EVIDENCE-BASED PRACTICE IN THE TIME OF COVID-19

By Sam Blanco PhD, BCBA, LBA, Mordechai Meisels MS, BCBA, LBA, Bryan J. Blair, PhD, LABA, BCBA-D, and Laura Leonard MS, BCBA, LBA

As providers of services to people with an autism spectrum disorder (ASD), we are experiencing an unprecedented situation given the impact of COVID-19 on nearly all service providers. As schools, organizations, and individual practitioners work to shift their practice to a virtual service delivery model, it is essential that we maintain a commitment to evidence-based practice. When faced with so much uncertainty, it can be a relief to turn to the research base and identify how to implement best practices within this new model. Research on telehealth provided to individuals with autism has grown in recent years and demonstrated that effective treatment is possible (Ferguson, Craig, & Dounavi, 2019; Peterson, Piazza, Luczynski, & Fisher, 2017; Vismara, McCormick, Young, Nadhan, & Monlux, 2013; Ferguson et al, 2019).

The first priority when implementing services via telehealth is to ensure you are using a HIPAA-compliant platform, such as Doxy.me or WhatsApp. When we approach evidence-based practice, we must focus on three primary areas of research: the basic principles of ABA and its practical applications, applications of telehealth, and other uses of technology in teaching. The good news is that there is a lot of research-based information available to guide us as we change to a telehealth model.

Current research on telehealth for individuals with ASD primarily focuses on parent training and supervision. However, in the current crisis, it is necessary that direct care be provided through telehealth. In order to effectively provide direct care, we are suggesting the following steps in order to appropriately implement telehealth services. 

(1) Assess prerequisite skills and unique needs of the client. An assessment and survey is provided at the end of this article (Appendix A). The BCBA should complete this assessment with parents/caregivers in the room with the client. If the results of the assessment demonstrate that the client does not have the prerequisite skills to participate effectively in interventions delivered remotely (i.e., telehealth), then the prerequisite skills will need to be taught and/or a parent/caregiver will be required to be in the room with the client during direct care. It is also possible that with drastic changes in routines and supports, problem behaviors may have increased or topographies of problem behaviors may have changed. If this is the case, the BCBA should also conduct a functional behavior assessment (FBA). An FBA can effectively be conducted through telehealth (Wacker, et al, 2013). 

There are many options for how a telehealth session can be conducted and how a display (e.g., computer screen) can be presented to the client. In assessing prerequisite skills of the client, it may also be beneficial to conduct a preference assessment of the general set up for the client. For example, does the client respond better when the screen only shows the practitioner’s face, or does the client respond better when the screen shows the practitioner’s face and a token system, etc. There are many options for how the screen is presented to the client. 

(2) Conduct parent training to adequately prepare for telehealth. Prior to any direct care provided by a behavior technician, the BCBA should conduct parent training. There are three goals that should be targeted and met here. First, the BCBA and parent should work together to teach prerequisite skills to the client. If prerequisite skills cannot be taught quickly, then a clear plan should be developed and implemented for how the parent/caregiver will assist with prompting and providing reinforcement during sessions with the BT. The next goal is to identify any potential safety issues and provide guidance on implementation of any interventions. Finally, the parents should be taught what to expect from telehealth and provided with a clear plan for giving feedback to the BCBA throughout the process. 

(3) Identify reinforcers and how reinforcement will be provided. A preference assessment should be conducted with the client utilizing any new options presented through the use of technology as well as identifying any barriers resulting from the use of telehealth. For example, a potential new option might be sharing your screen to show clips of a client’s favorite show on YouTube. A potential barrier might be that a highly reinforcing activity might include social mediation and/or interaction with another person that is not possible unless you’re physically in the room or that the client is unwilling to relinquish a reinforcer when the BT is not physically present in the room.

Speak with the parents (and the client if he/she is capable of participating in the conversation) about specific reinforcers to include in the preference assessment. After the preference assessment is conducted, you should create a clear plan for how reinforcement will be provided. 

One potential option here is the use of a token system. The research-base on using token systems with telehealth is primarily focused on teaching parents how to utilize the token system correctly (Hall, 2018; Machalicek, Lequia, Pinkelman, Knowles, Raulston, Davis, & Alresheed, 2016).  If a token system is currently in place, it may be beneficial to continue with the existing system as long as the necessary materials are in the room with the client and either the client can provide his/her own tokens upon being told to do so by the BT or a person in the room can provide the tokens. Another option is to use existing technology to provide tokens. If you elect to use technology, you can remotely split the computer screen to show a token system on one side of the screen, use built-in capabilities of platforms such as Microsoft Teams to switch control of the screen to the client so he/she can give the token upon correct responding, or use built-in capabilities of platforms to share the screen of an existing token system app. If a token system is being used and earning the requisite number of tokens results in an activity within the client’s room (i.e., access to a preferred toy) you must assess the client’s ability to relinquish the reinforcer. A final possibility here is to incorporate access to preferred videos or songs through the shared screen.

If a token system is not being utilized, a clear plan and schedule of reinforcement should be defined. The plan could include delivery of reinforcement in the form of videos, online games, or apps through the telehealth platform by the BT. If reinforcement includes items that are present in the room with the client (such as edibles or favored toys) then an additional person (such as a parent or older sibling) will be required to be present in the room with the client during sessions. 

If the client responds to vocal praise as a reinforcer during in-person sessions, then it should be determined if vocal praise through the screen is also reinforcing for the client. If it is not, a response-stimulus pairing procedure (Dozier, Iwata, Thomason-Sassi, Worsdell, & Wilson, 2012) should be utilized. 

Sessions with the BT should not begin until the previous steps have been completed and the BT has been trained on both the platform for delivering services and the steps for implementing programs and delivering reinforcement.

(4) Train the BT on how to implement discrete trial instruction through telehealth. Discrete trials training can be implemented as it typically is, though technology can be utilized to streamline the process when images, text, or videos are used. Cummings & Saunders (2019) utilized PowerPoint 2016 to create matching-to-sample trials for use in discrete trial instruction. Blair & Shawler (2019) identified best practices and provided a tutorial for developing and implementing emergent responding through computer-based learning tools. In addition, there are apps such as Kahoot or Quizlet Learn that can be utilized. 

It is essential that any technology components that you introduce are clearly understood by the BCBAs and the BTs. Our recommendation is that brief video models be provided (i.e.,video-supported task analyses)  so that the steps of implementation are clear to all practitioners implementing services. After video models have been viewed, the BT should practice implementing the technology with the parent or the BCBA prior to conducting a direct care session.

If it has been determined that the client does not yet have the prerequisite skills for the BT to implement services through telehealth, the parents should be trained on implementing discrete trials. Hay-Hansson & Eldevik (2013) outlined a procedure for using videoconferencing to train discrete-trial instruction teaching. 

(5) Consider how visual schedules and supports may be used. Visual schedules and supports can be presented on the screen, utilized through a separate app (such as Todo Visual Schedule or Choiceworks), or made with pre-existing materials that are in the home. If you elect to use a separate app for the visual schedule, ensure that the BT has mastered the platform for providing instruction before implementing additional technologies. 

(6) Consider how to implement Active Student Responding (ASR). Drevno, Kimball, Possi, Heward, Gardner, & Barbetta (1994) identify a clear procedure for implementing error corrections during ASRs. With the use of technology as described previously (such as Microsoft PowerPoint) error corrections can be made quickly because they can be built directly into the presentation. 

Ultimately, as you review the suggestions, two things become very clear. First, we must consider the training needs of the client to effectively participate in treatment through telehealth. Second, we must consider the training needs of the practitioners who will be implementing treatment to ensure they can effectively put these practices in place. More than ever, we must assist each other in providing resources: sharing video tutorials for how to implement specific technologies, identifying technologies that will allow us to better implement services, and identifying platforms that reduce response effort and training needs for BCBAs and BTs. 

Download Appendix A: Telehealth Clinical Effectiveness Survey here.


Mordechai Meisels is the Founder and Chief Clinical Officer of Encore Support Services, a leading provider in special education and ABA therapy services.  Under his leadership, Encore quickly expanded across state lines, servicing thousands of children in the Tri-State area. Mordechai’s vast expertise in the behavioral health industry inspired him to fill a critical void with the founding of Hadran Academy, a high school for high functioning autistic youth. In true visionary form, Mordechai combined his background as an expert clinician and passion for technology with the creation of Chorus Software Solutions. As the Founder and CEO of Chorus, Mordechai is committed to creating innovative technology to empower care teams, increase operational efficiency, and ultimately impacting quality of care.  

Dr. Bryan J. Blair is a licensed behavior analyst (MA), Board Certified Behavior Analyst, and is currently an Assistant Professor at Long Island University – Brooklyn where he is also the coordinator of the Applied Behavior Analysis graduate certificate and supervised fieldwork programs.  He has worked with children and adults with developmental disabilities and other clinical disorders for over 15 years in a variety of settings.  For more information or to contact Dr. Blair please see his website:  https://www.bryanjblair.com.

Laura Leonard MS BCBA LBA is the owner and clinical director of ABA TREE, a behavioral health agency in NYC, former ABA director of an early intervention program and current Director of Behavioral Services at a private school in Brooklyn. Laura provides supervision to BACB candidates and is primarily focused on reduction of maladaptive behaviors. www.abatree.org

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

Posted in ABA

Getting Through The Day During School Shut Downs

It’s difficult to know what advice to give when schools are shutting down and parents are faced with an unknown period of time without services. Here are a few ideas for how to approach each day with your child with autism. Our goal is not only to ease this transition (for your child and your entire family) but also to prepare for the upcoming transition when school resumes. 

One note before we jump into suggestions: you should view these suggestions as just that – possible tips to help improve your day. Some of them may not be a great fit for your child or your family; others may spur additional ideas. These should not be viewed as additional requirements or be something that increases your stress.

  • First and foremost, try to maintain the small routines as much as possible. For example, have your child still get up and get dressed, instead of making it a pajama day every day. 
  • Provide structure. A simple thing you can do for both yourself and your child is to create a schedule for each day. Included in this schedule can be basic routines (get up and eat breakfast,) and new ones (complete work in workbook, do a puzzle,) as well as fun things (choose a movie to watch, dance to music) A visual or written schedule will help everyone with structure during the day.  Don’t forget to add in hand washing regularly as this is the best prevention for spreading the virus.  
  • Indicate changes on the calendar or schedule.  Most children with autism prefer structure and routine, so setting this up day one will be helpful.  Oftentimes, explaining to your child, in whatever way they best process information, that you will be home for many weeks may help them no longer wonder. Putting “home” on each day of a kitchen calendar, at least through your school district closing date may allow your child to visually see that school taking place for a period of time.
  • Get fresh air.  Whether you take a walk around the block or sit outside and count cars that drive by, being in social isolation does not mean being homebound.  Getting some fresh air, while remaining only with family members can be helpful to everyone.  Depending on your child’s interests, kicking a ball around, using your home swing set, taking a walk or biking can really enhance the day.
  • Give yourself breaks. Whatever schedule you make should include some breaks for yourself as well. This might be allowing your child to watch a youtube for 15 minutes in the middle of the day so you can take a little breather. Scheduling it can be helpful for giving your child structure, but also letting yourself know when you get that break! 
  • Ask your service providers and teachers for any tips. They may have suggestions for how and when to use reinforcers during this time, or ways you can incorporate maintenance of skills throughout the day. These staff may be able to share websites that your child enjoys and uses in school such as Go Noodle, Epic, or other educational sites.
  • Use familiar materials. If possible, access materials used in school that are familiar to your child that may help them stay engaged during times you have other tasks to complete. These might include file folders, task boxes or others. Many items can be printed from websites, such as Teachers Pay Teachers.
  • Use technology to increase social time for both yourself and your kids. Set up virtual “playdates” with cousins, friends, etc. You might also consider taking a look at this list from Common Sense Media for multiplayer apps. These include games that can be played by people in the same room or in different locations. 
  • Get your child involved. The first step to this is giving your child choices throughout the day. You can also provide some new options. Perhaps there are things you’ve been wanting to do, such as teach your child how to make a couple of basic meals, and you can add these in now. You can also ask your child if they have ideas for things they might want to do during this time. 
  • Talk about COVID-19:  You know your child best and if it is appropriate to talk about what coronavirus is or not. If this seems appropriate, the CDC posted some useful information on how to talk to your child about this.  In addition, they created a child friendly video that may help your child understand the virus.
  • Make hand washing fun:  Since you will likely do this more often with your child, try to make it fun!  Sing their favorite song while rubbing hands, use soaps that foam or have desired scents, and if appropriate, even play with soap in the kitchen sink, making bubbles or washing preferred toys.  Playing with bubbles will increase handwashing post the activity too!

Finally, the Autism Research Institute is hosting some webinars for parents in how to deal with issues related to changes in schedules and routines due to Coronavirus. You can view their schedule here: https://www.autism.org/webinars-autism/

Our society is facing an unprecedented time and everyone is feeling unsure of what will happen next.  It is important to rely on those who can support you, even if it is virtual.  It sounds cliché, but relying on others to support us in these unknown times can really make a difference.  

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Written By Sam Blanco, Phd, LBA, BCBA and Cheryl Davis, PhD, LABA, BCBA-D

Sam 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

Cheryl has been in the field of Applied Behavior Analysis for over 25 years, working with clients with Autism Spectrum Disorders, developmental delays, and social emotional learners.  She consults to parents, public and private schools, as well as supervises BCBA/BCaBA candidates.  Cheryl believes in using progressive ABA techniques in her educational, behavioral and social programming for clients. She is an assistant professor in the ABA program at The Sage Colleges, owner of 7 Dimensions Consulting and co-owner of SupervisorABA.

Posted in ABA

Visual Schedule to Improve Independent Play Skills in Children with Autism

Parents, caregivers, therapists and teachers alike work so hard to teach a variety of play skills but what happens when your child or student doesn’t make that leap from facilitated play to independent play? Independent play is such an important skill that will allow him or her to better connect with their peers, build friendships, expand problem-solving skills and structure downtime. A successful transition from demonstrating play skills with adult support to playing independently can be impacted by a myriad of variables.

Some of my students struggle with independent play because it is difficult to move from a thick schedule of reinforcement of 1:1 adult attention to a thinner one of just having an adult “check in” once in a while. Other learners have impairments impacting executive function, specifically the organization and sequencing of steps for meaningful and reinforcing play as well as on-task behavior, task completion and working memory. Additionally, in some cases the skill of independent play is elusive because teachers struggle to find ways to fade out prompts or to successfully thin out the schedule of reinforcement.

Below is the visual schedule with data sheets for measuring acquisition and progress that I have created. I have found it useful with learners with very different skill sets and abilities. Click here for a comprehensive Task Analysis on teaching independent play using a visual schedule.

Keep in mind that this is for learners that:

  • Have successfully acquired a varied repertoire of play skills
  • Do not require visual schedules that break down every step of the play
  • Are able to complete activities with delayed reinforcement

In order to prepare this for use with the learner:

  • Set up a toy organizational system that has toys bins
  • Print the materials and laminate the schedule strip and the cut out shapes.
  • Attach Velcro dots to the bins, schedule strip and shapes and to the work surface if you like
  • Identify activities that are suitable for this schedule

Remember that any open-ended activities like building blocks or coloring can be turned into close-ended activities by limiting the number of pieces or by teaching the learner to use a timer.

As you would when teaching any schedule, use a most-to-least prompting strategy, only use verbal instruction for the initial direction or S(e.g. “Go play.”), and prompt only from behind and out of view.

The schedule I have been using has a smiley face at the end of the schedule indicating a “free choice” time which all of my students understand. However, if you are using this with a learner that requires a visual reminder of what they are working for, you could easily adapt this by putting a picture of the reward in the place of the smiley face. Time to play!

*Don’t forget to download your free visual schedule and data sheets here!

Posted in ABA

Suggestions for Ethically Fading Out ABA Services

While ABA is generally a long term commitment that a client and his or her caregiver makes, oftentimes before the child reached his or her third birthday, it is still important to have a fade-out policy in place in for when the client reaches their treatment goals or the provider is no longer able to provide services. Unlike many professions, behavior analysts want our clients to reach a point where they no longer need our services! Here are some tips for developing an effective fade out policy that is supportive of your client’s transition out of services.

1. Clearly outline eligibility, timeline and fade out procedure

The fade-out policy should explicitly state the conditions that qualify a client for fade out of services (e.g. client is no longer benefitting, client no longer requires the services, client requests discontinuation, client violates terms of client-services agreement, etc.). In addition, a fade-out should provide the family with a transition plan detailing when caregivers will be notified of anticipated discharge date, rate of fade out (e.g. Decreasing frequency of sessions from once per week to once every two weeks) and resources provided for addressing remaining areas of deficit. Having a clear plan takes the guesswork out of the process of transitioning out of services for both clinicians and caregivers.

2. Communicate your fade-out policy to caregivers at the onset of treatment

Include your fade-out policy as part of the initial intake process. This informs caregiver expectations and prevents them from assuming the myth that formal ABA therapy is going to be part of the rest of their child’s life.

3. Planning ahead for at least 6 months prior to termination of services

Structure treatment plans to account for and support transition out of services to ensure that fade out does not feel sudden or disruptive. Treatment should always maximize opportunities to utilize natural teaching strategies and caregiver training and support. It is recommended that the provider adequately train caregivers to support generalization of mastered programs as well as provide training so they have the necessary skills to know how to prompt, reinforce, and adjust the environment when necessary. In addition, work with any new provider who will be supporting the client to ensure a smooth transition and continuity of services.

4. Support client independence and teach functional skills

The long-term goal of ABA therapy is to help clients learn functional skills that can help them integrate into an inclusive environment. Thus, treatment plans should address functional skills first in order to ensure that the client can achieve maximum independence if services are no longer available.

5. Develop a network of professionals and community partners to assist in transition of care beyond scope of practice

Collaborate with ABA-friendly providers to provide resources for clients after they transition out of formal ABA services to maximize skill maintenance and continuity of care. Some BHCOEs partner with adult transitional programs that assist in job-placement into sites that utilize ABA-strategies to ensure success.

6. Include an aftercare plan with follow-up consultations when possible

Schedule follow-up consultations with caregivers after transition out of services to troubleshoot issues that may have arisen.


This piece was written by the Behavioral Health Center of Excellence and has been shared with their permission. For more information, please visit www.bhcoe.org.

Posted in ABA

Considerations for Parents on Grounding Kids

Many parents choose to “ground” their kids when they make poor decisions. Maybe they lose access to video games for a week, or can’t watch TV for a month. Grounding in and of itself is not necessarily a bad thing. Here are a few considerations:

  • If you keep grounding your kid for the same behavior, then grounding is not changing the behavior. Sometimes grounding your child is a default response, but if it’s not working, you might want to consider some other options. You can take a look back at our series on differential reinforcement or our post on noncontingent reinforcement.
  • When possible, the consequence should be connected to the behavior. If your child throws a controller, then not having access to video games makes great sense. However, if video games are taken away for any infraction, it may not be the most logical punishment and over time, it may even backfire. If the child is losing video games for everything, then he/she might stop trying to earn video games at all.
  • Longer durations of grounding may make you miss out on opportunities for reinforcing appropriate behaviors. Remember that reinforcement is simply any consequence that increases the future likelihood of the behavior. If you have set a rule that your child is grounded from using video games for one year, then you are missing many, many opportunities to teach the appropriate behavior. The same can be said for one month or even for one week. Especially when considering children with autism, they may require multiple trials of the appropriate behavior before you see an increase in the appropriate behavior. In that case, grounding may just not be the best option.
  • Longer durations of grounding may backfire if you experience fatigue. Often our kids are experts at asking the same question repeatedly until you finally give in. The last thing you want to do is set a standard that when you say your child is grounded for a week, they are really only grounded until they wear you down.
  • Consider a different tactic. This isn’t possible for all behaviors, but if you are seeking a specific appropriate behavior, set a standard that if a certain duration or a certain number of appropriate behaviors results in more access to preferred items and activities. This is sort of the inversion of grounding and may be more successful.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

Posted in ABA

Common Mistakes In Implementing Reinforcement

Over the years, I’ve seen several behavior intervention plans written and implemented. Typically, these plans include reinforcement for the desirable behavior, but I see the same mistakes crop up again and again. Here are a few common mistakes in implementing reinforcement to look out for:

Fail to identify individual reinforcers. Hands down, the most common error I see is identifying specific activities or items as reinforcing. For instance, many people love gummy bears, but they make me want to puke. Presenting me with a gummy bear would not increase my future likelihood of engaging in the appropriate behavior! You must account for individual differences and conduct a preference assessment of your learner, then make a plan based on his or her preferences.

Fade reinforcement too quickly. Let’s say you’re working with a child named Harold who draws on the walls with crayon. You implement a reinforcement plan in which he earns praise and attention from his parent each time he draws on paper. The first few days it’s implemented, Harold’s rate of drawing on the wall greatly decreases. Everyone claims that his behavior is “fixed” and suddenly the plan for reinforcement is removed… and Harold begins drawing on the wall once more. I see this sort of pattern frequently (and have even caught myself doing it from time to time). After all, it can be easy to forget to reinforce positive behavior. To address this issue, make a clear plan for fading reinforcement, and use tools such as the MotivAider to help remind you to provide reinforcement for appropriate behavior.

Inconsistent with reinforcement plan. Harriet is writing consistently in a notebook, to the detriment of her interactions with peers. Her teachers implement a DRO, deciding to provide reinforcement for behavior other than the writing. However, the teachers didn’t notify all the adults working with her of the new plan, so Harriet’s behavior persists in certain environments, such as at recess, allowing her to miss multiple opportunities for more appropriate social interaction. To address this issue, make a clear outline of the environments in which the behavior is occurring and what adults are working in those environments. Ensure that all of the adults on that list are fully aware of the plan and kept abreast of any changes.

Don’t reinforce quickly enough. This one can be quite challenging, depending on the behavior and the environment. Let’s saying you’re working with a boy named Huck who curses often. You and your team devise a plan to reinforce appropriate language. You decide to offer him tokens that add up to free time at the end of the school day. However, sometimes as you are handing him a token for appropriate language, he curses again right before the token lands in his hand. Though it was unintentional, the cursing was actually reinforced here. Remember that reinforcement should be delivered as close to the desired behavior as possible. To address this issue, consider your environment and materials and make a plan to increase the speed of delivery.

Fail to make a plan to transfer to natural reinforcers. Ultimately, you don’t want any of these behaviors to change based solely on contrived reinforcement. Making a plan for reinforcement of appropriate behavior is essential, but your ultimate goal is to have the behavior be maintained by naturally occurring reinforcement. To address this issue, the first thing you need to do is identify what that naturally occurring reinforcement might be. For Harold, it might be having his artwork put up in a special place or sharing it with a show and tell. For Harriet it might be the interactions she has with peers on the playground. Once you have identified those reinforcers, you can create a plan for ensuring that the learner contacts those reinforcers over time. This might include pairing the naturally occurring reinforcers with the contrived reinforcers, then fading out the latter.

Ultimately, it’s important to remember that reinforcement is not as simple as it seems. Taking the time to plan on the front end will help with long-term outcomes.


WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

Posted in ABA

“I hear that BCBAs don’t believe in sensory issues. What gives?”

This month’s ASAT feature comes to us from Carl Sundberg, PhD, BCBA-D
Behavior Analysis Center for Autism and David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

Some people believe behavior analysts are “anti-sensory” — opposed to offering any sensory-based experience for individuals with autism spectrum disorder (ASD).  The term “sensory” can be problematic and ambiguous because it does not specify whether an individual is showing a sensory preference or sensory aversion, nor whether the sensory experience is a “like” or a “need.” It may also minimize or disregard other explanations for why a behavior is occurring. These distinctions are significant when developing a treatment plan. In this brief article, we clarify how behavior analysts approach sensory issues.

Not every behavior problem should be assumed to have a sensory basis.

It would be beneficial to discuss the many faces of motivation. Each of us, not just children with autism, may be highly motivated by sensory experiences that vary in modality, intensity, and duration. Ever catch yourself tapping your pencil, twiddling your thumbs, biting your nails, or popping bubble wrap. If so, would you say you have “sensory issues”?  We are all highly motivated by other experiences as well such as attention, a smile, a knowing look, or laughter. Other times, it is something tangible and specific, such as a new pair of sneakers or a piece of artwork. We all engage in a wide array of behaviors to access these experiences. On the flip side, sometimes we are motivated to avoid or escape certain forms of attention (e.g., closing our office door or ignoring telemarketer calls) or other specific things (e.g., a traffic ticket or non-preferred vegetables).  Why is this important?

First, assessment of challenging behavior must carefully assess the function for that behavior (i.e., underlying motivation) in order for it to have the greatest likelihood of leading to effective intervention. We intentionally referenced the same behavior (biting) in a few different examples to help make the distinction between form (e.g., biting) and function (e.g., to escape a demand of gain sensory input).

  • Tommy bites his teacher when she attempts to help him put on his snow boots.
  • Lisa bites her father as soon as he stops playing with her and attempts to leave the room to take a phone call.
  • Sudhir bites his babysitter when she asks him to put away his iPad.
  • Melanie bites classmates when the fire alarm sounds or her older sister plays music loudly.
  • Jennica bites her father’s arm when he wears long sleeve dress shirts.
  • Mitchell’s teeth are coming in and he has been seen biting a plastic hanger.

As you can see, the same behavior (biting) occurs in very different contexts and likely serves very different functions. In some instances, the motivation may be to get or keep a preferred item or activity, whereas in other instances, the child is trying to avoid or escape something he or she does not like. A “sensory” explanation based on the fact that they are biting would miss the mark in most of the examples illustrated above. If we mislabel certain behaviors as “sensory,” the recommended sensory intervention will not address the targeted behavior properly and may prevent access to more effective intervention.

Not every sensory-seeking behavior reflects a “need.”

Let’s examine the misuse of the term “sensory need” and differentiate between a sensory need and a sensory preference. Some individuals with autism enjoy swinging, may be willing to work hard to earn it and show pleasure while swinging. Whereas other children may start off agitated and appear calmer following swinging, but it is not necessarily an experience they would choose (children experiencing pain relief from taking aspirin may also benefit from it but not necessarily choose it).

Activities stimulating the senses can serve multiple behavioral functions, depending on the motivation. Jumping on a trampoline is likely to be repeated because of its reinforcing vestibular effects — it is fun. This leads to the question, “Does the student jump on the trampoline because he or she needs to jump on the trampoline, or because it’s enjoyable?” Again, the responses one engages in depend on the learning history, communication skills, social contingencies, and the strength of the motivation.      

“Sensory” concerns have profound implications for the teaching of new skills that can be targeted through behavior analytic strategies.

Any discussion on “sensory issues” would be remiss without some mention of sensory hypersensitivity. We have also observed some individuals with autism who have extreme reactions to sensory input (e.g., loud noises, bright lights) and there are those who are extra sensitive to textures or certain clothing (e.g., the tag in the back of a shirt or particular food). These children/adults learn to engage in behaviors that reduce the aversive nature of such stimulation. But this isn’t exclusive to autism – there are also people without autism who are sensitive to certain stimuli as well.

There are individuals who experience extreme discomfort when exposed to situations which would be considered typical to most of us (e.g., loud music). Some will engage in behaviors that relieve the anxiety, such as escape behaviors (leaving the situation), avoidance behaviors (skipping the situation entirely), or engaging in some incompatible behaviors (practicing relaxation techniques). In these cases, sophisticated skills and strategies are in place.

It is unfortunate that many people with autism do not have the skills to engage in the socially accepted methods that relieve anxiety or discomfort. However, many other non-socially accepted behaviors have been shaped and have proven to be effective in removing the aversive stimulation. If we were in a room where the music is too loud, we would leave or ask for it to be turned down. If those behaviors are not possible, we may have to tolerate the situation. We have learned that behaviors such as biting will result in undesired social consequences. But what if:

  • We did not have the language to ask for the music to be turned down?
  • We did not know that leaving was an option, or did not know how to ask, or were forced to stay?
  • We didn’t value the social consequences as others so? That is, we didn’t currently care how others perceive us or if we get invited back.

If all those were true, we might engage in biting to get the music turned off or get removed from the room once we see that this is an effective behavior.

Now, suppose we do have those skills, and we can always find a way to get out of situations that cause stress or sensory overload; or we tough it out because of the social contingencies that have been learned over our lifetime. Chances are, no one would suggest we had sensory issues and put us on a sensory diet or prescribe sensory integration therapy. However, a person with autism who may have the same level of discomfort and escapes the situation in the only way he or she knows how, is often said to have “sensory issues” when perhaps it would be more helpful to say he or she has skill deficits.

In summary, to develop the most appropriate and effective treatment, one must analyze the function, evaluate whether the behavior has a sensory basis (and whether it reflects a “need” or a “like”) or other underlying motivations. It is then important to identify skills (e.g., requesting) that may either compete with and potentially replace the behavior or provide the individual with coping skills to better negotiate his or her environment.

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Carl Sundberg, PhD, BCBA-D, is the chief clinician and founder of the Behavior Analysis Center for Autism. He received his doctorate degree in ABA from Western Michigan University under the direction of Dr. Jack Michael. While a graduate student, he taught behavior analysis at WMU for seven years. Dr. Sundberg has publications in The Analysis of Verbal Behavior (TAVB), A Collection of Reprints on Verbal Behavior, and the Journal for the Experimental Analysis of Behavior (JEAB). Dr. Sundberg has over 30 years of experience using behavioral interventions to teach individuals with autism and other developmental disabilities. He oversees the training of all the staff at BACA and consistently spends time with the clients. Eighty percent of his time is spent contributing to the training of staff and addressing specific client programs.

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

Posted in ABA

Creating Daily Routines to Eliminate Downtime and Increase Productivity

Imagine telling your students to sit down at the table for math. You finally get 4 students seated, but then you turn your back for two seconds to grab the materials for your lesson, and in the meantime, two kids pop up and run back to their preferred activities. Scenarios like these make me want to pull my hair out…I hate downtime…my students struggle with it, which makes my life as a teacher so much harder. So one way I have found to eliminate as much downtime as possible (besides packing my day full of activities) is to create routines in every part of my day. This way, students know what is expected and can independently get going with an activity even when I have to run and grab some materials, deal with a challenging behavior, etc. It makes my students (and me) more productive! In today’s post, I want to share some helpful tips and activities I have found to reduce downtime in the classroom.

Visual Schedules. One helpful way to do this is to post a visual schedule of your routine. In the beginning, you will need to teach this to your students on a very consistent basis. Over time, they will get into the swing of things and they’ll be ready to get started without you! For my morning group, by the end of the year, I put each kid in charge of a different activity (their names were written on a clothespin and clipped onto the activity) which gave me time to do attendance, get the lunch count, check backpacks, etc. while still monitoring the group as needed.

Binders. Binders can be another helpful way to create routines. Students can grab their binders and begin working on activities in order. If you need students to stop and pause between activities for more instruction, use dividers to split the binder into sections along with a “stop and wait” visual. (Check out this post for more info on my morning work binders or this post for 8 ways to use binders in your classroom).

I often find it is the beginning of the lesson that is the hardest…like I said before, teachers need time to get set up, materials gathered, smart board turned on, etc. In general ed, teachers often have a “do now” or “warm up” activity where their students do a review activity, practice problem, or introduction activity for the lesson that will follow. I find this extremely helpful in my classroom as well. Here are a couple activities I have used to fill the downtime in the beginning of a lesson.

Correcting Sentences. To start my advanced morning group, I had my students start with a daily correcting sentence worksheet. We would review as a group, then move onto other literacy activities (click here to see a blog post detailing what we did in this group).

Fluency Timings. I have utilized a few different versions of fluency timings in my classroom and they can be extremely helpful as a beginning “warm up” activity. [My little soapbox on fluency….fluency is speed + accuracy. Our students can sometimes learn skills, but they are too slow with that skill to make it actually functional. Fluency activities help students practice a skill and increase their speed.] With my beginner students, we use these fluency timings where students label as many pictures/numbers/letters/etc. out loud in one minute. With my advanced students, we did written fluency timings. We had kids assigned to be in charge of these as well (yellow cards were student initials who were in charge). These helped my kiddos increase their ability to generate ideas when given a topic, speed of writing, and made writing into a fun activity. And of course, including some visual directions for the activity increased student independence!

Check-in/out. I helped a teacher create this check-in for students who came into her room when they needed a break from their general ed classroom. To help them not disrupt her other groups and get to their break as quickly/independently as possible, she came up with the idea to have them check-in, select their break activity, set a timer, and check out when they were finished. I have also seen some great social skills groups start and end with a check-in/out worksheet. Here is a sample from do2learn which provides these FREE.

Predictable Worksheets.  I like these worksheets for practicing letters/numbers as they involve minimal writing, but more coloring, tracing, and circling.  Most of my kiddos could complete these with minimal assistance, and with so many worksheets, we could use them throughout the year to begin a group.

File folders, puzzles, or adapted books.  Have a bin of these at the ready to either set at each student’s spot or have them make a choice from the bin as the beginning activity before starting your lesson. I love using my “All About Me” books which each student has to practice targeting personal information.


About The Author

This piece was originally published on Autism Tank.

My name is Hailey and I have been a special education teacher for students with autism for over 10 years.  I taught students in 1-8th grade.  My class size has ranged from 4-13 students over my career and I have had between 1-4 paraprofessionals full time in my classroom. I currently work in a school district as an autism specialist and help teachers in all disability areas to implement evidence-based interventions for their students. I have had several family members with disabilities, which initially made me interested in the special education field.  I took an intro to special education course in college, where I absolutely fell in love.  As a course requirement, we had to volunteer every week in a classroom, and it became the highlight of my week!  

Posted in ABA

How to Take Family Conversations from Painful to Pleasant

A parent writes:  “Dear Behavior BFF, My son likes to talk about the Octonauts (Cartoon). If I hear one more thing about Kwazii the cat, I may stab myself in the ear. Help!”

I think so many parents can make this exact statement, just change out Octonauts for whatever your kid is into right now: Santa, trains, Frozen, the weather, a book, the number four, whatever! But please refrain from injuring your own eardrums. There are positive behavior supports to employ before resorting to anything extreme! 

Let’s get technical for a minute. Have you ever heard of DRL: Differential Reinforcement of Low Rates? If you are an ABA nerd like me, the answer had better be yes. If you are a mom (also like me), the answer is probably now. With DRL, you provide reinforcement for responses that are lower than a criterion you set.

How many times a day does your child talk about (insert preferred and rather annoying subject here)? Let’s say 20. Set a number lower than 20. Your child can talk about that subject 15 times tomorrow to earn positive reinforcement.

You set a number that is acceptable to us and achievable to the child. You can’t go from 20 times a day to 5 times a day. That may be acceptable to you, but will your child ever get to earn that positive reinforcement? Doubtful.

A structured way you can set this up in your family is to create a behavior contract (aka contingency contract). This is a physical document that outlines the exact behavior that must be completed to earn a specified reward. It also includes a place to keep track of that behavior & reward. It needs to be specific.

Write down the exact task to complete. The task in this situation would be talk about ___subject____   no more than __number___ times. 

Specify the reward. If this contract is going to last all day, the reward had better be pretty good — what is the reward, when will it be received, how much of it — be precise!

And finally, include a task record. This means you write down whether or not they achieved it that day. You could put some tally marks down to show the number of times your child talked about that subject. Or you could just put a check mark or happy face on days when the reward was earned.

What’s the purpose of documenting this? So you can review it again with your child and show them the progress they are making!

What if the contract isn’t working? If they aren’t making progress, then revisit your criteria. Do you need to raise the number of times they talk about Octonauts a little? Is the reward not awesome enough? Do you need more options? Is a whole day too long? Do you need to do a reward opportunity for the morning and the evening? There are options here! Step away from the silverware — do not stab yourself in the eardrum!

The physical visibility of the contract can be a helpful cue or response prompt to remind your child how many times they have left to talk about Octonauts or it may be a visual reminder of that potential reinforcer coming their way. Hang it on the fridge or some other prominent spot to serve as a helpful tool in and of itself!

Over time, you should be able to lower that daily goal. From 20 times a day, to 18 times a day, to 15 times a day, to 12 times a day, etc. Don’t go too fast. Let your child be successful at each level a few times before lowering that number of allowed times they can talk about their favorite thing. And don’t go too low. I don’t want my daughter to think I never ever want to hear about what she is into. I do, however, want her to learn some balance and variety when it comes to conversation topics.

If your son’s conversations about Octonauts are decreasing, does he know what else to talk about? You need to teach him some other replacement topics that are appropriate and interesting to him. We aren’t going to jump from Octonauts to the Blacklist or Grey’s Anatomy, but maybe he can talk about books instead of just his favorite TV show. How about talking about experiences he’s had? Making plans for the future? Give him some choices of topics and model those conversations. Encourage and provide positive reinforcement when he uses any different appropriate topic of conversation.

Here it is in a nutshell:

Set a reasonable & doable number of times your child can engage in that behavior (talking about Octonauts). Provide positive reinforcement when he stays at or under that level. This is called DRL: Differential reinforcement of low rates of responding.

Formalize it with a behavior contract. Be specific. Hang it where it can be seen. Document progress. Revise as needed.

Teach your child a replacement behavior. What CAN he talk about instead? Make it appropriate for your child, for the situation, but make it something he is interested in. Maybe he doesn’t love these other topics as much as Octonauts, but pick some interesting topics to keep him engaged.

And most importantly, don’t stab yourself in the ear!  Find a way to make pleasant conversations in your home possible.  No, more than just a possibility, make pleasant family conversations a regular occurrence. You can do it!


Leanne Page, MEd, BCBA, is the author of Parenting with Science: Behavior Analysis Saves Mom’s Sanity. As a Behavior Analyst and a mom of two little girls, she wanted to share behavior analysis with a population who could really use it- parents!

Leanne’s writing can be found in Parenting with Science and Parenting with ABA as well as a few other sites. She is a monthly contributor to bSci21.com, guest host for the Dr. Kim Live show, and has contributed to other websites as well.

Leanne has worked with children with disabilities for over 10 years. She earned both her Bachelor’s and Master’s degrees from Texas A&M University. She also completed ABA coursework through the University of North Texas before earning her BCBA certification in 2011. Leanne has worked as a special educator of both elementary and high school self-contained, inclusion, general education, and resource settings.

Leanne also has managed a center providing ABA services to children in 1:1 and small group settings. She has extensive experience in school and teacher training, therapist training, parent training, and providing direct services to children and families in a center-based or in-home therapy setting.

Leanne is now located in Dallas, Texas and is available for: distance BCBA and BCaBA supervision, parent training, speaking opportunities, and consultation. She can be reached via Facebook or at Lpagebcba@gmail.com.

Posted in ABA

Tips For Handling A Crisis

Take A Deep Breath

This advice seems so absolutely silly and obvious. I used to hate when people would tell me to take a deep breath. “Got it. I’m breathing. I’m not going to suffocate myself. Chill.” But then I realized that sometimes in a crisis I jump in split-second too early. Yes, when there is a safety risk we want to act as quickly as possible. But the 3 seconds of taking a deep breath before acting usually resulted in me responding not reacting. A reaction is based off of emotion, it’s impulsive, and it’s more likely to be wrong. A response is planned and thought. A deep breath is the difference.

Have A Crisis Plan

Sick of hearing me talk about crisis plans? Too bad! They are still THAT important. This is your insurance policy. Hopefully, you’ll never have to use it but you sure as heck better have one. Check out my mini video training series on Developing a Crisis Plan. You can also download my simple and visual crisis plan here

Keep Other Students Safe And On Task

What’s worse that one crisis? More than one crisis. Keep your other students safe but also try to keep them on their schedule and engaged in an activity. I always recommend keeping bins of puzzles, file folders, and other independent work in every area of the classroom so you always have something to give other students. If students are getting distracted, give headphones and an iPad to keep them occupied during this time. 

Gather Information

Every major behavioral incident is a chance to learn about your student. What are his triggers? What helps him deescalate? Even though you are working on keeping your student and others safe, be gathering valuable information while doing so. Write it down as soon as you can. This information may help prevent this issue in the future. 


About The Author 

Sasha Long, BCBA, M.A., is the founder and president of The Autism Helper, Inc. She is a board-certified behavior analyst and a certified special education teacher. After ten years of teaching in a self-contained special education classroom, Sasha now works full time as a consultant, writer, and behavior analyst. Sasha manages and writes The Autism Helper Blog, as a way to share easy to use and ready to implement strategies and ideas. Sasha also travels internationally as a speaker and consultant providing individualized training and feedback to parents, educators, therapists, and administrators in the world of autism. She is currently an adjunct professor in the school of Applied Behavior Analysis at The Chicago School of Professional Psychology. Sasha received her undergraduate degree in Special Education from Miami University and has a Masters Degree in Applied Behavior Analysis from The Chicago School of Professional Psychology. Contact Sasha at sasha.theautismhelper@gmail.com.

Posted in ABA