Using Boundary Markers to Support Students with Autism in Classroom Settings

Boundary settings are a type of environmental support for students with ASD. Basic boundary markers which establish physical space for specific activities such as break time areas, and reading areas help students differentiate expectations across settings, especially when one area is used for different activities (this is very common in classrooms around the world). For example, if two or more tasks must be completed at the same work space or work area, using a colored tablecloth can help distinguish one activity from another. Reading could take place at the table and then it could be covered with an orange tablecloth when it is time for math. Additionally, sectioning off an area on the floor with colored tape, rugs, or anything else that would indicate where a student is expected to be during any given activity is an effective environmental support. This type of marking or labeling is simple and seems to be a minor modification, but in fact, it is highly effective for working with students with ASD. These modifications can reduce students’ confusion and increase clarity by identifying expectations.

It is important to note that simply applying these types of environmental supports without explicitly demonstrating them to the student and explaining what they are intended for will likely not result in the desired outcome. It is almost always necessary to show the student how they are intended to be followed for the markers and boundaries to be effective. Often times, showing or demonstrating to the students how the boundaries and markers are to be followed needs to be done repeatedly and over time.

Finally, when boundaries and markers begin to show effectiveness with students with ASD, rewards for appropriately following the supports should be utilized. That is, when a student correctly follows them they should be provided with social praise or other types of rewards.

Increasing Language for Children with Autism

Impairment in communication is one of the main diagnostic criteria for a child with autism, specifically a delay in or total lack of spoken language.  Behavior analysts break down “language” into many reasons a child would communicate.  Based on these reasons, they identify where there are deficits and how they can increase these deficit areas.  We will outline some of them here in a very easy-to-understand manner and then give some advice on how to increase these forms of language every day.

The first form of language a child engages in is repeating.  This happens when a child repeats what another person says.  You may be thinking at this point that your child with autism does this a lot!  Many children with autism engage in this behavior although it is repetitive in nature and they do not do it to get attention from others (why typically developing children repeat language); they do it because it is fun for them. In order to learn other forms of language (which we will discuss below), a child should be able to repeat what an adult says on command. If your child does not do this regularly, give many opportunities for repetition, each day throughout the day.  Get your child’s full attention, say a simple sound or word very clearly to them (e.g., “ahhhh”) and continue to do this until they repeat or approximate what you are saying.  Provide lots of praise and even preferred items.

Another important form of language a child engages in is requesting.  Many children with autism engage in challenging behaviors as a form of requesting (e.g., crying to get a cookie and this results in them getting a cookie so they will quiet down), instead of using appropriate language (e.g., “mommy, can I have a cookie?”).  This form of language can be taught throughout the day, every day, if you know what your child wants.  Keep many of their preferred items out of reach, especially food items.  Whenever they show a desire for something, model what they should say or do to communicate (e.g., you say “cookie”, engage in the manual sign for cookie, or point to the cookie icon or picture for them to give you) and require them to engage in the same communicative behavior that you modeled before you give them the cookie.  Give them small pieces of food items, little sips of drinks, or a short amount of time to play with preferred toys so you can remove the item and practice requesting for the item again.  If you do this about three times each time they want varied things throughout the day, your child will begin to gain this requesting skill, and you may see a decrease in challenging behaviors.

Remember, to learn language your child must receive lots and lots of learning opportunities per day.  You can provide this by engaging in simple strategies such as the ones we discussed above.

What challenges have you faced? Please write us back and we will respond.

What are the Changes to the Diagnosis of Autism with the DSM-V?

The first change with the new edition of the DSM is to combine the formerly separate diagnoses of autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not-otherwise-specified into one group with the name of Autism Spectrum Disorder. The stated reason for this was that of reliability and validity. That is, the DSM IV could, to the satisfaction of the committee, distinguish individuals with autism from typically developing individuals. Further, the committee stated that because autism is described by a common set of behaviors that it is best represented as a single disorder. Finally, the committee stated that a single spectrum disorder represents the current state of knowledge regarding the disorder and how it appears clinically to clinicians.

The second change is the combining of the three domains that appeared in DSM-IV (Qualitative impairments in social interaction, Qualitative impairments in communication, and restricted repetitive stereotyped patterns of behavior) into two domains (Social Communication Deficits and Fixed Interests and Repetitive Behaviors). The following rationale were provided: 1) deficits in communication and social behaviors are inseparable and; 2) delays in language are neither unique to autism (i.e., they appear in other disorders), nor are they universal (i.e., not all individuals with autism have them); 3) The changes improved specificity of the diagnosis while not compromising the sensitivity; 4) Increased sensitivity across severity levels of autism; 5) Secondary analyses of data sets support the combination of categories.

The third change is a change in the criteria within the social/communication domain were merged and streamlined to clarify diagnostic requirements. The following rationale was provided. In the previous version of the DSM several criteria measured the same symptom thus giving greater importance to that symptom (social/communication) and the merging of these criteria requires a new approach to them. Secondary data analyses were conducted to determine the most sensitive and specific symptom clusters to facilitate diagnosis for a range of ages and language levels.

Next, there is a new requirement of two symptoms from repetitive behavior and fixated interests be identified. It was also proposed that this change will increase specificity while not decreasing sensitivity. In addition, there is a requirement for multiple sources of information (clinical observations and parent/caregiver report).

These changes represent the current iteration of the DSM-V diagnosis of autism.

How to teach your child to wait and what you could do before and after telling your child “no”

Two common difficulties that we encounter when working with families over the years are regarding waiting and when a child is told no.  These two scenarios can be overwhelming as they are often accompanied by the most intense challenging behaviors.  We will go over these on this this post.

First off, the skill of requesting appropriately must be well-established already.  If this skill is not yet in your child’s repertoire then it must be taught first. If the skill is already there, but it’s not as fluent as we’d need it to be, then work on that first.

Let’s say your child can already ask for a cookie—this is great, but what can you do if for some reason, you child has to be told to wait?   If your first thought given that question you just read is along the lines of “oh…” then do consider the following.  There is this passage of time that happens between being asked to wait for something and finally getting that something.  The key here is working on that gap.  Depending on how your child “understands” that concept—time—you may have to be more hands-on when helping out your child go through it.   Instead of simply saying “wait,”  try giving your child something that he likes to “kill time.” This is not something out of the ordinary. Case in point: look at long lines of people at a grocery store, a theme park ride, at a bank, et cetera.  It is very rare to see a long line of people, waiting, just starting blankly at the back of the head of the person in front of them (unless you’re in the military or something similar) and just “wait” for their turn.  Perhaps you’ll notice a handful dealing with waiting in not-so-positive ways but for the most part, people will do something to pass time.  From being on their phones, talking to someone whom they are with, looking around, reading a book—we, again, most of us, can handle waiting because we fill that gap with something else.  And that is something that you can try out—offer your child something that they will not mind doing while they wait.  The more reinforcing that activity the better. When starting to teach your child to wait while engaged in something, make sure to keep the wait-time very short. How short?  It depends on each child really, but a good rule of thumb is to end the wait when your child is still behaving well (i.e., before your child starts that path to a full-blown tantrum). Let’s say that time is around one minute—great. Keep it around that time limit and systematically increase the time just a bit and stay on that higher limit (e.g., from one minute to about two minutes) until your child gets used to it.  From there, you can once again increase the limit to say three minutes.  This does not happen without any difficulty—the key here is you being consistent.  Also, avoid a situation wherein the wait time had been too long that your child “forgets” about whatever it is he or she is waiting for.  You need your child’s motivation for whatever it is he or she is waiting for for the learning process to “click.”  Once that motivation goes away, the teachable opportunity is lost so it is best to be realistic on how long you really want your child to wait.

Again, teach waiting only if they can truly have that cookie, but at a later time (or after a number of activities).  If they cannot have that cookie, then don’t say wait (after which they do) then tell them no in the end. Hence, the next topic: what can you do when you are about to tell your child no (i.e., denial).

True: a no is a no and that is something our children must learn; however, before we get to that lesson, let’s take a few steps back.  If you know that your child cannot have that cookie, give your child’s behaviors a chance to not escalate.  Offer your child something she likes instead of whatever that is she wants at the moment.  The key here is you offering an alternative that she truly wants—whatever that is given that moment.  If your child accepts the alternative—great!  If your child does not like your attempts to compromise—and if your child is capable—ask her to choose her own alternative item/food/activity.  Be prepared to honor her choice.  If your child accepts that scenario—great!   If not, time to roll up your sleeves—it’s time to teach your child that no means no.  There is no going around this.  You have offered her alternatives. You have also given her a chance to choose her own alternative.  If those fail, you have done your job but despite your efforts to teach alternatives, the tantrums will happen. As those behaviors are happening, the worst thing that you can do is give in—no.  Don’t give in as that will only reinforce all those not-so-nice behaviors.  It will be difficult, but a no is a no.

When your child’s behaviors start to de-escalate, it is still possible to offer her alternative and/or giving her a chance to select her own, but never give in.

If your child already engages in the most extreme challenging behaviors such as self-injurious behaviors or property destruction or any other behaviors that compromise the safety of others during times when he or she is denied access to something, we highly recommend that you immediately seek assistance from a trained professional.

Using Social Stories to Help Individuals with Autism in Classrooms and Other Settings

Using Social Stories is a strategy that is likely not new to teachers. However, not all teachers know that they can be used to work with and teach individuals with autism specific skills surrounding social and behavioral needs. Social stories interventions enhance social skill acquisition for many students with autism. They help individuals with autism to better understand the tones of interpersonal communication so that they can interact in an effective and appropriate manner.

Let’s take a look at social stories are and how can they be used with students with autism?

A social story is a mini book that describes a social situation and the appropriate social responses. Social stories are individualized for each student and teach a specific desired response. They are used to seek answers to questions that an individual with autism may need to know to interact with others, for example, answers to who, what, when, where and why in social situations.  Social stories can also be used to learn new routines, activities, and how to respond appropriately to feelings like anger and frustration.

Social stories are written using four sentence types. Descriptive sentences, which provide information about the subject, setting, and action; directive sentences, which describe the appropriate behavioral responses; perspective sentences, which identify the possible feelings and reactions of others; and control sentences, which describe the actions and responses of the story participants. A sample control sentence might be, a puppy barks to get its owner’s attention. Or, Ginny yelled to get the teacher’s attention. It is customary for social stories to have two to five descriptive, perspective, or control sentences in the story. Writing social stories for lower functioning students or students who have the tendency to over focus on a specific part of the story may require dropping the control sentence.

When creating a social story there are 10 steps that are used: One, identify the target behavior in the problematic situation. Two, define the target behavior. Three, collect baseline data on the target behavior. Four, write a social story using the four-sentence types. Five, present one to three sentences on each page. Six, use photographs and drawings or icons. Seven, read the social story to the student and model the desired behavior for them. Eight, collect data on the target behavior. Nine, review the data and the social story procedures and modify if they are not effective. Ten, plan for maintenance and generalization.

Social stories are written in the first-person point of view or the child’s point of view. It should also be in the present tense and the child’s level of vocabulary and comprehension should be considered.

Remember that students with autism frequently do not maintain or generalize skills that they have learned. Although you will ultimately fade the use of a social story, plan activities to assist the student in generalizing skills across content, persons, environment, and situation. Remember to transition the newly acquired skill to the naturally occurring contingencies. Social stories appear to be a promising intervention method for improving the social behavior of individuals with autism.

How Choice Boards and “Wait Supports” Can Be Used to Support Students with Autism in Classrooms

A “Choice Board” is a type of visual environmental support that can be beneficial for students, especially students with ASD. Choices should be incorporated into as many activities as possible as choice boards provide students with decision-making opportunities. As such, it can display the objects, pictures, icons, or words that would represent a menu of activities or reinforcers. These can easily be made with supplies such as poster paper, card stock, white boards, or on any surface that you can attach or write on. Choice boards are often placed next to a student’s daily schedule, and when a designated time arrives, students simply select a preferred activity from the board. Choice boards with preferred activities can be placed near the free time or break time area of the room, and provide a stimulus for independent selection of an activity.

Similar to choice boards, ‘Waiting Supports’ are another visual strategy, or tool that can be incorporated throughout the school day. As we know, waiting is a difficult skill for many children, with or without disabilities. But for students with autism in particular, waiting typically presents problems because they have limited ability to delay gratification and comprehend the concept of waiting. We also know that if a student is waiting too long or is not engaged in some type of activity, even if it is a simple activity such as putting a back pack away or clearing a desk, then more than likely, unwanted behaviors will occur. Therefore, students with ASD will typically require specific instructions to develop appropriate waiting behaviors. When developing waiting supports, we need to determine if the student has the prerequisite skills that are necessary to engage in waiting behaviors. This is easy to do. First, role-play and practice waiting using different instructions and in different settings when you want to identify this skill. Keep in mind that when you are practicing ‘learning to wait’ with your students, make sure it is authentic and in an actual setting where you would expect the student to use this skill. Again, be sure to teach waiting skills across a variety of settings to increase the likelihood of generalization. Even using a peer model or a peer buddy during waiting times can offer support for desired behaviors, and specific ‘physical supports’ such as chairs near the waiting area, setting a timer, or holding a picture representing “wait” can also help a student learn this concept.

As we know, for any kind of learning to take place, it is essential for students to have active involvement with their teachers, peers, and the curriculum. Students with autism tend to be passive learners. Therefore, it is necessary to plan activities that require students to become active participants. Creating opportunities for students to respond is a high instructional priority. Research supports a functional relationship between academic performance and how often a student is able to respond. Therefore, the more a student participates in an activity, the more off task and disruptive behaviors will decrease.

Teaching alternative behaviors to decrease or stop inappropriate challenging behaviors

Implementing a behavior intervention plan to decrease or stop a challenging behavior is one thing.  Teaching an alternative to the challenging behavior is another.  Imagine this: your child climbs on the kitchen counter to reach for a jar of cookies way up in a cabinet.  Can you implement a plan to decrease or eliminate the behavior of climbing on the counter?  Yes, but there is also a chance that your child will just learn another challenging behavior to get him the same result.  In practice, it is always best to teach and alternative behavior.  Teaching the alternative behavior, in a way, can make the “unlearning” of the challenging behavior much faster.

There are four reasons why children may engage in challenging behaviors: either to get something she or he wants (access), to get out of doing something they don’t want (escape), to get attention, or because the behavior itself feels good or pleases them (self-stimulatory/automatic).  The general theme that you will see throughout this article is that the alternative behavior that you should teach your child should still lead to your child getting what they want (i.e., one of the four reasons).

Let’s say your child screams and throws objects when they are done with their dinner.  Your child is trying to get out of something—the dinner table.  What might you teach your child to do instead of throwing and screaming?  You can possibly teach your child to “properly” communicate when they are done whether it be signing “all done” with their hands, saying “all done,” giving an “all done” laminated picture to an adult at the table, or some other mode of communication based on your child’s repertoire of skills.  At first, assist your child when you begin to see the signs of them being all done by guiding them through the physical movements of communicating (i.e., exchanging a picture or signing), or modeling the words they should use.  Gradually fade this assistance until they are doing it on their own, without engaging in the challenging behaviors.

The same strategies should be utilized for the other “functions” of behaviors, or when your child engages in challenging behaviors for other reasons.  When they want a cookie that is out of reach in the kitchen, teach your child to ask for the cookies using whatever mode of communication is appropriate for your child to replace the climbing on the counters.  It is important to give your child cookies every time they ask when they are first learning as this will be the key to decreasing the challenging behavior of climbing on the counter.  As your child gets used to this process, you can start giving him what he wants once in a while—this is a way to guarantee that the new behavior becomes stronger over time.

For attention-based challenging behaviors, one way to tackle this is to figure out what you think your child should be doing instead of the inappropriate behavior.  Of course, considering your child’s repertoire of skills first is important when figuring out what replacement behavior to teach.  Let’s say your child somehow finds the time you spend with him getting a “lecture” from you reinforcing, maybe one thing that you can do is stop or at least minimize the amount of time that you spend lecturing him and spend more time with him when he is behaving appropriately.  While doing that, also you can also do your best to spend more time with your child when he or she is behaving well (e.g., spending some time to play a favorite game, watching a favorite tv show, about talking about school/anything).

Lastly, when your child engages in challenging behaviors because it feels good, a little more thought has to be put into the alternative behavior.  It should be something that is not harmful and something, preferably, that you can control.  For example, if your child engages in repeating words/phrases or just vocalizing sounds that are not socially appropriate, allowing your child to engage in these behaviors in a particular environment (e.g., their bedroom) and teaching them to ask for “talking in my room” or something similar may help to gain control of where they may engage in this behavior.  When your child engages in this behavior anywhere else, he should be required to use the communication phrase and then go to the specified location.  Self-stimulatory behaviors can be very difficult to address on your own—more so if the behavior is also self-injurious in nature.

It will help you as a parent to practice on these concepts; however, should you continue having difficulties as to how to address you child’s most challenging behaviors, it is a good idea to reach out to a trained professional such as a BCBA as soon as possible.

What approach should caregivers take with challenging behaviors?

Managing challenging behaviors can be quite stressful.  Most of the time, parents just do what they can to get through the situation with as little fuss and fighting as possible.  Unfortunately, this often times involves strategies that may be counterproductive, increasing the chance of these behaviors occurring in the future.  If the goal is to decrease these behaviors in the long run, there are specific strategies to use based on why the behavior is occurring.  Not all behaviors should be treated the same.  These strategies that we will discuss below and in future posts may not always be the first strategy a parent would think of, we do recommend consultation with a behavior analyst who can provide a treatment plan and provide support for you and your family along the way.

In general, it is important to plan for a) alternative behaviors to teach your child to engage in instead of the behaviors they currently engage in during specific situations, as well as b) how to handle behaviors in the moment when they are occurring.  When planning for these strategies, it is crucial to always think about why your child is exhibiting the particular challenging behavior.  There are four reasons that people engage in maladaptive behaviors, to get something they want, to get attention from someone, to get out of a situation, and to get sensory feedback from the behavior itself.  We will briefly review these four reasons in this post.

Children often engage in maladaptive behaviors to get something they want.  For example, a child may want a cookie out of reach in the kitchen, so he screams in the kitchen, hitting his head until someone comes in the kitchen and offers what they can until he or she gets what they want.  The child learned that screaming and hitting his head is an effective way to get a cookie.

Children also engage in maladaptive behaviors to get attention from others.  Have you ever been talking with your partner and your child starts screaming or engaging in other bad behaviors?  This may be because he or she wants your attention, for you to pay attention.

A very common reason why children engage in challenging behaviors is to get out of things.  Imagine a child eating dinner and he starts throwing his food and hitting their caregiver.  The caregiver says, “okay, okay, all done,” and allows the child to leave.  The child learned that throwing and hitting is an effective way to get out of eating.

Lastly, children diagnosed with autism engage in challenging behaviors sometimes because they like how the challenging behavior feels.  Screaming, pinching their bodies, pulling their hair, banging their heads on hard surfaces are all behaviors that may serve some sensory need.  It is important to distinguish this from any of the other reasons previously discussed before determining how to react and what to teach instead.

Take some time to think about your child’s challenging behaviors and why he or she may be engaging in them.  Stay posted for future posts outlining strategies for how to react to these behaviors and what to teach your child instead, based on why they are engaging in the behavior.

What have been your specific challenges?

Using Visual Schedules to Support Students with Autism

Visual schedules can be used to support students with ASD in classrooms. They are a very common support that we’re sure that many teachers have already used or may being using in their classrooms currently. Visual schedules can be an extremely important element to provide students with an overview of the day’s activities and events, by identifying specific tasks that will occur at specific times. Visuals can present an abstract concept such as time in a more concrete and manageable form. The use of visual schedules for students with autism and Asperger Syndrome has many benefits. For example, visual schedules allow students to anticipate upcoming events and activities.

Visual schedules can help develop an understanding of time and they can really help facilitate the ability to predict change. Additionally, visual schedules can be used to stimulate communication exchanges by discussing past, present, and future events, as well as to teach new skills such as health care and grooming. Finally, visual schedules have been used to successfully increase on-task behavior, as well as enhancing the student’s ability to be independent and to make transitions from one activity to another. Visual schedules are effective because they capitalize on the visual strength exhibited by many students with ASD.

When creating visual schedules, consideration of each student’s level of understanding, that is if a student can read, of course we want the schedule to be handwritten, and if a student is at a pre-primer level, or just learning to read, the use of pictures, icons, or actual photographs, can be created. It’s important to make decisions based on the strengths of each of these students; Construct visual schedules to correspond to a student’s ability to understand visual representation. For students who require concrete visual schedules to understand upcoming events, an object schedule that uses the actual materials for each of the activities can be used. For example, if the student is expected to brush his or her teeth after lunch, put a toothbrush on the schedule to indicate that it’s time for the student to brush his teeth. Photographs of students actually completing the target activity can also be used with the visual schedules for students who require concrete representation.

The important thing to keep in mind here is to determine the appropriate level of visual representation. If a student is functioning at a photographic level, a color drawing can be paired with the photograph to induce the higher-level concept. Similarly, if a student is functioning at the black-and-white drawing or icon level, written words can and should be paired with that icon; clock faces can be added to the visual schedules to begin to introduce the concept of time. Schedules can be arranged either a left right or top to bottom format. Schedules can be constructed in a variety of formats, and so when you are developing the schedule, consider the length of time the schedule will be used, how durable the materials must be to meet the demands of the student, and whether the schedule is going to be permanent or if it needs to be mobile.

Additionally, student participation in creating visual schedules can allow a student to feel more comfortable when they’re allowed to participate in preparing their visual schedules. The participation can occur first thing in the morning, as the student enters the room, during morning routines; students can assist in assembling the schedules, copying it, or even adding their own personal patch in some manner. This interaction can be used to review the daily routine, discuss changes, and reinforce the rules. Be creative; have fun developing the visual schedules! And again, these schedules promote independence by identifying student expectations.

When You Start an ABA program, What Should You Reasonably Expect from Your Service Provider?

The following are things that you should expect as a parent when you begin treatment for your child with Autism.

You and your child have a right to a therapeutic environment.  This means that the teaching environment set up to help your child is one in which socially significant learning occurs.  As a client, your child also has the right to services from an agency in which their number one goal is the personal welfare of your child (e.g., safety, treatment efficacy, advocacy). This means that all energy put into the program is to help your child become more independent and lead a better life.

It is also your child’s right to have a treatment program supervised by a competent behavior analyst. Unfortunately, as the rates of autism have increased, so have the number of treatment programs allegedly providing assistance to children with autism.  Furthermore, in many locations, the demand presently outweighs the supply for trained, experienced behavior analysts. It is imperative that the credentials and qualifications of your service provider be credible.

Your child has a right to be provided with a program that teaches functional skills. Functional skills are skills that a child can use in their everyday life and that furthers their independence (tying shoes, initiating conversation, engaging in cooperative play, etc.). There is little benefit in taking the time and dedication to teach a child something that cannot be incorporated or used in their everyday life.

Assessment and ongoing evaluation are crucial components of any ABA program, and should be expected.  This includes setting up a program based on the individual needs of a child and continuing a program based on the ongoing needs of a child. These needs will continually change, therefore ongoing assessments and modifications are imperative, necessary, and a right.

Parent and caregiver trainings should be included in the ABA program. These typically include meetings between parents or caregivers and their service provider in which valuable ABA strategies are discussed, demonstrated, and implemented. The focus of these meetings is to educate parents about various but individualized ABA based techniques they can implement with their child to address challenging behaviors, reinforce desirable behaviors, and promote generalization of progress.

Lastly, and perhaps most importantly, a child with autism has the right to the most effective treatment procedures available. In this case – scientifically validated treatment programs which today have only been shown to be based on ABA principles and techniques.