ABA Tools of the Trade: A book review from ASAT!

This month’s ASAT feature comes to us from Karrie Lindeman, EdD, BCBA-D, LBA and David Celiberti, 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!

Save 20% on ABA Tools of The Trade and our Tools of the Trade kit now through June 17th!

Data collection is the core of the success of our science. Without data, are we are not providing behavior analytic service to our clients; however, data collection can be a scary new journey for many. What do I collect? How do I collect it? What do I put it on? How do I manage the other children in the class? What do I do with the data once I have it? How do the data guide my decision-making? All of these questions pose roadblocks to the individuals attempting the collection.

To date, many training manuals and books have attempted to provide insight and guidance for struggling data-collection newbies. Some of these books have fallen short of delivering a clear and concise message to its readers. ABA Tools of the Trade provides a unique take at explaining the what, why, and most importantly, the “how-to” of data collection.

The authors start off describing the purpose of the book, addressing concerns that teachers and technicians face in the field every day: Why am I doing this? And how can I create easy to navigate data sheets with simple graphs for analyzing after I have collected the data? ABA Tools of the Trade breaks down their material into five sections which simplify the anatomy of a data sheet, review different types of data collection systems available, discuss how to utilize them with simple behavior change procedures, and offer activities to ensure supervisees are competent (huge bonus!). Throughout the sections, the material is organized in a way to help you identify exactly what you need to do, with helpful vignettes providing real-world examples.

The breakdown of the five sections allows the reader to easily find the information they are looking for, along with supporting documents. The first section delves into the Anatomy of Data Collection, describes not only why we collect data, but how to do so in the most simplistic way. This section is great for someone new to data collection or looking to expand their practice. A bonus includes describing different tools that may be helpful in your data collection journey with informative descriptions and visuals. Examples include tally counters, interval timers, and time timers, to name a few. A useful hints page highlights how the specific tools can be matched to the different measures of behavior that need to be tracked.

The second section is the Data Collection Systems sectionwhich describes more complex systems and strategies that work in different settings. It starts off with a comprehensive list of 10 rules of data collection. These rules are extremely important as they lay the groundwork for ethical data collection and reviews potential issues that may arise as you begin to collect data. These include examples of consent issues, confidentiality mishaps, and an important reminder to adhere to state and local laws. Finally, a handy task analysis of data collection steps provides a simple way for readers to grasp the needed components for specific targeted behaviors and wraps up the section.

The third and fourth sections include Behaviors and Simple Behavior Change Systems, which describes the Functional Behavior Assessment and Behavior Intervention Plan process in user-friendly terms. This is a great introduction for those starting out and looking to brush up on appropriate procedures. This section reviews what qualifies as efficient data collection in an FBA and how to analyze results. An added bonus is the discussion on antecedent strategies, which provides the reader with tactics and corresponding examples. Following the breakdown, vignettes of very specific behavioral episodes are provided, which allow the reader to apply the knowledge derived from the reading in everyday situations. Each vignette is followed by a general solution and helpful hints on dealing with the presented issue. For those interested in learning more about the topic, references and recommended readings are provided after all examples. Great source!

The fifth and final section, Supervision Practices, is a bonus for those supervising candidates for board certification in behavior analysis. It is comprehensive, well organized, and synched with the 5th Edition of Task List providing not only lessons but scenarios for practice with corresponding rubrics. Please note, as the Task List is updated, the alphanumeric codes may change. Three phases are addressed:

  • The Pre-Data Collection Phase addresses information gathering from parents and professionals surrounding prior attempts to address behavior (what was implemented and for how long) including defining behavior and determine how best to measure it.
  • The Data Collection Phase involves implementing the data collection system and making timely modifications, as well as proper training of the data collectors and determining an adequate schedule. Interobserver agreement is also addressed.
  • The Post-Data Collection Phase involves reviewing the collected data, preparing for graphic representation, and using data-based decision making.

Given that many newly credentialed BCBAs are assuming a supervisory role for the first time, this section is very helpful. Learning objectives and activities for each lesson are clearly articulated and rubrics are provided to support application and assess the skill level of the supervisee.

This short, well-organized, and easily-accessible resource belongs on the shelves of those first working towards BCBA certification, BCBAs who are starting out, and current BCBAs providing Registered Behavior Technician and BCBA supervision. The content spans all data collection needs, from the very basics on how to ensure those we supervise understand and demonstrate necessary skills from the Task List. It would also be a practical, yet easy supplemental read for students progressing through their coursework in college programs. To maintain quality service, it is imperative to ensure the next generation of BCBAs have the skills necessary to provide and supervise quality service provision. The inclusion of sections related to modifying one’s behavior as well as supervisory considerations only strengthen the utility of this already informative guide. This book is a great resource, and recommended without reservation!


About The Authors

Karrie Lindeman completed her undergraduate degree at C.W. Post University with a major in psychology. She went on to Queens College to complete her Masters in Psychology and advanced certificate in Behavior Analysis. From here, she worked in a school for children with autism for 10 years before moving on to consult in the public school and early intervention setting. Karrie completed her doctorate in learning and teaching at Hofstra University in 2015. She continues to provide direct service, parent training, and consultation in a variety of settings. Karrie is currently the Program Director of the Behavior Analysis program at Touro College in New York City.

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 Co-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.

Ideas for Interactive Play For Learning

Creating opportunities for interactions is key when working with any child, but it is especially important when working with children with autism. ABA often gets a bad rap for being staid or leaving a kid stuck at a table doing discrete trials for hours on end. In reality, it should be neither! While I do discrete trials in my practice, my biggest priority is always focused on increasing learning opportunities by taking advantage of the child’s natural motivations. This typically means leaving the table, so I alternate between discrete trials and lots of teaching through games and activities. Here are a few of my favorites:

Toss & Talk
For this activity, I usually use a large ball, a soft ring, or something else the child can toss. I name a category, and we take turns tossing the ball (or other item) and naming an item from that category. The game can be easily modified for whatever you’re working on: counting, skip counting, or even vocal imitation. I like the game because it’s simple, it provide a back-and-forth that is similar to a conversation, and it can easily be modified to include peers, siblings, or parents. This is particularly great if your learner likes throwing balls, but I’ve also modified it to push a train back and forth or take turns hopping towards one another.

Play Dough Snake
This game is one I saw a preschool teacher use years ago and have had great success with. In this game, I simply create a snake out of play dough. I make a large opening for the snake’s mouth, then roll up little balls of dough that will be “food.” I tell the child that we are going to pretend the play dough is food. I have a silly snake voice, and I tell the child “I’m so hungry. Do you have something I can eat?” The child picks up a piece of the rolled-up play dough, tells me what kind of food it is, and then feeds it to the snake. I pretend to love it, and the little ball of play dough becomes incorporated into the snake’s play dough body (which is great, because the more “food” the snake eats the bigger it gets.) I can expand the game to have the snake dislike certain foods or tell the child he is too full. On several occasions, the learner has asked if they can be the snake, which is fantastic! This is another great game for peer play, sibling play, and modeling.

Pete’s A Pizza/You’re A Pizza
One of my favorite books for young learners is Pete’s A Pizza by William Steig. In this book, it’s a rainy day and Pete’s parents entertain him by pretending they are making him into a pizza: they roll up the “dough,” toss him in the air, add toppings, etc.
This is another game I saw a preschool teacher using during play time, and one I’ve used with many, many students. Sometimes I read the book beforehand, but if my learner’s level of comprehension or attention span is not appropriate for the book, I can just introduce it as a standalone game. I say, “It’s time to make a pizza!” Then, we get into the fun part of rolling the learner around, tossing him on a couch or mat, etc. This can generate a lot of language, work on sequencing, and provide a lot of opportunity for requesting activities.

Anything with a Parachute
My parachute is one of my best purchases of all time. I use it often and it allows me to play a wide range of games. Besides just having the learner lay on the floor and have the parachute float down onto his/her body, it is a highly motivating toy for a range of activities. Many of my learners love just pulling that large item out of it’s small bag. I’ve already written about three games I frequently play with the parachute. You can see that here.


Songs

Repeating rhymes and songs with motions that your learner loves can provide anticipation of an activity that may increase eye contact and manding. One of my favorites is shown in a video here. While this video is shown with toddlers, I’ve used it with kids up to 6 or 7 years old. Similar activities might include Going on a Bear Hunt; Heads, Shoulders, Knees, and Toes; and Animal Action.

It’s important to note that none of these activities is beloved by every learner I encounter. The idea is to have a range of possible activities to learn which ones are motivating to your learner, then use those to create opportunities for language and interaction.


WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

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

ABA Journal Club: A Response From Elizabeth A. Drago, M.A., BCBA, LBA

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

  • The researchers trained caregivers on a university campus using the BST model prior to home visits. In your current work, would this be a possibility for you? If not, how could you provide this type of training to caregivers? What obstacles can you predict, and how might you address them?

The majority of my clinical practice is primarily situated in home-based settings.  Delivering behavior analytic services in home-based settings presents with a multitude of circumstances contributing to variable rates of success in teaching new skills for both the client and caregivers.  Two variables contributing to such challenges in service delivery is caregiver accessibility and limited service hours allotted, particularly if the services are funded through insurance-based sources.  Formal Behavior Skills Training (BST) often requires time intensive performance and competency- based components, creating a challenge to implement in the home setting at times. With careful planning and caregiver commitment to participation, BST training in the home setting is quite “do-able”.

To address time constraints, a ‘train the trainer’ model or pyramidal training (Pence, St. Peter, & Tetreault, 2012), may be a beneficial strategy to assist in training multiple caregivers as well as contribute to increased proficiency in treatment fidelity.  A pyramidal training model involves a senior trainer (e.g., a behavior analyst) training a small group of staff or caregivers who in turn train other staff or caregivers.  This type of training model may be particularly beneficial to clinicians working in settings where time constraints may be a factor (such as residential services).  

  • Discuss the multiple baseline design used in the study. How does it demonstrate experimental control? What can you determine from a visual analysis of the data?

The researchers in this study utilized a concurrent multiple-baseline-across-modules design to analyze the effects of the BST module training delivered to parents to teach their children mands. Concurrent multiple-baseline-across modules design allows for simultaneous measurement to occur for all clients. Research suggests concurrent measurement controls better for threats to internal validity and result in somewhat stronger inferences than do nonconcurrent designs (Watson and Workman, 1981). Multiple baseline designs are appropriate when target behaviors are not reversible. Use of a concurrent multiple-baseline design to evaluate treatment effectiveness minimizes the ethical concerns related to a withdrawal design. Training skills sequentially using a multiple-baseline-across-modules design is beneficial since it allows trainers to teach skills gradually and gave trainees repeated rehearsal opportunities on previously trained skills. The trainer could also monitor ongoing caregiver performance and make decisions to advance caregivers through the training based on the consistency and accuracy of their performance on trained skills.  Researchers of the study required caregivers to reach specific mastery criterion rates to advance to additional modules in the BST to assess the maintenance of the caregiver’s accuracy of procedural integrity and the child’s mands.

Upon visual analysis of the data, results of the study support effects of a BST model for training caregivers to implement mand training procedures.  In addition, after training, caregivers did not exhibit difficulties generalizing the skills to implement mand training procedures to the child.  Additional training was provided to caregivers during sessions with the child when mastery criterion was not achieved.  The researchers found by staggering the training across modules, caregivers learned to capture and contrive motivating operations contributing to the emergence of spontaneous mands.

  • Part of this study included a measure of whether a competently trained parent could teach their spouse how to implement mand training. Why is this important? Have you implemented similar strategies in your own work?

Training caregivers to effectively generalize behavior analytic treatment strategies and interventions to the child outside of training sessions is one of the goals of family support behavior analytic services.   Strategies to fade out the necessity of behavior analytic services is developed in the client’s treatment plan at the initiation of services.   Delivering BST to a caregiver who demonstrates proficiency of the designated steps is invaluable in the treatment process.  Through BST,  trained caregivers who have demonstrated mastery of a skill, have the ability to train additional caregivers (e.g., grandparents and siblings) in the client’s environment, facilitating generalization of treatment effects. 

In addition, research has supported the finding that providing caregivers with training and education to increase their family member’s functional skills (such as communication) may reduce caregiver stress by increasing the caregiver’s confidence levels (Bebko et al. 1987).  Researchers have also found that parents who reported high levels of confidence in managing their child’s major difficulties and perceived others in the family as similarly successful also reported lower stress rates (Sharpley and Bitsika 1997).

In my practice, I utilize BST to teach caregivers skills related to communication and socialization training and areas of daily living such as toileting, dressing, toothbrushing and community safety.  I recently utilized BST to teach a modified PECS (Picture Exchange Communication System) to a client’s caregivers. After reaching fluency criteria for each step of the target skill, the trained caregiver was capable of effectively training the modified PECS procedure to the second caregiver.  Success rates for each steps of the BST procedure were measured by observation, data collection and data analysis of procedural integrity demonstrated by the second parent during sessions with the client.  Success rates were also measured by data analysis  of the client’s rate of progress in reaching various communication targets via use of the modified PECS taught by caregivers. 

  • This study did include maintenance data. Why is this data valuable? Do you collect maintenance data on the caregiver training you provide?

According to Alberto & Troutman, 2013, ‘maintenance’ is defined as “performing a response over time, even after systematic applied behavior procedures have been withdrawn”.  Maintenance is demonstrated over time when the skill continues to occur after all direct teaching of the particular skill has been discontinued. 

 Maintenance data could also be utilized to assist in shaping additional skills.  For example, prior to teaching a client receptive discrimination skills related to picture identification in a field of 3 stimuli, it is important to evaluate the presence or absence of certain prerequisite skills such as attending, gesturing (i.e., pointing or eye gaze), following direction and ability to identify objects depicted in the array.  Without information gathered from maintenance skill probes (i.e., attending, pointing, tact repertoire, etc.), teaching the skill of receptive discrimination may not be possible if the client has not exhibited mastery of specific prerequisite skills first.

During skill acquisition training, I typically teach a targeted behavior until the recipient exhibits fluency in exhibiting that behavior.  The computer- generated data system I utilize in my practice includes pre-set monitoring schedules of maintenance data based upon a timed schedule.  Maintenance probes are automatically scheduled in a staggered fashion.  For example, if the client exhibits proficiency in engaging in a specific skill during baseline, that skill is automatically scheduled for a maintenance probe on a monthly basis.  If a client reaches fluency of a specific skill after commencement of treatment, the target is scheduled for maintenance in a staggered time frame (i.e., weekly, bi-weekly, monthly, bi-monthly and annually). After the client reaches mastery criterion for annual maintenance, the target is considered ‘closed’.  If at any time the target fails maintenance, the target is added back into treatment.  

If a clinician is teaching skills to fluency, the necessity of relying on maintenance data to determine if the skill remains in that client’s behavior repertoire becomes less relevant. 

  • Consider a particular skill you are teaching one or more clients. What would BST look like to teach caregivers how to implement the necessary procedures for teaching that skill?

A particular skill BST could be utilized to teach is use of utensils during mealtime.

Instruction – For this step, if a client exhibits adequate receptive skills related to vocal/verbal instruction, one may say to the client, “When you eat certain foods, such as spaghetti or vegetables, you use a fork to pick the food up. You wouldn’t use a fork to eat foods such as cereal or pudding.”

If the client does not exhibit adequate receptive language skills, one may describe the skill to the caregiver.  For example: “We teach the skill of eating with utensils to assist with independent functioning.  We will practice this skill first, with a fork and upon reach specific mastery criteria, we will proceed in teaching use of additional utensils, such as a spoon.  It’s best to practice this skill when motivation to eat is high in order to increase rate of reinforcement and eventually, acquisition of mastery criteria (i.e., if the client is hungry, his motivation to follow the rule to use a fork to eat may be higher compared to times when he is not hungry). Reinforcement for use of the fork is naturally built in, as the food he eats with the fork will serve as reinforcement for the targeted behavior.”

Along with vocal/verbal instruction of the BST steps, I may also provide the caregiver with written steps to the procedure to assist with fluency.

Modeling – For this step, during mealtime, I model the steps described above to the caregiver.  I provide a description of each step as the step is being performed to the caregiver.

Rehearsal –For this step, encourage the caregiver to implement the steps to practice the skill.  During these practice sessions, data recording is critical to determine fluency of the practice of the targeted skill.

Feedback – Prior to this step, I discuss with the caregiver the form of feedback they prefer to receive (in-situ feedback or feedback after each trial session has ended).   Throughout my career I have learned the importance of tailoring my delivery of feedback to individual preference (some caregivers prefer feedback while they are performing the step, while others prefer to receive feedback after they have completed the step).  Once I have determined the timing of my feedback, I deliver the feedback in the context agreed upon.

  • The article states, “General instructions were provided prior to baseline, but parents were only able to implement the procedures effectively when full instructions, modeling, rehearsal and feedback were used to train to mastery.” How can you change your current practice to ensure that you are providing the necessary steps to help caregivers master skills they have selected for parent training?

To streamline the often time-intensive process BST requires, I typically stagger the trainings across multiple sessions.  Delivery of insurance-based family training services is generally provided in a time intensive and structured fashion. To meet these stringent guidelines and to ensure I deliver the most effective and efficient services, I provide the caregiver with written and verbal steps to BST across several consecutive sessions.  I review each step with the caregiver and assign weekly assignments to practice specific steps.  During each family training visit, I review and model the steps and request the caregiver to perform the step they worked on the week prior.  After the caregivers reach specific fluency rates in responding accurately,  additional steps are introduced.  

One method of training I may consider including in my caregiver trainings when delivering BST, is use of video modeling.  Video modeling is a teaching procedure that involves an individual viewing a videotaped sample of a model performing a specific, scripted activity or task. Immediately following having viewed the video-based model, the individual is directed to perform the activity or script he or she observed in the video (e.g., MacDonald, Clark, Garrigan, & Vangala, 2005). Use of video modeling may further address time constraints to training that is often a barrier in delivery of home-based services.  Video modeling may also assist in in higher rates of procedural integrity when working with caregivers who learn more effectively through use of visual guides as opposed to textual guides only.

BST is an incredibly invaluable method of teaching new skills.  With careful planning and commitment to learning, caregivers have a unique opportunity to actively participate in their family member’s treatment to help them engage in socially meaningful ways.

References

Alberto, P., & Troutman, A. C. (2013). Applied behavior analysis for teachers. Boston: Pearson.

Bebko JM, Konstantareas MM, Springer J. Parent and professional evaluations of family stress associated with characteristics of autism. Journal of Autism and Developmental Disorders. 1987; 17:565–576.

MacDonald, R., Clark, M., Garrigan, E., &Vangala, M. (2005) Using video modeling to teach pretend play to children with autism. Behavioral Interventions, 20, 225-238. 

Parsons M. B., Rollyson J. H., Reid D. H. Evidence-based staff training: A guide for practitioners. Behavior Analysis in Practice. 2012; 5:2–11. 

Parsons, M. B., Rollyson, J. H., & Reid, D. H. (2013). Teaching Practitioners to Conduct Behavioral Skills Training: A Pyramidal Approach for Training Multiple Human Service Staff. Behavior analysis in practice6(2), 4–16. doi:10.1007/BF03391798.

Pence S. T., St. Peter C. C., Tetreault A. S. Increasing accurate preference assessment implementation through pyramidal training. Journal of Applied Behavior Analysis. 2012;45:345–359.

Sharpley, C. F., & Bitsika, V. (1997). Influence of gender, parental health, and perceived expertise of assistance upon stress, anxiety, and depression among parents of children with autism. Journal of Intellectual and Developmental Disability, 22, 19–29.

Watson, Paul & A. Workman, Edward. (1981). The non-concurrent multiple baseline across-individuals design: An extension of the traditional multiple baseline design. Journal of behavior therapy and experimental psychiatry. 12. 257-9.


Elizabeth A. Drago, M.A., BCBA, LBA, is a Board Certified and Licensed Behavior Analyst and a consultant at Proud Moments Therapy located on Long Island, New York and Comprehensive Behavior Supports, located in Brooklyn, NY.  She has over 15 years’ experience working with individuals with developmental and related disabilities and has advanced training in areas of autism, behavior disorders, sleep disorders, intellectual disabilities and positive behavior supports.  As a consultant in home and educational settings, she clinically oversees client cases, provides parent training, implements comprehensive skill assessments and programming goals for children diagnosed with ASD, conducts staff trainings for effective performance improvement practices and behavior analytic practices and procedures. She holds professional memberships in organizations such as New York State Association for Applied Behavior Analysis, Association for Behavior Analysis International, Association of Professional Behavior Analysis.

Elizabeth is a Board member of the New York State Association for Behavior Analysis (NYSABA), serving the role of Representative at Large. She is also an active member of NYSABA’s Legislative Committee, focusing on efforts to remove the licensure scope of practice restriction in Behavior Analysis in New York State. Elizabeth has contributed significantly to disseminating information related to the scope restriction in Behavior Analysis in NYS. Some of Elizabeth’s achievements in these efforts include developing initiatives such as the video series entitled, ‘This is ABA’.  The purpose of the video series is to highlight the effectiveness and applicability of the practice of Behavior Analysis to individuals of varying diagnoses, not only for those diagnosed with an Autism Spectrum Disorder. This video series is currently featured on the NYSABA website.   Elizabeth also works collaboratively with NYSABA’s Executive Director, Mari Wantanbe-Rose in the development and oversight of NYSABA’s Inaugural ABA Ambassador Award. The NYSABA ABA Ambassador Award recognizes future behavior analysts, or students, who help to disseminate the usefulness and versatility of behavior analysis in various settings.

Elizabeth has presented at NYSABA’s annual professional conference on the topics of Systematic Desensitization (2017) and Self-Care for the Behavior Analyst (2018). She has been invited as a speaker at a roundtable meeting at Proud Moments ABA, presenting on the topic of the use of technical jargon when interacting with caregivers. Elizabeth has also been featured in a newsletter (August 2018 edition) generated by Comprehensive Behavior Supports in recognition of the many significant contributions to the agency and families she serves across Long Island as a Licensed and Board Certified Behavior Analyst.  Elizabeth has been a guest speaker on a Behavior Analytic podcase, ‘Behaviorbabe’, hosted by Dr. Amanda Kelly, discussing the NYS licensure law scope restriction on the practice of Behavior Analysis in NYS. Elizabeth received a Bachelor’s Degree in Clinical Psychology from St. John’s University, graduating Summa Cum Laude. She continued her education, earning her Master’s Degree in Clinical Psychology at Teacher’s College, Columbia University, where she received an honors certificate in education and teaching and was a member of Kappa Delta Phi- Honor Society in Education.   Elizabeth attended post-graduate studies at Penn State University, where she completed coursework in Applied Behavior Analysis.  She earned her BCBA certification and licensure in Behavior Analysis in 2014.

ABA Journal Club #5: Caregivers as Interventionists

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

There is a wealth of studies demonstrating that training caregivers to implement interventions is valuable for generalization of skills, improved learner outcomes, and decreases caregiver stress. While many teachers, behavior analysts, and other practitioners work to train caregivers; these practitioners are rarely given specific training on how to train caregivers.

In this month’s journal club article, behavior skills training (BST) is utilized to teach caregivers to be interventionists. BST is a model that involves instruction, modeling, rehearsal, and feedback. We hope this article will get you talking about your current level of training with BST and how your organization can improve in training practitioners to teach caregivers to implement behavior analytic strategies.

Loughrey, T. O., Contreras, B. P., Majdalany, L. M., Rudy, N., Sinn, S., Teague, P., … & Harvey, A. C. (2014). Caregivers as interventionists and trainers: Teaching mands to children with developmental disabilitiesThe Analysis of Verbal Behavior30(2), 128-140.

  • The researchers trained caregivers on a university campus using the BST model prior to home visits. In your current work, would this be a possibility for you? If not, how could you provide this type of training to caregivers? What obstacles can you predict, and how might you address them?
  • Discuss the multiple baseline design used in the study. How does it demonstrate experimental control? What can you determine from a visual analysis of the data?
  • Part of this study included a measure of whether a competently trained parent could teach their spouse how to implement mand training. Why is this important? Have you implemented similar strategies in your own work?
  • This study did include maintenance data. Why is this data valuable? Do you collect maintenance data on the caregiver training you provide?
  • Consider a particular skill you are teaching one or more clients. What would BST look like to teach caregivers how to implement the necessary procedures for teaching that skill?
  • The article states, “General instructions were provided prior to baseline, but parents were only able to implement the procedures effectively when full instructions, modeling, rehearsal, and feedback were used to train to mastery.” How can you change your current practice to ensure that you are providing the necessary steps to help caregivers master skills they have selected for parent training?

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

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

How to Avoid Prompt Dependence in Teaching Students with Autism

“She won’t say hi unless I say ‘Say Hello.’” “He will only wash his hands if I put his hand on the knob to turn on the water.” “He won’t use his fork until I put it in his hand.”

I hear statements like this all the time from both parents and providers working with learners what autism. What they are describing is “prompt dependence,” which is when a learner requires a prompt from a teacher or parent in order to complete a task. So how do you avoid prompt dependence with your own learners?

Let’s start with the prompt itself. There are many different ways to prompt which can be divided into levels by how intrusive the prompt is. Below is a sample of a prompt hierarchy, with the least intrusive prompt at the top and the most intrusive prompt at the bottom. Your goal is to quickly move through the prompt levels to move your learner to independence.

Now let’s look at two different examples to show these prompt levels. In the first example, the goal is for the learner to greet a person who walks into the room. In the second example, the goal is for the learner to pull up his/her pants after using the bathroom as a part of a toileting routine.

Research shows that least-to-most prompting increases the potential for errors and slows down the rate of acquisition for new skills. Therefore,most-to-least prompting is preferred for teaching new skills. This means that you would start at a full physical prompt and then move your way up the prompt hierarchy until your learner achieves independence with the task.

In the past, when working with discrete trials, it has been common practice to have a learner master a skill at a certain prompt level, then move to a less intrusive prompt and have the learner master the skill at that prompt level, steadily moving towards independence. This can actually encourage prompt dependence because the learner remains on the same prompt level for too long.

Instead, you should try to quickly move up the prompt hierarchy in a way that makes sense for the skill you are trying to teach. Below are some tips to help you help your learners achieve independence.

  • Follow the rule of three: Whether you are teaching with discrete trials or in the natural environment, once your learner has successfully responded to a demand three times consecutively, move to a less intrusive prompt.
  • If you are taking data, make a notation of what prompt level you are using at each step. (And remember, that only independent responses should be counted towards the learner’s percentage of correct responses.)
  • At the end of a session or group of trials, note what prompt level you were at by the end of the session. Then start at that level during the next session.
  • If your learner does not respond correctly when you move to a less intrusive prompt, then move back to the most recent prompt level. Once they respond again correctly at that prompt level three times consecutively, move again to a less restrictive prompt.
  • Remember that verbal prompts are very difficult to fade. Though they are less intrusive, you should avoid using them when possible.
  • You can pair prompts and then fade out the more intrusive prompts. For example, with the sample of pulling up pants described above, you can pair a visual prompt with a gestural prompt by showing the symbol for pulling up pants while pointing at the pants. Over time, you stop using the symbol and just use the gestural prompt. The gestural prompt can be faded by moving your point further and further away from the pants.
  • Write down what the prompt levels will look like for the specific task you are teaching. This way you will be fully prepared to quickly move your learner towards independence.
  • Differentiate your reinforcement! If you move to a less intrusive prompt and the learner responds correctly, then you should immediately provide a stronger reinforcer than you did for previous responses. If a learner spontaneously responds without a prompt, you should do what I call “throwing them a party” by combining reinforcers (such as tickles and high fives) or providing a highly desirable reinforcer.

Prompting can be very difficult to do well, but following these tips should help set your learner on the path to independence.


WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

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

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:

  • 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.
  • 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.
  • 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.
  • 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.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

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

ABA Journal Club: Interventions and RBTs (response)

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

This week, Solandy Forte, PhD, LCSW, LBA, BCBA-D provided a response to some of Sam’s questions about the article below:

I am thrilled to contribute to the conversation about RBT as it deserves the attention particularly as we continue to grow as a field.  We are a young field that is experiencing growing pains but they are good ones.  I appreciate the contributions that many practitioners in our field have shared relating to credentialing of RBTs.  At the end of all this, I am confident we will have established training and experience standards to will lead to positive outcomes for our consumers.  We have a long road ahead. 

Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Smith, T., Harris, S. L., … & Volkmar, F. R. (2017). Concerns about the Registered Behavior Technician™ in relation to effective autism intervention. Behavior Analysis in Practice10(2), 154-163.

  • The authors discuss the evolution of the BACB and concerns with certifying behavior analysts prior to the advent of RBTs. What did you think of the concerns identified here? Are these still concerns we have about BCBAs? How are they similar or different than concerns about RBTs?

The field of behavior analysis is practically in its adolescence.  There are many other helping professions such as psychology, psychiatry, and social work that have experienced growth for over a century and have had to navigate through barriers impacting the practitioner’s ability to provide quality behavioral healthcare with the increasing demand of service.  It is not unusual for a growing field to consider identifying ways to meet the healthcare needs of the population particularly when the number of qualified practitioners is not sufficient to meet the demands.  For instance, in the nursing field, registered nurses are often supported by nursing assistants and nurse aides.  The nursing field developed training and experience standards for each of these credentials and these standards have likely been modified as the profession has studied the impact on the overall delivery of services and its impact on the patient. 

Sure, the concerns raised are valid and should be evaluated carefully by researchers so that they can inform special matter expert groups established by the BACB®.  However, the field of behavior analysis cannot ignore the obvious increase in demand for applied behavioral analysis services.  It will take decades for the field to assess what are the most appropriate training and experience requirements to promote optimal consumer outcomes.  This is not only the case for RBTs® but also for BCBAs®.  Again, this is a growing field and we should expect to see modifications in the credentialing requirements. 

  • How does the current training of RBTs compare to the training of behavior technicians in early behavior analytic studies?

Any training of behavior technicians in early studies were developed by science practitioners who based their training procedures (e.g., topics, hours, teaching methodology, etc.) on either previous studies that evaluated training methods or training procedures that best fit their setting, staff, and client needs.  These research studies were not evaluating the training requirement of the RBT®.  Regardless, these studies contributed to the field of behavior analysis particularly when practitioners were developing in-house training requirements and adjusting along the way as they observed the behavior technician’s ability to implement behavioral technology with fidelity and retain what they had learned in the initial training overtime.  Currently, research studies are evaluating training packages that are aligned with the RBT® requirements and these will contribute to any revisions to credential requirements. 

  • Look at the RBT task list. The authors argue that the current amount of training does not meet standards set forth by research on staff training. How can BCBAs and organizations hiring RBTs support their mastery of the skills on this list?

Every organization is responsible for setting their own standards with regard to training of staff.  Training requirements will vary depending on the setting and in some cases requirements will expand beyond RBT® training.   For instance, there are organizations that require staff to receive physical management training, CPR, and first aid, to name a few.  It is common for training to occur on a regular or annual basis for an organization to remain in compliance with state regulations or enhance the delivery of services.  With regard to the RBT® credential, organizations are responsible and should carefully evaluate mastery of skills.  Further, organizations should include in their training protocols procedures for evaluating generalization and maintenance of acquired skills.  It is not only to important to meet mastery for each item on the RBT® task list but it is critical for staff to implement the skills they have acquired in a variety of setting over time.  RBTs work a variety of settings including home, school, and community; therefore, mastery of skills cannot just be mastered in the classroom setting but also must be generalized to the settings in which will be applied. 

  • Many of the recommendations by the authors include changes the BACB should enact as well as research that should be conducted. How are you able to take a role in these types of recommendations?

There is no doubt that research should be conducted to further evaluate the training and experience requirements for RBTs® but again this is going to take time.  Research studies take years to plan, execute, and disseminate.   This is not an easy feat but one that should be charged by the practitioners in the field and the demand for the delivery of high-quality behavioral services.  Our goal is to contribute to the solution by collecting and sharing data that experts can use to revise RBT® requirements.  We cannot ignore the obvious need for research in this area that will ultimately contribute to the positive growth of our field. 


Solandy Forte, PhD, LCSW, LBA, BCBA-D, is the Director of Consultation Services and Community Outreach at Milestones Behavioral Services.  She is a doctoral level Board Certified Behavior Analyst licensed in Connecticut and Massachusetts and a Licensed Clinical Social Worker.  Dr. Forte provides consultation services to the school programs at Milestones serving individuals with a diverse set of complex learning needs.  In addition to providing direct consultation to children within the private school setting, she also has provided consultation to multi-disciplinary teams within the public school setting where she assisted with program development initiatives to promote building capacity for educating children with autism and related neurodevelopmental disorders within the least restrictive educational setting.  Dr. Forte has experience working with children and young adults with special needs in their homes, schools, and community settings. She is an adjunct professor for the Institute of Autism and Behavioral Studies at the University of Saint Joseph in West Hartford, Connecticut and the Institute of Behavioral Studies at Endicott College in Beverly, Massachusetts. 

Journal Club #4: RBTs and Interventions

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, Ph.D., LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

In my daily work, I supervise Registered Behavior Technicians (RBTs) who are providing the direct care to my clients with autism. The RBT designation is only a few years old, and there are concerns about the training and maintenance of skills for these employees. However, another concern is the low number of people available to provide frontline services for high number of individuals who require it.

The work that RBTs do is important and necessary. It’s important for our field, as well as individual organizations and BCBAs to identify potential problems with the current model of providing treatment, and work to continuously improve upon the model. One way to start the conversation within your own organization is to read the following article and identify ways in which you can address the concerns it brings to light.

Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Smith, T., Harris, S. L., … & Volkmar, F. R. (2017). Concerns about the Registered Behavior Technician™ in relation to effective autism intervention. Behavior Analysis in Practice10(2), 154-163.

  • The authors discuss the evolution of the BACB and concerns with certifying behavior analysts prior to the advent of RBTs. What did you think of the concerns identified here? Are these still concerns we have about BCBAs? How are they similar or different than concerns about RBTs?
  • How does the current training of RBTs compare to the training of behavior technicians in early behavior analytic studies?
  • Look at the RBT task list. The authors argue that the current amount of training does not meet standards set forth by research on staff training. How can BCBAs and organizations hiring RBTs support their mastery of the skills on this list?
  • Have you identified concerns with the current model (BCBAs supervising RBTs who provide direct care) that were not mentioned in the article? If so, how have you worked to address those concerns?
  • Discuss the unintended consequences described in the article. Have you seen these consequences in your current setting?
  • Many of the recommendations by the authors include changes the BACB should enact as well as research that should be conducted. How are you able to take a role in these types of recommendations?

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

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

Ask A BCBA: I’m a Brand-New BCBA! What Should I Expect??

Ask A BCBA is a new series where we take your questions to our favorite ABA professionals. Do you have a question for a BCBA? Email us at info@difflearn.com and you could be featured in a future post!

Congratulations on passing your BACB exam!  Not only did you pass this notoriously difficult test, but you completed hundreds of hours of graduate coursework and supervised experience to get to this point.  You had to have been dedicated and hard-working.  You have demonstrated your knowledge to your supervisor(s) and on a written exam.  You should feel proud!

You are now entrusted with the tools to change behavior, shape new skills, and make lives better.  Make no mistake, this is a big responsibility.  As a BCBA, you are expected to be proficient in all of the skills of a behavior analyst (as per the BACB task list) and to abide by the BACB Code of Ethics.  Part of the ethical code is that there is no excuse for not knowing the ethical code.

Some new BCBAs feel overwhelmed by their new responsibilities.  This is completely normal, and not a bad thing if it leads you to approach your new position with respect and caution.  Here are some suggestions for easing this transition and building your confidence.

  • Maintain contact with your supervisor or another mentorMost supervisors are happy to continue to have some continued less-structured contact to provide guidance.  Other seasoned BCBAs in your community might also be open to providing some informal mentoring.
  • Join a community of other BCBAs.  There are so many options for how to do this.  Joining your state ABA association is an excellent idea if you haven’t done so already.  If you are a social media person, there are many Facebook groups for BCBAs.  Other BCBAs at your job may want to connect, too.
  • Keep your resources handy.  Yes, I realize that you probably never want to see “The White Book” again – at least for a while – but don’t be afraid to look something up if you’re not sure.  Although you passed the exam, you may still need a refresher on less-familiar concepts when they come up in your work.
  • Start collecting CEUs!  Yes, now!  You need to document at least 32 CEUs every 2 years, so don’t fall behind.
  • Subscribe to journalsJABA is not expensive, even when you are no longer a student, and you may not have access to your university library anymore.

Some new BCBAs feel overwhelmed by their new responsibilities.  This is completely normal, and not a bad thing if it leads you to approach your new position with respect and caution.  Here are some suggestions for easing this transition and building your confidence.

Remember that learning is a lifelong journey.  Even though you have made an amazing accomplishment, you aren’t expected to know everything.  Take the energy and enthusiasm that got you to this point, and use them to continue to develop your skills and your network.  As B.F. Skinner wrote in Walden Two, “It is not a question of starting.  The start has been made.  It’s a question of what’s to be done from now on.”  The hard part is over, so go ahead and make the most of your accomplishment!


About The Author

Dana Reinecke, Ph.D., BCBA-D 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 in the Applied Behavior Analysis department at Capella University.  She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum, forms, and hours tracking.  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, self-management training of college students with 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).

What Autism Awareness Should Be About

This month’s ASAT feature comes to us from David Celiberti, 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!

April is Autism Awareness Month. Blue puzzle pieces will appear on thousands of Facebook pages and billboards, and the media will give greater attention to autism. Further awareness is wonderful, as detection and diagnosis are necessary first steps to accessing help in the forms of treatment, information, and support. With well over 500 treatments from which to choose, parents of children with autism need guidance, tools, and accurate information to empower them to make the best possible choices for their children: these choices will undoubtedly have a profound impact on both their current quality of life and their children’s future and potential.

When I first entered the field over 30 years ago, autism was considered a rare condition. When people asked what I did for a living, they often misheard me and thought I worked with “artistic” children. I got that a lot.  With the incidence of one in 59 children today, our own families, neighbors, and co-workers are all touched by autism. In fact, the sheer numbers have heightened awareness of autism in and of themselves. This awareness is essential: it promotes early detection, and with early detection, we hope for a relatively clearer course toward effective treatment and better outcomes.

Sadly, however, the early detection of autism alone does not provide a seamless path to intervention. Furthermore, families whose children are diagnosed with autism are still not able to access the most effective science-based treatments available expeditiously. Instead, families often have to sort through hundreds of pseudoscientific treatments until they arrive at the most effective interventions supported by peer-reviewed research to address the complexities of autism.

“Autism Awareness” should be about more than just detection and diagnosis. At the Association for Science in Autism Treatment (ASAT), it has always been our hope that the conversation around autism awareness would be broadened to focus upon addressing the obstacles that separate individuals with autism from receiving effective, science-based intervention and combatting the misinformation that distracts families, caregivers, and teachers from accessing accurate information.  I offer 11 perspectives about what “Autism Awareness” should be about, along with several ways that ASAT can assist families and providers alike in navigating the complex maze of autism treatment options. 

#1  “Autism Awareness” must differentiate effective treatments that are scientifically validated from the plethora of “therapies” and “cures” lacking scientific support. Such a distinction is critical.   

Autism treatment is a billion-dollar industry. For the majority of the 500+ available interventions, science is overlooked in favor of pseudoscience, and they are marketed using heart-wrenching testimonials, anecdotes and video montages, and often bolstered with poorly crafted and misleading surveys. Many interventions boast inaccurate and even outrageous claims that are touted as evidence of effectiveness. Marketing of these so-called “therapies” and “cures” is unambiguously aggressive in nature, and so overwhelming that it can drown out accurate information for those parents desperate to help their children access the very best treatment. We are in a time when anything can be placed before the word therapy and pushed forth as a “bonafide treatment” (Legos, llamas, bleach, sand, magnets and even Shakespeare to name but a few examples).

We do no favors for children with autism, their families, and those responsible for providing needed services when we not only ignore junk science, but allow it to proliferate by failing to counter baseless claims. Visit our website to learn more about the scientific support behind various autism treatments, the relevance of peer-reviewed research, the pitfalls of testimonials, as well as many other articles related to becoming a savvy consumer. Please also see our review of the second edition of Dr. Sabrina Freeman’s book, The Complete Guide to Autism Treatment.

#2 “Autism Awareness” must recognize our collective responsibility to make sound choices.

As adults, voters, consumers, providers, and parents, choice underlies all of our decisions. We have a right to make these decisions, even poorly; however, when we hold the futures of individuals with autism in our hand, decision-making power comes with tremendous responsibility. Responsibility that should never be abdicated. There is a myriad of “decision-makers” whose choices have profound implications for children and adults with autism – not just parents, but siblings, teachers, treatment providers, administrators, program coordinators, and taxpayers.

Please see our webpage for parents.  There you will find an article on questions to ask marketers/providers so you can make sure that the individual with autism in your life is receiving science-based treatment,  as well as questions that you can ask yourself. You can also read more about the three phases of inquiry about particular interventions and their associated questions and considerations in the Road Less Traveled: Charting a Clear Course for Autism Treatment.

#3 “Autism Awareness” must alert and remind the community that available information on the Internet (and actual information from providers) varies greatly in accuracy, and, in fact, can be completely wrong.

As we know, not all information on the Internet is reliable and accurate. You have probably heard the term, caveat emptor (“Let the buyer beware”). Consumers must also practice caveat lector (“Let the reader beware”). Often, Internet information is deemed equivalent in relevance, importance, and validity to research published in peer-reviewed scientific journals, but it is not.  Testimonials and uncontrolled studies from so-called researchers can lead parents astray and be a tremendous source of distraction.  Parents of newly-diagnosed children may be particularly vulnerable. Know the red flags to avoid and learn how to evaluate research by visiting our website. Our library of articles highlights scientific concepts and methods as they relate to potential autism interventions, with the goal of providing families, educators, and clinicians with the information they need in order to be savvy consumers of marketed treatment products and therapies.

#4 “Autism Awareness” must include responsible reporting by journalists who embrace their role as “public educators” and who are committed to spreading accurate information.

There are scores of “miracle cures” and “breakthroughs” for autism that receive widespread media attention (e.g., print and online news outlets, radio and television programs), even if these treatments have not been shown to be beneficial through peer-reviewed, published research.  The media has a responsibility to scrutinize sensational claims related to a proposed treatment, and to be knowledgeable enough to report on those treatments with healthy skepticism and objectivity. To support accuracy in the media, ASAT has developed a webpage for journalists. For examples of accurate and inaccurate reporting, please learn more about our Media Watch campaign, review resources about science journalism, and peruse our bank of archived letters. You will find that some of these showcase accurate media representations whereas others highlight concerns about inaccurate representations.

#5 “Autism Awareness” must recognize the critical need for newly-diagnosed children to access effective treatment ASAP. We know that early intervention makes a huge difference.

While individuals with autism learn and progress across their lifespan, it is widely understood that the earlier intervention begins, the greater the potential for an optimal outcome. Please learn more about the research basis for early intervention.  It is also important to remember the limited window of time there is to prepare children for the “least restrictive setting” once they enter the public school system.  

The fact that resources allocated early can save a tremendous amount of resources over an individual’s lifespan does not always enter the conversation when evaluating costs and benefits. This must change. These cost savings should become an integral part of the conversation about the appropriateness of intensive early intervention. Please see the following articles on the ASAT website:

#6 “Autism Awareness” should also instill hope for a better tomorrow for those individuals who are not part of the “best outcome” group.

With the right treatment and preparation for adolescence and adulthood, all individuals with autism demonstrate improvement, and many go on to lead happy, productive, and fulfilling lives.  Much of the conversation about treatment, however, focuses on “best outcome” and this is often defined as entering “mainstreamed” education settings or losing the diagnosis of autism altogether. This may delegitimize the significant progress made by most individuals with autism, whose outcome may be different, but no less important and meaningful. We know, for example, with intensive intervention based on applied behavior analysis (ABA), individuals with autism learn to live and work in the community, access faith communities, fully participate in routine healthcare, enjoy a range of recreational pursuits including a commitment to fitness, become independent in their self-care needs, have meaningful relationships and are active, contributing members of their communities. The importance of such gains must be recognized as a significant benefit of effective treatment and are relevant conversations to have, particularly at a time when some vocal bloggers are viciously maligning any and all treatment efforts as abusive, immoral, or otherwise unethical.  This includes the denigration of parents who only want to help their child realize his or her fullest potential.

Autism awareness should definitively include a celebration of a broad array of outcomes as was touched upon in our recent interview with Catherine Maurice, author of Let Me Hear Your Voice, as well as editor of a number of other titles. Please also visit our Perspectives page that highlights success stories of young people with autism, who are not necessarily in the best outcome group, carving out sustainable vocational experiences.

#7 “Autism Awareness” must mandate accountability from all treatment providers regardless of discipline.

Accountability involves a shared commitment to objectively defined targets, data collection, and respect for the scientific method. It is every provider’s responsibility to objectively measure outcomes. No one should get a pass on accountability. No one is immune from defining their target and objectively measuring progress. No one should get away with implementing their intervention carelessly and in non-transparent manner. No one should be permitted to boast claims that they cannot demonstrate through data. These unfortunate realities should not be tolerated.

Providers using interventions that lack scientific support have an ethical obligation to share this fact with consumers, and to exercise caution in making claims about outcomes. Far too often, applications of interventions that lack any scientific support are carried out in a manner devoid of transparency and objective measures to substantiate claims of the treatment’s success. This must not be tolerated. Providers must make sound, scientifically-validated decisions and recommendations. Please visit our website for more information about ethics and evidence-based practice.

#8 “Autism Awareness” must involve recognition that an abundance of clinical research already exists, and this body of research matters.

In the world of autism intervention, peer-reviewed research, which should guide and inform treatment efforts, is too often disregarded or ignored altogether. Imagine a world in which it was deemed acceptable for mainstream cancer providers to treat childhood leukemia with methods they preferred without consideration of existing research. Sadly, that is the reality of autism treatment, as many providers use their personally-preferred methods, often divorced from scientific support and then often carried out without any objective means to assess benefit. 

If treatment providers and consumers are interested in published research on diverse topics such as improving conversation skills, promoting academic skills, eliminating self-injurious behavior, or developing tolerance for health care procedures, they can find it. Sadly, these peer-reviewed studies are often not accessed by treatment providers and caregivers. Thousands of researchers and experts in their fields have published their findings in peer-reviewed journals that can guide autism treatment, yet their findings are often overshadowed by media representations which put sensationalism about the “next big thing” in autism treatment over objective scientific research. Please visit our website often to read our ever increasing number of research synopses  and vast library of treatment summaries.

#9 “Autism Awareness” should help us identify and overcome the barriers that families and individuals with autism face even within their own communities.

Like all families, those with children with autism want to be able to live comfortably and fully within their community. That may mean simply going to the park, enjoying play dates, attending religious services, accessing routine medical care, going to the movies with friends, or eating at a restaurant with their family. Unfortunately, many families are not able to access these activities because the community is not sufficiently informed or prepared to include individuals with autism within these settings. In some cases, the children are not taught how to manage these situations well due to ineffective treatments. As a result, families of children with autism are often isolated. With 1 in 59 children being diagnosed, every facet of society should become aware of the supports necessary for individuals with autism to succeed within their communities. This could involve accessing information about success stories, receiving education and training, and an open dialogue with families about what could be helpful. It would be prudent if every facet of society evaluated what they are doing to support individuals with autism, what they are not doing, and what they could be doing differently.

#10 “Autism Awareness” is needed worldwide.  In many countries, families of individuals with autism face incredible challenges and barriers.

As a US-based organization we recognize the many benefits that exist here in our country. These include, although are not limited to, well-established special education laws, the lion’s share of board-certified behavior analysts and providers from other disciplines who are committed to science-based practice, and a longer history of the conversation about best practices. This is in contrast to the experience of families of children with autism residing in many other countries who are offered outdated therapies such as psychoanalysis, have very limited resources, face stigma and rejection within their communities, may encounter a professional community that has low expectations about what may be possible, and lack the support of laws mandating even adequate treatment and education. Providers eager to learn and use best practices will face limited education and training opportunities, a dearth of accessible supervisors, and struggle to access supporting professional networks. In some countries, the social and economic conditions may be so poor that autism treatment is relegated to the back burner. 

We believe that knowledge is power and that a global community of savvy and informed consumers can help shape the landscape of effective intervention. Please note that we have flyers about our website and our monthly publication, Science in Autism Treatment, in several languages including Arabic, Brazilian Portuguese, French, Hebrew, Hindi, Italian, Russian, Serbian, and Spanish. If you are interested in distributing our translated materials, please write us at info@asatonline.org. At the bottom of every page we make it easy to disseminate knowledge through a variety of social media platforms. Please also note the Google language translation option in the upper right-hand corner of our webpage. 

#11 “Autism Awareness” should be about the reality that the hundreds of thousands of children with autism will soon become hundreds of thousands of young adults with autism; unfortunately, we are woefully ill-prepared to meet their needs.

When children with autism become adults (at the age of twenty-one in the U.S.), funding for services drastically changes. As a result, there are very few quality programs for adults with autism.We are facing a crisis in the field, with a scarcity of services for adults with autism and the absence of a clear strategy for closing the gap between the ever-increasing need, and an unprepared supply of resources. Quality evidence-based services for individuals with autism must continue into the adult years. Research indicates that interventions such as applied behavior analysis (ABA) can effectively help adolescents and adults with autism continue to work toward their fullest potential.

At ASAT, we have broadened our scope so that we can be a part of this important and essential dialogue and have written extensively about that commitment and are continuing to add to our webpage that addresses lifespan topics. Here one can learn about maximizing employment opportunities, strategies to support older learners, and transitioning to adulthood. We are expanding our collection of research synopses to include adolescent and adult participants with autism and we have written about this topic extensively within Media Watch with the letters showcased on our Lifespan page.

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We hope these 11 perspectives have furthered your appreciation of the complexities and nuances surrounding autism awareness. We all play a role in advancing science, bettering the lives of individuals with autism, and helping their families and supporters become skilled and savvy consumers. Embrace that role with an eye toward identifying what additional steps you can take to become a contributor to important discussions and an even bigger part of the solution. For more information on how to join ASAT and be part of the solution, please subscribe to Science in Autism Treatment, visit our website, and follow us on Facebook. Learn more about how to become a sponsor, volunteer, or extern. Or you can support our work by making a donation. Join us in making a difference in the autism community!


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 Co-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.