“Guided Playdates” by Caitlin Reilly & Carole Deitchman

This week, we’re proud to partner with ASAT – Association for Science in Autism Treatment – to bring you this practical article on Guided Playdates. We will be periodically showcasing articles from our colleagues at the Association for Science in Autism Treatment (ASAT). 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!  In this piece, authors Caitlin Reilly, MA and Carole Deitchman, MA, BCBA discuss the importance of play dates while offering accessible information on planning an effective play date and selecting peers, as well as on data collection.

My child with autism is doing well in his academic programming, but I’d like to help him develop social skills with peers. He participates in play dates, but I often worry that we are not making the most of these opportunities. How can I help him learn to play with a friend?

Answered by Caitlin Reilly, MA, BCBA and Carole Deitchman, MA, BCBA

The importance of play dates

Fostering the development of play and social skills should be an essential component of any educational or home program for children with autism. Possessing these skills not only improves a child’s overall quality of life and ability to sustain relationships, but also enhances his or her ability to learn from others. Many children with autism often need direct and systematic instruction to learn these skills.
Girls Holding Hands

Parent-guided play dates can provide the structure and practice needed to help a child improve peer social skills and make friends (Koegel, Werner, Vismara, & Koegel, 2005). Play dates may be a more effective and rewarding social activity for your child if the following foundation skills are already in the child’s repertoire or are being currently targeted:

  • knowing how to tolerate, attend to, and imitate other children;
  • being able to communicate his or her wants and needs;
  • understanding simple directions;
  • taking turns; and
  • playing with a few age-appropriate toys and one or two simple games (Smith, 2001).

As you think about the types of activities that may occur during the play dates, make a list of the skills that your child will need to successfully play with a friend. It is often very helpful to teach these important skills with adults first (Leaf & McEachin, 1999), as an adult is more likely to reliably and favorably respond to your child than a peer might be. Many of the above listed skills are likely ones that your child is also working on in school, and your addition of practice opportunities at home will help your child generalize learning to other people and situations.

Planning an effective play date

In addition to empowering your child with an array of foundational skills, it is important to guide his play dates using evidence-based methods. These methods incorporate techniques that have been repeatedly shown to be effective through controlled, scientific research. For your child’s play dates, such methods include the use of motivational systems, the strategic use of reinforcement, and the use of systematically faded prompts. While the first few play dates may require a close adult shadow and contrived reinforcement for desired behavior (e.g. chips or candy), the goal is to systematically fade the adult’s proximity and prompts and foster the child’s contact with naturally occurring reinforcement (e.g. the enjoyment of playing a game or talking to a peer). Evidence-based methods also call for the collection of objective data to monitor progress.

In order to increase motivation during the play date, use toys and activities that are especially enjoyable for your child and his friend (Koegel et al., 2005). Motivation is essential for keeping both children engaged, and for maximizing your child’s learning. Your child will be more likely to ask his friend to play a game if he enjoys that game. Similarly, the peer may be less likely to engage with your child if he does not enjoy the play date activity. Taking turns in selecting activities or using a choice schedule of activities may help in this regard.

It is also important to identify specific skills that you want to teach your child during his play dates. These may include such skills as greeting friends, initiating an activity, or asking questions. For example, the first several play dates may focus on saying “Hi” and “Bye” to the peer and playing catch. As with other types of skill instruction, consider pre-teaching these play and social skills with adults or at home with a sibling. Your child may require significant prompting initially, so think about how you can fade those prompts as your child’s skills improve and how to provide plenty of practice opportunities across settings, activities and individuals. Once your child greets his friend with ease and independence, focus on teaching him more complex play skills such as asking questions (e.g. “How are you?” and “Do you want to play?”) and making comments while interacting with the peer (e.g. “This is fun!” or “This is my favorite game.”). Start with teaching simpler skills, and then build on those your child has already accomplished.

If your child has difficult behavior, make a plan for how to manage it and follow through during play dates. Your plan may include “preventative” strategies, such as limiting the duration of the play date, using visual supports (e.g., activity board), providing a break, or minimizing activities that are a source of obsession or possible angst. Do not be concerned so much about embarrassing your child as giving him the support and repeated practice opportunities that he needs to be successful (e.g., repeating an interaction in which eye contact was not exhibited). Consistent consequences are essential in order to decrease disruptive behaviors and to help your child successfully relate to his peers (Maurice, Green, & Luce, 1996).

Selecting peers

Potential play date peers should include boys and girls of different ages (Smith, 2001). The best peers for play dates are often open and responsive. That is, they provide ample opportunity for your child to learn; they ask questions, they respond with enthusiasm, and they exhibit patience as your child practices socializing. From a behavior analytic standpoint, we might view a peer’s response as reinforcement for your child’s response. So, if his peer is unresponsive, your child may be less likely to initiate with that peer again during future opportunities. Ask your child’s teacher or other school staff for peer suggestions, or ask the parents of neighborhood children whom you know. Peers that your child naturally comes into contact with on a regular basis, such as family members, are ideal for practicing social skills (Oppenheim-Leaf et al., 2012). It is important that your child’s peer and his or her parents know about your child’s unique behaviors and needs (Baker, 2003). Prepare them for what to expect, and ask the other parent for permission to give rewards during or after the play date. For example, the peer might be rewarded for asking your child a question or waiting patiently while your child responds. Reinforcing the peer for interacting with your child will motivate him to interact with your child more in the future.

Data collection

Taking data on your child’s progress is essential to ensuring effective teaching strategies. This process will help you set goals, monitor changes objectively, and alter your teaching methods if progress has stalled or declined. For example, if your child is not learning to say, “Hi” to his or her peer, you may need to increase motivation to learn, increase your level of assistance (such as providing a verbal model of the greeting), or consult with a qualified therapist for other suggestions.

The following is an example of a basic data sheet that can be created to track your child’s progress during each play date. The skills that you teach and the data you collect will vary depending upon your child’s individual needs and abilities.

Tommy’s Play Date Data Sheet

Date: 10/25/12
Peer: Kyle

  1. Says “Hi” to peer when prompted +
  2. Initiates activity with peer using photo prompt in activity schedule. – / + / + / + / +
  3. Instances of problem behavior (tally): 1
Tommy’s Play Date Data Sheet

Date: 11/2/12
Peer: Kyle

  1. Says “Hi” to peer when prompted +
  2. Initiates activity with peer using photo prompt in activity schedule – / + / + / + / +
  3. Instances of problem behavior (tally): 0

Conducting an effective play date

Set aside favorite snacks to use as rewards for your child during his play dates (Leaf & McEachin, 1999). It is best to save these special snacks for play dates only, as this will make your child more eager to earn them. During the play date, “shadow” your child by positioning yourself behind him in order to prompt initiations with and responses to his peer (Krantz & McClannahan, 1993). When your child demonstrates target behaviors (e.g., making eye contact with his peer) or is successful in relating to his peer (e.g., making eye contact and saying “Hi, Kyle.”), praise him (e.g., “Great job saying ‘Hi’ to Kyle!”), and give him a small piece of his favorite snack. As your child’s learning progresses and he demonstrates these skills independently, you should fade use of this shadowing technique, including use of your prompts and instruction, as well as reducing the delivery of snacks and social praise as rewards. Ultimately, your child’s behavior will be rewarded by playing and talking with his friend, rather than your delivery of verbal and edible praise. It may also be necessary to reinforce the efforts of the peer, particularly if your child is not cooperating.

Many children with autism learn new things by using activity schedules (Krantz & McClannahan, 1998). Therefore, it may be worthwhile to make a “play date schedule” that your child and his friend can follow. This might include pictures of the activities and/or peer. As your child learns, you can gradually fade out the schedule so that the play date becomes more natural. You might also arrange materials so that the children must work together to complete an activity (Koegel et al., 2005). For example, if making cookies, have one child hold the measuring cup while the other pours the ingredients.

When starting out, keep the play dates short rather than stretching them out as long as the child seems comfortable or until something goes awry (Smith, 2001). A five-minute-long successful peer interaction is better than a 30-minute one that ends in a disruptive outburst. It may take several play dates for your child to become comfortable with his peer, and it will take time for him to learn new skills. It may be helpful for your child to have play dates with one particular child until he demonstrates mastery (i.e., independence) of specific skills; then try teaching those play skills with another child.

Since the pioneering work of Dr. Ivar Lovaas (1981), who demonstrated how parents could teach important skills to their children with autism, we have learned many effective ways to teach social and play skills (Leaf & McEachin, 1999; Lydon, Healy, & Leader, 2011; Koegel, Werner, Vismara, & Koegel, 2005; Smith, 2001; Krantz & McClannahan, 1993; Krantz & McClannahan, 1998; Maurice, Green, & Luce, 1996). Consulting with a qualified specialist may be helpful for planning and implementing effective play dates, but remember, you are your child’s first teacher. By using these techniques during guided play dates you are not only teaching your child essential social and play skills, you are teaching him how to have more fun!


Baker, J. E. (2003). Social skills training for children and adolescents with Asperger Syndrome and social communication problems. Shawnee, MI, Kansas: Asperger Publishing Company.

Freeman, S., & Dake, L., (1997). Teach me language: A language manual for children with autism, Asperger’s syndrome and related disorders. Langley, BC: SKF Books.

Koegel, R. L., Werner, G. A., Vismara, L. A., & Koegel, L. K. (2005). The effectiveness of contextually supported play date interactions between children with autism and typically developing peers. Research & Practice with Severe Disabilities, 30, 93-102.

Krantz, P. J., & McClannahan, L. E. (1993). Teaching children with autism to initiate to peers: Effects of a script fading procedure. Journal of Applied Behavior Analysis, 26, 121-132.

Krantz, P. J., & McClannahan, L. E. (1998). Activity schedules for children: Teaching independent behavior. Bethesda, MD: Woodbine House.

Leaf, R., & McEachin, J. (1999). A work in progress: Behavior management strategies and a curriculum for intensive behavioral treatment of autism. New York: DRL Books.
Lovaas, O. I. (1981). Teaching developmentally disabled children: The me book. Austin, TX: Proed.

Lydon, H., Healy, O., & Leader, G. (2011). A comparison of video modeling and pivotal response training to teach pretend play skills to children with ASD. Research in Autism Spectrum Disorders, 5(2), 872-884.

Maurice, C. Green, G., & Luce, C. (1996). Behavioral intervention for young children with autism: A manual for parents and professionals. Austin, TX: Proed.

Oppenheim-Leaf, M. L., Leaf, J. B., Dozier, C., Sheldon, J. B., & Sherman, J. A. (2012). Teaching typically developing children to promote social play with their siblings with autism. Research in Autism Spectrum Disorders, 6(2), 777-791.

Smith, M. J. (2001). Teaching play skills to children with autism spectrum disorder: A practical guide. New York: DRL Books.


Reilly, C., & Deltchman, C. (2013). Guided play dates. Science in Autism Treatment, 10(2), 18-20.


Caitlin Reilly, MA, BCBA currently works as a behaviorist for the Summit Public School District, and is concurrently working toward her PsyD in School Psychology at Fairleigh Dickinson University. She also serves as the Sponsorship Coordinator and is a media watch contributor for the Association for Science in Autism Treatment.

Carole Deitchman, MA, BCBA consults for families and school districts to help children with autism. She is completing her PhD research in applied behavior analysis by teaching children with interfering rituals and routines to self-manage their behavior.

ABOUT the Association for Science in Autism Treatment

We 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. Since autism was first identified, there has been a long history of failed treatment fads, levied on vulnerable individuals and their families. Many of these treatments have been too hastily adopted by professionals, sensationalized by the media, and embraced by consumers before evidence existed for their effectiveness or safety. Visit our website at www.asatonline.org and subscribe to our free quarterly newsletter at www.asatonline.org/newsletter/. Follow us on Facebook at www.facebook.com/ASATonline and on Twitter at @asatonline.

Pick of the Week: Auditory Memory for Short Stories

Listen to short, silly stories like “Aunt Pat’s Hat,” “Hannah’s Bananas,” or “Ollie the Octopus,” and then answer questions about each story. These 51 illustrated cards provide a novel and engaging approach to improving your students’ auditory memory skills. This week, save 15%* when you order Auditory Memory for Short Stories by applying our promo code STORIES at checkout!

One side of each card shows an illustration and title, while the reverse presents the story along with three questions. The deck also includes game ideas and 5 open-ended “Wh” topic picture cards to help learners make up their own stories and questions. Cards measure 2½” x 3½” and come in a sturdy tin.

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Pick of the Week: Special Savings on Hooray for Play! Activity Cards

Pretend play offers children an opportunity for perspective taking, problem solving, cooperation, social emotional skill acquisition and language development. Children learn through their experiences and what better way to engage in the largest possible array of activities than through pretend play? For a special price of $12.95 only $4.95, you can get your set of Hooray for Play! and start off the school year with endless learning opportunities through play.

Hooray for Play! is a multi-use deck of 31 beautifully hand-drawn cards that can be implemented initially by parents and educators as an instructional tool and later used by learners independently. This week, we’re offering Hooray for Play! at a special price of only $4.95. No promo code necessary. Get your set of Hooray for Play! at a discounted price while stock lasts!

Hooray for Play! breaks down the components of the 31 individual play schema cards into the three organized sections that provide a memorable framework for sociodramatic play. The Do! Section explains the various roles, Say!! outlines possible scripted statements by the involved actors and Play!!! offers suggestions for props and set-up. An additional card in the set offers suggestions for use that guides users through creative steps in reinforcing learning and play skills.

Get your deck of Hooray for Play! at only $4.95 this week and start making playtime a rewarding and educational experience for your students! Have fun!

Pick of the Week: Sequencing Verb Tenses Card Deck

Help students identify and use the past, present, and future tenses of 48 action verbs with the Sequencing Verb Tenses card deck. And this week only, you can save 15%* on this set by using promo code SEQVERB at check-out!

This set contains 24 regular and 24 irregular three-step, illustrated sequences. Choose an action verb to teach, and then have students put the cards in order while filling in the blanks with the correct verb tenses. For example: She will paint the fence. She paints the fence. She painted the fence.

Each of the 144 cards measures 3¼” x 4¼” and comes with game ideas. Don’t forget – you can save 15%* this week on the Sequencing Verb Tenses card deck by using promo code SEQVERB at check-out!

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Pick of the Week: More What’s Wrong? ColorCards – Develop skills in problem-solving, storytelling, and more!

Help students develop skills in observation, deduction, problem solving, anticipation, storytelling, insight, and more with the More What’s Wrong? ColorCards. This set of 36 photographic cards shows a range of activities and situations with incorrect, unusual, or unexpected elements to identify and discuss, and even induce a few chuckles! Save 15%* this week on the More What’s Wrong? ColorCards by applying promo code WHATSWRONG at check-out!

The open-ended nature of the problems posed also enables different levels of application ranging from single identification of what’s wrong to understanding and explaining how to fix the situation and the potential consequences.







An instruction booklet with possible discussion points and ways to structure a session is also included, with pages that identify which cards show mistakes with clothes, wrong objects, wrong methods, or impossible/unlikely events. Don’t forget – you can take 15%* off your order of the More What’s Wrong? ColorCards by using promo code WHATSWRONG at check-out this week!

Pick of the Week: Reading Comprehension Cubes

Make reading discussions fun with Reading Comprehension Cubes! These foam cubes with comprehension questions on each side are great for promoting conversations, peer learning, and active reading. This week only, you can take 15%* off your order of Reading Comprehension Cubes with promo code READCUBES at check-out!

To use the Reading Comprehension Cubes, students answer the questions before reading with the red cubes, during reading with the blue cubes, and after reading with the green cubes. Your set includes 2 of each cube and an Activity Guide. Each of the 6 cubes measures 1½ inches.

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Simplifying the Science: Teaching Hand-Raising to Children with Autism

There are many concerns that come up when considering moving a child with autism to a general education setting. One is that the child with autism may not initiate interactions, which makes it less likely they’ll raise their hand to either ask or answer questions. Hand-raising is an important social behavior in the classroom setting as it facilitates learning as well as teacher-understanding of a child’s comprehension of the current topic. In the general education setting, there is much more group instruction than in the special education setting, which makes hand-raising all the more important. A study by Charania, LeBlanc, Sabanathan, Ktaech, Carr, & Gunby (2010) focuses on this skill, stating “Failure to raise a hand when one could answer means a missed opportunity for reinforcement or error correction, whereas raising a hand when one has no subsequent response to provide could be embarrassing or disruptive to ongoing instruction.”

The participants in the study were three boys with autism, ages 8, 9, and 10 who were preparing to transition from a center-based program to a general education setting and had substantial verbal repertoires as assessed by the VB-MAPP. The researchers recognized that often the boys would know the correct answer to a question posed by the teacher during a group activity, but would not raise their hands to respond. They addressed this by building three successive skills. The goal was to teach the boys to raise their hand when they did know the answer, and keep their hands down when they did not know the answer.

In the first task, the boys were placed together for group instruction. Each child was given an opaque bag with a different item in it. The instructor would ask “Who has the [item]?” The boy with that item would raise his hand. Once this skill was mastered, the second task was introduced. In this task, the instructor would tell one boy a “secret” word, while whispering a greeting to the other two boys. The instructor would then ask “Who knows the secret word?” The boy who heard the secret word would raise his hand. Finally, after mastering the second task, the final task would be introduced. Here, the task involved providing verbal responses to factual questions, such as “What animal has a tail and four legs?”

This successive teaching of skills is important to the acquisition of the target skill. In the first task, there was an auditory and a visual stimulus provided to elicit the target response of hand raising (the question and the object in the bag). In the second task, the visual stimulus was replaced with another auditory stimulus, making it two auditory stimuli (the question and the whispered secret word). Finally, the last task consisted of the auditory stimulus, the question itself. The final task emulated the stimulus that would naturally occur in the classroom to elicit hand-raising.

The authors note in their discussion that “The results suggest the importance of conducting both hand-up and hands-down learning trials to establish discriminated responding, rather than simply reinforcing hand raises on every question (i.e., excessive hand raising during hands-down trials might be just as problematic as a complete lack of hand raising).” The method of successive conditional discrimination can be useful for teaching both children who do not raise their hands when they should or who raise their hands when they shouldn’t. All three boys learned how to raise hands appropriately for each of the three tasks. And while there are many more skills related to hand-raising that the three participants would need to learn, the skills taught in this study are essential to promoting success in the general education environment.


Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently pursuing her PhD in Applied Behavior Analysis at Endicott College.

Pick of the Week: “Language Development Lessons for Early Childhood” Workbook

Strengthen listening and speaking skills in your learner with this workbook by speech-language pathologist Jean Gilliam DeGaetano that contains 80 pages of reproducible Student and Instructor Worksheets. The worksheets cover 3 basic techniques – Yes or No Answers, Choosing Between Two Answers, and Completing Sentences. This week only, you can save 15%* on Language Development Lessons for Early Childhood by using our promo code LANG15 at check out!

The lessons in this workbook feature various scenarios along with corresponding questions that ask the listener to answer yes or no, choose between two answers, and complete descriptive statements read aloud by the instructor. All three techniques in this book are great for stimulating receptive and expressive language in young children.

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We’ve extended our Language Builder promotion! Save 30% and more!

Great news for those of you who might have missed our 3-day promotion for our Language Builder sets! We’ve extended our sale to last through next Tuesday, April 28th. Just use our promo code BUILDER15 at check-out to redeem these savings below on all of our Language Builder card sets until next Tuesday:

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Everyone’s favorite—the Language Builder Picture Cards—is a 350-card set that teaches key language concepts to children with autism or other speech and language delays. With vivid, beautiful noun cards created by a parent and professional experienced in the program needs of ABA, this set will foster receptive and expressive language skills. Get the individual set of the Language Builder Picture Cards for $149 only $110—just apply our promo code BUILDER15 during check-out!

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The Language Builder Picture Noun Cards 2 is a 200-card set of photographic noun cards for building additional vocabulary in students who have mastered the original Language Builder Picture Cards. This set is great for labeling practice, as well as sorting, adjectives, functions, things that go together, storytelling and more.


The Language Builder Emotions Cards depict facial expressions and emotions by presenting various scenarios featuring men and women of various ages and ethnicities. This 80-card set will help students identify and discuss different feelings and emotions, inviting discussion about a range of emotions, why people may feel a certain way, and possible responses to these feelings.

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Autism Awareness Month Interview Series: Behavior Analysis and Speech Pathology: The Perfect Pairing for Speech Acquisition with Barbara Esch, BCBA-D, CCC-SLP

This week, we are absolutely honored to bring you an exclusive interview with the esteemed Barbara Esch, BCBA-D, CCC-SLP. Dr. Esch has made incredible contributions to the fields of both Behavior Analysis and Speech Pathology. In this interview with Sam Blanco, Dr. Esch shares important teaching techniques on developing language, setting developmentally appropriate goals, and addressing feeding issues. An enormous thank you to Dr. Esch for her invaluable insight.

Don’t forget to check out the other interviews in our Autism Awareness Month Interview Series here.

Behavior Analysis and Speech Pathology: The Perfect Pairing for Speech Acquisition
with Barbara Esch, BCBA-D, CCC-SLP

SAM BLANCO: As someone who is both an SLP and BCBA, how do you envision the two fields collaborating?

BARBARA ESCH: Professionals in each field, behavior analysis and speech pathology, bring unique and critical information and skills to an instructional team. Behavior analysis offers a science-based technology based on our field’s theoretical perspective, which allows us to analyze the contexts in which learning occurs (i.e., antecedent and consequent events) as well as to identify faulty learning and to efficiently remediate error responses and to remove possible obstacles to further skill acquisition. Of particular importance in understanding and teaching language skills is Skinner’s analysis of verbal behavior (Skinner, 1957). This analysis provides us with the critically important understanding of how we acquire language skills; it dispels the faulty notion that the words we say, in a connected language context, are stored in our head someplace to be retrieved when we need them; rather, we say them as a function of the related environmental context, as mands, tacts, and as other verbal operants. This analysis is absent from traditional language assessments (for a discussion of this topic, see Esch, Lalonde, & Esch, 2009), so the field of behavior analysis fills this gap and provides not only a conceptual analysis but also a powerful teaching technology that allows us to extend language learning from one context (e.g., mand) to another (e.g., intraverbal).

Speech pathologists have specialized information and skills regarding the physical system that controls speech sound production, voice quality, swallowing, and, to some degree, hearing. The instructional team benefits from an SLP’s in-depth knowledge of how speech occurs, the physiology of the speech-production system, and how we move our vocalization musculature to produce various speech sounds. Speech pathologists know how to help speech learners make these movements more fluently. They understand the speech requirements for this fluency (i.e., co-articulation) and this expertise allows them to pinpoint specific speech targets in a logical hierarchy of speech sound acquisition.

SB: In the past, you have written that “Speech Language Pathologists are ideal professionals to be included on an ABA team.” Can you share why you think this is true? What steps can SLPs and ABA providers take to promote shared input on goal-setting and program-creation for clients?

BE: Yes, as you suggest, that comment was in the context of shared goals (“Speech language pathologists are ideal professionals to be included on an ABA team since its members are focused on providing effective and efficient instruction, much of which is geared toward speech and language acquisition.” (See http://www.asatonline.org/researfch-treatment/clinical-corner/integrating-aba-and-speech-pathology/)

An ABA team is an instructional team that uses applied behavior analysis to promote student learning. As such, effective team members are knowledgeable in the principles of learning and are skilled at applying the technological procedures that derive from those principles (for example, reinforcement, prompting, prompt fading, shaping, discrimination training, and so on).

There are several steps SLPs and ABA providers can take to promote shared input in designing and carrying out instructional programs for their clients. First, it’s important to recognize that all professionals on an “ABA team,” by definition, should be knowledgeable and skilled in delivering this technology during instruction. That is, members of the ABA team should consider themselves “ABA providers” if they are applying behavior analysis (i.e., ABA) to the delivery of instruction. Thus, teachers, SLPs, technicians, parents, other therapists, behavior analysts, and any others on the team can all be considered “ABA providers” to the extent that they are knowledgeable and effective “appliers” of the learning technology from the field of behavior analysis. Next, each professional can resist the urge to claim ownership over the program and its development. I think the best way to do this is to acknowledge areas of expertise that each member brings to the team and to work together to bring their varied expertise to bear on program development. As an ABA team, goal setting should occur within the context of a behavior analytic perspective. The process can be enriched through the collaborative input of all team members. So, another way team members can promote shared input is to support other team members in learning cross-disciplinary skills or at least in familiarizing themselves with the special expertise of each individual team member.

SB: Developing verbal skills for children with autism is an important goal for everyone involved with the student. Can you describe the first steps you use in selecting developmentally appropriate goals for a particular student?

BE: The VB-MAPP (Sundberg, 2008) is a strong resource in pinpointing developmentally appropriate goals for learners with skills at the pre-school level. This assessment identifies milestones and component skills in 16 critical verbal and non-verbal areas as well as providing an assessment of existing learning barriers that may preclude the acquisition of these important foundation skills. When I look at a child’s VB-MAPP, some priority areas that seem to be “king-pin skills” are imitation, mand, play/leisure, and listener responding. That is, these are some of the first skills I like to see in place as “supporting skills” for the others. If a child can imitate, then I know s/he values people and their attention (thus, we can teach social skills as well as address many of the learning barriers that may be present). Also, since echoing is a type of imitation, I’m encouraged if a child who isn’t yet speaking is beginning at least to imitate gross- and/or fine-motor models. If a child can imitate, then we can teach him/her to mand (either through speech, sign, or picture selection) and, thus, establish language as powerful and personally beneficial. If a child has play/leisure skills, then all the items connected with those play skills are potential reinforcers for other skill learning. This, in turn, can strengthen learning to persist at a task (i.e., stronger reinforcer value for instructional items/activities); this task persistence allows a child to effectively access other instruction from teachers. If a child can respond as a listener, then we can expand his/her cooperation and follow through with more complex instructions, eventually leading to responding both verbally and non-verbally after time delays (i.e., remembering). So, the “king-pin” skills, although not exclusively important, are strong supports for further learning.

SB: You developed the Early Echoic Skills Assessment for the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). Can you describe the development of this tool and how practitioners should best utilize it?

BE: Dr. Mark Sundberg, author of the VB-MAPP (Sundberg, 2008), was interested in providing an assessment tool (and placement guide) that aligned with typical development of children from birth to 4 years. He wanted to include an echoic assessment that would reflect the details of this vocal skill for children in this age range and asked me if I would provide it. The Early Echoic Skills Assessment (EESA) is a criterion-referenced assessment of skills in echoing 1-, 2-, and 3-syllables in various vowel and consonant combinations, utilizing those consonants that would be expected developmentally from birth through 30 months. (Note: Echoic skills are only tested and reported on the VB-MAPP at Levels 1 and 2 because, by 30 months of age, these skills typically have been acquired; thus, there are no EESA items tested at VB-MAPP Level 3.)

The EESA can be helpful for clinicians and practitioners by pinpointing two critical skills: (1) echoic consistency and accuracy and (2) syllable fluency. For echoic consistency, we want to know if the child consistently says anything after an echoic model. If an echoic*, regardless of its accuracy, does not occur consistently (e.g., at least 90% of the time), then treatment can start with simply differentially reinforcing any vocal response that follows an auditory model, without regard for the accuracy of that response. In other words, the first skill to establish in speech training is to “say something” when the teacher asks you to. The next task, informed by the EESA, would be to determine the accuracy of the echoic response. That is, how closely does the child’s response match the vowels and consonants of the teacher’s model? An accurate description of any discrepancies here can serve as a template for target identification.

Finally, the EESA tells us if there is a fluency breakdown in terms of the child’s ability to repeat multiple syllables on one breath at a connected speech rate of about 3 syllables per second. This fluency is critical for normal-sounding speech, but we often see a teaching error related to this that makes fluency less likely to develop. Let’s say that you ask a child to repeat a 3-syllable utterance (e.g., computer, cookie please, let’s go play, where’s daddy?) and s/he omits one or more of the syllables. Often, when practitioners (teachers, parents, therapists) notice that a child omits some of the syllables in a phrase, they will break the phrase apart and reinforce the separate segments. For example, they might instruct the child: “say let’s” (good!), “say go” (that’s right!), “say play” (good job!). This is essentially training the child to emit 1-syllable utterances at a time and doesn’t increase the likelihood that the child will say “Let’s go play” as a unit nor that the phrase will ever occur as normal fluent speech. So, the EESA allows us to pinpoint the child’s current skill in terms of how many syllables s/he can say easily without omitting whole syllables, and it informs the next steps. Thus, treatment can focus on reinforcing, first, easy-to-produce consonant/vowel combinations in phrases of increasing syllable length and then, after that, increasing the phonemic complexity of these consonant/vowel combinations in even longer syllable-length vocalizations.

*An “incorrect echoic” is technically, according to a verbal behavior analysis, not an echoic at all. But this technicality will be set aside for this discussion, to make it easier to understand the 2 critical skills that are often missing in early speech learners: first, repeating a vocal model consistently, and then, repeating it accurately.

SB: Many parents and practitioners struggle with feeding issues in their learners with autism. Are there resources that you would recommend? Do you have tips/suggestions for them?

BE: You’ve identified one of the most challenging issues for parents and teachers of children with autism. Of course, it’s imperative first to rule out any medical concerns related to eating (accepting food, chewing it, swallowing it, and digesting it). So, the child’s pediatrician and other health-care professionals would be key initial contacts in moving forward to identify and resolve feeding issues. If no medical concerns are identified and behavioral treatment is not contraindicated, then it’s important to identify the behaviors related to feeding that have brought this concern to the forefront. Many children are picky eaters (e.g., no veggies; only sweet food) and some have unusual preferences (e.g., no food touching other food on the plate; no red food). Another common issue is texture preferences (e.g., nothing chunky that requires chewing). Some children accept so little food that their nutrition is compromised. Still others will accept food but keep it packed in their mouths and won’t swallow it. And, of course, many children engage in problem behavior that interferes with appropriate feeding (e.g., refusal to sit at the table, refusal to self-feed, refusal to open mouth, crying/tantrums during mealtime).

Fortunately, the behavior analytic literature is replete with research into on feeding issues. Much of this research comes from Dr. Cathleen Piazza, her colleagues, and her students over the years. Dr. Piazza is currently Director of the Pediatric Feeding Disorders Program at Munroe-Meyer Institute at the University of Nebraska Medical Center in Omaha, NE. Another well-published behavioral researcher in pediatric feeding disorders is Dr. Meeta Patel, a former colleague of Dr. Piazza and founder and executive director of Clinic 4 Kidz. The collective work of Drs. Piazza and Patel and others, much of which can be found in the Journal of Applied Behavior Analysis, has greatly informed the assessment and behavioral treatment of feeding disorders.

These are references for some of Dr. Piazza’s work (from her website):

Publications (within the last 5 years)

Rivas, K. M., Piazza, C. C., Roane, H. S., Volkert, V. M., Stewart, V., Kadey, H. J., & Groff, R. A. (in press). Analysis of self-feeding in children with feeding disorders. Journal of Applied Behavior Analysis, 47(4), 710-722.

Wilkins, J. W., Piazza, C. C., Groff, R. A., Volkert, V. M., Kozisek, J. M., & Milnes, S. M. (in press). Utensil manipulation during initial treatment of pediatric feeding problems. Journal of Applied Behavior Analysis, 47(4), 694-709.

Groff, R. A., Piazza, C. C., Volkert, V. M., & Jostad, C. M. (in press). Syringe fading as treatment for feeding refusal. Journal of Applied Behavior Analysis. 47(4), 834-839.

Volkert, V. M., Peterson, K. M., Zeleny, J. R., & Piazza, C. C. (2014). A clinical protocol to increase chewing and assess mastication in children with feeding disorders. Behavior Modification, 38(5), 705-29.

Bachmeyer, M. H., Gulotta, C. S., & Piazza, C. C. (2013). Liquid to baby food fading in the treatment of food refusal. Behavioral Interventions, 28(4), 281-298.

Kadey, H., Piazza, C. C., Rivas, K. M., & Zeleny, J. (2013). An evaluation of texture manipulations to increase swallowing. Journal of Applied Behavior Analysis, 46(2), 539-543.

Volkert, V. M., Piazza, C. C., Vaz, P. C. M., & Frese, J. (2013). A pilot study to increase chewing in children with feeding disorders. Behavior Modification, 37, 391-408.

Addison, L. R., Piazza, C. C., Patel, M. R., Bachmeyer, M. H., Rivas, K. M., Milnes, S. M., & Oddo, J. (2012). A comparison of sensory integrative and behavioral therapies as treatment for pediatric feeding disorders. Journal of Applied Behavior Analysis, 45, 455-471.

Vaz, P. C. M., Piazza, C. C., Stewart, V., Volkert, V. M., Groff, R. A., & Patel, M. R. (2012). Using a chaser to decrease packing in children with feeding disorders. Journal of Applied Behavior Analysis, 45, 97-105.

Dempsey, J., Piazza, C. C., Groff, R. A., & Kozisek, J. M. (2011). A flipped spoon and chin prompt to increase mouth clean. Journal of Applied Behavior Analysis, 44, 949-954.

LaRue, R. H., Stewart, V., Piazza, C. C., & Volkert, V. M. (2011). Escape as reinforcement and escape extinction in the treatment of feeding problems. Journal of Applied Behavior Analysis, 44, 719-735.

Groff, R. A., Piazza, C. C., Zeleny, J. R., & Dempsey, J. R. (2011). Spoon-to-cup fading as treatment for cup drinking in a child with intestinal failure. Journal of Applied Behavior Analysis, 44, 949-954.

Wilkins, J. W., Piazza, C. C., Groff, R. A., & Vaz, P. C. M. (2011). Chin prompt plus re-presentation as treatment for expulsion in children with feeding disorders. Journal of Applied Behavior Analysis, 44, 513-522.

Vaz, P. C. M., Volkert, V. M., & Piazza, C. C. (2011). Using negative reinforcement to increase self-feeding in a child with food selectivity. Journal of Applied Behavior Analysis, 44, 915-920.

Rivas, K. R., Piazza, C. C., Kadey, H. J., Volkert, V. M., & Stewart, V. (2011). Sequential treatment of a feeding problem using a pacifier and flipped spoon. Journal of Applied Behavior Analysis, 44, 387-391.

Volkert, V. M., Vaz, P. C. M., Piazza, C. C., Frese, J., & Barnett, L. (2011). Using a flipped spoon to decrease packing in children with feeding disorders. Journal of Applied Behavior Analysis, 44, 617-621.

Tang, B., Piazza, C. C., Dolezal, D., & Stein, M. T. (2011). Severe feeding disorder and malnutrition in two children with autism. Journal of Developmental and Behavioral Pediatrics. 32(3), 264-267.

Rivas, K. D., Piazza, C. C., Patel, M. R., & Bachmeyer, M. H. (2010). Spoon distance fading with and without escape extinction as treatment for food refusal. Journal of Applied Behavior Analysis, 43, 673-683.

SB: You’ve published research about behavioral treatments for early speech acquisition. Can you briefly describe your research? What do you think are important research questions in this area for the future?

BE: There are few behavioral treatments for early speech learners (i.e., individuals who haven’t acquired speech as would be developmentally typical). Further, the research on these treatments is not particularly robust at this point; either there is a paucity of studies available or the outcomes are inconsistent. It’s an area ripe for research because we need effective and efficient ways to jump start vocal behavior in individuals who haven’t yet acquired an echoic response. It’s not too difficult to teach someone to talk if they will repeat when asked to “say ___,” but without that echoic response, we must work to establish vocalizing in general as a “preferred activity,” producing a “preferred stimulus” that automatically reinforces the vocalizing that produced those sounds (i.e., babbling, vocal play). If we have that, then we can bring those vocalizations under the control of direct contingencies of reinforcement, as functional verbal behavior (e.g., mands, tacts). This post-babbling speech training is critical, because parents, teachers, and other caregivers in the child’s verbal community need to have their own vocal-verbal behavior reinforced by the child’s speech responses to them. Without that reciprocal interaction of vocalizing in context (i.e., speaker/listener), the frequency of functional speech interactions can spiral downward with resulting isolation for both speakers and listeners.

So, the first step in teaching speech to non-vocal learners is to establish an available pool of varied vocalizations that the child readily says that can then be reinforced by the child’s verbal community. Following the earlier work of behavioral researchers (e.g., Miguel, Carr, Michael, 2002; Sundberg, Michael, Partington, & Sundberg, 1996; Yoon & Bennett, 2000; Yoon & Feliciano, 2007), my colleagues and I have reported investigations (Esch, Carr, & Michael, 2005; Esch, Carr, & Grow, 2009; Petursdottir, Carp, Matthies, & Esch, 2011) of stimulus-stimulus pairing (SSP), a conditioning treatment aimed at increasing vocalizations in non-vocal or low-vocal learners by pairing certain sounds with preferred items/activities. As mentioned, if SSP induces vocalizations, the goal is then to apply direct reinforcement to establish these vocal responses as mands, tacts, echoics, and other verbal language skills. Another behavioral treatment is vocal variability (VV) training, aimed at increasing novel and varied vocalizations in speech learners who may emit some vocalizations but that tend to be repetitive (i.e., invariant). However, to date, there are only 2 published VV studies with low-vocal speech learners (Esch, Esch, & Love, 2009; Koehler-Platten, Grow, Schulze, & Bertone, 2013), although we have some research that has investigated increasing the variability of rote language responses with already-competent speakers (Lee et al., 2002; Susa & Schlinger, 2012).

In an effort to increase speech in non-vocal children, other studies have looked at comparisons of SSP with operant discrimination training (Lepper, Petursdottir, & Esch, 2013) and preceding echoic trials with a series of gross- and fine-motor imitation opportunities (i.e., RMIA procedures reported by Ross & Greer, 2003; Tsiouri & Greer, 2007). Investigations such as these may yield useful treatments for early speech learners.

There is much we don’t know about why children fail to learn to talk. We assume that success in speech learning is based on (a) hearing and attending to human voice, (b) valuing those sounds and combinations of sounds via a previous conditioning history, and (c) possessing a physical system that produces sounds similar to those with the conditioning history (i.e., the sounds of the child’s verbal community). If we assume that the child’s speech-producing mechanism (c above) is intact, then we can focus our research efforts on (a) and (b). In fact, SSP and VV training are targeted at increasing “sound value” and RMIA studies are aimed at increasing attending and responding to (i.e., imitating) rapid visual and auditory models. In a discussion related to these skill sets, Petursdottir et al. (2011) offer several important areas for future research. One is that of determining whether human speech (the auditory stimuli in speech training) is, indeed, a preferred stimulus for the learner (that is, does it “sound good” to the child?). Another is to identify the effects of such stimuli on the vocal responses of the speech learner. If the speech sounds of a child’s environment lacks reinforcing value, then what do we need to pair it with and in what conditioning procedure to ensure that it becomes a “preferred stimulus” that the early speech learner can produce himself by making those sounds? Another topic is the salience of auditory vocal stimuli; this has not been adequately measured and identified. It would be helpful to know whether a speech learner has, indeed, observed relevant speech sounds such that these are discriminable and evoke responding.

Additional Reading

Esch, B. E., LaLonde, K. B., & Esch, J. W. (2010). Speech and language assessment: A verbal behavior analysis. The Journal of Speech-Language Pathology and Applied Behavior Analysis, 5, 166-191.

Skinner, B. F. (1957). Verbal behavior. New York: Appleton-Century-Crofts.

Sundberg, M. L. (2008). VB-MAPP: Verbal behavior milestones assessment and placement program. Concord, CA: AVB Press.


Barbara EschDr. Barbara Esch, BCBA-D, CCC-SLP, is a behavior analyst and speech pathologist with more than 30 years of experience in behavioral interventions for individuals with developmental disabilities. She has worked in school, home, clinic, and hospital settings. Her workshops, training symposia, and research have been presented in the United States, Europe, and Australia, and focus on the use of behavioral procedures to improve speech, language, and feeding skills for individuals of all ages with a wide range of medical and educational diagnoses. Esch received her PhD in applied behavior analysis from Western Michigan University and her MA in speech pathology from Michigan State University. She is the author of the Early Echoic Skills Assessment, part of the Verbal Behavior Milestones Assessment and Placement Program: VB-MAPP (Sundberg, 2008). She is the founder and past chairperson of the Speech Pathology Special Interest Group of the Association for Behavior Analysis International. Her research on behavioral treatments for early speech acquisition appears in The Analysis of Verbal Behavior and the Journal of Applied Behavior Analysis. Esch is co-owner of Esch Behavior Consultants, Inc., a consulting company specializing in behavioral treatments for individuals with severe communication delays.