The Role of Culture and Diversity in ABA Treatment Plans: Creating Culturally Sensitive and Ethical Interventions Part 1

By: Nicole Gorden, M.S., BCBA, LBA

As a black behavior analyst, I have personally witnessed how culture and diversity profoundly impact the effectiveness of treatment for children with autism. It is crucial for us, as professionals, to recognize the role of culture and be conscious of our own biases when creating behavior change programs. We will explore the importance of cultural sensitivity in creating treatment plans and discuss how being attentive to diversity can lead to more ethical and effective interventions. Whether you are a parent, clinician, or teacher, understanding the influence of culture is essential for providing the best support for children with autism.

The Impact of Culture on ABA Treatment

Culture plays a significant role in shaping an individual’s beliefs, values, and behaviors. It influences how we communicate, perceive the world, and respond to interventions. Recognizing and respecting the cultural backgrounds of children with autism is vital in tailoring treatment plans that are both effective and ethical.

Cultural Bias and Behavior Change Programs

As professionals, it is essential for us to examine our own cultural biases. Our biases can inadvertently influence the goals we set and the strategies we employ in behavior change programs. By being aware of our biases, we can ensure that treatment plans are culturally sensitive and respect the unique needs and values of each individual.

For example, a provider working with a child from a collectivist culture may set a goal to increase the child’s independent decision-making skills during play activities. However, in the child’s cultural context, interdependence and collaboration are highly valued, and decision-making is often a shared process among family members. By overlooking this cultural aspect, the clinician’s bias towards individualism may unintentionally disregard the importance of cooperative decision-making, potentially limiting the cultural relevance and effectiveness of the treatment goal.

Cultural Sensitivity and Ethical Considerations

Behavior-change interventions must meet the culturally sensitive needs of the client to be considered ethical. Cultural sensitivity requires us to be attentive and respectful of the individual’s culture, considering how cultural contingencies can support their behaviors and aligning treatment recommendations with the values of their culture. It is crucial to foster an inclusive and culturally responsive environment to promote positive outcomes.

Consider a therapist working with a child from a culturally diverse background who exhibits challenging behaviors during mealtime. The BCBA recognizes that the family’s cultural practices include communal eating, eating with their hands, and the preparation of traditional foods. In this case, an ethically sound intervention would involve understanding and respecting the family’s cultural practices while addressing the challenging behavior. Instead of imposing rigid expectations of eating independently, forcing the child to eat with utensils, or conforming to other Western mealtime norms, the therapist would collaborate with the family to develop strategies that promote positive mealtime experiences while honoring their cultural traditions. This approach ensures that the behavior-change intervention is culturally sensitive and respectful, promoting the client’s well-being while maintaining the integrity of their cultural background.

Promoting Diversity in the Field

As highlighted by Dubay, Watson, and Zhang (2018), “The lack of racial, ethnic, and linguistic diversity in service providers is an issue facing many clinical fields.” Increasing diversity within the field is essential for ensuring culturally competent and effective treatment for individuals from diverse backgrounds. By promoting diversity, we can enhance our understanding of different cultures and provide more inclusive and tailored interventions.

The Importance of Culture in Achieving Socially Meaningful Goals

Recognizing the influence of culture in behavior analysis allows us to design interventions that are relevant, respectful, and aligned with the values of the individual and their community. This leads to interventions that are more meaningful, promote independence, and improve the quality of life for individuals with autism. In addition, it allows our clients to access naturally occurring reinforcement within their own environment which is critical for generalization and maintenance of skills.

Incorporating cultural sensitivity into treatment plans is crucial for creating effective and ethical interventions for children with autism. Recognizing the influence of culture, addressing our own biases, and promoting diversity within the field are key steps toward providing inclusive and meaningful support. By embracing cultural awareness, we can develop interventions that respect and value the unique cultural backgrounds of individuals, leading to better outcomes and enhancing the overall well-being of children with autism.

References

DuBay, M., Watson, L. R., & Zhang, W. (2018). In search of culturally appropriate autism interventions: Perspectives of Latino caregivers. Journal of autism and developmental disorders48, 1623-1639.

Fong, E. H., Catagnus, R. M., Brodhead, M. T., Quigley, S., & Field, S. (2016). Developing the cultural awareness skills of behavior analysts. Behavior analysis in practice9, 84-94.

About the Author

Nicole Gorden, M.S., BCBA, LBA has over 14 years of experience implementing Applied Behavior Analysis principles with the Autism Population. She currently works for Comprehensive Behavior Supports in Brooklyn, NY.

Posted in ABA

Focus on the Treatment Team: Speech-Language Therapy

This month’s ASAT feature comes to us from Kate McKenna, MEd, MSEd, MS, BCBA, and Lindsay Bly, MS, CCC-SLP, Melmark. 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!

This is part of the Description of the Treatment Team series.

History

The science of speech-language pathology in the United States had its roots in the study of elocution, what we now call articulation, for rhetoric debate, and theatre, which had risen to prominence in 18th century England. Several clinicians of the era (e.g., Potter) that were considered legitimate came from the profession of education, medicine, and elocution. With the publication of Speech and its defects. Considered physiologically, pathologically, historically, and remedially (Potter, 1882), the field expanded to include speech and language disorders. Potter provided a taxonomy of all speech disorders and a definition and suggested treatments for each. This publication then became the model for the field of speech-pathology in the early period in its history. Speech production continued to be the primary focus of the field in the United States as reflected by the establishment of the American Academy of Speech Correction, in 1925 at a meeting of the National Association of Teachers of Speech (NATS), held in New York City, whose members wanted to promote “scientific, organized work in the field of speech correction.” (https://www.asha.org/about/history/) The establishment of the Academy was the birth of American Speech-Language Hearing Association (ASHA).

As an organization the Academy has gone through several name changes and in 1978 took its current title of the American Speech-Language Hearing Association (ASHA). The organization that began with 25 charter members now represents over 228,000 speech-language pathologists. Based in Rockville, Maryland, ASHA is committed to a mission of empowering and supporting audiologists, speech-language pathologists, and speech, language, and hearing scientists.

As with the professions of physical and occupational therapy, injuries in the World Wars also spurred growth and diversification in the field of speech and language therapy. Soldiers returning from the battlefields had suffered brain injuries that resulted in aphasia, a language disorder that involves loss of the ability to understand or express speech and language. Consequently, during the 1940’s and ’50s, as brain studies, technological advances, and the development of standardized testing procedures gave rise to more useful receptive and expressive language assessments and treatment techniques, speech therapists began to expand their focus into the treatment of language disorders. The field of speech pathology became speech-language pathology during this time.

Although speech and language disorders can occur by themselves, they often exist together, which is why speech-language pathology is a combined field of study. During the 1960’s through the ’80’s, advances in linguistic studies further enhanced the speech-language pathologist’s understanding and ability to treat a variety of language delays and disorders in persons of any age. In the 21st century, speech-language pathologists have begun to research and treat the pragmatic use of language along with the other areas of communication disorders.

Today’s speech-language pathologist is a professional whose professional practice and expertise is in diagnosis, screening, assessment, and treatment of challenges and difficulties, in the areas of communication, including speech, language, cognition, voice, fluency, resonance and hearing, and swallowing in people of all ages. Moreover, SLPs practice within eight domains of speech-language pathology service delivery: collaboration; counseling; prevention and wellness; screening; assessment; treatment; modalities, technology, and instrumentation; and population and systems. In addition, SLPs engage in five domains of professional practice including: advocacy and outreach, supervision, education, research, and administration/leadership. A speech disorder is identified as when someone has a hard time producing speech sounds and misarticulations, has a voice problem, or stutters when speaking. A language disorder is when an individual experiences difficulties understanding and using language to communicate, sharing their thoughts and emotions, and engaging in conversation with others as a conversational partner.

Education

The education and training of speech-language pathologists is overseen by the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA), which is an entity within the American Speech-Language-Hearing Association (ASHA). ASHA is the national professional, scientific, and credentialing association of speech-language pathologists and audiologists. According to ASHA, to practice as a speech-language pathologist (SLP), a masters, doctoral, or other recognized postbaccalaureate degree from a CAA accredited program is required along with completing 400 supervised clinical hours, with at least 25 hours spent in guided observation and at least 375 hours spent in direct client/patient contact, with 325 completed at the graduate level. Supervision is required in real time and never less than 25% of the student’s total contact with each client/patient. Aspiring speech-language therapists must also pass a Praxis Exam in Speech-Language Pathology and complete a clinical fellowship of at least 36 weeks and 1260 hours of full-time experience or its part-time equivalent. During the clinical fellowship applicants are rated by their mentor according to the Clinical Fellowship Skills Inventory (CFSI), which consists of 18 skill statements covering the areas of evaluation, treatment, management, and interaction. Mentees are judged on accuracy and consistency, which assesses the performance of a skill without error, consistently across cases, as well as independence and supervisory guidance, which measure both the level of independence and the ability to self-monitor skill level and request support as necessary. After being granted a Certificate of Clinical Competency (CCC) from ASHA, speech-language pathologists are required to complete 30 hours of professional development every three years. Other license requirements vary by state.

Speech-Language Pathology Assistants (SLPA) can become certified through three different educational pathways and must complete 100 hours of clinical field work under the supervision of an SLP. In addition, applicants take courses in ethics, universal safety precautions and complete the ASHA online SLPA education modules. As with SLPs, speech-language pathology assistants pass a certification exam and renew their certification every three years.

Standards of Practice and Guiding Documents

In their practice speech-language pathologists are guided by the ASHA Code of Ethics, which reflects the values and expectations for both research and clinical practice. The code is intended to provide a framework for ethical decision-making and professional conduct. Four Principles of Ethics form the philosophical base of the Code: 1) responsibility to persons served professionally and to research participants, 2) responsibility for one’s professional competence, 3) responsibility to the public, and 4) responsibility for professional relationships. The Scope of Practice in Speech-Language Pathology also governs the practice of speech-language pathologists. This document is a framework for practice and describes the domains of service delivery. The work of speech-language pathologists assistants is guided by similar documents, a Code of Conduct, and a Scope of Practice, that describe the limits of service delivery as they work under the supervision of SLPs. A goal of SLPs is to provide evidence-based treatment and interventions to clients. To this end, ASHA has created Evidence Maps, a searchable online tool designed to assist speech-language therapists in making evidence-based decisions in their practice.

Professional Organizations

The American Speech-Language Hearing Association (ASHA), is the professional and credentialing organization for audiologists, speech-language pathologists, scientists studying speech, language and hearing, and has 20 Special Interest Groups (SIG) that indicate the breadth and depth of study in the professions. Its mission is “Making effective communication, a human right, accessible and achievable for all.”

ASHA publishes five peer-reviewed journals. American Journal of Audiology (AJA) is an online only peer-reviewed journal that publishes research and other scholarly articles pertaining to clinical audiology methods and issues. American Journal of Speech-Language Pathology (AJSLP) is an international journal that publishes clinical research on diverse aspects of clinical practice in speech-language pathology, including screening, diagnosis, and treatment of communication and swallowing disorders. Articles in the Journal of Speech, Language, and Hearing Research (JSLHR) touch on speech, language, hearing, and related areas such as cognition, oral-motor function, and swallowing. Language, Speech, and Hearing Services in Schools (LSHSS) focuses on school age children and adolescents and audiological and communication disorders that impact full participation in the school setting. Perspectives of the ASHA Special Interest Groups, a bimonthly online peer-reviewed journal, publishes research related to the 20 SIGs. The ASHA Leader, which highlights the latest research and practice advances in communication sciences and disorders, is a bimonthly newsmagazine for and about audiologists, speech-language pathologists, and speech, language, and hearing scientists available to all ASHA members.

Scope of Practice

The SLP profession falls under the larger discipline of communication sciences and disorders, which also includes audiology. Speech-language pathology is focused on a range of human communication and swallowing disorders affecting people of all ages. The practice of speech-language pathology includes those who want to learn how to communicate more effectively, such as those who want to work on accent modification or improve their communication skills. It also includes the treatment of people with tracheostomies and ventilators and those who use Augmented and Alternative Communication such as manual signs, gestures, picture or letter communication boards, and speech generating devices.

Speech is a verbal form of communication that is comprised of articulation, how speech sounds are produced (e.g., manner, placement, and voicing), voice, the coordination of the breathing/respiratory apparatus and vocal cords to produce those sounds, and fluency, the rhythm of speech. Speech problems often occur because a person has difficulty producing sounds due to difficulties or incorrect movement or development of the lips, tongue, and mouth, and/or coordination of the speech motor and respiratory mechanism. Language consists of socially shared rules that govern what words mean, how new words are created, and how words are put together in sentences. It also includes what we call the pragmatics of language, the socially accepted rules for interacting in daily life. This includes non-verbal communication (eye contact, facial expressions, body language) as well as conversational skills such as turn taking, asking questions, appropriately maintaining conversations, and adjusting language and vocabulary based on the situation. Speech-language pathologists treat both receptive (difficulty understanding others) and expressive language disorders (difficulty communicating thoughts, ideas, and feelings).

According to The American Speech-Language-Hearing Association, these are the eight domains of speech language disorder and the disorders that fall under the umbrella of speech-language pathology:

Fluency Disorders:

  • Stuttering: Interruption in the flow of speaking characterized by specific types of disfluencies.
  • Cluttering: Characterized by a perceived rapid and/or irregular speech rate, atypical pauses, maze behaviors.

Speech Production Disorder:

  • Motor planning and execution disorders:
    • Childhood speech apraxia: Neurological childhood speech sound disorder resulting from neuromuscular difficulties, such as abnormal reflexes or abnormal tone.
    • Adult speech apraxia: Speech disorder caused by neuromuscular difficulties, such as abnormal reflexes or abnormal tone; usually because of stroke, traumatic brain injury, dementia, or other progressive neurological disorders.
  • Speech sound disorders:
    • Articulation: Errors (e.g., distortions and substitutions) in production of individual speech sound
    • Phonological: Predictable, rule-based errors (e.g., fronting, stopping, and final consonant deletion) that affect more than one sound.

Language Disorder:

  • Language disorder: A significant impairment in the acquisition and use of language across modalities due to deficits in comprehension and/or production across any of the five language domains (i.e., phonology, morphology, syntax, semantics, and pragmatics).
  • Written language disorder: A significant impairment in fluent word reading (i.e., reading decoding and sight word recognition), reading comprehension, written spelling, and/or written expression. Dyslexia – word reading disorder.
  • Areas of language include phonology, morphology, syntax, semantics, pragmatics (language use and social aspects of communication), prelinguistic communication (e.g., joint attention, intentionality, communicative signaling), paralinguistic communication (e.g., gestures, signs, body language), literacy (reading, writing, spelling)

Cognition:

  • Cognitive-Communication Disorders: Difficulties paying attention, planning, problem-solving, or organizing their thoughts. Many times, these disorders occur because of a traumatic brain injury, stroke, or dementia.

Voice:

  • Voice disorders: Includes vocal cord nodules and polyps, vocal cord paralysis, spasmodic dysphonia, and paradoxical vocal fold movement.
  • Dysarthria: Impaired movement of the muscles used for speech production, including the vocal cords, tongue, lips, and/or diaphragm.

Resonance Disorder:

  • Resonance disorders: Too much or too little nasal and/or oral sound energy in the speech signal.

Feeding and Swallowing:

  • Swallowing Disorders: Difficulty eating and swallowing. Swallowing disorders are often a result of an illness, injury, or stroke.
    • Oral phase
    • Pharyngeal phase
    • Esophageal phase
  • Atypical eating (e.g., food selectivity/refusal, negative physiologic response)

Auditory Habilitation/Rehabilitation:

  • Speech, language, communication, and listening skills impacted by hearing loss, deafness.
  • Auditory processing

SLPs practice in many settings including schools, homes, and hospitals. They also provide services to those in outpatient clinics or in long-term care facilities. In addition to working with adults with persistent speech/language needs who were diagnosed with developmental disabilities from a young age, SLPs work with people across the lifespan, providing care and treatment in early intervention to working with adults with whom a major medical event may have caused a speech or language disorder. They also work in mental and behavioral health settings. SLPs are also involved in academia and research advancing the knowledge base of the field. Given the various settings that SLPs work in, overlapping scopes of practice across health care, educational and other settings is a reality. As such, SLPs engaged in interprofessional collaborative practice to ensure that individuals served will benefit from the collaborative comprehensive approach, receive effective interventions that lead to meaningful and best health and educational outcome.

Speech-language pathologists are health care professionals who identify, assess, and treat speech, language and swallowing disorders, preventing, and treating communication disorders in people of all ages.  The principles and code of ethics that guide members of the profession highlight safeguarding human dignity, protecting the rights of individuals seeking treatment, celebrating diversity, and embracing collaboration in their efforts to ensure that the individuals with whom they work can communicate effectively.

We would like to thank Dr. Lina Slim for her contributions to this article. We appreciate her insight and expertise.

References

American Speech-Language-Hearing Association. (1970, January 1). Assistants code of conduct. American Speech-Language-Hearing Association. Retrieved February 24, 2023, from https://www.asha.org/policy/assistants-code-of-conduct/.

American Speech-Language-Hearing Association. (1970, January 1). Scope of practice in speech-language pathology. American Speech-Language-Hearing Association. Retrieved February 17, 2023, from https://www.asha.org/policy/sp2016-00343/.

American Speech-Language-Hearing Association. (n.d.). About assistant’s certification.American Speech-Language-Hearing Association. Retrieved February 17, 2023, from https://www.asha.org/certification/about-assistants-certification/.

American Speech-Language-Hearing Association. (n.d.). Code of ethics (effective March 1, 2023). Code of Ethics (effective March 1, 2023). Retrieved February 20, 2023, from https://www.asha.org/siteassets/publications/code-of-ethics-2023.pdf

American Speech-Language-Hearing Association. (n.d.). History of Asha. American Speech-Language-Hearing Association. Retrieved February 24, 2023, from https://www.asha.org/about/history/.

American Speech-Language-Hearing Association. (n.d.). National Outcomes Measurement System (NOMS). American Speech-Language-Hearing Association. Retrieved February 24, 2023, from https://www.asha.org/noms/.

A Brief History of SPEECH-LANGUAGE PATHOLOGY. History of the Professions – Health Sciences Library – University of North Carolina at Chapel Hill. (n.d.). Retrieved February 24, 2023, from https://hsl.lib.unc.edu/speechandhearing/professionshistory.

Bullett, M. S. (1985). Certification Requirements for Public School speech-language pathologists in the United States. Language, Speech, and Hearing Services in Schools16(2), 124-128. https://doi.org/10.1044/0161-1461.1602.124

Duchan, J. F. (2002). What do you know about your profession’s history? The ASHA Leader7(23), 4-29. https://doi.org/10.1044/leader.ftr.07232002.4

Duchan, J. F. (n.d.). A History of Speech – Language Pathology. Judy Duchan’s History of Speech – Language Pathology. Retrieved February 24, 2023, from http://www.acsu.buffalo.edu/~duchan/new_history/overview.html.

Potter, S. (1882). Speech and its defects. Considered physiologically, pathologically, historically, and remedially. P. Blakiston, Son & Co.

Programs. ASHA Assistant Certification. (n.d.). Retrieved February 24, 2023, from https://caa.asha.org/programs/.

Citation for this article:

McKenna, K., & Bly, L. (2023). Focus on the treatment team: Speech-Language Therapy. Science in Autism Treatment, 20(5).

About the Authors

Kate McKenna, MEd, MSEd, MS, BCBA, LBA, received a Masters in Child Study from the Eliot-Pearson Department of Child Study at Tufts University, a Masters in Special Education from Pace University, and a Masters in ABA from Hunter College.  In addition to New York state certifications in general and special education from Birth to Grade 2 and Grades 1-6, she holds a New York State Annotated Certification in Severe/Multiple Disabilities. Kate is currently completing a Masters degree in Children’s Literature at Eastern Michigan University.  She was an extern at the Association for Science in Autism Treatment before joining the Board of Directors in 2020.

Lindsay Bly, MS, CCC-SLP, is an ASHA certified speech language pathologist. After receiving her master’s degree at Clarion University of Pennsylvania, she began specializing in dysphagia management and augmentative and alternative communication (AAC) evaluation and implementation. In 2018, Lindsay assumed a newly created speech language pathologist position in the intermediate care facility (ICF) at Melmark. Lindsay develops, creates, and collaborates on protocols to minimize the risk of aspiration in medically complex patients with significant and multiple disabilities including a rigorous evaluation schedule and maintenance treatment for all at risk patients. Lindsay has a passion for management of oropharyngeal dysphagia and maximizing quality of life through least restrictive and safest diets.

Posted in ABA

Compassionate Care In ABA Therapy For Autism

Reposted with permission from Action Behavior Centers

Applied Behavior Analysis therapy, most commonly known as ABA therapy, has grown to become the leading therapy for children with autism. Board Certified Behavior Analysts (BCBAs) primarily work with children on the autism spectrum and their families. As the field continues to grow, it is important to identify potential variables that will lead to a family choosing behavioral therapy (in this case ABA therapy) for their autistic child. 

The therapy that BCBAs and RBTS (Registered Behavior Technicians) provide, when done effectively, creates a genuine relationship between each therapist and child. To better understand each child’s individual needs, it is important to recognize the child’s unique perspective. Vast majority of BCBAs are trained in educational programs that focus primarily on teaching technical and concept-based skills. However, to be able to successfully work with families of children with autism, we require skills beyond conceptual scenarios.  

Critical interpersonal skills are essential when providing our families with the best, highest quality care possible. Amongst these skills, providing compassionate care is the most important stepping stone in building a relationship with the autistic child. This type of care also plays an important aiding factor in distressing families from any potential concerns. Compassionate care is vital to the success of ABA therapy as it builds the trust between the behavioral therapist and the child. This then helps strengthen the engagement and outcomes for each child. By providing compassionate care, a child is willing to move forward with the concept-based scenarios as if it is normal day-to-day activities, which ultimately results in the successful progression of positive skill development. 

In simple terms, compassionate care refers to one being able to put themselves in the shoes of those they are working with by responding with sympathy, empathy, and compassion. By applying techniques of compassionate care, an ABA therapist can identify a family’s perspective and tactfully use their own personal experiences to provide the appropriate response to both the child and their parents. We understand that receiving an autism diagnosis for your child can be overwhelming. After receiving a diagnosis, parents have just as much to learn about autism as the child. By providing compassionate care, we are able to help alleviate the stress that these new situations can cause. 

It is important to understand that being diagnosed with autism does not make your child less than. If anything, a child on the spectrum could be highly intelligent and extremely curious. Action Behavior Centers’ ABA therapist understands that providing compassionate care is understanding that your child may need a little extra support and attention. This extra support does not mean your child is lacking in ability. We believe in helping your child reach their full potential by believing in your child and helping them achieve new milestones. 

This blog post on compassionate care is built upon the insights gathered from two key studies, “The Training Experiences of Behavior Analysts: Compassionate Care and Therapeutic Relationships with Caregivers” by Linda A. LeBlanc, Bridget A. Taylor & Nancy V. Marchese and “Compassionate Care in Behavior Analytic Treatment: Can Outcomes be Enhanced by Attending to Relationships with Caregivers?” by Bridget A. Taylor, Linda A. LeBlanc & Melissa R. Nosik. To delve deeper into the subject of compassionate care, we encourage you to read these studies.

About Action Behavior Centers

Action Behavior Centers (ABC) is an organization committed to the treatment of children using empirically validated methods and strategies to assist each child in reaching his or her greatest potential and improving their quality of life.

Learn more at their website: https://www.actionbehavior.com/

Posted in ABA

5 Tips for Shifting Your Child to a School Sleep Schedule

Reposted with permission from BlueSprig

Helping your child transition to a school sleep schedule can be a rewarding and empowering experience for parents of children on the autism spectrum. While it may initially seem challenging to adjust to the structured routine of the school year, especially after the more relaxed summer months, there are effective strategies that can make this process smoother. By implementing these 5 tips, parents can ensure their child is energized, refreshed, and fully prepared to embrace each school day with enthusiasm. 

1) Create a Consistent Sleep Schedule 

A consistent sleep schedule in a child’s routine is crucial for several reasons. Firstly, having a predictable routine can bring about positive effects by reducing anxiety and providing a comforting sense of stability. Secondly, a lack of sleep can exacerbate behavioral challenges and difficulties with attention and focus. It is recommended for children to aim for 8-12 hours of sleep each night. Ensuring a regular sleep schedule increases the likelihood of children being well-rested, which can positively impact their overall mood, behavior, and cognitive abilities.

2) Establish a Bedtime Routine 

Establishing a consistent bedtime routine is essential for children. Following a predictable sequence of activities each night can help your child wind down and prepare for sleep. Begin by choosing calming activities, such as reading a book or a warm bath, to signal to your child that it’s time to relax.   

3) Gradually Adjust Bedtime and Wake-Up Time 

As you work to transition your child to a school sleep schedule, it’s important to do so gradually. Abruptly changing their bedtime and wake-up time can cause stress and resistance. Instead, make minor adjustments to their schedule each day, slowly shifting their bedtime and wake-up time closer to their school schedule. This will allow their body to adjust and make the transition smoother.  

4) Create a Calming Sleep Environment 

Creating a calming sleep environment is crucial for children to promote relaxation and restful sleep. Start by ensuring the bedroom is free from distractions, such as loud noises or bright lights. Use blackout curtains or a white noise machine to block out disruptive stimuli. Additionally, provide your child with a comfortable, cozy bed using soft blankets and pillows. Incorporating soothing elements like a nightlight or a weighted blanket (if appropriate for their age) can also help create a serene atmosphere. 

5) Implement Visual Aids and Rewards System 

Implementing visual aids and a rewards system can be beneficial when transitioning your child to a school sleep schedule. Visual aids, such as a visual schedule or a picture chart, can provide a clear and understandable visual representation of the bedtime routine. This can help your child understand and anticipate each step in the process. Additionally, a rewards system can motivate and positively reinforce bedtime routines and adherence to the sleep schedule. You can create a sticker chart or a token system where your child earns rewards for following the routine and going to bed on time. This can help make the transition more enjoyable and rewarding for your child, ultimately leading to a smoother adjustment to the school sleep schedule. 

About BlueSprig

BlueSprig is on a mission to change the world for children with autism.

BlueSprig Is the Premier Provider with the Highest Standards in ABA Therapy
Our mission is simple: we are focused on changing the world for children with autism.

The main question we seek the answer to is “what if?”

What if we focus on quality services? What if we are a leader in ABA research? What if we are strong advocates for the rights of all children with autism? Instead of choosing, we’re pursuing all three together – that’s the BlueSprig difference.

Learn more at https://www.bluesprigautism.com/

Posted in ABA

The 4 Functions of Behavior

Reposted with permission from Action Behavior Centers

What are the four functions of behavior? 

In the Applied Behavioral Analysis (ABA) field, it is believed that there is always an underlying reason for all behavior. Our behavior serves a purpose, even though it may not always be clear. All behavior can be narrowed down to one (or more) of four reasons, also known as functions. The 4 functions of behavior are categorized as attention, escape, tangible, and sensory. Trying to understand why an adult or child is engaging in a target behavior may be challenging, but determining the specific function of behavior that is being exhibited can assist in guiding a treatment plan to help decrease or increase a specific behavior. 

  1. Attention (Connection) – This function can be described as when someone engages in a behavior in an effort to gain attention. Children may behave negatively to get attention even if it isn’t positive attention. However, It is important to remember that not all attention seeking behavior should be perceived negatively. For example, raising your hand to be called on and screaming for someone to come over are both attention seeking behaviors, but one of the two is more socially acceptable.
  2. Escape (Avoidance) – Escape is one of the most common functions. This occurs when people engage in certain behaviors in order to avoid or end an unpleasant experience. A child may behave in a certain way that is unacceptable to get out of doing something they don’t want to do. Examples of this could be sleeping in class to avoid working or taking a different route home to avoid traffic.
  3. Tangible (Attaining) – This can be described as someone engaging in a behavior for access to something. In order to obtain an object or take part in an activity in which a person is particularly interested, a person may behave in a particular manner. A child screaming to get a toy or finishing their homework for tv time are both examples of a tangible function of behavior.
  4. Sensory (Automatic) – This behavior occurs when people engage in certain behaviors because they physically feel good or to relieve negative feelings. It is referring to stimulating the senses. An example of this would be itching an ant bite or fanning yourself on a hot day. 

Understanding Positive and Negative Reinforcements 

In general, behavioral outcomes can serve one of two purposes. The reasoning behind these behaviors is to either acquire something or remove from something. When a child behaves in a way to acquire something, it’s called positive reinforcement. On the other hand, negative reinforcement is the removal of something unpleasant to the child.

To help with further understanding, both positive and negative reinforcements can be better understood through attention and sensory reinforcement. Attention positive reinforcement occurs when a child receives something as a result of someone else’s actions. For example, a child might ask their father for a blanket. To positively reinforce the child’s communication of asking, the father will provide the blanket. Whereas, negative reinforcement might be where the father removes the blanket because the child no longer wants to use it.

A third concept is that of automatic reinforcement. In this circumstance, the reinforcement happens without the help of anyone else. The child is able to meet their needs on one’s own. Using the same scenario, a child getting their own blanket is positive reinforcement. As far as negative reinforcement, this would result in the child pushing the blanket off of themself. 

How can we help? 

A child’s motivation behind specific actions or behaviors can be pinpointed by understanding the four functions of behavior, but it is important to remember that a single behavior can hold two or more functions. In addition, it is important to comprehend both positive and negative reinforcements in order to fully grasp why a behavior is occurring. By identifying these functions, we can teach kids to meet their needs in a positive way. In ABA therapy, our staff will observe your child in their element. We will pay close attention to what is happening before and after the targeted behavior to identify the key function. After being assessed, we will teach replacement behaviors. The goal is to decrease target behaviors and increase desired behavior to ensure behavioral consistency in all environments to achieve success on the spectrum. 

About Action Behavior Centers

Action Behavior Centers (ABC) is an organization committed to the treatment of children using empirically validated methods and strategies to assist each child in reaching his or her greatest potential and improving their quality of life.

Learn more at their website: https://www.actionbehavior.com/

Posted in ABA

Supporting Your Clients During the Back-to-School Season: 4 Strategies BCBAs can Implement for a Smooth Transition

By Ashleigh Evans, MS, BCBA

Children with autism and other neurodivergence commonly struggle with transitions. The shift from summer to the start of a new school year is one of the most challenging transitions. Getting back into a new routine is not easy and often requires support and patience through these changes. Behavior analysts play a vital role in helping these children navigate the back-to-school season. Let’s review four strategies you can try to make for a successful back-to-school transition for your clients.  

1.   Maintain Open Communication with School Staff

Open communication between the ABA and school teams can help smooth the transition. Introduce yourself to your client’s teacher and support staff, communicating your desire to collaborate for your shared learner’s best interests. Use this as an opportunity to also share and celebrate your client’s growth during the summer. Share mastered skills that your client achieved over the summer and any new concerns to help the school team gain an updated picture of their current skills and behaviors.

2.   Review and Update Goals

Take a look through your client’s goals and progress made. The ultimate goal of ABA is to prepare our learners for optimal functioning in the least restrictive environments. Consider updating goals to encourage the development of skills that will help them be more successful at school. If they attended school last year, review their IEP and reflect on areas they struggled with in the previous year.

One area to consider is your learner’s self-advocacy skills. Do they have the necessary skills to express their needs and desires in a manner that school staff can understand? Do they have the ability to communicate when something is uncomfortable, they need a break, or someone is bothering them? These skills are all critical for success in school and onward. Ensure goals are in place to teach these skills, if not already mastered.

3.   Increase Caregiver Training and Support

During times of major transitions, parents and caregivers may also struggle to navigate the routine shifts that often come with behavioral changes in their child. Empower your client’s parents to support their child through this shift by enhancing caregiver training. If clinically appropriate and feasible, increase caregiver training sessions before and for the first few weeks after the school year starts. Providing additional support can set everyone up for success.

4.   Implement New Antecedent Strategies

Consider the antecedent strategies you can implement to help your client better cope with the new routines and expectations. Visual supports, such as a visual schedule with the child’s morning routine or daily schedule, can help your client envision what comes next, making it easier for them to get into the swing of things. If your client enjoys social stories, you can create one to review with them (or have parents read it to them) to familiarize them with what to expect. Make sure it’s personalized and unique to them with components such as their teacher’s name and picture.

Plan Ahead for a Successful School Year

The back-to-school season can be a stressful time for children and their families. However, with caregiver planning and support, behavior analysts can help make this process significantly easier. Help your families navigate change and prepare for a year of success at school by trying the aforementioned strategies. Each client is unique, so as always, tailor your approach to their particular needs and preferences.

About the Author

Ashleigh Evans, MS, is a Board Certified Behavior Analyst. She has been practicing in the behavior analysis field for over 13 years and opened her own independent practice in early 2022. Her experience has been vast across different age groups, diagnoses, and needs. She is passionate about improving the field through education, reformative action, and better supervisory practices, leading her to create content and resources for families and ABA professionals which can be found on her website, https://www.abaresourcecenter.com/.

Posted in ABA

Supporting Your Child With Visuals

Reposted with permission from Ashleigh Evans, MS, BCBA

Visual supports are items used as prompts/cues to help guide one toward the expected behavior. Visual supports are not exclusive to children with autism. Even as adults, we all use visual supports, from our planners to organization apps and more.

Visual supports can be beneficial in reminding children of the expectations and guiding them through adaptive behaviors.

We’ll review a few common visual supports. If your child is receiving treatment, chat with their care team about implementing the most appropriate visual supports for your child. It’s easy to get carried away with all the visuals, but that can get overstimulating for many kids. Try one thing at a time to get a good idea of what is most helpful and build from there.

First-Then Visual

This is a tool that is simple to create and implement. The purpose is to help your child understand what’s to come next. You can create this in a simple way with a paper labeled first on the left side and then on the right side. You can use words or visuals to show your child what the current task is and what will come next.

Typically, the “first” side will have a non-preferred task such as “clean your room” and the “then” side will have a preferred item or activity such as “play outside.” So, first clean your room, then play outside.

Stop Signs

Ensuring your child’s safety is everyone’s number 1 priority. Teaching your child to respond to stop signs can be a great visual prompt as a reminder of locations they can and cannot go around the home.

Place a laminated stop sign on the doors leading outside (or any other areas in the home that are unsafe for your child). This can serve as a reminder to your child to pause and not go out that door if they are unaccompanied by an adult. This will take practice, but once they have the idea down, stop signs can be an excellent prompt!

Visual Schedules

The first-then visual is a simplified visual schedule showing two activities. A full visual schedule can be created to help your child understand several upcoming events. There are many ways to set this up. For example, you could set this up as a schedule of their full day. Or you may create one to support them through a portion of their day, such as the bedtime routine consisting of brush teeth, put on pajamas, bedtime story, etc.

Again, there are many ways you can go about creating this including using pictures or words. You could go about creating one yourself or purchasing one.

Visual Timers

Visual timers can be a really helpful way to help a child who doesn’t quite understand the concept of time, comprehend how much time is left of an activity. The red on the clock visually displays how much time is remaining for an activity or until an upcoming transition.

Visuals can be so valuable in prompting us through our daily lives. Finding effective visual supports for your child can make a huge difference.

About the Author

Ashleigh Evans, MS, is a Board Certified Behavior Analyst. She has been practicing in the behavior analysis field for over 13 years and opened her own independent practice in early 2022. Her experience has been vast across different age groups, diagnoses, and needs. She is passionate about improving the field through education, reformative action, and better supervisory practices, leading her to create content and resources for families and ABA professionals which can be found on her website, https://www.abaresourcecenter.com/.

Posted in ABA

Enhancing Emotional Understanding: Incorporating Emotion Flashcards in Natural Environment Teaching Activities for Children with Autism

By: Nicole Gorden, M.S., BCBA, LBA

Helping children with autism understand and express emotions is beneficial for their social and emotional development. One effective way to support this is by incorporating emotion flashcards into natural environment teaching (NET) activities. Below, we will explore the benefits of using emotion flashcards, provide guidance on incorporating them into everyday activities, and highlight their impact on promoting emotional understanding in children with autism. Whether you’re a parent, clinician, or teacher, this resource will empower you to create engaging and effective learning experiences for children with autism.

Understanding Emotion Flashcards

Emotion flashcards are visual aids that depict various emotions through pictures or illustrations. These cards provide a concrete representation of emotions, making them accessible and easily understandable for children with autism. By using emotion flashcards, we can teach children to identify, label, and understand their own emotions, as well as recognize and empathize with the emotions of others.

Benefits of Emotion Flashcards in NET Activities

  1. Visual Supports: Emotion flashcards offer visual supports that enhance communication and comprehension for children with autism. The visual nature of the cards helps bridge the gap between verbal and nonverbal communication, enabling children to better grasp and express emotions.
  2. Generalization: Incorporating emotion flashcards into naturally occurring activities allows children to practice recognizing and understanding emotions in various contexts. This promotes generalization of skills, helping children transfer their knowledge of emotions from flashcards to real-life situations.
  3. Personalization: Emotion flashcards can be customized to reflect the individual experiences and preferences of each child. Personalized cards featuring familiar faces or specific situations can help children relate to the emotions depicted and make the learning experience more meaningful and relevant.

Incorporating Emotion Flashcards in NET Activities

  1. Start with Basic Emotions: Begin by introducing a small set of basic emotions, such as happy, sad, angry, and surprised. Use the emotion flashcards during play activities that naturally evoke these emotions. For example, during playtime, show the happy card when the child is engaged in an enjoyable activity.
  2. Emotion Charades: Engage the child in a game of emotion charades using the flashcards. Take turns acting out an emotion while the other person guesses which emotion is being depicted. This activity promotes perspective-taking and understanding of nonverbal cues.
  3. Emotion Identification: Show the child a flashcard and ask them to identify the corresponding emotion. Provide reinforcement and praise for correct responses. Gradually increase the complexity by introducing more nuanced emotions, such as excited, frustrated, or worried.
  4. Emotion Role-Play: Use the flashcards to create role-play scenarios. Assign different emotions to the child and yourself, and act out how each emotion might be expressed in various situations. Encourage the child to mimic the facial expressions, body language, and tone of voice associated with each emotion.
  5. Emotion Matching: Create a matching game using emotion flashcards and corresponding facial expression cards. Have the child match the emotion flashcards with pictures of people displaying the corresponding emotions. This activity helps reinforce recognition and understanding of emotions in different contexts.
  6. Emotion Sorting: Provide a variety of flashcards representing different emotions and ask the child to sort them into categories based on positive and negative emotions or high-intensity and low-intensity emotions. This activity encourages categorization and differentiation of emotions.
  7. Emotion Journaling: Incorporate the use of emotion flashcards in a journaling activity. Have the child select a flashcard that represents how they are feeling at different times of the day and encourage them to write or draw their experiences and reflections.

Incorporating emotion flashcards into natural environment teaching activities can be a powerful tool for promoting emotional understanding in children with autism. By using visual supports, personalized experiences, and engaging activities, we can help children identify and understand emotions, enhance their social interactions, and develop important skills for lifelong emotional well-being. Whether you’re a parent, clinician, or teacher, incorporating emotion flashcards into everyday activities can create meaningful learning experiences that support the emotional growth of children with autism.

About the Author

Nicole Gorden, M.S., BCBA, LBA has over 14 years of experience implementing Applied Behavior Analysis principles with the Autism Population. She currently works for Comprehensive Behavior Supports in Brooklyn, NY.

Posted in ABA

ASD Intervention: How Do We Measure Effectiveness?

This month’s ASAT feature comes to us from Daniel W. Mruzek, PhD, BCBA-D, University of Rochester. 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 already published and peer-reviewed studies examining the effectiveness of their recommended intervention. 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) 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. Such questions 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., 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 starting the intervention.

Question 2: “How will these behavior changes be measured?”

Behavior change is often gradual and may occur in “fits and starts” (i.e., the change is variable). In some cases, the behavior may initially deteriorate. 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, number of bladder accidents, duration [in minutes] of tantrums). 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 portray 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 a background in behavior analysis can set up strategies for evaluating a possible treatment effect. For example, in order to gauge 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 a 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, which 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.

Citation for 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, PhD, BCBA-D has been a member of the faculty at the University of Rochester since 2002 and currently maintains an appointment in the Departments of Brain and Cognitive Sciences and Psychology. Also, he is CEO of Elevation Behavioral Services LLC, based at the Golisano Autism Center in Rochester, NY. As a psychologist and behavior analyst, Dr. Mruzek specializes in direct consultation and technical assistance to school districts and agencies through the region, nationally, and internationally. His areas of expertise include clinical and psychoeducational assessment of individuals with developmental and learning disabilities, assessment and treatment of challenging behavior, and promotion of inclusive practices (e.g., staff training and direct consultation to instructional teams). As a researcher, he has been the primary investigator and investigator on projects including the MCH Autism Intervention Research Program, the Adolescent Brain Cognitive Development (ABCD) Study, Seychelles Child Development Study, and the UR Intellectual and Developmental Disabilities Research Center (IDDRC).  A member of numerous committees and professional organizations, Dr. Mruzek is on the board of reviewers for several peer-reviewed scientific journals. His research has been funded by the National Institutes of Health, and he has published chapters in various books and monographs and in peer-reviewed journals including The Journal of the American Medical Association, Autism, and Environmental International.

Posted in ABA

How do you figure out what motivates your students?

This ASAT feature comes to us from Niall Toner, MA, BCBA of the New York State Institute for Basic Research in Developmental Disabilities. 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!

I am a special education teacher working with students with autism. At times I find it difficult to figure out what motivates my students and what they’re interested in. Can you make some suggestions about the best way to do this?

This is an excellent question and one that highlights a challenge often experienced not only by teachers but also by family members of individuals with autism. We know that the interests and preferences of individuals with and without autism vary significantly over time. Also, we know that effective teaching of skills and behavior change are predicated upon the timely use of powerful reinforcement (i.e., positive consequences of skilled behavior that motivate and strengthen that behavior). As discussed below, identifying an individual’s preferences is a critical first step in teaching new skills because these preferences often lead to the identification of powerful reinforcers; but how we do this can be easier said than done, especially when the learner has a limited communication repertoire or very individualized interests. The best way to identify preferences is through ongoing preference assessments.

The value of preference assessments

Since many individuals with autism may have difficulty identifying and communicating their preferences directly, we must consider alternative methods of obtaining this information. At the onset, it is important to keep in mind that what may be rewarding or reinforcing for one individual may not be for another. For example, one child may enjoy bubble play, crackers or a particular cause-and-effect toy while a classmate may find one or more of these uninteresting or even unpleasant. Furthermore, an individual’s preferences change across time. For example, an individual may have demonstrated little use for music at age 11, but she may demonstrate a keen interest in music at age 13.

Preference assessments provide a systematic, data-based approach to evaluating a host of potential interests (e.g., food, toys, activities) for an individual. Although preference assessments do require time and effort up front, their use can decrease the time and energy, required to change behavior in the long run. Research indicates that when caregivers use a presumed preference that, in fact, is not the learner’s actual preference, valuable time, energy and resources are lost (Cooper, Heron, & Heward, 2006).

Types of Preference Assessments

Preference assessment can be conducted in three distinct ways: (1) Interviews and Formal Surveys; (2) Direct observation; and (3) Systematic assessment.

Interviews are a straightforward technique that can be used to gather information quickly. They involve obtaining information from the individual’s parents, siblings, friends, and teachers (and
from the individual, if communicative) by asking both open-ended and comparison questions. Examples of open-ended questions include: “What does he like to do?” “What are his favorite foods?” and “Where does he like to go when he has free time?” Comparison questions might include: “Which does he like better, cookies or crackers?” and “What would he rather do, go for a walk or eat chips?” Resultant information is then compiled in a list and identified items and activities can be piloted out as possible reinforcers.

Formal surveys can also be used to guide these discussions. One widely used survey is the Reinforcement Assessment for Individuals with Severe Disabilities (RAISD; Fisher, Piazza, Bowman, & Amari, 1996). This interview-based survey gathers information about potential reinforcers across a variety of domains (e.g., leisure, food, sounds, smells), and ranks them in order of preference. It should be noted that, although simple and time-efficient, using interviews alone can result in incomplete or inaccurate information. In fact, some studies have shown that, for the same individual, staff interviews did not reveal the same information as using a survey (Parsons & Reid, 1990; Winsor, Piche, & Locke, 1994).

Direct observation involves giving the individual free access to items and/or activities that he or she may like (presumed preferences) and recording the amount of time the individual engages with them. The more time spent with an item or activity, the stronger the presumed preference. In addition, positive affect while engaged with these items and activities could be noted (e.g., smiling, laughing). During these observations, no demands or restrictions are placed on the individual, and the items are never removed. These direct observations can be conducted in an environment enriched with many of the person’s preferred items or in a naturalistic environment such as the person’s classroom or home. Data are recorded over multiple days, and the total time spent on each object or activity will reveal the presumed strongest preferences. Direct observation usually results in more accurate information than interviews but also requires more time and effort.

Systematic assessment involves presenting objects and activities to the individual in a preplanned order to reveal a hierarchy or ranking of preferences. This method requires the most effort, but it is the most accurate. There are many different preference assessments methods, all of which fall into one of the following formats: single item, paired items, and multiple items (Cooper, Heron, & Heward, 2006).

Single item preference assessment (also known as “successive choice”) is the quickest, easiest method. Objects and activities are presented one at a time and each item is presented several times in a random order. After each presentation, data are recorded on duration of engagement with each object or activity.

Paired method or “forced-choice” (Fisher et al., 1992) involves the simultaneous presentation of two items or activities at the same time. All items are paired systematically with every other item in a random order. For each pair of items, the individual is asked to choose one. Since all objects and activities have to be paired together, this method takes significantly longer than the single-item method but will rank in order the strongest to weakest preferences. Researchers found that the paired method was more accurate than the single item method (Pace, Ivancic, Edwards, Iwata & Page, 1985; Paclawskyj & Vollmer, 1995).

The multiple-choice method is an extension of the paired method (DeLeon & Iwata, 1996). Instead of having two items to choose from, there are three or more choices presented at the same time. There are two variations to this method: with and without replacement. In the multiple choice with replacement method, when an object is selected, all other objects are replaced in the next trial. For example, if the individual is given a choice of cookies, crackers, and chips, and he chooses cookies, the cookies will be available for the next trial, but the crackers and chips are replaced with new items. In the without replacement method, the cookies would not be replaced and the choice would only be between the crackers and chips. No new items would be available.

A few final recommendations

When conducting preference assessments, consider testing leisure items/activities and food assessments separately because food tends to motivate individuals more than toys and other leisure items (Bojak & Carr, 1999; DeLeon, Iwata, & Roscoe, 1997). Also, be sure to assess preferences early and often. Preference assessments should be conducted prior to starting any new intervention or behavior change program. And remember that preferences change over time and require continuous exploration. Therefore, assessments should be updated monthly or whenever an individual appears tired of or bored with the preferred items. Keep in mind too, that the identification of one type of preference may provide ideas for other potential reinforcers. For example, if an individual loves a certain type of crunchy cereal, he/she may like other cereals or crunchy snacks. Or if an individual enjoys coloring with crayons, consider exploring whether he/she may enjoy coloring with markers or using finger paints.

Finally, when selecting a preference assessment method, a practitioner or parent should consider the individual’s communication level, the amount of time available for the assessment, and the types of preferred items that will be available. Taken together, these preference assessment methods can provide the valuable information necessary to help motivate and promote behavior change in individuals with autism.

References

Bojak, S. L., & Carr, J. E. (1999). On the displacement of leisure items by food during multiple stimulus preference assessments. Journal of Applied Behavior Analysis, 32, 515-518.

Cooper, J. O., Heron, T. E., & Heward W. L. (2006). Applied Behavior Analysis (2nd ed.). Upper Saddle River, New Jersey: Prentice Hall.

DeLeon, I. G., & Iwata, B. A. (1996). Evaluation of multiple-stimulus presentation format for assessing reinforcer preferences.Journal of Applied Behavior Analysis, 29, 519-533.

DeLeon, I. G., Iwata, B. A., & Roscoe, E. M. (1997). Displacement of leisure reinforcers by food during preference assessments. Journal of Applied Behavior Analysis, 30, 475-484.

Fisher, W. W., Piazza, C. C., Bowman, L. G., & Amari, A. (1996). Integrating caregiver report with a systematic choice assessment. American Journal on Mental Retardation, 101, 15-25.

Fisher, W. W., Piazza, C. C., Bowman, L. G., Hagopian, L. P., Owens, J. C., & Slevin, I. (1992). A comparison of two approaches for identifying reinforcers for persons with severe to profound disabilities. Journal of Applied Behavior Analysis, 25, 491-498.

Pace, G. M., Ivancic, M. T., Edwards, G. L., Iwata, B. A., & Page, T. J. (1985). Assessment of stimulus preference and reinforcer value with profoundly retarded individuals. Journal of Applied Behavior Analysis, 18, 249-255.

Paclawskyj, T. R., & Vollmer, T. R. (1995). Reinforcer assessment for children with developmental disabilities and visual impairments. Journal of Applied Behavior Analysis, 28, 219-224.

Parsons, M. B., & Reid, D. H. (1990). Assessing food preferences among persons with profound mental retardation: Providing opportunities to make choices. Journal of Applied Behavior Analysis, 23, 183-195.

Windsor, J., Piche, L. M., & Locke, P. A. (1994). Preference testing: A comparison of two presentation methods. Research in Developmental Disabilities, 15, 439-455.


About The Author

Niall Toner MA, BCBA, LBA is a licensed behavior analyst and board certified behavior analyst with over 10 years experience working in the fields of applied behavior analysis and developmental disabilities. Niall is currently the Clinical Director for Lifestyles for the Disabled. Prior to the position he served as a consultant to various organizations including the New York City Department of Education. He also held the position of Assistant Director at the Eden II Programs. Niall has presented locally, nationally and internationally. His interests are Preference Assessments and Functional Analysis, which he presents and publishes.

Originally reposted to Different Roads to Learning on September 28, 2017