This article was reposted with permission from Stages Learning and author Frankie Kietzman.

Life is filled with routines. When you’re a student, you have years of repetition in a school setting to learn where to go when you arrive, how to get your lunch, transition in the hallways, and dress out for the gym. You’ve had the support of teachers and family to learn how to be a good student. However, for many students, especially autistic students, graduation finds them grossly underprepared for independent living. 

Figuring out how to cook a meal, do laundry, keep the house clean, and maintain hygiene can be hard for anyone, but sometimes overwhelming for autistic individuals. Education’s early emphasis on communication, academic, and social-emotional learning can sometimes unintentionally leave independent skills in the back seat. Those typical priorities may cause autistic students to become too reliant on others to take care of their more basic needs. 

One way we as educators and family members can remedy this is through intentional instruction of independent living skills through task analysis (TA) and higher awareness of our levels of prompting. Task analysis can also be a useful tool in helping students develop closer approximations toward higher levels of independence, thus leading to a higher quality of life when students leave the security of school and home. 

Task Analysis Refresher

You can find several online articles covering task analysis in more detail, but the main point is taking a task with multiple steps and breaking those down into smaller chunks. It’s helpful for a teacher to see each step in order to identify where a student may need more support and to determine if you should consider forward- or backward-chaining strategies.

What are independent living skills?

• Personal care
• Food preparation
• Clothing management
• Personal organization
• Household maintenance

 

When should I consider task analysis for teaching an independent living skill?

Skills for independent living include lots of components, not all appropriately addressed through task analysis. For any of those skills you’d like to teach, think about the number of steps involved in the process and any prerequisites the student already has mastered. 

Perhaps the ultimate goal is to cook a meal, which obviously entails many smaller steps: choosing a recipe, reading and following it, obtaining accurate materials or supplies, measuring, time management, and physical components to each recipe like whisking, kneading, and stirring. 

Once you consider all the pieces needed to complete the task, check or take baseline data to determine what skills the student already has. Maybe they’re mostly independent with all steps except following or reading the recipe. This is where task analysis could be used to target instruction. If your baseline indicates they are missing multiple components needed for the larger skill (in this case cooking), you may need to break down instruction in those areas like matching or motor imitation to get them prepared to generalize those skills later.

Here are some independent living skills that TA might help:

• Vacuuming
• Simple cooking (matching numbers on a microwave or oven)
• Using a dishwasher or laundry machines
• Washing hands or face
• Using the toilet
• Bathing—shower or bathtub
• Hygiene routines like toothbrushing or applying deodorant
• Fastening or unfastening clothing 
• Folding, hanging, or putting away clothing
• Cleaning the bathroom or kitchen

As you can see from the example and this list, there are a lot of pre-requisite skills to master before you’re ready to use an independent living TA for autistic students. Making sure they can imitate, sort, and match will be important skills as they move into this area.

Developing a Plan

Once you’ve determined a skill to teach and the student has the necessary pre-requisite skills, you are ready to develop your plan for what that perfect routine would look like when the student is engaging in this activity. Some of these skills may be individualized based on the student’s preferences—because there’s no necessarily “right” order for cleaning your body—so defer to the individual’s preferences but develop a TA that still makes sure they meet all requirements (like cleaning their entire body or brushing all of their teeth).

An example TA for the independent skill of folding pants could look like this:

1. Lay pants on a flat surface.
2. Smooth out the wrinkles.
3. Fold one pant leg on top of the other (in half)
4. Bring the bottom of the pants up to the waistband (in half again).

Wording can vary, but use vocabulary familiar to the student and be sure everyone working to support that skill uses the same words in this learning stage.

Visual Supports

Let’s talk visuals! Research continues to support visual aids as an evidence-based strategy for teaching skills to people with autism. Not only can you pair visual supports with your actual task analysis, but the visual supports can be part of the task itself. What do I mean? Glad you asked.

1. Dots or markers:

I remember when I tried to have a student clean tables after a meal or vacuum an area of the classroom and they’d just go back and forth on the same spot, so the greater area didn’t get clean. Something that helped students recognize they needed to get all over the table, floor, or window was to spread out some kind of markers so they’d know removal meant the areas were done. For vacuuming, I would clean out my hole-puncher and sprinkle the dots on the floor in the 4 corners of the space so they’d cover more ground. Think of other ways to visually mark an area that needs to be covered.

2. Jigs:

A jig is a tool that can help when folding shirts, towels, pants—you name it! Some you can purchase, or you can watch a video to DIY; just get some duct tape and cardboard and viola! You can also write numbers on the cardboard to correspond with the steps in their folding TA. Eventually, you can work to fade the jig support, but it is very helpful when first learning the skill.

3. Near-point models:

Besides having TA visuals accessible and nearby, a near-point model can help students improve executive functioning. For example, have the numbers they need to copy directly next to the area where they’ll be needed. If a student is cooking oatmeal for 1:10, I would have those numbers on a Post-it note on the microwave so they don’t have to look back and forth to fine print to enter the numbers. Finding ways to cut down on such processing can help students gain success as they practice these independent living skills.

The best part about focusing on intentionally teaching independent living skills is that these also have the potential to generalize into vocational opportunities, which means a whole new level of independence!

How have you been able to introduce task analysis for teaching independent living skills? How can visual supports paired with TA help enhance your practice? 

For more specific information on Task Analysis see:

• Using Task Analysis for Arrival and Dismissal Routines
• Teaching Multi-Step Skills Through Task Analysis for Students with Autism
• How to Use Chaining to Break Down Complex Tasks for Children with Autism

References:

https://achieve.lausd.net/cms/lib/CA01000043/Centricity/Domain/109/Self-Care_Independent%20Living%20-%20Home%20Activities%2005-11-20.pdf

http://life-skills.middletownautism.com/wp-content/uploads/sites/7/2017/10/Folding-clothes-TA.pdf

https://familyconnect.org/education/expanded-core-curriculum/independent-living-skills-671/#:~:text=Independent%20living%20skills%20encompass%20many,management)%2C%20and%20household%20maintenance.

About the Author

Frankie Kietzman is a Sales Development Associate for STAGES Learning with experience teaching as an elementary teacher, self-contained autism teacher for elementary and secondary students, autism specialist and coach for teachers dealing with challenging behaviors. Frankie’s passion for supporting children and adults with autism originates from growing up with her brother who is deaf and has autism. As one of her brother’s legal guardians, she continues to learn about post-graduate opportunities and outcomes for people with autism. Frankie has a Bachelor’s degree from Kansas State University in Elementary Education, a Master’s degree in high and low incidence disabilities from Pittsburg State University and in 2021, completed another Master’s degree in Advanced Leadership in Special Education from Pittsburg State University.

About Stages

Angela Nelson, a UCLA trained ABA Therapist, founded Stages Learning in 1997 when autism diagnoses first began to rise. The top-selling autism education product, the Language Builder Picture Cards, was designed to specifically meet the learning needs of children with autism. The research-based Language Builder Series has become a staple in home and school programs around the world and Stages Learning is now the premier developer of learning tools for children with autism.

This month’s ASAT article comes to us from Mi Trinh, BA, and Executive Director David Celiberti, PhD, BCBA-D, 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!

Description

Learning how to interact and engage with other children is among the many social challenges that children with autism spectrum disorder (ASD) confront, with some finding even minimal social interaction difficult. Including siblings in treatment can be potentially effective in helping a child with autism build these important interaction skills. Behavioral Sibling Training is the practice of engaging neurotypical siblings of an individual with ASD in the intervention efforts for a child with ASD hopefully leading to positive interactions in the future, as well as improved social and play skills (Ferraioli et al, 2012). For example, in a study conducted by Celiberti and Harris (1993), neurotypical siblings were taught in their homes how to target play and play-based language, to reinforce positive behaviors, and to prompt their siblings with autism to promote responding. Including siblings as agents of change is a natural extension of the existing literature on peer-mediated interventions, which has been studied and shown to be effective for many decades (e.g., Lancioni, 1982; Strain, Shores, & Timm, 1977; Wahler, 1967).

Prior to describing the research basis for involving siblings as intervention agents, it would be helpful to share with the reader other ways siblings may be engaged and supported outside of being a participant in interventions. Many programs already provide services to siblings that may include, although are not limited to, education about autism, social opportunities (“Sibling Appreciation Day”), and ongoing or time-limited sibling support groups. These latter experiences may include some aspects of skill building (e.g., communicating needs to parents, coping with stress, addressing peer questions about autism) but these are often narrow in focus, time limited in nature, and not intensive. As such, they are beyond the scope of this review. Further, there are some providers that target social initiation and play skills in other settings (e.g., school) and may request that parents arrange and/or assess the extent to which these newly acquired skills generalize during interactions with siblings in the home. In this case, siblings are often not provided specific training in how to facilitate that carryover and, therefore, this would not be considered an example of Behavioral Sibling Training.

Research Summary

Extensive systematic reviews of the research literature on the efficacy of using siblings in interventions for children with ASD have been carried out (e.g., Banda, 2015; Bene & Lapina, 2021). Sibling training efforts have included participants who are pre-school age (e.g., Jones & Schwartz, 2004; Oppenheim-Leaf et al., 2012; Tsao & Odom, 2006), school-age (e.g., Celiberti & Harris, 1993; Ferraioli & Harris, 2011; Glugatch & Machalicek, 2021), and adolescent (e.g., Rayner, 2011a; Walton & Ingersoll, 2012). Targeted skills have included cooperative play skills (e.g., Celiberti & Harris, 1993; Coe et al., 1991; Glugatch & Machalicek, 2021; Reagon et al, 2006), social interactions (e.g., Dodd et al, 2008; Strain & Danko, 1995), joint attention (e.g., Ferraioli & Harris, 2011; Tsao & Odom, 2006), motor skills (Colletti & Harris, 1977), imitation skills (e.g., Rayner, 2011a), and self-help skills (e.g., Rayner, 2011b). Intervention methods have included elements such as didactic teaching and roleplaying (e.g., Oppenheim-Leaf, Leaf, Dozier, Sheldon, & Sherman, 2012), in vivo modeling (e.g., Celiberti & Harris, 1993) and video modeling (e.g., Neff, Betz, Saini, & Henry, 2016). For more information about video modeling, please see Evoy (2023).

These studies showed that there were mutual benefits for both neurotypical siblings and siblings with ASD after treatments that engaged the typically developing siblings (Ferraioli et al, 2012). For children with ASD, researchers observed gains in targeted social-communication and play skills, and a decrease in problematic behaviors (Shivers & Plavnick, 2014). For neurotypical siblings, studies report an increase in confidence and pleasure in interaction with their brother or sister with ASD and a decrease in sibling frustration (Shivers & Planick, 2014; Banda, 2015). When typically developing siblings were trained to use behavioral strategies, they not only learned to generalize these strategies to facilitate social and communication behaviors with their siblings with ASD across various settings, but they also improved their own social behaviors from developing a more positive view on the siblings with ASD (Shivers & Plavnick, 2014; Banda, 2015; Bene & Lapina, 2020).

Bene and Lapina (2020) shared some encouraging data with respect to both generalization and maintenance, as well as social validity. In their review, 7 of the 16 studies reported generalization and maintenance although the probes were generally just a few months post-treatment. In addition, 11 of the 16 studies offered social validity information; however, this varied widely across studies. Although these studies often included reports of parental or sibling satisfaction with the outcomes, other studies used naïve observers to demonstrate that changes were observed in the siblings before and after intervention and these changes were positive in nature.

However, these literature reviews also point out many limitations across studies. For instance, the roles of neurotypical siblings vary across studies: some were passive (i.e., modeling behaviors through videos, or included in social stories), while some were active interventionists. Future studies should investigate how the extent of siblings’ involvement influences the impact on children with autism (Banda, 2015). There is also a need for further research about other factors that might influence the effectiveness of siblings’ interventions, such as age, gender, and closeness between the siblings (Shivers & Plavnick, 2014). Finally, most of the reviewed studies lacked long-term follow-up, which is necessary to make a definite conclusion regarding the long-term impacts of utilizing siblings in interventions (Shivers & Plavnick, 2014; Banda, 2015; Bene & Lapina, 2020). Aside from further research looking into the maintenance of the intervention effects, Glugatch and Machalicek (2021) also suggested that component analyses look carefully at which specific skills are pivotal to reciprocal play.

Recommendations

Based on the reviews of the existing body of literature, further research with better experimental designs is warranted to draw more robust conclusions regarding the long-term effects of engaging neurotypical siblings in intervention plans for children with autism. Although there is evidence across studies that these intervention models show positive impacts for both neurotypical siblings and for their siblings with autism, a better understanding of those benefits is an area warranting more research. Therefore, professionals and parents should base their decisions to pursue sibling training on a case-by-case basis, carefully considering their specific goals, and evaluating whether those goals and proposed methods align with the existing research (Banda, 2015). Despite the need for more research, Banda (2015) points out that utilizing siblings in interventions for children with autism might result in long-term improvement in siblings’ relationship and overall family wellbeing. These collateral effects can also be studied systematically as this body of research is expanded.

With respect to implementation, it is important that providers offering sibling training are practicing within their scope of competence. As sibling training often occurs in the home, providers should be particularly sensitive to family, cultural, linguistic, and socioeconomic considerations to enhance outcomes and overall experiences for all members of the family. Assent on the part of the sibling should be assessed at the onset and revisited frequently as the intervention unfolds and social validity can include more in-depth consideration of the siblings’ views on goals, interventions, materials chosen, etc. Parents and guardians interested in including their child with ASD’s siblings in intervention should inquire about providers’ prior experiences including siblings as agents of change and be open about family values, strengths, and limitations – even if not adequately solicited by prospective providers.

Finally, we encourage parents to be mindful of the potential knowledge differential surrounding autism between the autistic child and their sibling, particularly when the sibling is engaged in intervention (i.e., provided with background information, given strategies). For autistic children who do not yet understand much about their diagnosis, be as sensitive as possible when explaining it to others (such as the sibling), discussing it, or otherwise referring to it; and consider what steps can be taken to help the individuals with autism better understand their differences (e.g., Weiss & Pearson, 2016).

References

Systematic Reviews of Scientific Studies

Banda, D. R. (2015). Review of sibling interventions with children with autism. Education and Training in Autism and Developmental Disabilities, 50(3), 303-315.

Bene, K., & Lapina, A. (2020). A meta-analysis of sibling-mediated intervention for brothers and sisters who have autism spectrum disorder. Review Journal of Autism and Developmental Disorders, 8(2), 186-194.

Shivers, C. M., & Plavnick, J. B. (2015). Sibling involvement in interventions for individuals with autism spectrum disorders: A systematic review. Journal of Autism and Developmental Disorders, 45, 685-696.

Selected Scientific Studies

Celiberti, D. A., & Harris, S. L. (1993). Behavioral intervention for siblings of children with autism: A focus on skills to enhance play. Behavior Therapy, 24(4), 573-599.

Coe, D. A., Matson, J. L., Craigie, C. J., & Gossen, M. A. (1991). Play skills of autistic children: Assessment and instruction. Child & Family Behavior Therapy, 13(3), 13-40.

Colletti, G., & Harris, S. L. (1977). Behavior modification in the home: Siblings as behavior modifiers, parents as observers. Journal of Abnormal Child Psychology, 5(1), 21-30.

Dodd, S., Hupp, S. D., Jewell, J. D., & Krohn, E. (2008). Using parents and siblings during a social story intervention for two children diagnosed with PDD-NOS. Journal of Developmental and Physical Disabilities, 20, 217-229.

Ferraioli, S. J., & Harris, S. L. (2011). Teaching joint attention to children with autism through a sibling‐mediated behavioral intervention. Behavioral Interventions, 26(4), 261-281.

Glugatch, L. B., & Machalicek, W. (2021). Examination of the effectiveness and acceptability of a play-based sibling intervention for children with autism: A single-case research design. Education and Treatment of Children, 44(4), 249-267.

Jones, C. D., & Schwartz, I. S. (2004). Siblings, peers, and adults: Differential effects of models for children with autism. Topics in Early Childhood Special Education, 24(4), 187-198.

Neff, E. R., Betz, A. M., Saini, V., & Henry, E. (2016). Using video modeling to teach siblings of children with autism how to prompt and reinforce appropriate play. Behavioral Interventions, 32, 193-205.

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

Rayner, C. (2011a). Sibling and adult video modelling to teach a student with autism: Imitation skills and intervention suitability. Developmental Neurorehabilitation, 14(6), 331-338.

Rayner, C. (2011b). Teaching students with autism to tie a shoelace knot using video prompting and backward chaining. Developmental Neurorehabilitation, 14(6), 339-347.

Reagon, K. A., Higbee, T. S., & Endicott, K. (2006). Teaching pretend play skills to a student with autism using video modeling with a sibling as model and play partner. Education and treatment of children, 517-528.

Strain, P. S., & Danko, C. D. (1995). Caregivers’ encouragement of positive interaction between preschoolers with autism and their siblings. Journal of Emotional and Behavioral Disorders, 3(1), 2-12.

Tsao, L. L., & Odom, S. L. (2006). Sibling-mediated social interaction intervention for young children with autism. Topics in Early Childhood Special Education, 26(2), 106-123.

Walton, K. M., & Ingersoll, B. R. (2013). Improving social skills in adolescents and adults with autism and severe to profound intellectual disability: A review of the literature. Journal of Autism and Developmental Disorders, 43, 594-615.

Other References

Evoy, K. (2023). Video Modeling: A treatment summary. Science in Autism Treatment, 20(08).

Ferraioli, S. J., Hansford, A., & Harris, S. L. (2012). Benefits of including siblings in the treatment of autism spectrum disorders. Cognitive and Behavioral Practice, 19(3), 413-422.

Lancioni, G. E. (1982). Normal children as tutors to teach social responses to withdrawn mentally retarded schoolmates: Training, maintenance, and generalization. Journal of Applied Behavior Analysis, 15(1), 17-40.

Strain, P. S., Shores, R. E., & Timm, (1977). Effects of peer social initiations on the behavior of withdrawn preschool children. Journal of Applied Behavior Analysis, 10(2), 289-298.

Wahler, R. G. (1967). Child-child interactions in free field settings: Some experimental analyses. Journal of Experimental Child Psychology, 52(2), 278-293.

Weiss, M. J., & Pearson, N. (2016). Clinical Corner: How to manage the impact of child with autism on siblings. Science in Autism Treatment, 13(2), 22-26.

Citation

Trinh, M., & Celiberti, D. (2024). Treatment Summary: Behavioral sibling training Science in Autism Treatment, 21(01).

About the Authors

Mi Trinh, BA earned her bachelor degree in Finance from Brigham Young University in 2014 and is a former ASAT Extern. During her externship, she wrote a few articles for ASAT and translated several ASAT articles into Vietnamese as part of her project in disseminating evidence-based information about autism treatments internationally. One of her topics of interest is the collaboration between behavioral analysts and speech language pathologists. She is starting the PhD program in Speech and Hearing Sciences with a clinical track in Speech Language Pathology at the University of Iowa in the Fall 2024.

David Celiberti, PhD, BCBA-D, is the Executive Director of ASAT and Past-President, a role he served from 2006 to 2012. He is the Editor of ASAT’s monthly publication, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993 and his certification in behavior analysis in 2000. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis (ABA), and early childhood education. He works in private practice and provides consultation to public and private schools and agencies in underserved areas. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. In prior positions, Dr. Celiberti taught courses related to ABA at both undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.

By Kelly (McKinnon) Bermingham, MA, BCBA, author of The Group Experience and co-author of Social Skills Solutions: A Hands-on Manual

There is a long history of evidence and research indicating that early intervention is one of the most successful measures of autism spectrum disorder symptom reduction (ASD). In 2001, The National Research Council convened a panel of many of the most well-recognized national experts in the treatment of autism at the time. This panel was charged with integrating scientific literature and creating a framework for evaluating the scientific evidence concerning the effects and distinguishing features of the various treatments for autism. One of the significant recommendations for children on the autism spectrum is the need for early entry into an intervention program.

In a second Clinical Report of the American Academy of Pediatrics Council on Children With Disabilities, the report noted, “The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings. Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.”

In the field of child development, the term “early intervention” refers to intensive therapeutic services provided for infants and young children (typically from the ages of under 2 to 5 or 6 years old) who have a delay in reaching developmental milestones before they enter kindergarten. “Intensive” means the hours provided to the child are significant and impactful. These programs are often also called EIBI programs, Early Intensive Behavioral Intervention. In the field of ABA, this is often referred to as a “Comprehensive ABA program” that assess for and seeks to teach and develop skills that are needed across all developmental areas. Additionally, according to the National Research Council, Committee on Educational Interventions for Children with Autism, the committee noted that research shows that early diagnosis of, and interventions for, autism are more likely to have major long-term positive effects on symptoms and later skills.

A young child’s brain is still forming, meaning it is more “plastic” or changeable than at older ages. Because of this plasticity, treatments have a better chance of being effective in the longer term. Early interventions not only give children the best start possible but also the best chance of developing to their full potential.  Recent guidelines suggest starting an integrated developmental and behavioral intervention as soon as ASD is diagnosed or seriously suspected. ABA therapy programs should be designed for these crucial skills related to language and social communication deficits, including responsivity to social stimuli, which supports skills including imitation and joint attention as mentioned previously.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) was published in 2022. The DSM-5-TR is used to diagnose a person on the autism spectrum based on two primary domains.

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or historically:

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduce sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to the absence of interest in peers.

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or historically:

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal/nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take the same route or eat the same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
4. Hyper- or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

As we can see, the core symptoms of autism are heavily related to language and social communication deficits. Conversely, we know that in neurotypically developing children, social and communication skills develop inherently.  As these social and communication skills emerge, they are reinforced by people in their world and the environment they live in, further strengthening these skills. Let’s look at how these skills emerge and develop.

As young children age, they begin to look around and become aware of their surroundings. They smile or frown, or even cry based on what they see. They begin to imitate and respond to their environment based on what happens, or the consequences of their responses. They begin to point to ask for things or to show you things they see. They respond to the attention they receive when doing these things.  During the first year of life, children start to develop close connections with their parents and other caregivers. They begin to observe, imitate, and show pleasure and displeasure. During the second year of life, children begin to notice other children and seek interactions with other children. They may begin to show pleasure with others, as well as conflict, and begin to recognize emotions in others. During the third year of life, children expand their play skills and explore more. They begin to develop friendships with those in their proximity and engage in common play actions. They begin to cooperate, imitate, and learn to accept compromise during conflict, with adult support. During the fourth year of life, conversation skills improve and become robust. Their social interactions with others advance through shared play and conversations. They begin to show support and help toward others.

Children may also interact with other children or more people in their environment. They may go to daycare or preschool, then on to kindergarten. In preschool, children are taught and reinforced to use language to communicate. They are taught to play, share, and play together cooperatively toward a common goal. They are taught to wait. They use their imitation skills to learn how to dance and sing and observe and learn new skills from other children. They move on to kindergarten and are taught even greater communication and social skills that include learning how to negotiate and play a friend’s choice. They learn how to regulate their feelings and behaviors. They learn these in a group experience. During the fifth year of life, children can more comfortably create and maintain friendships through common interests and play. They can engage in more complicated games that require more attention and are guided by rules. There is a wide variety of words and actions in play and interactions, and they can directly express concern and help. As they move on to an educational setting, they are ready and able to learn in a group format. They can follow along with an adult leading the group, follow the directions, and manage themselves around others.

Children diagnosed with autism are not likely to demonstrate these skills and they are not coming into contact with reinforcement. Going back to the diagnostic criteria and symptoms of autism, we see that deficits in social communication and social interaction across multiple contexts result in challenges with interacting with others in a social setting and these crucial milestones being missed.

A new study by Blacher et. Al, 2022 found that nearly one in six kids with autism are expelled from preschool and daycare. Many of them, in the sample, were expelled more often from a private than a public program. Most of the children were expelled due to their behavior which included temper tantrums, hitting, and yelling. The study found that often the teachers were not trained or credentialed and didn’t have the required courses in autism.

ABA is a science devoted to the understanding and improvement of human behavior. Applied behavior analysts focus on objectively defined behaviors of social significance; they intervene to improve the behaviors while demonstrating a reliable relationship between the interventions and the behavioral improvements. Most people think of ABA instruction being delivered in a 1:1 format. Concerns arise when a child transitions to a daycare or classroom setting. The child learning in the 1:1 format may not have the skills to learn alongside other children in a group format. Now we are back to the statistic of one in six kids with autism being expelled from preschool and daycare.

By providing early intervention in a group ABA-based format as soon as possible, we can better prepare the child with autism for group learning. If you think of the very best teacher, you ever had in school, the teacher likely employed ABA strategies, such as: including environmental arrangements, priming, using visual supports, reinforcement/reward strategies, and using first this. That teacher likely considered motivation and created activities that were interesting and motivating to you while you learned. That is using ABA in a group format.

For many children diagnosed with ASD, a comprehensive program would look across all of these developmental areas, identify what skills are missing, and then identifying appropriate teaching methods to teach those skills. This comprehensive program would likely be heavily based on play and natural environment teaching. It would include caregivers in the programming, as well as siblings, peers, and possibly other family members. It would include consultation with other therapies or providers the child may be receiving and coordinating care with those services. It would be intensive in the hours provided in the beginning, often 27-40 hours of ABA recommended according to research. This program would focus on teaching the child to be able to attend to, respond to, and participate in group environments as they prepare to attend daycare, preschool, or kindergarten. The ultimate goal of the ABA-based Early Intervention program should be to move from 1:1 therapy to a group learning experience, focusing on the developmental milestones described earlier, and allowing these skills to come into contact with reinforcement from other children.

References

American Academy of Ped American Academy of Pediatrics (2001). Policy Statement: The Pediatrician’s Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children (RE060018) Pediatrics.

American Psychiatric Association (Ed.). (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (Fifth edition, text revision). American Psychiatric Association Publishing.

California Legislative Blue-Ribbon Commission on Autism (2007). Report: An Opportunity to Achieve Real Change for Californians with Autism Spectrum Disorders. Sacramento, CA: The Legislative Office Building. Available online at: http://senweb03.sen.ca.gov/autism.

Blacher, J., & Eisenhower, A. (2023). Preschool and Child-Care Expulsion: Is it Elevated for Autistic Children? Exceptional Children, 89(2), 178-196. https://doi.org/10.1177/00144029221109234

Dawson, G., Toth, K., Abbott, R., Osterling, J., Munson, J., Estes, A., & Liaw, J. (2004). Early social attention impairments in autism: social orienting, joint attention, and attention to distress. Developmental Psychology, 40(2), 271–283. https://doi.org/10.1037/0012-1649.40.2.271

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The Group Experience. Printed in the United States of America Published by: Different Roads to Learning, Inc. 12 West 18th Street, Suite 3E New York, NY 10011 tel: 212.604.9637 | fax: 212.206.9329 www.difflearn.com

About the Author

Kelly (McKinnon) Bermingham has been working in the field for 27 years and has been a Board-Certified Behavior Analyst since 2003. She is an ESDM certified Therapist and a PEERS-certified therapist.  Kelly wrote her first book, “Social Skills Solutions: A Hands-on Manual” in 2002.  Kelly has written several blogs for Autism Speaks, been published in several journals, and co-authored a chapter in the textbook, “Rethinking Perception & Centering the Voices of Unique Individuals: Reframing Autism Inclusion in Praxis.”  Kelly helped found a school for middle school & high school children on the autism spectrum and a sports league for children with autism. Kelly is part of The September 26^th Project, creating safety awareness checklists and reminders for those on the autism spectrum and their families. She was an Expert Subject Matter for CASP’s recent Organizational Guidelines for ABA companies. Kelly provides training on The Group Experience to organizations based on this book.