Leisure Skills for Adults with Autism

This month’s ASAT feature comes to us from Megan McCarron, MS, BCBA. 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 BCBA working in an ABA Teaching Home. I am adept with teaching play skills to younger children but would like some guidance on assessing interests and helping young adults develop hobbies that they can pursue in an independent and meaningful manner.

This is a very important question. There is an abundance of research on how to teach leisure activities using instructional methods such as modeling, video modeling, and activity schedules, moreover, it is vital that careful thought and planning be put into selecting and individualizing leisure activities.

Typically, one’s interests are developed over time via exposure to and interaction with new and varied people, places, and activities. Exposure usually occurs over the course of life without much forethought, resulting in interests that shift and change. Unfortunately, this is often not the case for individuals with autism spectrum disorder (ASD).

There are two key deficits within the diagnostic criteria for ASD that are likely to impact individuals’ exposure to and interaction within varied leisure activities. First, persistent limitations in social communication and social interaction can hinder an individual’s ability to request access to items and activities, and/or to express one’s level of interest. Second, the presence of restricted, repetitive patterns of behavior, interests, or activities may prevent an individual from exploring novel items or activities.

Individuals’ difficulty making or expressing choice limit exposure to new and varied items and activities. Limited interests or those that are markedly different from those of same-aged peers make it that much more difficult to determine ways to expand and develop interests. As a result, careful thought and planning are required to help individuals with autism engage in meaningful leisure activities.

Finding Leisure Activities

Given that there is an unending number of items or leisure activities that could be assessed, it is important to narrow down the field to things that are likely to be of interest before conducting your assessments. A few of these approaches are as follows:

Expand upon current interests. Ask caregivers, teachers, siblings, or others who spend time with the individual to complete an interview, checklist or other type of survey. Create your own questions or use published materials such as the Reinforcer Assessment for Individual with Severe Disabilities (RAISD). Do not immediately discount unusual or idiosyncratic interests. Look to see if there are groups in the community or online that share that interest. If necessary, teach when and where it is okay to engage in preferences that may be annoying to others or are socially stigmatizing. Examples:

Select novel activities that contain components of already preferred activities. Identify common features of known preferences, and then identify novel items or activities that contain the same or similar features. Examples:

Make modifications to existing activities to incorporate the preferred feature of other preferred activities. Examples:

Pair a known interest with a compatible novel activity. Examples:

Identify shared interests. In addition to identifying activities by exploring and expanding upon current interests of the individual, it can be worthwhile to identify interests of the people the individual spends a lot of time with and activities available in the individual’s school, home, and local community. These activities will offer up the opportunity for social interaction with others.

Assessing Activities

Once potential activities are selected, assessments can be conducted to determine how preferred the activities are. While preference assessments are commonly used and talked about in terms of finding reinforcers, they are equally useful for assessing preference levels for potential leisure activities. Initially, free operant assessments are very helpful in terms of assessing potential leisure activities. These can be conducted in the natural environment or a contrived and enriched setting.

Free operant preference assessments can be conducted through direct observation by providing free access to activities without demands, time limits or requirements to use items in a predetermined manner (unless it is a safety issue). Assessments can be conducted in either a natural or contrived setting, as described below (Toner, 2014; Chazin & Ledford, 2016).

Collect data on:

  • Which items/activities the individual interacts with
  • Duration of each interaction
  • Can be helpful to note the individual’s observable signs of positive affect during interactions, such as smiles or laughter
  • If the individual interacts with an item in an unexpected or unusual manner, make note of what he or she did.

Once the free operant assessment data have been collected and ranked in order of which activities were engaged with the most (e.g., by calculating a percentage of time of the observation in which the student engaged in each activity), subsequent paired choice preference assessments or MSWO assessments could be conducted to better assess the individual’s relative preference for activities. With this information, you can make an informed choice about what activities are likely to provide “enjoyment” and thus fit the definition of leisure.

Selecting Teaching Targets for the IEP

It is important to help an individual build a repertoire of activities that can be used to fill the various functions of leisure. Therefore, the activities chosen as a focus of teaching should cover a variety of leisure situations.

  • Social Activities (any activity done with another person).
  • Individual Activity (any activity that can be done alone).
  • Health and Fitness.
  • Longer duration activities.
  • Short duration activities that can be done while waiting (looking at books, magazines, music on phone, etc.)

Some activities may be adaptable enough to be used across several leisure functions. For example, listening to music can be a social or individual activity; it can easily be paired with a variety of health and fitness activities and can be used for short or long durations.

In addition to selecting specific activities/skills for leisure, it is advisable to include an objective in a student’s IEP that targets the individual’s exposure to leisure activities. The goal of this objective would be to have the student continue to try out new activities over three to four opportunities to further expose them to new activities. During the sampling sessions, staff should collect data on duration of engagement, observable signs of affect, and any skill deficits that inhibit engagement.

Considerations for Increasing Functional Independence in Leisure
While identifying preferred activities is a major part of building a leisure repertoire, there are a whole host of skills that can increase an individual’s ability to access and engage in leisure activities as independently as possible.

Ensure the individual has an effective means of communication. An essential skill, regardless of the individual’s vocal verbal ability, is teaching an appropriate way to request access to activities, especially those that are not readily available in the current environment such as requesting to go to the mall or to a specific store (Schneiter & Devine, 2001). Equally important is the ability for an individual to appropriately decline participation and/or end an activity when the activity is not preferred.

Teach prerequisite skills. If a student shows interest in an activity but is not able to fully engage in the activity, it may be necessary to teach the individual specific prerequisite skills. Examples:

If a Sampling Leisure Activities objective has been included in the IEP, the sampling period can be used to help identify what types of prerequisite skills may need to be taught.

  • The individual may need to be taught skills related to any materials or equipment required for an activity. For example, gathering equipment / materials prior to starting the activity; caring for the equipment / materials putting equipment away when finished, and problem solving (e.g., what to do if materials are missing, broken, or need to be replenished).
  • Time management skills, such as identifying when it is time to engage in a leisure activity, selecting an activity that fits the amount of time for leisure, identifying when activities are essential components of increasing independence. Using schedules and calendars can be helpful to structure and prompt leisure activities but may require specific teaching. For example, using a calendar app on a phone can be very useful, but it may be necessary to start off with teaching the student to respond to an alert to engage in an activity and build up to having them enter information into the calendar.

Final Thoughts

Every individual has different interests, abilities, and obstacles to work through in establishing leisure skills. However, building on and expanding from high preference, high availability activities and using evidence-based assessment and teaching strategies to establish independence in leisure activities provides a strong foundation from which to start.


References

Blum-Dimaya, A., Reeve, S. A., Reeve, K. F., & Hoch, H. (2010). Teaching children with autism to play a video game using activity schedules and game-embedded simultaneous video modeling. Education & Treatment of Children, 33(3), 351-370.

Carlile, K. A., Reeve, S. A., Reeve, K. F., & DeBar, R. M. (2013). Using activity schedules on the iPod touch to teach leisure skills to children with autism. Education & Treatment of Children, 36(2), 33-57.

Carr, J. E., Nicolson, A. C., & Higbee, T. S. (2000). Evaluation of a brief multiple-stimulus preference assessment in a naturalistic context. Journal of Applied Behavior Analysis, 33(3), 353-357.

Chan, J. M., Lambdin, L., Van Laarhoven, T., & Johnson J. W. (2013). Teaching leisure skills to an adult with developmental disabilities using a video prompting intervention package. Education and Training in Autism and Developmental Disabilities, 48(3), 412-420.

Chazin, K. T., & Ledford, J. R. (2016). Free operant observation. In Evidence-based instructional practices for young children with autism and other disabilities. Retrieved from http://vkc.mc.vanderbilt.edu/ebip/free-operant

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(1), 15-25.

Google Search. https://www.google.com/search?q=define+leisure&ie=utf-8&oe=utf-8&client=firefox-b-1 (accessed February 5, 2017).

Graff, R. B., & Karsten, A. M. (2012). Assessing preferences of individuals with developmental disabilities: A survey of current practices. Behavior Analysis in Practice, 5(2), 37-48.

MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. (1993). Teaching children with autism to use photographic activity schedules: Maintenance and generalization of complex response chains. Journal of Applied Behavior Analysis, 26(1), 89-97.

Schneiter, R., & Devine, M. A. (2001). Reduction of self-injurious behaviors of an individual with autism: Use of a leisure communication book. Therapeutic Recreation Journal, 35(3), 207-219.

Toner, N. (2014). How do you figure out what motivates your students? Science in Autism Treatment, 11(1), 12-14.

Please use the following format to cite this article:

McCarron, M. (2018). Leisure skills for adults with autism. Science in Autism Treatment, 15(2), 19-26.


About The Author

Megan McCarron M.S., BCBA, LBA (CT) holds a Master of Science Degree in Child Development, is a Board Certified Behavior Analyst, and Licensed Behavior Analyst in the state of Connecticut. She has been in the field of autism treatment since 1992. Megan has experience providing services for children with autism in school, home and community settings. She has worked at Milestones Behavioral Services (formerly, The Connecticut Center for Child Development, Inc.) since 1999. During her time at Milestones, she has served in various capacities. She started out as an instructor and is now a Clinical Director. In addition to her responsibilities in and around Milestones, Megan presents lectures and workshops on autism and Behavior Analysis at local and national conferences.

Resources For Parents

This month’s ASAT feature comes to us from Peggy Halliday, MEd, BCBA. 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!

The following websites include milestones’ checklists, booklets, and a wealth of information to help parents become savvy consumers of autism treatment. The contributors are parent groups well as professional, medical, scientific, and legal and/or advocacy organizations which are available to meet the needs of families.

American Academy of Pediatrics (AAP) 

The AAP is an organization of 67,000 pediatricians committed to the well-being of infants, children, adolescents, and young adults. The AAP website contains recent information about autism prevalence, links to many external resources and training websites, information about pediatrician surveillance and screening, and early intervention guidelines. This site offers great tools and resources for both pediatricians and families. 

Association for Behavior Analysis International (ABAI) 

The ABAI is a nonprofit professional membership organization whose objective for education is to develop, improve, and disseminate best practices in the recruitment, training, and professional development of behavior analysts. ABAI offers membership to professionals and consumers, which entitles them to a newsletter and other benefits, including event registration discounts, and continuing education opportunities. 

Association of Professional Behavior Analysts (APBA) 

The APBA is a nonprofit professional membership organization that is focused on serving professional practitioners of behavior analysis by promoting and advancing the science-based practice of applied behavior analysis. Membership is open to professional behavior analysts and others who are interested in the practice of ABA, including professionals from various disciplines, consumers, and students. 

Association for Science in Autism Treatment (ASAT)  

The ASAT is a non-profit organization founded in 1998 “to promote safe, effective, science-based treatments for people with autism by disseminating accurate, timely, and scientifically sound information, advocating for the use of scientific methods to guide treatment, and combating unsubstantiated, inaccurate and false information about autism and its treatment.” To serve its mission ASAT provides a comprehensive website which includes Research Synopses of a vast array of autism treatments to help families and organizations make informed choices, as well as specific resources for journalists, medical providers, and parents of newly diagnosed children. ASAT also publishes a monthly online publication, Science in Autism Treatment, with over 12,000 subscribers from all 50 states and over 100 countries. ASAT has Media Watch Initiative that responds quickly to both accurate and inaccurate portrayals of autism treatment in the media, and an Externship Program which includes students, professionals, and family members.

Autism New Jersey (Autism NJ) 

Autism NJ is now the largest statewide network of parents and professionals dedicated to improving the lives of individuals with autism and their families. Since its establishment in 1965, Autism New Jersey’s mission has been to ensure that all individuals with autism receive appropriate services. Autism New Jersey is a nonprofit agency committed to ensuring safe and fulfilling lives for individuals with autism, their families and the professionals who support them through awareness, credible information grounded in science, education, and public policy initiatives. 

The Autism Science Foundation (ASF) 

As well as providing information about autism to the general public and promoting awareness of the needs of individuals and families affected by autism, the Autism Science Foundation’s mission is to support and fund scientists and organizations conducting research into Autism Spectrum Disorder. 

Autism Speaks 

Autism Speaks supports global research into the causes, prevention, treatments, and cure for autism and raises public awareness. The website contains information on resources by state, resources for families, advocacy news, and suggested apps for learners with autism. The Autism Speaks 100 Day Kit for Newly Diagnosed Families of Young Children was created specifically for families of children ages 4 and younger to make the best possible use of the 100 days following their child’s diagnosis of autism.  

Autism Wandering Awareness Alerts Response Education (AWAARE).

This organization has developed three “Big Red Safety Toolkits” to respond to wandering incidents: one for caregivers, one for First Responders, and one for teachers. They are free and downloadable from their website.

Behavior Analyst Certification Board (BACB) 

The BACB is a nonprofit corporation established as a result of credentialing needs identified by behavior analysts, state governments, and consumers of behavior analysis services. Their mission is to develop, promote and implement an international certification program for behavior analysis practitioners. The BACB website contains information for consumers (including a description of behavior analysis), conduct guidelines, requirements for becoming certified and maintaining certification, and a registry of certificants that can be searched by name or state. 

Cambridge Center for Behavioral Studies 

The Cambridge Center for Behavioral Studies website seeks to bring together knowledge and behavior analysis resources, a glossary of behavioral terms, online tutorials and suggestions for effective parenting. A continuing education course series is offered through collaboration with the University of West Florida and is designed to provide instruction in a variety of areas of behavior analysis. To utilize all of the features of the website, you must register.

Centers for Disease Control and Prevention (CDC) 

The Act Early website from the CDC contains an interactive and easy-to-use milestones’ checklist you can use to track how your child plays, learns, speaks, acts, and moves ages 3 months through 5 years. The milestones checklist is now available as a free downloadable tracker that follows your child’s progress. There are tips on how to share your concerns with your child’s doctor and free materials that you can order, including fact sheets, resource kits, and growth charts. 

Council of Parent Attorneys and Advocates, Inc. (COPAA) 

The Council of Parent Attorneys and Advocates is a national American advocacy association of parents of children with disabilities, their attorneys, advocates, and others who support the educational and civil rights of children with disabilities. The website provides important information about entitlements under federal law and is divided into resources for students and families, attorneys, advocates, and related professionals, and a peer to peer connection site. 

Council for Exceptional Children (CEC) 

The CEC is an international professional organization dedicated to improving the educational outcomes and quality of life for individuals with exceptionalities. The focus is on helping educators obtain the resources necessary for effective professional practice. Autism is one of many disabilities discussed. 

Education Resources Information Center (ERIC) 

Sponsored by the Institute of Education Services (IES) of the U.S. Dept. of Education, ERIC provides ready access to education literature to support the use of educational research and information to improve practice in learning, teaching, educational decision-making, and research. 

First Signs 

The First Signs website contains a variety of helpful resources related to identifying and recognizing the first signs of autism spectrum disorder, and the screening and referral process. A video glossary is useful in demonstrating how you can spot the early red flags for autism by viewing side-by-side video clips of children with typical behaviors in comparison with children with autism. First Signs aims to lower the age at which children are identified with developmental delays and disorders through improved screening and referral practices. 

Individuals with Disabilities Act (IDEA) 

IDEA is a law that ensures services to children with disabilities throughout the nation. IDEA governs how states and public agencies provide early intervention, special education, and related services to more than 6.5 million eligible infants, toddlers, children, and youth with disabilities. The IDEA website contains information on early intervention services, local and state funding, and Individualized Educational Plan (IEP) issues including evaluation, reevaluation, and procedural safeguards. 

The Interagency Autism Coordinating Committee (IACC)

IACC coordinates ASD related activities across the United States Health and Human Services Department and the Office of Autism Research. The IACC publishes yearly summary advance updates from the field of autism spectrum disorder.

National Autism Center (NAC) 

The NAC is a nonprofit organization dedicated to disseminating evidence-based information about the treatment of autism spectrum disorder and promoting best practices. Through the multi-year National Standards Project, the NAC established a set of standards for effective, research-validated educational and behavioral interventions. The resulting National Standards Report offers comprehensive and reliable resources for families and practitioners. 

National Professional Development Center on Autism Spectrum Disorders (NPDC) 

In 2014 the NPDC, using rigorous criteria, classified 27 focused interventions as evidence- practices for teaching individuals with autism. This website allows you to access online modules for many of these practices as well as an overview and general description, step-by-step instructions, and an implementation checklist for each of the practices. NPDC is currently in the process of updating the systematic review through 2017 as part of the Clearinghouse on Autism Evidence and Practice. It also has a multi-university center dedicated to the promotion of evidence-based practices for ASD. The Center operates three sites at UC Davis MIND Institute, Waisman Center, and the Franklin Porter Graham Child Development Institute at the University of North Caroline Chapel Hill. Each of these websites delivers a wealth of information including online training modules, resources, factsheets, and more.

NIH National Institutes of Health (NIH) 

The NIH, a part of the U.S. Department of Health and Human Services, is the primary federal agency for conducting and supporting medical research. Helping to lead the way toward important medical discoveries that improve people’s health and save lives, NIH scientists investigate ways to prevent disease as well as researching the causes, treatments, and even cures for common and rare diseases. 

The Ohio Center for Autism and Low Incidence (OCALI)

OCALI working in collaboration with the Ohio Department of Education, is a clearinghouse of information on autism research, resources, and trends. The OCALI website contains training and technical assistance including assessment resources and ASD service guidelines.

Organization for Autism Research (OAR) 

OAR is a nonprofit organization dedicated to applying research to the daily challenges of those living with autism. OAR funds new research and disseminates evidence-based information in a form clearly understandable to the non-scientific consumer. The OAR website contains downloadable comprehensive guidebooks, manuals, and booklets for families, professionals, and first responders.  OAR offers recommendations and worksheets for educators and service providers to assist in classroom planning, and a newsletter, “The OARacle.” In conjunction with the American Legion Child Welfare Foundation, OAR also offers Operation Autism for Military Families, a web-based resource specifically designed and created to support military families that have children with autism. 

Rethinkfirst 

Rethink is a global health technology company which provides cloud-based treatment too for individuals with developmental disabilities and their caregivers. Their web-based platform includes a comprehensive curriculum, hundreds of dynamic instructional videos of teaching interactions, step-by-step training modules, and progress tracking features.

Virginia Commonwealth University Autism Center for Excellence 

VCU-ACE is a university-based technical assistance, professional development, and educational research center for autism spectrum disorder in the state of Virginia. VCU-ACE offers a wide variety of online training opportunities for professionals, families, individuals with ASD, and the community at large. The website contains many useful resources, including a series of short how- to videos demonstrating particular evidence-based strategies, webcasts, and online courses. 

Wrights Law 

Wrights Law is an organization which provides helpful information about special education law, education law, and advocacy for children with disabilities in the USA. The Wrights Law website contains an advocacy and law library including articles, cases, FAQs and success stories, and information on IDEA. 

Zero to Three: National Center for Infants, Toddlers, and Families

This is a national, nonprofit organization which seeks to inform, educate, and support professionals who influence the lives of infants and toddlers. The organization supports the healthy development and well-being of infants, toddlers, and their families by supplying parents with practical resources that help them connect positively with their babies. They also share information about the Military Families Project, which supplies trainings, information, and resources for military families with young children. 

Please use the following format to cite this article:

Halliday, P. (2016 revised 2019). Consumer Corner: Some resources for parents. Science in Autism Treatment, 13(2), 27-31.


Peggy Halliday, MEd, BCBA, has served as a member of the Board of Directors of ASAT since 2010. She has been a practitioner at the Virginia Institute of Autism (VIA) in Charlottesville, Virginia since 1998. She oversees trainings for parents and professionals and provides consultation to public school divisions throughout Virginia.

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.

Curriculum Guides For Older Learners

This month’s ASAT feature comes to us from Dr. Kirsten Wirth, C.Psych., 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!

My child is older now and the early years curriculum guides we have used (e.g., the Assessment of Basic Language and Learning Skills-Revised (ABLLS-R) and Verbal Behavior Milestones and Placement Program (VB-MAPP)) are no longer appropriate. How should we plan for his future and current goals?

Answered by

Kirsten Wirth, C.Psych., BCBA-D

Wirth Behavioural Health Services

There may be some good curricula that can be used at an older age (e.g., Partington’s Assessment of Functional Living Skills (AFLS)).  Curricula like the AFLS include measuring basic living skills, vocational skills, home skills, community participation, and independent living skills.  That said, there are several reports that highlight areas to consider in programming for any individual.  Peter Gerhardt (2009) developed a paper that covers what services are available for adults with autism spectrum disorder (ASD) and considerations that should be made. The Drexel Autism Institute put out a report discussing transitions into adulthood (Roux, Shattuck, Rast, Rava, & Anderson, 2015). This question will be answered using information from both reports as well as clinical experience working with children and adults with ASD over the past 18 years.

Both reports highlight the importance of starting early.  For example, on average, transition planning and working towards future goals should begin by 14 years of age, although in some states this may happen earlier.  In many high schools and programs this type of planning happens much later, but the reason 14 years is recommended is because it can take several years to teach job or recreational skills, as well as any skills that need to be taught well before the ultimate desired outcome.  Also, more time allows for assessing and incorporating changing and developing interests over time. It is ideal that all these skills are incorporated into the students’ school program.  Skill areas may include planning for a vocation, post-secondary education, recreation and leisure, community safety, transportation, vacationing, health and wellness, sexuality instruction, handling crisis and interacting with first responders, daily living, and communication.

Where to start? Start by thinking and talking with the individual, family, and staff involved that know the individual best. Think about each area and explore what the individual might be interested in 5-10 years down the road as a team. Once all the ideas are jotted down, start discussing what should be chosen to target or to explore further. Keeping in mind you should weed out things that are not realistic but keep things that may be a stretch.  How do you know if it is realistic or not?  Having a detailed and current assessment of the individual’s abilities and skills is helpful.  For example, if an individual has intellectual and adaptive scores at or near the average range, a traditional college education may make sense and they may not need goals set in post-secondary education.  However, making friends and enjoying leisure and recreation may be an area of weakness so goals should be set in those areas.  As another example, if an individual has very low intellectual and adaptive scores, a college education may not make sense, but a part time job and skills around that job may need to be learned. Most importantly, goals should be set incorporating the individual’s existing skills, preferences, and interests.

Vocational goals: Is the individual able or interested in part-time or full-time work?  If he is still in school, can he work part-time?  What kind of work can he do independently right now?  What kind of work is he realistically capable of gaining skills in during the next 5-10 years?  Sometimes exploring different types of work through volunteer experience can be set up either with a one-on-one support person, or just on his own.  If skills need to be taught, how much should they be broken down for the individual to perform all skills independently?  Can all skills be taught at the same time or one at a time?  For example, if he is going to do custodial work at a local small hotel, this might include vacuuming the hallways; sorting, putting laundry through the washers, and folding; sweeping up the breakfast area; and making small talk or hanging out during breaks.  Each skill may need to be taught explicitly or not, dependent on the individual. Sorting laundry may include teaching matching skills and sorting skills before applying to daily life; or, many of these tasks could be taught by practicing in the school or leisure program on a regular basis.  Making small talk or engaging in conversation during break may require setting goals in social skills and communication areas as well. Taking direction from supervisors or others in authority and learning how to ask appropriate questions might be another area of consideration.  How will the individual get to work? Is he able to learn to drive a car to get himself there? Should a bus route and taking the bus be taught?  Driving or even using transportation might have multiple steps to learn, especially if there are construction detours, or changes to timing that would have to be checked regularly.  Do the vocational goals require further education?  Do money concepts have to be taught? Counting out change? Entering an order into a computer system?

Post-secondary Education goals: Does the individual have any special skills or strengths that should be considered?  Is the individual interested in a trade?  Business?  Graduate school?  If the individual could realistically perform a job in their area of interest down the road, do goals need to be set for pre-requisite subjects at the high school level – even if it may take longer to meet them – such that entry requirements can be met?

Recreation & Leisure goals: What kinds of interests does the individual already have during downtime?  Are interests limited?  Developing new preferences might be required. This might include providing repeated exposure to new places or activities to see if the individual enjoys them, or providing additional reinforcement for participating in them.  Do any barriers exist to participating in the new experiences?  Does any desensitization (e.g., exposure to certain sounds or experiences in the environment while preventing problem behaviour) have to occur before going on outings?  Are there refusals or problem behaviours to be decreased?  If so, goals should be set in those areas as well.  Does he or she need help with setting goals to earn a specific amount of money to go on a desired vacation or attend an event?  Does the individual have a regular group of friends to attend events or hang out with?  Do friendships need to be established?  Are social and communication skills related to making friends required to be learned first or during?  Should the individual get a ride with friends?  Take the bus?  Drive and offer to pick up friends?  Establish a meeting place at the event with friends?

As you may have noticed, many of the areas described above overlap with social and communication areas, transportation, and others. Goals naturally should be set in each area to appropriately encompass all skills needed in one’s day-to-day life. Remember the other areas as well; i.e., health and wellness (e.g., exercise, healthy eating, good hygiene), sexuality instruction (e.g., how to have sex, when to have sex, protection from disease and pregnancy), daily living skills (e.g., laundry, cooking, shopping), and so on. Happy planning!

References

 

Gerhardt, P.F. (2009). The current state of services for adults with autism. Arlington, VA: Organization for Autism Research.

Roux, A.M., Shattuck, P.T., Rast, J.E., Rava, J.A., & Anderson, K.A. (2015). National Autism Indicator Report: Transition into young adulthood, Philadelphia, PA: Life Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel University.


About The Author 

Dr. Kirsten Wirth (C.Pysch., BCBA-D) is a licensed psychologist and board certified behavior analyst-doctoral with a PhD in Psychology – Applied Behaviour Analysis (ABA) from the University of Manitoba. She is an Advisory Committee Member, Founder, and a Past President of the Manitoba Association for Behaviour Analysis (www.maba.ca). Dr. Wirth is the Co-Coordinator of Clinical Corner for the international organization, the Association for Science in Autism Treatment (www.asatonline.org). She is also the author of “How to get your child to go to sleep and stay asleep: A practical guide for parents to sleep train young children.” Dr. Wirth has 18 years experience working with children, adolescents, and adults, with or without developmental disabilities and autism using, teaching, and training others to use ABA. She provides screening and diagnostic assessment for children with autism, early intensive behavioural intervention (EIBI/ABA) programming to children with autism and their parents, or intensive behavioural intervention (IBI) for older children or adults with autism or developmental disabilities. Dr. Wirth also conducts assessment and treatment of severe problem behaviour, child behaviour management, parent coaching, sleep assessment and coaching, toilet training, social skills training, skill building, school or daycare consultation, and more, for children with or without psychiatric diagnoses. Dr. Wirth has been an invited speaker and presenter at local and international conferences and is a co-investigator of a number of research projects including comparison of comprehensive early intervention programs for children with autism and comparison of prevalence rates and factors related to delayed diagnosis.

Qualifications of Practitioners/Consultants who Practice ABA

This month’s ASAT feature comes to us from Sabrina Freeman, PhD, ASAT’s Consumer Corner Coordinator. 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!

It’s crucial to be a savvy consumer when it comes to one of the most important decisions you will make for your loved one with autism – choosing an ABA treatment provider for your child. Those of us who have already walked in your shoes know that all treatment providers are not the same. To the uninitiated, these professionals all look marvelous. From the slick websites, to the large numbers of associations of which these professionals are members, it is becoming increasingly difficult to differentiate between mediocre and outstanding treatment providers. Furthermore, publication of research in high quality journals is not synonymous with clinical expertise.

Fortunately, in this issue of Consumer Corner, we present a summary of consumer guidelines created by the Autism Special Interest Group (SIG) of the Association of Behavior Analysis International to help you make an informed choice when searching for ABA professionals to design, run and maintain your child’s program. A complete copy of the SIG guidelines are available here: https://3lvvdfmmeol12qpvw2c75ch6-wpengine.netdna-ssl.com/wp-content/uploads/2018/07/Final-Autism-Sig-Guidelines-Parent-Version-May-2018.pdf It is important to remember that your child’s future depends on highly quality consulting. Good luck!

 

  1. Certification:

Treatment professionals must all have advanced degrees, e.g., a Master’s Degree or a Doctorate in a relevant field of study, and be certified either by the Behavior Analyst Certification Board (BACB), or a board that has equal or higher level requirements than the BACB. To look up your consultant, visit: www.bacb.com and click on “Find A Certificant.” If the potential consultant is not on this list, ask where he/she became credentialed, and trained so that you can verify licensure and experience to determine whether it is equal to/or surpasses the standards of the BACB. If this individual responds to your inquiry in a defensive manner, then you may consider looking elsewhere as you are well within your right to seek clarification about certification status.

Find & Contact Certificants

  1. Extensive Hands-On Supervised Training:

Consultants are required to have extensive hands-on training treating children with autism in which they have worked at least one full year (1500 clock independent supervised hours or 1000 hours if taking a university practicum and 750 hours if taking an intensive practicum) under the supervision of a credentialed BCBA Certificant. In addition, they need to prove competency in many areas that cover the design and implementation of both individualized ABA interventions, and comprehensive ABA treatment programs. The partial list below was created by the Autism Special Interest Group (SIG) below. Your consultant should be competent in all the following areas:

  1. a) Design and implement individualized ABA Interventions
  • community living skills
  • functional communication skills (vocal and non-vocal)
  • “learning to learn” skills (e.g., looking, listening, following instructions, imitating)
  • motor skills
  • personal safety skills
  • play and leisure skills
  • pre-academic and academic skills
  • reduction of behaviors that jeopardize health and safety and impede successful functioning (e.g., stereotypic, obsessive, ritualistic, aggressive, self-injurious, disruptive, and other behaviors often described as “challenging”).
  • school readiness skills
  • self-care skills
  • self- management skills
  • social interaction skills
  • vocational
  1. b) Design and implement both comprehensive ABA intervention programs (using multiple ABA procedures to address multiple intervention targets) and focused interventions (using one or more ABA procedures to address a small number of intervention targets).
  2. c) Delivering ABA interventions directly to at least 8 individuals with autism who present with a range of repertoires, levels of functioning, and ages.
  3. d) Implementing the full range of scientifically validated behavior analytic procedures, including but not limited to:
  • reinforcement (including differential reinforcement)
  • extinction
  • discrete-trial procedures
  • modeling (including video modeling)
  • incidental teaching and other “naturalistic” methods
  • activity-embedded intervention
  • task analysis
  • chaining
  • activity schedules
  • scripts and script fading
  • prompting and prompt-fading
  • errorless training
  • error correction
  • motivating operations
  • stimulus control
  • preference assessments
  • choice
  • augmentative and alternative communication training procedures.
  1. Continuing Education:

Not only do behavioral consultants need to be trained as above, in order to maintain their certification, practitioners must also pursue continuing education in a variety of areas that may include, but are not limited to, Applied Behavior Analysis.

Red Flag

These practitioners should not be working collaboratively with professionals who implement an eclectic mix of interventions that are untested, discredited or experimental in nature. If the consultant you use endorses an eclectic approach, understand that this practice is inconsistent with the BACB Guidelines for Responsible Conduct for Behavior Analysis. This red flag is a particularly helpful way to be forewarned about a consultant who is not a good choice to design and maintain your child’s program!

 

Managing a Home-Based ABA Program

This month’s ASAT feature comes to us from Beverley Sharpe, a founding member and Director of Families for Early Autism Treatment of B.C. 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!

We have a home-based intervention ABA program for our son. What are some helpful suggestions for managing the steady stream of professionals in our home?

Answered by Beverley Sharpe, parent of a 22- year-old daughter with autism

Opening your home to therapists, behavioral consultants, and other providers is part of effective treatment for your child. However, it can sometimes be difficult to supervise a home that doubles as a work environment and the many opportunities and challenges that come with that arrangement. I am humbled by the high level of energy and dedication my therapy teams, past and present, have demonstrated within my own child’s program. Teamwork and collaboration are crucial elements to make home therapy effective. The following are some helpful tips I’ve learned over the years to help make home team coordination more manageable.

Be a Good Host/Hostess

I have struggled at times to balance being a “boss” and a “hostess” within my home. At the start of a shift, I recommend a five-minute exchange to greet and debrief the provider. No matter what job one has, people deserve to be acknowledged and greeted. I typically put on the tea pot or provide a cold drink, say hello, debrief, then let the provider begin the shift. With a new provider, I allow more time for him or her to set up materials, reinforcers, and data sheets before bringing in my child.

Define Your Expectations of Those Who Work with Your Child

An agency that provides home-based intervention will have a written job description or list of expectations for employees. If you are not working with an agency but are, instead, hiring and training your own team, please take the time to put important expectations in writing. Being on time, completing data sheets, communicating about behaviors observed, being prepared for shifts (including bringing appropriate task and reinforcer materials), and respecting other family members are examples of appropriate expectations.

Get Feedback from Staff

Over time I learned to explain to the team that it is hard for me to be both a boss and a friend. I truly did want to be a good listener, and at the same time a good manager of the team. I enjoyed the one-on-one time at the beginning of a shift with each provider and would ask, “How are you?” and “How are you finding the work with my child?” Their answers inspired me to make changes to the program, address issues with the behavioral consultant, and work on team building during team meetings that became more frequent when my daughter’s inappropriate behaviors became challenging.

When conflicts of any kind arise, talk about it and clear the air so that tensions or misunderstandings do not fester. Speaking about problems factually, face-to-face, with a hot cup of tea or coffee is a strategy that I have used. Also, I would make sure my daughter was engaged in an activity before starting the conversation. Remember, you can control yourself, your communication style, and the environment when you address an issue. Being respectful, honest and kind are great ways to be sure you have done your best to address issues. In my experience, new directions have come from allowing members of the team to share their perspective with you. Your child’s quality of life depends on effective intervention, and a home that is warm and inviting to the hard working providers who share your vision will help your son realize his fullest potential.

Keep in Touch with Former Providers

Email has enabled me to keep in touch with some of the former providers who have worked so hard with my child. One of Allison’s former providers is now professionally trained in hairdressing. Every year before Christmas this provider comes to our home to gift Allison a Christmas haircut! I love the expression, “Friends are like stars, you can’t always see them, but you know they are there.” I think of all past and present providers as being Allison’s stars, not all providers will maintain relationships with the family. The reality of employing people in your home is that some will choose, for reasons of their own, not to stay in touch with you or your child. Don’t take it personally. Life happens to everyone! Also, keep in mind that agencies may have policies forbidding contact outside of the current professional relationship.

Acknowledge Other Siblings in the Household

Shortly after putting together my first therapy team in 1997, I realized I had to address the issue of acknowledging siblings in the household. My daughter, Allison, who was receiving services in the home, was 3 years old at the time. She had a big brother, Jackson, who was 5 years old. Jackson came to think of it as normal that he would have to move from one room to another when Allison’s therapy sessions were in progress. He was always good-natured about this. I wanted to keep big brother Jackson involved with sessions, as appropriate, to help him feel more involved, instead of just frequently displaced. For example, turn-taking was a wonderful way to involve Jackson, as was the “Go Find” program.

I also reminded providers to acknowledge Allison’s brother whenever possible. I reminded them that a simple and genuine greeting will go a long way with his cooperation in the house! This helped to make Jackson’s cooperation more likely when he was asked to move to another room during a therapy session. Also, Jackson was taught to ask a provider, “What can I do to help my sister today?” when a provider started her shift. This simple act facilitated Jackson’s knowledge of his sister’s abilities, and gave him a lot of pride when he was able to tell his friends that he was helping his sister to learn! Big brother Jackson then became a big help during sessions by moving and sharing his play toys, games and puzzles and allowing space for his sister and her therapy team. Always remember, siblings are part of the household that supports the learning of the child!

Recognize That Housekeeping Is Important

Remember, your home is a provider’s work environment. I do my best to clean and tidy the therapy area before tackling any other room in the house on cleaning days. I also do a quick check of the bathroom area before sessions, as everyone appreciates a clean washroom! I make sure therapy notes, bulletins, communiqués are all neatly on their clipboards. I also make sure that my child is clean and presentable for the shift. Finally, I make sure that there is an “outing fund” with money for community activities. If my child worked towards a reward of an outing to the zoo, Dollar Store, or movie theatre, I wouldn’t want the lack of funds to delay the delivery of that reinforcer. Make sure your team knows to keep receipts for outings which are approved by the behavioral consultant and yourself. Also, remember to reimburse bus fare or gas money for a provider. Agencies will likely already have a policy in place for travel expenses as well.

Be a Good Employer, Which Means Advocating for Your Staff

Therapy time does not equate to babysitting. I had to correct a few well-intentioned neighbors who referred to my providers as babysitters. When my child is in the community, grocery shopping, at a gymnasium, or at work experience, these hardworking men and women are providing therapy, not just watching or transporting my child. Providers are important members of your child’s medically necessary treatment team. Correct misconceptions by family and friends along the way. Many family and friends may not be familiar with this type of therapy or treatment and may need some educating about the purpose and format of a home-based intervention based on applied behavior analysis. This education can help preserve the dignity and respect of your child, your team, and the discipline of applied behavior analysis for autism.

Stay in the Home During Therapy Time

For insurance purposes, many agencies require that a provider not be left alone in your home. Providers work in your home and deserve a safe and respectful environment. This means that a parent must remain in the home during a therapy session. This can be helpful for routine questions and support as well as in case of any emergencies.

Set Clear Expectations Around Cell Phone Use

The abundance of cell phones means that providers and families can be in real-time communication for shift or program issues relating to the child. However, they can also be a distraction from active treatment and supervision of my child. This has occasioned another hiring criteria for being on my child’s treatment team: Cell phone use for anything other than communication about the child, on their shift, is not acceptable. Cell phone games, texting, social media, and other social messaging are not acceptable. Even the ten seconds (as stated by one provider) it takes to text back to a friend means you are disengaged, not observing, and not “on” with your client – my child. Cell phone use expectations must be made clear from the very beginning and reiterated as needed.

Gift Giving

Holiday time was always a tough time at my home. In British Columbia, there was zero funding for autism treatment when I started my daughter’s program in 1997. I wanted to give tokens of appreciation to my daughter’s home treatment team for the holiday season. My budget was beyond tight, but homemade cards were always appreciated. One family I knew put together a cookbook of favorite home recipes for their home team; another family made a huge holiday dinner, in conjunction with a team meeting, to thank their team. There is always a way to say thank you to your team that is respectful of one’s budget.

Please note that many agencies and ethical guidelines for behavior analysts have strict policies around gift exchange and it is often not permitted. Check with your agency and your providers if you have any questions around this topic. And please do not be offended if a member of your team is not able to accept a gift.

Use Different Cultures and Celebrations as Learning Opportunities

We took the opportunity to learn about different religious holidays when one of our providers shared that she was Jewish. This was a wonderful learning opportunity for everyone on the team. We even made a card for the start of the Jewish New Year – Rosh Hashanah. Over the years, my daughter’s providers brought the wonderful gifts of sharing their religious holidays, culture, and favorite recipes that have enhanced our lives!

Making birthday cards for therapy team members gave my child the opportunity to use pencil and coloring skills, printing skills, and to sing the “Happy Birthday” song. All of these skills took a long time for acquisition. However, after all the hard work, to see my daughter use her skills to put a smile on her providers’ faces was priceless. To hear my child use her voice (she was non-verbal for the first 6 years of her life), and to hear her sing Happy Birthday – well, it is a win-win situation!

With a therapy team, it is a wonderful opportunity to have a simple celebration for each of the several birthdays throughout the year. My child learned that birthdays are for others as well as for herself. This learning extended to teaching big brother Jackson that every time we celebrate a birthday, he does not always get a present!

As our programs progressed, our behavior consultant added a cooking and baking program to help include both children in all household birthday celebrations for family members and members of the treatment team. The beauty of a cooking program was that skills, such as: counting, measuring, mixing, pouring, baking, decorating with icing, and washing and putting away dishes, were all “taught” in a fun way. This was a very detailed program with the huge reinforcer of getting a tasty item to eat at the end of completing a recipe!

In Summary

Managing an ABA treatment team in your home can be challenging but can be rewarding as well. There are many things you can do to help the team work well together and be effective in providing your child with the services he or she needs and deserves. Remember, it’s a learning process for all!

Please use the following format to cite this article:

Sharpe, B. (2017). Clinical corner: Managing a home-based ABA program. Science in Autism Treatment, 14(3), 17-20.


About The Author 

Beverley Sharpe is a founding member and Director of Families for Early Autism Treatment of B.C. (FEATBC). Bev’s daughter Allison was diagnosed with autism twenty years ago and Bev became an advocate for effective autism treatment. She was a member of the Legal Steering committee for the Canadian landmark decisions (Auton and Hewko) regarding autism treatment. Bev participates in new parent intake, political lobbying, fundraising, and speaks regularly with parents regarding advocacy in the school system. She also helps new parents access funding for 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.

Explaining Decision to Use Science-based Autism Treatments

This month’s ASAT feature comes to us from David Celiberti, PhD, BCBA-D and Pamela Feliciano, PhD. 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 have decided to rely on science-based treatments for my child with autism. Now, how do I explain this to friends and relatives who insist I try something “cutting edge?”

 

We certainly respect any individual’s right to his or her own opinion, and certainly for parents of children with autism to make decisions for their child regarding treatment; however, we believe that scientific evidence and the use of objective data should guide treatment options for all diseases and conditions, and autism is no exception. The late Senator Patrick Moynihan eloquently said, “Everyone is entitled to their own opinions, but not their own facts.” It is simply a matter of fact that theories, hypotheses, and testimonials do not provide adequate information to guide treatment decisions.

When friends or acquaintances hear about our experiences with autism, quite often the first thing they ask is, “What is your opinion of vaccines?” despite the retraction of Andrew Wakefield’s article by the Lancet (a very rare occurrence by this highly reputable journal). Sadly, the vaccine debate has long distracted the autism community from important discussions such as how best to help children already diagnosed with autism realize their fullest potential and live a happy and meaningful life.

In an ideal world, all treatment providers would make a commitment to science and evidence-based practices, and all members of the journalism community would make a commitment to responsible journalism. Until these ideals become the norm, those who do understand science-based treatments must do what they can to inform and educate others about the benefits of scientifically validated treatment, and the use of data to guide decision-making when assessing the benefits of any and all treatments.

Although applied behavior analysis is the treatment for autism with the most scientific support, we are rarely ever asked our opinion of this therapy, or if it is effective. Instead, every few months or so, some “new” treatment (or “repackaging” of a known treatment) will gain the attention of consumers. Given the large numbers of television reports, newspaper articles, blogs, and websites putting forth “miracle cures” and “breakthroughs,” it is not surprising that parents frequently receive advice and suggestions from extended family members, neighbors, and co-workers, particularly after a news item is broadcast, printed, or otherwise disseminated. Many of these individuals have the best intentions and are eager to share what they believe is “cutting edge” information about autism. In other cases, the advice is sometimes provided in a manner that comes across as critical of what you are choosing to do or not do for your child (i.e., it may be implied that you are not doing enough as a parent to help your child with autism).

If the information is offered by a more casual acquaintance, it may be best to simply thank him or her for their interest and concern and move on; however, such a strategy may not fare as well with individuals with whom you have a closer relationship. In these cases, you might consider sharing the following:

     • There are dozens of “miracle cures” and “breakthroughs” (i.e., pseudoscience) for autism that manage to receive widespread media attention, even if they have not been proven effective. In fact, there are over 500 treatments touted to address autism;

     • It is important to be critical of all available information, regardless of the source, and to recognize that not all information on the Internet is reliable and accurate;

     • There is a large body of scientific research published in peer-reviewed journals and carried out by hundreds of researchers that supports the choices that you have made;

     • Numerous task forces (some are listed at the end) have looked closely and objectively at the available research and have determined that the vast majority of autism treatments lack any scientific support and, in fact, some may be harmful;

     • Autism treatment is a multi-million dollar industry, and many treatment proponents rely heavily on sensationalism and extraordinary claims to “sell” their products;

     • Interventions that are actually shown to be the most effective often receive the least amount of media attention; and

     • For most other medical conditions, a provider that disregards proven intervention and uses a fringe treatment may actually be sued for malpractice (you may even consider drawing an analogy to a medical condition of particular interest to the person providing the advice).

Of course, you may also consider addressing this matter proactively. This would involve clarifying your choices and commitment to science-based treatment to more significant family members and friends on your terms and at your convenience. It may be helpful to view this tactic as a series of tiny conversations. You may even consider sharing links to websites such as the Association for Science in Autism Treatment (ASAT), which will help your family members and friends separate the wheat from the chaff. We would like to draw your attention to a few sections of ASAT’s website that bear relevance to this discussion.

     • Learn more about specific treatments

     • Summaries of published research articles

     • Making sense of autism treatments: Weighing the evidence

     • Recommendations of expert panels and task forces

Finally, ASAT’s newsletter, Science in Autism Treatment, is a free publication, so encourage your friends and family to subscribe.

It is our hope that the information shared above may help your friends and family better understand the role that science should play in the treatment of autism, the need for objective data to drive decision making, how to better identify pseudoscience, and perhaps most importantly, why parents must be such savvy consumers.


David Celiberti, PhD, BCBA-D 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.

Pamela Feliciano, PhD, joined the Simons Foundation in 2013 and serves as the scientific director of SPARK (Simons Foundation Powering Autism Research through Knowledge) and is a senior scientist at SFARI. SPARK is a SFARI initiative that seeks to accelerate autism research through a vibrant and informative online platform (SPARKforAutism.org). Previously, Feliciano worked as a senior editor at Nature Genetics, where she was responsible for managing the peer review process of research publications in all areas of genetics. Feliciano holds a B.S. from Cornell University, an M.S. from New York University and a Ph.D. in developmental biology from Stanford University. Feliciano is also the mother of an adolescent boy with autism spectrum disorder.

How to Manage the Impact of Child with a Disability on Siblings

This month’s ASAT feature comes to us from Mary Jane Weiss, Ph.D., BCBA-D,LABA and Nicole Pearson, 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!

 

I am a mother of three children, one of whom has autism and requires a tremendous amount of time and care. I worry about how this is impacting my other children, both of whom are a few years older and are very aware of how our family has changed as a result of their sibling’s diagnosis. Do you have any advice on how to best address this with them?

Answered by: Mary Jane Weiss, Ph.D., BCBA-D,LABA
Professor of Education and Director of Programs in Autism and Applied Behavior Analysis, Endicott College and
Nicole Pearson, BCBA-D
Founder, West Side Behavioral Associates

Having a child with autism spectrum disorder inevitably impacts the entire family. From the stress and anxiety that accompanies the initial diagnosis to the time-intensive nature of navigating treatment options and providers, raising a child with autism presents unique challenges for parents. It can also present challenges for siblings as the sibling relationship is inevitably different from that of typical siblings. And while many of these differences can be positive and rewarding, it’s important for parents to be aware of the needs of siblings so that they can provide meaningful guidance and support.

While children of younger ages may not be fully aware of their sibling’s disability, they likely detect parental stress, perceive inequities in the amount of time and attention given and struggle with a sense of disruption in overall family life (Feiges & Weiss, 2004; Smith & Elder, 2010). As children age and their awareness grows, siblings may experience adjustment difficulties. These difficulties are influenced by such factors as sibling age and gender as well as family size. Siblings closer in age to the child with autism, and those who are younger and have not yet developed effective coping strategies can be more affected. However, as a parent, there are many strategies you can take to support sibling coping and adjustment.

Foster a supportive environment at home: Siblings are often aware of how different their experiences are from that of others, especially their friends. As a result, they may feel many emotions, including fear, anger, embarrassment, resentment and guilt, among others. Encouraging an environment of open communication allows the sibling to safely express negative emotions and frustrations. Listen to and reassure your child that it’s okay to have these feelings, and offer suggestions on how to work through them together. Doing so also helps with positive coping and establishes a foundation for good familial communication and problem solving.

Further, as siblings become aware of such differences, they will likely look to their parents and family members for guidance. Thus, parent coping and adjustment play an important role in sibling adjustment. As such, it is important for parents to be cognizant of the impact their actions, behaviors and decisions will have on all of their children.

Ensure your child understands what autism is: Parents sometimes overestimate their typical child’s understanding of autism as the child may be able to explain what it is without fully comprehending it. They may also pick up on information they overhear but likely have more questions than answers. Making sure that siblings have developmentally-appropriate information will help reduce their fears and misconceptions (Glasberg, 2000; Harris & Glasberg, 2003). These explanations can go a long way in influencing how siblings view and interact with their sibling with autism and how well they are able to explain autism to their peers.

When speaking with children under age nine, parents should keep explanations brief and frame the sibling with autism’s deficits in the context of having not yet learned or mastered particular skills, such as playing with others or communicating in ways that other children do. For example, saying, “Your sister learns a bit differently than you and me, so she needs extra help” or “Your brother may not be able to talk but we are teaching him other ways to show us what he wants to say.”

As children age, explanations can be more involved, such as sharing that autism is a problem in the brain and that it presents differently in each child. Depending on the extent of the child with autism’s behavioral problems, it may be necessary to help the sibling understand why they’re occurring and their role in behavioral escalations. Such escalations can be scary, embarrassing and disruptive for typical siblings so providing them with clear explanations can help alleviate some of these feelings. Regardless of the children’s age, parents should offer reassurance (especially of safety) to typical siblings, and convey love and acceptance of everyone in the family.

From a timing perspective, starting to discuss autism with siblings at an early age can be helpful, especially before they begin school or start having friends over. That way, they can be prepared with information about how to explain what may appear to be usual or different behavior in their sibling with autism. There are several free online resource guides available:

• Autism Speaks offers a “Siblings Guide to Autism” toolkit designed for siblings ages 6-12 that parents and siblings can read together to learn more about autism and facilitate conversation about it
• Organization for Autism Research’s “Kit for Kids” offers an illustrated booklet for elementary and middle school students, called “What’s up with Nick?” and “Autism, my sibling, and me”

Promote meaningful relationships between siblings: While every sibling relationship is special, the communication and socialization deficits inherent in autism diagnoses can make sibling bonding more difficult. Creating opportunities for younger children to play together or helping older siblings to find common interests, even if it’s as simple as doing a puzzle together or playing a video game, can go a long way in increasing the quality and quantity of interactions and ultimately building sibling bonds.
Another way to foster meaningful relationships between siblings is to teach your typical children how to be mentors to their younger sibling with autism. Doing so can be very fulfilling for siblings and promote feelings of self-efficacy and nurturing. It also creates opportunities for siblings to engage with one another socially and have positive interactions with their sibling with autism. Prior to starting, make sure that your typical children understand their sibling with autism’s skills, preferences and interests and start with easy tasks to ensure success. Such tasks might include modeling how your typical siblings can engage in simple toy play or teach their sibling with autism a basic daily living skill like putting on a coat or how to wash hands. Other skills that can be useful to teach include:

• how to get your sibling with autism’s attention,
• how to provide praise and reinforcement when he does well,
• how to assist him when he cannot do something,
• how to help him stop playing and clean up.

Build in one-on-one time for each sibling and foster individuality: Siblings are inevitably affected by the inordinate amount of time, energy and resources that are spent caring for their sibling with autism. Further, activities common in typical family life such as all spending time together, going to a movie or on vacation may be more limited. While inequities exist in all families, they are intensified in a family who has a child with autism. And if typical siblings feel dissatisfied with these inequities, their relationship with their sibling with autism is negatively impacted (Rivers & Stoneman, 2008). To help minimize the impact of these inequities, it’s important to make time for one-on-one interaction with each sibling. While this can seem difficult in the throes of managing busy schedules and the demands of therapies, carving out even a small amount of time where you’re giving your child your undivided attention can go a long way. So whether its running errands together or going for pizza, make time to check-in with your other children and let them know that even though they may not always get as much attention as their sibling, they’re loved and cared for equally.

And while having a child with autism is a 24/7 commitment, helping to foster distinct roles and interests in each child can further reduce the stress that siblings may feel. Encourage siblings to get involved in sports, clubs or other community activities where they can develop relationships with peers and just have fun. Doing so allows them the time and space to be their own person and establish a sense of individuality not defined by their sibling with autism (OAR, 2014). Ultimately, it may also make siblings more available to enjoy spending time with their sibling with autism.

Consider additional sources of support: Finally, sibling groups can be a helpful source of support. They provide siblings the chance to meet and speak with others who are going through similar experiences and can give them accurate and age-appropriate information about autism. Often these groups can help reduce fear and misconceptions among siblings as well as the feelings of isolation many experience. If a support group isn’t readily available within your children’s school or your community, consider looking at some of the following resources for more information:

Sibling Support Project – offers more than 475 community support programs, called SibShops, for younger siblings of children with special needs.
Online resources: There are several online communities for siblings, both teens and adults:
     o      SibTeen, an online Facebook group for teen siblings: https://www.siblingsupport.org/connect-with-others-sibs/meeting_other_sibs_online/sibteen
     o     SibNet online forum for adults: https://www.siblingsupport.org/connect-with-others-sibs/meeting_other_sibs_online/sibnet

The Organization for Autism Research (OAR) has also developed the “Autism Sibling Support Initiative” offering helpful resource guides for young children, teens and parents.

While much is often said about the challenges faced by siblings of people with autism, there are also substantial positive outcomes. Most siblings who reflect on the experience in adulthood attribute their high levels of compassion, tolerance, patience, and concern for others to having had a sibling with special needs. Furthermore, many of them develop a sense of mission and enter helping professions.

There is no universal description of the ways in which this role changes the lives of siblings of children with autism. And every sibling pair is on their own unique journey. But while this is a role that is not chosen by the sibling, it is a role that most siblings truly embrace. Parents can help their typically developing children by creating an environment of transparency and openness about autism and about issues arising in the family associated with it. They can help siblings find effective ways to interact with their brother or sister with autism, and can foster mentorship roles for them with their sibling. Parents can also ensure that every child in the family gets needed attention and permission to pursue their own dreams. Finally, they can remember that most siblings of children with autism end up being compassionate human beings who treasure their sibling and who note both the struggles and the strength that the family experienced as a result of being touched by autism.

Note: This submission was adapted from Drs. Weiss and Pearson’s book chapter, “Working effectively with families of children with autism spectrum disorders: understanding family experience and teaching skills that make a difference” which appeared in “School success for kids with autism.”

References:
Feiges, L.S., & Weiss, M.J. (2004). Sibling stories: Growing up with a brother or sister on the autism spectrum. Shawnee Mission, KS: Autism Asperger Publishing Company
Glasberg, B.A. (2000). The development of siblings’ understanding of autism and related disorders. Journal of Autism and Developmental Disorders, 30, 143-156.
Harris, S.L., & Glasberg, B.A. (2003). Siblings of children with autism. Bethesda, MD: Woodbine House.
Organization for Autism Research (OAR). (2014). Brothers, sisters and autism: A parent’s guide to supporting siblings. Retrieved from: http://www.researchautism.org/family/familysupport/documents/OAR_SiblingResource_Parents_2015.pdf
Rivers, J. W., & Stoneman, Z. (2008). Child temperaments, differential parenting, and the sibling relationships of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 1740-1750.
Smith, L. O., & Elder, J. H. (2010). Siblings and family environments of persons with autism spectrum disorder: A review of the literature. Journal of Child and Adolescent Psychiatry Nursing, 23, 189-195.
Weiss, M. J., & Pearson, N. K. (2012). Working effectively with families of children with autism spectrum disorders: Understanding family experience and teaching skills that make a difference. A. L. Egel, K. C. Holman, & C. H. Barthold (Eds.). School success for kids with autism. Waco, TX: Prufrock Press.

Please use the following format to cite this article:
Weiss, M. J. (2016). Clinical Corner: How to Manage the Impact of Child With a Disability on Siblings. Science in Autism Treatment, 13(2), 22-26.


Mary Jane Weiss, Ph.D., BCBA-D, LABA is a Professor at Endicott College, where she directs the Master’s Program in ABA and Autism and is a mentoring faculty member in the Doctoral program. She also does research at Melmark. Dr. Weiss has worked in the field of ABA and Autism for over 30 years. She received her Ph.D. in Clinical Psychology from Rutgers University in 1990 and she became a Board Certified Behavior Analyst in 2000. She previously worked for 16 years at the Douglass Developmental Disabilities Center at Rutgers University, where she served as Director of Research and Training and as Clinical Director. Her clinical and research interests center on defining best practice ABA techniques, exploring ways to enhance the ethical conduct of practitioners, evaluating the impact of ABA in learners with autism, teaching social skills to learners with autism, training staff to be optimally effective at instruction, and maximizing family members’ expertise and adaptation. She serves on the Scientific Council of the Organization for Autism Research, is on the Professional Advisory Board of Autism New Jersey, is a regular reviewer for a variety of professional journals, and is a frequent member of service committees for the Behavior Analyst Certification Board. She is also a Past President of the Autism Special Interest Group of the Association for Behavior Analysis International, a former member of the Board of the Association for Professional Behavior Analysts, and a former Vice President of the Board of Trustees for Autism New Jersey.

Dr. Nicole Pearson is a licensed psychologist and Board Certified Behavior Analyst (BCBA-D) who has specialized in working with individuals with autism and other developmental disabilities for almost a decade. Dr. Pearson received her initial training in Applied Behavior Analysis (ABA) at the Alpine Learning Group and went on to work in a number of other public and private educational settings, including NYC Autism Charter School where she served as Director of Education. She has also worked with autism programs internationally in Kenya and the Maldives. Most recently, Dr. Pearson served as a Behavioral Psychologist at St. Mary’s Hospital for Children, working with children with complex medical needs and training clinical staff in treatment protocols. She holds Masters and Doctoral degrees in Psychology from Fairleigh Dickinson University and a BS in Business Administration from Villanova University.

Setting Up the Classroom to Optimize Learning Opportunities and Effective Instruction

This month’s ASAT feature comes to us from Melissa Taylor, BCaBA. 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 recently accepted my first teaching position.  It’s a new classroom for the district serving students with autism. I have lots of materials, but nothing is organized or set up in my classroom. What are some tips to set up and organize the classroom to optimize learning opportunities and effective instruction?

Congratulations on your first teaching position! This is a common question for new teachers. When we talk about classroom organization, there are several things to take into account. Good classroom organization effectively makes use of space and barriers, has accessible materials for instruction and data collection, and facilitates efficient time management. It is critical that when you set up your classroom, you review the needs of your individual students as well as make sure to address the core characteristics of autism. You probably already know that many of your students will present with deficits in social interactions and communication, including challenges with requesting items from adults and peers. It will be important to create an environment that makes it necessary for students to interact frequently with other people to increase communication opportunities.  Once the environment is conducive to optimizing instruction, the instructors can implement effect behavioral strategies to teach desired behaviors.

Organizing the Space

Seating. When organizing a space, we want to make sure that the seating arrangement will allow students to access the materials needed for activities and respond accurately to instruction. For younger students, make sure the chairs allow their feet to touch the floor. Likewise, older students should be able to sit up straight with feet on the floor and legs at approximately 90-degree angle. Try to arrange seating so that you have space for group, as well as individual sessions. Also, allow enough room that additional support staff can sit behind students to make prompting less intrusive (e.g., sitting behind student and using physical guidance to help them learn the expected motor responses during the, “Wheels on the Bus” song).

Pathways for transitions. The furniture should be set up in a way that enables smooth transitions from one area to another without traffic jams. Walking between areas will be easier if there are not large dividers or barriers that slow down transitioning. Having open spaces and clear pathways between defined areas could also allow instructors to move quickly to different areas of the classroom if there is an episode of problem behavior or an unexpected opportunity to support a social interaction.

Defining areas. Some instructors find that using dividers helps clearly separate sections of the classroom. Keep in mind that every area should be open enough that the classroom teacher is able to see every student and classroom assistant. This will allow the teacher opportunities to provide immediate feedback to staff on interactions with students and to offer frequent student praise.  Try to avoid tall dividers that make it impossible to see into the other areas and dividers that are easily knocked over. Shelving units, desks, carpets, and tables can create more natural space dividers that can help define the areas. Keep in mind the function and purpose of each classroom area, and make sure that the instructional materials needed are in the area and replaced as needed. For example, if students are going to be required to request items during circle time, those items should be easy for the instructor to reach during group rather than requiring the instructor to get up, leave the group and look in a cabinet for items.  

Putting away preferred items. Children, including those with autism, are often good at finding and gaining access to the things they like without the help of other people. By keeping items out of reach, in clear containers that are difficult to open, and on high shelves, you can create new requesting opportunities and make communication with adults more valuable to students. Resalable plastic storage bags, totes, bins, shelving units, and aprons with pockets may all be useful to make it more likely that the students will need to request help from others to access the items they want or need. If the student already has a valuable item, you have lost an opportunity for communication.  By restricting access to valuable items, teachers can prompt requests for specific items and deliver items to students. Furthermore, when delivering the item, the teacher becomes more valuable to the student, who learns the significance of communicating. When these types of natural communication trials with preferred items occur in areas where instruction will occur, it becomes more likely that students will approach instructors and instructional areas. One important consideration with using such materials that in some cases, direct visibility to highly preferred items can be distracting to students or result in attempts to retrieve items outside of appropriate or scheduled times. In such instances, evaluate the situation and determine whether moving the student’s seat so that it is not facing those items or moving the items themselves will address the issue.

Organizing Materials

Materials for data collection. In preparing materials for instruction, we want to make sure that all instructors have easy access to necessary materials such as data collection tools and sheets. These items should be able to be easily accessed at any point of the day, so that instructors are more likely to capture all opportunities of the behaviors they are tracking. When data are recorded immediately following student behavior it is more likely to be accurate. Clipboards that have pockets attached to them are good for storing writing utensils, timers and additional data sheets. Student item lists, teaching stimuli, and data sheets can be kept in a cart with drawers to make it easily accessible during teaching. When collecting any type of data that require instructors to count the number of occurrences of a behavior, instructors can use clickers attached to their clothing with carabiner clips for convenience. Blank student specific datasheets can be carried with the student on clipboards, kept in a drawer on a cart, or hung on bulletin boards in centers where instructional activities occur.

Materials for instruction. Pencil cases or small craft boxes help organize small materials such as pieces of edibles, small toys, pencils, highlighters, picture cards, visual schedules or index cards for instruction.  For larger instructional items such as toys needed for teaching imitation skills, items needed for simply following direction tasks, or items needed to teach daily living skills, boxes, rolling carts with larger drawers, or labeled shelves can be used to organize materials by student or goal areas.

Consider posting wall cues, table/desk cue cards, or other reminders in places where staff will easily see them. These cues can be helpful to guide instruction without the need to flip through pages in consultation notes or program books to reference procedures. Types of items to post include specific teaching protocols and prompt hierarchies, reinforcement schedule reminders, behavior management strategies, toilet training schedules, reminders of how to teach play skills and student to student requesting, or other items that you want to generalize from one classroom area to another. Cue cards, wall cues, or student data sheets with specific targets listed can also guide instructor presentation during less structured teaching opportunities.  For example, if the student has been working on labeling the picture of gloves, and during circle time the teacher is dressing a weather bear, the instructor can ask that student to label the weather bear’s gloves. Additional targets to be posted for staff could include specific peer-to-peer requests or interactions (e.g., give item to peer, accept item from peer), specific motor skills (e.g., copying a line, opening a container), self-help skills (e.g., putting on shoes, washing hands), and other activities.  This allows for easy implementation of strategies such as natural environment teaching and incidental teaching.  Another point is to consider limiting other “wall clutter” that often serves as highly distracting stimuli to students. When possible, keep to salient items such as a classroom schedule, current student work or points of study (e.g., pictures of alphabet) but don’t feel the need to cover every available space with something!

Classroom Schedule

Time is valuable, and students with autism do not have time to waste. It is important to make the most of your day by having many opportunities to practice all targeted skills. Having a classroom schedule that allows for enough instructional time to make significant progress is critical. When creating a classroom schedule, make sure to address the who, when, what, and where questions. In other words, it should be easy to see who is working with a student at any given time as well as what skill they are working on and where they are working on that skill (e.g., red table, art table, hallway, etc.). Assigning student names to specific instructors can save valuable time during an emergency situation (student elopes, fire emergency).  Avoid unnecessary large chunks of non-academic or unstructured times. What each student will be working on should vary based on assessments conducted in the classroom. Instructors should consider posting the schedule on a wall, centrally located and large enough that all team members can see it. However, if you have many students and paraeducators going in and out of the room, you may consider having a master calendar but printing out individual copies for each staff member.  When you have a master schedule that is easy to change when students and staff are absent will cut down on unnecessary talk about who is with specific students and what they should be working on. Additionally, color-coding by students or staff will allow for staff member or administrators to easily follow from across the room or with a quick glance. Staff should be assigned to students at all time.  If a student is engaged in independent work, having a staff member still assigned to that child will help everyone know who is tracking data or responsible if an emergency occurs. 

If you take all of these suggestions into consideration when you begin planning your classroom, you will be well on your journey to make a big difference in the outcomes of your students. An organized classroom allows teachers to focus on effective instructional strategies and behavior management strategies that are individualized to each child and not waste valuable time locating materials, guiding staff behaviors, and planning groups.  We wish you well in your new teaching position and in the years to come.


About The Author

Melissa Taylor, BCaBA is a Consultant on the Autism Initiative for the Pennsylvania Training and Technical Assistance Network. Her current position focuses on training educators on the principles and implementation of behavior analysis within classroom settings. In addition, Melissa provides in-home behavior consultation to children and adults with autism. Currently, she serves as the Sponsorship Coordinator for the Association for Science in Autism Treatment.