A team of knowledgeable professionals from The LeafWing Center share their expertise about applied behavior analysis. They discuss the basics of the technique, what a good ABA program entails, reasonable expectations and the many benefits to be gleaned from this type of treatment. This is an in-depth tour of what ABA is and how it works.
Listen to the Podcast Episode here:
The Advantages of Applied Behavior Analysis Podcast
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.
In 2001, the National Research Council published findings effective treatments on Educational Interventions for Children with Autism from birth to age 8. The committee set out with the question “What are the characteristics of effective interventions in educational programs for young children with autism spectrum disorders?” The findings were published in a comprehensive book titled, “Educating children with autism.”
In answering the above question, the committee recognized that there were numerous articles written on autism treatment and that there were numerous treatment programs across the country claiming to be effective in helping children with autism. Treatments ranging from ABA-based programs to developmentally-based programs to diet-based programs or more idiosyncratic programs such as sensory integration. In order to base their recommendations on clear evidence of effectiveness, the committee ruled out treatment that did not base their statements on some form of data regarding the outcome of the children.
They took a look at over 900 articles written on the treatment of autism and also enlisted the assistance of ‘model’ programs currently in place for the treatment of autism. These model or state-of-the-art programs were typically university or research ran programs who that enlisted the services of highly qualified professionals. Of the ten model programs selected, seven were from an applied behavior analysis framework, one was from a developmental framework, one was purely parent training, and the last was a combination of behavioral and developmental frameworks.
The committee listed key features seen as variables of effective programs in an effort to use this information from these state-of-the-art programs and translate it to publicly funded early education programs across the country and to begin some quality control.
The first characteristic identified as a key feature of an effective treatment program is that of early entry into a program. When reviewing the information from these model programs and based on findings from the literature, the committee saw that the earlier a child is placed in treatment the better their chances of making gains. Therefore, their first recommendation was that educational services begin as soon as a child is suspected of having an autism spectrum disorder highlighting the importance of early intervention. Early detection and treatment are key phrases often heard in the medical field and this is the exact same case when it comes to the treatment of autism. So, early entry is recommendation number one.
Next, the committee looked at the intensity of these programs and what has been shown in the literature to be an effective level of intensity. Their conclusion upon review of the information was that educational services include a minimum of 25 hours a week, 5 days a week, 12 months a year during which time a child is actively engaged. The word minimum in this recommendation is key as some children may need more than this minimum of hours given the severity of their symptoms or their resistance to treatment.
Additionally, the notion of active engagement is very important as the recommended number of treatment hours is not merely the number of hours recommended for a child to be placed in a treatment program, but the number of hours to child is actively learning while in the program. This means that the child should not be just physically present in a treatment program, but that each and every hour of that program is designed in a way in which the child will learn for a minimum of 25 hours per week.
Another way of looking at this is if it was recommended that a child attend a special education program 30 hours a week, one would initially think that the recommendation for a minimum number of hours has been met. However, if, within these 30 hours, the child spends at least two hours a day playing alone in the playground, one hour a day eating lunch, a few hours a day in unstructured and unsupervised solitary play activities, and only two hours of actual teaching occurs within the school day, a child is left with only a 10-hour a week treatment program. And while play time is extremely important for any child, if a child does not yet have the skills to know how to play, how can the child be expected to interact with other children during these free play times without specific structured teaching? So, it is important to look beyond the number of hours and actually look at what each hour of the treatment program will entail whether that be an ABA program, school-based program, or any type of recommended treatment program. It’s imperative that a child be placed in a program where they can access the curriculum and where the teachers or therapists are actively engaging the child so as to capture each and every teaching opportunity and make it a worthwhile experience. There needs to be intensive teaching and learning occurring during a child’s time in an intervention program.
The committee actually described intensity as a “large numbers of functionally, developmentally relevant, and high-interest opportunities to respond actively.” In other words, a child’s time spent in a treatment program should result in high levels of learning when it comes to the matter of reaching their educational goals. So, the higher the level of active engagement, the higher the intensity, the higher the change rate for steady gains.
Next on the list of key characteristics was the child to teacher ratio. The committee recommended that programs consist of sufficient amounts of adult attention in order for a child to meet their educational goals, either learning with one-to-one or very small group instruction. The decision of student-to-teacher ratio should be made, depending on the learning ability of the child rather than depending on the staffing needs of the program. Therefore, if a child can learn in a small group of maybe two children and one teacher, then that should suffice; however, as is the case for many young children with autism, if the child cannot occupy their own free time in a constructive manner, redirect their attention when asked, or learn via observation of a peer, then the teaching instruction should be in a one-to-one manner, that is one teacher with one child.
The committee recognized the need for well-trained personnel. The committee noted that all the model programs they reviewed were developed by persons with Ph.D.’s in autism-related fields and the programs were directed and implemented by teams of professionals who had extensive training and experience in autism spectrum disorders. It is so important that the person designing a treatment program for a child with autism has extensive knowledge not only in the field of autism, but hands on experience in designing effective programs.
Next, the committee recognized the notion of individualization. A key characteristic of these model programs was that of comprehensive, individualized treatment goals based on the needs of each individual child rather than a one-size-fits-all curriculum for all the children in the program. The curriculum or individualized plan developed for each child should be based on their own personal strengths and weaknesses. The goals for each child should also focus on the development of a child’s social and cognitive abilities, their verbal and non-verbal communication skills, adaptive or self-help skills, and the reduction of behavioral difficulties using more positive behavioral approaches rather than punitive approaches.
The second part of this recommendation, that “goals “are frequently adjusted,” cannot be emphasized enough. While the initial curriculum and targets developed for a child may be individualized at the onset of a treatment program, it is critical that these goals and targets be reviewed routinely and adjustments be made when necessary.
And lastly, the committee recognized the important role parents have when it comes to the effectiveness of treatment programs. A key characteristic amongst all model programs was their emphasis on parental training and involvement in the program. The involvement of parents is a very valuable tool in the treatment of autism because children spend most of their time with their parents; therefore, parents must play an active part in the treatment team so as to continue where the formal treatment sessions end. With parents as active participants of the program, a child will always be in a consistent environment where their skills can be generalization generalized and maintained.
When you arrive home with the kids after school and work, the first thing you may want to do is relax! Turning on the television for your child, letting her watch a movie, or allowing her to engage in her repetitive behaviors to her heart’s content is very tempting. You have had a long day and rest is probably the first thing you would like to do. Allowing these things just discussed though should be kept to a minimum and used as “earned” activities or used in emergency situations (i.e., when you just can’t take it anymore!).
So, what do you do instead? When do you get “you” time? First, focus on creating structure for your child during these down times. Structure and routine are so important for children with autism. They are important for just about everyone but when it comes to children on the autism spectrum, they really thrive on routine and structure. You establish predictability with structure and routine and it can also help with meltdowns.
Create a visual schedule for your child for the evening routine using printed out photographs which you can Velcro in order to a piece of paper (a laminated paper is best). A child can, by following clear pictures, recognize the order and importance of daily activities. This reduces stress and anxiety because they know what to expect and what will be happening next. For example, you may allow 15 minutes of free play time, then homework, then dinner, then bath/shower, then bedtime routine activities, then bed. It allows your child to see what to expect for the evening and also guides you as the parent, reminding you each evening what the structure should be.
What if your child does not follow visual schedules independently? That’s okay! It may take a few days, or even a few weeks, but after you guide them through the schedule each night, using a timer to signal the end of each activity, and guiding them to take off each picture as it is completed, they will learn to follow the schedule themselves and become independent before you know it.
Final tips: Be sure to include fun things that your child likes on the schedule, not just work activities and boring nightly activities. Sometimes let them choose the activities during certain times (e.g., bedtime routine activities). Lastly, be sure that when your child has successfully completed their schedule and is successfully in bed, do something good for you! Enjoy that piece of cake that’s been sitting in the refrigerator or that glass of wine you’ve been waiting for all week. Watch a movie with your partner. Now it’s you time!
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.
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.
Remember those four reasons why people may engage in challenging behaviors discussed in the previous post? People may want attention from other people, may want something, may want to get out of something, or may enjoy how the behavior feels. If you haven’t already read it, we suggest reading the prior post so the information below is as useful as possible.
This post will focus on reactive strategies, based on the reason your child is engaging in the particular challenging behavior. In other words, what should you do in response to your child engaging in the behavior? This is probably the most stressful for parents as they may wonder if what they are doing is right. They may wonder if they are hindering or helping their child. Hopefully we can provide some guidance.
If your child engages in a particular challenging behavior to get something that he/she wants, it is important for him to learn that his behaviors do not lead to getting what he/she wants. You should avoid giving them what they want when engaging in the problem behavior, and even after the behavior ends. The child should only be allowed to get what they want if he engages in a more appropriate behavior, which we will discuss in a future post. This can be difficult for parents as giving the child what they want quiets them down and relieves much of the stress in the home or community setting. The problem is that your child will learn this connection and continue to engage in this behavior in the future when they want to same thing. It will become a repeated cycle.
If your child engages in a particular challenging behavior to get out of something, such as homework or eating dinner, it is important to not allow him to get out of the situation until they engage in a more appropriate behavior. If the child hits and screams while doing homework, it is important to follow through, require them to complete a few more problems without hitting and screaming, and then they can leave. More appropriate behaviors to get out of doing things they don’t want to do will be discussed in future posts.
If your child engages in a particular challenging behavior to get attention, you should avoid providing attention to them until the behavior is not occurring or he engages in a more appropriate behavior to get your attention. Providing attention only teaches them that this bad behavior leads to what they want. This connection needs to be disconnected and the child needs to be taught more appropriate ways to get attention.
Last, if your child engages in some challenging behavior because it feels good, such as head banging, it is important to block this behavior so that this particular behavior does not provide the sensory satisfaction that your child is receiving (in addition to preventing them from doing harm to themselves). You can physically block the behavior or there are many devices created for this purpose.
Stay tuned for a future post providing suggestions for what to teach your child to do instead of engaging in the bad behaviors they currently know will get them what they want. Just reacting how we have described above will not teach new, appropriate ways to get what they want. Teaching a new, more appropriate behavior is the key to decreasing challenging behaviors.
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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.
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?
One of the biggest concerns that parents have when raising children living with autism is that “their children just don’t listen.” Besides making instructions very clear and giving instructions only when the child is paying attention, the biggest most important thing a parent must do is follow through when the child does not respond. Not following through when your child does not respond only teaches your child that there is no need to follow your instructions in the future. This pattern, if not addressed, can be very frustrating and stressful.
Following through; however, can be difficult because many times parents are multitasking on a daily basis: cooking dinner, cleaning up the house, talking on the phone, and telling their kids to clean up in the other room et cetera. Think about this before giving instructions: make sure you have your child’s full attention before giving your instruction and once you give your instruction, make sure you can immediately assist your child with completing the instruction you just gave.
Imagine this situation. Mom gives Sally her clothes in the morning and tells her to get dressed. Mom then leaves the room and tries to get lunches and other kids ready as well. She comes back and Sally is still in her jammies playing with her dolls. Mom tells Sally again that she really needs her to get dressed, this time making sure Sally is looking at her while she gives her instruction, points to the clothes, and then leaves again to finish getting things ready for school. When she comes back five minutes later, Sally is still in her jammies playing with her dolls. When Sally’s mom tells her to put her jammies on in the future, do you think Sally will comply? Probably not.
Try this instead. Mom tells Sally she has three more minutes to play with her dolls then it’s time to get dressed. She sets a timer so the beep becomes a signal to transition to another activity (dressing). When the timer goes off, mom is right there to take the dolls and give Sally her clothes. She tells her “get dressed.” Instead of leaving the room, mom stays to make sure Sally starts getting dressed. If Sally just sits there, within about 10 seconds mom tells Sally again to get dressed but this time mom helps Sally start taking off her jammies, gradually backing away as Sally does more and more of the task herself. Mom does not leave the room and does not repeatedly tell Sally “get dressed” without helping and making sure Sally does get dressed. Once Sally is done getting dressed, Sally’s mom gives her the dolls back for 5 more minutes of play before school as a reward for getting dressed. Here, Sally will learn, over repeated times of Sally’s mom following through, that when her mom tells her to get dressed, she cannot continue playing with her toys unless she does what her mom says.
Again, one of the most important factors when increasing your child’s compliance is follow through! How easy is this for you to do?