraprofessionals.

A BCBA is a person who has met the educational and professional training requirements established by the Behavior Analysis Certification Board. A BCBA will typically hold a Master’s degree in Psychology, Child Development, or a related field. Some BCBAs may also hold a doctoral degree in one of these fields and are referred to as BCBA-Ds (doctorate level BCBAs). The primary duties of BCBAs include: conducting clinical assessments, establishing skill based and behavior goals, updating and modifying treatment goals, conducting parent and caregiver trainings, supervising Registered Behavior Technicians and BCaBAs, ensuring the ABA program is implemented correctly and effectively, and writing progress reports required by funding sources.

A BCaBA (assistant Behavior Analyst) works under the supervision and direction of a BCBA and has similar duties as a BCBA. A BCaBA is also certified by the Behavior Analysis Certification Board and has met the necessary training and education requirements. A BCaBA will typically hold Bachelor’s degree in the field of Psychology, Child Development, or related field.

As stated by the Behavior Analysis Certification Board, an RBT is a person who practices under the close, ongoing supervision of a BCBA, BCaBA, or BCBA-D. The Registered Behavior Technician is primarily responsible for the direct implementation of ABA services. This is the person who is typically working 1:1 with an individual in designated treatment settings (home, school, clinic, etc.) RBTs must be over 18 years old, possess at least a high school diploma, go through a designated training program, and pass other eligibility requirements. RBTs do not conduct assessments or create treatment programs, however they implement the treatment program designed by a Behavior Analyst and collect data on progress.

Other professionals such as Marriage and Family Therapists and Licensed Clinical Social Workers may also provide ABA therapy in some instances. However, the majority of ABA services are provided by Behavior Analysts and Registered Behavior Technicians. Other paraprofessionals, including individuals pursuing undergraduate or graduate degrees in Psychology and related fields and/or pursuing certification by the Behavior Analysis Certification Board, may also provide ABA therapy under the Supervision of Behavior Analysts.

When is a good time to start ABA therapy?

As a general recommendation, “earlier is better” when it comes to starting ABA therapy. The time at which a child is diagnosed with Autism or a related developmental disorder is typically also a good time to begin ABA therapy. There are several reasons for this. At younger ages, children go through more frequent critical periods in their development. These critical periods are maturation stages in which the individual is particularly sensitive to stimuli in their environment. Teaching certain concepts in these earlier years may pay off in the long run.

Additionally, the earlier a child learns critical and age relevant behaviors and skills, the more productive and meaningful their time at school will be. The child will be able to access more of the curriculum if the necessary prerequisite skills are targeted early on. For example, a child who is taught to raise their hand to ask for help, initiate a social play interaction, and count from 1-10 during ABA therapy may gain the ability to absorb more from the academic and social environment at the school setting.

Research indicates that early intervention can improve challenging behaviors and children’s overall development. Another reason early intervention is important is to ensure that challenging behaviors are addressed early on so that they do not have the opportunity to become entrenched with age. Without an individualized, function based intervention plan, challenging behaviors can become worse (e.g. increase in frequency, duration, and severity) over time. This is because reinforcement over time can strengthen behaviors. If a young child is constantly engaging in challenging behaviors, without a behavior plan in place, those challenging behaviors may be inadvertently reinforced, therefore contributing to the possibility that they may worsen over time.

Early intervention provides the skills necessary to set the child up for long term success. The more skills a child is equipped with early on, the more of their social and learning environments they will be able to access as they grow. In fact, teaching “pivotal behaviors” and “behavior cusps” are a crucial component of ABA programs, particularly during earlier stages of the ABA program. While these two terms are related, they refer to behaviors, that when learned, result in new and positive changes across many areas of a child’s life.

While there are significant benefits to starting ABA therapy as early as possible, that is not say there is a point at which it is “too late” to start. ABA programs are highly individualized to the needs of the learner and Behavior Analysts take into consideration numerous factors when designing an ABA program. These will include the learner’s current behavioral, social, academic, communication, self-help, and other needs from different curricular areas. This is why many individuals benefit from ABA therapy even when starting a program later in their development.

Therefore, while “earlier is better” is the common recommendation by most clinicians, ABA therapy can benefit many learners at various stages in their development due to its emphasis on individualization.

Using Activity Completion Signals to Support Students with Autism in Classroom Settings

An activity completion signal is a tool which can help students identify when an activity is over. Many students with autism have difficulty knowing how long an activity or task will last. These difficulties may also be present when students are asked to switch their focus to another task. Activity completion signals such as “Finish Pockets” or a “Finish Boxes” provide a lot of support for students transitioning between activities. Finish pockets, like other tools, can easily be created—folders or plastic containers can be labeled and placed near students’ visual schedules for students to place completed work into. When the student completes an activity, he or she should remove the icon of the current task or activity, and then also place it in the finish pocket. During this time, the teacher would indicate that the activity is over. For example, “math is over everyone, time for recess” thereby allowing a student to recognize a transition, and recognize what comes next in a visual format rather than only hearing the instructions.

There are various ways you can use activity completion signals such as turning an icon-card around so that it is facing backwards, placing an icon or object near the finish box, crossing off the name of the activity or task on a white board, and of course, the old tried and true timer to indicate the end of a task. The more creative you can be, the more variation you will have, but again, just like with visual schedules, the student’s learning rates and skill levels need to be considered when determining the type of signal you use.

In addition, it is always true that you will need to teach the student with autism how to respond to the signals and that you will need to reward (reinforce) the student’s correct responses to the signals.

Does Research Show that ABA is Successful in Treating Children with Autism?

Yes—research does show that ABA is successful in treating children living with autism. As a matter of fact, since the early 1960s, the effectiveness of ABA based interventions has been very well documented particularly when helping children with developmental disabilities. Over 400 research articles were published between 1964 and 1970 alone and all have concluded that behavior analytic interventions demonstrated the most consistent results with individuals living with developmental disabilities. From the mid ‘80’s to 2010, there were over 500 peer-reviewed, published articles on autism and Applied Behavior Analysis.

Many families of children with autism are or are becoming familiar with the 1987 study published by Lovaas. That 1987 study was the first “group study” looking at children with autism receiving intensive ABA treatment (i.e., 40 hours per week) and children with autism that received 10 hours of ABA treatment or none at all.  In this famous study, Lovaas and his research team implemented many of the basic principles and techniques of behavior analysis into an early intensive intervention program for children with autism. After approximately two years of ABA based interventions, 47% of the children in his study made tremendous gains and were able to enter a typical first grade classroom without any additional assistance and scored in the average range in IQ tests when prior to the intervention these same children scored in the low range in IQ tests. Of the control groups, the children in the study that did not receive ABA interventions but only community supports, only one child was placed in a first-grade placement and scored average IQ.

While this study is over 30 years old, there are recent replications and research studies that indicate similar findings. While it’s beyond the scope of this post to go into all the research studies indicating the effectiveness of ABA programs for children with autism, ABA currently is widely recognized as a safe and effective treatment for autism.  It has been endorsed by a number of state and federal agencies, including the US Surgeon General and the New York State Department of Health. And for that reason, the use of ABA principles and techniques has rapidly expanded in recent years as more studies demonstrate that these principles help individuals with autism live more independent and more productive lives.

Some Current Dimensions of Applied Behavior Analysis…Explained for Parents

In the first Journal of Applied Behavior Analysis article in 1968, Baer and colleagues described six dimensions of behavior analysis. To facilitate your understanding of this seminal article, we suggest that you substitute the word “characteristic” for the word “dimension.” We will do so for you in the following description. The six characteristics are; 1) that it is Applied; 2) that it is Behavioral; 3) that it is Analytical; 4) that it is Technological; 5) that it is Conceptually Systematic and Effective; and 6) that it has Generality. The reason why these six dimensions identified almost 40 years ago still pertain to this day has to do with their importance in the effectiveness of an ABA program when it comes to the treatment of children with autism. We will discuss each dimension briefly; however, for more in-depth analysis of these dimensions, I recommend you reviewing the article mentioned previously. It is available online at the Journal of Applied Behavior Analysis (JABA) for free.

Some of the implications of the article were to distinguish ABA from laboratory research and also from other fields that worked with behavior (e.g., psychology). There is nothing wrong with laboratory research. In fact, it has supplied us with a lot of the principles, laws, and techniques we use in ABA today. However, ABA was a relatively new applied science and setting the foundations was very important.

Let’s take a look at each of the dimensions in greater detail. The first dimension mentioned by the authors was that of behavior analysis being Applied. Everything that is typically studied in the research and/or addressed by change procedures in applied behavior analysis is studied because of its potential social significance in society rather than for the means of theory alone. If what’s being studied doesn’t have any social importance (i.e., it is not important to the majority of people), behavior analysts typically do not see it as important. This has direct implications on the implementation of the research being conducted in ABA as the research findings can be used in everyday settings to help people in socially significant and important ways. This also has relevance to individuals with autism. It is apparent that society values the use of applied behavior analysis to teach individuals with autism to communicate or to reduce self-injurious behavior for example. Without social significance, or intent to actually apply to the every-day world what’s being researched, everything a person could find out in a research study would contribute to theory, but would not immediately impact society. Research conducted in this manner would add to our scientific knowledge but not improve our everyday lives. The same applies to intervention. So, application in socially significant ways is the first dimension of ABA.

Second, the authors described one of the dimensions as being Behavioral. Unlike some forms of psychology and education which might rely on people’s personal accounts and other indirect representations of behavior, ABA is concerned with direct measures of actual behavior. Behavior, of course, is composed of physical, observable events. In other words, ABA is concerned with facts and actual occurrences of behavior, things that can be observed and measured. It’s pragmatic in that it is guided by practical experience and observation rather than theory. With intervention programs for individuals with autism, teams are focused on observing behavior—teaching behavior and not so much with that individuals inferred thoughts are.

Next is the suggestion that ABA is Analytical. What does this mean? Well according to the authors of the article, in order for results of any experiment to be credible, a researcher or the person actually conducting the experiment has to show that somehow the variables used or manipulated in the study actually controlled the behavior that they were looking at to the greatest extent possible (e.g., antecedent and consequence stimuli). In other words, the experimenters must show that by changing one or more aspects in a person’s environment a change in behavior occurred, and by returning those variables back to what they were before the experiment, you can stop the behavior from happening (this is sometimes referred to as experimental control or is referred to as the process of establishing a functional relationship). In an intervention program for children with autism, Analytical would refer to the fact that the individual performs behaviors when asked to do so (e.g., “touch the blue card” and the individual touches the blue card) and that the function of behaviors is analyzed (Baer does not explicitly state this in the article and this article pre-dates the concept of the behavioral function, but he is describing the foundations of the concept of behavioral function intentionally or not when he says ….”a believable demonstration of the events that can be responsible for the occurrence or non-occurrence of that behavior (p 94)”). So applied behavior analysis is Analytical.

The fourth dimension described by Baer and his colleagues pertains to the dimension of ABA being Technological. This simply means that the procedures used in ABA have to be thoroughly identified and described so that someone who has no familiarity with the procedures can read the description and know exactly what behavior to look for and how to implement the techniques needed. This is an important concept in ABA programs for individuals with autism. Operational definitions are used. The information is written clearly, objectively, and in a way in which it’s easily understandable for people involved. This concept is consistent with good practices in science and scientific practice in other fields.

Next, we have the dimension referred to as Conceptual. In the field of behavior analysis, it is important that any analysis conducted on changing behavior in socially significant ways can be related back to the basic principles of behavior.  When describing any teaching procedure with an individual with autism, it is important to describe the procedure in enough detail for others to follow (Technological), but to also tie that procedure back to the underlying concept or principle (e.g., forward chaining procedure). This provides others with two bits of information to assist them to recreate what you have done (i.e., the technical and the conceptual). Results of any analysis or any experiment can be and should be applicable to the basic principles of behavior analysis.

The fifth characteristic of ABA is Effectiveness. This notion of effectiveness means that the changes that were brought about by the ABA techniques must be significant enough to be of practical value and seen as helpful or significant to the people being helped (a conceptual precursor to social validity and the introduction of the concept of effect size in ABA). In addition, the change in behavior must be large enough to make a difference in an individual’s life (e.g., increasing attending to the classroom teacher during instruction time from 1-2 seconds to 3-5 minutes rather than increasing attending to the classroom teacher from 1-2 seconds to 4-5 seconds). The qualification of social importance can be determined by the child, the parents, the student, the teacher, and so on (and all should have a say in determining this). If the changing behavior isn’t seen as significant (i.e., meaningful) to the people you are trying to help, then all your efforts are wasted.

Lastly, Baer and colleagues looked at the dimension of Generality. Simply put, generality refers to changes that have been produced by behavioral techniques and the necessity that these changes should be durable over time, observable in a wide variety of environments, or spread to a wide variety of related behaviors.  All of us that work with individuals with autism know very well the importance of generalization of skills.

In 1987 Baer, Wolf, and Risley revisited the dimensions of ABA and found them still very relevant. Some of the dimensions were refined in terms of tactics, but still represent ABA. Now while all these dimensions were highlighted back in 1968 and 1987, all of these dimensions are still directly related with what experts believe as being effective characteristics of treatment programs for children with autism today.

How Does Senate Bill 946 Affect Individuals with Autism in California?

Senate Bill 946, passed by the State Assembly and the State Senate on September 9th, 2011 and signed by then Governor Brown and filed with the Secretary of State on October 9th, 2011 is a monumental step for individuals with Autism and Pervasive Developmental Disorder (PDD) in California. The new law took effect on July 1st, 2012.

Previous to this bill signing, individuals with autism could get necessary services in one of three ways. First, families or caregivers could pay out-of-pocket. Only a small segment of the population could afford this as estimated costs for monthly services ranged from $3,000 to $12,000. The second way to get services was to request them from your local school district. This has proven to be very challenging as the school districts have been unfamiliar with the unique service type and more recently are financially challenged. Last was the option of regional centers. There are 21 in the state of California at present and each one has taken a slightly different approach to providing services for Individuals with Autism and Pervasive Developmental Disorder. In addition, the budget crisis in California in the early 2010’s has greatly affected most regional center’s abilities to provide services. Thus, using a regional center then for services for an individual with Autism or PDD depending on where one lived and the policies of that regional center, could also prove challenging.

As a result of SB 946 over the last few years, individuals with Pervasive Developmental Disorders or Autism are entitled to use their medical insurance to obtain services. Specifically, as of July 1, 2012 individuals in the state of California can now use their medical insurance to obtain services Pervasive Developmental Disorders or Autism. This applies to the following medical service providers: Every health care service plan contract that provides hospital, medical, or surgical coverage. It appears that SB 946 does not apply to a medical insurance plan that does not provide behavioral health or mental health services, a health care service plan in the Medi-Cal program, a health care service plan in the Healthy Families Program, or health care benefit plan or contract entered into with the Board of Administration of the Public Employees’ Retirement System.

It is important to note that SB 946 specifically states that there is no intention of the bill to alter the responsibilities that have typically fallen under an Individual Educational Plan (IEP) under the Individuals with Disabilities Education Act (IDEA and its amendments and reauthorizations) or in and Individual Program Plan (IPP) under Title 17. We interpret this to mean that SB 946 does not mean that school systems will no longer have to provide services or will have to alter the services they provide to individuals with Pervasive Developmental Disorders or Autism because the bill now requires that medical insurance will now also cover services. In addition, we feel that the same conclusion can be reached that SB 946 will not eliminate, reduce, or alter regional center’s responsibilities to provide services to Pervasive Developmental Disorders or Autism under Title 17.

What treatments are covered? The following is what SB 946 is referring to when it is talking about services. Specifically, “Behavioral Health Treatment” means professional services and treatment programs, including Applied Behavior Analysis and evidence-based behavior intervention programs. Other than Applied Behavior Analysis, no specific mention of another treatment approach is made.

What is required of the treatment programs? The treatment programs must include all of the following criteria to be eligible for coverage. First, the treatment has to be prescribed by a physician or licensed psychologist. Second, the treatment follows a treatment plan prescribed (developed by) a qualified Autism service provider and administered by a qualified Autism service provider, a qualified autism service professional supervised and employed by the qualified autism service provider, or a qualified autism service paraprofessional supervised and employed by a qualified autism service provider. Third, the plan developed by a qualified Autism service provider has measurable goals that are specified to a timeline and that are unique to the individual being treated. The treatment plan has to be reviewed no less that once every six months, modified when appropriate, and describes the individual with Autism’s impairments that will be treated; develops an intervention plan that specifies the service type (i.e., techniques and methodology), the number of hours required, the level of parent participation to achieve those goals, and the frequency of progress evaluation and progress reporting. Fourth, discontinues intensive intervention services when goals have been achieved or are no longer appropriate. Last, the treatment is not used as a means of or a reimbursement for a respite program, day care, or educational services and cannot be used as a means to reimburse a parent for participating in the program.

What is a qualified Autism service professional? SB 946 specifies the following criteria must be met to be considered a qualified Autism service professional. First, this person provides behavioral health treatment (e.g., treatment for individuals with Autism). Second, if they do not meet the criteria to be a qualified Autism provider, that the person is employed and supervised by a qualified autism service provider (e.g., an agency or clinic). Third, that individual provides treatment that follows a treatment plan developed and approved by the qualified autism service provider. Third, is a behavioral service provider approved as a vendor by a California regional center to provide services as BCBA-D, BCBA, BCaBA, a Behavior Management Assistant, a Behavior Management Consultant, or a Behavior Management Program as defined in Section 54342 of Title 17 of the California Code of Regulations. We interpret this to mean that one of the criteria to be considered a qualified Autism professional is to have met the vendor requirements of a California regional center. Fourth, that the individual has training and experience in providing services for pervasive developmental disorder or autism.

SB 946 also provided for an Autism Advisory Task Force. The purpose of the task force was to submit a report to the Governor and specified members of the Legislature by December 31, 2012. The report developed recommendations regarding behavioral health treatment that is medically necessary for the treatment of individuals with autism or pervasive developmental disorder.