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:
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.
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.
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
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.
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.
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 ofAutism 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.
By: Different Roads to Learning, Originally published February 14, 2019
Unemployment rates in the autism community are alarming, but the number of individuals entering the workforce only continues to grow. This presents an overwhelming challenge for special educators tasked with preparing learners for what is often an uncertain future. Vocational training is essential as learners with autism approach the transition to adulthood. With this in mind, Nassau Suffolk Services for Autism (NSSA) introduced The Salad Shoppein the fall of 2017.
The curriculum was developed by Kathryn Reres and Rebecca Chi, devoted special educators determined to ensure dignified and purposeful futures for the eight young adult students in their classroom. The focus was to create a program that would provide functional tasks for each learner based on their individual skills, interests and IEP goals. The result was an innovative vocational training curriculum that highlights the strengths of each participant, introduces new skills into their everyday lives and serves as a profitable social enterprise.
The Salad Shoppe model requires multiple steps to be taken over the course of two days, including: Tracking and counting money, taking inventory, creating shopping lists, purchasing, food preparation, converting a customer’s order form to food assembly, delivery and clean up. This comprehensive list ensures that every learner has the opportunity to perform a task that is meaningful and functional to them. (The staff at NSSA are reaping the benefits too! Fresh, healthy, personally-delivered lunches each week have been a huge hit.)
In partnership with Different Roads to Learning, the creative teachers who designed The Salad Shoppe for NSSA are sharing their expertise with special educators everywhere. The published curriculum will allow teachers to implement The Salad Shoppe in a way that will best function for the learners they serve. Now more than ever, there is a crucial need to provide young adults with autism with the tools they will need to take on the competitive workforce. The Salad Shoppe is a cutting-edge curriculum that has opened new doors for educators, learners and parents and will continue to change the landscape of vocational training.
Developed by Kathryn Reres & Rebecca Chi, with illustrations by Brian Mannion, in partnership with NSSA and Different Roads to Learning
One of the core characteristics of autism spectrum disorder is an abnormal approach to social skills. The DSM specifically uses the language “persistent deficits in social communication and social interaction across multiple contexts.” While this may seem straightforward, social skills are an incredibly complex concept to dive into. There are considerations like culture, age, status, and personal preference that all contribute to how people choose to interact in our social world.
Social skills are also incredibly important! Being able to effectively interact with the world around you impacts virtually every other aspect of life. When we’re thinking about teaching people social skills, there can be a lot of pressure to get it right. Let’s take a look at some recommendations to help re-imagine teaching social skills from a neurodiversity-affirming perspective.
Ways to teach social skills in ways that are affirming:
Include the client in decision making. We might teach someone a social rule and the impact that it might have to not engage with that social rule. Then we can help that individual think about times when it might be important to follow that rule and times when it is less important. Small talk is a great example of a social norm that may not always be necessary, but can be a useful skill in the right circumstances.
Lead with consciousness about mental health. Self-image can be so challenging, especially when you’re closely examining how people interact with each other. It can feel alienating to know that you’re not clicking socially and that there’s some secret code that everyone else seems to know. Be kind!
It’s better to have one really good friend than 10 friends who don’t actually really like you. Prioritize quality relationships and helping your client find people who appreciate them for who they are instead of helping them fit in as a less authentic version of themselves.
Ways to teach social skills that are not affirming:
Over-emphasis on social scripts. Social scripts serve a function in a number of specific instances. However, genuine social skills come from a place of authenticity. Be conscientious about when they are useful, and when they might actually get in the way.
Forcing specific leisure skills on someone because of their age, gender, etc. It can be useful to have hobbies in common with the peers around you. However, if it’s not a genuine interest, it is going to be difficult to use that hobby to develop genuine friendships anyway.
Over-emphasis on the reduction of quirky behaviors in the interest of someone “fitting in.” It is true that sometimes certain behaviors can be off-putting in public and may impact someone’s ability to seamlessly navigate a social environment. However, this should not be the primary focus of a social skills program.
These strategies are just the tip of the iceberg. Autistic individuals have been providing a lot of feedback to therapists in recent decades about what supports feel useful and which ones feel alienating. As you continue to learn about social skills programming, I encourage you to learn directly from the people who are receiving the therapy. Happy programming!
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.
There is a common misconception that individuals with special needs require a slower pace of instruction. While they may require a slower pace through a curriculum, this does not mean that individual lessons should be taught at a slower pace. In fact, slowing the pace of instruction not only wastes precious instructional time, it may increase the occurrence of problem behaviors.
Higbee (2009) writes that “appropriately paced instruction helps students to maintain attention to the instructor and instructional materials. Though student attention can be lost when instruction is happening too rapidly, it is most often lost when the pace of instruction is not rapid enough” (p. 20).
So how can you maintain a fast pace of instruction that is appropriate for your student? Here are some things to consider:
Prepare! Set out your materials in such a way that they are easy to access quickly. I keep all the mastered skills on index cards so I can easily add maintenance questions into instruction. Organization is often the simplest way to increase efficiency in your session.
Take data. You want to increase attention and decrease problem behaviors. Try different paces of instruction and measure the behaviors you are wanting to change. For instance, if I have a student who is often grabbing for my shirt during a session, I may try a pace of instruction that includes 15 questions each minute, then try a pace of 20 questions per minute, another of 25 per minute. Next, I will compare the rates of grabbing for my shirt with each pace of instruction. Remember, these aren’t 15 questions for the target skill; some mastered skills will be intermixed.
Record a session. By taking video of yourself working with a child, you may see opportunities for increasing efficiency on your own. You may also observe specific times at which problem behaviors tend to increase, then be able to target those specifically. For instance, perhaps problem behaviors occur when you turn to write data in a binder, but didn’t recognize that pattern until you watched a recording later.
Use reinforcement effectively. Usually, pace of instruction in and of itself will not change behavior. Instead, pair it with reinforcement and be systematic with how you implement reinforcement. We’ve talked about reinforcement here on the blog a lot, so you can read about that in more detail here.
If possible, get input from supervisors or the individual you are working with. Supervisors may be able to observe your session and provide insight on how to increase your pace of instruction. And the individual you are working with may be communicating that they are bored through misbehavior, stating “I’m bored,” or nonvocal behaviors such as yawning. This may be an indication that you need to provide more challenging material or increase the pace of instruction.
REFERENCES
Higbee, T. (2009). Establishing the prerequisites for normal language. In R. A. Rehfeldt, Y. Barnes-Holmes, & S.C. Hayes (Eds.), Derived relational responding applications for learners with autism and other developmental disabilities: A progressive guide to change (7-24). Oakland, CA: New Harbinger Publications, Inc.
About the Author
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
