By Alicia Marshall, MAT, BCBA LBS

One of the most appealing aspects of entering the field of Applied Behavior Analysis (ABA) is that analysts and technicians have the opportunity to work in a variety of settings. It is common for these ABA practitioners to accept jobs with organizations that allow their employees to work in multiple settings such as clinic-based therapy, school-based therapy, and in-home therapy.  Furthermore, clinicians have the opportunity to implement strategies and build skills among various settings during their sessions. BCBAs and behavior technicians working in schools may have the ability to work with clinicians in multiple settings, such as the special education classroom, general education classroom, cafeteria, music class, and recess all in one day.  Additionally, BCBAs and other clinicians working in a traditional clinical setting are often responsible for generalizing skills and training all key stakeholders.  This variability and flexibility often comes with challenges and increased responsibilities.

Understanding Behavior Contrast

An important concept to consider when entering the field is the concept of behavior contrast.  Behavior contrast is a side effect of reinforcement of punishment procedures implemented in one setting that causes a behavior change in another setting where the same contingencies are not in place.  For example, if a reinforcement procedure is used in the school setting to increase functional communication, but the same procedures and strategies are not used at home, the clinicians and family are likely to see an increase in the functional communication in school and a possible contrast of decreased functional communication at home.  In order to avoid the effects of behavior contrast, it is important that clinicians properly and thoroughly train all key stakeholders and implement treatment with fidelity. 

Best practice would suggest that all key stakeholders undergo Behavior Skills Training (BST).

What is BST?

The basics of BST include having the lead clinician, most likely a BCBA, provide thorough verbal and written instructions followed by modeling the behavior in a role play or re life scenario.  The trainee, key stakeholder, would then reverse roles with the trainer and demonstrate the skill being taught in a role play or real life scenario.  The trainer would then provide timely and effective feedback to the trainee.  The implementation of BST is essential to ensure that treatment fidelity is high.  The higher the treatment fidelity, the more likely there is likely to be progress with the student or client.

Preparing for Generalization

Another key component to assure that expectations are met in a variety of settings is to include plans for generalization as soon as treatment begins.  A common misstep of some practitioners is only discussing behavior plans for the treatment setting and forgetting to consider other settings until mastery criteria is obtained in that initial setting .  BCBAs should account for generalization into other settings on the onset of treatment.  When a BCBA begins to create a behavior, he/she should consider types of reinforcement available in all settings.  The behavior plan will not be effective if potential motivators are available in one setting, but not another.  During initial planning, it is also important to plan for fading of reinforcement.  When starting to develop a behavior plan, it may be necessary for the stakeholders to offer a dense schedule of reinforcement.  However, over time a BCBA should plan to teach learners to retain skills without the need of continuous reinforcement.  This strategy can include providing access to preferred activities and items less frequently, or generalizing reinforcement to other intrinsic, or “natural”, motivators.

The field of Applied Behavior Analysis has many challenges.  Clinicians, families, and other key stakeholders have to collaborate effectively in order to generalize reinforcers, skill acquisition, and assist with behavior reduction in all of the settings the learner will be a part of.  Many Behavior Analysts and other clinicians must also start planning for effective collaboration and transition of services amongst settings from the onset of beginning services.  While these challenges can be stressful, having the opportunity to work with learners in many different environments and measuring progress leads to a rewarding career and success for all stakeholders involved.

About the Author

Alicia Marshall, MAT, BCBA LBS, started out as a Special Education teacher and made the switch over to full-time BCBA 5 years ago. Alicia received her BCBA coursework at Rutgers and currently works as a Director of Behavioral Health in the Greater Philadelphia area. Alicia is passionate about making learning fun for all stakeholders and to encourage educators to focus on socially significant goals and compassionate care. 

When Alicia is not disseminating the science of ABA, she can be found on the beaches of the Jersey Shore (and occasionally Hawaii) with her husband and two dogs.

By Ashleigh Evans, MS, BCBA

Have you ever been in an uncomfortable situation? Were you able to freely leave or voice your concerns and have them respected? Imagine being unable to communicate your discomfort or disagreement with the situation while being forced to stay. That is the reality many autistic children experience in school, therapy, and other areas of their lives. Gaining assent is critical to allow our learners to have a voice in their treatment. Let’s explore what assent is and consider some strategies to establish assent-based care.

Assent Versus Consent: What is the Difference?

First up–what distinguishes assent from consent? Consent is a term that refers to a client (if legally capable) or their parent or legal guardian agreeing to a treatment based on a comprehensive understanding of the intervention’s purpose, benefits, and risks. To provide consent, one must be legally capable of making these decisions. Children (and many adults with special needs) cannot legally provide consent.

Assent, on the other hand, is not a legal term. Assent refers to the client demonstrating signs of agreement or willingness to participate in treatment. Even if they cannot legally approve or deny therapies, every learner can express their preferences and willingness to engage in therapeutic activities.

What is the Significance of Assent?

Acknowledging and respecting assent and assent withdrawal demonstrates an upholding of client dignity, one of the four core principles outlined in the Ethics Code for Behavior Analysts. Gaining client assent in ABA is one component of what many refer to as “Today’s ABA,” a more compassionate approach to behavioral treatment. In the most recent update to the Ethics Code, assent is included as an ethical requirement, under section 2.11. Therefore, behavior analysts should not only understand what assent is but also actively empower their learners through assent-based practices. By doing so, they can create an environment where clients feel safe, valued, and motivated to learn.

What are the Signs of Assent and Assent Withdrawal?

Behavior Technicians and Behavior Analysts should watch for indications of assent and assent withdrawal. Signs of assent may be vocal, such as the learner making affirmative statements (e.g., “I’m having fun!”). They may also be non-vocal, such as eagerly approaching the therapist and actively engaging in activities.

Signs that your learner is providing assent include:

• Smiling and/or laughing
• Cooperating with learning activities
• Making approval statements, such as “I want to keep doing X” and “I love this!”
• Actively engaging in therapy activities
• Eagerly approaching the therapist
• Requesting to repeat activities
• Staying in the therapy space

Assent can be withheld or withdrawn at any time. Assent withdrawal refers to the indications that the learner does not approve of the treatment methods being utilized or goals being targeted. Signs of assent withdrawal may be both vocal, such as protesting (e.g., “no!”) and non-vocal, such as running away.

Signs of assent withdrawal include:

• Turning away or pulling away from learning activities
• Pushing away teaching stimuli
• Eloping from the therapist or therapy space
• Aggression, self-injurious behavior, property destruction, or other harmful behaviors
• Crying, screaming, or vocally protesting
• Dropping or flopping to the floor
• Avoiding the therapist
• Frowning

How Can You Implement Assent-Based Learning in ABA Therapy?

Gaining and maintaining assent is a complex, ongoing process that requires careful observation, flexibility, and respect for the client’s autonomy. Here are a few key strategies you can use to promote assent-based ABA therapy with your learners.

1. Prioritize Choices
   
   Empower your learners with choices to foster engagement and promote autonomy. Offer choices in activities, reinforcers, stimuli, location of sessions, and even the structure and order of programs or activities. While the client may not be able to make choices regarding every aspect of therapy, prioritize offering choices whenever possible.
   
   
2. Teach & Reinforce Self-Advocacy

Encourage your learners to communicate their needs, preferences, and boundaries. Regardless of their communication abilities or mode of communication, support them in developing critical self-advocacy skills, such as requesting a break and expressing discomfort.

3. Make Therapy Fun
    
   Therapy doesn’t have to feel like work. While there are bound to be goals that are challenging and tasks that aren’t the most preferred, there are countless ways to ensure therapy remains enjoyable and motivating. Regularly conduct preference assessments to ensure you are continuously enriching the environment with preferred items and activities.
   
   
4. Honor Assent Withdrawal
   
   

Respect your learner’s right to withdraw assent. This is essential for fostering trust.

5. Analyze & Address the Reasons for Assent Withdrawal
   
   When a client withdraws assent, that doesn’t mean the therapy session simply ends or the therapist allows them to do what they want for the remainder of the session. The therapist must analyze the situation to identify the reason(s) for assent withdrawal. They may need to modify various aspects of the learning environment, treatment modality, or goals to regain their learner’s assent. Here are a few things to consider:

• Has the therapist and client successfully paired? Does the therapist continuously focus on maintaining a positive rapport?
• Is the teaching style aversive to the client? (e.g., overly structured and repetitive when the learner may prefer a more naturalistic approach)
• Are the tasks too difficult? Are prerequisite skills missing? Is additional prompting necessary?
• Are the tasks too easy and monotonous?
• Is prompting aversive? (e.g., full physical when the learner does not like to be touched)
• Are there sensory sensitivities that may be making the learner uncomfortable?
• Are the learner’s preferences being accounted for and prioritized?

Beyond Compliance: The Power of Assent

While compliance has historically been a central focus of ABA therapy, the shift toward “today’s ABA” has redefined the field. True progress is about more than simply complying. It’s about trust, active engagement, and meaningful participation. By embracing assent-based practices, behavior analysts can empower their learners to play an active part in their therapeutic journey.

About the Author

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

By Nahoma Presberg, MS BCBA NYS-LBA

What do you do in ABA therapy, anyways? You might get this question a lot as a BCBA, and for good reason! ABA is a powerful technology that can be used to teach so many skills and reduce a wide variety of interfering behaviors. The possibilities are endless!

So how do we figure out what we should be teaching?

Assessment

The assessment process is (obviously) extremely important for putting together a curriculum. During the assessment process, we’re looking to get an understanding of:

• The learner’s skills
• The family’s concerns
• The reasons they’re seeking ABA services
• Perspectives from other providers

You may also want to take a look at my post about how to pick a social skills assessment.

Scheduling

Next we need to consider the schedule of services. Is the family looking for comprehensive services which may be as many as 20 or 30 hours a week? Or maybe they’re looking for therapy to focus on one specific concern.

Working with Insurance

Depending on your state, if you are providing ABA services covered by health insurance, there may be more specific rules about the kinds of goals that they will cover. Typically, these rules indicate that the goals must all be related to reducing the symptoms of autism. While this is a rather loaded statement, ultimately this means that goals must be related to the core deficits of autism, i.e. restricted and repetitive patterns of behavior or communication deficits.

Incorporating Family Preferences

One of the most important metrics of our therapy is social validity. Social validity addresses the extent to which the therapy makes a meaningful difference in our client’s and stakeholder’s lives. Families and clients have a lot of insight into what would make the biggest difference in their lives. For example, the family might have a tradition of going to the beach every summer but our client struggles with managing the different routines of a vacation schedule. We may choose to work on supporting the preparation and flexibilities skills required for our client to be able to successfully participate in vacation with the rest of the family. 

Our Role as Advocates

In our role as advocates, sometimes it is our job to help families understand more about autism or what is realistic to expect of their child at different points in their development. ABA therapy (particularly parent training) can be an important opportunity to teach families about autism in ways that might help them make their home more accommodating for their child or understand about what additional environmental supports might be needed.

Next Steps

Once you’ve compiled all this information, you’ll probably have a long list of skills you want to work on. You might need to prioritize and think about certain goals as “core” priorities, and other as supporting goals. There can often be a sense of urgency when looking at all of the things you want to teach but remember that slow and steady wins the race. It’s ok to prioritize just a few key goals that are really going to help your client the most and expand from there when they’re ready.

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About the Author

Nahoma Presberg, MS BCBA NYS-LBA, is a Board Certified Behavior Analyst. Nahoma obtained their master’s degree at the University of Rochester in Human Development. They have been working with clients in their homes for the past 6 years but has over a decade of experience supporting children with developmental disabilities. Nahoma is passionate about neurodiversity affirming care and thoughtful programming that helps every client thrive.

For more information about Nahoma, you can visit their website at https://www.nahomapresberg.com/.

This month’s ASAT feature comes to us from Julie Ashkenazi, MS, BCBA, Synthesis Behavior, and Lisa Tereshko, PhD, BCBA-D, Endicott College. 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!

Description

A father shows his adolescent child how to start a lawn mower. A tennis instructor shows a student how to serve. An older sibling shows their younger sibling how to flip a pancake. These are everyday examples of modeling. Modeling is an instructional procedure in which an individual proficient in a task, the model (e.g., a teacher, parent, or an interventionist), demonstrates the task for another person (e.g., student, child) who observes and subsequently attempts to copy the model’s performance (Cooper et al., 2020).

Modeling is a type of assistance that increases the likelihood of a correct response (Noell et al., 2021). It is helpful when other prompts, such as verbal (e.g., vocally saying, “Turn on the water”) or physical prompts (e.g., gently placing one’s hand on the learner’s hand to support them in turning on the water), are ineffective. It can be especially beneficial when teaching complex tasks (Noell et al., 2021), such as tying shoelaces, cooking a meal, or shaving. Modeling can also help individuals learn more naturalistically by observing others, which can be extremely useful when learning other skills across contexts and throughout the life span. Perhaps most importantly, modeling is an everyday procedure that all people are likely to encounter in multiple settings and contexts. Consequently, exposing learners to modeling (as an instructional approach) may help prepare them to imitate the actions of others when naturally experiencing unfamiliar or new contexts as they grow older.

Modeling can be a useful teaching strategy because it embeds an interactive learning opportunity when the learner is required to copy the model’s actions. It also enables the learner to observe the positive results of their actions by providing reinforcement opportunities, which, in turn, foster new skill development (DiSalvo & Oswald, 2002). For example, when a younger sibling (the learner) observes an older sibling (the model) flipping a pancake, the learner acquires cooking skills and is provided with an opportunity for reinforcement by enjoying a perfectly cooked pancake they then make themselves.

Peer modeling is unique because peers serve as models instead of professionals or caregivers. This type of modeling is appealing because it widens the range of people an individual can learn from. While peer modeling can be implemented in a range of settings (Athamanah & Cushing, 2019; Blew et al., 1985), it is particularly well-suited for school settings due to easy access to peers. In schools, peer modeling creates an opportunity for target skills to be developed more naturally (Athamanah & Cushing, 2019) and facilitates interactions with typically developing students. These increased interactions can help foster acceptance, social skills, play skills, and friendships (Chang & Locke, 2016). These benefits are notable, as they could help address concerns often shared by autistics educated in inclusive school settings, such as feelings of loneliness and lack of inclusion or acceptance within the class structure (Locke et al., 2012). Additionally, the benefits extend to the peer models, as they gain leadership skills, enhance self-efficacy, and enjoy positive interactions with their peers with disabilities (Chen, 2024).

Research Summary

Modeling is an established evidence-based intervention for autistic individuals (Hume et al., 2020; National Autism Center, 2015). Research shows that peer modeling, a specific type of modeling, is effective for teaching autistic individuals a variety of skills, including receptive labeling (Charlop et al., 1983), discrimination of colors, shapes, and prepositions (Egel et al., 1981), as well as making purchases, checking out library books, and crossing the street (Blew et al., 1985). Moreover, the results of these studies demonstrated that peer modeling could benefit autistics in inclusive classroom settings, with Charlop et al., (1983) reporting increased social behavior as a positive side effect of the intervention.

Recent studies have used peer modeling to support a variety of populations with different skills, including teaching adults to make lifestyle changes to improve health and manage chronic pain (Schweier et al., 2014), improving vegetable consumption in preschool children (Staiano et al., 2016), and increasing physical activity among inactive women in the workplace (Rowland et al., 2018).

In the context of autism intervention, peer modeling is often combined with other procedures such as rewarding appropriate responses (Sira & Fryling, 2012) or additional prompts (Chen, 2024). Kourassanis-Velasquez and Jones (2019) found that peer modeling combined with prompting and reinforcement increased responding and initiating bids for attention during game play for three children with Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), a diagnosis now classified under autism spectrum disorder (ASD; Autism Speaks, n.d.). Although the results revealed performance was generalized to novel peers, it was inconsistent after the intervention ended; however, the study included only one follow-up check, which limits understanding of long-term performance outcomes. Despite this, both parents and peer models rated the intervention positively. More recently, Chen (2024) used peer modeling with prompts and reinforcement to increase two autistic students’ (aged seven and nine) performance on tasks, such as packing a school bag, putting on a school bag, picking up trash, and lining up for dismissal. Results indicated that participants found peer support helpful, and all peer models indicated they would like to support other students in the future.

Additionally, modeling is a component of Behavioral Skills Training (BST), an intervention package with strong empirical support that also includes instructions, rehearsal, and feedback (Noell et al., 2021). There are numerous examples of interventions that integrate peer modeling with BST (Brady et al., 2016; Chambers & Radley, 2019; Covey & Alber-Morgan, 2021). Covey and colleagues (2021) increased interactive play with children with moderate to severe disabilities using peer modeling, BST, and task analyses. In the weeks following intervention, one participant showed a slight decrease in the trained skill, while the other three demonstrated additional increases in interactive play. Although participant satisfaction was not measured, peer models rated the intervention highly and felt they could engage better with peers with disabilities following the study.

Peer modeling can also be extended to older learners. Athamanah and Cushing (2019) increased independent engagement in vocational tasks and social interactions with autistic participants aged 14-18 using peer modeling as part of a work-based training. During the intervention, peers modeled how to perform tasks, ask questions, and make comments. They also used a variety of prompting strategies, including providing verbal, gestural, or hand guidance, to help facilitate independent participant performance, which led to increases in performance accuracy. Unfortunately, the transfer of skills to other settings and individuals and retention of the skills over time were not assessed due to time constraints of the study.

Recommendations

The research in this review shows that peer modeling is strongly supported by the evidence. This aligns with The National Autism Center’s National Standards Project (Phase 2) and Hume et al. (2021), which both established modeling as an evidence-based intervention for autistic individuals. Peer modeling can be used with learners of different ages to teach various skills (Covey & Alber-Morgan, 2021) and foster acceptance within inclusive educational settings (Chang & Locke, 2016). For modeling to be effective, it seems clear that learners must have two prerequisite skills: the ability to attend to the model and imitation skills (Noell et al., 2021). Therefore, the team directly working with an individual should guide treatment decisions to determine if it is an appropriate intervention for that individual.

Continued research is required to further enhance our understanding of peer modeling. One area needing further investigation includes the extent to which peer characteristics (e.g., age, gender) influence the impact of modeling for autistic individuals. Another item for further research is the generalization across settings and people and maintenance across time of the skills learned through peer modeling. Furthermore, though the benefits are many, it remains essential not only to ensure assent from the autistic learners but also from the peers modeling the desired behaviors. Finally, more research is needed on the satisfaction and preference of the individual learning through peer modeling.

Peer modeling offers significant benefits not only to autistic learners and those with developmental disabilities, but also to the peers who serve as models. These benefits include making friendships, promoting a sense of community, fostering personal growth, patience, and empathy, acquiring new skills, experiencing a sense of reward, and developing more positive attitudes toward individuals with disabilities (Travers et al., 2023). Given its advantages for learners and peers, peer modeling is both evidence-based and compatible with the movements toward building more compassionate and inclusive learning environments.

Systematic Reviews and Task Forces

Chang, Y. C., & Locke, J. (2016). A systematic review of peer-mediated interventions for children with autism spectrum disorder. Research in Autism Spectrum Disorders, 27, 1-10. https://doi.org/10.1016/j.rasd.2016.03.010

Hume, K., Steinbrenner, J. R., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2021). Evidence-based practices for children, youth, and young adults with autism: Third generation review. Journal of Autism and Developmental Disorders 51, 4013-4031.  https://doi.org/10.1007/s10803-020-04844-2

National Autism Center. (2015). Findings and conclusions: National Standards Project, Phase 2. Author.

Selected Scientific Studies

Athamanah, L. S., & Cushing, L. S. (2019). Implementing a peer-mediated intervention in a work-based learning setting for students with autism spectrum disorders. Education and Training in Autism and Developmental Disabilities, 54(2), 196-210. https://www.jstor.org/stable/26663977

Blew, P. A., Schwartz, I. S., & Luce, S. C. (1985). Teaching functional community skills to autistic children using nonhandicapped peer tutors. Journal of Applied Behavior Analysis, 18(4), 337-342. https://doi.org/10.1901/jaba.1985.18-337

Brady, M. P., Honsberger, C., Cadette, J., & Honsberger, T. (2016). Effects of a peer-mediated literacy based behavioral intervention on the acquisition and maintenance of daily living skills in adolescents with autism. Education and Training in Autism and Developmental Disabilities, 51(2), 122-131. https://www.jstor.org/stable/24827542

Chambers, C., & Radley, K.C. (2019). Training soccer skills to adolescents with autism spectrum disorder via peer-mediated behavioral skills training. Behavior Analysis in Practice, 13(2), 454-461. https://doi.org/10.1007/s40617-019-00381-2

Charlop, M. H., Schreibman, L., & Tryon, A. S. (1983). Learning through observation: The effects of peer modeling on acquisition and generalization in autistic children. Journal of Abnormal Child Psychology, 11(3), 355-366. https://doi.org/10.1007/BF00914244

Chen Y. L. (2024). Implementation of a peer-mediated intervention to teach behavioral expectations for two students on autism spectrum and a student with ADHD in an inclusive elementary classroom in Taiwan. Journal of Autism and Developmental Disorders, 54(3), 852-870. https://doi.org/10.1007/s10803-022-05873-9

Covey, A., Li, T., & Alber-Morgan, S. R. (2021). Using behavioral skills training to teach peer models: Effects on interactive play for students with moderate to severe disabilities. Education & Treatment of Children, 44(1), 19-30. https://doi.org/10.1007/s43494-020-00034-y

DiSalvo, C. A., & Oswald, D. P. (2002). Peer-mediated interventions to increase the social interaction of children with autism: Consideration of peer expectancies. Focus on Autism and Other Developmental Disabilities, 17(4), 198-207. https://doi.org/10.1177/10883576020170040201

Egel, A. L., Richman, G. S., & Koegel, R. L. (1981). Normal peer models and autistic children’s learning. Journal of Applied Behavior Analysis, 14(1), 3-12. https://doi.org/10.1901/jaba.1981.14-3

Locke, J., Rotheram-Fuller, E., & Kasari, C. (2012). Exploring the social impact of being a typical peer model for included children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 42(9), 1895-1905. https://doi.org/10.1007/s10803-011-1437-0

Kourassanis-Velasquez, J., & Jones, E. A. (2019). Increasing joint attention in children with autism and their peers. Behavior Analysis in Practice, 12(1), 78-94. https://doi.org/10.1007/s40617-018-0228-x

Rowland, S. A., Berg, K. E., Kupzyk, K. A., Pullen, C. H., Cohen, M. Z., Schulz, P. S., & Yates, B. C. (2018). Feasibility and effect of a peer modeling workplace physical activity intervention for women. Workplace Health & Safety, 66(9), 428-436. https://doi.org/10.1177/2165079917753690

Schweier, R., Romppel, M., Richter, C., Hoberg, E., Hahmann, H., Scherwinski, I., Kosmützky, G., & Grande, G. (2014). A web-based peer-modeling intervention aimed at lifestyle changes in patients with coronary heart disease and chronic back pain: Sequential controlled trial. Journal of Internet Medical Research, 16(7), e177. https://doi.org/10.2196/jmir.3434

Sira, B. K., & Fryling, M. J. (2012). Using peer modeling and differential reinforcement in the treatment of food selectivity. Education and Treatment of Children, 35(1), 91-100. http://www.jstor.org/stable/42900147

Staiano, A. E., Marker, A. M., Frelier, J. M., Hsia, D. S., & Martin, C. K. (2016). Influence of screen-based peer modeling on preschool children’s vegetable consumption and preferences. Journal of Nutrition Education and Behavior, 48(5), 331-335.e1. https://doi.org/10.1016/j.jneb.2016.02.005

Travers, H. E., Carter, E. W., Picard, E. T., & Hauptman, L. (2023). It “goes both ways”: The impact of peer-mediated interventions on peers. Inclusion, 11(3), 162-178. https://doi.org/10.1352/2326-6988-11.3.162

Other References

Autism Speaks. (n.d.). What is PDD-NOS? https://www.autismspeaks.org/pervasive-developmental-disorder-pdd-nos

Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis (3rd ed.). Pearson.

Noell G. H., Call N. A., Ardoin S. P., & Miller, S. J. (2021). Building complex repertoires from discrete behaviors. In W. W. Fisher, C. C. Piazza, & H. S. Roane (Eds.), Handbook of applied behavior analysis (2nd ed., pp. 252-269). Guildford Press.

Citation for this article

Ashkenazi, J., & Tereshko, L. (2025). A treatment summary of peer modeling. Science in Autism Treatment, (22)2.

About the Authors

Julie Ashkenazi, M.S., BCBA, LBA is the founder of Synthesis Behavior, a California-based behavior analytic consultancy, and an Adjunct Assistant Instructor in the Department of Behavior Analysis at the University of North Texas. She is also a co-manager of Shaping Change, a research community dedicated to advancing equitable and inclusive practices in behavior analysis. A former creative director, Julie holds a B.A. from Dominican University. She pursued a career in applied behavior analysis after a loved one received an autism diagnosis, earning an M.S. in Applied Behavior Analysis from Endicott College, where she completed her studies with a concentration in autism. An advocate for neurodiversity-affirming practices, Julie is passionate about supporting learners of all ages through meaningful programs that enhance quality of life. In line with this advocacy, her areas of interest include ethics, service quality, and parent collaboration.

Dr. Lisa Tereshko, Ph.D., BCBA-D, LABA is the Assistant Dean of Research for the Institute of Applied Behavioral Science at Endicott College. Lisa has over 20 years of experience working with individuals with autism and other behavioral disorders in schools, homes, and residential settings. Her research interests include: the effectiveness and efficiency of functional analyses, ethical and compassionate feeding interventions, increasing cultural competency in higher education, and identifying best pedagogical practices within higher education in which she has published peer-reviewed articles, books, and chapters. She has presented locally, nationally, and internationally on many topics, serves on committees at BABAT and at ASAT, and is on the editorial board of Behavior Analysis in Practice. 

By Sam Blanco, PhD, LBA, BCBA, Originally Posted October 11, 2018

Recently I was working with a parent who was using a Time Timer with her son to help him recognize when it was time to get ready for bed. Our plan was to start the timer every night while he was engaged in an activity, show him the timer and have him repeat how many minutes left, then have him tell his mom when the timer went off. For the first couple of weeks, this plan worked beautifully. The boy could see the time elapsing, brought the timer to his mother when it went off, and then started the process to get ready for bed without engaging in tantrum behaviors.

I went in for a parent training session after a month of the intervention and the boy’s mother informed me the timer just wasn’t working any more. As we started talking, I realized that the mother had drifted from our original plan in a way that is quite common. As her son experienced success, she used the timer less frequently. Then, if he was struggling, she would introduce the timer. In effect, she started only using the timer when he was misbehaving, instead of using it as a consistent tool to help him with the bedtime routine.

This type of procedural drift (when there is an unintentional or unplanned change in the procedure outlined for the intervention) is very common for parents, teachers, and ABA therapists. It’s important to understand this type of drift so it can be corrected when it occurs.

Here are a few things to remember when implementing an intervention

• First, any intervention should include a clear plan for fading the intervention. In the example above, the Time Timer was an appropriate tool for this particular child, who was only four years old. But we don’t want him to rely on the timer for the duration of childhood! A plan should include how to fade the intervention with specific steps and specific requirements for mastery.

• The use of the Time Timer is considered an antecedent intervention. This means that we are implementing a change in the environment prior to any problem behaviors to help the child contact reinforcement and experience success. Antecedent interventions should be implemented consistently as part of a routine, not ONLY when a problem behavior occurs. If it is only implemented when the problem behavior occurs, it is no longer an antecedent intervention.

• If we implement a tool (like the Time Timer) only when problem behavior occurs, it’s possible the tool will become aversive to the child and possibly result in an increased magnitude of the problem behavior.

• Consider using tools for the people implementing to intervention to remind them of the specific steps. For example, you might create a video model and instruct the parent (or other adult implementing the intervention) to watch it every couple days. Or you might post the steps in a clear space to be reviewed regularly.

• Finally, we have to remember that a couple of good days in a row without any instances of problem behavior does not mean that the problem is solved. This is why the first step outlined above is so important. We want to teach the child replacement behaviors and give them lots of opportunities to be successful with it.

Ultimately, we were able to re-implement the procedure with this parent and see more continued success with this particular case. We also decided to post the steps to the intervention on the back of the Time Timer for easy review on a daily basis.

However, in some cases, you might have to create an entirely new intervention using different tools. The goal is to be clear about the steps of the intervention, and to maintain those steps when implementing the intervention.

About the Author

SAM BLANCO, PhD, LBA, BCBA

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

By Anika Hoybjerg, PhD, EdS, BCBA-D, LBA and Casey Barron, BCBA, LBA

MOTAS Creation

Applied Behavior Analysis (ABA) therapy is an evidence-based practice commonly used when working with individuals who are on the autism spectrum. In ABA treatment, criterion referenced assessments are often used to assess current skills levels, develop goals to acquire new skills, and measure progress.

These assessments are useful tools in providing a structure on what skills to teach individuals, however there are certain gaps that have been observed that inspired the creation of the Meaningful Outcomes Treatment and Assessment Scale (MOTAS) and companion Levels of Optimum Performance (LOOP) interviews. These include aligning treatment goals with parent and family priorities, comprehensive care across the lifespan, and inclusion of teaching skills to increase flexibility that are a barrier to learning.

Parent Priorities

An important aspect of providing treatment to individuals with autism and related disabilities is to collaborate with parents, caregivers, and others who know and love the person. This includes incorporating their goals, values, and feedback into treatment. Understanding what barriers are preventing an individual from participating in desired hobbies, gaining friends, being with family during important moments or events, or participating in education and extracurricular activities are crucial to developing a comprehensive care plan that meets the needs of the individual and their loved ones who are supporting them. Having a structured interview and record of parent, caregiver, and client preferences, goals, and thoughts was one of the motivations when creating the MOTAS.

Additionally, in the time the authors have spent working with families, a pattern emerged when having discussions about goals for the future of their families. It was observed that some of the most important skills families wanted to work on were not part of current assessments. Goals such as going into novel locations for family events, tolerating unexpected changes in daily routines, understanding their siblings’ perspectives, establishing and maintaining relationships, and so many other skills were not addressed in a comprehensive way.

While this does not prevent professionals from addressing these skills in treatment, it can make it difficult to demonstrate progress when updating assessments. Demonstrating progress through increasing scores on skill assessments is often a recognized metric by insurance companies who are responsible for approving and paying for treatment.

Flexibility  

Despite one of the core characteristics of autism being restricted and repetitive behavior, this is not comprehensively addressed in existing assessments. Restricted and repetitive behavior is useful in many regards, however for some individuals, disruptions to changes in routine may cause distress, and for some may lead to instances of maladaptive behavior. Lack of inclusion on assessment does not prevent individuals from working on these skills, however it may result in difficulty demonstrating progress for payors, and rigidity and inflexibility may be a barrier to acquiring other skills.

While respecting routines and rituals is important, there are also times when teaching flexibility is important. The goal of working on flexibility is to help individuals gently bend without breaking or inducing trauma. Life is unpredictable, and developing flexibility helps one to navigate many situations with ease and comfort. Flexibility is usually required when things don’t go as expected, routines change, and we are required to adapt to these unexpected changes.

Meeting the Needs of a Variety of Individuals

Several commonly used assessments are widely used in the field of ABA to address early language skills, guide treatment according to early developmental milestones, and prepare individuals for living alone in some environments. However, gaps were noticed when attempting to select goals and develop treatment plans for individuals who are seeking to establish and maintain relationships, developing perspective taking skills, working on advocating for themselves, and are learning to adapt to unexpected changes in their day. The MOTAS includes skills related to each of these domains, and several others. The skills within each domain can be taught to individuals with varying communication styles, and facilitate functional, independent, and meaningful skills into adulthood.

Further Reading

Introducing the Meaningful Outcomes Treatment and Assessment Scale

Using the MOTAS and LOOP: Selecting Meaningful Goals

About the Authors

Anika Hoybjerg, PhD, EdS, BCBA-D, LBA
Dr. Hoybjerg is the CEO, founder, and owner of Autism & Behavioral Intervention (ABI) (a clinic-based ABA center in Draper, UT), ABA Education Center, and Integrity Billing. In addition to founding and leading these companies, Anika has worked in public schools and in private sectors with children and families for over 20 years. Anika is a Doctoral level Board Certified Behavior Analyst (BCBA-D) and a Licensed School Psychologist. Anika has a Bachelor’s degree in Human Development, a Master’s Degree in Curriculum and Instruction with an Emphasis in Autism, a Master’s degree in Human Exceptionality, an Ed.S in School Psychology, and a Ph.D. in Applied Behavior Analysis. Anika is currently pursuing a Master’s degree in Neuroscience and Trauma. Anika has presented at regional, national, and international conferences on a variety of topics relating to kindness in ABA services, autism, collaboration, and assessments.

Casey Barron, BCBA, LBA
Casey is a practicing Board Certified Behavior Analyst in Salt Lake City, Utah. She has been working in ABA since early 2015, spending several years first working as an RBT then as a BCBA in academic, home, and clinical settings. In addition to her work as a practicing BCBA, Casey works as the clinical director of an ABA center that has supported hundreds of children and where she oversees and trains staff members and future BCBAs. Since becoming a BCBA, Casey has presented at regional and international conferences on case studies from her own clinical practice.

Author Anika Hoybjerg discusses the importance of selecting meaningful goals.

By Anika Hoybjerg, PhD, EdS, BCBA-D, LBA and Casey Barron, BCBA, LBA

 As professionals in applied behavior analysis and related fields, it is our greatest privilege to work with those in our care. We have a responsibility to use our time, resources, knowledge, and skills to provide the most meaningful outcomes possible for our clients. Oftentimes, decisions about care are made solely by professionals based on an individual’s diagnosis, assessments, and characteristics of behavior. However, while the professionals in these fields have expertise regarding behavior, they are not the ones who are impacted by the treatment they provide day to day or over the years. In the article “I Can Identify Saturn But I Can’t Brush My Teeth,” Ayres and colleagues (2011) discussed the importance of clinicians selecting meaningful goals that have a significant influence on their client’s independence and quality of life.

Assessments are tools that can help guide and shape what skills are worked on during treatment, but they should not be used to mold individuals to fit the criteria of all the skills listed within it. Assessments are not just about mastering goals; it is about using a tool to develop and implement a plan to help individuals lead a satisfying life with steady improvements over time. Professionals should strive to truly know their clients, their strengths, and the areas of need that will help support their growth. Goals addressed during treatment are selected because they are necessary, important, functional, and lead to meaningful outcomes for the individual and their family.  Attempting to determine what skills are most important and will have the greatest impact can be a difficult task. Areas of importance can be done by interviewing and involving clients and stakeholders, collaborating with other professionals, building on an individual’s strengths and interests, building on skills that will lead to increased quality of life or independence, and giving the individual access to more opportunities that are enjoyable and preferred.

Author Casey Barron shares an example of how selecting more meaningful goals increases client buy-in

As mentioned above, one method for selecting meaningful goals may include interviewing and collaborating with the client you are working with (when appropriate), interviewing parents and caregivers, and collaborating with other professionals who work with the client. The Levels of Optimum Performance (LOOP) interviews are structured interviews that can be used to interview each of these stakeholders. The LOOP has questions related to the 20 domains of The Meaningful Outcomes Treatment and Assessment Scales (MOTAS), and provides a scale for the interviewee to rank how important it is to work on each domain. The information and scores from these interviews can be utilized to select treatment domains, allowing a professional to assess further in these domains and determine which skills are needed to help the individual achieve this goal.

Another important consideration when selecting meaningful goals is to take into account your learner’s current strengths, interests, and goals. This can be applied across a variety of teaching domains. For example, if you are teaching an individual to label animals and they love looking at books with mythical creatures, include labeling dragons, unicorns, and trolls into their program. This gives the individual a way to label things they are interested in and may give them ways to communicate and connect with others. There is time to work on building other common language skills, however focusing on what is important to the client should also be a priority.

Additionally, skills that allow for an individual to gain independence is a highly important component of providing treatment. Determining what independence looks like for an individual is going to be highly individualized and may change over time. For individuals who may be living with family members into adulthood, making their own meals, dressing themselves, participating in community activities, and engaging in interactions with family members may be some of the most important domains to work on. In contrast, individuals who may leave the home and live with roommates and have a job may work on skills related to gaining employment, time management, and perspective-taking skills. Independence may look different for each person, but by collaborating with clients, families, and professionals, setting high expectations, teaching in compassionate ways, problem-solving, and continuing to push the client to grow, we can aid these individuals in becoming more self-reliant.

Finally, it is important to consider goals that are going to give individuals opportunities to access activities, interactions, and people that they enjoy. Teaching communication, social skills, leisure activities, and community skills should not be taught only for them to accompany others on their errands or activities, but they should also be taught so the individual can participate in their preferred hobbies, spend time with others they care about in a variety of settings, and participate in other desired activities.

Additional Reading

See our recent blog, Introducing the Meaningful Outcomes Treatment and Assessment Scale

About the Authors

Anika Hoybjerg, PhD, EdS, BCBA-D, LBA
Dr. Hoybjerg is the CEO, founder, and owner of Autism & Behavioral Intervention (ABI) (a clinic-based ABA center in Draper, UT), ABA Education Center, and Integrity Billing. In addition to founding and leading these companies, Anika has worked in public schools and in private sectors with children and families for over 20 years. Anika is a Doctoral level Board Certified Behavior Analyst (BCBA-D) and a Licensed School Psychologist. Anika has a Bachelor’s degree in Human Development, a Master’s Degree in Curriculum and Instruction with an Emphasis in Autism, a Master’s degree in Human Exceptionality, an Ed.S in School Psychology, and a Ph.D. in Applied Behavior Analysis. Anika is currently pursuing a Master’s degree in Neuroscience and Trauma. Anika has presented at regional, national, and international conferences on a variety of topics relating to kindness in ABA services, autism, collaboration, and assessments.

Casey Barron, BCBA, LBA
Casey is a practicing Board Certified Behavior Analyst in Salt Lake City, Utah. She has been working in ABA since early 2015, spending several years first working as an RBT then as a BCBA in academic, home, and clinical settings. In addition to her work as a practicing BCBA, Casey works as the clinical director of an ABA center that has supported hundreds of children and where she oversees and trains staff members and future BCBAs. Since becoming a BCBA, Casey has presented at regional and international conferences on case studies from her own clinical practice.

By Stephanny Freeman, PhD, Kristen Hayashida, MEd, BCBA, and Dr. Tanya Paparella, originally posted by Different Roads to Learning, September 7, 2017

Most adults think of toy play as a natural part of childhood.  When my daughter was born, we were showered with plush animals, tea sets, and dress up clothes for her to use in play.  But what happens when the child does not find toy play to be natural?

Many children on the autism spectrum use toys non-functionally or repetitively.  When I ask parents of children with ASD to tell me about their child’s play they often say “he doesn’t know how to use toys appropriately!”  They then tell me about how the child may spin the wheels on the car while staring at the rotating objects.  They tell me about the specific scripts the child uses to carry out a routine with their toys and subsequent tantrums if the routine is disrupted.  Parents notice how this deficit in play impacts their ability to engage with peers or occupy their free time appropriately.

Symbolic play occurs when the child uses objects or actions to represent other objects or actions.  For example, a child using a doll as their baby and rocking the doll to sleep is an act of symbolic play.  The doll is not alive, but the child is representing a baby.  This skill is a core deficit in children with ASD.  This means that they do not “naturally” or “easily” acquire the ability to use toys to represent other things.  Development of symbolic play is crucial in early development and is tied to numerous subsequent skills:

Language

Symbolic play is highly correlated to language development.  This means that the better the child’s ability to play representationally, the better the child’s language skills.  There is also emerging evidence to support symbolic play as having a causal relationship to language.

Social Development

As neurotypical children continue their learning about symbolic play and through symbolic play, children with ASD often struggle to relate to their peers and understand their play schemes.  Some children with ASD may only engage peers in physical play (instead of symbolic play) or they may end up playing alone using their familiar play scripts.

Perspective-taking

Symbolic play allows the child early opportunities to take on the perspective of another being.  If a child pretends to be a pirate, they being to talk and think of things a pirate might want/do.  This early practice with perspective-taking allows the child to use this skill when interacting with peers and adults.

Meta-cognition and Problem Solving Skills

Meta-cognition is the ability to think about one’s own thinking.  This is an essential skill when solving problems and planning one’s time.  During play kids plan, organize and cognitively process through obstacles and mishaps with their toys.

Emotional Development

Through symbolic play, children can practice expressing emotion through the scenes they create.  There is also some evidence suggesting that this early practice contributes to emotion understanding and empathy.

Clearly, children need play for growth and development.   However, for children with ASD the development of symbolic play may be difficult and, even thought of as WORK!

Given the numerous skills that come out of symbolic play, we urge parents of children with ASD to consider the importance of toy play.  Dedicate time and effort to engage your child in symbolic play.  It is usually not easy at first!  It might have been decades since you picked up an action figure and used him to fight off bad guys, but practice with your child.

Parents know that it is part of their job to help their child learn to read and do basic math.  They would not let their child escape those tasks because they are hard.  Please consider PLAY to be just as important and necessary for the child’s development.  Even if it is work at first, insist the child play with you and in time, improvements may come not only in toy play but also in so many other key areas of development.

References

Jarrold, C., Boucher, J., & Smith, P. (1993). Symbolic play in autism: A review. Journal of Autism and Developmental Disorders, 23(2), 281-307.

Ungerer, J.A. & Sigman, M. (1981). Symbolic play and language comprehension in autistic children. Journal of the American Academy of Child Psychiatry, 20, 318-337.

About the Authors

Dr. Stephanny Freeman is a clinical professor at UCLA, a licensed clinical psychologist, and Co-Directs the Early Childhood Partial Hospitalization Program (ECPHP).  For 20 years, she has educated children with ASD and other exceptionalities as a teacher, studied interventions for social emotional development, and designed curriculum and behavior plans in school and clinic settings.

Kristen Hayashida is a Board Certified Behavior Analyst at the UCLA Early Childhood Partial Hospitalization Program (ECPHP).  For the last 10 years she has served as a therapist, researcher and educator of children and families living with autism spectrum disorder through the treatment of problem behavior.

Dr. Tanya Paparella is a specialist in the field of autism having spent more than 20 years in intervention and research in autism. She is an Associate Clinical Professor in the Division of Child Psychiatry at UCLA, a licensed clinical psychologist, and Co-Director of UCLA’s Early Childhood Partial Hospitalization Program (ECPHP), an internationally recognized model treatment program for young children on the autism spectrum.

-Authors Casey Barron and Anika Hoybjerg introduce the MOTAS.

By Anika Hoybjerg, PhD, EdS, BCBA-D, LBA and Casey Barron, BCBA, LBA

When working with individuals with autism or other related disabilities, it is common to use an assessment to measure current skill levels against typical developmental norms, or to measure skill acquisition over periods of time. There are several assessments that are commonly used, some of which are The Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP), The Assessment of Basic Language and Learning Skills (ABLLS), The Assessment of Functional Living Skills (AFLS), and Essentials for Living (EFL).

These assessments have paved the way for individuals to receive individualized treatment, give a starting place of where to begin teaching, and record progress over time.

However, while useful, these guides are not comprehensive across the lifespan, and are often used when it is no longer age or developmentally appropriate. Additionally, the scoring within these assessments (with the exception of EFL) does not account for generalization and maintenance of skills, which can make it difficult to accurately measure an individual’s true progress. The Meaningful Outcomes Treatment and Assessment Scale (MOTAS) was designed with some of these limitations in mind and seeks to address these needs.

Meaningful Outcomes Beyond Early Intervention

The MOTAS is appropriate for individuals ranging from age 5 through adulthood. It contains nearly 1,200 goals across 20 domains to comprehensively address skills that an individual needs to communicate wants and needs, gain independence, increase quality of life, build relationships, gain employment, and pursue opportunities of their choosing. The skills and domains were selected intentionally to ensure that any time spent on goals from this assessment would lead to increased opportunities for the individual. To ensure that no goal or domain is worked on to just “check a box” or fill a grid, a “Meaningful Outcome” has been provided for each domain and subdomain in the assessment, describing why that specific set of skills is important, and what can be gained by working on and addressing those skills.

Domains are comprehensive in covering skills for an individual who is just starting to learn these skills, and become progressively more complex. Additionally, nearly every domain includes goals related to safety, problem-solving, and flexibility.

Unique, Easy-to-Use Scoring

In addition to comprehensive skills and domains, the MOTAS has a unique scoring system that measures whether an individual has gained independence in a skill, whether they have generalized the skill to multiple environments and multiple people, and whether they have maintained the skill over time. The scoring system is easy to use while still offering a comprehensive look at the client’s progress:

0 – Not applicable

1 – Pre-skill: Has not yet demonstrated the skill

2 – Prompted: Completes the skill with prompts

3 – Independent: Independently engages in the skill without prompting

4 – Generalized: Completes the skill with multiple people and in multiple environments

5 – Maintained: Completes the skill without daily teaching and instruction, while also maintaining generalization of the skill (i.e., it is truly mastered)

Focus on Individualized Care

The MOTAS should be completely individualized to the person you are working with. This is highlighted in the instructions and throughout the assessment. Structured interviews were created to be used with the MOTAS in order to create a treatment plan that is unique to the client, and meets the needs of the client, family, caregivers, and other professionals. These interviews are called the Levels of Optimum Performance (LOOP) Interviews. Three versions of this interview are included in each booklet. One interview is designed to be used for caregivers, another with other professionals who work with the individual (such as an occupational therapist or a speech-language pathologist), and the third interview is designed to be used with the client themselves (the LOOP-C). The LOOP-C was designed in collaboration with multiple autistic individuals. They provided feedback and insight on the phrasing of questions, whether questions should be included or omitted, and provided suggestions on how to conduct the interview in a way that is comfortable for the individual being interviewed.

Working with the DSM-5 and Insurance

Another defining feature of the MOTAS is the inclusion of the diagnostic criteria for Autism Spectrum Disorder from the Diagnostic and Statistical Manual of Mental Disorders- Fifth Edition (DSM-5). Professionals who provide services to individuals with autism may be required to submit authorizations and treatment plans to insurance companies, many of which require that treatment goals align with the diagnostic criteria for autism. By providing this criteria within the assessment, professionals can be sure to align goals with this criteria, saving time for both the professional and the payor. 

As with any assessment, implementers hold an incredible responsibility in selecting the appropriate assessment for their client. Using the MOTAS is not simply about gathering data or observing behaviors; it’s about understanding the unique way to meet an individual’s needs, how their future is shaped, and increasing opportunities for independence.

About the Authors

Anika Hoybjerg, PhD, EdS, BCBA-D, LBA
Dr. Hoybjerg is the CEO, founder, and owner of Autism & Behavioral Intervention (ABI) (a clinic-based ABA center in Draper, UT), ABA Education Center, and Integrity Billing. In addition to founding and leading these companies, Anika has worked in public schools and in private sectors with children and families for over 20 years. Anika is a Doctoral level Board Certified Behavior Analyst (BCBA-D) and a Licensed School Psychologist. Anika has a Bachelor’s degree in Human Development, a Master’s Degree in Curriculum and Instruction with an Emphasis in Autism, a Master’s degree in Human Exceptionality, an Ed.S in School Psychology, and a Ph.D. in Applied Behavior Analysis. Anika is currently pursuing a Master’s degree in Neuroscience and Trauma. Anika has presented at regional, national, and international conferences on a variety of topics relating to kindness in ABA services, autism, collaboration, and assessments.

Casey Barron, BCBA, LBA
Casey is a practicing Board Certified Behavior Analyst in Salt Lake City, Utah. She has been working in ABA since early 2015, spending several years first working as an RBT then as a BCBA in academic, home, and clinical settings. In addition to her work as a practicing BCBA, Casey works as the clinical director of an ABA center that has supported hundreds of children and where she oversees and trains staff members and future BCBAs. Since becoming a BCBA, Casey has presented at regional and international conferences on case studies from her own clinical practice.