Author Anika Hoybjerg discusses the importance of selecting meaningful goals.

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

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

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

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

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

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

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

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

Additional Reading

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

About the Authors

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

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

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

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

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

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

Language

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

Social Development

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

Perspective-taking

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

Meta-cognition and Problem Solving Skills

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

Emotional Development

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

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

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

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

References

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

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

About the Authors

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

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

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