This month’s ASAT feature comes to us from Kate McKenna, MEd, MSEd, MS, BCBA, and Kristina Gasiewski, MEd, MOTR/L, BCBA, Association for Science in Autism Treatment. 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!

This is part of the Description of the Treatment Team series.

History

Behavior analysis is the science founded on the belief that behavior should be the primary focus of scientific study (Cooper et al., 2020). It is both a discipline and a practice. The philosophy on which the science of behavior analysis rests is radical behaviorism, the supposition that all human behavior including thoughts and feelings can be studied and understood. The experimental analysis of behavior, associated with B.F. Skinner, emphasizes scientifically studying the relationship between behavior and the variables in the environment that control it.

Applied behavior analysis (ABA), as the name implies, is the application of behavioral principles to real-world problems with the goal of effecting lasting and positive change in socially important behavior (Baer et al., 1968; Fennell & Dillenburger, 2014). At the heart of applied behavior analysis is the belief that behavior can be studied and understood, and that this understanding can guide how teachers and clinicians respond or intervene. Since behavior is shaped by the individual’s interactions with people, objects, and events in the environment, we can arrange the environment to affect the change we want to see. In other words, by studying the antecedents (what happens before a behavior occurs) and consequences (the response from the environment after the behavior occurs), it is possible to ascertain the purpose or function of behavior (the reason the behavior happened). That information allows us to arrange the environment to result in behavior that is beneficial to the individual engaging in the behavior and the broader society, and that will respond effectively to social problems faced by a community (Cooper, 2020).

Although ABA is often used as a catch-all descriptor of current techniques used in the treatment of autism, it has a history unrelated to autism treatment dating back to the turn of the 20^th century. Classical conditioning of behavior was described by Ivan Pavlov in his famous set of experiments with dogs. Learning theory developed by Edward Thorndike held that learning results in the consequences of our behavior. John Watson is known as the “father of behaviorism.” He posited that behavior is the result of observable and recordable environmental events. This was a sea change in the investigation of learning and the science of behavior. At that time psychology studied mental processes, the conscious, and the unconscious. Introspection was used as the method of investigating the purpose of behavior. In contrast, Watson suggested direct observation of environmental stimuli and the responses that result.

In the 1920s B.F. Skinner advanced the idea that understanding our behavior is essential to understanding ourselves. He wrote extensively on the application of behavioral principles to social issues such as education, the law, economics, and self-control. Skinner thought it possible to create living environments that benefit all individuals and societies. He believed that all behavior, including thinking and feeling emotions, which he called “private events,” could be described and observed. Skinner called this radical behaviorism.

The seven dimensions of ABA were first outlined in a seminal article published in the Journal of Applied Behavior Analysis (Baer et al, 1968). ABA is applied in that it focuses on creating socially significant change that is meaningful for those involved. ABA is behavioral in that it objectively defines and measures target behavior in such a way that it is possible for anyone to observe and record instances of the behavior. The dimension of being analytic refers to the ability to predict and control a target behavior. This functional relationship allows the clinician or teacher to create environmental conditions in which a target behavior is more or less likely to occur. In meeting this dimension, in both research and clinical practice, BCBAs are guided by their professional code of ethics to ensure that target behavior and goals are truly beneficial to the learner.

Any description of scientific research, treatment plan, or educational program must be written with sufficient clarity and detail so that another researcher can replicate the study to substantiate reported results or that a clinician unfamiliar with the student can step in based on the information provided. This is the definition of technological. Related to this dimension is the call that ABA-based interventions and research be conceptually systematic, that is that it be grounded in the principles and tenets of applied behavioral analysis. The final two dimensions of ABA, effectiveness and generality, speak to the goal of lasting significant change that benefits all stakeholders. Target behavior, interventions, and research must be socially valid and matched to the individual’s skills, needs, and their interactions in their environment. For an intervention to be effective it must fit within the daily lives of the people involved. Methods used to support change should be practical, not overly costly, and designed to be as convenient as possible to those who will live with them long term. Interventions should be generally applicable. That is, they should be functional in a variety of environments, apply to a range of behaviors, and have sustainable and maintainable effects. The ability to generalize newly acquired knowledge and skills in new environments, with similar but not identical materials, and with a variety of people is critical to the success of ABA-based interventions.

The principles of ABA have been found beneficial in the fields of addiction and substance abuse (Silverman et al., 2011), gambling (Weatherly & Flannery, 2008), eating disorders (Peterson et al, 2022), forensic analysis (Ruben, 2019), gerontology (Burgio & Burgio, 1986), and other mental health specialties (Harvey et al., 2009). These broad applications speak to the strength of ABA-based interventions in addressing many diverse challenges.

As with any scientific field, new discoveries and knowledge prompt discussion and influence how principles are put into practice. Standards of ethical and effective practice have evolved since the 1960’s. The concepts of assent and consent are at the heart of the effective practice of ABA. Assent is agreeing or approving of something after considering it carefully. Consent involves granting permission for something to happen or agreeing to do something. Both assent and consent are important in the interactions during teaching sessions between the providers and learners as well as the balance in the relationships between providers, individuals, and family members. One key aspect of learning is genuine engagement in the activity and with the materials. The goal is for the individual to be “happy, relaxed, and engaged,” willingly participating with no visible signs of discomfort (Hanley, 2021; Parenti & Rothman, 2023).

Education

Behavior analytic professionals include Board Certified Behavior Analysts (BCBA®), Board Certified Assistant Behavior Analysts (BCaBA®), and Registered Behavior Technicians (RBT®). Certification programs are accredited by the National Commission for Certifying Agencies (NCCA), the accreditation body of the Institute for Credentialing Excellence (ICE). While there are BCBAs across the world, as of January 1, 2023, the BACB made changes to their international focus and currently accepts certification applications from individuals who reside in the United States (US), Canada, Australia, and the United Kingdom (UK). The International Behavior Analysis Organization (IBAO) certifies applied behavior analysts worldwide and offers two certifications, the International Behavior Analyst (IBA) and the International Behavior Therapist (IBT).

A BCBA is a graduate-level certification in behavior analysis. BCBA practitioners can practice with either a Master’s or Doctoral Degree. The Board-Certified Behavior Analyst-Doctoral (BCBA-D ®) is a BCBA with a doctorate degree. It is not a separate certification, and functions within the same capacity as a BCBA.

There are different pathways to sit for the Behavior Analyst Certification Board (BACB) exam. First, behavior-analytic coursework can be attained through either an Association for Behavior Analysis International (ABAI) accredited or recognized behavior analysis degree program, or a Verified Course Sequence. Master’s or higher behavior analysis degree programs that have been accredited or recognized by ABAI have met these standards for the curriculum, faculty, and resources, among others. Accredited programs may be found on ABAI’s Accredited Programs web page. A Verified Course Sequence is a set of courses that have been verified by ABAI as having met the BACB’s behavior-analytic coursework requirements. Verified Course Sequences may be located using ABAI’s Verified Course Sequence Directory. Some typical courses of study include the study of ethics for behavioral practice, functional behavioral assessment and analysis, experimental analysis of behavior, experimental design and research, evidence-based instructional methods, methodologies of behavior change, science and philosophy of ABA, verbal behavior, collaboration, and supervision.

Once coursework has been started, candidates can begin to accrue fieldwork hours. There are two means of satisfying hours including supervised fieldwork (2,000 hours) or concentrated supervised fieldwork (1,500 hours). Trainees may accrue hours in a single category or may combine the two types, supervised and concentrated, to meet the fieldwork requirements. Hours accumulated each month must be at least 20 hours but cannot exceed 130 hours. Additionally, fieldwork hours include independent hours (supervisor not present) and supervised hours (supervisor present). There are specific requirements for each type of fieldwork that specify the number of required contacts with the supervisor, observations, and percentages for supervision per supervisory period, individual supervision, and unrestricted activities.

Once the above requirements are met, a candidate may take the BCBA examination, which is composed of 185 multiple-choice questions. Once certified, a BCBA is to obtain 32 continuing education units (CEUs) within each 2-year recertification cycle including 4 CEUs in ethics and 3 CEUs in supervision (for supervisors). For specifics and the most up-to-date information on obtaining the BCBA credential, please refer to the BCBA handbook.

BCaBAs have an undergraduate-level certification in behavior analysis and must be supervised by BCBAs. Like the BCBA, there are different eligibility pathways. Each pathway requires a degree, behavior-analytic content, supervised fieldwork (1,300 Supervised fieldwork or 1,000 concentrated supervised fieldwork) and passing the BCaBA certification examination. The BCaBA examination comprises 160 multiple-choice questions. Once certified, BCaBAs must obtain 20 CEUs per 2-year recertification cycle including 4 CEUs in ethics and 3 CEUs in supervision (for supervisors). For specifics and the most up-to-date information on obtaining the BCaBA credential, please refer to the BCaBA handbook.

RBTs are paraprofessionals certified in behavior analysis. They assist in delivering behavior-analytic services and practice under close supervision from a BCBA. RBTs have a high school-level education or equivalent. Once a candidate completes a 40-hour training and Competency Assessment, and has a supervisor on record with the BACB, they are eligible to sit for the RBT certification exam. The RBT examination comprises 85 multiple-choice questions. Renewal of this certification is every year and includes an RBT Renewal Competency Assessment. For specifics and the most up-to-date information on obtaining the RBT credential, please refer to the RBT handbook.

Standards of Practice and Guiding Documents

Knowledge requirements, ethical standards, and disciplinary procedures in the practice of behavior analysis are established and monitored by the Behavior Analyst Certification Board, Inc.^® (BACB^®). The BCBA Task List (5^th ed.) outlines the minimum knowledge and skills necessary for effective practice and serves as the foundation for the questions on the BCBA examination for prospective BCBAs and BCaBAs. The Ethics Code for Behavior Analysts guides the professional activities of BCBAs and BCaBAs by outlining core principles involved in ethical decision-making that apply to behavior analysts’ professional activities during in person service delivery, in written reports, and in interactions via phone, email, text message, and video conferencing. Core principles, which guide all aspects of the work of behavior analysts and form the basis of ethical decision-making, are to benefit others; treat others with compassion, dignity, and respect; behave with integrity; and ensure our own competence (practice only within our scope of competence). Separate documents cover ethical behavior and scope of practice limitations for RBTs.

Professional Organizations

Established in 1998, the Behavior Analyst Certification Board, Inc.^® (BACB^®) is the professional organization that certifies BCBAs, BCaBAs, and RBTs. The BACB’s stated mission is to “protect consumers of behavior-analytic services by systematically establishing, promoting, and disseminating professional standards of practice.” The BACB establishes practice standards, develops certification examinations, and oversees continuing education of certificants. It has also created ethics requirements and a system of oversight for each of the three certification options and for those in a supervisory role in their practice.

The Association for Behavior Analysis International (ABAI), established in 1974, is the primary professional organization for behavior analysts. Through its special interest groups, affiliated chapters, international conferences and journals, ABAI fulfills its mission of supporting and educating professionals interested in the philosophy, science, application, and teaching of behavior analysis. ABAI has 40 special interest groups which speaks to the breadth of application ABA has to society. ABAI publishes six peer-reviewed journals. Perspectives on Behavior Science is the official publication of ABAI and publishes articles on theoretical, experimental, and applied topics in behavior analysis. Since 1937, The Psychological Record has published empirical and conceptual articles related to behavior analysis, behavior science, and behavior theory. Behavior Analysis in Practice provides information on best practices on topics relevant to service delivery to service providers, school personnel, and supervisors. Education and the Treatment of Children presents articles written in a practitioner-friendly style for individuals working with children and youth at risk for or experiencing emotional and behavior challenges, and who are practicing in schools or treatment centers. The stated mission of The Analysis of Verbal Behavior is to “support the dissemination of innovative empirical research, theoretical conceptualizations, and real-world applications of the behavioral science of language.” Affiliated with the Behaviorists for Social Responsibility special interest group, Behavior and Social Issues is an interdisciplinary journal that publishes articles that analyze the social behavior of people to better understand and address significant social problems.

The Society for the Experimental Analysis of Behavior (SEAB) was founded in 1957 to promote the advancement of the science of experimental analysis of behavior and to disseminate information about behavior analysis. To that end, the Society publishes the Journal of the Experimental Analysis of Behavior and the Journal of Applied Behavior Analysis. The Journal of the Experimental Analysis of Behavior publishes articles primarily related to research on individual organisms. The Journal of Applied Behavior Analysis, first published in 1968, publishes research on the use of behavior analytic principles to issues and problems of social importance.

Scope of Practice and Approach to Intervention

Applied Behavior Analysis is a scientific approach for identifying environmental factors that reliably influence socially significant behavior. Socially significant behaviors are those that enhance and improve people’s lives. These behaviors can include social, language, academic, daily living, self-care, vocational, and/or recreation and leisure behaviors. The overarching goal is to change behavior, either by increasing or decreasing the occurrence, and is achieved through various principles of behavior (e.g., reinforcement, punishment, stimulus control, environmental contingencies; Cooper, et al., 2020). BCBA’s use ABA-based programs and strategies in a variety of other fields, such as gerontology, brain injury rehabilitation, addiction, both general and special education, organization behavior management, public health, and sports psychology.

BCBAs are guided by ABA principles. Behavioral methods are utilized to measure behavior, teach functional skills, and evaluate progress. Common services may include but are not limited to, conducting behavioral assessments, analyzing data, writing behavior-analytic treatment plans, training others to implement components of treatment plans, and direct implementation of treatment plans (Cooper, et al., 2020). Data are reviewed on a regular and systematic basis including visual graphs. In summary, the analysis of data drives changes to interventions. (Cooper, et al., 2020; BACB, 2020).

It is a common misconception that ABA itself is an autism intervention. ABA is not the teaching strategy in and of itself. ABA is the science behind how research is conducted, and educational and behavioral services are provided. There are many autism interventions based on the principles of ABA that have been demonstrated to increase learning and decrease challenging behavior in individuals with autism. These interventions are backed by decades of rigorous scientific research carried out by hundreds of individuals that demonstrate the efficacy of interventions based on the principles of ABA (Cooper et al., 2020). For a more detailed description of an ABA-based treatment program for autism, please click here. In treatment for autistic individuals and those with developmental disabilities, ABA has proven to be effective in supporting people across the lifespan in reaching goals to improve communication, social, and life skills that lead to greater independence and self-determination.

In autism treatment, ABA-based interventions and teaching techniques include, but are not limited to, breaking tasks into smaller components (task analysis, chaining), the use of antecedent interventions, modeling (both in real time and video), visual supports, and positive reinforcement. A particular focus in autism treatment is responding to challenging behavior that interferes with learning. The ultimate goal of a treatment program is to support the individual in acquiring new skills related to academics, language, communication, and social interactions to increase agency and independence to the fullest possible extent.

References:

Association of Professional Behavior Analysis (APBA). (2017). Identifying applied behavior analysis interventions. https://cdn.ymaws.com/www.apbahome.net/resource/collection/1FDDBDD2-5CAF-4B2A-AB3F-DAE5E72111BF/APBAwhitepaperABAinterventions.pdf

Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior Analysis. Journal of Applied Behavior Analysis, 1, 91-97.

Behavior Analyst Certification Board. (2022). Board certified behavior analyst handbook. Littleton, CO: Author. https://www.bacb.com/wpcontent/uploads/2022/01/BCBAHandbook_23102

Behavior Analyst Certification Board. (2022). Board certified assistant behavior analyst handbook. Littleton, CO: Author. https://www.bacb.com/wp-content/uploads/2022/01/BCaBAHandbook_231023-a.pdf

Behavior Analyst Certification Board. (2023). Registered behavior technician handbook. Littleton, CO: Author. https://www.bacb.com/wp-content/uploads/2022/01/RBTHandbook_231023-a.pdf

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/

Behavior Analyst Certification Board. (2018). RBT task list (2nd ed.). Littleton, CO: Author

Behavior Analyst Certification Board. (2017). BCBA task list (5th ed.). Littleton, CO: Author

Behavior Analyst Certification Board. (2020). BCaBA task list (5th ed.). Littleton, CO: Author

Behavior Analyst Certification Board. (2021). RBT ethics code (2.0). https://www.bacb.com/wp-content/rbt-ethics-code

Burgio, L. D., & Burgio, K. L. (1986). Behavioral gerontology: Application of behavioral methods to the problems of older adults. Journal of Applied Behavior Analysis, 19(4), 321-328.

Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied Behavior Analysis – 3rd ed. Prentice-Hall.

McKenna, K. & Huang, X. (2023). What can I expect from a quality ABA program? Science in Autism Treatment, 20(2).

Celiberti, D., Wirth, K., & McKenna, K. (2021). Humanity of ABA: ABA as a humane approach. In J. A. Sadavoy, & M. L. Zube. (Eds.), Scientific framework for compassion and social justice: Lessons from applied behavior analysis (1^st ed.). Routledge.

Fennell, B., & Dillenburger, K. (2014). The evidence debate for behavioural interventions for autism. International Research in Education, 2(2), 1-15. https://doi.org/10.5296/ire.v2i2.4989

Ghaemmaghami, M., Hanley, G. P., & Jessel, J. (2021). Functional communication training: From efficacy to effectiveness. Journal of Applied Behavior Analysis, 54(1), 122-143. https://doi.org/10.1002/jaba.762

Hanley, G. (2021, September 9). A perspective on today’s ABA from Dr. Hanley.
https://practicalfunctionalassessment.com/2021/09/09/a-perspective-on-todays-aba-by-dr-greg-hanley/

Harvey, M. T., Luiselli, J. K., & Wong, S. E. (2009). Application of applied behavior analysis to mental health issues. Psychological Services, 6(3), 212-222.

Parenti, K., & Rothman, H. (2023). What is the importance of engagement when working with individuals with intellectual and developmental disabilities and autism? Science in Autism Treatment, 20(01).

Peterson, K. M., Phipps, L., & Ibañez, V. F. (2022). Food-related disorders and applied behavior analysis. In J. L. Matson & P. Sturmey (Eds.) Handbook of Autism and Pervasive Developmental Disorder. Autism and Child Psychopathology Series. Springer, Cham. https://doi.org/10.1007/978-3-030-88538-0_44

Ruben, D. (2019). Behavioral forensics: Using applied behavior analysis in psychological court evaluations. Academic Press.

Silverman, K., Kaminski, B. J., Higgins, S. T., & Brady, J. V. (2011). Behavior analysis and treatment of drug addiction. In W. W. Fisher, C. C. Piazza, & H. S. Roane (Eds.), Handbook of applied behavior analysis (pp. 451-471). The Guilford Press.

Weatherly, J. N., & Flannery, K. A. (2008). Facing the challenge: The behavior analysis of gambling. The Behavior Analyst Today, 9(2), 130-142. https://doi.org/10.1037/h0100652

Citation for this article:

Gasiewski, K., & McKenna, K. (2023). Focus on the treatment team: Applied behavior analysis. Science in Autism Treatment, 20(12).

Other articles in this series

1. Description of the Treatment Team
2. Focus on the Treatment Team: Speech-Language Therapy
3. Focus on the Treatment Team: Occupational Therapy

About the Authors

Kristina Gasiewski, MOTR/L, MEd, BCBA received her Bachelor of Science in psychology and her Master of Occupational Therapy from University of the Sciences in Philadelphia. She went on to receive her Master of Education in autism and applied behavior analysis from Endicott College. Kristina works at Melmark PA, and recently has transitioned into her new role as the behavior analysist/QIDP in adult clinical services. Previously she worked as a school-based occupational therapist. Being dually credentialed, her research interests include collaboration between occupational therapists and behavior analysts and bridging the gap in order to best serve individuals with autism and developmental disabilities. Kristina is a member of the American Occupational Therapy Association (AOTA) as well as the Association for Behavior Analysis International (ABAI), and has had the opportunity to present at both organizations’ annual conferences. Additionally, Kristina is a Board member of the Association for Science in Autism Treatment (ASAT). 

Kate McKenna, MEd, MSEd, MS, BCBA, LBA, received a Masters in Child Study from the Eliot-Pearson Department of Child Study at Tufts University, a Masters in Special Education from Pace University, and a Masters in ABA from Hunter College.  In addition to New York state certifications in general and special education from Birth to Grade 2 and Grades 1-6, she holds a New York State Annotated Certification in Severe/Multiple Disabilities. Kate is currently completing a Masters degree in Children’s Literature at Eastern Michigan University.  She was an extern at the Association for Science in Autism Treatment before joining the Board of Directors in 2020.

By Ashleigh Evans, MS, BCBA

‘Tis the season for joy and excitement. Perhaps a bit of stress and chaos too. October through December can be exhausting for many families. With holidays back to back, it can be challenging to maintain a comfortable routine. Children with autism tend to thrive on structure and routine, making these months particularly challenging. Rest assured, there are strategies you can take to prepare your child and your family for these major upcoming changes.

Plan ahead

Sudden or unexpected changes are often the most difficult for children with autism to cope with. When children are primed in advance for the upcoming holidays, this can greatly improve their response when the holiday events come along.

Holiday preparation strategies might include any number of the following:

• Talk to your child often about the holidays and specifically what activities you all will be doing. For example, you might focus on Thanksgiving, discussing how you’ll be going to dinner at Grandma and Grandpa’s house that day.
• Read social stories and/or books about the holiday and associated events. Social stories are great for outlining and reviewing exactly what the plans and expectations are.
• Create a visual countdown or a calendar that shows when the holidays are to serve as a visual reminder of the upcoming events. Prompt your child to reference this visual each day as you discuss the upcoming holiday.
• Make backup plans in case things don’t go quite as planned.
• Prepare a holiday bag with any supports your child might need. Depending on what their individual needs are, this bag might include things such as noise-reducing headphones, fidgets, or weighted vests.
• Ensure your child has a way to safely escape if the setting becomes too overwhelming. For example, establish a dedicated location where they can go to calm down at each holiday event.

Maintain consistency where possible

With so much out of the ordinary during the holidays, it’s a good idea to try to avoid unnecessary major changes during these times. This isn’t always possible as life can be unpredictable. However, to whatever degree possible, maintain a consistent routine for your family.

Prioritize activities

With each holiday, there is an abundance of possible ways to celebrate, from large family gatherings and public outings to independent activities. The ways we celebrate holidays are often tied to sentimental family traditions. As such, it can be challenging to branch off from those activities that are special to us. It may, however, be helpful to prioritize the activities that are most important and most enjoyable to you and your family. If a particular holiday tradition historically causes more stress than enjoyment, consider alternative activities you can try that may be just as special to your family. Take your child’s preferences into consideration when planning events as well.

Be flexible

Sometimes our best-laid plans simply don’t work out. We might think our child can handle a new activity this year, but it still turns out to be overstimulating for them. Try to go into the holidays with a flexible mindset. If things don’t go quite as planned, have a backup plan prepared for alternative activities.

Recognize the progress, no matter how small

Focus on the victories, whether great or small. Holidays can be both magical and taxing on the whole family. Don’t forget to take the time to acknowledge the growth that your child has made. Happy holidays to all!

About the Author

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

Originally published November 11, 2022 by Different Roads to Learning.

This month’s ASAT feature comes to us from Lisa Tereshko, Ph.D., 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!

Everyday all individuals complete a variety of sequences of behaviors that were taught to them at some point in their lives. Some of these sequences include getting dressed, packing a lunch for school or work, and cooking dinner. Independently completing these sequences are essential for one to have independence throughout their day. One way of teaching sequences of behavior is using visual activity schedules. Visual activity schedules are an arrangement of pictures or words used to display a sequence of upcoming events. For example, when teaching getting dressed, a visual activity schedule might include a picture of under garments that signals the individual to put those on first, then a picture of a shirt signaling the next item to put on, and so on until the individual is completely dressed. This visual activity schedule could be posted on the side of the dresser of clothes or on the closet door.

Visual activity schedules encompass three evidence-based strategies: antecedent interventions, prompting, and visual supports (Hume et al., 2021). They are antecedent interventions in that they are presented prior to the initiation of the task as a cue to help the individual understand what is expected of them. The presentation of the visual activity schedule before the activity may also reduce the likelihood of challenging or interfering behaviors that could occur if the individual is frustrated because they do not understand the expectations or are disinclined to do the activity. Visual activity schedules also serve as a prompt, or support, that can increase the individual’s success completing the activity or task. Finally, visual activity schedules are a visual support as they are an additional visual stimulus that can support an individual’s increased independence and decrease their reliance on others for assistance.

The use of visual activity schedules can benefit all individuals to increase productivity and success across the day. People use various forms of visual activity schedules to complete a variety of activities throughout their day (e.g., to-do lists, daily planners, and following written directions). For individuals with autism/autistic individuals, visual activity schedules can be further beneficial by increasing independence. Individuals with autism/autistic individuals frequently display prompt dependency on another individual (Koyama & Wang, 2011). The use of visual activity schedules as a visual prompt can allow the individual to prompt themselves or rely on environmental cues rather than other people. The addition of visual activity schedules can additionally benefit individuals with autism/autistic individuals by reducing the auditory information they need to process. Previous research has shown that auditory information can be difficult for individuals with autism/autistic individuals to interpret (Knight et al., 2015); therefore, strategies relying on visual input may be more beneficial.

Visual activity schedules can take many forms (Koyama & Wang, 2011; Knight et al., 2015). The presentation of pictures can be displayed either in a linear (vertical or horizontal) pattern or within a small book (with one picture per page) where the individual engages with the schedule by moving the icon to a “done” column, checking it off a list, sliding a bar to indicate completion, or turning a page. It can also be modified to include actual objects to cue the activity for individuals who may have more difficulty identifying pictures (Hugh et al., 2018). For individuals who have word identification skills, visual activity schedules may also be presented in a narrative format where words replace pictures. Furthermore, technological advances have led to many options for the presentation of visual activity schedules as pictures or videos, and in the context of apps on tablets or other electronic devices.

Research Summary

There is a growing body of research that supports the use of visual activity schedules to increase a variety of skills and to assist with the reduction of interfering behaviors for individuals with autism/autistic individuals. According to the National Standards Project: Phase 2 (2015), the use of schedules with children with autism/autistic individuals is an established intervention that has been shown to increase their independence and their ability to plan for events that are upcoming. Furthermore, in a review by Hume et al. (2021) that evaluated evidence-based treatments for individuals with autism/autistic individuals, the authors provided additional support for visual activity schedules by identifying visual supports as an evidence-based practice.

Two systematic literature reviews have provided further support for the use of visual activity schedules as an evidence-based intervention. The review conducted by Koyama and Wang (2011) identified 23 peer reviewed studies that evaluated the use of visual activity schedules. They found that visual activity schedules had been effectively used to teach individuals with autism and intellectual disabilities to engage in a variety of activities, including on-task behavior. Knight et al. (2014) conducted another comprehensive review of the literature to expand the findings of past reviews and to determine if the use of visual activity schedules continued to be an evidence-based procedure. Their review identified 31 articles that targeted the use of visual activity schedules with individuals with autism/autistic individuals. The researchers found that visual activity schedules were effective for teaching a variety of skills across the lifespan of individuals with autism/autistic individuals. Furthermore, they found that the use of visual activity schedules was a low-effort intervention that provided individuals with consistent cues about upcoming events.

The use of visual activity schedules has been successful in teaching individuals with autism/autistic individuals across ages a variety of skills and activities such as completing the steps of toothbrushing (Moran et al., 2022), completing medical exams (Chebuhar et al., 2013), getting ready for bed (Hart Barnett et al., 2022),and leisure or play skills (Koyama & Wang, 2011). Furthermore, in the articles reviewed by Koyama and Wang (2011), there were 69 total participants including preschool students (24.6%), school-aged students (30.4%), and adults (23.2%) and more than half of those individuals had a diagnosis of autism (59.4%). Some recent literature supports the use of visual activity schedules with individuals with autism/autistic individuals to increase compliance during physical activity (Becerra et al., 2021), appropriate feeding behavior (Kirkpatrick et al., 2019), engagement in academic tasks while maintaining low rates of interfering behavior (Boyle et al, 2021), choice-making (Deel et al., 2021), completion of job-related tasks (Lora et al., 2020; Sances et al., 2019), completion of less preferred tasks without interfering behavior (Lory et al., 2020), successful transitions (Pierce et al., 2013), and social skills (Osos et al., 2021).

A variety of methods to implement visual activities is also supported in research. For some students, the use of video technology can be beneficial. Kirkpatrick et al. (2019) used video-enhanced activity schedules to reduce food stuffing (rapid eating), which resulted in a reduction of food stuffing and an increase in appropriate pacing of the meal for the participant. Brodhead et al. (2018) successfully increased the variety of games played on a tablet using an activity schedule on the tablet. Burckley et al. (2015) used a tablet to implement a video activity schedule in the community to increase the shopping skills of a young adult with autism. In only three lessons, the video activity schedule substantially helped to increase the young adults’ shopping skills.

Similar results were found when a visual activity schedule delivered via a smartphone was implemented in the community to teach an individual with autism to order items from a bakery (Cheung et al., 2016). Even a smart watch can be used to implement visual activity schedules, as shown by Jimenez-Gomez et al. (2021) when they increased the independence of play skills for three young children with autism/autistic children. The use of technology, such as tablets, smartphones, and smartwatches, may help to enhance the reach of visual activity schedules by increasing their portability and reducing the social stigma that may be associated with carrying a visual activity schedule into the community.

Though there is much research supporting the use of visual activity schedules. There are some cautions to note when examining their use. Knight et al. (2014) found that all but three studies used visual activity schedules in combination with other systematic instruction (e.g., graduated guidance, reinforcement, and prompting), which could have enhanced the effects. The maintenance and generalization of the use of visual activity schedules have limited research and represent an important direction for future research. With that said, the limited research that has been conducted appears promising. For example, MacDuff et al. (1993) successfully used visual activity schedules to teach on-task behavior that then generalized to novel pictures and activities in the schedule. Furthermore, Koyama and Wang (2011) noted that those studies that included maintenance information were able to successfully maintain the use of the visual activity schedule and those that did include generalization were successful with generalizing to novel activities or settings.

Recommendations

The application of visual activity schedules has been well documented in the research to be a successful intervention to increase a variety of skills across a variety of ages of individuals with autism/autistic individuals. This literature review is aligned with the National Standards Project: Phase 2 and other systematic literature reviews (e.g., Knight et al., 2014; Koyama and Wang, 2011) that support the recommendation to use visual activity schedules as an intervention for increasing skills and independence for individuals with autism/autistic individuals. Although research supports the success of visual activity schedules with individuals with autism/autistic individuals, the determination of appropriate intervention techniques for everyone should be decided by the team directly involved with that individual.

When using activity schedules with an individual with autism/autistic individual, it is important to consider the individual’s skills associated with symbolic representations, receptive language, and reading and comprehension when determining the mode of implementation (Hugh et al., 2018). Additionally, individual preference should be considered when determining the modality of the visual activity schedule (Knight et al., 2015). Giles et al. (2017) found similar acquisition rates when comparing static pictures to tablet-based modalities and preference for the different formats was idiosyncratic across participants. Additional clinical considerations include attention to assent and to the development of component skills. Specifically, learner assent should be assessed and regularly revisited; intervention should continue in the context of willingness and engagement (Morris et al., 2021). Component skills that can be built incidentally include choice-making, stamina for independent tasks, appropriate social engagement during activities, and self-monitoring. Many work-relevant skills can be shaped through the use of activity schedules.

Continued research should continue to explore the long-term effects of visual activity schedules and their ability to generalize effects across environments. The use of technology with visual activity schedules may help reduce the social stigma of some modalities of visual activity schedules and should continue to be explored to assist individuals in increasing their independence. While we await additional research, visual activity schedules remain an evidence-based intervention that can be valuable in increasing sequences of behavior for individuals with autism/autistic individuals.

Selected References

Systematic Reviews and Task Forces

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

Knight, V., Sartini, E., & Spriggs, A. D. (2015). Evaluating visual activity schedules as evidence-based practice for individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45, 157-178. https://doi.org/10.1007/s10803-014-2201-z

Koyama, T., & Wang, H. T. (2011). Use of activity schedule to promote independent performance of individuals with autism and other intellectual disabilities: A review. Research in Developmental Disabilities, 32, 2235-2242. https://doi.org/10.1016/j.ridd.2011.05.003

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

Selected Scientific Studies

Becerra, L. A., Higbee, T. S., Vieira, M. C., Pellegrino, A. J., Hobson, K. (2021). The effects of photographic activity schedules on moderate-to-vigorous physical activity in children with autism spectrum disorder. Journal of Applied Behavior Analysis, 54(2), 744-759. https://doi.org/10.1002/jaba.796

Boyle, M. A., Bacon, M. T., Sharp, D. S., Mills, N. D., & Janota, T. A. (2021). Incorporating an activity schedule during schedule thinning in treatment of problem behavior. Behavioral Interventions, 36, 1052-1064. https://doi.org/10.1002/bin.1813

Brodhead, M. T., Courtney, W. T., & Thaxton, J. R. (2018). Using activity schedules to promote varied application use in children with autism. Journal of Applied Behavior Analysis, 51(1), 80-86. https://doi.org/10.1002/jaba.435

Burckley, E., Tincani, M., & Fisher, A. G. (2015). An iPad-based picture and video activity schedule increases community shopping skills of a young adult with autism spectrum disorder and intellectual disability. Developmental Neurorehabilitation, 18(2), 131-136. https://doi.org/10.3109/17518423.2014.945045

Chebuhar, A., McCarthy, A. M., Bosch, J., & Baker, S. (2013). Using picture schedules in medical settings for patients with autism spectrum disorder. Journal of Pediatric Nursing, 28, 125-134. https://doi.org/10.1016/j.pedn.2012.05.004

Cheung, Y., Schulze, Leaf, J. B., & Rudrud, E. (2016). Teaching community skills to two young children with autism using a digital self-managed activity schedule. Exceptionality, 24(4), 241-250. https://dx.doi.org/10.1080/09362835.2016.1215654

Deel, N. M., Brodhead, M. T., Akers, J. S., White, A. N., & Miranda, D. R. G. (2021). Teaching choice-making within activity schedules to children with autism. Behavioral Interventions, 36, 731-744. https://doi.org/10.1002/bin.1816

Giles, A., & Markham, V. (2017). Comparing book- and tablet- based picture activity schedules: Acquisition and preference. Behavior Modification, 41(5), 647-664. https://doi.org/10.1177/0145445517700817

Hart Barnett, J. E., Zucker, S. H., & More, C. M. (2022). Visual schedule to promote compliance with bedtime routine in a child with autism spectrum disorder. Education and Training in Autism and Developmental Disabilities, 57(2), 196-203.

Jimenez-Gomez, C., Haggerty, K., & Topcuoglu, B. (2021). Wearable activity schedules to promote independence in young children. Journal of Applied Behavior Analysis, 54(1), 197-216. https://doi.org/10.1002/jaba.756

Lora, C. C., Kisamore, A. N., Reeve, K. F., & Townsend, D. B. (2020). Effects of a problem-solving strategy on the independent completion of vocational tasks by adolescents with autism spectrum disorder. Journal of Applied Behavior Analysis, 53(1), 175-187. https://doi.org/10.1002/jaba.558

Lory, C., Rispoli, M., Gregori, E., Kim, S. Y., & David, M. (2020). Reducing escape-maintained challenging behavior in children with autism spectrum disorder through visual activity schedule and instructional choice. Education and Treatment of Children, 43, 201-217. https://doi.org/10.1007/s43494-020-00019-x

Kirkpatrick, M., Lang, R., Lee, A., & Ledbetter-Cho, K. (2019). A video-enhanced activity schedule reduces food stuffing in child with pervasive developmental disability: A single subject design case study. Advances in Neurodevelopment Disorders, 3, 281-286. https://doi.org/10.1007/s41252-019-00100-6

Moran, K., Reeve, S. A., Reeve, K. F., DeBar, R. M., & Somers, K. (2022). Using a picture activity schedule treatment package to teach toothbrushing to children with autism spectrum disorder. Education and Treatment of Children, 45, 145-156. https://doi.org/10.1007/s4349-022-00074-6

Osos, J. A., Plavnick, J. B., & Avendaño, S. M. (2021). Assessing video enhanced activity schedules to teach social skills to children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 51, 3235-3244. https://doi.org/10.1007/s10803-020-04784-x

Pierce, J. M., Spriggs, A. D., Gast, D. L., & Luscre, D. (2013). Effects of visual activity schedules on independent classroom transitions for students with autism. International Journal of Disability, Development and Education, 60(3), 253-269. http://dx.doi.org/10.1080/1034912X.2013.812191

Sances, J., Day-Watkins, J., & Connell, J. E. (2019). Teaching an adult with autism spectrum disorder to use an activity schedule during a vocational beekeeping task. Behavior Analysis in Practice, 12, 435-439. https://doi.org/10.1007/s40617-018-00306-5

Other Works Cited Above

Hugh, M. L., Conner, C., & Stewart, J. (2018). Intensive intervention practice guide: Using visual activity schedules to intensify academic interventions for young children with autism spectrum disorder. National Center for Leadership in Intensive Intervention. https://files.eric.ed.gov/fulltext/ED591075.pdf

Morris, C., Detrick, J. J., & Peterson, S. M. (2021). Participant assent in behavior analytic research: Considerations for participants with autism and developmental disabilities. Journal of Applied Behavior Analysis, 54(4), 1300-1316. https://doi.org/10.1002/jaba.859

Citation for this article

Tereshko, L. (2023). A treatment summary of visual activity schedules. Science in Autism Treatment, 20(6).

About the Author

Dr. Lisa Tereshko, Ph.D., BCBA-D, LABA is the Director of Quality Assurance and 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.