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.

How ASAT Supports Special Education and General Education Teachers

This month’s ASAT feature comes to us from David Celiberti, PhD, BCBA-D, Kaitlyn Evoy, BA, Sarah Cummins, MA, BCBA, and Kate McKenna, MEd, MSEd, BCBA, LBA. 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!

The Association for Science in Autism Treatment strives to promote evidence-based practices for individuals with autism spectrum disorder (ASD) in all aspects of their life, including in the classroom. The reality is, of all the professionals and specialists in the field of education, teachers have the largest amount of time with children with ASD over the course of their formative years. Despite this fact, teachers often have the least amount of formal training in the area of autism.

Most special education programs prepare teacher candidates for a wide variety of positions, working with students with an array of needs, abilities, and required accommodations. The reasoning is simple: only a relatively smaller percentage of candidates in the program will work with students who require substantial levels of support. This reality molds their training programs to prepare future teachers for their more likely positions, working with students with high-incidence disabilities. This begs two questions: Are university students who exit special education training programs truly trained to educate learners with complex needs? And, do employers (e.g., schools) have the expectation that new teachers should come with this education and training?

Legislation has aimed at holding special education teachers to high standards, with specific wording calling for the necessity for “highly qualified” teachers. This performance expectation is hard to reach. While people in power (e.g., legislators, politicians, administrators) want schools to hire teachers who have high qualifications, the reality is that it is challenging for teachers to achieve this status. Special education teachers often lack support in the form of staffing, curriculum, administration backing, supplies, and the planning time needed to prepare and provide for what their students need. In order to successfully teach their students, special education teachers often use their own time to seek professional development, support, and advice. The array of information on treatments, approaches, and therapies is overwhelming. The resources are often lacking in evidence, difficult to understand, or simply do not exist. Combine these truths with the stress and burnout this career brings, and teachers are set up to struggle daily. Yet, the pressure on teachers to be “highly qualified” remains.

We acknowledge that students with autism are educated in a variety of settings, and that teachers are subsequently expected to work in a variety of settings. General education teachers may have students with autism in their classrooms, with and without paraprofessionals for support. Special education teachers could be working in a more supportive role in a general education classroom or pulling students out to work in a resource room. Another scenario is working in self-contained special education classrooms with no paraprofessional support, or they may have to supervise a team of support staff. Teachers in classrooms with paraprofessionals may be responsible for educating classroom staff about autism and training them in specific intervention strategies. This is despite a lack of substantial training about autism and limited training in supervising and working with support staff. Furthermore, many teachers are directing large numbers of paraprofessionals while still retaining direct teaching responsibilities, not to mention that staff shortages may require daily triaging to ensure that students are adequately covered.

Additionally, teachers in both general and special education settings may find themselves facing challenges that were not addressed in their college or university coursework or their student teaching experience. For example, snack and lunch time may be complicated by issues of feeding disorders or food refusal. Families may require school support with teaching toileting skills or addressing school refusal. Challenging behavior may disrupt lessons and cause problems during transitions. Teachers can be expected to incorporate the use of augmentative and alternative communication (AAC) devices into the curriculum and daily routines of the classroom.

ASAT can be a bright light in a landscape of confusion. With explicit aim to offer resources for a wide variety of professions, including teachers, our information is comprehensive, easily organized, and backed by science. Gone are the days when teachers had to rely solely on advice from colleagues, blogs, or Pinterest to find intervention strategies and techniques. ASAT gathers and creates information about evidence-based practices that are easy to read on a platform that is easy to navigate – and it is all free.

It is our hope that this article serves to provide a comprehensive list of resources offered to teachers of students with autism. The links presented here focus on solutions to a variety of challenges including increasing independence, developing skills, augmenting inclusion opportunities, increasing community integration, preparing for adulthood, as well as other topics of interest to family members and other service providers who work with this population. We anticipate this list of offerings will continue to grow. In the future, we very much look forward to sharing new, innovative articles that are currently in development.

Prior to sharing many of our offerings that are well suited for teachers, we would first like to highlight three broader initiatives:

  1. ASAT publishes a monthly newsletter, Science in Autism Treatment, containing reviews of published research, books, and consumer resources (e.g., training videos, websites, or resource lists like this one on promoting success at the dentist), interviews with leaders in the field of autism treatment for older children and adults, as well as parent advocates, answers to questions about important clinical issues related to education and treatment, tips to differentiate evidence-based options from others marketed as panaceas, and more. In addition, you can find links to the current newsletter, Science in Autism Treatment, as well as past issues in the Archived Newsletters section. You can read more about Science in Autism Treatment and its diverse content and features here and also subscribe for free.
  2. ASAT’s website (www.asatonline.org) offers resources for teachers and other educational personnel (e.g., lists of apps to use in the classroom, bullying prevention resources, as well as lists of print resources like this one that helps classmates learn about autism). We also provide resources geared towards parents and medical professionals. As part of our vision to provide accurate information, we update our content to reflect up-to-date research and evaluations of new treatments. Our website also has interviews that reflect the perspectives of different stakeholders, including parents. We are pleased to share that we have launched a special page for teachers that lists articles topically.
  3. ASAT also has a 150-hour Externship program for students, professionals, and family members to gain experience in a not-for-profit organization while increasing their knowledge within the field of autism. Many of our past and current Externs are teachers or hold degrees in education (which include the 2nd, 3rd, and 4th authors of this article). Furthermore, many members of our Board of Directors and Professional Advisory Board possess teaching degrees and certificates.

In the remainder of this article, we describe many of our resources in greater detail as they relate to teachers and individuals with autism in school settings.

Science Corner

Science Corner offers user-friendly knowledge about scientific concepts to help our readers become savvier consumers. Recent published installments include topics such as making sense of the evidenceretraction of published researchpitfalls of circular reasoning, and conducting a comprehensive literature search. In order to evaluate research, claims, and educational interventions for students with autism spectrum disorders, it is crucial to understand and recognize the differences between science and pseudoscience. There is also a group of articles that evaluates whether or not specific treatments or fads are evidence-based (i.e., “Is There Science Behind That?”). Some of the topics teachers may encounter in their careers or be asked about by their students’ parents include Facilitated Communicationsensory dietsservice dogs, and gluten-free/casein free diets.

Research Synopses

Research Synopses, as its name implies, contains reviews of relevant studies related to autism. There, teachers can find quick summaries of complex research, helping them to save time in their review of literature on their journey to use evidence-based practices in the classroom. There is a growing list of specific psychological, educational, and therapeutic interventions. Some interventions have multiple studies referenced and reviewed. If teachers are looking for more information on specific interventions, including the evidence or lack thereof, they can find those as well. Applied behavior analysis has dozens of studies linked given the tremendous body of literature, including classroom applications of functional analysisa meta-analysis on TEACCHsupporting appropriate transitions, and early intervention in public preschool and kindergarten to name a few. A section on effective procedures for teaching specific skills to individuals with autism covers studies ranging from the challenges and possibilities of teaching reading skills to students with autism, to communication interventions for minimally verbal children with autism. Because teachers often encounter stakeholders interested in non-evidence based, therapeutic, or biomedical treatments, ASAT addresses issues like the persistence of fad interventions such as facilitated communicationthe lack of evidence supporting the rapid prompting method, and the results of a controlled trial regarding hyperbaric treatment for children with autism. Find the full gamut of research synopses available here.

Clinical Corner

Clinical Corner provides responses to frequently asked questions about autism treatment. This is a particularly content-rich area of the ASAT website which spans many critical issues related to teaching, such as use of reinforcement, effective interventions, behavior management, and issues impacting families. Examples of specific questions answered are related to topics such as the importance of early diagnosissetting up an evidence-based program, and teaching children social skills. Questions posed by teachers working in the field are included within this section. Some of these cover subjects including, but not limited to, teaching WH questionspreparing students for fuller inclusion, and safety skills. See the full array of our Clinical Corner installments here.

Book and Resource Reviews

On our website you will find reviews of several useful books related to teaching and behavior management. In addition, you will find summaries of some available resources listed below topically. Many of these reviews are for books and resources that are available free of charge.
Autism Educational and Treatment Considerations

  1. A review of The complete guide to autism treatments 2nd Edition
  2. A review of Countering evidence denial and the promotion of pseudoscience in autism spectrum disorder
  3. A review of The persistence of fad interventions in the face of negative scientific evidence
  4. A review of Autism for public school administrators: What you need to know

Early Intervention

  1. A review of The activity kit for babies and toddlers at risk
  2. A review of Autism: Start here, what families need to know (3rd Edition)

Parenting and Family Resources

  1. A review of Autism 24/7: A family guide to learning at home and in the community
  2. A review of Autism and the family: Understanding and supporting parents and siblings
  3. A review of Life as an autism sibling
  4. A review of Life Journey Through Autism: A parent’s guide to research
  5. A review of Blessed with autism: A parent’s guide to securing financial support for the treatment of children with autism
  6. A review of Broccoli Boot Camp: Basic training for parents of selective eaters
  7. A review of The power of positive parenting

Skill Acquisition

  1. A review of Teaching social skills to people with autism: Best practices in individualizing interventions
  2. A review of Discrete-trials teaching with children with autism: A self-instruction manual
  3. A review of Focus on behavior analysis in education: Achievements, challenges, and opportunities
  4. A review of Activity schedules for children with autism: Teaching independent behavior
  5. A review of Applied behavior analysis and autism: An introduction

Behavioral Intervention

  1. A review of The function wheels
  2. A review of Elopement of children with autism: What we know, successful interventions, and practical tips for parents and caregivers
  3. An overview of ABA Ultimate Showdown Podcasts for Round 1 (IISCA vs. Traditional FA)
  4. A review of Punishment on trial
  5. A review of ABA tools of the trade: Easy data collection for the classroom
  6. A review of Compassionate care in behavior analytic treatment

Transition

  1. A review of Journey to community housing with supports
  2. A review of Finding your way: A college guide for students on the spectrum
  3. A review of Life Journey Through Autism: A guide for transition to adulthood
  4. A review of Working in the community: A guide for employers of individuals with autism spectrum disorders

Media Watch

ASAT’s Media Watch monitors mainstream media to identify published information about autism and autism treatments. Understanding that every media contribution has the potential to reach thousands of consumers and service providers, we support accurate media depictions of empirically-sound interventions. We also respond to inaccurate information about proposed treatments reported and, at times, promulgated by news outlets. You can review our 200+ published letters. Many of our letters focus on topics related to schools and teacher preparation. We have compiled a list of a few dozen letters written over the last 10 years that teachers may find interesting. These are organized topically below:

Early Intervention

  1. ASAT responds to The New York Times’ Early treatment for autism is critical, new report says
  2. ASAT responds to news.com.au’s Mum Julia Coorey on surviving an autism diagnosis and importance of early diagnosis
  3. ASAT responds to NBC News’ Brain scans detect signs of autism in high-risk babies before age 1

Supporting Students

  1. ASAT responds to The Philadelphia Inquirer’s Children with autism spectrum disorder need more support during the pandemic (02/19/21)
  2. ASAT responds to The Conversation’s Report sparks concern about how schools support students with disabilities (6/12/17)
  3. ASAT responds to New Zealand Herald’s Opinion: Teach all teachers strategies for autistic children, Urges Autism NZ (4/12/17)

Family Experiences

  1. ASAT responds to Autism Parenting Magazine’s, Simple ways you can Help strengthen the ASD sibling relationship (2/15/2017)
  2. ASAP Responds to kswo.com’s How autism affects the whole family (01/14/2016)
  3. ASAT responds to TheAtlantic.com’s The economic impact of autism on families 07/13/2012)
  4. ASAT responds to Examiner.com’s Reshaping public misconceptions of parenting a child with autism

Outcomes

  1. ASAT responds to abc.news.go.com’s How a child with autism became ‘His own man’ after treatment (02/08/2016)
  2. ASAT responds to ABC.net.au’s Hope for autistic teens: How applied behaviour analysis helped Ian Rogerson’s son overturn bleak prognosis (1/08/2015)
  3. ASAT responds to Bangor Daily News’ Old Town Athlete Honor Student shares story of overcoming ‘bleak diagnosis’ of autism (05/17/2014)
  4. ASAT responds to FoxPhilly.com’s Parents of autistic children worry what life will bring when they’re adults (04/01/2013)

Employment

  1. ASAT responds to Click on Detroit’s Ford aims to boost hiring of employees with autism (10/15/20)
  2. ASAT responds to lohud’s Spectrum Designs will provide opportunities for those on the autism spectrum (01/13/20)
  1. ASAT responds to ABC News’ (AU) Workers with autism recognized for unique skill set, ANZ recruiting nine new employees (3/5/2018)
  2. ASAT responds to Triblive.com’s Autism services hope to make inroads in workplace (04/24/2013)
  3. ASAT responds to MSNBC’s 1 in 3 autistic young adults lack jobs, education (04/07/2012)

Community Opportunities and Needs

  1. ASAT responds to Good Housekeeping’s Costco is hosting sensory-friendly shopping hours for people with autism (03/04/2017)
  2. ASAT responds to CNN’s Helping patients with autism navigate the stressful ER (05/22/2016)

Transition Concerns from School to Adulthood

  1. ASAT responds to The Inquirer’s Falling off the cliff (12/27/2017).
  2. ASAT responds to Psychologytoday.com’s Making severe autism visible (12/29/2015)
  3. ASAT responds to Portland Press-Herald’s Graduating to an uncertain fate (06/15/2011)

Please take a moment to explore other sections of our dedicated pages for teachers including our topical list of resources.

Citation for this article:

Celiberti, D. A., Evoy, K., Cummins, S, & McKenna, K. (2021). How ASAT supports special education and regular education teachers. Science in Autism Treatment, 18(5).

About The Authors

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

Kaitlyn Evoy, BA is a special education teacher with a Bachelor’s degree in Special Education, and she holds a Learning Behavior Specialist-1 Certification in Illinois. She obtained her Bachelor’s degree from Lewis University in 2014, and she is currently studying Autism and Other Pervasive Developmental Disorders at Johns Hopkins University. Kaitlyn is drawn towards the study of evidence-based practices and their execution in classroom environments. She is an Extern at the Association of Science in Autism Treatment focusing on dissemination to teachers and other educational support staff. 

Sarah Cummins, MA, BCBA is a special education teacher and BCBA with a Bachelor’s degree in Special Education and a Masters’s degree in Special Education with a Concentration in Applied Behavior Analysis. She obtained both her Bachelor’s degree and Master’s degree from Seton Hall University in 2016 and 2020 respectively.  Sarah currently works as a teacher in a self-contained public special education classroom with students between the grades of K and 2 as well as a BCBA in the private sector.  Sarah has experience in developing content for ASAT’s social media account, as well as material geared toward teachers and teaching staff. She has been an Extern at the Association of Science in Autism Treatment since May of 2020. 

Kate McKenna, MEd, MSEd, BCBA, LBA, received a Masters in Child Study from the Eliot-Pearson Department of Child Study at Tufts University and a Masters in Special Education from Pace University.  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 ABA from Hunter College. She was an extern at the Association for Science in Autism Treatment before joining the Board of Directors in 2020.

Posted in ABA

“What goes into teaching children to answer WH questions?”

This month’s ASAT feature 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:

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

Supporting Parents and Families

In the ideal world, every child would have parents and other loving family members who are engaged in their education, social activities, health and wellness, and leisure time.  This engagement provides protection for the child, emotional bonding for the family, and opportunities for parents to pass along their wisdom and values.  Caretakers explicitly and implicitly teach their children through modeling, conversation, and interaction every day. 

For families that include individuals on the autism spectrum, sometimes parents and caretakers may benefit from additional support to engage with and help their children.  Additionally, when children are receiving ABA services it is essential for caretakers to be included in planning and delivery of programming. 

One important reason for including parents and other family members in ABA intervention is because they are key sources of information and guidance for behavior analysts.  No one knows children better than the people who love them.  Exploring the functions of behavior and then developing plans for the most effective teaching and behavior support strategies requires collaboration with parents or closest caregivers.  If a behavior analyst wants to know about a client’s reinforcers and motivators, they should speak to the client.  If the client is unable to communicate with the behavior analyst, the people close to the client are the next best source of information.  Parents or other close caregivers can provide a wealth of knowledge about their children who may not yet be able to speak for themselves. 

Next, parents or guardians are the providers of consent for their child’s assessment and treatment.  They should be actively engaged in deciding what goals should be set, how behavior should be assessed, and how interventions should be implemented.  Goals and interventions should be based on the values and culture of the family, not the behavior analyst.  The only way to do this authentically is to connect in a meaningful way with the family and engage in respectful conversation about their needs and their preferences.  Next to the client, parents and/or caregivers as the most essential members of the team.

Another reason to engage caregivers in behavioral intervention planning and implementation is simply that they have almost continuous access to their child and therefore can have the most impact.  If a caregiver who is with the child for most of the day has a good understanding of how to implement behavioral interventions, including antecedent-based strategies, language interventions, and natural environment teaching, the power of the intervention is magnified tremendously.  Not only does the child benefit from opportunities for learning and positive support throughout the day, but generalization and maintenance of skills learned in more formal therapy are dramatically improved. 

Following are some thoughts about how to facilitate this collaboration but remember that every parent or caregiver is different and should be approached and addressed in the way that works best for them. 

  1. First, let’s look at the term “parent training.” While the term means “training parents about ABA,” it also implies that parents need to be trained to be parents.  Not only is this inaccurate, but it may come across as hurtful or arrogant.  Also, remember that not everyone who comes to parent training is a parent, and not everyone who comes to parent training needs to learn the same things.  Some parents or caregivers are very new to participating in their child’s programming, and others have been deeply involved for a long time, but we all can benefit from collaboration.  Funding sources often refer to the service as “parent training” so we may be stuck with the term, but it can be very helpful to explain to parents and caregivers from the beginning that they are not going to be told what to do, they are not going to be judged, and everyone is here for the same reason – to work together to help their child.
  2. As mentioned above, not everyone who receives parent training is a parent. Remember that families may have very different configurations, and sometimes children are cared for by those other than their parents.  Sometimes grandparents, aunts, uncles, or older siblings are involved in raising children.  For a variety of reasons, sometimes paid caregivers are involved.  Whoever is part of the child’s world on a day-to-day basis may benefit from collaborating with the child’s behavioral programming team.
  3. Remember that although the individual receiving the behavioral intervention is technically the client, everyone who is affected by the child’s services should be treated according to the same principles as the client. Take the time to assess the caregiver’s wants, needs, and motivators, and not just in direct relation to their child.  Caregivers will usually readily describe what they want for their child to get out of therapy, but we can also ask what caregivers want for themselves.  We can and should also ask how caregivers prefer to learn, receive feedback, review progress, and interact with us.  Some caregivers will prefer a highly technical experience and will appreciate graphs and journal articles, while others would rather have practical advice.  Some caregivers will want to proceed slowly and step-by-step, and others will want to have a big-picture plan.
  4. As noted above, this will depend on the individual parent or caregiver, but for the most part it is advisable to start by using approachable language, introducing jargon only if needed or wanted. Most caregivers need to know how to help their child today and tomorrow and do not need to know about complicated schedules of reinforcement or technical terminology that may be off-putting or upsetting.  Of course, if a parent prefers technical terminology, it is totally appropriate to use it and to introduce them to books, websites, and other resources to provide any background and theory they may be interested in.
  5. Be clear and kind in setting boundaries. Collaboration with caregivers usually means getting involved in their family on a deeper and more compassionate level than other professionals.  They may be close to their dentist or pediatrician, but most will likely only see those professionals a few times per year, and not in their homes.  The members of the ABA team, by contrast, are usually involved in family life many times in a week, often in the family’s home, and it is not unusual or problematic to develop concern for each other.  Ethical guidelines against developing dual relationships can be respected with kindness, within the greater context, and should be consistent and not unexpected for the family.
  6. Be respectful of competing demands. Remember that as a professional your interaction with the caregiver is mostly in relation to the child who is receiving services, but caregivers often have other responsibilities to be balanced.  These may include other children and family members, work, and their own physical and mental health needs.  If a caregiver is not as responsive as we would like, assume good intentions and try to analyze how they could be better supported to participate.  Sometimes this means changing the expectations for what they can do, and other times it means providing additional resources or different suggestions that are more consistent with their situation.
  7. It is important to remember to show interest and compassion for the whole family. Remember that the client is part of a unit, and the people who are important to them can be important to the team, too.  Not only does this level of consideration lead to better outcomes for the child because the family will be more engaged with the professionals, but it will also result in a more fulfilling experience for the professionals.  We all entered this field to help people; working within the context of the family allows us to help many people at one time.

References Consulted

Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for behavior analysts. Author.

Callahan, K., Foxx, R. M., Swierczynski, A., Aerts, X., Mehta, S., McComb, M. E., Nichols, S. M., Segal, G., Donald, A., & Sharma, R. (2019). Behavioral artistry: Examining the relationship between the interpersonal skills and effective practice repertoires of applied behavior analysis practitioners. Journal of Autism and Developmental Disorders, 49(9), 3557-3570.

LeBlanc, L. A., Taylor, B. A., & Marchese, N. V. (2019). The training experiences of behavior analysts: Compassionate care and therapeutic relationships with caregivers. Behavior Analysis in Practice13, 1-7.

Taylor, B. A., LeBlanc, L. A., & Nosik, M. R. (2018). Compassionate care in behavior analytic treatment: Can outcomes be enhanced by attending to relationships with caregivers?  Behavior Analysis in Practice, 12(3), 654–666.

About The Authors

Dana Reinecke is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA). Dana is a Core Faculty member and Associate Chair in the Applied Behavior Analysis department at Capella University. She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum and documentation. Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities. She has presented original research and workshops on the treatment of autism and applications of ABA at regional, national, and international conferences. She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism. Current areas of research include use of technology to support students with and without disabilities and online teaching strategies for effective college and graduate education. Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA), and is currently serving as Past President (2019-2020).

Dr. Cheryl Davis: I am a licensed and board certified behavior analyst as well as a special education teacher who received my doctoral degree from Endicott College in Applied Behavior Analysis.  I am an Assistant Professor at The Sage Colleges, as well as owner of 7 Dimensions Consulting, LLC. I received a Master’s of Science Degree in Intensive Special Education from Simmons College in Boston, MA after attending The University of Connecticut where I received a bachelor’s degree in Human Development.  I then pursued my BCBA, while working in a world renown ABA school.  With over 25 years of experience working with children and families with autism, developmental disabilities, and related disorders, I specialize in effective supervision for upcoming BCBA/BCaBA candidates.  I have a passion for supervision, in both providing it to people who are in locations with limited access to behavior analysis and working with other supervisors to develop best supervision practices.  I also specialize in skill acquisition programming for clients in need, online teaching, and active student responding. I have had experience as a supervisor, teacher, job coach, home therapist, residential supervisor, public school consultant, staff trainer and professor. I have extensive experience in developing training topics for both parents and teaching staff.  I am a self-describe radical behavior analyst with one worldview!

Posted in ABA

Your Child’s Autism Diagnosis Long Term

In the years immediately after a parent learns of a diagnosis of autism, it can be especially challenging to think of your child’s autism diagnosis long-term. But as parents advocate for their child, and as practitioners work with the family to create goals for that child, the long term must be considered. Here are a few suggestions to help with considering the long term, while focusing on short-term goals:

  1. Create a vision statement. One of my favorite books is From Emotions to Advocacy: The Special Education Survival Guide by Pam Wright and Pete Wright. This book covers everything parents need to know about advocating for a child with special needs. One of the first things they suggest is creating a vision statement. They describe this as “a visual picture that describes your child in the future.” While this exercise may be challenging, it can help hone in on what is important to you, your family, and your child with special needs in the long term.
  2. Look at your child’s behaviors, then try to imagine what it might look like if your child is still engaging in that behavior in five or ten years. Often, behaviors that are not problematic at three are highly problematic at 8 or 13 years old. Such behaviors might include hugging people unexpectedly or (for boys) dropping their pants all the way to the ground when urinating (which could result in bullying at older ages). While it is easy to prioritize other behaviors ahead of these, it’s important to remember that the longer a child has engaged in a behavior, the more difficult it may be to change.
  3. Talk to practitioners who work with older students. Many practitioners only work with a certain age group of children. While they may be an expert for the age group they work with, it may be helpful to speak with a practitioner who works with older kids and ask what skill deficits they often see, what recommendations they may make, and what skills are essential for independence at older ages.
  4. Talk with other parents. Speaking with other parents of children with special needs can be hugely beneficial. Over the years, I’ve worked with hundreds of parents who are spending countless hours focusing on providing the best possible outcomes for their children. And while it’s impossible to prepare for everything that will come in your child’s life, it may be helpful to find out what has blindsided other parents as their children with special needs have grown up.

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

Using Token Economies In Autism Classrooms

Token economies are used in many different environments. They’re typically simple to implement and achieve desired results for behavior change, especially in autism classrooms. Furthermore, there are tons of research on how to best use them. If you want to get the best results while simultaneously promoting independence in your learners, it is not as simple as just putting some stars on a chart.

  1. Use a preference assessment. This will help you identify reinforcers your learner may want to earn. As I’ve mentioned in previous posts, I often use the Reinforcer Assessment for Individuals with Severe Disability (Fisher, Piazza, Bowman, & Amari, 1996). 
  2. Define the target behavior. What behaviors do you want to increase? And how can you define them so they are clearly observable and measurable. For instance, your learner could earn tokens for raising his or her hand in class or responding to a question within 3 to 5 seconds. It is important the behavior is clear and everyone using the token economy agrees on what each behavior looks like.
  3. Choose your tokens. When I was a classroom teacher, I had a class-wide token economy in which my students earned paperclips. The paperclips had no value initially, but once the students understood the system, I could put paperclips in the bags of the students who were sitting quietly while still continuing to teach my lesson. It allowed them to reinforce the appropriate behaviors and make the most of instructional time. For other students, I’ve used things such as Blue’s Clues stickers, smiley faces I drew on a piece of paper, and even tally marks on an index card.
  4. Choose when and how tokens will be exchanged. With the paperclip system in my classroom, exchanges occurred at the end of the day. After everyone had their bags packed and were sitting at their desk, we did the “paperclip count” and students could decide whether to spend or save. There was a menu of options ranging in price from 10–100 paperclips. It was also a great way to reinforce some basic math skills (such as counting by fives and tens and completing basic operations). For other students, they might be able to exchange tokens after earning a set amount. Depending on their level of ability, that set amount may be very small (such as 2 to 3) or much larger (such as 25). Sometimes, students have a choice of items or activities, while at other times they earn a pre-selected item or activity.
  5. Keep it individualized. Conducting a preference assessment helps to make sure it’s individualized to your learner’s preferred items. With my students, the menu of items/activities they could earn was generated through a conversation with them.
  6. Decide if you will implement a response cost. For my students, I have never used a system in which they could lose tokens they had already earned. But you may find that utilizing it may help. It all depends on your particular learner, which makes the next point all the more important.
  7. Take data. You need to take data so you will know if your token economy is helping you achieve your goal with the target behaviors you have set.
  8. Thin the reinforcement over time or change the target behaviors. I do not want any of my learners to be using a token economy for one behavior for all eternity! Let’s say I start with a young learner who is not sitting down for instruction. I may start the token economy by having my student earn a token for every instance in which they are seated correctly for a specified period of time. As my student masters that, I will increase the amount of time required before a token will be earned. Once they’ve achieved the goal I set, I can either fade out the token economy, or keep the token economy but use it for a new behavior.

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

Teaching Gestures For Pre-Verbal Learners

Everyone does it! In a global pandemic, we do it more since our mouths are covered by masks.

What is it? Some people call them signs, talking with your hands, body language, and if we want to get real fancy, gesticulations…

But let’s keep it simple… gestures.

My newest favorite gesture, in this era of Zoom meetings, is to silently give the double thumbs up to communicate my happiness when one of my team members has a good idea or is asking for a response. I learned this gesture from my 16-year-old daughter, who uses it during her face time interactions with friends and Zoom virtual schooling.  Since it is hard to talk in groups over Zoom, this subtle and fun gesture allows for effective communication and proof of engagement.

Are gestures a big deal to communication?

In short, YES! There are many different types of gestures, and many different names that go along with these gestures. To simplify the categories and language, I will be focusing today on gestures that serve two functions:  for requesting and sharing communication.

Requesting gestures are used to gain something from another person. A young child may point at a toy that is out of reach so his mother can grab it. You may hand your friend a jar that is tightly shut to ask for help with opening it. Without words, communication is clearly happening between people. 

On the other hand, requests for sharing communication are those gestures used to communicate an interest, or lack of interest in something. For example, pointing to the loud, annoying helicopter in the sky or showing that new trending social media video to your friend. These communicative gestures are integrated seamlessly and automatically into our daily interactions with others.

Do I need to teach gestures?

Yes! There are natural differences between people in how much they use their bodies when orally communicating with another person. But from a developmental perspective, gesturing is an important aspect to early communication skills. 

Gesturing actually helps facilitate language development. Child-initiated gestures engage attention and language, and increase word and concept development. Gestures reflect what the children know, and provide opportunity for developmental change. Gesturing in young children is predictive of later language skills such as expressive vocabulary, but also of perspective taking and abstract thinking. Lack of gestures in very young children may indicate developmental concerns.

Recently some professionals and parents of older preverbal children have expressed resistance to including gestures as a language target – stating that intense focus should be placed on oral language or assistive technology, and claiming that gestures will replace the child’s use of broader communication.  This fear is unfounded, and research supports the benefit of gestures throughout development to facilitate and assist, not to hinder.

A child’s language abilities should not dictate whether or not gestures are taught. Further, gestures should be taught along with other communication modalities, regardless of what method of communication your preverbal child is learning.  Whether they use sounds, word approximations or sound generating devices, gestures enhance communication skills across their lifetime.

This PCSES curriculum, though it provides activities to teach various early social behaviors with both adults and peers, also focuses on teaching early initiating and responding gestures. This includes teaching your child to gesture “up” to be carried, teaching your child to give high fives to friends, and even teaching your child to lead you to something cool to share. 

Where should I begin?

So how do you integrate these gestures? It’s simple. Pick one gesture to teach, then model that gesture across different activities. Your child, in return, should imitate your model in all opportunities. I am a big proponent of social reinforcement, so please don’t forget to praise your child for gesturing. For example, you want to teach the “high five” gesture. Easy. Plan to do some fun and easy gross motor activities with your child like jumping forward on the lines found on concrete sidewalks. After each jump (or attempt), raise your hand to receive the high five gesture from your child. Once they give you the high five, socially praise by saying, “Wow, awesome high five!” Your child may need some physical support at first, and that’s okay too. Reinforce all high fives. One more thing to keep in mind. Focus your attention on the gesture being taught, not how well your child completes the activity. That can be left for another day.

I’m pointing at you all right now with a tilt of my head, followed by a thumbs up, and a high five.

Capone, N. C., & McGregor, K. K. (2004).  Gesture development:  A review for clinical and research practices.  Journal of Speech, Language, and Hearing Research47, 173-186.

Crais, E., Douglas, D. D., & Campbell, C. C. (2004). The intersection of the development of gestures and intentionality. Journal of Speech, Language, and Hearing Research 47, 678–694.

Goldin-Meadow, S. (2009). How gesture promotes learning through childhood.  Child Development Perspectives, 3, 106-111.

Manwaring, S.S., Stevens, A.L., Mowdood, A., & Lackey, M., (2018). A scoping review of deictic gesture use in toddlers with or at-risk for autism spectrum disorder. Autism & Developmental Language Impairments3, 1-27.

Written by Stephanny Freeman PhD

Posted in ABA

Differential Reinforcement of Incompatible Behavior

Today, we are going to take a closer look at Differential Reinforcement of Incompatible behavior (DRI). DRI is defined as “a procedure for decreasing problem behavior in which reinforcement is delivered for a behavior that is topographically incompatible with the behavior targeted for reduction and withheld following instances of the problem behavior (e.g., sitting in seat is incompatible with walking around the room) (Cooper, Heron, & Heward, 2007).

Let’s look at a few examples of DRI in action:

  1. Mrs. Clark is teaching a classroom with six students with autism. One of her students has recently begun to pinch his arms. She takes data on the behavior and discovers that it functions for attention. (When he pinches his arms, she or a teacher’s aid comes over and tells him “no pinching.”) She decided to implement an intervention that utilizes DRI. She teaches him how to sit with his hands intertwined on his desk. This is an incompatible behavior with pinching because he is not able to pinch while his hands are intertwined. She and the teacher’s aid reinforce him for intertwining his hands (come over and tell him, “great job” or “I like how you’re sitting”) and do not provide attention when he engages in arm pinching.
  2. Carly has a 9-year-old daughter. When her daughter wants a break from doing homework, she reaches over and hits Carly’s arm. Carly typically says, “Do you need a break now?” Then, she allows her to take a five-minute break. Carly recognized that her daughter’s intensity with hitting seemed to be increasing, and she was worried she might get hurt. She decided to implement an intervention that utilized DRI. She put a timer on the table within her daughter’s reach, and taught her daughter to touch the timer when she wanted a break. This is an incompatible behavior because her daughter cannot simultaneously touch the timer and hit Carly. When Carly’s daughter touched the timer, she immediately received a break. When she hit Carly, she did not receive a break. This was an especially useful intervention because, over time, Carly taught her daughter to set the timer on her own and become more independent with managing break times.
  3. Mr. Holley teaches a preschool class. During circle time, many of his students become very excited and can be quite loud. Sometimes it seems as though all of his students are yelling at the same time. Once they become too loud, it is very challenging to regain their attention. He decides to implement an intervention utilizing DRI. He uses a decibel meter on his tablet (such as the app Too Noisy). He teaches the students that when the noise level is below a certain number or threshold they all earn stickers. This is differential reinforcement of an incompatible behavior because the children cannot possibly speak loudly and softly simultaneously.

DRI is not always the best option. For example, it may be very challenging to come up with an incompatible behavior. Or, in the case of self-injurious or aggressive behavior, it may be dangerous to use such an intervention.

If you do use DRI, you may consider explicitly telling your learner(s) that you are implementing this new plan, such as Mr. Holley did in the third example above. And remember, this is only one form of differential reinforcement. If DRI is not appropriate for your situation, there are definitely still options for reinforcing appropriate behavior in an effective and efficient manner.

REFERENCES

Cooper, J.O., Heron, T.E., & Heward, W.L. (2007). Applied Behavior Analysis – 2nd ed. Englewood Cliffs, NJ: Prentice-Hall.

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

Resources for Promoting Dental Hygiene and Success at the Dentist

David Celiberti, PhD, BCBA-D, Maithri Sivaraman, MSc, BCBA, and Yash Gupta
Association for Science in Autism Treatment

Resistance associated with dental visits is an all-too-common challenge for many individuals with (and without) autism spectrum disorder (ASD).  Such resistance can lead to the use of restraint or pharmacological management, and sadly in some instances can be associated with inadequate preventative dental care or delays to access treatment which can lead to more serious health complications. More specifically, individuals with autism requiring special needs such as anesthesia dentistry, can face long waits for service (Bai, 2020). Furthermore, interventions that rely heavily on exposure training require a clinical setting able to make that investment which is often hampered by billing constraints, limited insurance reimbursement, and other logistical barriers.

This list of annotated resources has been created to serve as a helpful reference for families, clinicians, and educators alike. We have incorporated resources for dental providers as well, since there is some research suggesting that the majority of dentists feel anxious or uncomfortable treating patients with special needs (e.g., Dao et al., 2005).  We showcase online resources that highlight strategies and information to address the myriad of obstacles surrounding dental care. We hope that this information shared below will support your efforts, promote cooperation, and help improve dental outcomes. This piece was initially published a few years ago and is now expanded and updated.

Resources for Families (Video/Audio):

Child Preparation- Bergen Pediatric Dentistry. On this very helpful page, Dr. Purnima Hernandez shares several video models and narratives for parents, providers, and children. The videos showcase specific tools and their corresponding sounds which may help prepare your child for a cleaning visit. These videos expose the child to some of the more potentially aversive sensory experiences in a brief and non-threatening manner.

Making Going to the Dentist Easier for Kids with Autism. This helpful video blog by Dr. Mary Barbera describes several strategies you can consider to make dental visits and oral care easier. Dr. Barbera discusses the importance of careful reflection on past visits, learning from those experiences, and setting reasonable goals. She models some of these strategies in this 11-minute video.

Autism: Making Tooth Brushing Possible/Fun. This 12-minute 2013 video by Autism Live includes an interview with Dr. Jonathan Tarbox and addresses the role of reinforcement and shaping/exposure procedures.  Specifically, Dr. Tarbox outlines strategies to reduce the motivation to escape, including criteria to guide gradual progression, and careful use of probes to guide toleration efforts. He also discusses the importance of limiting access to high-ticket rewards so that they can only be achieved by completing one certain task, for example tooth brushing.

Dental Toolkit. In recognition that good oral health habits can be challenging for many individuals with autism, Autism Speaks collaborated with Colgate and Philips-Sonicare to create this 10-minute video. It provides tips for families so they can help their loved ones with autism access a suitable dental care provider as well as how to choose the right brush/toothpaste and practice skills at home, including getting ready for the first visit. Two dentists shared their experiences serving patients with autism offering numerous suggestions, such as how to adapt the examination depending on the child’s reactions.

How To Help Your Autistic Child During A Dental Appointment | Autism Tips by Maria Borde.   

This quick, 3-minute video by Maria Borde showcases many strategies to help prepare for the dentist. Some tips mentioned for children with autism at the dentist are: preparing them in advance by showing them the tools and making them comfortable with the tools, bringing a tablet with your child’s favorite shows as a distraction, and using sunglasses and sound cancelling headphones for children who find bright lights or loud sounds aversive.

Resources for Families (Print Materials):

Autism Dental Information Guide for Families and Caregivers. In an effort to create information guides for families of individuals with autism, service providers, and dental professionals, the Southwest Autism Research & Resource Center (SARRC) published this booklet in collaboration with dental experts and academics. This well-organized and consumer friendly booklet contains background information on the importance of good oral hygiene and care. It provides a comprehensive list of suggestions for scheduling the dental appointment, including a sample form for use when calling the dentist to set up the initial appointment. The sections related to preparing for the office visit and carrying out oral care in the home are particularly detailed and helpful. Finally, there is information about the use of fluoride and metal fillings (amalgam) to help parents become more informed about these products.

Taking Your Son/Daughter with an Autism Spectrum Disorder to the Dentist. This resource was prepared by the Indiana Resource Center for Autism. The article contains many helpful tips, such as bringing the child’s toothbrush and toothpaste to the dental visit for familiarity and having the dental chair already in a reclined position for those children who may not like to be moved backward mechanically. A Tell/Show/Do strategy is described for promoting cooperation and participation during dental routines. This strategy first involves verbally describing the forthcoming step, followed by displaying the tool or instrument and allowing the child to see it, and finally, carrying out the step. Appendices include a list of books, a sample social story, and a visual schedule for visiting the dentist.

Healthy Smiles for Autism: Oral Hygiene Tips for Children with Autism Spectrum Disorders. This publication is based on a collaboration of the National Museum of Dentistry, the Kennedy Krieger Institute’s Center for Autism and Related Disorders, and the University of Maryland Dental School. It showcases best practices related to oral health care for children with ASD. This booklet highlights the importance of parental modeling and recommends that parents invest time in choosing a toothbrush, toothpaste, and flossing materials that work best for the child. Guidelines for helping children brush and floss successfully are consistent with well-established behavior analytic principles and are consumer-friendly, as are the suggestions surrounding how to access dental care (e.g., finding a dental provider, getting ready for the initial visit). This booklet includes well-designed visual sequencing cards, social stories, and a picture dictionary.

Helping Your Child Overcome Fear of the Dentist and Develop Lifelong Oral Hygiene Habits. In this resource shared by Solving Autism, readers will find a brief overview of the common challenges observed in children with autism, tips for finding the right dentist including helpful questions to ask, and proactive strategies in preparation for the visit. There is also a user-friendly set of suggestions for developing sound oral hygiene habits.

Autism and Dental Care: A Guide for Their Oral Treatment. In this resource, Drs. Greg Grillo and David Hudnall offer many helpful strategies in preparing for upcoming dental visits, as well as tips and techniques to promote the development of proper oral health habits. They discuss sedation as well as the benefits of splitting examination components over multiple visits. This resource is available in Spanish (Autismo y el Cuidado Dental) and also refers to a blog in Spanish.

Dental Health Guidance for Parents and Caregivers of Children with Autism Spectrum Disorder. This fact sheet put together by the Washington State Department of Health and University of Washington’s DECOD (Dental Education in the Care of Persons with Disabilities) Program provides a very helpful list of questions to guide initial conversations with the dentist. It includes an array of tips and strategies to prepare for the visit, as well as some action items for the day of the visit.

Resources for Dental Professionals:

Autism Dental Information Guide for Professionals. This guide has been created by SARRC for dental professionals. Besides information on relevant dental issues associated with ASD, and what to expect with a patient with ASD, the guide offers valuable input on specific items to include in a welcome package. An important strategy for an individual with ASD to have a successful visit to a dental clinic is the preparedness of the professional and the patient for the experience. The guide offers suggestions such as sending pictures of the dental team and the office prior to the visit and providing pamphlets (when appropriate) and parent questionnaires to learn about existing behavioral challenges and sensory preferences towards preparedness.

Autism Speaks Dental Toolkit. The dental toolkit by Autism Speaks is aimed at both parents and professionals. Specifically, the 10-minute video has advice from dental experts with experience treating patients with ASD and highlights the importance of rapport-building for a successful experience. The toolkit also offers a visual schedule that dental professionals can adapt to help their patients anticipate and tolerate the different steps and activities that will occur during their visit to the clinic. Autism Speaks also offers a detailed task analysis for toothbrushing. As is the case with every task analysis, this should be individually tailored to target the child’s needs, skills, and deficits.

University of Washington’s Fact Sheet for Professionals.  This fact sheet put together by the Washington State Department of Health, and University of Washington’s DECOD outlines the symptoms of ASD, commonly associated comorbid conditions, and strategies for dental professionals to manage patients with autism. This resource offers guidance for promoting cooperation in the dental chair and specific tips on techniques to use before and during the appointment. In addition, seizure management during treatment, and ways to handle visible signs of trauma are briefly summarized. This is important given that many individuals with autism develop seizure activity. An analogous Fact Sheet for Dental Professionals has also been developed for ADHDDown Syndrome and cerebral palsy.

National Institute of Child Health and Human Development Resource Center (NICHD)’s Practical Oral Care for People with Autism. This is a handbook for oral care physicians created by the NICHD in collaboration with the National Association of Dental and Craniofacial Research. The booklet is one in a series on providing oral care for people with developmental disabilities including ASD, Cerebral Palsy, Downs Syndrome, and intellectual disability. The autism handbook lists the issues and oral health challenges common in individuals with ASD and provides care strategies for them. Specific ways to prepare for patients who present with “unusual and unpredictable body movements” and sensitivity to sensory stimuli are offered.

Dental Care – Continuing Education course. Dental Care offers a free continuing education course for dental professionals, with an aim to promote understanding of ASD and prepare learners to serve patients with this diagnosis. The course content is extensive and provides modules on creating a sensory friendly office, developing an office protocol for patients with ASD, utilizing a visual schedule, and behavior management strategies to increase appropriate behavior. The course is intended for all types of dental professionals as well as dental students, and is self-instructional.

Dental Exam Tolerance with Dr. Kelly McConnell — ABA Inside Track. This 1 hour and 22-minute podcast with Dr. Kelly McConnell by ABA Inside Track showcases recent behavior analytic research to help children with autism better tolerate dental appointments. It mentions strategies that could be considered when children with autism meet with their dentists, as well as things to avoid. A distinction is made between desensitization and graduated exposure as the latter may be a more accurate description of the procedures typically used.  As shared throughout many of the resources described in this article, it was discussed that adjustments and increased demands should be made gradually.

We hope you will find these resources beneficial whether you are an individual with autism, a family member to someone with autism, an education or behavioral professional, or a dental care professional. We will continue to update this annotated list and reshare with our readers as new resources become available. Together, we can help to make dental visits successful for people with autism. Please consider sharing this article with clients, friends, and colleagues.

References:

Bai, N. (2020, February 24). For patients with special needs, any dentist is hard to find.    https://www.ucsf.edu/news/2020/02/416726/patients-special-needs-any-dentist-hard-find

Dao L. P., Zwetchkenbaum S., & Inglehart M. R. (2005) General dentists and special needs patients: Does dental education matter? Journal of Dental Education, 69(10), 1107-15. PMID: 16204676.

Citation for this article:

Celiberti, D., Sivaraman, M., & Gupta, Y. (2021). Consumer Corner: An updated and annotated list of online resources for promoting dental hygiene and success with dental care. Science in Autism Treatment, 18(5)

Please also see other related ASAT articles:

A Non-exhaustive list of recent research in the area:

Allen, K. D., & Wallace, D. P. (2013). Effectiveness of using noncontingent escape for general behavior management in a pediatric dental clinic. Journal of Applied Behavior Analysis, 46, 723-737. https://doi.org/10.1002/jaba.82   

Altabet, S. (2002). Decreasing dental resistance among individuals with severe and profound mental retardation. Journal of Developmental and Physical Disabilities, 14, 297-305. https://doi.org/10.1023/A:1016032623478  

Appukuttan, D. P. (2016). Strategies to manage patients with dental anxiety and dental phobia: Literature review. Clinical, Cosmetic and Investigational Dentistry, 8, 35-50. https://doi.org/10.2147/CCIDE.S63626   

Blitz, M., & Britton, K. C. (2010). Management of the uncooperative child. Oral and Maxillofacial Surgery Clinics of North America, 22(4), 461-469. https://doi.org/10.1016/j.coms.2010.08.002   

Carter, L., Harper, J. M., & Luiselli, J. K. (2019). Dental desensitization for students with autism spectrum disorder through graduated exposure, reinforcement, and reinforcement fading. Journal of Developmental and Physical Disabilities, 31, 161-170. https://doi.org/10.1007/s10882-018-9635-8   

Chandrashekhar, S., & Bommangoudar, J. S. (2018). Management of Autistic Patients in Dental Office: A Clinical Update. International Journal of Clinical Pediatric Dentistry11(3), 219–227. https://doi.org/10.5005/jp-journals-10005-1515

Cuvo, A. J., Godard, A., Huckfeldt, R., & Demattei, R. (2010). Training children with autism spectrum disorders to be compliant with an oral assessment. Research in Autism Spectrum Disorders, 4, 681-696.

Delli, K., Reichart, P. A., Bornstein, M. M., & Livas, C. (2013). Management of children with autism spectrum disorder in the dental setting: concerns, behavioural approaches and recommendations. Medicina Oral, Patologia Oral y Cirugia Bucal18(6), e862–e868. https://doi.org/10.4317/medoral.19084

Du, R. Y., Yiu, C. K., & King, N. M. (2019). Oral health behaviours of preschool children with autism spectrum disorders and their barriers to dental care. Journal of Autism and Developmental Disorders, 49(2):453-459. https://doi.org/10.1007/s10803-018-3708-5.  

Fakhruddin, K. S., Yehia, H., & Batawi, E. (2017). Effectiveness of audiovisual distraction in behavior modification during dental caries assessments and sealant placement in children with autism spectrum disorder. Dental Research Journal, 14(3), 177-182.

Ferrazzano, G. F., Salerno, C., Bravaccio, C., Ingenito, A., Sangianantoni, G., Cantile, T.  (2020). Autism spectrum disorders and oral health status: Review of the literature. European Journal of Paediatric Dentistry, 21(1):9-12. https://doi.org/10.23804/ejpd.2020.21.01.02.

Friedlander, A. H., Yagiela, J. A., Paterno, V. I., & Mahler, M. E. (2006) The neuropathology, medical management and dental implications of autism. Journal of the American Dental Association, 137(11): 1517-1527. https://doi.org/10.14219/jada.archive.2006.0086  

Hernandez, P., & Ikkanda, Z. (2011). Applied behavior analysis: behavior management of children with autism spectrum disorders in dental environments. Journal of the American Dental Association,142(3):281-7. https://doi.org/10.14219/jada.archive.2011.0167

Jaber M. A. (2011). Dental caries experience, oral health status and treatment needs of dental patients with autism. Journal of Applied Oral Science: Revista FOB, 19(3), 212–217. https://doi.org/10.1590/s1678-77572011000300006  

Loo, C., Graham, R., Hughes, C. (2008) The caries experience and behavior of dental patients with autism spectrum disorder. Journal of the American Dental Association, 139, 1518-1524. https://doi.org/10.14219/jada.archive.2008.0078.

Marion I. W., Nelson T. M., Sheller B., McKinney C. M., & Scott J. M. (2016). Dental stories for children with autism. Special Care in Dentistry, 36(4):181-6. https://doi.org/10.1111/scd.12167.

McConnell, K. L., Sassi, J. L., Carr, L., Szalwinski. J., Courtemanch, A., Njie-Jallow, F., & Cheney, W. R. (2020). Functional analysis and generalized treatment of disruptive behavior during dental exams. Journal of Applied Behavior Analysis 53(4), 2233-2249. https://doi.org/10.1002/jaba.747   

Ming, X., Brimacombe, M., Chaaban, J., Zimmerman,-Bier, B., Wagner, G. C. (2008). Autism Spectrum Disorders: Concurrent Clinical Disorders. Journal of Child Neurology, 23, 6-13. https://doi.org/10.1177/0883073807307102

Nelson, T., Chim, A., Sheller, B. L., McKinney, C. M., & Scott, J. M. (2017). Predicting successful dental examinations for children with autism spectrum disorder in the context of a dental desensitization program. The Journal of the American Dental Association, 148(7), 485-492. https://doi.org/10.1016/j.adaj.2017.03.015  

Nelson, T. M., Sheller, B., Friedman, C. S., & Bernier, R. (2015). Educational and therapeutic behavioral approaches to providing dental care for patients with Autism Spectrum Disorder. Special Care in Dentistry, 35(3). 105-113. https://doi.org/10.1111/scd.12101

O’Callaghan, P. M., Allen, K. D., Powell, S., & Salama, F. (2006). The efficacy of noncontingent escape for decreasing children’s disruptive behavior during restorative dental treatment. Journal of Applied Behavior Analysis, 39(2), 161-171

Stark, L. J., Allen, K. D., Hurst, M., Nash, D. A., Rigney, B., & Stokes, T. F. (1989). Distraction: its utilization and efficacy with children undergoing dental treatment. Journal of Applied Behavior Analysis22(3), 297–307. https://doi.org/10.1901/jaba.1989.22-297

Virdi, M. S. (2011). Application of contingency management in pediatric dentistry practice. Journal of Innovative Dentistry, 1(1), 1-4.

About The Authors

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

Maithri Sivaraman is a BCBA with a Masters in Psychology from the University of Madras and holds a Graduate Certificate in ABA from the University of North Texas. She is currently a doctoral student in Psychology at Ghent University, Belgium. Prior to this position, Maithri provided behavior analytic services to children with autism and other developmental disabilities in Chennai, India. She is the recipient of a dissemination grant from the Behavior Analysis Certification Board (BACB) to train caregivers in function-based assessments and intervention for problem behavior in India. She has presented papers at international conferences, published articles in peer-reviewed journals and has authored a column for the ‘Autism Network’, India’s quarterly autism journal. She is the International Dissemination Coordinator of the Association for Science in Autism Treatment (ASAT). 

Yash Gupta is a 9th grader attending high school in California. Yash has a family member with autism and has been volunteering for the Association for Science in Autism Treatment on a variety of projects. In his spare time, he enjoys playing tennis and drawing and partakes in the Boy Scouts and debate. He is working to broaden his experience with autism research and aspires to pursue a career in the medical field. His goal is to spread awareness about ASD, so that people with autism are better treated and represented in society. 

Posted in ABA

Returning To School After Virtual Learning

On my first day returning to the office after over a year of working from home and Zoom, I felt as if I had lost all of my leaving-the-house skills. What shoes did I wear? What could I pack for lunch? Did I have time to drink my coffee at home or would I need to bring a travel mug? Where I used to be able to make it out the door 45 minutes after waking up, I suddenly was running 20 minutes late. What had been years of routine was now completely unfamiliar.

Many of us will probably be feeling the same way, including our students with Autism. How do we possibly ease this transition? Below are a few suggestions, and we’d love to hear any you may have as well. 

  1. Offer choice whenever possible. Access to choice is motivating for many kids, and can be a balm in instances where so much is out of their control. You can provide choices with what they pack for lunch, what outfits they wear, or what fun activity they can do when they return home from their first day back to school.
  2. Create alerts and schedules. Have your kid participate in creating a basic schedule, setting alarms, or putting alerts in your smartphone for new activities added to the schedule. Another benefit of creating a schedule is that you can add fun events/activities in with the new required activities.
  3. Identify supports within the school. Many schools and teachers are creating their own plans to ease the transition. Find out what your school and/or your child’s classroom teacher are doing, and see what you can do to support that plan or carry it over into your home.
  4. Practice the new transitions. Role-play the new routine as much as possible. This could be as simple as setting the alarm for the new wake-up time; or it can be more complex in that you wake up, go through the morning routine, and practice the drive to school. Practice will help your child adjust to the new routine, but will also alert you to any potential problems without the added stress of having to complete the routine in its entirety.
  5. Prep what you can in advance. Set out clothing the night before, prep lunches in advance with your child, or set a time with a fellow parent for children to meet prior to walking into the school.
  6. Use tools that have been successful in the past. Reflect on transitions that have been challenging in the past for your child. What strategies worked in those instances? How could those strategies be implemented now to ease this transition?
  7. Prepare your child for additional changes. There are many changes that will be outside of your control. It’s possible the school will change (or has already changed) its re-open date, or that it will close again after re-opening. It can be helpful to state this possibility for your child, and tell them what you’ll do if plans change.
  8. Check in. Set aside time to check in with your child. One game that can be fun for check-ins is “high, low, buffalo.” Here, you and your child each share a high point of your day (high,) a low point of our day (low,) and a something else funny or fun or interesting about your day (buffalo.) Providing this structure can be a great way to normalize check-ins and ensure that you are addressing any issues that may arise during the transition.

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