Navigation's ABA and Autism

Suggestions for Providing Parent Training

After writing my previous blog entry about the necessity for training, I realized it is probably a good idea to provide more suggestions on how to provide training with examples for providers who would like more information on this topic. I am by no means an expert on providing training but the following is a summary of examples that have worked well for me. I was fortunate during my graduate studies, to have a class where I wrote a paper on parent training so one of the first things I did relating to parent training was a literature review. I would suggest that all providers do the same. The one thing that stuck out in all of the articles that I read is that Behavior Skills Training is the most effective form of providing training. I have also found a few other components to be helpful so below I will provide an example of how I typically do parent training/staff training.

Step One: Make Training a Requirement of Services

If training is optional or the importance of training is not emphasized, then it will be very difficult to conduct training. Parents are typically very busy so unless they know that training is a crucial component of successful intervention, it is not very likely that they will participate in training. At the end of this blog I will post my policies relating to training so that you can see what I tell parents and how I determine termination of services due to lack of participation. These policies were developed during my time as Clinical Coordinator. I had to experience a lack of a requirement/termination policy in order to develop one. Services are much more effective and parent training is much more successful when the requirements are laid out from the beginning. If you do not currently have policies in place, simply write up a policy and let your clients know that effective a certain date this new policy will go into effect. I have to do this all the time as new issues arise.

Step Two: Determine What Areas Need To Be Trained

Depending on the needs of the child, you may have several topics that the parents need to receive training on. I typically determine what all of the topics are by observing/assessing the child and discussing with the parents/staff what they would like more training on. I then make a list of these topics and train on 1 topic at a time starting from most important AND easiest and moving down the list. I try to do one topic at a time so as not to overwhelm the parent. I also try to pick a topic that is important to the parent but will be fairly easy to train. This is so that the parent has a positive training experience.

Step Three: Time Permitting Take Baseline Data

After you have assessed the behaviors and determined a plan that you would like to use with the child and that you would like to train the parent/staff how to do, try to take baseline data. Make an integrity checklist of the steps to follow for the specific topic that you are training on. Do not show the checklist to the parent. Set up a situation and observe the parent in the target situation. Fill out the integrity checklist to record what behaviors the parent is currently doing and what behaviors the parent is not doing. The purpose of the baseline data is to show that your training was effective (pre/post scores on the checklist), to determine what areas the parent might need more training in, and to give the parent feedback on the current performance. When going over the checklist with the parent, make sure to point out all of the things that the parent did correctly on the list and then let the parent know that you will teach them how to do the other things. See the end of this blog for an example of an integrity checklist.

Step Four: Provide the initial training using BST

I always type up a training packet for the parent that includes a description of what we will be doing for training, a modeling section, a role play section with an integrity checklist, and a in situ observation section with an integrity checklist. As I go over the procedure with the parent, I also make sure that everything is feasible and works for them and modify as needed. After I explain the procedure, I model for them all of the steps. I then have them role play the steps with me and fill out an integrity checklist. I will give them feedback using the integrity checklist and then have them try the skill with their child. Sometimes it is not possible to have the situation occur on cue so I will keep the integrity checklist with me and use it whenever the situation does occur while I am at the house. After each occurrence of the situation, I will go over the checklist with the parent. I always provide positive feedback and try to limit my corrective feedback so that training is a positive experience. See the end of the blog for an example of a parent training packet.

Step Five: Provide ongoing training and feedback

Once i have trained a parent on a skill, I will continue to do integrity checklist until they have mastered the skill. I will then continue to provide social praise when I see them do the skill. I usually will try to train on 1 new topic per week until all topics have been covered. However, if a certain topic is difficult or involved, I will focus solely on that for a while and then move on to other topics. I try to allow the parents to determine what topics we cover so that I can address their concerns first. However, I sometimes I have to provide training to them on a topic so that their child can make more progress. I also continuously assess what areas are of concern to the parent so that I can update the training topics frequently.

Example of Parent Training Requirement/Participation Policy

Participation Requirements

Participation in monthly meetings: parent/guardians are expected to be present for each monthly meeting because their child’s treatment programming will be discussed and changed at this time. It is imperative to have the parent/guardian present in order to provide the best treatment to the child and to receive feedback and input from the parent/guardian.

Participation in training regarding child’s programming: Parent/guardian actively participates in training conducted by the consultant.

Implementation of reduction behavior protocols: Parent/guardian actively participates in training on how to follow protocols set in place by consultant in order to reduce behaviors. Parent/guardian implements behavior protocols consistently and notifies consultant if the protocols are too difficult to follow. Parent/guardian allows therapist to conduct integrity checklist and provide feedback on adherence to protocols.

Generalize and Practice targets with child: The parent/guardian will be informed by therapist what skills their child is working on. The parent/guardian when practice these skills throughout the day in the child’s natural environment to increase generalization.

Following through with day-long programs: Parent/guardian follows the protocol for day-long programs such as toilet training, feeding programs, or sleeping programs.

Procedure for Lack of Participation

The following is an explanation of the steps that will be taken if a parent/guardian is not participating in their child’s programming.

1. The first time that a parent or guardian does not meet one of the participation requirements, the consultant will provide the parent or guardian with a verbal warning reminding the parent or guardian of the participation requirements. The consultant will explain clearly to the parent or guardian where their participation is lacking. The consultant will offer more training if this is part of the issue.

2. The second time that a parent or guardian does not meet one of the participation requirements, the consultant will provide the parent or guardian with a written notice reminding the parent or guardian of the participation policy. The notice will clearly explain to the parent or guardian where their participation is lacking. The consultant will offer more training if this is part of the issue.

3. The third time that parent or guardian does not meet one of the participation requirements, the consultant will meet with the parent or guardian and provide them a final written notice reminding the parent or guardian of the participation policy. The notice will clearly explain to the parent or guardian where their participation is lacking. The case manager and consultant will work closely with the parent or guardian to provide the training necessary to correct the issue. Additionally, the notice will explain to the parent that if the parent or guardian does not meet the participation requirements again, the child’s services will be discontinued.

4. The fourth time that a parent or guardian does not meet one of the participation requirements, the child’s services will be discontinued on the grounds that I cannot provide effective treatment if the parent or guardian is not participating in the child’s programming. The consultant will meet with the parent or guardian to explain to the parent where their participation is lacking. Services will be faded back according to a fade plan that will be individually determined for each child.

Working Together for the Success of Each Child

Megan will work closely with every parent or guardian in order to ensure that parent participation is as easy and enjoyable as possible for every parent or guardian. When issues do arise, the cconsultant will work closely with the parent or guardian to determine how to resolve the issue. When parents or guardians participate fully in their child’s programming, they should see more progress from their child and have a better understanding of how to respond to various behaviors.

Example of an Integrity Checklist

The checklist wouldn't post properly but it should be a table where there is a column for Yes, No, NA and a row for each step.

Mand Training Checklist

Yes	NO	NA	Checklist Item
			*Environmental Set Up*
			-Restricts access to preferred items by placing them out of reach
			-Requires XXXX to request item before allowing access
			*Shaping Requests*
			-Allows immediate access to item if XXXX makes appropriate request: eye contact, clear, full sentence
			-Follows prompt hierarchy to shape request if XXXX doesn’t make appropriate request: expectant look, reminder, full prompt
			-Allows access to item only after XXXX makes the request with eye contact and a clear full sentence
			-If XXXX uses wording that is not appropriate, prompts XXXX with more appropriate wording
			-Only allows access to item if XXXX says with appropriate wording, eye contact, and clear full sentence
			*Allowing Access*
			-If XXXX makes appropriate request: eye contact and a clear full sentence, allows immediate access to item
			-When XXXX is highly interested in an item, requires him to complete a few demands before allowing access
			-Occasionally takes turns between engaging with toy and completing demands
			-does not always require XXXX to complete a demand and does not always provide immediate access to the item

FEEDBACK:

Items that you did really well were:___________________________________________

________________________________________________________________________

Things to work on:________________________________________________________

________________________________________________________________________

SIGNATURES:

Monitor____________________________________

Trainee______________________________________

Example of a Parent Training Packet

Parent Training

Client: XXXX

Date:

Purpose: The purpose of this parent training activity is to train XXXX’s parents to appropriately respond to inappropriate behavior in order to reduce the occurrence of the inappropriate behavior. Once the training is completed, XXXX’s parents should be able to identify the type of situation and how to respond appropriately.

Inappropriate Behavior in Response to a Demand:

XXXX occasionally engages in inappropriate behavior when asked to do something that he would prefer not to do.

Definition of Behavior: Any instance of XXXX saying “stupid,” saying “go away,” whining, crying, screaming/yelling, dropping to the floor, aggressing towards others or objects or throwing items in response to a demand.

Procedure for decreasing behavior:

Repeat the instruction while providing a prompt. Using the Least-to-Most prompt hierarchy to prevent prompt dependence. Prompt him through the instruction while eliminating eye contact and minimizing talking to only the instruction. Prompt hierarchy:

Gestural prompt (point to item/activity)
Model prompt (show him what to do, this may not always be applicable)
Partial Physical (start to physically guide him to or through activity)
Full Physical (physical guide him through entire instruction)

Provide 3-5 seconds between each prompt level to give him a chance to respond
Repeat the instruction each time a new prompt is delivered
Ignore any aggression/problem behavior
DO NOT talk to, look at, touch, reason with, or try to console XXXX while following through with the demand. Simply provide prompts to complete the task.
Upon responding, provide differential praise depending on how much prompting he needed

If he cried the entire time and needed a full physical prompt, after prompting him through it, say in a neutral tone “that’s coloring”
If he complied with only a gestural prompt and was no longer crying, tell him enthusiastically “Great job coloring!”
Remember to always praise enthusiastically with hugs/tickles etc when he complies with ANY instruction the first time he is asked (come here, let’s go outside, clean up toys etc). He should not have to engage in problem behavior before receiving praise. Decrease the amount of reinforcement when there is an increase in assistance.

Try to get XXXX to use his words, upon precursors to tantrum behavior such as turning in the chair, or slight whining prompt XXXX to ask for a break by asking him “Do you need a break? Say ‘I need a break’”.
Deliver a few simple instructions until XXXX complies without prompts so he gains access to reinforcement

Procedure for Increasing Appropriate Behavior

Throughout the day when XXXX does comply with a demand, make sure to praise, give tickles, high fives, etc EVERY time he complies with a low preference demand.
When you are about to present a demand that XXXX doesn’t prefer, prompt him right away to use his words. Example “XXXX it is time to clean up, use your words” Then you can prompt him to say how he is feeling “Say ‘I am mad. I don’t like cleaning up. First I clean up, then I watch t.v.’ “ Or other phrases that might be appropriate.
Only prompt XXXX to use his words and give him words to say if he is calm or just whining. Do not prompt him if he is intensely tantruming because you might reinforce the behavior and/or see the tantrum escalate.
Remind XXXX during NEUTRAL situations that if he listens to mommy or daddy he is a big boy and can do fun things, but if he doesn’t listen, he doesn’t get to do fun things.
BE CONSISTENT. If you tell XXXX he must complete a demand in order to get a reinforcer, DO NOT give him the item unless he completes the demand.
DO NOT BRIBE XXXX. Set out the consequences PRIOR to placing the demand. “We need to clean up, then eat ice cream.” Or if XXXX asks for a highly preferred activity, you can work off the motivation “Oh, you want bubbles, let’s clean our room then do bubbles.” DO NOT do this “XXXX clean your room.” (XXXX resists) “Oh come on XXXX if you clean your room, I’ll give you candy.” Then you are allowing XXXX to manipulate the situation. You should be the one setting the consequences.

Now that we know what the procedure is. Let’s role play and practice so that you can follow it with XXXX. I will be looking for the behaviors/steps listed in the checklist below:

Checklist for inappropriate behavior in response to a demand – Role Play

Yes	NO	NA	Checklist Item
			-Presents demand
			-XXXX knows what the consequence is for completing the demand
			-Upon occurrence of inappropriate behavior:
			Does not react to the inappropriate behavior (no touching, talking, eye contact)
			Repeats instruction and provides lowest prompt level
			Continues to work up the prompt hierarchy until compliance is achieved
			Presents 2 or 3 more easy demands before providing a break
			-Prompts to use words when inappropriate behavior begins
			-Prompts what words to say “I’m Mad” etc and still follows through with demand
			-Discontinues prompting for using words if inappropriate behavior escalates
			-Uses differential reinforcement for compliance: if complies quickly, provides praise; if needs prompts the whole time doesn’t praise just acknowledges being done
			Doesn’t bribe, provides consequences before presenting demand

FEEDBACK:

Items that you did really well were:___________________________________________

________________________________________________________________________

Things to work on:________________________________________________________

________________________________________________________________________

SIGNATURES:

Monitor____________________________________

Trainee______________________________________

Checklist for inappropriate behavior in response to a demand – with child

Yes	NO	NA	Checklist Item
			-Presents demand
			-XXXX knows what the consequence is for completing the demand
			-Upon occurrence of inappropriate behavior:
			Does not react to the inappropriate behavior (no touching, talking, eye contact)
			Repeats instruction and provides lowest prompt level
			Continues to work up the prompt hierarchy until compliance is achieved
			Presents 2 or 3 more easy demands before providing a break
			-Prompts to use words when inappropriate behavior begins
			-Prompts what words to say “I’m Mad” etc and still follows through with demand
			-Discontinues prompting for using words if inappropriate behavior escalates
			-Uses differential reinforcement for compliance: if complies quickly, provides praise; if needs prompts the whole time doesn’t praise just acknowledges being done
			Doesn’t bribe, provides consequences before presenting demand

FEEDBACK:

Items that you did really well were:___________________________________________

________________________________________________________________________

Things to work on:________________________________________________________

________________________________________________________________________

SIGNATURES:

Monitor____________________________________

Trainee______________________________________

Inappropriate Behavior in Response to Being Told “NO” or Access to Tangibles

XXXX also engages in inappropriate behavior when he is denied access to an item or an item is taken away.

Definition of Behavior: Any instance of XXXX saying “stupid,” saying “go away,” whining, crying, screaming/yelling, dropping to the floor, aggressing towards others or objects or throwing items in response to a demand.

Procedure for Reducing Inappropriate Behavior:

Offer XXXX a choice of something else he could do. Be sure to do this quickly, right after you say “No we can’t have tv right now but you can have either dress up or books”
If he doesn’t make a choice and continues to whine, start ignoring the behavior by turning away from him and not talking to or looking at him.
If XXXX is trying to aggress toward you or one of his siblings, you can either remove him from the situation or remove the other children so that they are not harmed. Do whichever is easier.
Only tell him each option one time
If he starts to engage in the activity, wait for 5 seconds of quiet and praise him for participating.
If he calms down at any point, praise him for being calm and try to redirect him to a different task.
If he continues to whine, do not provide any attention, including: talking, eye contact or head movement in his direction, it may help to engage in an activity (play or paperwork) yourself so you are not just sitting there listening, this may also help to reengage him.
Upon the occurrence of whining/screaming to get access to items that you are willing to give him ( i.e. wants a snack but starts yelling) you can then prompt XXXX to “ask nicely.” Try not to do this until he is calm for a second so as not to reinforce the whining.
Do not allow access to the previously denied item at any point.
When redirecting XXXX to a different task after whining/tantrumming has occurred DO NOT engage him in his MOST PREFERRED activity because this will reinforce inappropriate behavior. Pick an activity that is preferred but not highly preferred.

Procedure for increasing appropriate behavior:

We are going to start a “wait” and “accepting no” program for XXXX. Both of these should help build up his repertoire for tolerating “no” and being denied access to activities. Training will occur on this next time.
Make sure to praise XXXX every time he calmly accepts no, uses his words, and/or picks a new activity to engage in.
When you are about to deny XXXX access to an activity or have him wait, make sure to prompt right away to use his words. “You can’t have pizza right now say ‘I’m mad, when can I have pizza.’ “ Prompt XXXX with exactly what he should say so you can help him work through the situation.
Only prompt XXXX if he remains calm or is whining slightly. Discontinue prompts and start ignoring the behavior if the behavior escalates: he starts to get aggressive, begins screaming and crying, etc.

Now that we know how to react to the behavior, let’s practice.

Checklist for inappropriate behavior in response to “no” – Role Play

Yes	NO	NA	Checklist Item
			-When denying access, provides a choice of 2 other activities
			-Immediately prompts XXXX to use his words after denying access
			-Upon occurrence of inappropriate behavior:
			Ignores inappropriate behavior – no touching, no talking, no eye contact
			Only gives choices ONE time
			Engages self with one of the other activities to help redirect
			Doesn’t engage with a highly preferred activity
			Doesn’t try to talk the child into coming over to the activity
			Only allows child access to the new activity if calm
			-When child calms down, praises for being calm
			-Doesn’t provide access to previously denied activity
			-If previously denied activity is allowed to occur, only allows access if child asks nicely

FEEDBACK:

Items that you did really well were:___________________________________________

________________________________________________________________________

Things to work on:________________________________________________________

________________________________________________________________________

SIGNATURES:

Monitor____________________________________

Trainee______________________________________

Checklist for inappropriate behavior in response to “no” – with Child

Yes	NO	NA	Checklist Item
			-When denying access, provides a choice of 2 other activities
			-Immediately prompts XXXX to use his words after denying access
			-Upon occurrence of inappropriate behavior:
			Ignores inappropriate behavior – no touching, no talking, no eye contact
			Only gives choices ONE time
			Engages self with one of the other activities to help redirect
			Doesn’t engage with a highly preferred activity
			Doesn’t try to talk the child into coming over to the activity
			Only allows child access to the new activity if calm
			-When child calms down, praises for being calm
			-Doesn’t provide access to previously denied activity
			-If previously denied activity is allowed to occur, only allows access if child asks nicely

FEEDBACK:

Items that you did really well were:___________________________________________

________________________________________________________________________

Things to work on:________________________________________________________

________________________________________________________________________

SIGNATURES:

Monitor____________________________________

Trainee______________________________________

Miscellaneous

Keep in mind that we ALWAYS want to be giving lots of attention for APPROPRIATE behavior and very little to none for inappropriate behavior
A lot of XXXX’s behavior is attention maintained, if he starts whining, or engaging in inappropriate behavior and you are thinking to yourself “ I really wish he wouldn’t do that” DO NOT attend to the behavior. This applies to when people leave, when he comes home from school, throughout the day. If there is a behavior you DO NOT want him doing, DO NOT interact with him while he is doing the behavior. You can block him from doing it and redirect him to something else. Let’s practice this.
Limit the amount of “no” or “stop” you say to XXXX. Only tell him these things and give him attention for those behaviors, if the behavior will harm himself or someone else. All other behaviors can and should be ignored.
When you do tell him to stop, only tell him one time. Say it in a firm, neutral voice. Do not use exaggerated expressions, or say it in a fun way. XXXX might start to do things just to see your reaction.
When you tell him to stop, if he doesn’t stop, make sure to follow through and help him stop. We always do: Say, show, do. This means tell them what to do, show them how to do it, hand over hand guide them to do it if necessary.
If you absolutely must attend to an in inappropriate behavior, make sure you make up for it by attending 4x as much to appropriate behavior: Ratios should be: for every 1 “negative” feedback the child receives 4 positive feedback statements. (this is research based).

Posted by Megan DeLeon BCBA at 8/9/2010 7:36 PM | Add Comment

How much training are you or your tutors/therapists receiving????

An issue that I frequently encounter either through parent report, tutor report, or my own observation is a lack of training for parents and tutors. There are a few reasons why this is a big problem: leads to less effective intervention for the child, can hinder progress of the child, and it violates the BACB code of conduct (and the structure of the Autism Demonstration Project for military members). I will discuss each of these issues below as well as provide some reasons why I think a lack of training occurs, a description of what a lack of training looks like, ways to address the issue.

Leads to less effective intervention for the child

Research in the field of behavior analysis and autism treatment in general indicates that parent training and tutor training are crucial to the success of an intervention package. Lynn and Robert Koegel have done an extensive amount of research on parent training and consistently show that parents serve well as the child's teacher and parent training leads to gains for both the child and the parent. I will provide summaries of other research regarding parent training at the end of this blog.

Most children receiving behavior analysis services only receive a few hours of treatment per week (around 7-10) but the recommended intervention amount is 30-40 hours. If the parent does not receive proper training, you are looking at countless hours that are being wasted and possibly un-doing the work that the therapist is doing during her 7-10 hours with the child. If the tutor/therapist doesn't receive proper training, you are looking at even less progress for the child because the few hours of therapy that are being provided, are not as effective as they could be. Sometimes I will see children who make wonderful progress with poorly trained tutors/therapists and parents and it saddens me because they could be making at least double that progress if everyone was trained.

Can hinder the progress of the child

An even worse situation is when lack of training leads to hindering the progress of a child. Most of the time children who are receiving services require a very consistent and structured intervention package. If the tutor/therapist is following this package but the parent does not, all of the work that is being done during sessions could be counteracted when the session is over. For example, if a child is hitting himself for attention and the intervention plan consists of providing a thick schedule of attention throughout the session when the child is not hitting himself, gently blocking the hitting when it does occur, and not providing eye contact, talking, or other attention during the hitting; but the parents tell the child "NO HITTING" and provide a lot of attention every time the hitting occurs, you will have a behavior that not only doesn't decrease but might increase. This is is because the behavior is now on a variable reinforcement schedule, meaning sometimes it is reinforced (the child receives attention) and sometimes it is not (the hitting is blocked and ignored). Because the child never knows what reaction he will receive, he is going to continue to hit in the hopes that he gets attention and he might do it more intensely when he doesn't get attention to see if hitting harder will get him the attention he is wanting.

Additionally, if the tutor/therapist hasn't received proper training on how to assess the function of a behavior, the therapist/tutor and the parent might be reinforcing the behavior. For example, some children will refuse to follow an instruction and a therapist/tutor will automatically provide escape extinction as a consequence. This means, the therapist/tutor will hand over hand guide the child to do the task. This also sometimes results in a physical struggle of trying to keep the child in the chair, trying to maintain the materials if the child is pushing them away, etc. I don't typically use this procedure even if the child is trying to escape a demand but that is a topic for a different blog. If no analysis is done and no data collection is kept to see how frequently the child is doing this behavior and whether or not the behavior is increasing/decreasing, the tutor/therapist will not know if the escape extinction intervention is effective. It is the job of the BCBA to train the therapist/tutor on how to collect this data, when to collect this data, and for the BCBA to devise a plan on how to intervene in order to decrease the behavior. If the child was not responding because he enjoys the physical prompting and struggle, the behavior will actually increase.

Violates the BACB Guidelines for Responsible Conduct

Not providing training to parents or therapists/tutors results in the following violations of the BACB:

2.02 Accepting Clients - The behavior analyst accepts as clients only those individuals or entities (agencies, firms, etc.) whose behavior problems or requested service are commensurate with the behavior analyst’s education, training, and experience. In lieu of these conditions, the behavior analyst must function under the supervision of or in consultation with a behavior analyst whose credentials permit working with such behavior problems or services.

If the behavior analyst isn't providing training because he/she doesn't know how to intervene, then they are violating 2.02 because they should not be accepting clients whose service needs are outside their area of training without also seeking supervision from another behavior analyst who does have this training.

3.02 Functional Assessment of Behavior - (a) The behavior analyst conducts a functional assessment, as defined below, to provide the necessary data to develop an effective behavior change program.

(b) Functional assessment includes a variety of systematic information-gathering activities regarding factors influencing the occurrence of a behavior (e.g., antecedents, consequences, setting events, or motivating operations) including interview, direct observation, and experimental analysis.

If the behavior analyst has not trained the tutor/therapist how to collect data, nor collects data/analyzes the behavior herself, then she is violating 3.02 because the behavior is not being assessed for function. Additionally, if the behavior analyst trains the tutor how to collect data but never uses that data to develop an intervention plan, then she is violating 3.02 because the behavior is still not being analyzed.

3.03 Explaining Assessment Results - behavior analysts ensure that an explanation of the results is provided using language that is reasonably understandable to the person assessed or to another legally authorized person on behalf of the client. Regardless of whether the interpretation is done by the behavior analyst, by assistants, or others, behavior analysts take reasonable steps to ensure that appropriate explanations of results are given.

If the behavior analyst doesn't analyze the behavior in the first place, then 3.03 would automatically be violated because you can't explain the results if you don't analyze the behavior. Sometimes the behavior analyst will analyze the behavior but will not explain the results thus violating 3.03.

3.05 Describing Program Objectives - The behavior analyst describes, in writing, the objectives of the behavior change program to the client or client-surrogate (see below) before attempting to implement the program. And to the extent possible, a risk-benefit analysis should be conducted on the procedures to be implemented to reach the objective.

Again if 3.02, and 3.03 are violated then 3.0 is automatically violated. Sometimes though a behavior analyst will assess the behavior but not type up an intervention plan with objectives. If this is not done, it makes it very hard to train the tutor/therapist and parent and it violates 3.05.

4.01 Describing conditions for Program Success - The behavior analyst describes to the client or client-surrogate the environmental conditions that are necessary for the program to be effective.

If the behavior analyst is not providing training, then he/she is not describing to the parent and tutor/therapist the conditions for success of the program. Typically, parent training and tutor/therapist training is one of the conditions that are necessary for the success of the program.

4.04 Approving Interventions - The behavior analyst must obtain the client’s or client-surrogate’s approval in writing of the behavior intervention procedures before implementing them.

If the behavior analyst is not providing training to the parent, then he/she is not getting approval for the interventions because typically the interventions are just being done without the parent knowing what is happening.

5.11 Training, Supervision and Safety - Behavior analysts provide proper training, supervision, and safety precautions to their employees or supervisees and take reasonable steps to see that such persons perform services responsibly, competently, and ethically. If institutional policies, procedures, or practices prevent fulfillment of this obligation, behavior analysts attempt to modify their role or to correct the situation to the extent feasible.

If the therapist/tutor is an employee or supervisee of the BCBA and the BCBA is not providing training, supervision and safety precautions, then 5.11 is being violated.

In this section it is also important to note that the Tricare Autism Demonstration Project requires monthly parent training so if a child is receiving services through this project and the parent is not receiving parent training, the BCBA is violating the conditions set out by Tricare and violating another guideline 2.14 Accuracy in reports to those who pay for services (In their reports to those who pay for services or sources of research, project, or program funding, behavior analysts accurately state the nature of the research or service provided, the fees or charges, and where applicable, the identity of the provider, the findings, and other required descriptive data.). The Demonstration project also requires that tutors/therapists receive ongoing supervision and TRAINING as well. Most companies will come out to observe the tutor but not provide training. They need to do both in order to meet the requirements of the Demonstration project.

Why the lack of training?

I think there are a few reasons for a lack of training:

1. For a lot of providers, the focus is on the child so they are typically caught up in doing what they can with the child while they are there. So the lack of training isn't purposeful or meant to hinder the child's progress, the provider is just so caught up in the child, that they don't realize training the tutors and parents is key to the child's progress.

2. Sometimes parents don't realize they need training and treat ABA intervention similar to speech or OT where a person comes and works with the child and then leaves. The principles, techniques, and programming laid out in an ABA intervention package have to be followed 24/7 or the intervention will not be as effective. Therefore, it is crucial that parents receive training. It is also important for the BCBA to lay out from the start of services that training is required.

3. Sometimes the BCBA is so booked with clients, that she does not have time to train the tutors/therapist. There is an easy fix for this one, include training time in your schedule and do not book so many clients. It is more important that your clients receive effective treatment then take on too many clients who receive mediocre intervention due to a lack of training.

4. Sometimes the BCBA does not know how to provide training. Some programs don't train BCBAs how to provide training to others on the interventions. There are certain techniques that work better than others when providing training. Behavior Skills Training is typically the most effective technique but not all BCBAs know what this is or how to do it so they just don't provide training. Some will provide training but it is poorly done so it is ineffective.

5. Sometimes the BCBA does not realize that training is a crucial part of the intervention package. The program that trained them didn't have much training or focus much on training so they don't realize it is something they need to be doing.

6. Sometimes parents are resistant to training because it is not done well and they are trained on the wrong things. In my experience, it is best to train the parent using terminology that they understand, examples from their lives (hopefully related to their child), to not bog them down in understanding behavior analysis in the same way that we do, and to teach them how to follow the intervention within the natural environment. I very rarely have a parent sit down and do drills with a child (I very rarely do drills with a child). However, I will teach them how to intersperse targets during the daily routine and how to react/prevent challenging behavior within the daily routine. If a BCBA is trying to teach a parent how to run a session or make them learn all of our terminology in the same way we learn it, that is typically going to be a big turn off for parents and they won't want to participate in training.

7. Second to last and almost as important, sometimes training does not occur because of limited funding. Sometimes parents can only afford the rate of the tutor and not the rate of the BCBA. In this situation a few things can and should be done. 1. If the BCBA still wants to provide services to the client, the rates could be lowered based on what the client is able to pay and a minimum amount of supervision/training should be set per either week or month. If the parents really cannot afford to pay the minimum should be at least 1 hour/month on site training with the parent and the tutor. And then the tutor should meet with the BCBA and receive feedback and training and then take that back to the child and train the parent but only if the tutor is experience enough to provide such training. 2. A budget should be made with the family where they receive x amount of tutor hours per month and then x amount of BCBA hours per month. This might mean not having as many sessions with the tutor so that the BCBA can still provide services at his standard rate but the overall effectiveness of therapy will benefit. 4. If these solutions will not work, the BCBA should refer the parent to a company that can use one of these solutions. Because training of the tutor and parent is key to providing effective treatment, if the BCBA cannot figure out a way to provide these in the amount that is necessary for the client either because of funding or time constraints, then the BCBA should not take on the client. Otherwise the client's money is being wasted and the child might receive counter productive services.

8. Lastly, and most importantly sometimes the BCBA doesn't know how to handle the behavior or skill so they can't provide training. This is most important because in a situation like this, the BCBA should seek the supervision and consultation of another BCBA who does know how to handle the behavior or skill. With all of the message boards and internet pages for behavior analysis now a days, there is no excuse for not finding someone who can provide ideas/supervision/consultation to a BCBA who does not know how to handle a certain behavior.

What Does a Lack of Training Look Like

There are some obvious signs and some not so obvious signs that adequate training is not occurring:

1. The BCBA never talks to the parent or therapist/tutor about the programming. The BCBA does not explain what programs are being done, what interventions are in place for challenging behaviors, how to practice these programs, and how to intervene for challenging behaviors.

2. The child is continuously engaging in the same challenging behavior or having the same programming issue with acquiring certain skills. If the BCBA is providing proper training, these issues would be analyzed and the plans would be modified.

3. A treatment plan, behavior plan, or plan of intervention does not exist. It is basically impossible to provide training on a child's programming if there is not a treatment plan that outlines programming, reinforcement criteria, prompting criteria, other instructional techniques, and plans for reducing challenging behavior.

4. When the tutor/therapist or parent asks the BCBA to assist with a skill, the BCBA provides short answers (or sometimes no answers) but never sits down and trains the tutor/therapist or parent on the skill. Effective training typically consists of: explanation of the plan, modeling the technique, role playing the technique, providing feedback, and practicing the technique in the actual teaching/natural setting.

5. There is not a system in place for monitoring the intervention with the tutor or parent. Integrity checklist are typically used to monitor whether or not an intervention is being implemented correctly. I don't use them for every little thing I do but when a reduction program is complicated or a new acquisition program requires multiple steps or a child really needs prompting done a certain way, I will use integrity checklists to show the tutor or parent how well they are following the plan.

6. The parent or tutor/therapist thinks they really have no clue what to do with the child.

Ways to address this issue

I have split this into two categories: one for behavior analysts and one for parents or tutors.

If you are a BCBA who has difficulty training parents/tutors:

1. Make it part of your company's policy that parents and tutors participate in a minimum amount of training each WEEK. The minimum will depend on the client but I will do anywhere from 15 minutes to 1 hour and sometimes more.

2. Schedule training into your session. Sometimes parents are very busy and use session time to get all of the things done that they need to get done. This is fine, but they still need to know how to interact with their child. Talk to the parent and tutor/therapist and set up specific days/times where training will occur.

3. Use behavior skills training. Google it and you will find tons of information. I also have a blog about it if you go here BST

4. Provide the training specific to the client and make it understandable. Try to teach parents how to use behavioral techniques and follow the child's program within the context of the natural environment.

5. Have contingencies set up. If possible try to do a reinforcement contingency among all of your clients. You can catch parents, tutors/therapist doing a good job following the intervention plan and give them a ticket. At the end of the month a ticket is pulled for a prize. At the very least praise and reinforce parents or tutors/therapists when you see them doing a great job or at least trying to follow the intervention (don't forget to shape the behavior). Just as importantly, have a policy in place for parents or tutors/therapist who refuse to be trained or follow the protocol. If you are not able to provide effective services because of a lack of participation, you have to discontinue services. Have this in your company's policies. I do a three strikes and your out where I will tell the person 3 times how they are not participating and work with them to fix this: provide additional training, adjust the schedule, make the plan more feasible, etc and if they still don't comply, I have to terminate services. There are too many children who need services and are on waitlist to allow a parent to not participate in their child's programming. DO NOT however, just discontinue services without ever explaining to the parent that they are required to participate or giving them warnings and feedback and working with them to fix the issue first. I have worked at places where this happened and the parents were infuriated (rightfully so) because they didn't even know that there was an issue and the company just terminated services.

6. Use integrity checklists. Contact me if you need more info on this but you have to monitor the performance of your parents and the tutors/therapists and give them positive and constructive feedback on how they can better follow the plans.

If you are a parent or tutor/therapist who is not receiving proper training:

1. Ask your BCBA for more training. If the BCBA refuses or doesn't really respond print out a copy of this blog and ask them why they are not doing training. Make sure to point out to them that by not training you, they are in violation of the BACB Code of Conduct

2. Try to just observe sessions with your child (if you are a parent) or of other therapists (if you are a therapist). You can learn a lot by observing as long as the session is being done correctly.

3. Ask the BCBA what their training policy is and if they don't have one push them to create one. If you work for the company, offer to help create one.

4. If the training is over your head or not relevant to you and your child (client), ask the BCBA to make it more relevant to you and to break it down more. Ask for a typed up plan and/or training packet and ask the BCBA to use behavior skills training to teach you the skills.

5. If you are a tutor or parent who is paying out of pocket and the BCBA is not providing training to either of you because of this, talk to them and work out a situation where this can happen. Determine as a team how much supervision/training is necessary for this particular child and figure out a way to make that happen whether it means cutting down on some of the tutor time and convincing the BCBA to lower his rate because you are paying out of pocket. It is almost pointless to receive services from a tutor if you are not receiving adequate training/supervision from the BCBA.

Resources

Here are some resources related to parent training and tutor/therapist training

-Most publications by Robert and Lynn Koegel include descriptions of how to train. Visit their website for more information

-For more information on the BACB Code of Conduct, click here

Articles on Parent Training:

1. Lafaskas and Sturmey (2007) studied the effects of using Behavior Skills Training to teach parents to use Discrete Trial Teaching. The parents learned the skill and the children acquired skills faster.

2. Chaabane, Albar-Morgan, DeBar (2009) studied the effects of training parents to teach their children to request items using PECS. The children acquired novel requests and the parents successfully implemented the protocol.

3. Osborne and colleagues (2008) studied the effects of stress on effectiveness of treatment. They found that parent stress counteracted the effectiveness of treatment. Therefore, when doing parent training it is important to identify stressors and help train the parents in a way that will reduce these stressors and increase the effectiveness of therapy.

4. Iovanonne and colleagues (2003) identified components of effective programming as: (a) individualized supports and services for students and families, (b) systematic instruction, (c) comprehensible/structured learning environments, (d) specialized curriculum content, (e) functional approach to problem behavior, and (f) family involvement.

5. Dawson and colleagues (2010) ) compared the effectiveness of the Early Start Denver Model, which is a developmental behavioral approach to intervention that consists mostly of training the parent and the tutors to a community model and found that the Denver model was more effective.

I know that there is more research than this but I unfortunately cannot find where I saved the information and do not have time to look for more links. Please feel free to comment on additional research.

Posted by Megan DeLeon BCBA at 8/7/2010 5:46 AM | View Comments (2) | Add Comment

Highlights from ABAI: Potty Training, The Next Step in Motivation, Ethical Issues and more!

The annual Applied Behavior Analysis International Conference was this past weekend in San Antonio, TX. I thoroughly enjoyed a few presentations and of course networking/picking the brains of behavior analysts that I admire and aspire to be like. Below is a summary of a few of the topics that I learned more about this weekend:

The Next Step in Motivation

The workshop presented by Robert Schramm on instructional control was by far my favorite presentation of the conference. I have already read his book and had been incorporating procedures similar to his for a few years but he has been doing this longer and has refined the technique. In the workshop we learned how to decrease escape and noncompliance without using force, blocking, or nagging. The basic idea is to withhold reinforcement completely and wait the child out. The child's learning environment should be an "oasis of fun" so the child should be so motivated within the environment that he/she doesn't try to leave but if he/she does, that is fine you just stop the oasis of fun until the child returns. Following the 7 steps of instructional control along with a few other techniques not only decreases noncompliance and escape behaviors but it results in a willing and motivated learner. I will write much much more on this topic in future blogs as I will be doing a review of Robert's book. I call this the next step in motivation because pioneers such as Jack Michael, Dr. Sundberg, Dr. Partington, and Dr. Carbone all recognized that the "traditional" method of sitting at a table and plowing away wasn't working. They devised current motivational procedures of pairing the table and therapist with reinforcers and focusing heavily on developing a fun relationship with the child where they see you as a walking m&m. Robert's approach is taking this one step further by not just saying that the therapist or parent should pair with the child but providing more direction on what this pairing should look like, how much of it should occur, and what should happen when the child doesn't want to interact and pair. Most people would say when the child doesn't want to do the demand, force them to but this counteracts all of that pairing you were doing. If you are forced to do something, you don't generally enjoy it and you aren't as motivated. My favorite video that Robert showed was one of a therapist pairing with a little girl who loved music. In most ABA sessions you might see a therapist play music and sing along and the child may or may not enjoy it or even notice the therapist is sitting there, but this is considered pairing. In the video Robert showed, the therapist was swinging the little girl around (which the little girl enjoyed but not as much as she enjoyed the music) and the little girl would sometimes walk away from the therapist. It was ok for this to happen, but the music was paused if the child was not interacting with the therapist. Then when the little girl rejoined the therapist, the music was turned back on. This truly pairs the therapist with the music and it motivates an interaction. This is HUGE when looking at autistic children who are severely delayed with social interactions. If they can only have their preferred items when interacting socially with someone, then the reinforcing value of social interactions will increase greatly. I highly recommend attending a workshop by Robert, reading his book or visiting his website. His book is Educate Toward Recovery and his website is www.knospe-aba.com

Potty Training

I thought I knew everything there was to know about potty training but the informative presentation done by Patrick Friman and Ennio Cipani taught me a few things:

1. Never use aversive methods for accidents when potty training. This point was made by Patrick Friman. I personally have never used aversive methods but I know people who do. The method doesn't even have to be intended to be aversive but if a child finds it aversive, then it is. For instance I had a client who started crying when we praised him for peeing in the potty. We were trying to reinforce him but he did not like it so we had to stop throwing a party while he was peeing. Some places will have you require the child to clean themselves up or help clean themselves up after an accident, some will do positive practice where you take the child back and forth the the potty from the spot of the accident. These are designed to have a consequence for accidents but should not be aversive, if they are then they should be discontinued because you don't want the potty training to be aversive.

2. Pants Off! while potty training. This was discussed by both Patrick Friman and Ennio Cipani. While I myself have had this idea before I had never thought to phrase it the way they did. For those of you who are behavior analysts out there think about the child's history with peeing. Prior to potty training, peeing is done when pants are on so Pants on is a Sd for peeing. Whereas if the child might try to pee without their pants on while their diaper is being changed, parents might punish that or quickly throw the diaper on. Therefore, pants off is a S delta for peeing, meaning the child has learned when my pants are off I should not pee. This relationship obviously needs to be reversed to have successful potty training. This method is not necessary for all children but should be considered when you have a child who doesn't pee in the potty and literally does not pee until you put their pants/diaper/etc back on after hours of a potty protocol. I have definitely worked with clients who sat on the potty contently for 10 min or longer and would not go so we would put their clothes back on and within seconds they would pee. Clearly they were under the impression that this is where they should pee. The recommended procedure was to keep pants off during the training. As soon as the child goes in the potty, put their pants on for 5 minutes because they shouldn't pee again right after peeing. Then take their pants back off until they pee again. Increase the amount of time with pants on each time the child is successful in the potty. So it would look like this: pants are off, take child to potty every 15 minutes, child pees in the potty, put pants on for 5 minutes, take pants off, take child to potty after 15 minutes, child pees in the potty, put pants on for 6 minutes, take pants off, etc. This whole time you follow the standard potty training procedure described by Azrin and Foxx of scheduled trips to the potty, frequent liquids, and reinforcement for peeing in the potty.

Ethical Issues

I talked at length with numerous behavior analysts about issues regarding supervision and oversight by the BACB. While a good number of behavior analysts are trained well and provide stellar work, the high demand in our field is resulting in an issue with proper training at the newer behavior analysis programs and the online programs. The good news is a lot of BCBAs are aware of this issue and are hounding the board about it and everyone who is concerned agrees changes need to be made regarding supervision requirements/monitoring. The bad news is that a lot of the people in charge of making the decisions live in a little bubble where they are not exposed to some of the issues that others experience on a daily basis. It was good to see people at least talking about these issues and trying to come up with solutions.

Psychotropics and Exercise

One of the other talks I went to that was rather interesting was about psychotropics. I haven't attended any talks on psychotropics so this was rather interesting. I do not recall who all presented but the main message was that most psychotropics don't work, they are over prescribed, and a lot of the reasons given for needing them are false. For instance, I thought it was well established that depression and/or schizophrenia are caused by chemical imbalances. There is actually NO evidence to indicate this and it is still merely a theory that has yet to even come close to being proven. Yet, pharmaceutical companies imply links in their commercials and get the psychiatrists on board to prescribe the meds. This isn't to say that some people don't need meds but MOST people do not. There was also discussion about the lack of effectiveness of meds and the side effects. For instance Zyprexa is not very effective, led to serious side effects in 22% of the clients and 20 people died. Yet psychiatrist down play these side effects. Also to become FDA approved the drug companies only have to prove some effect and they can do this by doing as many studies as they want. So they might do 10,000 studies and only have 2 that show an effect and become FDA approved. They also will stop studies in the preliminary stages if they are not seeing the results they want. And they pay half the cost of the FDA approval process. On the other hand one person presented on the effectiveness of exercise to decrease depression, anxiety, and other mood disorders. In one study more than half of the participants no longer had depression after following the exercise protocol. This is definitely an area of interest to me but I am still in love with autism more than anything else.

Posted by Megan DeLeon BCBA at 6/2/2010 5:06 PM | Add Comment

Some insights from a message board

I participate on a few message boards related to autism, autism intervention, and behavior analysis. Recently, someone posted a discussion about a “new cure” for autism. One of the members of the message board responded to the post and I think his description of what snake oil salesmen are doing to families and people diagnosed with autism and what it means to be autistic is a very well articulated. I asked him if I could re-post his response for others to see, and he said yes. Below is his original post followed by some tips that he gave when I sent him an email asking if I could post this.

“In response to whatever is commented above. Autism is not treatable, you cannot create a new highway of neurotransmitters between the left side of the brain and he right side of the brain with Omega 3 (just an example). Such products stimulate the processes already there like road maintenance. Any healthy diet or supplement will have a possitive effect on people with Autism. However, do the same test on people without autism and the results are the same.

My example; take the study in prisons with high violence rates. They provided better quality food with a higher vitamine and mineral concentration and the violence got significantly less. Case conclusion; people who feel more healthy are more relaxed and are lesser influenced by triggers from the outside.

This is what happens when you do treatments like this to autistic children. Food and their quality is vital for body performance. You don't have to have a disorder for the benefits. To sell it as a cure is criminal towards the parents of such children. Autism is a taboe because people dop not understand how broad the autistic spectrum is. Actually, autism is not such a bad deal when people listen to the message first instead of how the message is said and feel "hurt".

we have to be sooooo politically correct because we are afraid that one statement that could be interpreted differently may cause you your carreer that it has penetrated privat life. This is exactly one of the weak spots of people with autism. The outside world makes it a big deal especially the ones who feel they can make a lot of money by milking the autism cow. Parents are desperate to find a cure and will spent money to find and it to help their beloved children. They are emotionally not realistic and try anything.

In my perspective, its a new way of crime.

You can train people with autism how to handle situations (some better than others, Aspergers have it more easier), you can get them on a healthier diet and the most important thing of all, you can love them and treat them as regular human beings by showing them the repsect that you would like to receive from others yourself.

I think that there are people like XXXX who do believe they are doing the good thing, he is just not unbiased enough to see the truth behind the whole thing and he does not really understand what autism is, certainly not what it means to be autistic.

XXXX, you are working on a hoax. The responses above are meant to convince you. I know by experience that it does not work like this. You are like the parents, you want to believe it's true. You cannot say acradabra and turn water into wine, you still have to feed the water to the soil so the grapes can grow and make wine from the grapes, there is no short-cut with a magical pill.

I don't see autism as a disorder. Others make it a disorder. because of my autism, I have a talent that surpases many others and even more important, I am needed. My IQ surpases 160 (EU scale) (out of 180 max), that's makes me incredible (just like Alex and Partick and many others). because of people like us, we have computers with micro chips and Iphones, frozen TV dinners etc. The world cannot do without us anymore so stop trying to cure us and accepts us like who we are for what we are.

As a message to parents, don't let the outside world bring you down. Love you child and stimulate him as much as you can. You will see, your child is perfectly happy with who he/she is. Again, it's the outside world who creates the problems.”

Here are the suggestions/tips from the poster as well. Please keep in mind that these are his suggestions. They are wonderful suggestions but every child is different so the suggestions might not be what your child needs. Nevertheless, they are still excellent suggestions:

“How colour full is your living room - colour full pictures, strange shaped sculptures untidy rooms are always in focus of the autistic eye and prevents their brain to settle down for a moment. Its the same with class rooms. Its very distracting

How structured is the day - They want to know what comes. If you visit family or the doctors or go shopping, prepare your child by a do and don't list. repeat this list everytime you do something, like: don't scream, don't run, let people finsh their sentence before interupting and ask questions etc. This means on before hand.... not while you do it (in the car before you step out or in the morning going through the day etc)

Stimulate what they are good at - do sums, they like numbers, don't let them fold origami or colour with pencils, their motoristic skills are not good enough and they get frustrated, the same with their handwriting, they don't have the motoristic skills to have a readable handwriting, let them type but don't let them stop learning how to write. “

Posted by Megan DeLeon BCBA at 5/8/2010 9:41 PM | View Comments (1) | Add Comment

When does ABA end???

I often hear parents and even behavior analysts say that their child or client is "done with ABA" or "graduated". While I have met many children who no longer need intensive behavioral services, I have never met an autistic child who no longer needs to have the principles of behavior/learning incorporated into their daily life. The purpose of this blog is to explain why incorporating principles of behavior technically never ends for autistic children or people in general. I know that doesn't sound very hopeful and might give readers a bad taste in their mouth to start but bear with me and you will see that even though incorporating principles of behavior into the child's life should never end, that doesn't mean your child will always require intervention or a behavior analyst. In this blog I will discuss what people typically mean when they say a child is done with ABA, what it means to incorporate behavior analysis into everyday life, and examples of situations with explanations of whether ABA is truly "done."

What does it mean to say child is done with ABA?

The two main reasons a a parent or behavior analyst would have for saying a child is done with ABA are:

The behavior analyst is not trained to work on the skills the child needs
The child is where he/she needs to be and the parent is adequately trained

1. Behavior analyst is not trained to work with the skills the child needs

I have seen numerous situations where a program or individual behavior analyst will "graduate" a client saying that the child no longer needs ABA. The child still has deficits typically in social skills and more advanced language/academic skills. The parents typically have no idea how to work on these skills and unfortunately the behavior analyst thinks he/she doesn't either. Rather than tell the parent that the behavior analyst has gone as far as he/she can with the child based on his/her training, the behavior analyst tells the parent that the child has graduated and can be done with ABA. This happened so many times at a previous place I worked and the parents were so upset. Then they were left wondering what to do to help their child continue to make gains and mistakingly thinking that ABA could no longer help them.

Some programs recognize that their main training is with early learner skills and will tell parents when starting that they only work with children of certain ages. There are early intervention programs that only work with a child to age 3, and then there are some programs that only work with a child to age 6, etc. When children are done with these programs, it is the duty of the program based on the behavior analysis code of ethics, to recommend options for the parent so that the child can continue to develop skills. If a behavior analyst has not told a parent that they will end services when their child reaches a certain age, but the child reaches a point where the behavior analyst is not adequately trained to work on the skills the child needs, the behavior analyst should not just end services but either receive training and research how to teach the skills or recommend other behavior analyst who are trained to work on the more advanced skills.

A lot of behavior analyst also use the ABLLS or VB MAPP to develop programming for a child. Often, once the child has completed all or most of the programs in these assessments, a behavior analyst might say that the child is done with ABA but the child still has deficits in language, social skills, academics, academic skills, etc. So what is the next step? Typically in this situation the behavior analyst ends services and the parent seeks out other types of programs. Some examples are relationship development intervention, brain training, other social skills curriculums, social skills groups, tutors, etc. Will these programs be helpful for the child? It is hard to say because it will depend on: if the programs address the child's areas of deficit and whether or not the programs make use of behavior analytic techniques. A child might make progress using these other programs without the input of a behavior analyst but the most effective method of incorporating these programs is to use the curriculums while incorporating the principles of behavior analysis. In this situation there are three options:

1. The parent can find someone whose main training is in the areas that the child still has deficits but is not in behavior analysis

2. The parent can find the person mentioned previously and have the behavior analyst consult on how to incorporate behavior analytic principles

3. The parent can ask her behavior analyst to incorporate curriculums that are needed for the child and/or to recommend another behavior analyst who has experience with the deficits.

No matter which solution is chosen, the best results will always be achieved when the principles of behavior analysis are incorporated. So the best solution would be either number 2 or number 3. A lot of other curriculums/approaches will say that behavior analysis isn't used but when you break down what is done during the sessions, the programs incorporate many principles of behavior analysis. Whether a program wants to admit it or not, or even know it or not, effective programs are always incorporating the principles of learning. I could go into more detail but that is a topic for another blog.

2. The parent is adequately trained

The other situation I have seen where services are ended with the behavior analyst are when the parent is adequately trained. This means the parent as learned through direct training and experience with the child how to incorporate the principles of behavior analysis into everyday life and apply them when necessary with the child. Typically, in these situations the parent will remain in contact with the behavior analyst and consult as needed. Otherwise, the parent continues to determine the curriculum and programs needed for the child and incorporates the principles of behavior analysis. The parent might hire a tutor or someone to help determine the curriculum but the parent directs the tutor on how to work with the child. The parent also continues to follow the principles of behavior analysis when responding to inappropriate behaviors and throughout the daily routine.

Behavior Analysis is Technically Never "Done"

While services with a behavior analyst might be done, incorporating the principles of learning and behavior analysis should never be "done." Even if someone intentionally ends their formal ABA program, if the child is still learning and making gains, principles of learning are still at play. The most progress will be made though if those principles are intentionally incorporated.

Principles of behavior/learning never go away. The field of behavior analysis aims at identifying in real life what factors, methods, techniques result in behavior change/skill acquisition. Making use of this knowledge can result in changes not just for autistic children but in schools, colleges, work places, nursing homes, and society in general. Whether the parent is interested in trying RDI, Brain Training, Social Skills Training groups, etc when any curriculum or programming effectively incorporates principles of behavior/learning you will see more progress than when the program does not make use of these principles.

A behavior analyst may always be needed to some extent for a child on the spectrum if a parent does not know or does not feel comfortable with applying these techniques/principles. It will also depend on the extent that a child needs to have these techniques effectively applied. Even for typically developing children, parents or teachers who make use (either knowingly or just by natural tendencies) of principles and techniques of learning will have children who acquire skills faster than parents who do not have this knowledge and might not be effectively teaching their children. This holds true for professors, bosses, etc anyone in a position of requiring behavior/learning.

If a parent acquires the necessary skills to know how to prompt, reinforce, and adjust the environment when necessary (among other techniques), then their child will not always need a behavior analyst. This of course will depend on the child’s deficits and behavior. Even for a child who has a lot of deficits or intense behavior, if the parent or others working with the child are trained well enough, the level of input needed from a BCBA may be minimal.

So the point here is even if you end your formal programming, it is always best to still incorporate the principles of behavior analysis/learning so that your child will make the most progress.

Ending a formal ABA program

I am not sure if there is any research on this topic but my preferred way to end a formal ABA program is to fade the behavior analyst out of the situation and remain consultation on an as needed basis. If the parent typically receives services a few days/week, services are dropped to 1x/wk, then 1x/2wks, 1x/month, 1x/3 months (if needed), 1x/6 months (if needed), and 1x/year. Using the fade out procedure ensures that a child/parent really is ready to no longer receive input from a behavior analyst. A lot of times a child will do well so the services are just ended and then all of the old behaviors/issues arise again. Fading out the behavior analyst allows the parent to receive training and feedback on how to continue to achieve results with their child. Even during the less frequent times, the behavior analyst or a behavior analyst should always be available for a consult when necessary.

Examples of situations:

Here are some examples of situations where a parent or behavior analyst might decide to end formal services.

A student possesses most necessary skills to succeed academically and socially. The student is staring soccer and art classes. Does the behavior analyst need to be involved?

If the parent is able to provide training and guidance to the coach and art teacher, then the behavior analyst is most likely not necessary. If the parent does not feel comfortable or is unable to provide guidance, then the behavior analyst might be involved initially and then fade out. A trial soccer practice/art class might also be done to see if the coach or art teacher even need input from the parent/behavior analyst. It is possible that the child will do so well that no guidance is necessary.

A Student is advanced academically but lacks social skills. The BCBA lacks training in social skills and the parent does not feel comfortable being the person responsible for teaching these skills. Should the BCBA continue to provide services?

There are several options for this situation. The parent could enroll the child in social skills groups. When doing this, the parent should find groups that incorporate the principles of behavior analysis to promote learning and acquisition of the skills. If the group does not incorporate principles of behavior analysis, the behavior analyst can provide consultation on how to teach the child. If a group does not exist, the behavior analyst can either research social skills curriculums and develop programs for the child based on the child's deficits or refer the family to a behavior analyst who has training in teaching social skills.

A Student is advanced academically, possesses social skills, but still engages in intense outbursts/aggression occasionally for different reasons. The parent adequately implements behavior reduction programs with the guidance of the BCBA but needs assistance when the behavior changes. Should the BCBA continue to provide services?

For this situation, the BCBA might not be needed on a frequent basis but should still provide consultation services to the client. If the child still engages in intense outbursts/aggression and the parent is not always capable of responding appropriately, the behavior analyst can develop plans and provide training when needed.

A Student has completed ABLLS-R but struggles academically and with certain skills such as language comprehension and auditory processing. The BCBA's training is mostly with using the ABLLS-R but the BCBA is willing to research other curriculums/programs. Should the BCBA continue services?

There are a couple of options for this situation as well. If the BCBA is willing to research other curriculums and programs, the services should be maintained because they will be able to effectively incorporate the principles of behavior analysis to help the child gain skills. If the parent is unsure of the BCBA's ability to determine new programming, the parent might want to seek the input of a provider with experience addressing these skills and have the BCBA consult on how to teach the child.

Posted by Megan DeLeon BCBA at 4/8/2010 8:54 PM | View Comments (1) | Add Comment

What does it mean to be a behavior analyst or to DO ABA?

Behavior analysts take many different paths to get to the point in their life where they decide to purse behavior analysis as a career. Some take a few psychology courses as an undergrad that have a behavior analytic focus, some want to work in another setting (mental health, nursing homes, businesses, developmental disabilities) and then are exposed to how effective behavior analysis is, and the list goes on. I personally, took psychology classes and was drawn to Cognitive Behavioral Psychology because it was the only type of therapy that seemed effective and I was additionally fascinated with the field of autism. Originally, I didn't want to go to graduate school at the Florida State University to learn behavior analysis, I wanted to learn about how to more effectively work with autistic children. My professors constantly reminded me that I was not in an autism program I was in a behavior analysis program. I consider myself extremely fortunate that THIS was the type of program I was in. Some college programs do not have this focus, they are other programs: special ed, developmental disabilities, general psychology, etc that add in a behavior analytic component. But FSU'S program was a Behavior Analytic program that taught about the various applications of behavior analysis. I am often astounded and baffled when I meet fellow behavior analysts working in the field of autism who literally do not seem to have a clue about behavior analysis. I know that they are well intentioned and probably came from the same path in life as me: working with autistic children. However, they somehow missed out on learning a VERY important component of being a behavior analyst: using behavior analysis to develop programming. Some of the people are "experts" in the Lovaas Method, or Verbal Behavior Approach, or Pivotal Response training, or using the ABLLS but throw something at them that is a little different from how they were originally trained and they have no clue what to do. This is NOT a behavior analyst.

So what does it mean to be a behavior analyst and to do ABA?

First let's start with the definition of behavior analysis:

Behavior analysis is a science that studies behavior. Behavior analysts focus on finding and using the best techniques to increase, decrease, or otherwise change behavior based on the needs of the client/parent.

The theories, principles, and techniques researched in behavior analytic research can be applied to a plethora of settings, populations, and situations. One of my favorite quotes from Dr. Bailey at FSU was "If it moves, we own it." Basically meaning behavior analysts literally can work in any situation where behavior occurs. That doesn't necessarily mean they should or will work in those situations....but they could. Additionally, they should only work with populations in settings where they received training or be under direct supervision of someone who has training in that area. For instance, my primary area of training is with children diagnosed with autism or developmental delays so if I wanted to work in a nursing home, I would need to be supervised by a behavior analyst that has training with this population.

Merging behavior analysis with autism

I have noticed two trends for working with autistic children:

1. A behavior analyst who assesses the child using direct observation, parental report, specific assessments such as the ABLLS-R, VB-MAPP, Lovaas Approach etc, functional assessments, environmental assessments, and any other pertinent information or assessments. The behavior analyst then uses this information PAIRED with the latest research to develop the child's programming

2. A behavior analyst is trained to use a specific assessment/protocol such as the ABLLS-R, VB-MAPP, Lovaas Approach, Verbal Behavior Approach, etc and then the behavior analyst uses this protocol to design the child's programming.

Trend 2 is completely lacking when it comes to actually applying behavior analysis and making use of behavior analytic principles in the child's programming. Someone cannot just use an assessment or protocol that was designed by a behavior analyst or behaviorally oriented person and say they are doing behavior analysis. Conversely, if someone uses a "developmental" protocol or programming protocol that was not designed by a behavior analyst and does not have research to support it; as long as they pull from this programming and apply it in accordance to the behavior analytic research, they ARE doing behavior analysis.

It is important to note that when working with a population such as autistic children, the behavior analyst must become an expert in analyzing behavior and if they are developing the child's programming an expert in program development for autistic children. There are hundreds of programs, protocols, and resources to use when teaching autistic children and if the behavior analyst is developing programming as well as assessing the child from a behavior analytic perspective, then it is on them to learn about these approaches even if they don't use the approaches.

A good behavior analyst will look at a child's strengths and weaknesses and develop the child's programming by:

*Assessing the deficits from a behavioral perspective (do the prerequisite skills exist, is the child attending, is the child motivated, does the material need to be presented differently, are there environmental factors that are impeding learning, etc), *Determining how to make use of the strengths when teaching,

*Draw from the relevant behavioral research, assessments, and protocols AND

*Draw from autism specific resources.

For example if I have a client who is not motivated and not attending to the task, then it is my duty to:

*Determine how to increase the child's motivation and how to increase attending. I will do this by:

*Looking at behavioral research on motivation and attending,

*Looking at protocols/programming that designed for autistic children that have specific ideas/programs for increasing motivation and attending, and

*Assessing the child's lack of motivation and attending to determine where the exact deficits lie (is the child motivated for an item, but loses interest once a demand is placed?, does the child have free access to all items so it is difficult to have the child "work" for an item, will the child attend to preferred items but not common items?,etc).

I would then pull all of this information together to design the child's programming.

Additionally, while working with a child, if the child starts to engage in a novel behavior that is dangerous such as hitting their head, it is my responsibility as a behavior analyst, to analyze why this behavior is occurring. I shouldn't just guess and put forth a general plan for responding to the behavior. I need to collect data and determine what the antecedents and consequences are, I also need to make use of the research when designing the behavior intervention plan.

A Behavior Analyst is...

*A behavior analyst is someone who collects information about a child's behaviors, skills, strengths, weaknesses, and environment

*A behavior analyst is someone who uses information collected from the assessment to develop an individualized plan for the child using behavior analytic principles and techniques

*A behavior analyst is someone who constantly assesses the child and modifies programming based on the child's performance. If a child has difficulty with a task, the behavior analyst immediately determines why and modifies

*A behavior analyst is not automatically an expert on autism

*A behavior analyst is not someone who just uses one protocol, assessment, or approach when working with autistic children. Instead the behavior analyst researches the BEST methods to use with the child based on the research

*A behavior analyst is someone who follows the Behavior Analysis Certification Board's Code of Conduct

*A behavior analyst is an analyzer, modifier, and researcher and this should be reflected in their work.

My basic point for behavior analysts out there is to be a behavior analyst first and foremost. If you took the time to earn your certification, make use of your degree and the knowledge that you have about behavior analytic techniques and principles. If you do not approach your client's programming from a behavior analytic perspective and you get stuck in following a certain approach, protocol, or assessment, then you might as well not be a behavior analyst. On the other hand if you are going to work with autistic children, learn about the plethora of assessments, protocols, techniques, and approaches that are available to you so that you can develop the BEST program for your child.

For more information on what it means to be a behavior analyst, I highly recommend checking out this book: How to Think Like a Behavior Analyst

Posted by Megan DeLeon BCBA at 2/15/2010 8:33 PM | View Comments (3) | Add Comment

Understanding the ABLLS-R part 9: How I do the assessment

This is the last part of the ABLLS-R series for now. When I originally made this document, it was for graduate students who would be using the ABLLS-R with their clients so I finished the document with an explanation of how I complete the assessment. This is the way that has worked best for me but is not necessarily the best way to complete the assessment. I conclude the section with a description of 3 stages of learners I typically encounter and the types of programs I typically do with these learners. Everything is ALWAYS individualized but I use these profiles as a starting point for determining programming. I would like to make it very clear that reading this series DOES NOT replace formal training on the ABLLS-R and that anyone using the ABLLS-R should read the companion guide as well prior to using the assessment. Here is the link for purchasing the ABLLS-R and/or Companion Guide Additionally, what you will find below is all based on my OWN experience. As far as I know there is limited to no research to support my suggestions. I made theses suggestions and provided these explanations based on my experience with how clients acquired skills and what worked best for my purposes. Always remember to invdividualize programming for your child/client and consult the research. The information that I am sharing here is to provide a basic skeleton for people who are not familiar with the sections of the ABLLS. Hopefully after reading this series you will have a better understanding of what skills are targeted in each section of the ABLLS, how to combine goals when possible, and what the typical progression of skills is like for children on the spectrum. "Typical" progression means that typically the skills are easier when done in this order however this is not always true. For instance, sometimes you will have a child who is highly verbal but does not listen well so it is easier to teach them expressive tasks first then receptive. If any providers/parents who read this blog have suggestions on other ways to combine/target/organize goals, please do share

How to Complete an Assessment:

I typically have the parents do the assessment by having them answer whether their child can do the skill or not because it takes too long to go through and do it with each parent. Then as I decide to start programs I will double check the parental assessment if I think the parent either over or underestimated the child’s ability. Sometimes it is obvious when a child does/doesn’t have a skill and sometimes you need to test it first. I also typically tell a parent that certain sections do not to be filled out if their child is not engaging in skills from that program yet such as Section G Labeling if the child doesn't talk or sign.

The grid is filled in by looking at each section and the “tasks” listed. You look at your grid and see the label of the section “cooperation and reinforcer effectiveness” then task label “A1.” It is easiest to fill out the grid if you have a copy of it and hold it while looking at the descriptions in the book.

Look at page 1. The task is A1. We determine the score by looking at the criteria at the end. If the child takes the item within 3 seconds then they have a “2” and you fill in 2 boxes. If they only do it sometimes they have a 1 and you fill in one box. If they do it never. Then they have a 0 and you fill in the o.

Each box represents a “criteria.” You fill in a box for each criteria the child meets in that task. Some tasks have 2 criteria and some have 4.

Each task also has:

Task Name – the name of the task we typically use this as the program label
Task Objective – the point of the task
Question – an assessment question to ask yourself “can the child…..”
Examples – an example of what the task should look like or how it should be presented

Some tasks have targets listed in the back.

Typical Programming for children doing A-H

This how programming of A-H typically progresses for students. Every client should also have play programs, reading, writing, and math as they progress toward stage 3. All of those areas should be incorporated for a stage 3 learner. We will take about more advanced programming later.

Stage 1

Compliance Training – use tasks from the A and C section if child has not acquired skills such as takes preferred reinforcing item. If the child won’t engage in preferred activities with you when asked, you won’t make much progress with new activities.
Mand Training – start with signs if child is not vocalizing, words if child is vocalizing and echoing, signs and words if the child does a little bit of both, and PECS if the child is highly visual but doesn't vocalize or have an imitation repertoire
Attending – A3 and C3. The child should attend to reinforcing items first.
Matching
Motor imitation
Object imitation
Shape sorter
Basic Puzzles

These are all programs that a typical early learner lacks and most of them are prerequisite skills for more advanced learning. Sometimes we may need to incorporate a “sit” program and some other attending type programs if the child has difficulty. You will determine whether to implement all or some of these based on each child. Do not do all if the child is non-compliant and frustrated. Start with tasks the child is most likely to understand.

Stage 2

To determine programming for a middle learner, look at what areas the child lacks the most. Try to focus on tasks from these areas if it isn’t too frustrating. You want to try to even the areas out. Most middle learners will have a lot of receptive programs because you typically need to master those before doing expressive programs

Advanced puzzles
Block designs
Patterns
Sorting
Receptive identification of objects/pictures
Receptive commands
Receptive identification of feature, function class, associated pictures
A few advanced imitation tasks
Vocal imitation
Labeling items/pictures as they are mastered receptively
Fill in songs
Fill in fun activities

Stage 3

An advanced learner is one who has learned all of the basic skills and is ready to start intraverbals and stringing words together

Patterns
Sequencing
Seriation
Mazes
Receptive pronouns, community helpers, actions, prepositions
Receptive identification based on 2 characteristics
Labeling feature, function, class, pronouns, community helpers, actions, prepositions as he masters them receptively
Receptive and expressive identification of body parts
Receptive and expressive identification of emotions
Receptive and expressive identification of adjectives
Personal questions
Fill in feature, function, class, associations
Answering basic WH questions

Some goals need to be mastered in one section first before they can be targeted in another section. Here is the typical progression for adjectives, features, functions, and class:

Adjectives: C24 select adjective vary objects on only 1 dimension G13 label adjective with picture
Function: C37 select by function G15 label item in array of 3 when told function  G24 label function when shown picture  H8 fill in item given function (no pictures) H9 fill in function given item (no pictures)
Feature: C38 select by feature  G12 label feature of object with picture  G16 label item when told feature with pictures  H16 fill in feature given item  H17 fill in item given feature
Class: C39 Select by class G17 label item when told class  G25 label class when shown object G27 label class of set of items H14 fill in item given class H15 multiple responses for a class  H18 fill in class given item

Posted by Megan DeLeon BCBA at 2/14/2010 10:23 PM | Add Comment

Teaching a child to use their words

I have noticed on a few of the list servs that I am on that a lot of parents and providers ask questions about children who are hitting, tantruming, etc because they do not have the words to communicate what they want/need. Sometimes people will focus too much on reducing these behaviors and not enough on increasing functional language and responses. It is very important to teach a child what to do rather than just focusing on what not to do. Children who engage in tantrums, aggression, SIB, etc typically have a skill deficit of: not being able to communicate and not being able to calm themselves, or leave the situation. I highly recommend using Behavior Skills Training (BST) and Functional Communication Training (FCT) to help children acquire these skills. Both of these methods are supported by the research and are used very often by behavior analysts. In this blog I will provide a brief description of each of these procedures with examples. It is important to keep in mind though that the examples I am giving are specific to a particular child and should not be used directly for your child/client. I am only providing them as a model. It is also important to read the research on BST and FCT for yourself in order to better understand the techniques. I have included resources at the end. It is also important for both of these techniques that the behavior is analyzed to determine the function and the areas of deficit so that you are training the child a response that is functionally equivalent. If you think that the behavior is occurring because the child wants out of a demand and you teach the child to ask for a break but really the behavior is happening because the demand is too hard and you don't teach the child to ask for help, then the behavior will probably still occur.

Behavior Skills Training

Behavior skills training is a technique that is used to help people acquire complex/difficult behaviors. This method is frequently used to train employees, parents, and behavior analysts. Research indicates that people learn skills better when the steps used in behavior skills training are followed as opposed to other training methodologies.

Behavior Skills Training consists of these steps:

Explain the steps of the behavior

Have the person tell you the steps

Model the steps for the person either via video or in vivo

Have the person do the steps

Provide feedback and reinforcement

I usually combine BST in this way:
Behavior Skills training + additional practice +prompting + reinforcement

Here is an Example of BST for Calming techniques:

Explain the steps: “ when you something is hard or your are upset you should: 1. use your words 2. calm yourself 3. ask for help”

Have the person tell you the steps: “what do you do when you are upset”

Model the steps “ok now I am going to show you what to do when you are upset” Pretend like you don’t like a worksheet, say “this is hard”, ask for rubs and a break, and then go back to work. YOU DO ALL OF THIS

Have the person do the steps - “its your turn. Show me what to do when you are upset” NOW THE CHILD DOES THE STEPS

Provide feedback and reinforcement - you can video tape and have the child watch her self and point out what she did well and what she needs to do different, you can have a checklist for her that you check off or put smileys next to the steps that she did, etc
Continue to follow these steps until the child is able to do all of the steps independently

This needs to also be paired with:

Additional Practice - throughout the day and session ask the child “show me what you do when you are upset” and reinforce for her doing the steps

Prompting - set up situations that you know upset her and remind her prior to starting the situation “remember what to do when you get upset: 1____ 2______ 3______” present the demand and prompt again “if this is to hard, you can calm down”

Reinforcement - provide reinforcement: smiley faces, longer break from demands, etc anytime the child engages in the appropriate behavior Make sure it is more reinforcing for her to stay calm than get upset. It is ok to give her a change in demands/manipulate the environment for her, for now when she engages in appropriate behavior to express she is not happy. But if she is whining and tantruming you absolutely must not give in to her or manipulate the situation.

Example: You give the child a worksheet and she says “this is hard” and whines a little but chooses a calming technique - it is ok to say “we will do it later thank you for staying calm.” If however she said “this is hard” and had a tantrum, you would HAVE to follow through on the doing the worksheet or at least part of it once she is calm. So that she learns: when I stay calm, I can remove the demand. If I get upset, the demand stays.

Functional Communication Training

The purpose of Functional Communication Training is to teach a more appropriate/functional response to replace an inappropriate response.  FCT has successfully been used to teach a wide variety of responses to children with autism and other communication deficits. It is important to determine the function of the behavior and to choose a response that is appropriate for the child. My example below is for a child that is vocal. However, FCT can be used for nonvocal children as well by teaching them a sign, gesture, or even a response as simple as holding up a card. The response should be something that is already in the child's repertoire so that you are not trying to teach them a whole new response and to use that response during the situations where they typically engage in tantrums, aggression, etc. The response can be shaped over time to a more complex response but always start with a response that is easy for the child.

Steps of Functional Communication Training

Identify the function of inappropriate behavior

Choose a functional replacement (a behavior that serves the same function and is already in the child's repertoire)

Teach the functional replacement (using training trials a few times a day)

Provide reinforcement for replacement behavior and no reinforcement for inappropriate behavior

Here is an example of this process:
Identify the function of the inappropriate behavior

A functional assessment indicated that the behavior functions as an escape from a demand or to indicate that the environment is aversive in some way.

Choose a functional replacement behavior
The replacement behavior for XXXX will be to teach her to request breaks, to indicate when she doesn’t like something, and to indicate when she needs to go somewhere or do something to calm herself down.
Teach the functional replacement
Typically the functional replacement is taught by doing training trials and reinforcing for appropriate responses. For XXXX we will teach the functional replacement by:

Training the use of the skills by purposely presenting situations that we know will trigger XXXXs inappropriate behavior. (more info on this below)
Prompting XXXX immediately when a situation arises where she needs to engage in the appropriate behavior

Provide reinforcement for the replacement behavior and no reinforcement for inappropriate behavior

It is EXTREMELY important that the appropriate responses result in access to reinforcement: ending the demand, fixing the situation, AND access to a preferred item for now (skittle, pop rocks, etc). Additionally, when XXXX engages in the inappropriate behavior, she should NOT receive access to the reinforcement.

Situations to Present

The following are some examples of situations you can present to practice use of functional appropriate communication. You will also follow these steps when situations like this naturally come up throughout XXXX’s day.

Low Preference Demands

Remind XXXX before presenting the demand “if you don’t want to do something, remember you can ask to do it later”

As you start the demand tell her “you can say ‘can I do this later’”

If XXXX says the phrase, tell her she can do it later and provide a time (we will do this AFTER.....) because she does need to do it eventually and provide her with extra reinforcement (candy, a smiley, etc)

If XXXX doesn’t say the phrase and starts to engage in inappropriate behavior offer her choices “XXXX you can say ‘can I do this later’ or you can do this sheet now.”

If XXXX starts to tantrum, follow through with the demand.

Make sure to tell XXXX the phrase “if you don’t want to do something you can ask to do it later” prior to high preference demands too so that she doesn’t think you only say it before a low preference demand

Difficult Demands or making mistakes

Remind XXXX before presenting the demand “if something is hard, remember you can say ‘this is hard will you help me?’”

As you start the demand tell her “you can say ‘can you help me’”

If XXXX says the phrase, help her with the task either by providing help or modifying the task so that it is easier and provide her with extra reinforcement (candy, smiley, etc)

If XXXX doesn’t say the phrase and starts to engage in inappropriate behavior, offer her choices “XXXX you can ask for help or you can do the sheet.”

If XXXX starts to tantrum, continue the demand WITHOUT help. If she asks for help after the tantrum make her do about 5 seconds without help and then help her.

Make sure to tell XXXX the phrase “if something is hard, you can say ‘this is hard will you help me?’” before easy demands occasionally too so that she doesn’t think you only say it before a hard demand.

Aversive Environment/interaction (Situations that are not liked by XXXX)

Remind XXXX before presenting the aversive situation “if you don’t like something, you can say ‘I don’t like that’” and then you can (calming technique)

As you start to present the aversive situation tell her “you can say ‘I don’t like that’”

If XXXX says the phrase, and it is appropriate to stop what you are doing, stop. If it is not appropriate to stop, tell her “thank you for telling me you can (calming technique)” and provide her with extra reinforcement (candy, smiley, etc)

If XXXX does not say the phrase and starts to engage in inappropriate behavior, present her with the choice “you can say ‘I don’t like that’ or you can stay here

If XXXX starts to tantrum, continue the aversive situation and do not provide extra reinforcement. If she says “I don’t like that” after the tantrum, wait a few seconds and then acknowledge.

Make sure to tell her “if you don’t like something, you can say ‘I don’t like that’” during non aversive situations too

This is going to be the trickiest one to do and it is important to provide her with appropriate phrases and a lot of practice. Phrases we need her to learn include: “I don’t like that” “Stop” “Can I leave”
Resources for BST and FCT
SkillStreaming is a program designed to teach social skills/problem solving skills to children using BST. Manuals and videos can be purchased on their website

Miltenberger and colleagues have done a lot of research on using BST to teach safety skills to children. Here is a reference to one of their articles but I highly recommend doing a google search or search in the Journal of Applied Behavior Analysis for Behavior Skills Training.

Miltenberger, R. G., Flessner, C., Gatheridge, B., Johnson, B., Satterlund, M., & Egemo, K. (2004). Evaluation of behavioral skills training to prevent     gun play in children. Journal of Applied Behavior Analysis, 37, 513–516.

A longer explanation of FCT from Reinforcement Unlimited.

A book on using FCT with Severe Behavior Problems by Durand

Articles on FCT:
Carr, E. (1988). Functional equivalence as a mechanism of response generalization. In R. Horner, R. Koegel, & G. Dunlap (Eds.), Generalization and maintenance: Life-style changes in applied settings (pp. 221-241). Baltimore: Paul H. Brookes.

Carr, E., & Durand, V. M., (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18, 111-126.

Durand, V. M. (1993). Functional communication training using assistive devices: Effects on challenging behavior and affect. Augmentative and Alternative Communication, 9, 168-176.

Mirenda, P. (1997). Supporting individuals with challenging behavior through functional communication training and AAC: Research review. Augmentative and Alternative Communication, 13, 207-225.

Sigafoos, J., & Meikle, B. (1996). Functional communication training for the treatment of multiply determined challenging behavior in two boys with autism. Behavior Modification, 20(1), 60-84.

Fisher, W. W., Adelinis, J. D., Volkert, V. M., Keeney, K. M., Neidert, P. L., Hovanetz, A. (2005). Assessing preferences for positive and negative reinforcement during treatment of destructive behavior with functional communication training. Research in Developmental Disabilities, 26, 153-168.

Hagopian, L. P., Kuhn, S. A., Long, E. S., & Rush, K. S. (2005). Schedule thinning following communication training: Using competing stimuli to enhance tolerance to decrements in reinforcer density. Journal of Applied Behavior Analysis, 38, 177-193.

Lalli, J. S., Casey, S., & Kates, K. (1995). Reducing escape behavior and increasing task completion with functional communication training, extinction, and response chaining. Journal of Applied Behavior Analysis, 28, 261-268.

O’Neill, R. E., & Sweetland-Baker, M. (2001). Brief report: An assessment of stimulus generalization and contingency effects in functional communication training with two students with autism. Journal of Autism and Developmental Disorders, 31(2), 235-240.

Posted by Megan DeLeon BCBA at 2/12/2010 9:47 AM | Add Comment

Understanding the ABLLS-R part 8: Section H Intraverbals

I would like to make it very clear that reading this series DOES NOT replace formal training on the ABLLS-R and that anyone using the ABLLS-R should read the companion guide as well prior to using the assessment. Here is the link for purchasing the ABLLS-R and/or Companion Guide Additionally, what you will find below is all based on my OWN experience. As far as I know there is limited to no research to support my suggestions. I made theses suggestions and provided these explanations based on my experience with how clients acquired skills and what worked best for my purposes. Always remember to invdividualize programming for your child/client and consult the research. The information that I am sharing here is to provide a basic skeleton for people who are not familiar with the sections of the ABLLS. Hopefully after reading this series you will have a better understanding of what skills are targeted in each section of the ABLLS, how to combine goals when possible, and what the typical progression of skills is like for children on the spectrum. "Typical" progression means that typically the skills are easier when done in this order however this is not always true. For instance, sometimes you will have a child who is highly verbal but does not listen well so it is easier to teach them expressive tasks first then receptive. If any providers/parents who read this blog have suggestions on other ways to combine/target/organize goals, please do share

ABLLS-R Section H – Intraverbals

Focus: The focus on this section is on basic fill-ins at first then developing advanced conversation.

Skill progression: filling in words in preferred activities  answering personal information fill in feature function and class  answering wh questions naming previously observed events identifying items based on several descriptors describing items conversation exchange telling stories

When/how to implement: This goal can be started when the child is reliably saying or signing for a few items in mand training and/or if you have a child who loves music and already sings. You want to make sure to go in the order listed at first up to about H7. Then you get into feature/function/class. For this area you want to find all of the goals related to feature, all related to function, and all related to class. Progress through each of those in the order described. DO NOT implement these goals until they have been mastered in B, C, and G. Some of them may seem similar but you are presenting the material differently. Make sure to probe these goals though. The more advanced goals will not be implemented with most children until they have pretty much mastered all of the previous sections.

Goals that can be combined:

H10/11/23/24 – all of these deal with answering “what” questions. You can target these at one time by making sure the program has “what” questions from each of the areas described. You do not need to do the number listed in criteria. Shoot for about 25 to start. If the child learns them quickly you can stop. If the child has difficulty and there are other “what” questions you think they should be able to answer then continue with the program.
H12/13/25 – all of these deal with answering “where” questions. You can target these at one time by making sure the program has “where” questions from each of the areas described. You do not need to do the number listed in the criteria. You want the child to answer 50 “where” questions or acquire novel questions within one session whichever comes first. Make sure the child can answer obvious “where” questions first.
H19/20/21 – these all deal with name previously observed items, activities, and people. Combine these and target each one in the same program. This program is often done by asking the child immediately then increasing the duration.

Posted by Megan DeLeon BCBA at 2/8/2010 9:09 PM | Add Comment

Understanding the ABLLS-R part 7: Section G Labeling

I would like to make it very clear that reading this series DOES NOT replace formal training on the ABLLS-R and that anyone using the ABLLS-R should read the companion guide as well prior to using the assessment. Here is the link for purchasing the ABLLS-R and/or Companion Guide Additionally, what you will find below is all based on my OWN experience. As far as I know there is limited to no research to support my suggestions. I made theses suggestions and provided these explanations based on my experience with how clients acquired skills and what worked best for my purposes. Always remember to invdividualize programming for your child/client and consult the research. The information that I am sharing here is to provide a basic skeleton for people who are not familiar with the sections of the ABLLS. Hopefully after reading this series you will have a better understanding of what skills are targeted in each section of the ABLLS, how to combine goals when possible, and what the typical progression of skills is like for children on the spectrum. "Typical" progression means that typically the skills are easier when done in this order however this is not always true. For instance, sometimes you will have a child who is highly verbal but does not listen well so it is easier to teach them expressive tasks first then receptive. If any providers/parents who read this blog have suggestions on other ways to combine/target/organize goals, please do share

ABLLS-R Section G – Labeling

Focus – The focus in this section is teaching basic labeling and then more advanced labels.

Skill Progression- Label items label feature/function/class/etc label two component advanced labels

When/how to implement – If the child is requesting items using signs or words you can implement this program. You will start with labeling reinforcing items then move to common items/pictures. You typically do not want to implement some of the goals in this program unless they have been mastered in B and C first. Sometimes some of our children learn better expressively so if this is the case you can target the G items first then do them receptively. You will progress through this section in the basic order given. If you are targeting a goal that has already been mastered receptively, make sure to probe it first. Some of these goals can be targeted informally like using carrier phrases and stringing labels together. If the child doesn’t pick up the carrier phrases and stringing words together, then you will need to have a program for this.

Goals that can be combined:

G1/2/3/4 – these all deal with labeling items. Start with reinforcing items then move to pictures and objects. You can target the picture and object by having a column for each. Make sure to use items that have already been taught in B and C first then do novel items.
G7/G8 – these both deal with actions. One is label ongoing actions and one is to label pictures. You can do together by having 2 columns and recording mastery of both.
G11/G18/G19/G20/G21/G22/G34/G36/G38/G44/G45 - these all deal with various ways of combining words and using carrier phrases. You can combine them all into an advanced language program and target the different combinations as appropriate. It is typically best to target this informally in the natural environment. A common mistake with these goals is they are taught at the table and lack functionality. When taught this way, the responses often become rote and do not generalize to the natural environment.

Posted by Megan DeLeon BCBA at 2/6/2010 9:36 PM | View Comments (1) | Add Comment

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