ABA Journal Club #5: Caregivers as Interventionists

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

There is a wealth of studies demonstrating that training caregivers to implement interventions is valuable for generalization of skills, improved learner outcomes, and decreases caregiver stress. While many teachers, behavior analysts, and other practitioners work to train caregivers; these practitioners are rarely given specific training on how to train caregivers.

In this month’s journal club article, behavior skills training (BST) is utilized to teach caregivers to be interventionists. BST is a model that involves instruction, modeling, rehearsal, and feedback. We hope this article will get you talking about your current level of training with BST and how your organization can improve in training practitioners to teach caregivers to implement behavior analytic strategies.

Loughrey, T. O., Contreras, B. P., Majdalany, L. M., Rudy, N., Sinn, S., Teague, P., … & Harvey, A. C. (2014). Caregivers as interventionists and trainers: Teaching mands to children with developmental disabilitiesThe Analysis of Verbal Behavior30(2), 128-140.

  • The researchers trained caregivers on a university campus using the BST model prior to home visits. In your current work, would this be a possibility for you? If not, how could you provide this type of training to caregivers? What obstacles can you predict, and how might you address them?
  • Discuss the multiple baseline design used in the study. How does it demonstrate experimental control? What can you determine from a visual analysis of the data?
  • Part of this study included a measure of whether a competently trained parent could teach their spouse how to implement mand training. Why is this important? Have you implemented similar strategies in your own work?
  • This study did include maintenance data. Why is this data valuable? Do you collect maintenance data on the caregiver training you provide?
  • Consider a particular skill you are teaching one or more clients. What would BST look like to teach caregivers how to implement the necessary procedures for teaching that skill?
  • The article states, “General instructions were provided prior to baseline, but parents were only able to implement the procedures effectively when full instructions, modeling, rehearsal, and feedback were used to train to mastery.” How can you change your current practice to ensure that you are providing the necessary steps to help caregivers master skills they have selected for parent training?

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

What Autism Awareness Should Be About

This month’s ASAT feature comes to us from David Celiberti, PhD, BCBA-D. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

April is Autism Awareness Month. Blue puzzle pieces will appear on thousands of Facebook pages and billboards, and the media will give greater attention to autism. Further awareness is wonderful, as detection and diagnosis are necessary first steps to accessing help in the forms of treatment, information, and support. With well over 500 treatments from which to choose, parents of children with autism need guidance, tools, and accurate information to empower them to make the best possible choices for their children: these choices will undoubtedly have a profound impact on both their current quality of life and their children’s future and potential.

When I first entered the field over 30 years ago, autism was considered a rare condition. When people asked what I did for a living, they often misheard me and thought I worked with “artistic” children. I got that a lot.  With the incidence of one in 59 children today, our own families, neighbors, and co-workers are all touched by autism. In fact, the sheer numbers have heightened awareness of autism in and of themselves. This awareness is essential: it promotes early detection, and with early detection, we hope for a relatively clearer course toward effective treatment and better outcomes.

Sadly, however, the early detection of autism alone does not provide a seamless path to intervention. Furthermore, families whose children are diagnosed with autism are still not able to access the most effective science-based treatments available expeditiously. Instead, families often have to sort through hundreds of pseudoscientific treatments until they arrive at the most effective interventions supported by peer-reviewed research to address the complexities of autism.

“Autism Awareness” should be about more than just detection and diagnosis. At the Association for Science in Autism Treatment (ASAT), it has always been our hope that the conversation around autism awareness would be broadened to focus upon addressing the obstacles that separate individuals with autism from receiving effective, science-based intervention and combatting the misinformation that distracts families, caregivers, and teachers from accessing accurate information.  I offer 11 perspectives about what “Autism Awareness” should be about, along with several ways that ASAT can assist families and providers alike in navigating the complex maze of autism treatment options. 

#1  “Autism Awareness” must differentiate effective treatments that are scientifically validated from the plethora of “therapies” and “cures” lacking scientific support. Such a distinction is critical.   

Autism treatment is a billion-dollar industry. For the majority of the 500+ available interventions, science is overlooked in favor of pseudoscience, and they are marketed using heart-wrenching testimonials, anecdotes and video montages, and often bolstered with poorly crafted and misleading surveys. Many interventions boast inaccurate and even outrageous claims that are touted as evidence of effectiveness. Marketing of these so-called “therapies” and “cures” is unambiguously aggressive in nature, and so overwhelming that it can drown out accurate information for those parents desperate to help their children access the very best treatment. We are in a time when anything can be placed before the word therapy and pushed forth as a “bonafide treatment” (Legos, llamas, bleach, sand, magnets and even Shakespeare to name but a few examples).

We do no favors for children with autism, their families, and those responsible for providing needed services when we not only ignore junk science, but allow it to proliferate by failing to counter baseless claims. Visit our website to learn more about the scientific support behind various autism treatments, the relevance of peer-reviewed research, the pitfalls of testimonials, as well as many other articles related to becoming a savvy consumer. Please also see our review of the second edition of Dr. Sabrina Freeman’s book, The Complete Guide to Autism Treatment.

#2 “Autism Awareness” must recognize our collective responsibility to make sound choices.

As adults, voters, consumers, providers, and parents, choice underlies all of our decisions. We have a right to make these decisions, even poorly; however, when we hold the futures of individuals with autism in our hand, decision-making power comes with tremendous responsibility. Responsibility that should never be abdicated. There is a myriad of “decision-makers” whose choices have profound implications for children and adults with autism – not just parents, but siblings, teachers, treatment providers, administrators, program coordinators, and taxpayers.

Please see our webpage for parents.  There you will find an article on questions to ask marketers/providers so you can make sure that the individual with autism in your life is receiving science-based treatment,  as well as questions that you can ask yourself. You can also read more about the three phases of inquiry about particular interventions and their associated questions and considerations in the Road Less Traveled: Charting a Clear Course for Autism Treatment.

#3 “Autism Awareness” must alert and remind the community that available information on the Internet (and actual information from providers) varies greatly in accuracy, and, in fact, can be completely wrong.

As we know, not all information on the Internet is reliable and accurate. You have probably heard the term, caveat emptor (“Let the buyer beware”). Consumers must also practice caveat lector (“Let the reader beware”). Often, Internet information is deemed equivalent in relevance, importance, and validity to research published in peer-reviewed scientific journals, but it is not.  Testimonials and uncontrolled studies from so-called researchers can lead parents astray and be a tremendous source of distraction.  Parents of newly-diagnosed children may be particularly vulnerable. Know the red flags to avoid and learn how to evaluate research by visiting our website. Our library of articles highlights scientific concepts and methods as they relate to potential autism interventions, with the goal of providing families, educators, and clinicians with the information they need in order to be savvy consumers of marketed treatment products and therapies.

#4 “Autism Awareness” must include responsible reporting by journalists who embrace their role as “public educators” and who are committed to spreading accurate information.

There are scores of “miracle cures” and “breakthroughs” for autism that receive widespread media attention (e.g., print and online news outlets, radio and television programs), even if these treatments have not been shown to be beneficial through peer-reviewed, published research.  The media has a responsibility to scrutinize sensational claims related to a proposed treatment, and to be knowledgeable enough to report on those treatments with healthy skepticism and objectivity. To support accuracy in the media, ASAT has developed a webpage for journalists. For examples of accurate and inaccurate reporting, please learn more about our Media Watch campaign, review resources about science journalism, and peruse our bank of archived letters. You will find that some of these showcase accurate media representations whereas others highlight concerns about inaccurate representations.

#5 “Autism Awareness” must recognize the critical need for newly-diagnosed children to access effective treatment ASAP. We know that early intervention makes a huge difference.

While individuals with autism learn and progress across their lifespan, it is widely understood that the earlier intervention begins, the greater the potential for an optimal outcome. Please learn more about the research basis for early intervention.  It is also important to remember the limited window of time there is to prepare children for the “least restrictive setting” once they enter the public school system.  

The fact that resources allocated early can save a tremendous amount of resources over an individual’s lifespan does not always enter the conversation when evaluating costs and benefits. This must change. These cost savings should become an integral part of the conversation about the appropriateness of intensive early intervention. Please see the following articles on the ASAT website:

#6 “Autism Awareness” should also instill hope for a better tomorrow for those individuals who are not part of the “best outcome” group.

With the right treatment and preparation for adolescence and adulthood, all individuals with autism demonstrate improvement, and many go on to lead happy, productive, and fulfilling lives.  Much of the conversation about treatment, however, focuses on “best outcome” and this is often defined as entering “mainstreamed” education settings or losing the diagnosis of autism altogether. This may delegitimize the significant progress made by most individuals with autism, whose outcome may be different, but no less important and meaningful. We know, for example, with intensive intervention based on applied behavior analysis (ABA), individuals with autism learn to live and work in the community, access faith communities, fully participate in routine healthcare, enjoy a range of recreational pursuits including a commitment to fitness, become independent in their self-care needs, have meaningful relationships and are active, contributing members of their communities. The importance of such gains must be recognized as a significant benefit of effective treatment and are relevant conversations to have, particularly at a time when some vocal bloggers are viciously maligning any and all treatment efforts as abusive, immoral, or otherwise unethical.  This includes the denigration of parents who only want to help their child realize his or her fullest potential.

Autism awareness should definitively include a celebration of a broad array of outcomes as was touched upon in our recent interview with Catherine Maurice, author of Let Me Hear Your Voice, as well as editor of a number of other titles. Please also visit our Perspectives page that highlights success stories of young people with autism, who are not necessarily in the best outcome group, carving out sustainable vocational experiences.

#7 “Autism Awareness” must mandate accountability from all treatment providers regardless of discipline.

Accountability involves a shared commitment to objectively defined targets, data collection, and respect for the scientific method. It is every provider’s responsibility to objectively measure outcomes. No one should get a pass on accountability. No one is immune from defining their target and objectively measuring progress. No one should get away with implementing their intervention carelessly and in non-transparent manner. No one should be permitted to boast claims that they cannot demonstrate through data. These unfortunate realities should not be tolerated.

Providers using interventions that lack scientific support have an ethical obligation to share this fact with consumers, and to exercise caution in making claims about outcomes. Far too often, applications of interventions that lack any scientific support are carried out in a manner devoid of transparency and objective measures to substantiate claims of the treatment’s success. This must not be tolerated. Providers must make sound, scientifically-validated decisions and recommendations. Please visit our website for more information about ethics and evidence-based practice.

#8 “Autism Awareness” must involve recognition that an abundance of clinical research already exists, and this body of research matters.

In the world of autism intervention, peer-reviewed research, which should guide and inform treatment efforts, is too often disregarded or ignored altogether. Imagine a world in which it was deemed acceptable for mainstream cancer providers to treat childhood leukemia with methods they preferred without consideration of existing research. Sadly, that is the reality of autism treatment, as many providers use their personally-preferred methods, often divorced from scientific support and then often carried out without any objective means to assess benefit. 

If treatment providers and consumers are interested in published research on diverse topics such as improving conversation skills, promoting academic skills, eliminating self-injurious behavior, or developing tolerance for health care procedures, they can find it. Sadly, these peer-reviewed studies are often not accessed by treatment providers and caregivers. Thousands of researchers and experts in their fields have published their findings in peer-reviewed journals that can guide autism treatment, yet their findings are often overshadowed by media representations which put sensationalism about the “next big thing” in autism treatment over objective scientific research. Please visit our website often to read our ever increasing number of research synopses  and vast library of treatment summaries.

#9 “Autism Awareness” should help us identify and overcome the barriers that families and individuals with autism face even within their own communities.

Like all families, those with children with autism want to be able to live comfortably and fully within their community. That may mean simply going to the park, enjoying play dates, attending religious services, accessing routine medical care, going to the movies with friends, or eating at a restaurant with their family. Unfortunately, many families are not able to access these activities because the community is not sufficiently informed or prepared to include individuals with autism within these settings. In some cases, the children are not taught how to manage these situations well due to ineffective treatments. As a result, families of children with autism are often isolated. With 1 in 59 children being diagnosed, every facet of society should become aware of the supports necessary for individuals with autism to succeed within their communities. This could involve accessing information about success stories, receiving education and training, and an open dialogue with families about what could be helpful. It would be prudent if every facet of society evaluated what they are doing to support individuals with autism, what they are not doing, and what they could be doing differently.

#10 “Autism Awareness” is needed worldwide.  In many countries, families of individuals with autism face incredible challenges and barriers.

As a US-based organization we recognize the many benefits that exist here in our country. These include, although are not limited to, well-established special education laws, the lion’s share of board-certified behavior analysts and providers from other disciplines who are committed to science-based practice, and a longer history of the conversation about best practices. This is in contrast to the experience of families of children with autism residing in many other countries who are offered outdated therapies such as psychoanalysis, have very limited resources, face stigma and rejection within their communities, may encounter a professional community that has low expectations about what may be possible, and lack the support of laws mandating even adequate treatment and education. Providers eager to learn and use best practices will face limited education and training opportunities, a dearth of accessible supervisors, and struggle to access supporting professional networks. In some countries, the social and economic conditions may be so poor that autism treatment is relegated to the back burner. 

We believe that knowledge is power and that a global community of savvy and informed consumers can help shape the landscape of effective intervention. Please note that we have flyers about our website and our monthly publication, Science in Autism Treatment, in several languages including Arabic, Brazilian Portuguese, French, Hebrew, Hindi, Italian, Russian, Serbian, and Spanish. If you are interested in distributing our translated materials, please write us at info@asatonline.org. At the bottom of every page we make it easy to disseminate knowledge through a variety of social media platforms. Please also note the Google language translation option in the upper right-hand corner of our webpage. 

#11 “Autism Awareness” should be about the reality that the hundreds of thousands of children with autism will soon become hundreds of thousands of young adults with autism; unfortunately, we are woefully ill-prepared to meet their needs.

When children with autism become adults (at the age of twenty-one in the U.S.), funding for services drastically changes. As a result, there are very few quality programs for adults with autism.We are facing a crisis in the field, with a scarcity of services for adults with autism and the absence of a clear strategy for closing the gap between the ever-increasing need, and an unprepared supply of resources. Quality evidence-based services for individuals with autism must continue into the adult years. Research indicates that interventions such as applied behavior analysis (ABA) can effectively help adolescents and adults with autism continue to work toward their fullest potential.

At ASAT, we have broadened our scope so that we can be a part of this important and essential dialogue and have written extensively about that commitment and are continuing to add to our webpage that addresses lifespan topics. Here one can learn about maximizing employment opportunities, strategies to support older learners, and transitioning to adulthood. We are expanding our collection of research synopses to include adolescent and adult participants with autism and we have written about this topic extensively within Media Watch with the letters showcased on our Lifespan page.

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We hope these 11 perspectives have furthered your appreciation of the complexities and nuances surrounding autism awareness. We all play a role in advancing science, bettering the lives of individuals with autism, and helping their families and supporters become skilled and savvy consumers. Embrace that role with an eye toward identifying what additional steps you can take to become a contributor to important discussions and an even bigger part of the solution. For more information on how to join ASAT and be part of the solution, please subscribe to Science in Autism Treatment, visit our website, and follow us on Facebook. Learn more about how to become a sponsor, volunteer, or extern. Or you can support our work by making a donation. Join us in making a difference in the autism community!


David Celiberti, PhD, BCBA-D, is the Executive Director of ASAT and Past-President, a role he served from 2006 to 2012. He is the Co-Editor of ASAT’s monthly publication, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993 and his certification in behavior analysis in 2000. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis (ABA), and early childhood education. He works in private practice and provides consultation to public and private schools and agencies in underserved areas. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. In prior positions, Dr. Celiberti taught courses related to ABA at both undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.

ABA Journal Club #3: Functional Analysis

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

Head to our Facebook page to join the discussion and let us know your thoughts!

When I was first starting out in behavior analysis, I was amazed at the simplicity and accuracy of functional analysis. Behaviors that had seemed complex and impossible to change suddenly made sense. I felt ready to create interventions to address those behaviors, and started to see more success in my behavior change procedures. Functional analysis remains one of my favorite topics to teach, and one of the questions I get most often from my graduate students is about ethical concerns in relation to completing a functional analysis for potentially dangerous behaviors. 

This has been a concern in the field, and there is a strong evidence base that identifying, assessing, and treating precursor behaviors is effective in reducing the target problem behavior. For this month, I have selected a paper on this topic.

Herscovitch, B., Roscoe, E. M., Libby, M. E., Bourret, J. C., & Ahearn, W. H. (2009). A procedure for identifying precursors to problem behavior. Journal of Applied Behavior Analysis42(3), 697-702.


What is the purpose of the current study? How is it relevant to your current work?

The researchers used both indirect and descriptive methods for identifying precursor responses. What were these methods?

Describe each of the probability measures the researchers used. How were these related to each other? Could these be used in your current setting?

What did the authors find was most probable to occur prior to head-hitting behavior? Why is this information important?

When the researchers conducted the functional analysis on the precursor behavior, was the head-hitting behavior eliminated? Why is this important to recognize? What implications does it have for practitioners?

Identifying the precursor behavior can decrease risk resulting from problem behaviors such as self-injurious behavior or aggression. Can you identify a current problem behavior for one of your clients and create a plan for determining precursor behaviors?

Please note that this particular study has only one participant. Sometimes, behavior analysis as a field is criticized for the use of single-subject studies. You can read this previous post  for more on the topic of single-subject studies.


WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

The founder of ABA Journal Club, Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

The Salad Shoppe: Changing the Landscape of Vocational Training

Unemployment rates in the autism community are alarming, but the number of individuals entering the workforce only continues to grow. This presents an overwhelming challenge for special educators tasked with preparing learners for what is often an uncertain future. Vocational training is essential as learners with autism approach the transition to adulthood.  With this in mind, Nassau Suffolk Services for Autism (NSSA) introduced The Salad Shoppe in the fall of 2017.

The curriculum was developed by Kathryn Reres and Rebecca Chi, devoted special educators determined to ensure dignified and purposeful futures for the eight young adult students in their classroom. The focus was to create a program that would provide functional tasks for each learner based on their individual skills, interests and IEP goals. The result was an innovative vocational training curriculum that highlights the strengths of each participant, introduces new skills into their everyday lives and serves as a profitable social enterprise. 

The Salad Shoppe model requires multiple steps to be taken over the course of two days, including: Tracking and counting money, taking inventory, creating shopping lists, purchasing, food preparation, converting a customer’s order form to food assembly, delivery and clean up. This comprehensive list ensures that every learner has the opportunity to perform a task that is meaningful and functional to them. (The staff at NSSA are reaping the benefits too! Fresh, healthy, personally-delivered lunches each week have been a huge hit.)

In partnership with Different Roads to Learning, the creative teachers who designed The Salad Shoppe for NSSA are sharing their expertise with special educators everywhere. The published curriculum will allow teachers to implement The Salad Shoppe in a way that will best function for the learners they serve. Now more than ever, there is a crucial need to provide young adults with autism with the tools they will need to take on the competitive workforce. The Salad Shoppe is a cutting-edge curriculum that has opened new doors for educators, learners and parents and will continue to change the landscape of vocational training.

Ready to bring The Salad Shoppe to your school? You can save 15% on this incredible program now through February 18th!

Pick of the Week: The Salad Shoppe!

This week, save 15% on our brand new vocational curriculum! Click on the graphic for more details!

ABA Journal Club #1

            For January, I have selected not one, but two texts. The first is a foundational article that every behavior analyst has probably read more than once. However it’s an important one to revisit, and one that I gain more insight from with each read. The second is a follow-up to the original article.

Article One: Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis1(1), 91-97.

Article Two: Baer, D. M., Wolf, M. M., & Risley, T. R. (1987). Some still‐current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis20(4), 313-327.

Discussion Questions for Baer, Wolf, Risley (1968):

The tone of the 1968 article is hopeful. The authors express a belief that behavior analytic procedures will become more prevalent as people understand the technology. Do you think they were accurate in this belief? What has been your experience with people accepting the principles of ABA?

Among the seven dimensions discussed in this article, what did you find most interesting?

The authors state that the term applied is defined by the interest society shows in the problem being studied. Is this how you have thought of the term applied in the past? How does your current work fit into this description? And how do we know society is interested?

In their discussion of analytic, the authors explain two designs commonly used to demonstrate reliable control of behavior change. Do you use these designs in your every day practice? Why or why not?

Do you think all seven of these dimensions hold equal importance? Why or why not?

How do the seven dimensions make ABA different from other fields?

Discussion Questions for Baer, Wolf, Risley (1987):

Compare and contrast the descriptions of each of the seven dimensions across the two articles.

The authors identify social validity as a good measure of effectiveness. However, they also identify issues with the assessment of social validity. How do you think that has changed since they wrote this article? How do you assess social validity in your own work?

What do you think of the discussion of high-quality failures?

In what ways do you follow the seven dimensions in your current work?

Can you identify a way to improve your own work based on the seven dimensions?

If you were to identify an eighth dimension that is not currently represented in these articles, what might you add?


SAM BLANCO, PhD, LBA, BCBA is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

How Do We Measure Effectiveness?

This month’s ASAT feature comes to us from Dr. Daniel W. Mruzek, PhD, BCBA-D, Associate Professor, University of Rochester Medical Center. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

Marketers of purported interventions for autism spectrum disorder (ASD), whether they are pills, devices, or exercises, claim that their products are effective. As proof, they point to any number of measures some valid, some questionable, and some potentially misleading. Given that many of these “treatments” may be costly, ineffective and even dangerous, it is good to consider what constitutes legitimate measures of therapeutic benefit. How will we know if the intervention actually works?


A first step when presented with a potential treatment option is to investigate its scientific record. One can certainly ask the marketer (or therapist, interventionist, clinician, etc.) for examples of peer-reviewed studies examining the effectiveness of their recommended intervention. Indeed, this can be a great first step. An honest marketer will be glad to give you what they have in this regard or freely disclose that none exist. A good second step is to consult with a trusted professional (e.g., physician, psychologist, or behavior analyst who knows your family member), in order to get an objective appraisal of the intervention. If, after this first level of investigation is completed, a decision is made to pursue a particular intervention for a family member there are additional questions that one can ask the marketer prior to implementation that may prove very helpful in determining effectiveness after the intervention has been employed. These include the following:


Question 1: “What behaviors should change as a result of the intervention?”
Virtually any ASD intervention that is truly effective will result in observable change in behavior. For example, a speech intervention may very well result in increased spoken language (e.g., novel words, greater rate of utterances). An academic intervention should result in specific new academic skills (e.g., greater independent proficiency with particular math operations). An exercise purported to decrease the occurrence of challenging behavior will, if effective, result in a lower rate of specific challenging behaviors (e.g., tantrums, self-injury). As “consumers” of ASD interventions, you and your family member have every right to expect that the marketer will identify specific, objective, and measurable changes in behaviors that indicate treatment efficacy. Scientists refer to such definitions as “operational definitions” – these are definitions that are written using observable and measurable terms. If the marketer insists on using ill-defined, “fuzzy” descriptions of treatment benefit (e.g., “increased sense of well-being”, “greater focus and intentionality”, an increased “inner balance” or “regulation”), then “Buyer Beware!” These kinds of outcome goals will leave you guessing about treatment effect. Insist that operational definitions of target behaviors be agreed upon prior to start of intervention.

Question 2: “How will these behavior changes be measured?”
Behavior change is often gradual and variable. Behavior change often occurs in “fits and starts” (i.e., the change is variable). Also, our perception of behavior change can be impacted by any number of events (e.g., the co-occurrence of other therapies, our expectations for change). Therefore, it is the marketer’s responsibility to offer up a plan for collecting data regarding any change in the identified “target” behaviors. Usually, it is best to record numerical data (e.g., number of new words spoken by the individual, duration [in minutes] of tantrums, etc.) The use of numerical data to measure the change of operationally defined target behaviors is one of the best ways for a treatment team to elevate their discussion above opinion, conjecture and misrepresentation. If a pill, therapy or gadget is helpful, there is almost assuredly a change in behavior. And, that change is almost always quantifiable. Setting up a system to collect these numerical data prior to the initiation of the new intervention is a key to objective evaluation of intervention. Don’t do intervention without it.


Question 3: “When will we look at these intervention data and how will they be presented?”
Of course, it is not enough to collect data; these data need to be regularly reviewed by the team! One of the best ways to organize data is “graphically”, such as plotting points on a graph, so that they can be inspected visually. This gives the team a chance to monitor overall rates or levels of target behaviors, as well as identify possible trends (i.e., the “direction” of the data over time, such as decreasing or increasing rates) and look for change that may occur after the start of the new intervention. Note that the review of treatment data is generally a team process, meaning that relevant members of the team, including the clinicians (or educators), parents, the individual with ASD (as appropriate) often should look at these data together. Science is a communal process, and this is one of the things that makes it a powerful agent of change.


An interventionist with background in behavior analysis can set up strategies for evaluating a possible treatment effect. For example, in order to gage the effectiveness of a new intervention, a team may elect to use a “reversal design”, in which the target behaviors are monitored with and without the intervention in place. If, for example, a team wishes to assess the helpfulness of a weighted blanket in promoting a child’s healthful sleep through the night, data regarding duration of sleep and number of times out of bed might be looked at during a week with the blanket available at bedtime and week without the blanket available. Another strategy is to use the intervention on “odd” days and not use it on “even” days. Data from both “odd” and “even” days can be graphed for visual inspection, and, if the intervention is helpful, a “gap” will appear between the data sets representing the two conditions. These strategies are not complex, but they give the team an opportunity to objectively appraise whether or not a specific intervention is helpful that is much better than informal observation. Few things are as clarifying in a team discussion as plotted data placed on the table of a team meeting.


If the marketer does not answer these questions directly and satisfactorily, consider turning to a trusted professional (e.g., psychologist, physician or behavior analyst) for help. Families have a right to know whether their hard-earned money, as well as their time and energy, are being spent wisely. Asking these questions “up front” when confronted with a new intervention idea will help. Marketers have a responsibility to present their evidence – both the “state-of-the-science” as reflected in peer-reviewed research, as well as their plans to measure the potential effectiveness of their intervention for the individual whom they are serving.


Speaking of measuring treatment effectiveness, fellow ASAT board member Eric Larsson offers his considerations regarding the use of standardized measures (e.g., IQ) as outcome measures in treatment research (next article; page 20). Though this might be a little out of context for some of our readers, for those of us who rely on direct interpretations of peer-reviewed studies in our work (e.g., researchers, clinicians), Dr. Larsson describes the limitations of sole reliance on change in standardized measures is assessing the scientific validation of an intervention.


Please use the following format to cite this article:
Mruzek, D.W. (2014). ASD intervention: How do we measure effectiveness? Science in Autism Treatment, 11(3), 20-21


About The Author
Daniel W. Mruzek, Ph.D., BCBA-D is an Associate Professor at the University of Rochester Medical Center (URMC), Division of Neurodevelopmental and Behavioral Pediatrics in western New York. He received his doctoral training in Psychology at the Ohio State University and is a former Program Director at the Groden Center in Providence, Rhode Island. Currently, he is an associate professor and serves as a clinician and consultant, training school teams and supporting families of children with autism and other developmental disabilities.


Mruzek coordinates his division’s psychology postdoctoral fellowship program in developmental disabilities and is an adjunct faculty member in the University of Rochester Warner School of Education. He is actively involved as a researcher on several externally funded autism intervention research studies and has authored and co-authored more than 20 peer-reviewed articles and book chapters on autism and other developmental disabilities. Dr. Mruzek is on the editorial board for the journals Focus on Autism and Other Developmental Disabilities, Behavior Analysis in Practice, Journal of Mental Health Research in Developmental Disabilities, and Intellectual and Developmental Disabilities. Dr. Mruzek is a former member of the Board of Directors of the Association for Science in Autism Treatment.

The Function Wheels

This month’s ASAT feature is a review of the Function Wheels, one of our Different Roads exclusives! To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

Reviewed by
Jen Cote, M.Ed.
David Celiberti, PhD, BCBA-D

Individuals with autism often demonstrate challenging behaviors in home, school, and community settings and, as a result, their service providers develop behavioral interventions to address these challenges. The effectiveness of behavioral interventions is predicated on consistency across people and settings. Aside from inconsistent implementation, one of the primary reasons for the failure of interventions targeting the reduction of challenging behavior is that the intervention does not adequately address the underlying function of the behavior. Behavior intervention plans can be conceptualized in one of three ways:

  • Functionally relevant in which the intervention reflects the underlying function of the challenging behavior;
  • Functionally irrelevant in which the intervention does notreflect the underlying function of the challenging behavior; and
  • Functionally contraindicated in which the intervention includes components that may actually serve to reinforce the challenging behavior (e.g., a time out procedure for a behavior maintained by escape).

Function Wheels is a quick, easy-to-use resource that enables individuals working with students to better understand the underlying function of a student’s behavior and its direct implications for behavioral intervention. Function Wheels is a systematic approach that sequentially guides users through the process of identifying the function of a problem behavior, collecting data on the occurrences of problem behavior, developing a hypothesis based on the pattern of data collected, and implementing research-based interventions for each function. The purpose of the guide is to offer assistance when writing behavior intervention plans, with specific examples laid out in a step-by-step format.

Prior to providing a summary of the contents of this guide, we wanted to share a few cautionary statements with our readers. The Function Wheels is not intended to replace a more in-depth Functional Behavior Assessment (FBA) or Functional Analysis (FA) (Amerson, 2014). According to the author, “While Function Wheels is a handy and useful behavioral tool in the management of behavior, careful considerations should also be given when a more-in-depth and formal FBA or FA is warranted. In such cases, information using Function Wheels can be incorporated into the FBA or FA descriptive information”. (A Guide to Behavioral Interventions, pg. 8). Though this guide provides conceptually systematic interventions, the author further recommends that if a multi-variable treatment package is used, which may be required for certain individuals, multiple treatments should be implemented in consultation with a Board Certified Behavior Analyst (BCBA) or licensed professional who possesses the clinical experience to design, implement, monitor, and/or modify the treatment package accordingly (Amerson, 2014).

As with any tool, the effectiveness is directly connected to the integrity and consistency demonstrated during implementation by the user. For this reason, users must be able to objectively assess their own ability and others’ ability to follow each component of the intervention, and determine if they or the other persons have the skills necessary to effectively implement the intervention techniques. All users should be prepared to seek additional support and training if needed, or request consultation with a Board Certified Behavior Analyst or a licensed professional who possesses the clinical experience to train and support others in the implementation of intervention.

Function Wheels Components

The Function Wheels system consists of separate components, meant to work as a whole, to help teachers proactively identify why problem behavior occurs so they can then follow the research-based interventions and strategies provided. The Function Wheels kit includes:

Guide to Behavioral Interventions:

Provides research-based interventions and features conceptually systematic interventions that can be adapted and used as a resource to help identify specific management strategies. The first four sections of the Guide to Behavioral Interventions focus on the four main behavioral functions; behaviors with the function used to obtain attention, behaviors with the function to escape, behaviors with the function to gain access to preferred items, and behaviors maintained by automatic reinforcement. In addition to providing the user with a general knowledge of what the behaviors may look like, the authors also provide examples of how the behaviors may be displayed during specific environmental conditions or situations for different age ranges. When developing a behavior intervention plan, it is critical to match the intervention to the function of the behavior, or reason the behavior is being exhibited. If the function of the behavior is not determined, the intervention implemented could be ineffective or counterproductive.

This guide provides the user with intervention strategies for each function of problem behavior. Each intervention discussed throughout the guide has a brief overview of the history of the intervention and examples of the interventions being implemented. Intervention strategies for the four function areas include, but are not limited to: non-contingent reinforcement/attention, time-out, behavior contract/ contingency contracting, reinforcement of successive approximations, contingent sensory access/breaks, sensory extinction, non-contingent reinforcement, and differential reinforcement of other behaviors. Research provided for the interventions ranges from 1969 to 2013. As the author mentioned, this guide is not intended to list all possible interventions, only to provide a sample of interventions available. As research in this field continues to grow, the research basis for the underlying techniques can be expanded upon to reflect the advancements that have been made in the field.

Procedural steps are written out under the intervention. The procedural steps provide the reader with the sequence in which the intervention should be implemented. These procedures include data collection, environmental setup, and reinforcement and consequence dependent on behavioral response. In addition, the author also includes a Key Notes section, which provides the user with additional knowledge of directions/instructions to be considered when implementing the particular intervention.

User Guide:
The User Guide describes how to use the Function Wheels system, step-by-step. Before determining any functions or implementing any interventions, it is essential for the user to feel comfortable with their abilities, and have a solid understanding of all the pieces to this kit. As mentioned previously, it is noted that when looking at the User Guide, the sequence of the steps would lead one to believe that Writing Descriptive Notes (step 5) would take place after the function has been calculated (step 4). In order to determine the function of a behavior, one must fully evaluate the description of the behavior, the antecedent (triggering event) and the consequence (maintaining event). This would be followed by the identification of the function.

Function Wheel:
A double-sided wheel feature eight research-based conditions. One side of the wheel displays antecedent conditions and the other side displays consequent conditions. Turning the wheel allows each user to align an environmental event with the function(s) of the behavior. The smaller, inner wheel represents the presence of a behavior (attention, escape, tangible, automatic), while the larger, outer wheel represents the environmental event, or condition, that triggered and/or maintained the behavior. The function wheel is designed to be a straightforward way of determining the function behind a problem behavior; however, in order to prevent any confusion, it would be helpful to differentiate the side of the wheel designed to help identify the trigger from the side designed to help identify the maintaining event.

Student Screening Sheet: 
Provides a template for tracking each incident of the problem behavior. The Student Screening Sheet allows for up to 15 behavioral events to be recorded. Fifteen recordings across at least three observations are recommended to provide an adequate sample to help identify the function of the problem behavior. The Student Screening Sheet has three distinct sections: Description of Observable Behavior, Functional Categories, and Descriptive Notes (detailed information about the antecedent and consequent condition for each observable behavior recorded). Though the Student Screening Sheet offers its user a simplistic way to track data on behavior, the arrangement of the screening tool could mislead one to believe the function of the behavior is determined prior to examining antecedent variable and consequent/maintaining variable. When in fact, the function of a behavior should not be determined prior to the examination of all variables.

Intervention Wheels:
The four Intervention Wheels are Attention, Escape, Tangible, and Automatic. The specific Intervention Wheeldirectly related to the identified function provides recommended research-based treatments across 6 intervention areas. In addition to providing the user with research-based treatments across the intervention areas, the authors have placed ‘Facts to Remember’ on the front of each Intervention Wheel. The facts offer broad tips that are beneficial when working with any behavior despite the function, but it may be more beneficial to connect function. Although this guide provides conceptually systematic interventions, the author further recommends that if a multi-variable treatment package is used, which may be required for certain individuals, multiple treatments are implemented in consultation with a Board Certified Behavior Analyst or licensed professional who possesses the clinical experience to design, implement, monitor, and/or modify the treatment package accordingly (Amerson, 2014).

Utilizing the Function Wheels System

The Function Wheels system can be used two ways, the Function Wheels Brief Method or the Function Wheels Extended Method. Both methods can be utilized by any individual working with students. The Function Wheels Brief Method includes collecting data using the Student Screening Sheet to capture functions of behaviors as they occur, then based on the information obtained, proceeding to the corresponding Intervention Wheel to read about interventions which could minimize the occurrence of problem behavior and reduce any unwanted, inadvertent, or unintentional reinforcement of the problem behavior. A limitation of the Brief Method noted by the author, involves careful consideration of the tentative hypothesis formed about the function as it is not verified prior to intervention when the Brief Method is employed.

The second method, Function Wheels Extended Method utilizes the same framework but with more detail. Time is taken to meet as a team to define the target behavior and discuss data collection. Following the data collection process, the team meets again to discuss and analyze the variables associated with the unwanted problem behavior, determine the behavior’s function, and what potential interventions can be employed. The difference between the two methods is the time spent collecting data, which during the Extended Method takes place over several sessions or days. This will allow for confirmation or provide the team with an opportunity to test the hypothesis regarding the function(s) of the student’s challenging behavior and more importantly, to engage in a validation process prior to the start of any intervention.

Conclusion

The Function Wheels kit is an easy-to-use resource that provides service providers who have a basic knowledge of learning principles and the communicative intent of challenging behavior and its functions with a way to quickly determine appropriate interventions for problem behaviors based on the function of the behavior. For effective implementation of behavior intervention plans, it is essential for the user to have clinical knowledge and experience, or access to working directly with a more qualified professional. A concern with the utilization of this kit with those who are less experienced or knowledgeable would be the counterproductive effects it can have on students who are already struggling. Secondly, the research basis underlying techniques includes many citations from decades ago, which may give the reader the impression that no other research has been published related to that intervention and that the field has not advanced. Nonetheless, the responsible use of the Function Wheels kit may aide in the quick and effective identification of functions and a comprehensive array of interventions that would benefit many students. We applaud the author for compiling this resource in such an innovative and meaningful manner. For more information, please visit the website for Different Roads to Learning.

 

Please use the following format to cite this article:

Cote, J., & Celiberti, D. (2016). Resource reviews: Review of “The Function Wheels” Science in Autism Treatment, 13(4), 34-37.


About The Authors

Jennifer Cote, M.Ed.

Jennifer received an undergraduate degree in Mental Health and Human Services from the University of Maine Augusta in 2010. Working at a residential facility with adolescents diagnosed with autism sparked an interest in this population. In 2011 she switched her field to Special Education and earned her teaching certification, and completed a Master’s Degree through University of Southern Maine in Special Education in 2017.  After becoming interested in Applied Behavior Analysis Jennifer is currently working toward completing the requirements to sit for the BCBA exam. She enjoys enjoy working with children and watching them grow and develop. She continues to teach Special Education.

David Celiberti, PhD, BCBA-D

David is the part time Executive Director of ASAT and Past-President, a role he served from 2006 and 2012. He is the Co-Editor of ASAT’s newsletter, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis, and early childhood education, and been an active participant in local fundraising initiatives to support after school programming for economically disadvantaged children. He works in private practice and provides consultation to public and private schools and agencies in underserved areas. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. In prior positions, Dr. Celiberti taught courses related to applied behavior analysis (ABA) at both the undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.

Being Realistic about Changing the Environment

Recently I visited the home of one of my clients. I asked the RBT working there if our client was still throwing materials. She said he hadn’t thrown anything all week. I was excited to hear this news, until I heard her next sentence. “I realized he always throws the materials when he asks to be all done and I say ‘not yet.’ So now, whenever he says he’s all done, we just clean it up.”

While it is true that behavior analysts make changes to the environment to improve behaviors, that doesn’t mean we change the environment at the expense of teaching new skills. Our ultimate goal for any client is that they lead as independent a life as possible. For this particular client, I hope that one day he will be employed. This means that we need to start teaching him now that sometimes he will have to complete a task, even when he doesn’t feel like it.

So how do you know when you’re being realistic about changing the environment?  Here are a few questions you should ask yourself:

Is the environmental change I’m suggesting something that will be implemented in the natural environment? If no, then you should think about how to shape appropriate behaviors rather than simply avoid the problematic behavior. For this client, refusing to work further would not be acceptable in a school or in future work environments. It could also potentially result in more restrictive learning environments for the client.

In what future circumstances might this behavior cause problems for my client? If you can envision scenarios in employment, social situations, or in public, then you need to focus on teaching an appropriate behavior rather than simply avoiding the problematic behavior. Furthermore, thinking about these circumstances may help you identify potential replacement behaviors that you can teach.

How can I shape an appropriate behavior? Think about the steps you can plan for shaping a replacement behavior. For instance, with the example of my client, we could start by requiring him to complete one more simple instruction before putting the activity away (such as placing one more puzzle piece, responding to one more question, or imitating one more action.) After he’s mastered that step, we could increase the requirement to completing two more simple instructions, then to working for one more minute, then two more minutes, etc. We can implement a systematic plan for teaching an appropriate response and completing the work even if he doesn’t want to anymore.

Is what I’m asking reasonable? In another case, one of my clients’ goals was to pull her hair back into a ponytail independently. The intention behind this goal was to do it in situ, when she would naturally be pulling her hair back. However, the implementation of the goal resulted in her practicing pulling her hair back and taking it down multiple times. Her hair would often tangle and she would feel pain while taking her hair out of the ponytail. It’s fair to say that asking a client to put up and take down her hair several times is an unreasonable request. If your request isn’t reasonable, think about how to change it so the client still learns the skill without it becoming aversive.

Ultimately, we should not change the environment in order to avoid behaviors, unless there is something unreasonable or unnecessary about what we are requesting the client to do. It is our job to teach the client how to communicate effectively, as well as to teach and reinforce appropriate behaviors to promote independence.


WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

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