How Do We Measure Effectiveness?

This month’s ASAT feature comes to us from Dr. Daniel W. Mruzek, PhD, BCBA-D, Associate Professor, University of Rochester Medical Center. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

Marketers of purported interventions for autism spectrum disorder (ASD), whether they are pills, devices, or exercises, claim that their products are effective. As proof, they point to any number of measures some valid, some questionable, and some potentially misleading. Given that many of these “treatments” may be costly, ineffective and even dangerous, it is good to consider what constitutes legitimate measures of therapeutic benefit. How will we know if the intervention actually works?


A first step when presented with a potential treatment option is to investigate its scientific record. One can certainly ask the marketer (or therapist, interventionist, clinician, etc.) for examples of peer-reviewed studies examining the effectiveness of their recommended intervention. Indeed, this can be a great first step. An honest marketer will be glad to give you what they have in this regard or freely disclose that none exist. A good second step is to consult with a trusted professional (e.g., physician, psychologist, or behavior analyst who knows your family member), in order to get an objective appraisal of the intervention. If, after this first level of investigation is completed, a decision is made to pursue a particular intervention for a family member there are additional questions that one can ask the marketer prior to implementation that may prove very helpful in determining effectiveness after the intervention has been employed. These include the following:


Question 1: “What behaviors should change as a result of the intervention?”
Virtually any ASD intervention that is truly effective will result in observable change in behavior. For example, a speech intervention may very well result in increased spoken language (e.g., novel words, greater rate of utterances). An academic intervention should result in specific new academic skills (e.g., greater independent proficiency with particular math operations). An exercise purported to decrease the occurrence of challenging behavior will, if effective, result in a lower rate of specific challenging behaviors (e.g., tantrums, self-injury). As “consumers” of ASD interventions, you and your family member have every right to expect that the marketer will identify specific, objective, and measurable changes in behaviors that indicate treatment efficacy. Scientists refer to such definitions as “operational definitions” – these are definitions that are written using observable and measurable terms. If the marketer insists on using ill-defined, “fuzzy” descriptions of treatment benefit (e.g., “increased sense of well-being”, “greater focus and intentionality”, an increased “inner balance” or “regulation”), then “Buyer Beware!” These kinds of outcome goals will leave you guessing about treatment effect. Insist that operational definitions of target behaviors be agreed upon prior to start of intervention.

Question 2: “How will these behavior changes be measured?”
Behavior change is often gradual and variable. Behavior change often occurs in “fits and starts” (i.e., the change is variable). Also, our perception of behavior change can be impacted by any number of events (e.g., the co-occurrence of other therapies, our expectations for change). Therefore, it is the marketer’s responsibility to offer up a plan for collecting data regarding any change in the identified “target” behaviors. Usually, it is best to record numerical data (e.g., number of new words spoken by the individual, duration [in minutes] of tantrums, etc.) The use of numerical data to measure the change of operationally defined target behaviors is one of the best ways for a treatment team to elevate their discussion above opinion, conjecture and misrepresentation. If a pill, therapy or gadget is helpful, there is almost assuredly a change in behavior. And, that change is almost always quantifiable. Setting up a system to collect these numerical data prior to the initiation of the new intervention is a key to objective evaluation of intervention. Don’t do intervention without it.


Question 3: “When will we look at these intervention data and how will they be presented?”
Of course, it is not enough to collect data; these data need to be regularly reviewed by the team! One of the best ways to organize data is “graphically”, such as plotting points on a graph, so that they can be inspected visually. This gives the team a chance to monitor overall rates or levels of target behaviors, as well as identify possible trends (i.e., the “direction” of the data over time, such as decreasing or increasing rates) and look for change that may occur after the start of the new intervention. Note that the review of treatment data is generally a team process, meaning that relevant members of the team, including the clinicians (or educators), parents, the individual with ASD (as appropriate) often should look at these data together. Science is a communal process, and this is one of the things that makes it a powerful agent of change.


An interventionist with background in behavior analysis can set up strategies for evaluating a possible treatment effect. For example, in order to gage the effectiveness of a new intervention, a team may elect to use a “reversal design”, in which the target behaviors are monitored with and without the intervention in place. If, for example, a team wishes to assess the helpfulness of a weighted blanket in promoting a child’s healthful sleep through the night, data regarding duration of sleep and number of times out of bed might be looked at during a week with the blanket available at bedtime and week without the blanket available. Another strategy is to use the intervention on “odd” days and not use it on “even” days. Data from both “odd” and “even” days can be graphed for visual inspection, and, if the intervention is helpful, a “gap” will appear between the data sets representing the two conditions. These strategies are not complex, but they give the team an opportunity to objectively appraise whether or not a specific intervention is helpful that is much better than informal observation. Few things are as clarifying in a team discussion as plotted data placed on the table of a team meeting.


If the marketer does not answer these questions directly and satisfactorily, consider turning to a trusted professional (e.g., psychologist, physician or behavior analyst) for help. Families have a right to know whether their hard-earned money, as well as their time and energy, are being spent wisely. Asking these questions “up front” when confronted with a new intervention idea will help. Marketers have a responsibility to present their evidence – both the “state-of-the-science” as reflected in peer-reviewed research, as well as their plans to measure the potential effectiveness of their intervention for the individual whom they are serving.


Speaking of measuring treatment effectiveness, fellow ASAT board member Eric Larsson offers his considerations regarding the use of standardized measures (e.g., IQ) as outcome measures in treatment research (next article; page 20). Though this might be a little out of context for some of our readers, for those of us who rely on direct interpretations of peer-reviewed studies in our work (e.g., researchers, clinicians), Dr. Larsson describes the limitations of sole reliance on change in standardized measures is assessing the scientific validation of an intervention.


Please use the following format to cite this article:
Mruzek, D.W. (2014). ASD intervention: How do we measure effectiveness? Science in Autism Treatment, 11(3), 20-21


About The Author
Daniel W. Mruzek, Ph.D., BCBA-D is an Associate Professor at the University of Rochester Medical Center (URMC), Division of Neurodevelopmental and Behavioral Pediatrics in western New York. He received his doctoral training in Psychology at the Ohio State University and is a former Program Director at the Groden Center in Providence, Rhode Island. Currently, he is an associate professor and serves as a clinician and consultant, training school teams and supporting families of children with autism and other developmental disabilities.


Mruzek coordinates his division’s psychology postdoctoral fellowship program in developmental disabilities and is an adjunct faculty member in the University of Rochester Warner School of Education. He is actively involved as a researcher on several externally funded autism intervention research studies and has authored and co-authored more than 20 peer-reviewed articles and book chapters on autism and other developmental disabilities. Dr. Mruzek is on the editorial board for the journals Focus on Autism and Other Developmental Disabilities, Behavior Analysis in Practice, Journal of Mental Health Research in Developmental Disabilities, and Intellectual and Developmental Disabilities. Dr. Mruzek is a former member of the Board of Directors of the Association for Science in Autism Treatment.

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Common errors with token systems

I love token systems and use them frequently with my clients. Sometimes I use Velcro stars or stickers, or the Token Towers (which are great because you can hear the token going in the plastic tube.) It’s easy to vary the token system to fit the interests and age of a client I am working with. However, I see several errors in their use. Below are a few of the common ones:

• Inconsistent Use – The use of a token system should be predictable. When I am doing an ABA session, the token system is usually available throughout the session. But token systems may be specific to certain activities or certain environments. Using them only some of the time though doesn’t improve their effectiveness.
• Lack of Clarity – You should know what behavior you are focusing on for the token system. For example, I will write down for myself that I am providing tokens for a few specific behaviors (such as whenever a client responds correctly to a current learning target, when they remain in their seats for a period of five minutes, and when they greet a person who comes into the room.) It should be clear for you, as the person implementing the token system, what behaviors you are attempting to increase so you can provide tokens when those behaviors are exhibited.
• Lack of Differentiation – One of the things I love about token systems is that it allows me to easily differentiate reinforcement. For example, let’s say I’m working with a child to teach them to name items from different categories. Usually, when I ask them to name an animal, they name one animal and I provide a token for a correct response. But on this particular day, they name three animals. I can provide more than one token for the higher quality response.
• Not Allowing the Token System to Grow with the Child – Another benefit of token systems is that they can grow with the child. Once a child has mastered a certain behavior, I no longer include it in the token system. The child is always earning tokens for behaviors or responses that are difficult. If you have a client who has been receiving tokens for the same behavior for several months, then one of the two things is happening: (1) the client has mastered the behavior and you aren’t providing reinforcement for more challenging behaviors OR (2) the client has not mastered the behavior and for some reason your token system is not working. Either way, a change needs to be made.
• Fail to Provide a Motivating Reward – I have had some experiences in which the token was supposedly reinforcing on its own. In rare cases, this might just work. However, the tokens should be used to earn a known reinforcer for that particular client.
• Fail to Provide Choices in Rewards – There’s a great body of research on how choice improves motivation. Unfortunately, many children with developmental disabilities have fewer choices in their day-to-day lives than their typically developing counterparts. Allowing your client to choose from a selection of activities or toys for reinforcement will likely improve the quality of your token system.


WRITTEN BY 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.

How to Maintain a Fast Pace of Instruction

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.


WRITTEN BY 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.

Things You Should Know About BCBAs

Maybe you’ve never heard of Board Certified Behavior Analysts (BCBAs), or you’ve heard of them frequently but never been provided an explanation of how a BCBA differs from an ABA therapist. Here are a few things you should know:

BCBAs are required to take extensive coursework in applied behavior analysis and complete 1500 hours of supervised work. Furthermore, they are required to take a difficult comprehensive exam at the end of their coursework and supervision hours. Once they have completed the hours and passed the exam, they are officially a BCBA.
BCBAs must complete 32 units of continuing education every two years. There is a requirement that some of these hours pertain to ethics, but the rest can be focused on skills such as addressing verbal behavior, feeding issues, aggressive behaviors, and more.

BCBAs are held to the Professional and Ethical Compliance Code for Behavior Analysts. If a BCBA does not comply with the code, they can be reported to the Behavior Analyst Certification Board. Several states have also introduced licensure for behavior analysts, so there may be a state board for reporting any ethical violations.
BCBAs are required to utilize evidence-based practice. A BCBA should be aware of current research in the field and should be able to easily reference the literature when encountering a difficult problem or working on an intervention.

One of my favorite parts of the ethical code for BCBAs is that “clients have a right to effective treatment.” Your BCBA should be taking data and implementing interventions that are effective in creating behavior change for clients. If an intervention is not working, then adjustments should be made.

The goal of Behavior Analyst Certification Board is to ensure appropriate training and accountability for behavior analysts.


WRITTEN BY 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.

Posted in ABA

Technology Do’s (and one Don’t!)

Technology can be a great addition to an educational or behaviorally supportive program for individuals with autism. It may be used as a powerful reinforcer for some, can facilitate language and communication, and help to organize and present visual and auditory cues efficiently. Items like tablets and smart phones also tend to be highly acceptable to learners, parents, and society as a whole. We have come a long way from the days of Velcro, laminate, and tackle boxes full of reinforcers! In some cases, the entire array of tools needed to support and teach may be included in a single device.

As great as technology may be for learners with autism, their families, and their teachers, however, there are some cautions that need to be observed. Here are some suggestions to make sure that technology is used effectively and does not have any detrimental effects.

1. Do carefully evaluate the functionality of the technology for the individual. Like any behavioral intervention, technology is not one-size-fits-all, and may not be appropriate for every use for every learner. Choose the type and application of technology that works best for the individual. Collect data on the success of the technology intervention, and make adjustments as needed.

2. Do teach alternative strategies that don’t rely on technology, to prepare for times when technology may be unavailable, broken, or inappropriate. Practice occasionally not using technology, so that when the inevitable happens (e.g., power outage, broken tablet, etc.), the individual is prepared and has some coping strategies.

3. Do monitor for safety and appropriate usage. Many apps are so easy for learners to use that they can easily connect with other people, make purchases, or share personal information without parents or teachers noticing. Devices that connect to the internet via wi-fi or data plans must be carefully monitored for such activity.

4. Do teach learners to manage their devices independently. Learners should know how to charge devices, set alarms and reminders, and use other apps for self-management. Technology isn’t just for fun; it’s become a part of life for most of us, and learners can benefit the same as anyone else.

5. Don’t use technology for technology’s sake. If it doesn’t serve a real purpose for teaching or behavioral support, it should not be in use. Any application of technology in teaching or behavioral interventions should be clearly defined, conceptually systematic, and precisely planned.


About The Author

Dana Reinecke, PhD, BCBA-D is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA).   Dana is a Core Faculty member in the Applied Behavior Analysis department at Capella University.  She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum, forms, and hours tracking.  Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities.  She has presented original research and workshops on the treatment of autism and applications of ABA at regional, national, and international conferences.  She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism.  Current areas of research include use of technology to support students with and without disabilities, self-management training of college students with disabilities, and online teaching strategies for effective college and graduate education.  Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA), and is currently serving as President (2017-2018).

Beyond Light Up Toys

There are many things that I would love to change about the treatment of individuals with Autism Spectrum Disorder. One of them is the notion that all kids with ASD are motivated by the same things. Certainly, some kids with autism love light up toys, squeezes, or music, but that’s true of the population at large. After all, I am mesmerized by Christmas lights, love a good head massage, and have songs I listen to on repeat.
The issue with the assumption that all kids with ASD are motivated by these small number of things is that it can lead to some very specific problems, such as practitioners trying out a smaller number of toys or activities with the child, practitioners depending solely on “sensory toys” for reinforcers instead of working to expand the number of reinforcers a child responds to, or the larger community making assumptions about the preferences of the child. Furthermore, there is evidence that the broader the range of reinforcers is for a child, the better the learning outcomes (Klintwall & Eikeseth, 2012.) Failing to think beyond the stereotypes about the interests of kids with ASD impedes their ability to learn and develop new skills.

The children I’ve worked with over the years have varied interests, ranging from dinosaurs and maps to bean bag toss and board games. And while some of the kids I work with love light up toys or trains, it’s important that we don’t take a whole swath of the population and decide that they all have similar interests. It doesn’t serve their skill development or our potential to develop real relationships with people with ASD.
As a practitioner, here are some important questions to ask yourself in relation to reinforcers and developing interests:

• Have you conducted a preference assessment? This should be one of the first things you do whenever you start a new case, and something you should continue to do informally.

• Have you talked to the client and/or the parents about what interests they would like to develop? If the client is able to discuss goals and interests with you, you should definitely be having that conversation with them. You should also talk to the parents about their goals. Perhaps they have seen some interest in one area that they would like to further develop. It’s also possible that there are specific family activities or traditions they would like their child to enjoy with the family.

• Have you read about this topic? A great place to start is Chapter 3 of the book A Work in Progress. It clearly explains how to use reinforcers and expand the reinforcer repertoire. There is also a ton of research out there about reinforcement. Take the time to search journals such as Journal of Applied Behavior Analysis and Journal of Developmental Disabilities.

Klintwall, L., & Eikeseth, S. (2012). Number and controllability of reinforcers as predictors of individual outcome for children with autism receiving early and intensive behavioral intervention: A preliminary study. Research in Autism Spectrum Disorders, 6(1), 493-499.
McEachin, J. & Leaf, R. B. (1999). A work in progress: Behavior management strategies and a curriculum for intensive behavioral treatment of autism. New York: DRL Books.


WRITTEN BY 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.

The Absolute Authority Of The SD

The Discriminative Stimulus is defined as a stimulus in the presence of which a particular response will be reinforced (Malott, 2007, Principles of Behavior).

SD is just ABA speak for the demand, instruction, or the event/stimulus that serves as a signal to someone that there is something they need to respond to. Now, that response can also include a non-response. Not responding is always a possible choice, that comes with its own possible consequences.

For example, if my cell phone rings and it is someone I do not want to talk to I have choices:
-answer the phone
-don’t answer the phone

The phone ringing is a SD because when it rings, there is a specific response that in the past has led me to contact different consequences. Some pleasant, and some not so pleasant.
When my cell phone rings, I am not confused about what I should do. I know what my choices are, and depending on who is calling (or if I recognize who is calling) I then make a choice based on my history of reinforcement with that person.

SD’s can vary in how they are delivered, the specific reinforcement that they make available, as well as the specific expected response.

In ABA therapy sessions, sometimes hundreds of SD’s can be delivered throughout the session, and each one of those SD’s has a specific expected response, as well as specific consequences available for each possible response.

The SD has an authority based on the history of consequences being delivered.
I’ll say that another way: Let’s say I state the SD “give me blue” to a child, and I then provide a consequence of playing on an iPad if the child gives me yellow. Assuming playing on the iPad is a reinforcer, over time I am going to see the child consistently respond to my SD by giving me yellow. Is yellow in this example actually correct? No. But it does not matter: I gave my SD, I followed the child’s response with a reinforcer, and I have super-glued this particular response to the SD.

And this explains why your kids don’t listen.

Reinforcement is like the most powerful superglue on the market. It binds things together, as can be seen in the example below:
(SD) “Clean up the toys” —-> (Response) child cleans up the toys —> (Consequence) “Thanks so much, you can go outside now”

Assuming in the above example that going outside is a reinforcer, over time the child will learn the expected response to the SD of “clean up the toys”, AND they will learn that good things happen after they demonstrate the expected response. In other words, you just taught your child that when they clean up their toys, they might get to go outside.

If I flip this scenario on its head, I can show you how SD’s (and their absolute authority) can sometimes cause you to teach things you did not mean to teach:
(SD) “Clean up your toys” —> (Response) child cries/child screams “no!”/child does not respond to the SD —> (Consequence) “Ugh! Fine, I’ll clean the toys up. Just go outside while I clean up this mess”

Assuming in the above example that going outside is a reinforcer, over time what will the child learn? A few things actually:

-child will learn that problem behavior or not responding is a response
-child will learn that escape/avoidance behaviors work
-child will learn that cleaning up the toys is not a requirement to be able to go outside

Did you mean to teach that? I am nearly positive you did not. Unfortunately, the absolute authority of the SD remains unmoved by the fact that you didn’t intend to teach new ways to avoid a demand.

Don’t freak out, there is a way to avoid this trap.

First, understand what Instructional Control is and how it can help you. I promise, it isn’t as scary as it sounds.

Second, see below for some common characteristics of successful SD’s. A successful SD helps your child learn in an effective manner WHAT to do, and WHY to do it (because good things might happen). Let the absolute authority of the SD work for you, and not against you.

Characteristics of Successful SD’s
 

The SD is precise: A precise SD includes only the language necessary for the individual to know what to do. Extra details, threats, or reminders are best left off the SD, particularly if the individual has communication deficits or is very young. Good example – “Get down”. Not-so-good-example – “Michael Benjamin Clark, you get down off that railing right now before you fall and break your neck”.

The SD is stated, not asked: Unless you are cool with the individual tossing you a “No/I don’t feel like it/I don’t want to”, then do not present the SD as a question. A question gives the option of refusal. 

The SD allows for a brief time to begin to respond: Brief as in, a few seconds. I have been in this field a long time, and I have developed an internal countdown timer that kicks in when I give a SD. To help yourself learn this skill, when you give your child a demand silently count to 3. Or, you could subtly tap a finger against the inside of your palm 3 times. If you get to 3 and the individual has not at least started to respond, it is time to provide a consequence. Another completely personal reason why I like this “internal countdown” is because it helps parents not flood the child with SD’s. If you are busy counting in your head, you can’t rattle off 4 more demands, when the child hasn’t even responded to demand #1.

The SD is consistent: Especially if the child has communication deficits or is very young, avoid changing up the SD rapidly. This can possibly be confusing, and impede learning. Once your child is demonstrating they know how to respond to the SD, that is the point where you can start to change the language used, or not use language at all (such as pointing at a book on the floor to indicate the child needs to put the book away).

The SD consequence is consistent: The most critical point about understanding SD’s is that what follows the response equals learning. You are teaching your child how to respond to you based on what happens when they respond correctly, and what happens when they respond incorrectly. If you decide that the SD “Make your bed” means fluffing all the pillows, then the bed being made with 1 pillow fluffed, or the bed being made with some of the pillows fluffed, are both incorrect responses. No exceptions. You would then prompt the correct response so the child knows they made an error.

Attention is gained before the SD is given: If you observe the ABA team work with your child you will get to see possibly hundreds of SD’s delivered during a therapy session. You may also note that the team works to gain the child’s attention before stating the SD, to make sure it is heard. This could look like approaching the child, bending/squatting down to look in the child’s face, waiting for a break in crying/screaming, or making a statement such as “Are you ready?”, to verify the child is attending.

The SD is not repeated over and over again, nor is it screamed, or shouted: SD’s are bosses. SD’s are in charge. SD’s call the shots. They do not need to beg, bargain, plead, scream, or lose their cool. Remember, your child only has a short time to respond correctly. If they do not respond correctly, you just deliver a consequence (such as a prompt). It will be very tempting to state the SD over and over again, but don’t give in to that temptation. Over time, this will actually teach your child they do not need to listen to you the first time, and that ignoring you is an effective way to avoid a demand.


About The Author 

“I’ve been providing ABA therapy services to young children with Autism since early 2003. My career in ABA began when I stumbled upon a flyer on my college campus for what I assumed was a babysitting job. The job turned out to be an entry level ABA therapy position working with an adorable little boy with Autism. This would prove to be the unplanned beginning of a passionate career for me.

From those early days in the field, I am now an author, blogger, Consultant/Supervisor, and I regularly lead intensive training sessions for ABA staff and parents. If you are interested in my consultation services, or just have questions about the blog: contact me here.”

This piece originally appeared at www.iloveaba.com

Curriculum Guides For Older Learners

This month’s ASAT feature comes to us from Dr. Kirsten Wirth, C.Psych., BCBA-D. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

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

Answered by

Kirsten Wirth, C.Psych., BCBA-D

Wirth Behavioural Health Services

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

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

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

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

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

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

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

References

 

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

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


About The Author 

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