How will autism affect my child?

Autism Spectrum Disorder (ASD) is a condition related to brain development that impacts how a child perceives and socializes with others, causing problems in social interaction and communication. The disorder also includes limited and repetitive patterns of behavior. The term “spectrum” in autism spectrum disorder refers to the wide range of symptoms and severity.

Autism affects every child differently, and, while cases of Autism may be similar, no two cases are ever the same. Some children with Autism may be mildly or moderately impacted while others may be profoundly impacted. Applied Behavior Analysis (ABA) therapy is a type of therapy that can improve social, communication, and learning skills through positive reinforcement of those children diagnosed with Autism. Most experts consider ABA to be the gold-standard treatment for children with autism spectrum disorder. The professional ABA therapists at LeafWing Center will provide you and your child the support and therapy required to ensure your child is receiving the highest quality Autism care.

An autism diagnosis, and its effect on your child

Autism may affect several areas of your child’s development including communication, socialization, daily living skills, motor skills, executive functions, among many others. Challenging behaviors such as tantrums and difficulty communicating wants and needs may be present as well. Generally speaking, an Autism diagnosis can impact attention span, eye contact, socialization abilities, play abilities, motor skills, academic performance, emotional regulation, self-care skills, communication skills, among other areas.

Your child’s autism: other considerations

In addition to the diagnosis itself, many factors affect the ways in which a child is impacted by Autism. These factors include but are not limited to: accessibility of effective treatment, timing of treatment (earlier vs. later), developmental areas affected (motor, play, communication, etc.), as well as a child’s environment (school placement, access to resources, etc.). As mentioned earlier, some children who are diagnosed with Autism may only have mild to moderate skill deficits and challenging behaviors. Others may present with more profound deficits such as limited speech or communication skills and aggressive behaviors. Additionally, many children diagnosed with Autism also present with sleeping, feeding, and toileting difficulties. It is a clinical and ethical requirement for all Applied Behavior Analysis (ABA) programs to be individualized to fit the needs of the individual. Therefore, behavior and skill development goals must be custom tailored and specifically designed to match the clinical needs of the learner. When applicable, strong ABA programs will place an emphasis on the development of communication skills as this is an integral component of many aspects of development. In fact, many challenging behaviors occur when there is a lack of communication skills present. In other words, if a child does not know how to communicate, either through vocal language, sign language, PECS (picture exchange communication system), or another communication device, the more likely he or she will be to engage in challenging behaviors to gain access to wants and needs.

Despite the degree to which a child is impacted by Autism, ABA therapy can help. Through the use of research backed strategies and principles, ABA programs can be utilized to facilitate positive and desirable changes in behavior.

Autism and my child’s challenging behaviors

ABA Therapy

One of the ways in which ABA therapy is effective is through the identification and treatment of a child’s challenging behaviors. Effective ABA programs will identify challenging and undesirable behaviors at the onset of services. The function or purpose of identifying the challenging behavior(s) is so that a comprehensive Behavior Intervention Plan (BIP) will be established for your child with autism. An effective BIP should include research-backed principles to reduce the unwanted behavior and should also identify replacement behaviors. Replacement behaviors are behaviors that achieve the same result as the challenging behavior but are considered to be socially appropriate, easy to engage in, and, generally speaking, more desirable than the challenging behavior. For example, if it is determined that a learner engages in aggressive behaviors to escape a difficult task, replacement behaviors which will be taught may include requesting a break or asking for help. Hence, one of the ways in which ABA therapy is effective is through the assessment and treatment of undesirable behaviors.

Challenging behaviors

A child or adult with autism spectrum disorder may have limited, repetitive patterns of behavior, interests or activities, including any of these indicators:

  • Performs repetitive movements, such as rocking, spinning or hand flapping
  • Performs activities that could cause self-harm, such as biting or head-banging
  • Develops specific routines or rituals and becomes disturbed at the slightest change
  • Has problems with coordination or has odd movement patterns, such as clumsiness or walking on toes, and has odd, stiff or exaggerated body language
  • Is fascinated by details of an object, such as the spinning wheels of a toy car, but doesn’t understand the overall purpose or function of the object
  • Is unusually sensitive to light, sound or touch, yet may be indifferent to pain or temperature
  • Doesn’t engage in imitative or make-believe play
  • Fixates on an object or activity with abnormal intensity or focus
  • Has specific food preferences, such as eating only a few foods, or refusing foods with a certain texture

Your child’s signs and symptoms of autism

ABA Therapy

There is often nothing about how a child with Autism looks that distinguishes them from people without an ASD diagnosis. A child with Autism Spectrum Disorder, however, may communicate, interact, behave, and learn in ways that are drastically different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some people with ASD require significant help in their daily lives; others need less.

Signs and Symptoms

A child with Autism often have problems with social, emotional, and communication skills. They might repeat certain behaviors and might be resistant to change in their daily routine. Many people with ASD also have different ways of learning, paying attention, or reacting to things. ABA therapy is used as a method of treatment to improve or change certain behaviors. Signs of ASD begin during early childhood and typically last throughout a person’s life.
A Child with Autism might:

  1. not point at objects to show interest (for example, not point at an airplane flying over)
  2. not look at objects when another person points at them
  3. have trouble relating to others or not have an interest in other people at all
  4. avoid eye contact and want to be alone
  5. have trouble understanding other people’s feelings or talking about their own feelings
  6. prefer not to be held or cuddled, or might cuddle only when they want
  7. appear to be unresponsive when people talk to them but respond to other sounds
  8. be very interested in people, but not know how to talk, play, or relate to them
  9. repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language
  10. have trouble expressing their needs using typical words or motions
  11. not play “pretend” games (for example, not pretend to “feed” a doll)
  12. repeat actions over and over again
  13. have trouble adapting when a routine changes
  14. have unusual reactions to the way things smell, taste, look, feel, or sound
  15. lose skills they once had (for example, stop saying words they were using)

Frequently asked questions about ABA therapy

What is ABA Therapy used for?

ABA-based therapy can be used in a multitude of areas. Currently, these interventions are used primarily with individuals living with ASD; however, their applications can be used with individuals living with pervasive developmental disorders as well as other disorders. For ASD, it can be used in effectively teaching specific skills that may not be in a child’s repertoire of skills to help him/her function better in their environment whether that be at home, school, or out in the community.  In conjunction with skill acquisition programs, ABA-based interventions can also be used in addressing behavioral excesses (e.g., tantrum behaviors, aggressive behaviors, self-injurious behaviors). Lastly, it can also be utilized in parent/caregiver training.

In skill acquisition programs, a child’s repertoire of skills is assessed in the beginning phase of the services in key adaptive areas such as communication/language, self-help, social skills, and motor skills as well.  Once skills to be taught are identified, a goal for each skill is developed and then addressed/taught by using ABA-based techniques to teach those important skills. Ultimately, an ABA-based therapy will facilitate a degree of maintenance (i.e., the child can still perform the learned behaviors in the absence of training/intervention over time) and generalization (i.e., the learned behaviors are observed to occur in situations different from the instructional setting).  These two concepts are very important in any ABA-based intervention.

In behavior management, the challenging behaviors are assessed for their function in the beginning phase of the services. In this phase, the “why does this behavior happen in the first place?” is determined. Once known, an ABA-based therapy will be developed to not just decrease the occurrence of the behavior being addressed, but also teach the child a functionally-equivalent behavior that is socially-appropriate.  For example, if a child resorts to tantrum behaviors when she is told she cannot have a specific item, she may be taught to accept an alternative or find an alternative for herself. Of course, we can only do this up to a certain point—the offering of alternatives.  There comes a point when a ‘no’ means ‘no’ so the tantrum behavior will be left to run its course (i.e., to continue until it ceases).  This is never easy and will take some time for parents/caregivers to get used to, but research has shown that over time and consistent application of an ABA-based behavior management program, the challenging behavior will get better.

In parent training, individuals that provide care for a child may receive customized “curriculum” that best fit their situation.  A typical area covered in parent training is teaching responsible adults pertinent ABA-based concepts to help adults understand the rationale behind interventions that are being used in their child’s ABA-based services.  Another area covered in parent training is teaching adults specific skill acquisition programs and/or behavior management programs that they will implement during family time.  Other areas covered in parent training may be data collection, how to facilitate maintenance, how to facilitate generalization of learned skills to name a few.

There is no “one format” that will fit all children and their families’ needs. The ABA professionals you’re currently working with, with your participation,  will develop an ABA-based treatment package that will best fit your child’s and your family’s needs. For more information regarding this topic, we encourage you to speak with your BCBA or reach out to us at [email protected].

Who Can Benefit From ABA Therapy?

There is a common misconception that the principles of ABA are specific to Autism. This is not the case. The principles and methods of ABA are scientifically backed and can be applied to any individual. With that said, the U.S. Surgeon General and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorders (ASD). Children, teenagers, and adults with ASD can benefit from ABA therapy. Especially when started early, ABA therapy can benefit individuals by targeting challenging behaviors, attention skills, play skills, communication, motor, social, and other skills. Individuals with other developmental challenges such as ADHD or intellectual disability can benefit from ABA therapy as well. While early intervention has been demonstrated to lead to more significant treatment outcomes, there is no specific age at which ABA therapy ceases to be helpful.

Additionally, parents and caregivers of individuals living with ASD can also benefit from the principles of ABA. Depending on the needs of your loved one, the use of specified ABA techniques in addition to 1:1 services, may help produce more desirable treatment outcomes. The term “caregiver training” is common in ABA services and refers to the individualized instruction that a BCBA or ABA Supervisor provides to parents and caregivers. This typically involves a combination of individualized ABA techniques and methods parents and caregivers can use outside of 1:1 sessions to facilitate ongoing progress in specified areas.

ABA therapy can help people living with ASD, intellectual disability, and other developmental challenges achieve their goals and live higher quality lives.

What does ABA Therapy look like?

Agencies that provide ABA-based services in the home-setting are more likely to implement ABA services similarly than doing the same exact protocols or procedures. Regardless, an ABA agency under the guidance of a Board-Certified Behavior Analyst follows the same research-based theories to guide treatment that all other acceptable ABA agencies use.

ABA-based services start with a functional behavior assessment (FBA). In a nutshell, a FBA assesses why the behaviors may be happening in the first place. From there, the FBA will also determine the best way to address the difficulties using tactics that have been proven effective over time with a focus on behavioral replacement versus simple elimination of a problem behavior. The FBA will also have recommendations for other relevant skills/behaviors to be taught and parent skills that can be taught in a parent training format to name a few. From there, the intensity of the ABA-based services is determined, again, based on the clinical needs of your child. The completed FBA is then submitted to the funding source for approval.

One-on-one sessions between a behavior technician and your child will start once services are approved. The duration per session and the frequency of these sessions per week/month will all depend on how many hours your child’s ABA services have been approved for—usually, this will be the number recommended in the FBA. The sessions are used to teach identified skills/behaviors via effective teaching procedures. Another aspect of ABA-based services in the home-setting is parent training. Parent training can take many forms depending on what goals have been established during the FBA process. The number of hours dedicated for parent training is also variable and solely depends on the clinical need for it. If a 1:1 session is between a behavior technician and your child, a parent training session or appointment is between you and the case supervisor and with and without your child present, depending on the parent goal(s) identified. Parent training service’s goal is for you to be able to have ample skills/knowledge in order for you to become more effective in addressing behavioral difficulties as they occur outside of scheduled ABA sessions. Depending on the goals established, you may be required to participate in your child’s 1:1 sessions. These participations are a good way for you to practice what you have learned from the case supervisor while at the same time, having the behavior technician available to you to give you feedback as you practice on those new skills.

As mentioned in the beginning, no two ABA agencies will do the same exact thing when it comes to providing ABA services; however, good agencies will always base their practice on the same empirically-proven procedures.

How do I start ABA Therapy?

In most cases, the first item required to start ABA therapy is the individual’s autism spectrum disorder (ASD) diagnosis report. This is typically conducted by a doctor such as a psychiatrist, psychologist, or a developmental pediatrician. Most ABA therapy agencies and insurance companies will ask for a copy of this diagnosis report during the intake process as it is required to request an ABA assessment authorization from the individual’s medical insurance provider.

The second item required to start ABA therapy is a funding source. In the United States, and in cases where Medi-Cal or Medicare insurances are involved, there is a legal requirement for ABA services to be covered when there is a medical necessity (ASD diagnosis). Medi-Cal and Medicare cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of the coverage and to ensure that ABA is in fact, a covered benefit. Additionally, some families opt to pay for ABA services out-of-pocket.

The next step to starting ABA therapy is to contact an ABA provider whom you are interested in working with. Depending on your geographic location, ABA agencies exist in many cities across the United States. Your insurance carrier, local support groups, and even a thorough online search can help you find reputable and properly credentialed ABA agencies near you. Our organization, LeafWing Center, is based in southern California and is recognized for aiding people with ASD achieve their goals with the research based on applied behavior analysis.

Once you have identified the ABA provider with whom you wish to work, they should help you facilitate the next steps. These will include facilitating paperwork and authorizations with your funding source. Once the assessment process begins, a BCBA (Board Certified Behavior Analyst) or qualified Program Supervisor should get in contact with you to arrange times in which interviews with parents/caregivers and observations of your loved one can be conducted. This will help in the process of gathering important clinical information so that with your collaboration, the most effective treatment plans and goals can be established for your loved one. This process is referred to as the Functional Behavior Assessment (FBA) and is elaborated on in different blog posts on our website. With regard as to what can be expected once ABA therapy begins, please read our blog post titled: When You Start an ABA program, What Should You Reasonably Expect from Your Service Provider?

Using Graphic Organizers to Help Individuals Living with ASD in Classrooms and Other Settings

A graphic organizer is a visual support that provides visual representation of facts and concepts within the organized framework. Graphic organizers arrange key terms to show their relationship to one another, providing abstract of implicit information in a concrete, visual manner. They are particularly useful with content area material that occurs in K – 12 curricula. Graphic organizers are effective for a variety of reasons: they can be used before, during, or after students read a selection wither as an answer organizer of a measure of concept attainment. Graphic organizers also allow processing times for students as they can reflect on the written material at his or her own pace.

Additionally, abstract information is presented in a visual, concrete manner that is often more easily understood than a verbal presentation of the material alone.  One type of graphic organizer is a “thematic map.”  The focal point of the thematic map is the key word or concept enclosed in a geometric figure such as a circle or a square and if necessary, in a pictorial representation of the word or concepts. Lines and arrows connect this shape to the other shapes and words or information related to the central concepts are written on the connecting lines or in other shapes. As the map expands, the words become more specific and detailed.

The student may neither understand the concept of main idea, and/or not understand when the teacher is giving cues to students for salient information. For example, when the teacher repeats an item or changes voice tone, the information is important and typical students naturally pick this up. As with other areas, some students in the ASD spectrum do not pick up on these cues naturally and therefore need guidance. The teacher can assist the students by providing the following: (1) a complete outline that contains the main points in the lecture, (2) allowing students to follow the lecture, (3) while freeing them from any note-taking, (4) or the teacher may provide a skeletal outline that contains only the main point. Students may use this format to fill in pertinent details delivered through the direct verbal cues.  Verbal cues such as “this is the first main point” or “be sure to include…” assist the students in identifying which points are important. Subtle verbal cues also provide cues regarding importance such as “during the 1900’s…” “did you include that in your outline?” Or “make sure to remember the names.” The note-taking level of students on the spectrum then must be considered when selecting the appropriate type of assistance to be provided to the student.

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!

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.

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.

Using Mini Schedules and Task Organizers to Help Students with ASD In Classroom Settings

There are many types of visual schedules that can complement children’s daily tasks and activities by providing more specific cues about those tasks and activities. Mini schedules are used to provide specific information about the task at hand. These mini schedules can be highly individualized based on the individual’s skill level to meet the requirements of a given task. For example, if a student needs support on steps necessary to complete a math task, a mini schedule would be used to help identify step-by-step instructions of the task.

A mini schedule can also be designed to provide opportunities for choice making. For example, a mini schedule for an art lesson would direct a student to the stages required for drawing and coloring an object. At specific points along the mini schedule, the student would be required to make a choice between two or more items to create the art project. In this application, the mini schedule provides both the structure and the opportunity for decision-making.

Another visual schedule – the task organizer, can be used to add more structure to a lesson or activity depicted on the mini schedule. Task organizers provide a task analysis, or breakdown, of the steps required to complete activities. In the case of a math lesson, a task organizer could be used to further describe the steps within a specific activity, such as writing odd or even numbers.

Mini schedules and task organizers should only be used when a student needs extra structure for understanding activities, or to provide opportunities for decision-making to help a student perform at the most appropriate, independent level. For example, some students require minimal external structure and would need only a daily schedule to keep on task. However, those students who need more assistance to complete a task on their daily schedule would benefit from a series of mini schedules for each major activity.

Remember that a mini schedule or task organizer is usually not enough to help the student be successful. Most often, each of the steps in the mini schedule would need to be taught by repeatedly prompting and correcting attempts by the student. Last, remember that you will need to reinforce (reward) the student’s correct performance of the steps in the mini schedule or task organizer.

How Do Attention and Learning Rates Play a Role in a Child’s ABA Program

Children with autism can be easily distracted and may require a high level of assistance in order to attend to tasks and activities. Their attention span is typically shorter than that of their typically developing peers. When this is the case, an ABA program will begin teaching concepts by breaking them down into simple teachable steps in a distraction free environment, such as in their bedroom or in a quiet room in the house. For example, it may be too difficult for a child with autism to learn to count from 1-10 all at one time. Therefore, each number in the sequence will be taught one by one, at the pace of your child’s learning (chaining). On Monday, they may learn the number ‘one,’ on Tuesday, if they still maintain the memory of the number “one,’ they will be taught the number ‘two,’ on Wednesday, if they still maintain the memory of numbers ‘one’ and ‘two,’ they will be taught ‘three,’ and so on. While this may seem like a very slow learning rate, a child will be taught at the rate they are capable of learning.

With shorter attention spans, it is also important to note that clear, concise, and simple instructions are typically more effective in producing effective learning opportunities. This is why simple and clear language is often used in ABA programs. For example, the instruction, “point to number 1” is a much clearer instruction than “can you please point to the piece of paper that has the number 1 written on it?” and therefore, more likely to produce the desired response. However, it is also important to note that with continued success, and as attention and learning rates increase, language and instructions should be modified to include more complexity. This will help to promote generalization.

Children with autism typically need to not only learn in small steps, but require much repetition until the skill comes easily to them. Therefore, in an ABA program, the learning environment is structured so that it will allow as much repetition as a child needs while maintaining their motivation  and interest in learning. When children begin ABA programs, they may need many repetitions on the concept before learning or mastering the concept. However, it is common to find that over time as a child learns “how to learn,” that these repetitions become fewer and fewer and learning rates increase. Some describe this phenomena as “learning to learn”.

What is Applied Behavior Analysis (ABA)? An elaboration

Applied Behavior Analysis is the applied science of behavior formalized by B.F. Skinner. It is sometimes referred to as Behavior Modification, ABA, or Behavior Analysis. The theories, laws, and techniques have their foundations in years of basic research and describe some of the most fundamental things we know about behavior. Some early influences on the field of ABA include Watson, Thorndyke, Pavlov, and groups of psychologists, philosophers, and scientists in the late 1800’s and early 1900’s that pursued empirical science.

Contemporary hallmarks of ABA include the Law of Reinforcement, functions of behavior, contextualism, and determinism. Let’s briefly look at these areas to get a better understanding of the field of applied behavior analysis.

Simply put, the Law of Reinforcement states that behavior that is reinforced will continue to occur or will occur more often in the future. Conversely, a behavior that is not reinforced will not occur or will decrease in occurrence over time (though, sometimes we see a short increase after reinforcement is discontinued for a behavior that has been previously reinforced).

Through a great deal of clinical experience, it has become apparent that one challenge with really applying this law and understanding its fundamental truth relates to a not having a good understanding of what reinforcement is or can be. Some general misunderstandings include the assumption that consequences most people would describe as positive or pleasant will function as reinforcers. For example, most people would assume that receiving a thank you note would be a reinforcer for a job well done. In practice, this is not the case. There are individuals that would have no interest in a thank you note, but would rather prefer a pay increase. There are, of course, some that would.

Often times, people attribute what they would find reinforcing to another person. Life shows us, this is not the case. Conversely, when we talk about reinforcement, something that we think may be reinforcing may in fact be punishing (a consequence that causes a behavior not to occur or to decrease in the future). Similarly, reinforcers can vary in their magnitude or effectiveness dependent on the environment and on what has happened in the time before the reinforcer is being used.

One final thought is that behavior is often under multiple schedules. Some of the schedules are reinforcing and some of them are punishing. The effects of the reinforcers and punishers that are a part of each schedule vary. This makes it challenging for all but only the most skilled Behavior Analysts to have a good understanding of reinforcement, reinforcers, and schedules of reinforcement. The field of Behavioral Economics is making strides in empirically describing these concerns. However, the law of reinforcement remains one of the important concepts in Applied Behavior Analysis.

One of the more recent (relatively speaking as it dates back to the very early ’80’s) concepts in Applied Behavior Analysis is behavioral function. Previous to this notion, the field was more commonly known as behavior modification and behavior was mainly changed by modifying consequences (e.g., reinforcers and punishers).

Research in the early 80’s demonstrated functional relationships between problem behavior and the conditions that reinforced it. This research led to the concept of behavioral function. Simply, a behavior must be analyzed in terms of what function (i.e., purpose) the behavior served for the individual performing it.

Nowadays, we commonly look at the inappropriate behavior that children with autism perform in these terms. We ask, “are they performing this behavior for attention? Are they performing it to escape or avoid something that they do not like? Are they performing the behavior to get access to something that they want? Are they doing it because it gives them some sort of pleasure?”

Additionally, there are two questionnaire-based assessments, the Questions About Behavior Function (QABF) and Motivation Assessment Scale (MAS), that assist users with determining the function of the behavior in question. The QABF was developed with adults with developmental disabilities and the MAS was developed on children with developmental disabilities.

Contextualism is a concept somewhat close to behavior function. In short, contextualism refers to analyzing behavior in terms of the context that it occurs. What are the characteristics of the environment? Is it loud? Quiet? Hot? Who is there when the behavior happens?  What happens right before the behavior occurs? What happens earlier in the lead up to the occurrence of the behavior? What happens after?

All of these questions are things that we ask when we analyze behavior. Taking these things into consideration is why we refer to Applied Behavior Analysis as contextual.

Our final hallmark of ABA is one of the more ephemeral concepts. It is complex and philosophical in nature and often times needs to be reflected on to really get a grasp of it. This is the concept of determinism. This is also one of the more controversial concepts in ABA. Essentially, the concept of determinism says that our behavior is under the influence of our learning histories, the antecedents that occasion the behavior, and the consequences that reinforce or punish it. We are not operating under the umbrella of free will.

Like was said earlier, this is a controversial concept. Some say that our verbal behavior (i.e., thoughts) can control our behavior. In some cases, it may mitigate our behavior and, of course, it is behavior and therefore is under the same influences of antecedents, consequences and learning history. However, with the exception of the species-specific behavior we are born with, we are products of our learning histories and present environmental factors.

Applied Behavior Analysis is an elaborate science of behavior and it has been applied in many arenas (businesses, animal training, individuals with developmental disabilities, individuals with Traumatic Brain Injury, etc.,). There are many laws and principles and even more techniques based on these laws and principles. Some of the main hallmarks remain those referenced above (i.e., reinforcement, functions of behavior, contextualism, and determinism).