By Ashleigh Evans, MS, BCBA

Behavior Technicians (BTs) and Registered Behavior Technicians (RBTs) are vital for the success of Applied Behavior Analysis (ABA) therapy programs. When opening a new ABA clinic or beginning a new supervisory relationship, it’s important to establish an environment with supervision dynamics that allow clients to make progress while behavior technicians grow and thrive. Let’s explore some essential BT and RBT supervision practices that will set you up for success.

Establish Clear Expectations

When developing a new supervisory relationship, the first step is to clearly define expectations for your supervisee and yourself. Outline the technician’s roles, responsibilities, and performance expectations, and detail your responsibilities as the supervisor. Clear expectations set the foundation for a mutually beneficial working relationship.

You can establish clear expectations with your behavior technicians by:

• Writing detailed job descriptions
• Conducting comprehensive orientation and training for new hires
• Creating an employee handbook with written policies and procedures
• Holding 1:1 meetings to set goals collaboratively
  
  

Setting clear expectations reduces the likelihood of mishaps as time passes. If challenges arise later, take them as an opportunity to reflect on whether performance expectations were clearly delineated.

Provide Ongoing Feedback

Ongoing feedback is necessary for an RBT’s professional growth and development. Feedback is also vital for ensuring treatment fidelity and promoting high-quality care. Feedback can sometimes be uncomfortable for both the person giving the feedback and the one receiving it. Establishing clear expectations from the start can help prepare technicians for receiving feedback. During orientation, explain the importance of feedback and discuss how they can expect to receive both positive and constructive feedback. During onboarding, you can also take the time to ask staff how they most prefer feedback. For example, some people like company-wide shout-outs, while others find that quite aversive and prefer 1:1 feedback instead.

Also, take your time to develop rapport with new BTs. A strong rapport may ease their nerves and make them more receptive to feedback.

Create a plan for providing behavior technicians with feedback across areas such as:

• Professionalism
• Communication
• Accuracy and reliability of data
• Following procedures as written
• Writing objective session notes
• Recognizing and honoring assent withdrawal.

Maintain Channels of Open Communication

Ensure there are open and transparent channels of communication. Encourage all staff to feel comfortable coming to you with questions and concerns. Inform them of the best ways to reach you and your general availability.

Also, establish opportunities for RBTs to provide anonymous feedback. Feedback should always go both ways. While staff should be encouraged to offer feedback, they are often less likely to do so directly due to the power dynamics. Instead, provide a channel for anonymous feedback. Creating a Google Form that allows anonymous feedback is one easy way to set this up. Send the link to new staff upon hire and include it in your email signature for easy access when needed. 

Support Professional Development

It is natural to crave growth. While many technicians are comfortable staying in their roles, others will likely want to experience career growth. By investing in professional development, you can show your staff that you value their career growth and contributions to your organization.

Some ways you can support your RBT’s professional development include:

• Offer ongoing training, workshops, and continuing education opportunities
• Allow staff to pursue their interests and passions within the field by systematically developing new roles
• Implement RBT leveling systems with additional training and responsibilities at each higher level
• Hold roundtable discussions with technicians taking turns running them
• Offer fieldwork supervision for staff who wish to pursue BCaBA or BCBA certification
• Create professional development plans to outline staff’s career goals and action steps for achieving them

Reflect on your Own Supervision Practices

Section 4.10 of the BCBA Ethics Code for Behavior Analysts requires BCBAs to actively and continuously evaluate their own supervisory practices. Develop plans to self-evaluate your supervision. You can do this by seeking and reflecting on feedback from your staff and clients. You can also self-assess your supervisory practices by evaluating the progress your clients and staff are making toward their individualized goals. Through self-evaluations, you can identify whether your supervisory practices are having a positive impact and develop plans for modification if they are not.

Cultivate a Culture of Support

To run a successful ABA organization, you must foster a culture of support and collaboration where staff feel valued, respected, and empowered. Without the dedication of behavior technicians, your learners would not make progress, and your organization would not thrive. You can create a positive, empowering environment by establishing clear expectations, providing and accepting feedback, ensuring open communication, and supporting professional development. Take care of your staff first. Then, they will take care of your clients.

References

Sellers, T. P., Valentino, A. L., & LeBlanc, L. A. (2016). Recommended Practices for Individual Supervision of Aspiring Behavior Analysts. Behavior analysis in practice, 9(4), 274–286. https://doi.org/10.1007/s40617-016-0110-7

Sellers, T. P., Alai-Rosales, S., & MacDonald, R. P. (2016). Taking Full Responsibility: the Ethics of Supervision in Behavior Analytic Practice. Behavior analysis in practice, 9(4), 299–308. https://doi.org/10.1007/s40617-016-0144-x

About the Author

Ashleigh Evans, MS, is a Board Certified Behavior Analyst. She has been practicing in the behavior analysis field for over 13 years and opened her own independent practice in early 2022. Her experience has been vast across different age groups, diagnoses, and needs. She is passionate about improving the field through education, reformative action, and better supervisory practices, leading her to create content and resources for families and ABA professionals which can be found on her website, https://www.abaresourcecenter.com/

This article was reposted with permission from Stages Learning and author Frankie Kietzman.

Life is filled with routines. When you’re a student, you have years of repetition in a school setting to learn where to go when you arrive, how to get your lunch, transition in the hallways, and dress out for the gym. You’ve had the support of teachers and family to learn how to be a good student. However, for many students, especially autistic students, graduation finds them grossly underprepared for independent living. 

Figuring out how to cook a meal, do laundry, keep the house clean, and maintain hygiene can be hard for anyone, but sometimes overwhelming for autistic individuals. Education’s early emphasis on communication, academic, and social-emotional learning can sometimes unintentionally leave independent skills in the back seat. Those typical priorities may cause autistic students to become too reliant on others to take care of their more basic needs. 

One way we as educators and family members can remedy this is through intentional instruction of independent living skills through task analysis (TA) and higher awareness of our levels of prompting. Task analysis can also be a useful tool in helping students develop closer approximations toward higher levels of independence, thus leading to a higher quality of life when students leave the security of school and home. 

Task Analysis Refresher

You can find several online articles covering task analysis in more detail, but the main point is taking a task with multiple steps and breaking those down into smaller chunks. It’s helpful for a teacher to see each step in order to identify where a student may need more support and to determine if you should consider forward- or backward-chaining strategies.

What are independent living skills?

• Personal care
• Food preparation
• Clothing management
• Personal organization
• Household maintenance

 

When should I consider task analysis for teaching an independent living skill?

Skills for independent living include lots of components, not all appropriately addressed through task analysis. For any of those skills you’d like to teach, think about the number of steps involved in the process and any prerequisites the student already has mastered. 

Perhaps the ultimate goal is to cook a meal, which obviously entails many smaller steps: choosing a recipe, reading and following it, obtaining accurate materials or supplies, measuring, time management, and physical components to each recipe like whisking, kneading, and stirring. 

Once you consider all the pieces needed to complete the task, check or take baseline data to determine what skills the student already has. Maybe they’re mostly independent with all steps except following or reading the recipe. This is where task analysis could be used to target instruction. If your baseline indicates they are missing multiple components needed for the larger skill (in this case cooking), you may need to break down instruction in those areas like matching or motor imitation to get them prepared to generalize those skills later.

Here are some independent living skills that TA might help:

• Vacuuming
• Simple cooking (matching numbers on a microwave or oven)
• Using a dishwasher or laundry machines
• Washing hands or face
• Using the toilet
• Bathing—shower or bathtub
• Hygiene routines like toothbrushing or applying deodorant
• Fastening or unfastening clothing 
• Folding, hanging, or putting away clothing
• Cleaning the bathroom or kitchen

As you can see from the example and this list, there are a lot of pre-requisite skills to master before you’re ready to use an independent living TA for autistic students. Making sure they can imitate, sort, and match will be important skills as they move into this area.

Developing a Plan

Once you’ve determined a skill to teach and the student has the necessary pre-requisite skills, you are ready to develop your plan for what that perfect routine would look like when the student is engaging in this activity. Some of these skills may be individualized based on the student’s preferences—because there’s no necessarily “right” order for cleaning your body—so defer to the individual’s preferences but develop a TA that still makes sure they meet all requirements (like cleaning their entire body or brushing all of their teeth).

An example TA for the independent skill of folding pants could look like this:

1. Lay pants on a flat surface.
2. Smooth out the wrinkles.
3. Fold one pant leg on top of the other (in half)
4. Bring the bottom of the pants up to the waistband (in half again).

Wording can vary, but use vocabulary familiar to the student and be sure everyone working to support that skill uses the same words in this learning stage.

Visual Supports

Let’s talk visuals! Research continues to support visual aids as an evidence-based strategy for teaching skills to people with autism. Not only can you pair visual supports with your actual task analysis, but the visual supports can be part of the task itself. What do I mean? Glad you asked.

1. Dots or markers:

I remember when I tried to have a student clean tables after a meal or vacuum an area of the classroom and they’d just go back and forth on the same spot, so the greater area didn’t get clean. Something that helped students recognize they needed to get all over the table, floor, or window was to spread out some kind of markers so they’d know removal meant the areas were done. For vacuuming, I would clean out my hole-puncher and sprinkle the dots on the floor in the 4 corners of the space so they’d cover more ground. Think of other ways to visually mark an area that needs to be covered.

2. Jigs:

A jig is a tool that can help when folding shirts, towels, pants—you name it! Some you can purchase, or you can watch a video to DIY; just get some duct tape and cardboard and viola! You can also write numbers on the cardboard to correspond with the steps in their folding TA. Eventually, you can work to fade the jig support, but it is very helpful when first learning the skill.

3. Near-point models:

Besides having TA visuals accessible and nearby, a near-point model can help students improve executive functioning. For example, have the numbers they need to copy directly next to the area where they’ll be needed. If a student is cooking oatmeal for 1:10, I would have those numbers on a Post-it note on the microwave so they don’t have to look back and forth to fine print to enter the numbers. Finding ways to cut down on such processing can help students gain success as they practice these independent living skills.

The best part about focusing on intentionally teaching independent living skills is that these also have the potential to generalize into vocational opportunities, which means a whole new level of independence!

How have you been able to introduce task analysis for teaching independent living skills? How can visual supports paired with TA help enhance your practice? 

For more specific information on Task Analysis see:

• Using Task Analysis for Arrival and Dismissal Routines
• Teaching Multi-Step Skills Through Task Analysis for Students with Autism
• How to Use Chaining to Break Down Complex Tasks for Children with Autism

References:

https://achieve.lausd.net/cms/lib/CA01000043/Centricity/Domain/109/Self-Care_Independent%20Living%20-%20Home%20Activities%2005-11-20.pdf

http://life-skills.middletownautism.com/wp-content/uploads/sites/7/2017/10/Folding-clothes-TA.pdf

https://familyconnect.org/education/expanded-core-curriculum/independent-living-skills-671/#:~:text=Independent%20living%20skills%20encompass%20many,management)%2C%20and%20household%20maintenance.

About the Author

Frankie Kietzman is a Sales Development Associate for STAGES Learning with experience teaching as an elementary teacher, self-contained autism teacher for elementary and secondary students, autism specialist and coach for teachers dealing with challenging behaviors. Frankie’s passion for supporting children and adults with autism originates from growing up with her brother who is deaf and has autism. As one of her brother’s legal guardians, she continues to learn about post-graduate opportunities and outcomes for people with autism. Frankie has a Bachelor’s degree from Kansas State University in Elementary Education, a Master’s degree in high and low incidence disabilities from Pittsburg State University and in 2021, completed another Master’s degree in Advanced Leadership in Special Education from Pittsburg State University.

About Stages

Angela Nelson, a UCLA trained ABA Therapist, founded Stages Learning in 1997 when autism diagnoses first began to rise. The top-selling autism education product, the Language Builder Picture Cards, was designed to specifically meet the learning needs of children with autism. The research-based Language Builder Series has become a staple in home and school programs around the world and Stages Learning is now the premier developer of learning tools for children with autism.

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

Description

Learning how to interact and engage with other children is among the many social challenges that children with autism spectrum disorder (ASD) confront, with some finding even minimal social interaction difficult. Including siblings in treatment can be potentially effective in helping a child with autism build these important interaction skills. Behavioral Sibling Training is the practice of engaging neurotypical siblings of an individual with ASD in the intervention efforts for a child with ASD hopefully leading to positive interactions in the future, as well as improved social and play skills (Ferraioli et al, 2012). For example, in a study conducted by Celiberti and Harris (1993), neurotypical siblings were taught in their homes how to target play and play-based language, to reinforce positive behaviors, and to prompt their siblings with autism to promote responding. Including siblings as agents of change is a natural extension of the existing literature on peer-mediated interventions, which has been studied and shown to be effective for many decades (e.g., Lancioni, 1982; Strain, Shores, & Timm, 1977; Wahler, 1967).

Prior to describing the research basis for involving siblings as intervention agents, it would be helpful to share with the reader other ways siblings may be engaged and supported outside of being a participant in interventions. Many programs already provide services to siblings that may include, although are not limited to, education about autism, social opportunities (“Sibling Appreciation Day”), and ongoing or time-limited sibling support groups. These latter experiences may include some aspects of skill building (e.g., communicating needs to parents, coping with stress, addressing peer questions about autism) but these are often narrow in focus, time limited in nature, and not intensive. As such, they are beyond the scope of this review. Further, there are some providers that target social initiation and play skills in other settings (e.g., school) and may request that parents arrange and/or assess the extent to which these newly acquired skills generalize during interactions with siblings in the home. In this case, siblings are often not provided specific training in how to facilitate that carryover and, therefore, this would not be considered an example of Behavioral Sibling Training.

Research Summary

Extensive systematic reviews of the research literature on the efficacy of using siblings in interventions for children with ASD have been carried out (e.g., Banda, 2015; Bene & Lapina, 2021). Sibling training efforts have included participants who are pre-school age (e.g., Jones & Schwartz, 2004; Oppenheim-Leaf et al., 2012; Tsao & Odom, 2006), school-age (e.g., Celiberti & Harris, 1993; Ferraioli & Harris, 2011; Glugatch & Machalicek, 2021), and adolescent (e.g., Rayner, 2011a; Walton & Ingersoll, 2012). Targeted skills have included cooperative play skills (e.g., Celiberti & Harris, 1993; Coe et al., 1991; Glugatch & Machalicek, 2021; Reagon et al, 2006), social interactions (e.g., Dodd et al, 2008; Strain & Danko, 1995), joint attention (e.g., Ferraioli & Harris, 2011; Tsao & Odom, 2006), motor skills (Colletti & Harris, 1977), imitation skills (e.g., Rayner, 2011a), and self-help skills (e.g., Rayner, 2011b). Intervention methods have included elements such as didactic teaching and roleplaying (e.g., Oppenheim-Leaf, Leaf, Dozier, Sheldon, & Sherman, 2012), in vivo modeling (e.g., Celiberti & Harris, 1993) and video modeling (e.g., Neff, Betz, Saini, & Henry, 2016). For more information about video modeling, please see Evoy (2023).

These studies showed that there were mutual benefits for both neurotypical siblings and siblings with ASD after treatments that engaged the typically developing siblings (Ferraioli et al, 2012). For children with ASD, researchers observed gains in targeted social-communication and play skills, and a decrease in problematic behaviors (Shivers & Plavnick, 2014). For neurotypical siblings, studies report an increase in confidence and pleasure in interaction with their brother or sister with ASD and a decrease in sibling frustration (Shivers & Planick, 2014; Banda, 2015). When typically developing siblings were trained to use behavioral strategies, they not only learned to generalize these strategies to facilitate social and communication behaviors with their siblings with ASD across various settings, but they also improved their own social behaviors from developing a more positive view on the siblings with ASD (Shivers & Plavnick, 2014; Banda, 2015; Bene & Lapina, 2020).

Bene and Lapina (2020) shared some encouraging data with respect to both generalization and maintenance, as well as social validity. In their review, 7 of the 16 studies reported generalization and maintenance although the probes were generally just a few months post-treatment. In addition, 11 of the 16 studies offered social validity information; however, this varied widely across studies. Although these studies often included reports of parental or sibling satisfaction with the outcomes, other studies used naïve observers to demonstrate that changes were observed in the siblings before and after intervention and these changes were positive in nature.

However, these literature reviews also point out many limitations across studies. For instance, the roles of neurotypical siblings vary across studies: some were passive (i.e., modeling behaviors through videos, or included in social stories), while some were active interventionists. Future studies should investigate how the extent of siblings’ involvement influences the impact on children with autism (Banda, 2015). There is also a need for further research about other factors that might influence the effectiveness of siblings’ interventions, such as age, gender, and closeness between the siblings (Shivers & Plavnick, 2014). Finally, most of the reviewed studies lacked long-term follow-up, which is necessary to make a definite conclusion regarding the long-term impacts of utilizing siblings in interventions (Shivers & Plavnick, 2014; Banda, 2015; Bene & Lapina, 2020). Aside from further research looking into the maintenance of the intervention effects, Glugatch and Machalicek (2021) also suggested that component analyses look carefully at which specific skills are pivotal to reciprocal play.

Recommendations

Based on the reviews of the existing body of literature, further research with better experimental designs is warranted to draw more robust conclusions regarding the long-term effects of engaging neurotypical siblings in intervention plans for children with autism. Although there is evidence across studies that these intervention models show positive impacts for both neurotypical siblings and for their siblings with autism, a better understanding of those benefits is an area warranting more research. Therefore, professionals and parents should base their decisions to pursue sibling training on a case-by-case basis, carefully considering their specific goals, and evaluating whether those goals and proposed methods align with the existing research (Banda, 2015). Despite the need for more research, Banda (2015) points out that utilizing siblings in interventions for children with autism might result in long-term improvement in siblings’ relationship and overall family wellbeing. These collateral effects can also be studied systematically as this body of research is expanded.

With respect to implementation, it is important that providers offering sibling training are practicing within their scope of competence. As sibling training often occurs in the home, providers should be particularly sensitive to family, cultural, linguistic, and socioeconomic considerations to enhance outcomes and overall experiences for all members of the family. Assent on the part of the sibling should be assessed at the onset and revisited frequently as the intervention unfolds and social validity can include more in-depth consideration of the siblings’ views on goals, interventions, materials chosen, etc. Parents and guardians interested in including their child with ASD’s siblings in intervention should inquire about providers’ prior experiences including siblings as agents of change and be open about family values, strengths, and limitations – even if not adequately solicited by prospective providers.

Finally, we encourage parents to be mindful of the potential knowledge differential surrounding autism between the autistic child and their sibling, particularly when the sibling is engaged in intervention (i.e., provided with background information, given strategies). For autistic children who do not yet understand much about their diagnosis, be as sensitive as possible when explaining it to others (such as the sibling), discussing it, or otherwise referring to it; and consider what steps can be taken to help the individuals with autism better understand their differences (e.g., Weiss & Pearson, 2016).

References

Systematic Reviews of Scientific Studies

Banda, D. R. (2015). Review of sibling interventions with children with autism. Education and Training in Autism and Developmental Disabilities, 50(3), 303-315.

Bene, K., & Lapina, A. (2020). A meta-analysis of sibling-mediated intervention for brothers and sisters who have autism spectrum disorder. Review Journal of Autism and Developmental Disorders, 8(2), 186-194.

Shivers, C. M., & Plavnick, J. B. (2015). Sibling involvement in interventions for individuals with autism spectrum disorders: A systematic review. Journal of Autism and Developmental Disorders, 45, 685-696.

Selected Scientific Studies

Celiberti, D. A., & Harris, S. L. (1993). Behavioral intervention for siblings of children with autism: A focus on skills to enhance play. Behavior Therapy, 24(4), 573-599.

Coe, D. A., Matson, J. L., Craigie, C. J., & Gossen, M. A. (1991). Play skills of autistic children: Assessment and instruction. Child & Family Behavior Therapy, 13(3), 13-40.

Colletti, G., & Harris, S. L. (1977). Behavior modification in the home: Siblings as behavior modifiers, parents as observers. Journal of Abnormal Child Psychology, 5(1), 21-30.

Dodd, S., Hupp, S. D., Jewell, J. D., & Krohn, E. (2008). Using parents and siblings during a social story intervention for two children diagnosed with PDD-NOS. Journal of Developmental and Physical Disabilities, 20, 217-229.

Ferraioli, S. J., & Harris, S. L. (2011). Teaching joint attention to children with autism through a sibling‐mediated behavioral intervention. Behavioral Interventions, 26(4), 261-281.

Glugatch, L. B., & Machalicek, W. (2021). Examination of the effectiveness and acceptability of a play-based sibling intervention for children with autism: A single-case research design. Education and Treatment of Children, 44(4), 249-267.

Jones, C. D., & Schwartz, I. S. (2004). Siblings, peers, and adults: Differential effects of models for children with autism. Topics in Early Childhood Special Education, 24(4), 187-198.

Neff, E. R., Betz, A. M., Saini, V., & Henry, E. (2016). Using video modeling to teach siblings of children with autism how to prompt and reinforce appropriate play. Behavioral Interventions, 32, 193-205.

Oppenheim-Leaf, M. L., Leaf, J. B., Dozier, C., Sheldon, J. B., & Sherman, J. A. (2012). Teaching typically developing children to promote social play with their siblings with autism. Research in Autism Spectrum Disorders, 6(2), 777-791.

Rayner, C. (2011a). Sibling and adult video modelling to teach a student with autism: Imitation skills and intervention suitability. Developmental Neurorehabilitation, 14(6), 331-338.

Rayner, C. (2011b). Teaching students with autism to tie a shoelace knot using video prompting and backward chaining. Developmental Neurorehabilitation, 14(6), 339-347.

Reagon, K. A., Higbee, T. S., & Endicott, K. (2006). Teaching pretend play skills to a student with autism using video modeling with a sibling as model and play partner. Education and treatment of children, 517-528.

Strain, P. S., & Danko, C. D. (1995). Caregivers’ encouragement of positive interaction between preschoolers with autism and their siblings. Journal of Emotional and Behavioral Disorders, 3(1), 2-12.

Tsao, L. L., & Odom, S. L. (2006). Sibling-mediated social interaction intervention for young children with autism. Topics in Early Childhood Special Education, 26(2), 106-123.

Walton, K. M., & Ingersoll, B. R. (2013). Improving social skills in adolescents and adults with autism and severe to profound intellectual disability: A review of the literature. Journal of Autism and Developmental Disorders, 43, 594-615.

Other References

Evoy, K. (2023). Video Modeling: A treatment summary. Science in Autism Treatment, 20(08).

Ferraioli, S. J., Hansford, A., & Harris, S. L. (2012). Benefits of including siblings in the treatment of autism spectrum disorders. Cognitive and Behavioral Practice, 19(3), 413-422.

Lancioni, G. E. (1982). Normal children as tutors to teach social responses to withdrawn mentally retarded schoolmates: Training, maintenance, and generalization. Journal of Applied Behavior Analysis, 15(1), 17-40.

Strain, P. S., Shores, R. E., & Timm, (1977). Effects of peer social initiations on the behavior of withdrawn preschool children. Journal of Applied Behavior Analysis, 10(2), 289-298.

Wahler, R. G. (1967). Child-child interactions in free field settings: Some experimental analyses. Journal of Experimental Child Psychology, 52(2), 278-293.

Weiss, M. J., & Pearson, N. (2016). Clinical Corner: How to manage the impact of child with autism on siblings. Science in Autism Treatment, 13(2), 22-26.

Citation

Trinh, M., & Celiberti, D. (2024). Treatment Summary: Behavioral sibling training Science in Autism Treatment, 21(01).

About the Authors

Mi Trinh, BA earned her bachelor degree in Finance from Brigham Young University in 2014 and is a former ASAT Extern. During her externship, she wrote a few articles for ASAT and translated several ASAT articles into Vietnamese as part of her project in disseminating evidence-based information about autism treatments internationally. One of her topics of interest is the collaboration between behavioral analysts and speech language pathologists. She is starting the PhD program in Speech and Hearing Sciences with a clinical track in Speech Language Pathology at the University of Iowa in the Fall 2024.

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.

By Kelly (McKinnon) Bermingham, MA, BCBA, author of The Group Experience and co-author of Social Skills Solutions: A Hands-on Manual

There is a long history of evidence and research indicating that early intervention is one of the most successful measures of autism spectrum disorder symptom reduction (ASD). In 2001, The National Research Council convened a panel of many of the most well-recognized national experts in the treatment of autism at the time. This panel was charged with integrating scientific literature and creating a framework for evaluating the scientific evidence concerning the effects and distinguishing features of the various treatments for autism. One of the significant recommendations for children on the autism spectrum is the need for early entry into an intervention program.

In a second Clinical Report of the American Academy of Pediatrics Council on Children With Disabilities, the report noted, “The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings. Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.”

In the field of child development, the term “early intervention” refers to intensive therapeutic services provided for infants and young children (typically from the ages of under 2 to 5 or 6 years old) who have a delay in reaching developmental milestones before they enter kindergarten. “Intensive” means the hours provided to the child are significant and impactful. These programs are often also called EIBI programs, Early Intensive Behavioral Intervention. In the field of ABA, this is often referred to as a “Comprehensive ABA program” that assess for and seeks to teach and develop skills that are needed across all developmental areas. Additionally, according to the National Research Council, Committee on Educational Interventions for Children with Autism, the committee noted that research shows that early diagnosis of, and interventions for, autism are more likely to have major long-term positive effects on symptoms and later skills.

A young child’s brain is still forming, meaning it is more “plastic” or changeable than at older ages. Because of this plasticity, treatments have a better chance of being effective in the longer term. Early interventions not only give children the best start possible but also the best chance of developing to their full potential.  Recent guidelines suggest starting an integrated developmental and behavioral intervention as soon as ASD is diagnosed or seriously suspected. ABA therapy programs should be designed for these crucial skills related to language and social communication deficits, including responsivity to social stimuli, which supports skills including imitation and joint attention as mentioned previously.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) was published in 2022. The DSM-5-TR is used to diagnose a person on the autism spectrum based on two primary domains.

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or historically:

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduce sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to the absence of interest in peers.

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or historically:

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal/nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take the same route or eat the same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
4. Hyper- or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

As we can see, the core symptoms of autism are heavily related to language and social communication deficits. Conversely, we know that in neurotypically developing children, social and communication skills develop inherently.  As these social and communication skills emerge, they are reinforced by people in their world and the environment they live in, further strengthening these skills. Let’s look at how these skills emerge and develop.

As young children age, they begin to look around and become aware of their surroundings. They smile or frown, or even cry based on what they see. They begin to imitate and respond to their environment based on what happens, or the consequences of their responses. They begin to point to ask for things or to show you things they see. They respond to the attention they receive when doing these things.  During the first year of life, children start to develop close connections with their parents and other caregivers. They begin to observe, imitate, and show pleasure and displeasure. During the second year of life, children begin to notice other children and seek interactions with other children. They may begin to show pleasure with others, as well as conflict, and begin to recognize emotions in others. During the third year of life, children expand their play skills and explore more. They begin to develop friendships with those in their proximity and engage in common play actions. They begin to cooperate, imitate, and learn to accept compromise during conflict, with adult support. During the fourth year of life, conversation skills improve and become robust. Their social interactions with others advance through shared play and conversations. They begin to show support and help toward others.

Children may also interact with other children or more people in their environment. They may go to daycare or preschool, then on to kindergarten. In preschool, children are taught and reinforced to use language to communicate. They are taught to play, share, and play together cooperatively toward a common goal. They are taught to wait. They use their imitation skills to learn how to dance and sing and observe and learn new skills from other children. They move on to kindergarten and are taught even greater communication and social skills that include learning how to negotiate and play a friend’s choice. They learn how to regulate their feelings and behaviors. They learn these in a group experience. During the fifth year of life, children can more comfortably create and maintain friendships through common interests and play. They can engage in more complicated games that require more attention and are guided by rules. There is a wide variety of words and actions in play and interactions, and they can directly express concern and help. As they move on to an educational setting, they are ready and able to learn in a group format. They can follow along with an adult leading the group, follow the directions, and manage themselves around others.

Children diagnosed with autism are not likely to demonstrate these skills and they are not coming into contact with reinforcement. Going back to the diagnostic criteria and symptoms of autism, we see that deficits in social communication and social interaction across multiple contexts result in challenges with interacting with others in a social setting and these crucial milestones being missed.

A new study by Blacher et. Al, 2022 found that nearly one in six kids with autism are expelled from preschool and daycare. Many of them, in the sample, were expelled more often from a private than a public program. Most of the children were expelled due to their behavior which included temper tantrums, hitting, and yelling. The study found that often the teachers were not trained or credentialed and didn’t have the required courses in autism.

ABA is a science devoted to the understanding and improvement of human behavior. Applied behavior analysts focus on objectively defined behaviors of social significance; they intervene to improve the behaviors while demonstrating a reliable relationship between the interventions and the behavioral improvements. Most people think of ABA instruction being delivered in a 1:1 format. Concerns arise when a child transitions to a daycare or classroom setting. The child learning in the 1:1 format may not have the skills to learn alongside other children in a group format. Now we are back to the statistic of one in six kids with autism being expelled from preschool and daycare.

By providing early intervention in a group ABA-based format as soon as possible, we can better prepare the child with autism for group learning. If you think of the very best teacher, you ever had in school, the teacher likely employed ABA strategies, such as: including environmental arrangements, priming, using visual supports, reinforcement/reward strategies, and using first this. That teacher likely considered motivation and created activities that were interesting and motivating to you while you learned. That is using ABA in a group format.

For many children diagnosed with ASD, a comprehensive program would look across all of these developmental areas, identify what skills are missing, and then identifying appropriate teaching methods to teach those skills. This comprehensive program would likely be heavily based on play and natural environment teaching. It would include caregivers in the programming, as well as siblings, peers, and possibly other family members. It would include consultation with other therapies or providers the child may be receiving and coordinating care with those services. It would be intensive in the hours provided in the beginning, often 27-40 hours of ABA recommended according to research. This program would focus on teaching the child to be able to attend to, respond to, and participate in group environments as they prepare to attend daycare, preschool, or kindergarten. The ultimate goal of the ABA-based Early Intervention program should be to move from 1:1 therapy to a group learning experience, focusing on the developmental milestones described earlier, and allowing these skills to come into contact with reinforcement from other children.

References

American Academy of Ped American Academy of Pediatrics (2001). Policy Statement: The Pediatrician’s Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children (RE060018) Pediatrics.

American Psychiatric Association (Ed.). (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (Fifth edition, text revision). American Psychiatric Association Publishing.

California Legislative Blue-Ribbon Commission on Autism (2007). Report: An Opportunity to Achieve Real Change for Californians with Autism Spectrum Disorders. Sacramento, CA: The Legislative Office Building. Available online at: http://senweb03.sen.ca.gov/autism.

Blacher, J., & Eisenhower, A. (2023). Preschool and Child-Care Expulsion: Is it Elevated for Autistic Children? Exceptional Children, 89(2), 178-196. https://doi.org/10.1177/00144029221109234

Dawson, G., Toth, K., Abbott, R., Osterling, J., Munson, J., Estes, A., & Liaw, J. (2004). Early social attention impairments in autism: social orienting, joint attention, and attention to distress. Developmental Psychology, 40(2), 271–283. https://doi.org/10.1037/0012-1649.40.2.271

Myers, S.M., Johnson, C.P. & the American Academy of Pediatrics Council on Children With Disabilities, (2007). Management of children with autism spectrum disorders. Pediatrics. 120, 1162–1182.

National Research Council (2001). Educating Children with Autism, Committee on Educational Interventions for Children with Autism, Division of Behavioral and Social Sciences and Education, Washington, D.C.: National Academy Press.

The Group Experience. Printed in the United States of America Published by: Different Roads to Learning, Inc. 12 West 18th Street, Suite 3E New York, NY 10011 tel: 212.604.9637 | fax: 212.206.9329 www.difflearn.com

About the Author

Kelly (McKinnon) Bermingham has been working in the field for 27 years and has been a Board-Certified Behavior Analyst since 2003. She is an ESDM certified Therapist and a PEERS-certified therapist.  Kelly wrote her first book, “Social Skills Solutions: A Hands-on Manual” in 2002.  Kelly has written several blogs for Autism Speaks, been published in several journals, and co-authored a chapter in the textbook, “Rethinking Perception & Centering the Voices of Unique Individuals: Reframing Autism Inclusion in Praxis.”  Kelly helped found a school for middle school & high school children on the autism spectrum and a sports league for children with autism. Kelly is part of The September 26^th Project, creating safety awareness checklists and reminders for those on the autism spectrum and their families. She was an Expert Subject Matter for CASP’s recent Organizational Guidelines for ABA companies. Kelly provides training on The Group Experience to organizations based on this book.

This article was reposted with permission from Stages Learning

Life is filled with constant multi-step directions and processes. That’s why a common elementary project is to have students write exact directions to make a peanut butter and jelly sandwich. Their peers are then told to only do exactly what the directions say. As you might imagine, hilarity ensues—inevitably some steps are missing, like “Open the jelly jar” or “Spread the peanut butter evenly across (one or both slices) of bread.” Peers will stare confusedly at jars or pile massive amounts of peanut butter on the bread just to make a point when detailed steps are left out. What students may not realize is, this assignment is actually a task analysis in the making.

What is it?

Task analysis (TA) is the process of taking a complex skill such as making a sandwich, running the dishwasher, or doing laundry—and breaking it down into smaller, manageable, and observable steps.

Why is it useful?

If a student is struggling to complete a skill in its entirety, breaking the task down into steps can make it more apparent to teachers or parents as to where the error is occurring. Then we can use prompting, reinforcement, and/or modeling to help fill the gaps.

Autistic students particularly struggle with executive functions that govern the ability to plan and organize thoughts, recall and remember information, and initiate an activity. Listing manageable steps can be a quick reference as they learn new skills through repetition and muscle memory.

When should I use task analysis?

Task analysis should be used to chain-link together a sequence of smaller steps to perform a bigger action. Many functional, self-help, or vocational skills fit this description—rather than simply opening a microwave, the act of cooking a packet of oatmeal is comprised of multiple small steps to complete the greater action.

Here are some ideas for skills that task analysis could be helpful in breaking down:

• Laundry
• Doing dishes
• Vacuuming
• Setting the table
• Logging on to a device
• Cooking a meal
• Tying shoes
• Using the bathroom

But is it only for life skills? Absolutely not! Task analysis can also be tremendously helpful in breaking down academic and social skills that have set steps such as long division, multi-digit multiplication, and turn-taking during a board game, or kickball.

TA can also be a great way to introduce simple play scripts for anyone learning how to appropriately use play materials. Sample ideas could include:

• Feeding a baby doll
• Playing dress up
• Building a train track
• Playing restaurant
• Making sandcastles
• Building block patterns

How to implement it?

1. Choose a specific skill to target

To identify the skill you will teach, start by identifying the student’s needs and the team’s goals for them. Depending on age or developmental level, the necessity or desire of the individual to learn the skill (such as toilet training) may be an important factor in prioritizing where to start.

2. Assess the learner’s ability level and necessary materials or supports

Begin by collecting baseline data on the student’s ability to complete the identified skill. If you were going to teach them how to cook something in the microwave but they cannot accurately match numbers on a recipe to the microwave, then you may need to start with preliminary instruction before you’re ready to begin teaching the broader skill of cooking. 

Similarly, if the need is high for an individual to learn a skill and they can perform each step, but they lack motivation, you may need to evaluate how to provide ample reinforcement when going through the TA.

3. Break down the skill

As described earlier in the peanut butter sandwich challenge, breaking down a skill into smaller steps can be harder than you’d expect. The best way to segment the information is by actually completing these steps or observing someone else doing so, and analyzing the process as it occurs. Here are a few different breakdowns of steps to provide some ideas of what the process can look like:

Task Analysis for PB&J Sandwich

Strategies	Skills Required
Get ingredients:BreadPeanut ButterJellyKnifePlate	Knowledge of ingredients and location
Open up the bread bag and take out 2 slices of bread	Untwisting a twisted tieCounting two objects
Place the slices side-by-side on the plate	Knowledge of “side-by-side”
Open up the peanut butter jar	Ability to twist off a lid
Put the knife in the jar and while still holding the knife, with the other end, get out about 2 Tbsp of peanut butter	How to use a knifeKnowledge of the quantity of Tbsp
With the knife, smear the peanut butter on one large side of the bread — not on the crust, and use all the peanut butter that is left on the knife	How to smear with a knifeKnowledge of the concept of “large”Knowledge of the definition of “bread crust”
Open up the jelly jar	Ability to twist off a lid
Put the knife in the jar and get out about 2 Tbsp of jelly	How to use a knifeKnowledge of the quantity of Tbsp
With the knife, smear the jelly on top of the peanut butter that is on the bread	How to use a knifeKnowledge of the concept of “top”
Place the plain piece of bread on top of the one with the peanut butter on it	Knowledge of the definition of “plain”Knowledge of the concept of “top”

And of course, after eating the PB&J, you may need to consider brushing your teeth!

 

TASK ANALYSIS EXAMPLE: Brushing Teeth (Mason et al., 1990)

1. Obtains materials
2. Takes cap off toothpaste
3. Puts paste on the toothbrush
4. Replaces toothpaste cap
5. Wets brush (I know—debatable for when to wet the toothbrush!!!)
6. Brushes left outer surfaces
7. Brushes front outer surfaces
8. Brushes right outer surfaces
9. Brushes lower right chewing surfaces
10. Brushes lower left chewing surfaces
11. Brushes upper left chewing surfaces
12. Brushes upper right chewing surfaces
13. Brushes upper right inside surfaces
14. Brushes upper front inside surfaces
15. Brushes upper left inside surfaces
16. Brushes lower left inside surfaces
17. Brushes lower front inside surfaces
18. Brushes lower right inside surfaces
19. Rinses toothbrush
20. Wipes mouth and hands
21. Returns materials

Of course, when writing a task analysis, there’s room for flexibility. I personally wet my toothbrush before I put the toothpaste on, and I definitely put peanut butter on both pieces of my bread when I make a sandwich, so I may write my version a bit differently—that’s where personalization comes into play.

4. Determine the comprehensiveness of task analysis

The best way to make sure you’ve developed a comprehensive TA is to have someone else run the steps exactly as you’ve written them. Then you’ll see if anything has been left out and revise the steps as needed.

5. Develop a teaching plan

Depending on the complexity of the skill and the student’s baseline data, the teacher should determine the best way to teach it—can the learner manage the TA in its entirety, should some of the steps be taught in phases or using forward or backward chaining? For students who are very reinforced by the end product (for example: cooking), start with the last several steps (backward chaining) and end with the positive experience of how to get there.

Similarly, the way in which the TA is presented should take into account the student’s learning style and ability. Some may need pictures of each step, some readers may have the steps written out and still others may benefit from a video model of the task before they complete it. Steps should be subtle but thorough and efficient in communicating the process to the learner.

6. Implement and monitor progress

When collecting data for task analysis, a checklist for each step can pinpoint discrete steps that may be difficult for the student—isolating those independent skills lets the teacher practice any step in isolation (when possible or applicable). Further, the checklist should include a section that outlines the level of prompting a student requires to complete the skill. Since the goal is always for students to be as independent as possible, this will help guide future instruction, too.

So whether you’re making a sandwich, washing your car, editing a paper, cooking dinner, or taking a shower, life is filled with many discrete steps that make up a larger action. Finding a way to effectively break those steps down and instruct the gaps can help students gain valuable skills, a greater quality of life, and self-reliance. 

What other tips and tricks have been effective in using task analysis in your practice? Are there any specific skills that you’d like help breaking down?

For more specific information on Task Analysis see:

—Using Task Analysis for Arrival and Dismissal Routines

—Using Task Analysis to Develop Independent Living Skills

References:

https://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/TaskAnalyis_Steps_0.pdf

https://cehs.unl.edu/documents/secd/csi/pbj.pdf

About the Author

Frankie Kietzman is a Sales Development Associate for STAGES Learning with experience teaching as an elementary teacher, self-contained autism teacher for elementary and secondary students, autism specialist and coach for teachers dealing with challenging behaviors. Frankie’s passion for supporting children and adults with autism originates from growing up with her brother who is deaf and has autism. As one of her brother’s legal guardians, she continues to learn about post-graduate opportunities and outcomes for people with autism. Frankie has a Bachelor’s degree from Kansas State University in Elementary Education, a Master’s degree in high and low incidence disabilities from Pittsburg State University and in 2021, completed another Master’s degree in Advanced Leadership in Special Education from Pittsburg State University.

About Stages

Angela Nelson, a UCLA trained ABA Therapist, founded Stages Learning in 1997 when autism diagnoses first began to rise. The top-selling autism education product, the Language Builder Picture Cards, was designed to specifically meet the learning needs of children with autism. The research-based Language Builder Series has become a staple in home and school programs around the world and Stages Learning is now the premier developer of learning tools for children with autism.

This month’s ASAT article comes to us from Preeti Chojar, MCA, ASAT Parent Board Member. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

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

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

Meeting composition

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

Develop the agenda

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

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

Circulate the agenda

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

Starting the meeting

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

During the meeting

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

Make sure to end on a positive note

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

Take meeting notes

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

Distribute meeting notes

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

Final Suggestion

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

Citation for this article:

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

About the Author

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

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

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

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

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

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

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

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

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

About Action Behavior Centers

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

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

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

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

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

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

Barriers Impacting Effective BIPs

1. Effective Training While it is a crucial skill set for behavior experts and is part of their required coursework, our research has revealed that these professionals lack confidence in their ability to develop and teach BIPs. In our survey of over 200 individuals responsible for developing BIPs, only 43% reported feeling confident choosing strategies to fit individual learner needs. In this same survey, 79.4% reported initially not feeling prepared to independently develop a BIP and only 35% of respondents reported currently feeling effective at disseminating their plan to their staff & stakeholders.

• Technical Jargon The complexity and confusion associated with commonly used, technical behavior terminology contributes to the abandonment of potentially beneficial BIPs. This abandonment leaves stakeholders feeling under-supported and service providers feeling ineffective. Technical language negatively affects comprehension and acceptability of evidence-based strategies, particularly for individuals with little or no training in Applied Behavior Analysis (ABA) principles. In our own survey, we found that 90% of stakeholders expressed a greater likelihood of using behavior strategies if they were presented in a more understandable manner. This difficulty in understanding likely contributes to published research findings indicating that team members implement fewer than 60% of the strategies outlined in a BIP, with an average accuracy rate of only 68% when implemented.

•  Time Constraints In our pilot study, we discovered that the average time spent developing a BIP was 3.6 hours. While BCBAs have genuine intentions to develop an individualized support plan that considers the learner’s preferences, strengths, and needs, as well as the practicalities for the team, the demanding nature of this process consumes a considerable amount of time and effort. In fact, “time” was the number one barrier reported by behavior experts in our pilot study interviews. Many BCBAs face constraints on their time, limiting their ability to dedicate the necessary resources for creating comprehensive and tailored BIPs. This time limitation may compromise the thoroughness and quality of BIPs, impacting their overall effectiveness in supporting individuals with behavioral needs.

• Traditional Teaching Methods After a behavior expert has developed a BIP, the traditional method of teaching this plan to the team involves providing them with a multi-page text document and reviewing it together. However, our surveys and research indicate that this method is not effective for optimal learning and retention, and it does not adequately support those who could benefit from the plan. In our pilot study, the average number of strategies included in a BIP was 26 (ranging from 4 to 45), while those responsible for implementation were only able to recall an average of 3 strategies (ranging from 0 to 5). This discrepancy aligns with established research on memory retention, which indicates that information presented in dense text is prone to being forgotten. The brain quickly loses information, tends to overlook the middle portions of lengthy texts, and may become overwhelmed by dense material.
  

Finding a Solution

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

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

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

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

About the Author

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

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

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

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