Productive Meetings in Home ABA Programs

This month’s ASAT article comes to us from Preeti Chojar, MCA, ASAT Parent Board Member. 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!

I am a parent who has a home-based ABA program. We are fortunate to hold monthly meetings with all of the providers that work with my child. I am looking for some ideas on how to make the most of these meetings. Any suggestions?

It is terrific that your team meets monthly! Collaboration and consistency amongst members of the professional team is the hallmark of a successful home program. I have found that a great way to build teamwork is to have regular meetings to keep my son Ravi’s team on the same page. Here are some suggestions to help you use this time effectively and efficiently. In our particular case, we meet monthly, but keep in mind that some teams may need to meet more or less frequently (depending on the composition of the team, level of oversight required, and needs of the child).

Meeting composition

Ideally a time can be scheduled in which the entire team can be present. This would include any related service providers if feasible such as the family trainer, speech pathologist, occupational therapist, or physical therapist. Assign a meeting chair if possible. Assembling the entire team can be difficult given constraints such as other children on caseload, family responsibilities, school schedules, reimbursement for time, etc. Try your best!

Develop the agenda

Always create an agenda well before a team meeting. Please note that this agenda should not sidestep any other communication that should be occurring (e.g., the consultant may want to know right away if a new skill-acquisition program or a behavioral strategy is not going well).

  • Start by writing down what is going well/not going well, along with any new behaviors, both positive and challenging.
  • Have data summarized and analyzed before the meeting.
  • Add anything that the supervisor or the collective wisdom of the group could help resolve.
  • Review last month’s meeting notes paying close attention to any open or unfinished items. This should occur at every meeting.
  • If the child is also receiving services in a school or center-based environment, seek input from those providers as well.
  • Bring to the table any observations made by people in the community that highlight some skill or skill deficit which might have gone unnoticed.
  • Prioritize agenda items and, if necessary, allocate a specified amount of time to discuss each item.
  • Finally, make sure the agenda is well balanced and addresses everyone’s concerns.

Circulate the agenda

  • Make sure to circulate the agenda to everyone attending the meeting, ideally a few days before the meeting.
  • Ask all team members to notify you ahead of time of any other agenda items they might have that were not added yet.

Starting the meeting

  • Begin the meeting promptly (and end on time as well).
  • Ensure that there is agreement about the agenda items and inquire about whether there are any important items to add.
  • Ask members to share a personal good news story. This is a great way to get to know each other and build team morale.

During the meeting

  • Stick to the agenda to the extent possible, being flexible to add in any new items of importance.
  • Encourage every team member to share their ideas, tips for working with the child, or difficulties.
  • Have team members share details about specific reinforcers or strategies with the group.
  • Discuss any struggles to teach a particular skill. This will help the group learn about any discrepancies across team members.
  • Similarly, they may be struggling to teach a particular skill. This will help them learn about any discrepancies
    across team members or general concerns.
  • Whenever two members go off on a tangent that doesn’t require the full team’s attention, ask them to discuss it after the meeting. This would include off-topic discussions and other “small talk.”
  • Discourage attendees from checking their phones or texting during the meeting.
  • Vary the format as warranted.
  • Review videos as a group (e.g., teaching sessions, generalization of skills in different situations/settings).
  • In some instances, involve the child in the meeting as well. Every team member can work briefly with the child on one or more tasks while the remainder of the team observes and offers feedback if suitable. The supervisor can take notes and give feedback afterwards if this would be more appropriate.

Make sure to end on a positive note

  • Mention any positive events or achievements of the child.
  • Reinforce the efforts of the team or individual’s efforts (be specific about what is being praised and why).

Take meeting notes

  • Take careful notes of any recommendations, ideas or changes to specific programs. Meeting notes should clearly identify any action items along with who is responsible for completing that item (include time frame for completion).
  • Any action items not completed from last month’s meeting notes should be continued on the subsequent month’s meeting notes.
  • The meeting notes would not preclude the consultant from distributing written recommendations (this would be particularly important if a behavior reduction plan was warranted).

Distribute meeting notes

  • Send the meeting notes to everyone attending the meeting and anyone who missed the meeting (we rely heavily on email with the assurance that the email content is privileged and kept confidential). Send copies to any other relevant people, like the child’s teacher or other related service providers.
  • In some cases, it may be helpful to have attendees initial a group copy to ensure that the notes were reviewed and understood or respond back via email to indicate such.

Final Suggestion

Use applied behavior analysis with your team, not just with your child, by assessing the team’s skill at using meeting times productively and efficiently and at taking steps needed to improve both group process and outcomes. It helps if everyone is committed to helping the child realize his or her fullest potential and to investing in the process to become better providers and team members. Best of luck to you with your meetings.

Citation for this article:

Chojar, P. (2016). Clinical Corner: Productive meetings in home ABA programs. Science in Autism Treatment, 13(3), 29-32.

About the Author

Preeti Chojar, MCA, has been a Board Member of the Association for Science in Autism Treatment (ASAT) since 2007 and currently serves as the lead on all of ASAT’s website efforts. This role includes uploading new content weekly, updating content when needed, developing new pages, and otherwise managing the site. 

When her son was diagnosed, she had no knowledge of autism. She educated herself by attending numerous conferences, asking questions and reading as many books and articles as possible. She worked hand in hand with the staff at her son’s schools and the team at home.

She is a software professional. She has used those skills, innovative thinking and her commitment to her son to develop and carry out an unrelenting path forward for him. Her level of involvement and commitment to science-based treatment has sustained over the years.

Posted in ABA

Assent in ABA Therapy: Autism Rights

This article has been reposted with permission from Action Behavior Centers.

In the field of Applied Behavior Analysis (ABA) therapy, ABA therapists perform techniques to help children with autism or other developmental disorders improve their social, communicative, and behavioral skills. ABA autism therapy involves breaking down complex skills into smaller, more manageable steps, and using positive reinforcement to encourage the child to learn and practice these skills. ABA therapists and behavioral technicians will often use visual aids, such as pictures and charts, to help children on the spectrum understand what is expected of them. Through these processes, it is very important to understand that the progression of treatment and successes are optimized as the child shows comfortability and a willingness to proceed.

In Applied Behavior Analysis (ABA) therapy, an autistic child’s agreement or willingness to participate in a particular intervention or activity is known as assent. It is an essential ethical requirement in ABA therapy to obtain the child’s assent before initiating any treatment. Assent is different from consent, which is obtained from a parent or legal guardian before starting any treatment or intervention. Assent is important for all children, regardless of their perceived ability to understand the nature and purpose of the treatment. 

The process of obtaining assent involves an autism therapist or clinician explaining the therapy process to the child on the spectrum in a way that they can understand and encouraging them to ask questions or express any concerns they may have. Listen carefully to their responses and address any issues or fears that they may have. For children with limited receptive and expressive language, assent is granted and revoked through other cues. This might include the child shaking their head, crying, or looking away. At ABC, we require clinicians to assess each child’s method of granting and revoking assent. If the child does not give their assent, then the treatment or goals are revised to meet the child’s needs. It is important to honor their wishes and find alternative solutions if necessary. 

Assent plays a vital role in the process of autism therapy. By providing assent, you are allowing the autistic child the right to make decisions about their own treatment. This helps build a positive relationship by involving the child in the decision-making process. This lays the foundation between the therapist and the child to increase trust, cooperation, and engagement in therapy. When a child gives their assent, they are more likely to be invested in the treatment process and to actively participate. This can lead to greater treatment effectiveness and better outcomes for the child’s autism symptoms. 

It is also important to note that the age at which a child can provide meaningful assent will vary depending on the situation and the child’s individual development. At Action Behavior Centers, we make sure that obtaining assent from a child is at the forefront of our practices as it is an important step of ABA therapy. We believe that it ensures that the child’s rights and interests are protected and that they are treated with respect and dignity. By following this practice, we are prioritizing the comfortability of children on the spectrum and guiding them into a more successful outcome from our ABA services. 

About Action Behavior Centers

Action Behavior Centers (ABC) is an organization committed to the treatment of children using empirically validated methods and strategies to assist each child in reaching his or her greatest potential and improving their quality of life.

Learn more at their website: https://www.actionbehavior.com/

Posted in ABA

Unveiling Barriers with Behavior Intervention Plans

By Morgan van Diepen, M.Ed., BCBA, Co-owner of ABA Visualized

Developing and disseminating Behavior Intervention Plans (BIPs) is a crucial and common approach for providing effective support for individuals who exhibit challenging behaviors. These individualized plans are designed to decrease these behaviors that impede learning and pose safety risks. However, despite their significance, several barriers hinder the realization of desired outcomes. Chances are, you’ve encountered some of these barriers firsthand and perhaps have even experienced feelings of burnout or imposter syndrome as a result. In a recent pilot study, we interviewed and surveyed more than 200 people responsible for writing or implementing BIPs. One theme from our findings was alarming: many of us are quietly struggling.

When we asked behavior experts to complete this sentence, “When I first was expected to write behavior plans independently, I felt _____________,” the answers were troubling: like I was thrown in, completely overwhelmed, like I had to learn through trial and error, terrified, unsure, stressed, lost, nervous, so much pressure of being a brand new BCBA & parents are looking to you with desperation.

When we asked parents and teachers about their experiences with BIPs, many expressed sentiments such as “not understanding it,” “having only seen it once,” or “not believing it’s helping.” Considering that this carefully curated plan is intended to help support neurodiverse individuals to lead safe and meaningful lives, these shared experiences highlight the critical need for enhanced support in creating and implementing BIPs. In this article, we’ll reveal the four main barriers we identified through our research and propose a solution!

Barriers Impacting Effective BIPs

  1. Effective Training While it is a crucial skill set for behavior experts and is part of their required coursework, our research has revealed that these professionals lack confidence in their ability to develop and teach BIPs. In our survey of over 200 individuals responsible for developing BIPs, only 43% reported feeling confident choosing strategies to fit individual learner needs. In this same survey, 79.4% reported initially not feeling prepared to independently develop a BIP and only 35% of respondents reported currently feeling effective at disseminating their plan to their staff & stakeholders.
  • Technical Jargon The complexity and confusion associated with commonly used, technical behavior terminology contributes to the abandonment of potentially beneficial BIPs. This abandonment leaves stakeholders feeling under-supported and service providers feeling ineffective. Technical language negatively affects comprehension and acceptability of evidence-based strategies, particularly for individuals with little or no training in Applied Behavior Analysis (ABA) principles. In our own survey, we found that 90% of stakeholders expressed a greater likelihood of using behavior strategies if they were presented in a more understandable manner. This difficulty in understanding likely contributes to published research findings indicating that team members implement fewer than 60% of the strategies outlined in a BIP, with an average accuracy rate of only 68% when implemented.
  •  Time Constraints In our pilot study, we discovered that the average time spent developing a BIP was 3.6 hours. While BCBAs have genuine intentions to develop an individualized support plan that considers the learner’s preferences, strengths, and needs, as well as the practicalities for the team, the demanding nature of this process consumes a considerable amount of time and effort. In fact, “time” was the number one barrier reported by behavior experts in our pilot study interviews. Many BCBAs face constraints on their time, limiting their ability to dedicate the necessary resources for creating comprehensive and tailored BIPs. This time limitation may compromise the thoroughness and quality of BIPs, impacting their overall effectiveness in supporting individuals with behavioral needs.
  • Traditional Teaching Methods After a behavior expert has developed a BIP, the traditional method of teaching this plan to the team involves providing them with a multi-page text document and reviewing it together. However, our surveys and research indicate that this method is not effective for optimal learning and retention, and it does not adequately support those who could benefit from the plan. In our pilot study, the average number of strategies included in a BIP was 26 (ranging from 4 to 45), while those responsible for implementation were only able to recall an average of 3 strategies (ranging from 0 to 5). This discrepancy aligns with established research on memory retention, which indicates that information presented in dense text is prone to being forgotten. The brain quickly loses information, tends to overlook the middle portions of lengthy texts, and may become overwhelmed by dense material.

Finding a Solution

In addressing the barriers to effective Behavior Intervention Plans (BIPs), one solution shines bright: the transformative impact of visuals!

Whether utilizing resources like the ABA Visualized Guidebook or making your own illustrated scenarios of the recommended behavior strategies, integrating visual elements into coaching sessions improves retention, understanding, and engagement.

Also, because you can leave the visual resource with the parent, teacher, or behavior staff, visuals provide a tangible reference point between your sessions, ensuring continuity in implementation. By embracing the power of visuals, you can feel more confident when explaining behavior strategies and your team can feel more prepared to support their learners.

Ready to learn more about the impact of using visuals in Behavior Intervention Plans? Download our free The Power of Visuals infographic!

About the Author

Our mission at ABA Visualized is to make behavioral expertise approachable, accessible, and relatable. This has been our mission since our first publication in 2018 and continues to guide decisions in everything we do.

As a BCBA working abroad and then with the vibrant international community in Los Angeles, Morgan quickly developed a passion for supporting under-serviced families. She realized the recurring barriers affecting these communities and limiting their access to effective behavioral expertise: long waitlists to learn from expert service providers and an abundance of technical jargon-filled texts. Morgan began to refine her approach to better disseminate behavior strategies to those who truly need it: families and educators.

As an infographic designer, Morgan’s husband, Boudewijn (Bou), naturally understands how visual storytelling can make the unclear, clear and the unknown, known. In a true collaboration between Morgan and Bou’s skillset, their flagship product, the ABA Visualized Guidebook, was created utilizing step-by-step visuals and approachable language to accomplish that sought-after accessible behavior expertise.

Since this publication, ABA Visualized as a company has grown to offer a collection of books and trainings available worldwide. We aim to continue empowering others through approachable education on strategies that can make truly meaningful impacts on individuals’ lives.

Posted in ABA

Proactive Strategies for Reducing Problem Behaviors Before They Happen

This article was reposted with permission from Stages.

Using Routines and Pre-Correction in the Classroom for Autistic Students

What is the best way to address a problem behavior? Before it happens! Procedures and routines paired with pre-correction strategies are evidence-based interventions for supporting autistic students. Instead of waiting for a challenge to arise and reacting to it, use proactive strategies to reduce opportunities for negative behaviors to occur. When you front-load lessons by pre-teaching expectations, students know exactly how to behave in the setting—and through repetition, they will be more likely to perform the skill without additional prompting or support.

Procedures and Routines

What is a routine?

A routine is simply a set of procedures for handling things such as attendance, turning in assignments, or starting a class period. It could also outline what students should do when there are minor interruptions to instruction such as how to ask to use the bathroom or when transitioning to different areas of the classroom. These procedures are not necessarily only for students, but can also be for staff. Staff members often have procedures for things like getting attention, passing out papers, and posting lesson objectives.

Why do it?

Routines and procedures help make the classroom setting predictable and safe, which can help reduce anxiety in what is already a complex environment for autistic students. The classroom especially can be incredibly overwhelming when it comes to navigating the space, social situations, and sensory inputs, all while trying to learn! Established routines let students know what to expect and what is expected from them—as a result, they are more likely to follow the procedures. What’s more, adding structure to your setting increases students’ feeling of safety. As we know through Maslow’s hierarchy, students must have their basic needs met before they are ready to engage with learning.

How should I do it?

The key to teaching a procedure is to have a plan. There are multiple routines throughout a school day to consider. There are transition routines between activities in and out of the classroom, transition to free-time activities when work is completed, bathroom routines, leaving within the setting (for things like throwing away trash, sharpening pencils, and getting supplies), and emergency transitions like a fire drill. There are also routines meant only for the teacher and routines that only students perform.

1. Have a plan: 

It’s helpful to start thinking of a step-by-step list of what you would want the behavior to look like. Think about where you want them to stand or put things and if certain times are appropriate or inappropriate to follow the routine. For example, I realized I needed to teach a pencil-sharpening routine only after I found students were sharpening during lessons, causing constant interruptions!

2. Practice: 

Next, make a plan to teach the class the routine and practice, practice, practice. Depending on the routine and needs of the students, you could develop visual supports with the steps included for student reference such as using the Language Builder cards. If you’re not sure what procedure to start with, consider where students are having the most challenging behaviors—sometimes the reason is that there are no clear procedures.

Precorrection

What is precorrection?

Precorrecting is a proactive strategy that involves providing a verbal, gestural, or visual prompt shortly before an anticipated problem behavior. It can be given to a whole class, a small group, or to an individual student. It focuses on using positive language so the autistic student knows what they should be doing and, just like routines and procedures, it allows staff to reduce the likelihood of a negative behavior occurring in the first place.

Why do it?

Addressing the problem before it occurs allows you to focus on teaching the expected rather than responding to negative behaviors. If data indicates that the autistic student is struggling in a particular setting, routine, or activity, pre-correcting can be paired with other interventions like using social stories. This can be a positive way to teach a skill rather than playing catch-up after the negative behavior has already occurred.

How should I do it?

The best part about precorrection is that you can do it at any point in time. If I am getting ready to ask the whole class a question, I might raise my hand as my prompt and say, “If you know the answer, raise your hand.” However, there may be moments in your classroom when you need a more explicit teaching model.

1. Identify key times: 

Start by looking for periods in the day when problem behavior is more likely to occur, even after you’ve already adjusted a routine or procedure and taught it to the class.

2. State expectations: 

Processing a lot of steps can be overwhelming for autistic students. When stating the expectations, keep directions concise. Pairing the direction with some kind of a gestural or visual cue could also help ensure the students understand what is expected. This might sound like, “Before we line up, remember to walk in a straight line, with voices off and hands to self.”

3. Roleplay:

One strategy to consider in precorrection is to teach the “super student” model. Research shows that autistic students respond more effectively to imitating neurotypical peers. After stating the expectation, you might say, “Before we line up, we’re all going to have Johnny show us how.” If a peer model is not available and the autistic student is struggling with a particular skill, you could practice with them one-on-one and then pair them with a neurotypical student to model for the class, or they may be able to do it independently.

When using either of these strategies to proactively address behavior in your classroom, it is critical to reinforce students positively. That will help to increase the likelihood that students will continue to use the skill. Whether it be a formal, positive behavioral support system or behavior-specific praise such as, “I like how you waited to sharpen your pencil until after the lesson was done,” giving some kind of recognition is key to helping make your classroom run successfully.  

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.

Posted in ABA

Self-Care Tips for ABA Therapists: Managing Stress and Burnout

This article has been reposted with permission from Action Behavior Centers.

When it comes to Autism Spectrum Disorder (ASD), Applied Behavior Analysis (ABA) has proven to be a transformative approach, offering individuals with autism the tools they need to reach their full potential. As ABA therapists and clinicians dedicate themselves to improving the lives of their patients, it’s possible to overlook their own well-being in the process. The demanding nature of the profession, combined with the emotionally rewarding yet occasionally draining day-to-day operations highlights the undeniable importance of self-care for ABA therapists. Due to the nature of this field, it is essential for ABA therapists to prioritize self-care to make sure they can manage stress and prevent burnout.

For an ABA therapist, stress and burnout can manifest in various ways. They might experience heightened anxiety and emotional exhaustion due to the demanding nature of their role. The constant need to maintain a structured and controlled environment, manage challenging behaviors, and meet individualized goals can lead to feelings of being overwhelmed and frustrated. At Action Behavior Centers, our commitment to the well-being of our employees is unwavering, which is why we are dedicated to offering our teammates and all other ABA therapists a valuable resource of self-care tips designed to address the unique challenges of ABA therapists in autism therapy. 

Prioritize Work-Life Balance

Balancing the demands of a rewarding yet demanding job with a personal life can be challenging. Establish clear boundaries between work and personal time. When you’re off the clock, focus on activities that rejuvenate your energy and allow you to disconnect from work-related stressors.

Engage in Mentor Sessions

ABA therapists should not underestimate the importance of regular support from their mentors. These sessions can provide a platform to discuss concerns, share experiences, and seek guidance, which can contribute to reducing burnout and promoting professional growth.

Practice Mindfulness and Stress Reduction

At ABC, we offer a free subscription to the Calm app. The Calm app provides users with guided meditation sessions, breathing exercises, sounds to aid sleep, and relaxation techniques to promote mindfulness, reduce stress, and improve overall mental well-being. Dedicate a few minutes each day to practicing mindfulness to center yourself and reduce feelings of being overwhelmed. 

Build a Supportive Network

Connecting with colleagues who understand the unique challenges of ABA therapy can create a supportive network where you can share experiences, exchange advice, and find camaraderie. Attend professional events, conferences, or online forums to expand your network.

Pursue Continuous Learning

Stay engaged by continuously expanding your knowledge and skills. Attend workshops, webinars, and training sessions that not only enhance your abilities but also remind you of your commitment to personal growth within the field. 

Set Realistic Goals

It’s important to set achievable goals both in your professional and personal life. Break down large goals into smaller, more manageable steps. This not only prevents burnout but also provides a sense of accomplishment along the way.

Find Creative Outlets

Engaging in creative activities outside of work can be therapeutic. Whether it’s painting, writing, playing a musical instrument, or gardening, having a creative outlet can provide an emotional release and foster a sense of accomplishment.

Practice Self-Compassion

Acknowledge that you’re only human and will have good and challenging days. Treat yourself with the same kindness and patience that you extend to your clients. Remember, self-care isn’t selfish; it’s a necessity. 

Unplug and Reconnect

In the digital age, it’s easy to be constantly connected. Make a conscious effort to unplug from technology during your free time. Spend quality time with loved ones, engage in outdoor activities, or simply enjoy moments of solitude.

Effectively Communicate Boundaries

Effective communication of boundaries is crucial for self-care among ABA therapists. By clearly articulating their limits and expectations, therapists can safeguard their mental and emotional well-being. This not only helps prevent burnout and exhaustion but also maintains the quality of care provided to patients. Additionally, setting boundaries ensures ethical practice and professionalism, reducing the risk of blurred lines in therapeutic relationships. Transparent communication also fosters mutual respect and understanding with patients and their families, ultimately enhancing the overall effectiveness and sustainability of ABA therapy. 

At Action Behavior Centers, the well-being of our teammates is at the forefront of our minds. We understand that a healthy and supportive work environment is essential for productivity and overall job satisfaction. To that end, we offer resources, support, and initiatives aimed at promoting mental wellness. As a part of the medical benefits we offer, teammates have access to virtual counseling sessions through First Stop Health for free. We also offer 3 free mental health sessions each year. Our commitment to our employees’ mental health underscores our dedication to their growth and success within the company. Teammates can find out more about the self-care resources and initiatives we offer by reaching out to your teammate ambassador for Action Behavior Centers Self-Care Resources

As ABA therapists pour their hearts into empowering individuals with autism, they must remember that nurturing their well-being is essential. By implementing these self-care tips, ABA therapists can find a balance between providing exceptional care and safeguarding their own mental, emotional, and physical health. As ABA therapists learn to care for themselves, they become better equipped to continue making a difference in the lives of those they serve.

About Action Behavior Centers

Action Behavior Centers (ABC) is an organization committed to the treatment of children using empirically validated methods and strategies to assist each child in reaching his or her greatest potential and improving their quality of life.

Learn more at their website: https://www.actionbehavior.com/

Posted in ABA

Focus on Generalization and Maintenance

On more than one occasion, I’ve been in the situation that a student will only demonstrate a skill in my presence. And I’ve heard from other colleagues that they have had similar experiences. This is highly problematic. When it happens with one of my students, there is only one person I can blame: myself.  A skill that a student can only demonstrate in my presence is a pretty useless skill and does nothing to promote independence.

So what do you do when you find yourself in this situation? You reteach, with a focus on generalization. This means that, from the very beginning, you are teaching with a wide variety of materials, varying your instructions, asking other adults to help teach the skill, and demonstrating its use in a variety of environments. Preparing activities takes more time on the front-end for the teacher, but saves a ton of time later because your student is more likely to actually master the skill. (Generalization, after all, does show true mastery.)

Hopefully, you don’t have to do this, though. Hopefully, you’ve focused on generalization from the first time you taught the skill. You may see generalization built into materials you already use.

Another commonly cited issue teachers of children with autism encounter is failure to maintain a skill. In my mind, generalization and maintenance go hand-in-hand, in that they require you to plan ahead and consider how, when, and where you will practice acquired skills. Here are a few tips that may help you with maintenance of skills:

  1. Create notecards of all mastered skills. During the course of a session, go through the notecards and set aside any missed questions or activities. You might need to do booster sessions on these. (This can also be an opportunity for extending generalization by presenting the questions with different materials, phrases, environments, or people.)
  2. Set an alert on your phone to remind you to do a maintenance test two weeks, four weeks, and eight weeks after the student has mastered the skill.
  3. Create a space on your data sheets for maintenance tasks to help you remember not only to build maintenance into your programs, but also to take data on maintenance.

Considering generalization and maintenance from the outset of any teaching procedure is incredibly important. Often, when working with students with special needs, we are working with students who are already one or more grade levels behind their typically developing peers. Failing to teach generalization and maintenance, then having to reteach, is a waste of your students’ time.

Sam Blanco, PhD, LBA, BCBA is an ABA provider for students ages 3-15 in NYC. Working in education for sixteen years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges, and she is the Senior Clinical Strategist at Chorus Software Solutions.

What Goes Into Teaching Children to Answer WH Questions?

This article was originally an ASAT feature. It comes to us from Alan Schnee, PhD, BCBA-D. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

I’ve been teaching children with ASD for many years. Often my attempts to teach WH questions are unsuccessful. While children learn some rote responses, once I attempt to generalize to new situations, children seem to confuse questions. For example, if I ask a child, “Where did you eat?” the child might say, “Pizza.” Do you have any idea why the child gets confused, and do you have any suggestions to address this?

Answered by Alan Schnee, PhD, BCBA-D
Nexus Autism Intervention Services, Cherry Hill, NJ

This is an excellent question. Children with autism often confuse WH questions. They often respond to a given WH question as though a different question were asked. For example, a child may answer a, “what” question when a, “where” question is asked. It is sometimes suggested that children confuse WH questions because of an auditory “discrimination problem,” which is to say that children don’t differentiate the words. However, it’s been our experience that children who can match words in verbal imitation still confuse WH questions. So, what else can it be? It is important to consider that children simply don’t know what these terms mean. To say that someone knows the meaning of a word is based on behavioral criteria and what a word means is determined by convention. To say that someone doesn’t know what a word means is to say they do not use and respond to it according to the rules for its use (Hacker 2013, p. 115).

So, what does this mean for us? It means we need to consider what it would take for children to learn how to use and respond to given words. This means that children need to learn what a word is used for. It means that we need to consider how to engineer intervention so that children learn compatible words to which target words are linked. It means that we need to contrive circumstances, situations and transactions in which progressive mastery is achieved within a normative structure and ultimately, it means that much more goes into teaching children to answer WH questions than relying exclusively on rote responses to long lists of arbitrary WH questions.

Considerations for Preparing Children to Answer “Where” Questions

When we ask a, “where” question, our uncertainty concerns locations and destinations. Thus, to ask, “where” is to ask, “At which place or from which place.” To such questions we expect answers that reference some place in conjunction with a preposition (e.g., from the kitchen, on the table). Therefore, in order to be able to answer rudimentary, “where” questions, children need to learn the names of things (couch, table, rooms, stores, etc.) and prepositions (close, to, at, near, from, under, on, beside, etc.) used in relation to a place, as well as non-specific spatial referents (here, there) – which requires that children are able to follow/use a point, eye gaze, or other gestures.

When we begin teaching children to answer, “where” questions, it is common to start with basic ‘table-top’ spatial relations. For example, when we arrange on a table, a red block on a cup and a green block next to a cup we might ask, “Where is the red block?” (Frazier, 2018; Leaf & McEachin,1999; Lund & Schnee, 2018; Taylor & McDonough, 1996). Once these rudimentary relations are in place, children will need to go places and report on where they went, came from, and where they are going (declaring destinations). They will need to be stationed in places (self-positioned) and report where they are so to be able to learn and link destinations and locations using “at,” “to,” ”from,” “in,” etc.

Additionally, it is important to keep in mind that uses of, “where’’ extend beyond spatial relations. Thus, to ask, “Where are you?” can in one sense be used to ask for an opinion, or in another to ask about progress within a process (e.g., “I’m in the middle.” “I’m at the beginning.”) or to ask about a state of attention (e.g., “Sorry, I was in ‘In La-La Land”). These examples also illustrate that responses to, “where” questions may rely on metaphoric or idiomatic uses of prepositional terms, as when we say we are standing, “on line,” even though we are not standing on anything.

It should also be pointed out, when answering, “where” questions, pragmatic considerations come into play (Lund, 2015). So, when asked, “Where are my keys?” answering factually that, “They are in New Jersey” may not be particularly helpful if both the person asking and the person answering are in the same kitchen in New Jersey. However, if the same question were asked in Chicago, that same answer would be suitable. Similarly, history needs to be taken into account. Thus, if I’m in Chicago, and my wife is in our kitchen in New Jersey and she asks where the keys are and I say “In the can.” then our shared history makes my response both understandable and useful. However, the same answer would not be suitable to a new guest staying in our house who asks the same question. Given these considerations, hopefully this section illustrates some different ways the word, “where” is used, what it would take for children to respond appropriately to, “where” questions and how learning to memorize responses from item lists cannot prepare children for such a task.

Considerations for Preparing Children to Answer “Why” Questions

When teaching children to answer, “why” questions, there is also a tendency to teach children rote responses from item lists. This section should clarify why doing so will not advance children’s abilities in this area. In language, to ask a, “why” question is to say, “Give me a reason.” In the, “why” language game, any number of reasons could be offered to a question. For example, to the question, “Why did you wash your hands?” there is an indeterminate number of appropriate answers:

  • “Mommy told me to.”
  • “My M&M melted in my hand.”
  • “We always wash before prayer.”
  • “I hate when my hands are dirty.”

The possible reasons follow from an unpredictable number of factors and situations. One may state their reason/s for why they did or didn’t do something, say or didn’t say something, felt one way or another, believed, desired, needed or hoped for something, etc. based on whim, preference, need, demands, fear, shame, misinformation, new information, etc.

Before we begin to teach children to answer or use, “why,” it is important that other abilities are in place. Children need to learn to do things, make things, go places, give and get things, look for things, etc. The use of, “why” and responding to, “why” questions often hangs on circumstances which often fall out of activity. Once children are doing things, they should be able to (at a minimum) report on what they are doing, using, or where they are going. We find it especially helpful, before we introduce, “why” questions, that children learn to use tools (for making art, eating, building things, cleaning or cooking, etc.) and to ask for things they need.

One early strategy we employ for introducing, “why” questions is ‘piggybacking’ off of interrupted chains; sabotaging an activity so that it can’t be completed without the child seeking assistance in some way. For example, once a child can make things using tools (e.g., in order to make a face, a child can use tape or some other tool to attach googly eyes to the paper), we make sure the tool is unavailable. This assumes the child has learned to ask for things she needs in order to complete a task. Thus, when a needed tool is unavailable (by design) and when the child asks for it, we can ask the child, “Why do you need it?” to which we prompt the child to say something like, “I need it to attach the eyes to the paper.” Working like this has the added benefit of providing a platform for introducing or strengthening concepts such as, in this case, “attach.” Additionally, arranging things in this way is important for teaching ‘functions’ since in such scenarios, children are actually learning to use the tools they need, to ask for them when it’s appropriate and to explain why they need them, all in real time. We do this as opposed to teaching children to answer rote questions out of context. Working this way addresses several dimensions of skill acquisition simultaneously and illustrates considerations related to careful planning for the construction of ‘advanced’ abilities.

Considerations for Preparing Children to Answer “When” Questions

The concept, “when” denotes time. To ask a, “when” question is to ask, “At which time?” Answers to when questions take the form, “When x,” such as to the question, “When are you coming for dinner?” to which the answer has the form, “When I finish work.” The answers also take a form combined with prepositions so the answers could look like, “At 5:00,” “On Tuesday,” or, “In a minute.” Thus, the word, “when” is bound up with prepositions (before, after, on, in, at, next, etc.) in relation to standard time markers such as calendar events (days, weeks, months, years, holidays, seasons), or clocked times (minutes, hours, seconds). “When” is also linked to commonly used, non-specific time related concepts, “soon,” “later,” and, “now.”

We need to be mindful of the fact that prepositional terms (before, after, on, in, at, next, etc.) used to mark time are also used to refer to spatial relations. Teaching children to use them when learning to answer one WH question (e.g., when) will not likely translate or ‘generalize’ to use in others (e.g., where). For example, saying, “In a minute.” and, “In the cup.” each require different teaching arrangements if children are to learn their varied applications.

Finally, it is important to point out that the concept, “when” is bound up with rule following. While ‘when rules’ may be based on standard time markers, it is probably more common in everyday linguistic practice that they do not. Rather, rules for some future event are often linked to arbitrary, idiosyncratic events such as, “You start running when the gun sounds.” or, “You can watch your video when Mommy comes home.” Hopefully, pointing out these considerations illustrates that more needs to be considered than teaching children only rote responses if they are to be able to answer, “when” questions.

Considerations for Preparing Children to Answer “Who” Questions

The concept, “who” is a pronoun that is used to stand in for persons or personified objects such as dolls or play animals. When a “who” question is asked, we are asking, “Which person?” Thus, “who” is linked to persons’ names, personal pronouns (I, you, my, your, me, my, mine, we, they, us, his, her, etc.) and to things personified.

We often introduce the concept, “who” by asking children to identify persons in pictures (e.g., “Who is it?”). Once this basic ability is in place, we will combine, “who” questions with other concepts:

  1. Actions (Who is acting?)
  2. Prepositions (Who is under, on, in etc.?)
  3. Possession (Who has ‘x’ ?)
  4. Gender (Who is that boy?)
  5. Role (Who is that teacher?)
  6. Attribute (Who is that tall person?)

The difficulty in responding to, “who” questions increases significantly as the requirement to answer them involves using other subject pronouns (e.g., I, you, he, she, we, they) or objective pronouns (e.g., me, him, her, us, them).

Considerations for Preparing Children to Answer “What” Questions

When we ask, “what,” we expect answers that point to things, actions, events/experiences. Early in intervention, children learn to answer, “what” questions related to colors, shapes, functions, actions, size, naming objects, etc. (Frazier, 2018, Leaf & McEachin,1999: Lund & Schnee, 2018; Taylor & McDonough,1996). Learning to respond to, “what” questions as addressed in introductory manuals also includes learning to answer rudimentary ‘what-action’ questions such as, “What are you doing?” or “What did you do?” This offers a good start, but more than naming current or past actions is required when considering ‘what-action’ questions. For example, when teaching progressive actions, children’s answers are based on the intended outcome (Lund & Schnee, 2018). So, if children are building a tower with colored blocks, the response to the question, “What are you doing?” is not, “Putting the red square on top of the green cylinder.” but “Building a tower.” Therefore, teaching children to state their intentions related to future activities also needs to be considered.

There will be times when it is important to teach children to memorize responses to factually based WH questions, as long as there are good reasons for doing so. Very often, memorized responses will be needed for the construction of other abilities. For example, being able to answer questions like, “What color is an apple?” and “What are the parts of a car?” will later be needed for teaching children to make comparisons (similarities and differences). Beyond this, children will need to learn to answer non-factual, “what” questions for which memorized answers are not possible. Such questions include queries about emotional, sensory or perceptual experiences, as well as questions involving psychological predicates, “thinking,” “believing,” “wishing,” etc.

Solidifying Rules for Answering WH Questions

Once basic abilities are in place concerning WH terms, a next step is vital and requires that we systematically intersperse WH terms. When doing so, children will have to pay close attention, as there are more moving parts, more possible moves since several ‘games’ are rotated in and out of play, in quick succession. Interspersing terms should help solidify the rules for responding to these terms (when/time, where/place, what/ things-actions, who/persons, why/reasons), at least at a rudimentary level. Below is a example, modified from Lund and Schnee, (2018, p.107) which intersperses, “who” in the context of, “where” and, “what.”

In this exercise, two-to-three (or more) persons are situated around a room or are seated in a circle. Familiar objects are placed around the room and questions are randomized. For example:(a) “What is over there?”

(b) “Where is the [object]?”

(c) “Where is [person]?” followed by, “What does (person) have?”

(d) “Who has the [object]?” followed by, “Where is she?”

(e) Add the question: “Where is the [object]?” when someone is holding the object. The child should answer, “[person] has [it]” rather than, “over there.” Randomize questions about objects in someone’s possession (“[person] has it”) and not in someone’s possession (“over there”).

Introducing Use Of WH Terms

When children learn to appropriately use and respond to WH terms, we can say with greater confidence that children possess the concepts, “where,” “why,” “when,” “who” and “what”. Introductory exercises for learning to ask some WH questions can be found in Leaf and McEachin,1999; Lund and Schnee, 2018; Taylor and McDonough,1996. To enhance learning beyond what is found in introductory manuals, we take advantage of ‘everyday occurrences’ and manipulate their frequencies in order to increase practice opportunities. For example, we can, as we begin to leave a room, grab our coats or briefcases and make statements that invite a question by saying something like, “See ya later.” or, “I’m going out.” Such statements pull for the question, “Where are you going?” An example of how we begin to get asking, “when” off the ground, might involve telling a child that they will have access to an activity in the near future by saying something like, “We’re going to the park later.” Such statements naturally pull for a, ‘when’ question. A variety of strategies can be then employed to help children situate the upcoming event in relation to a current activity. If we simply pay attention to situations that call for the use of these terms and find ways to systematically arrange for their occurrences at greater frequencies, children will have corresponding opportunities to learn to ask appropriate questions given those situations. In these ways, we can do much to help children learn to use these terms appropriately and to strengthen their overall abilities concerning them.

A Final Note

I hope I was able to shed light on some of what is involved in preparing children to be able to answer WH questions. I further hope that I was able to illustrate why it is important to move beyond the practice of only teaching children to memorize responses to WH questions and why doing so may help children learn to answer them masterfully. While there are times it is useful to teach children to memorize responses (for constructional considerations), the general practice of teaching children to memorize responses does not inform what we, as teachers, need to consider as we begin to support children in developing abilities related to answering or asking WH questions. Teaching children to memorize responses to different WH questions ignores considerations involving compatibilities and combinatorial possibilities between terms and the complicated engineering required to link them in use. It ignores the different uses of some of the terms. It ignores the need to ensure that prerequisite abilities are reliably demonstrated and ready for uploading into the many possible situations, circumstances or transactions in which they may be put to use. Ultimately, it ignores the considerations that will prepare children to participate in the practices, activities, actions and reactions in characteristic contexts in which the rule-governed use of these words is integrated (Hacker, 1999). There is much to consider (not all of which could possibly be accounted for here) as intervention is developed toward progressive mastery of these terms within a normative structure.

References

Frazier, T. J. (2018). ABBLLS-R skill acquisition program manual set. DRL Books.

Hacker, P. M. S. (1999). Wittgenstein (the great philosophers series). Rutledge.

Leaf, R. B., & McEachin, J. (1999). A work in progress: Behavior management strategies and curriculum for intensive behavioral treatment of autism. DRL Books.

Lund, S. K. (2015). Untitled. Unpublished manuscript.

Lund, S. K., & Schnee, A. (2018). Early intervention for children with ASD: Considerations. Infinity.

Taylor B. A., & McDonough, K. A. (1996). Selecting teaching programs. In C. Maurice, G. Green, & S. C. Luce (Eds.), Behavioral intervention for young children with autism: A manual for parents and professionals. (pp. 63–177). Pro Ed.

Citation for this article

Schnee, A. (2020). Clinical corner: What goes into teaching WH questions?, Science in Autism Treatment, 17(5).

About The Author 

Alan Schnee, Ph.D., BCBA-D consults domestically and internationally to families, agencies and schools that are committed to providing Early Intensive Behavior Intervention. He has been involved in autism intervention for almost 30 years. He is the founder of Nexus Language Builders, a center-based, full-day, intensive learning program for school age children, formally in Verona, NJ. Dr. Schnee is the co-author of the book, Early Intervention for Children with ASD: Considerations and he continues to lecture and write on topics related to the intricacies of teaching language and the conceptual foundations of language. He has also written on topics concerning the enhancement of memory, attention, executive function, social awareness and social acuity in children with ASD. Dr. Schnee earned a Ph.D. in clinical psychology from Georgia State University and has been board certified as a behavior analyst, doctoral level since 2010. He is based in New Jersey.

Posted in ABA

Focus on the Treatment Team: Physical Therapy

This month’s ASAT feature comes to us from Kate McKenna, MEd, MSEd, MS, BCBA, Association for Science in Autism Treatment, and Brittany Hardie, PT, DPT, Melmark. 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

As detailed in Moffat (2003), physical therapy has a long history in the United States and the profession has evolved over time in response to multiple major historical and medical events. The involvement of physical therapists in responding to polio epidemics that erupted sporadically from the 1800’s to the 1950’s, when the development of the Salk polio vaccine led to control of the disease, resulted in a gradual expansion of the field and innovations in the use of physical therapy to treat severe mobility deficits. Bed rest with long-term splinting and casts which immobilized limbs and the spine was an early accepted treatment for polio. This treatment led to muscle atrophy which then required physical therapy in an attempt to regain mobility. Later interventions for polio included exercise, massages, heat and light therapy, hydrotherapy, and the use of assistive and adaptive equipment. Physical therapists were at the forefront of responding to those who survived polio and needed support to cope with the effects of the disease.

The two World Wars also heavily impacted development and innovations in physical therapy. During World War I, physical therapists, known also as reconstruction aides, worked with doctors, providing exercise programs, hydrotherapy, and massage therapy to wounded soldiers. The number of amputations in World War II led to the funding of the Artificial Limb Program, a 25-year effort to enhance prosthetic services and to support veterans in their use. As with treating polio survivors, physical therapists were instrumental in staffing the programs that developed new technology and intervention strategies for amputees.

Professional associations for physical therapists were first founded in the 1920’s with the American College of Physical Therapy (ACPT), which was later known as the American Congress of Physical Therapy. The American Women’s Physical Therapeutic Association (AWPTA) held its first meeting in 1921 to establish professional and scientific standards for physical therapists, who at that time were predominantly women. The name of this organization was changed to the American Physiotherapy Association (APA) in 1922. The goals of the APA included establishing standards for education and scientific research, promoting the practice of physical therapy, providing a central registry of trained therapists, and providing current information on physical therapy to members of the medical profession and the public. By the late 1930’s, physical therapy was considered a medical specialty. In 1946, the APA changed its name to the American Physical Therapy Association. Also in 1946, the Hill Burton Act was passed. The bill established an effort to build a nation-wide system of hospitals across the United States. Six thousand nine hundred hospitals were built by 1975. As medical specialists, physical therapists continued to work alongside doctors, nurses, and hospital staff to provide critical care in the area of movement rehabilitation.

When the Education of All Handicapped Children Act, now known as the Individuals with Disabilities Education Act, was passed in 1975, physical therapy became a related service offered to students in educational systems. Today, physical therapy is a commonly mandated related service provided to students with autism and other developmental disabilities.

Education

Graduate-level coursework for physical therapists (PTs) includes courses in anatomy, physiology, kinesiology, neuroscience, pharmacology, ethics/values, behavioral sciences, biomechanics, and clinical reasoning. All certified and licensed PTs hold a clinical Doctor of Physical Therapy (DPT) if they enter the field after 2016. This involves obtaining a bachelor’s degree in a related field, such as health science or biology, and then continuing with a 3-year DPT program at an accredited college or university. Prospective PTs then must pass the National Physical Therapy Exam (NPTE®) for physical therapists, which is based on a comprehensive practice analysis to assess critical knowledge, skills, and abilities of physical therapists. Additionally, PTs are licensed to practice in the state or jurisdiction where they work.

A Physical Therapy Assistant (PTA) practices with an associate’s degree from an accredited physical therapy program, which is a combination of coursework and clinical training. PTAs must also pass the National Physical Therapy Exam (NPTE®) for physical therapist assistants. PTAs practice under the supervision of a DPT and the parameters of that supervision may vary by state. The Continuing Education (CE) requirements needed to maintain both levels of licensure also vary by state.

Guiding Documents

PTs are guided in their practice by the American Physical Therapy Association Code of Ethics for the Physical Therapist which consists of eight principles that speak to protecting the dignity of consumers, acting with integrity, the use of evidence-based practices, committing to ongoing professional development, and engaging in ethical business and organizational practices. PTAs practice under the APTA Standards of Ethical Conduct for the Physical Therapist Assistant, which describes the principles as they apply to PTAs, and outlines the limit of their practice under the supervision of a PT.

All members of APTA have access to Clinical Practice Guidelines which are based on systematic reviews of the research evidence. The Guidelines are also intended to maintain consistency in care decisions. To aid PTs in staying current with trends and the latest refinements in their practice, the APTA website provides links for its members through Article Search with full-text access to research and articles from more than 5,000 clinical and academic publications.

Professional Organizations

The mission of the Federation of State Boards of Physical Therapy (FSBPT) is to “protect the public by providing service and leadership that promote safe and competent physical therapy practice.” The process of establishing the FSBPT began in the early 80’s in an effort to form a professional organization to oversee the continuing development and administration of the National Physical Therapy Exam (NPTE), which at that time was owned by the APTA. In 1987, 22 states committed to joining the newly formed FSBPT and in 1989 the ownership of the NPTE transferred from the APTA to the FSBPT. In addition to the certification exam, the FSBPT works to safeguard consumers by identifying and promoting effective regulation in physical therapy, ensuring safe and competent physical therapy service delivery, and providing educational programs and materials to its members and the public.

The American Physical Therapy Association (APTA) is the professional organization of physical therapists in the United States. Its mission is to build a community that advances the profession of physical therapy to improve the health of society. APTA’s stated vision for the profession of physical therapy is to transform society by optimizing movement to improve the human experience. Currently, APTA offers board-certification in 10 specialty areas of physical therapy:

  • Cardiovascular and Pulmonary
  • Clinical Electrophysiology
  • Geriatrics
  • Neurology
  • Oncology
  • Orthopedics
  • Pediatrics
  • Sports
  • Women’s Health
  • Wound Management.

PTJ: Physical Therapy & Rehabilitation Journal, the official journal of APTA, is an international journal publishing peer-reviewed articles for both clinicians and researchers on topics related to physical therapy and rehabilitation. The Journal of Orthopaedic & Sports Physical Therapy (JOSPT®, Inc.) is the monthly publication of the Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy of the American Physical Therapy Association. The journal publishes content for members of the health care community with the goal of advancing musculoskeletal and sports-related practice globally. The organization has developed partnerships with 32 orthopedic, manual therapy, and sports organizations in 23 countries worldwide. Physical and Occupational Therapy in Pediatrics (POTP) delivers information to physical therapists involved in the developmental and physical rehabilitation of infants, children, and youth who practice in hospitals, rehabilitation centers, schools, and health and human services agencies. The Journal of Physical Therapy Science is the official journal of the Society of Physical Therapy Science. This monthly publication seeks to accelerate the progress of physical therapy research in Asia. The American Journal of Physical Medicine & Rehabilitation is a publication of the Association of Academic Physiatrists (AAP). Physical Medicine and Rehabilitation (PM&R), also known as physiatry, is a subspecialty of medicine related to the diagnosis, treatment, and rehabilitation of people with a disability who are disabled by disease, disorder, or injury due to conditions with the nervous and musculoskeletal systems. Physical and Occupational Therapy in Geriatrics seeks to publish a balance of articles related to research and clinical practice across the healthcare continuum when working with older clients.

Scope of Practice

PTs practice in a variety of settings including schools, hospitals, homes, and community settings. They provide early intervention, short-term remedial, or long-term care related to improving movement and mobility. Additionally, physical therapists practice in mental and behavioral health settings such as rehab centers. Others conduct research to improve the knowledge and treatments used in practice. Physical therapists also serve as advocates for both their profession and the clients they serve by promoting legislation related to insurance reimbursement, workplace safety, and ensuring that those that would benefit from physical therapy have access to it. In their professional practice, PTs are not solely concerned with client welfare. Their scope of practice also includes contributing to public health services and legislation to maintain and improve the health of the general public.

Many individuals with autism experience delays in gross motor development and function. Early delays in sitting upright, crawling, and walking, for example, can result in a cascade effect in which children lose opportunities to learn by interacting with and exploring their environment. Deficits in postural strength, coordination, and stamina hinder one’s ability to engage in such activities as riding a bike, playing kickball, or swimming. Physical therapists, sometimes working in the area of adaptive physical education, may target functional mobility, body and safety awareness, the ease of transitioning from one activity to another, and increased motor imitation skills. Across the lifespan, individuals on the spectrum may need to learn to step off and, on a curb, enter and exit public transportation, or use an escalator. Physical therapists work with people on the spectrum to build the motor planning skills, strength, and stamina required to access their environment, navigate stairs, move through hallways, sidewalks, and outdoor spaces safely and with as much independence as possible.

Physical therapists diagnose and treat dysfunction and difficulties with movement. In their practice, PTs seek to restore and maintain the optimal physical function and well-being of their clients. Their intensive training provides them a distinct body of knowledge of how the body functions in motion that PTs use to support their clients’ purposeful, precise, and efficient movement across the life span.

References

Becoming a PTA. American Physical Therapy Association. https://www.apta.org/your-career/careers-in-physical-therapy/becoming-a-pta

Brody, L. T., & Hall, C. M. (2005). Therapeutic exercise: Moving toward function, 2nd Edition. Lippincott Williams and Wilkins.

Direct access in practice. American Physical Therapy Association.
https://www.apta.org/your-practice/practice-models-and-settings/direct-access

Directory of physical therapy programs. (n.d.). Commission on Accreditation in Physical Therapy Education. https://www.capteonline.org/

Learn physical therapy basics. (n.d.). The Federation of State Boards of Physical Therapy. https://www.fsbpt.org/Secondary-Pages/The-Public/Learn-Physical-Therapy-Basics

Moffat, M. (2003). The history of physical therapy practice in the United States. Journal of Physical Therapy Education 17(3), 15-25. The History of Physical Therapy Practice in the United States: Journal of Physical Therapy Education (lww.com)

Physical therapist’s scope of practice. (2017, September 13). American Physical Therapy Association. https://www.apta.org/your-practice/scope-of-practice

Specialist certification. American Physical Therapy Association.https://www.apta.org/your-career/career-advancement/specialist-certification

Standards of practice for physical therapy. (2020, August 12). American Physical Therapy Association. Standards of Practice for Physical Therapy | APTA

Citation for this article:

McKenna, K., & Hardie, B. (2023). Focus on the treatment team: Physical therapy. Science in Autism Treatment, 20(10).

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
  4. Focus on the Treatment Team: Applied Behavior Analysis

About the Authors

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.

Brittany Hardie PT, DPT, is a physical therapist at Melmark, PA and serves on team for individuals with autism from ages 5 to 22 years. She received her Bachelor’s degree in Health Science from Eastern Nazarene College and a Doctor of Physical Therapy from the University Of Maryland School Of Medicine, Baltimore.  Dr. Hardie is licensed in Pennsylvania and New Jersey and has been practicing for 9 years.  She is also a certified clinical instructor.  Dr. Hardie strives to achieve the best outcomes related to mobility and movement for the individuals she serves and enjoys the abundant opportunities to collaborate with colleagues from other disciplines afford by her current position.

Posted in ABA

A Spotlight On Executive Function in the Early Childhood Classroom

By: Stephanny Freeman, PhD and Kristen Hayashida, MEd, BCBA

The new year brings opportunities for introducing new ideas and refining existing techniques for young learners. This week, we’re revisiting a blog from our archives that focuses on executive function.

When kindergarten teachers are asked what skills they would like their students to have the beginning of the year, their answers might be surprising!  Parents and caregivers are often concerned with making sure their children can say their ABC’s, count to 10, and know their colors. Some may believe that their children should be reading by the time they start kindergarten.  However, kindergarten teachers often have a different set of priorities, and instead are looking for skills such as:

  • The ability to listen to and follow directions
  • Follow classroom routines
  • Control impulses
  • Resolve a conflict or solve a problem calmly with another child

Kindergarten teachers value these skills because they are critical for school readiness, paving the way for children to be academically and socially successful.  Moreover, children who are behind in these skills can require disproportionate amounts of teachers’ attention, derail classroom activities and routines, and interfere with other children’s learning.

Underlying these school readiness skills are a set of higher order thinking skills collectively referred to as Executive Functions (EFs). EFs are the cognitive control functions that help us inhibit our initial impulses and think before acting.

But while most teachers agree that EF skills are very important, they are not explicitly taught in most early education settings (or at any point in most children’s educational experiences).

What skills are part of executive functioning?

Three key skills are generally agreed upon as the core of EF:

  1. Working memory: holding information in mind to manipulate, work with, or act on at a later time.
  2. Inhibitory control: the ability to regulate one’s attention, behavior, thinking, and emotion particularly in response to distractions or temptations.
  3. Cognitive flexibility: the capacity to shift one’s thinking, such as changing one’s approach to solving a problem if the previous approach is not working or recognizing and responding when the demands of that task have changed.

Seven additional skills are also considered to fall under the umbrella of EF, often relying and building on the three foundational EF skills:

  1. Initiation: the ability to begin a task or activity or to generate ideas independently in order to answer questions, solve problems, or respond to environmental demands.
  2. Fluency: how fluidly one can access and use relevant knowledge or skills.
  3. Planning: the ability to identify and sequence all the different steps needed to achieve a specific goal.
  4. Organization: the capacity to prioritize and make decisions about which tasks to undertake, and the needed resources to complete those tasks.
  5. Problem solving: carrying out the steps to achieve a desired goal, while monitoring progress making necessary adjustments.
  6. Time awareness: part of the broader skill of Time Management, which includes to the ability to anticipate how long tasks might take, to be aware of time constraints, track one’s progress, and adjust one’s behavior in order to complete tasks efficiently.
  7. Emotion regulation: skills including identifying one’s own emotion states and responding appropriately to emotional experiences.

Why do executive function skills matter?

Executive function skills predict a host of short-term and long-term outcomes!

  • They are a stronger predictor of school readiness than IQ.
  • They are also associated with higher achievement in both reading and math throughout children’s schooling.
  • EF skills, when tested in early childhood predict outcomes later in childhood and adolescence, including psychological and physical health.

Because EF skills are so predictive of later outcomes, they are being increasingly recognized as a critically important focus of intervention. 

Early EF training is … an excellent candidate for leveling the playing field and reducing the achievement gap between more- and less-advantaged children.

Diamond and Lee (2011, p. 6)

Can executive function skills improve?

Yes! All young children (typically developing and those with difficulties) can benefit greatly from instruction in EF!  Frequent practice of these skills and gradually raising the difficulty benefits children most in generalization and increasing gains. Practitioners and parents should consider:

  • Providing focused instruction in EF skills.
  • Combining explicit targeted instruction in EF skills with other activities in which they can then apply and practice those skills.
  • Building targeted EF skills into daily routines.
  • Providing multiple opportunities every day, particularly for children with disabilities, to test out and practice EF skills.

Most experts consider the development of self-regulation skills, of which executive functions are the crown jewel, to be the most important objective of high quality preschool—to help children focus attention, be emotionally expressive, not be impulsive, and to engage in purposeful and meaningful interactions with caregivers and other children.

Blair (2017, p.4)

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.

Getting Pronouns off the Ground

By Alan Schnee, Ph.D, BCBA-D.

Roughly 34% of the 50 most common words used in English are pronouns. Yet, with few exceptions, children on the spectrum struggle to use them.

Why is it so difficult for children to learn? One likely reason is that the use of pronouns is contextually determined. Learning to use them requires vigilant tracking across shifting speakers and listeners (you, I, they, he, she, Ralph, etc.), and shifting events. It is a complex process requiring acute attention to who is in possession of what, changes in possession, attention to who did or said what,  and who did or said what to whom, etc. If our goal is to assist in teaching children to use and respond appropriately to pronouns, where should we begin?

First, we need to clear up some confusion Pronouns are words that stand in for nouns. Though it is commonly said that we ‘tact pronouns’, saying this lacks sense. Pronouns are not objects or events or properties of an object or event. They are simply words. They exist in language and are used within a normative linguistic practice. There are no pronouns in the world and thus it makes no sense to say we “tact” them.

When it comes to learning pronouns, children need to learn the complicated things we do when we use them; under which circumstances we use which one(s) and the ‘linguistic acrobatics’ required for fluent use. So, for example, when a child is told to, “Go tell Mommy that you need her keys, they need to be able to formulate the response,  “Mommy, I want your keys.”

Teaching pronouns needs to be taken slowly and requires considerable practice (repetition). It requires getting rudiments in place before tackling more complex arrangements and objectives.

Early pronoun exercises quickly become far more complex as ‘transformations’ are required. For example, a standard “My/Your program”, (teacher says, “Touch my nose or touch your nose”) requires learning a straightforward discrimination. However, once a follow-up question such as “Whose nose is this?”, is presented, things become very difficult for children since they need to switch their response such that what was just “my” becomes “your” and visa versa. Instruction in the use of pronouns requires meticulous execution of discrete trials. Additionally, echoic prompting is contra-indicated. Children will need to learn to respond to a “say” instruction. The exercise below, taken from Lund and Schnee (2018) illustrates just how complicated teaching use of pronouns can be.

Nominal Pronouns (4): Shifting speakers

(This sample exercise follows more basic ‘pronoun’ exercises.)

Purpose

To teach the child to use nominative pronouns “I” and “You”, combined with proper names

Set Up

Three or more persons required

Have the child hold an object (e.g. cup)  and you and an assistant each hold different objects. You and the assistant   rotate asking.

Procedure

Step one: You and assistant rotate asking, “Who has the  “X” (e.g. cup) vs “Who has “Y” (e.g. ball), “Who has “Z” (e.g. spoon). When you ask questions regarding the assistant, the child refers to her by name.  When you are the spectator and the assistant is asking questions ,the child will refer to you by your proper name and the assistant as “you”.  Of course the child always refers to themselves as “I” and when you are asking, the child refers to “you” as “you”.

Step two: You or assistant ask the child “What do you have” , “What do I have”, “What does (person/proper name have?)”.

Prompt correct responses according to who is in possession of each object, i.e, I have the X or You have Y, ‘Proper name’ (Sally) has Z . This is more difficult than step one because if requires transforming the pronoun. Make sure to change what each of you is holding so that the child will not memorize responses.

Considerations

This exercise is not only matter of answering questions. It entails personal deixis; the right answer depends on who is asking. The primary goal is to teach the child to say “you” when the speaker asks the child what the speaker is holding, to say “I” when the speakers asks about what the child is holding and to use a proper name when the child is asked about what any other person is holding (if that person is not the speaker). This discrimination requires considerable practice.

If the child struggles with these arrangements, segment instruction into smaller ‘switched’ sequences as described in step 3 of Assigning Pronouns to Pictures of Persons 1.


About the Author

Alan Schnee, Ph.D, BCBA-D. offers consultations to families, schools, and other organizations wishing to enhance their programs so that their children derive maximum benefit from services. His unique approach increases learning efficiencies, broadens the scope, depth, and breadth of your program, provides clarity for children and teachers and imparts sensible purpose and directions to teams and parents.

Posted in ABA