How Do We Measure Effectiveness?

This month’s ASAT feature comes to us from Dr. Daniel W. Mruzek, PhD, BCBA-D, Associate Professor, University of Rochester Medical Center. 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!

Marketers of purported interventions for autism spectrum disorder (ASD), whether they are pills, devices, or exercises, claim that their products are effective. As proof, they point to any number of measures some valid, some questionable, and some potentially misleading. Given that many of these “treatments” may be costly, ineffective and even dangerous, it is good to consider what constitutes legitimate measures of therapeutic benefit. How will we know if the intervention actually works?


A first step when presented with a potential treatment option is to investigate its scientific record. One can certainly ask the marketer (or therapist, interventionist, clinician, etc.) for examples of peer-reviewed studies examining the effectiveness of their recommended intervention. Indeed, this can be a great first step. An honest marketer will be glad to give you what they have in this regard or freely disclose that none exist. A good second step is to consult with a trusted professional (e.g., physician, psychologist, or behavior analyst who knows your family member), in order to get an objective appraisal of the intervention. If, after this first level of investigation is completed, a decision is made to pursue a particular intervention for a family member there are additional questions that one can ask the marketer prior to implementation that may prove very helpful in determining effectiveness after the intervention has been employed. These include the following:


Question 1: “What behaviors should change as a result of the intervention?”
Virtually any ASD intervention that is truly effective will result in observable change in behavior. For example, a speech intervention may very well result in increased spoken language (e.g., novel words, greater rate of utterances). An academic intervention should result in specific new academic skills (e.g., greater independent proficiency with particular math operations). An exercise purported to decrease the occurrence of challenging behavior will, if effective, result in a lower rate of specific challenging behaviors (e.g., tantrums, self-injury). As “consumers” of ASD interventions, you and your family member have every right to expect that the marketer will identify specific, objective, and measurable changes in behaviors that indicate treatment efficacy. Scientists refer to such definitions as “operational definitions” – these are definitions that are written using observable and measurable terms. If the marketer insists on using ill-defined, “fuzzy” descriptions of treatment benefit (e.g., “increased sense of well-being”, “greater focus and intentionality”, an increased “inner balance” or “regulation”), then “Buyer Beware!” These kinds of outcome goals will leave you guessing about treatment effect. Insist that operational definitions of target behaviors be agreed upon prior to start of intervention.

Question 2: “How will these behavior changes be measured?”
Behavior change is often gradual and variable. Behavior change often occurs in “fits and starts” (i.e., the change is variable). Also, our perception of behavior change can be impacted by any number of events (e.g., the co-occurrence of other therapies, our expectations for change). Therefore, it is the marketer’s responsibility to offer up a plan for collecting data regarding any change in the identified “target” behaviors. Usually, it is best to record numerical data (e.g., number of new words spoken by the individual, duration [in minutes] of tantrums, etc.) The use of numerical data to measure the change of operationally defined target behaviors is one of the best ways for a treatment team to elevate their discussion above opinion, conjecture and misrepresentation. If a pill, therapy or gadget is helpful, there is almost assuredly a change in behavior. And, that change is almost always quantifiable. Setting up a system to collect these numerical data prior to the initiation of the new intervention is a key to objective evaluation of intervention. Don’t do intervention without it.


Question 3: “When will we look at these intervention data and how will they be presented?”
Of course, it is not enough to collect data; these data need to be regularly reviewed by the team! One of the best ways to organize data is “graphically”, such as plotting points on a graph, so that they can be inspected visually. This gives the team a chance to monitor overall rates or levels of target behaviors, as well as identify possible trends (i.e., the “direction” of the data over time, such as decreasing or increasing rates) and look for change that may occur after the start of the new intervention. Note that the review of treatment data is generally a team process, meaning that relevant members of the team, including the clinicians (or educators), parents, the individual with ASD (as appropriate) often should look at these data together. Science is a communal process, and this is one of the things that makes it a powerful agent of change.


An interventionist with background in behavior analysis can set up strategies for evaluating a possible treatment effect. For example, in order to gage the effectiveness of a new intervention, a team may elect to use a “reversal design”, in which the target behaviors are monitored with and without the intervention in place. If, for example, a team wishes to assess the helpfulness of a weighted blanket in promoting a child’s healthful sleep through the night, data regarding duration of sleep and number of times out of bed might be looked at during a week with the blanket available at bedtime and week without the blanket available. Another strategy is to use the intervention on “odd” days and not use it on “even” days. Data from both “odd” and “even” days can be graphed for visual inspection, and, if the intervention is helpful, a “gap” will appear between the data sets representing the two conditions. These strategies are not complex, but they give the team an opportunity to objectively appraise whether or not a specific intervention is helpful that is much better than informal observation. Few things are as clarifying in a team discussion as plotted data placed on the table of a team meeting.


If the marketer does not answer these questions directly and satisfactorily, consider turning to a trusted professional (e.g., psychologist, physician or behavior analyst) for help. Families have a right to know whether their hard-earned money, as well as their time and energy, are being spent wisely. Asking these questions “up front” when confronted with a new intervention idea will help. Marketers have a responsibility to present their evidence – both the “state-of-the-science” as reflected in peer-reviewed research, as well as their plans to measure the potential effectiveness of their intervention for the individual whom they are serving.


Speaking of measuring treatment effectiveness, fellow ASAT board member Eric Larsson offers his considerations regarding the use of standardized measures (e.g., IQ) as outcome measures in treatment research (next article; page 20). Though this might be a little out of context for some of our readers, for those of us who rely on direct interpretations of peer-reviewed studies in our work (e.g., researchers, clinicians), Dr. Larsson describes the limitations of sole reliance on change in standardized measures is assessing the scientific validation of an intervention.


Please use the following format to cite this article:
Mruzek, D.W. (2014). ASD intervention: How do we measure effectiveness? Science in Autism Treatment, 11(3), 20-21


About The Author
Daniel W. Mruzek, Ph.D., BCBA-D is an Associate Professor at the University of Rochester Medical Center (URMC), Division of Neurodevelopmental and Behavioral Pediatrics in western New York. He received his doctoral training in Psychology at the Ohio State University and is a former Program Director at the Groden Center in Providence, Rhode Island. Currently, he is an associate professor and serves as a clinician and consultant, training school teams and supporting families of children with autism and other developmental disabilities.


Mruzek coordinates his division’s psychology postdoctoral fellowship program in developmental disabilities and is an adjunct faculty member in the University of Rochester Warner School of Education. He is actively involved as a researcher on several externally funded autism intervention research studies and has authored and co-authored more than 20 peer-reviewed articles and book chapters on autism and other developmental disabilities. Dr. Mruzek is on the editorial board for the journals Focus on Autism and Other Developmental Disabilities, Behavior Analysis in Practice, Journal of Mental Health Research in Developmental Disabilities, and Intellectual and Developmental Disabilities. Dr. Mruzek is a former member of the Board of Directors of the Association for Science in Autism Treatment.

Introducing The Salad Shoppe!

The Salad Shoppe curriculum was developed by dedicated special educators who aspire to change the face of vocational training. Working with a group of 8 young adults with varying abilities, these teachers were charged with teaching academics and supporting their transition into adulthood.

This curriculum has changed the landscape of job training by highlighting the strengths and interests of each learner and applying them to functional tasks. The Salad Shoppe curriculum is a tool to take traditional teaching methods out of the classroom and integrate them into a comprehensive and functional setting.

Learn more at our website!

Common errors with token systems

I love token systems and use them frequently with my clients. Sometimes I use Velcro stars or stickers, or the Token Towers (which are great because you can hear the token going in the plastic tube.) It’s easy to vary the token system to fit the interests and age of a client I am working with. However, I see several errors in their use. Below are a few of the common ones:

• Inconsistent Use – The use of a token system should be predictable. When I am doing an ABA session, the token system is usually available throughout the session. But token systems may be specific to certain activities or certain environments. Using them only some of the time though doesn’t improve their effectiveness.
• Lack of Clarity – You should know what behavior you are focusing on for the token system. For example, I will write down for myself that I am providing tokens for a few specific behaviors (such as whenever a client responds correctly to a current learning target, when they remain in their seats for a period of five minutes, and when they greet a person who comes into the room.) It should be clear for you, as the person implementing the token system, what behaviors you are attempting to increase so you can provide tokens when those behaviors are exhibited.
• Lack of Differentiation – One of the things I love about token systems is that it allows me to easily differentiate reinforcement. For example, let’s say I’m working with a child to teach them to name items from different categories. Usually, when I ask them to name an animal, they name one animal and I provide a token for a correct response. But on this particular day, they name three animals. I can provide more than one token for the higher quality response.
• Not Allowing the Token System to Grow with the Child – Another benefit of token systems is that they can grow with the child. Once a child has mastered a certain behavior, I no longer include it in the token system. The child is always earning tokens for behaviors or responses that are difficult. If you have a client who has been receiving tokens for the same behavior for several months, then one of the two things is happening: (1) the client has mastered the behavior and you aren’t providing reinforcement for more challenging behaviors OR (2) the client has not mastered the behavior and for some reason your token system is not working. Either way, a change needs to be made.
• Fail to Provide a Motivating Reward – I have had some experiences in which the token was supposedly reinforcing on its own. In rare cases, this might just work. However, the tokens should be used to earn a known reinforcer for that particular client.
• Fail to Provide Choices in Rewards – There’s a great body of research on how choice improves motivation. Unfortunately, many children with developmental disabilities have fewer choices in their day-to-day lives than their typically developing counterparts. Allowing your client to choose from a selection of activities or toys for reinforcement will likely improve the quality of your token system.


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 Maintain a Fast Pace of Instruction

There is a common misconception that individuals with special needs require a slower pace of instruction. While they may require a slower pace through a curriculum, this does not mean that individual lessons should be taught at a slower pace. In fact, slowing the pace of instruction not only wastes precious instructional time, it may increase the occurrence of problem behaviors.

Higbee (2009) writes that “appropriately paced instruction helps students to maintain attention to the instructor and instructional materials. Though student attention can be lost when instruction is happening too rapidly, it is most often lost when the pace of instruction is not rapid enough” (p. 20).

So how can you maintain a fast pace of instruction that is appropriate for your student? Here are some things to consider:

  1. Prepare! Set out your materials in such a way that they are easy to access quickly. I keep all the mastered skills on index cards so I can easily add maintenance questions into instruction. Organization is often the simplest way to increase efficiency in your session.
  2. Take data. You want to increase attention and decrease problem behaviors. Try different paces of instruction and measure the behaviors you are wanting to change. For instance, if I have a student who is often grabbing for my shirt during a session, I may try a pace of instruction that includes 15 questions each minute, then try a pace of 20 questions per minute, another of 25 per minute. Next, I will compare the rates of grabbing for my shirt with each pace of instruction. Remember, these aren’t 15 questions for the target skill; some mastered skills will be intermixed.
  3. Record a session. By taking video of yourself working with a child, you may see opportunities for increasing efficiency on your own. You may also observe specific times at which problem behaviors tend to increase, then be able to target those specifically. For instance, perhaps problem behaviors occur when you turn to write data in a binder, but didn’t recognize that pattern until you watched a recording later.
  4. Use reinforcement effectively. Usually, pace of instruction in and of itself will not change behavior. Instead, pair it with reinforcement and be systematic with how you implement reinforcement. We’ve talked about reinforcement here on the blog a lot, so you can read about that in more detail here.
  5. If possible, get input from supervisors or the individual you are working with. Supervisors may be able to observe your session and provide insight on how to increase your pace of instruction. And the individual you are working with may be communicating that they are bored through misbehavior, stating “I’m bored,” or nonvocal behaviors such as yawning. This may be an indication that you need to provide more challenging material or increase the pace of instruction.

REFERENCES

Higbee, T. (2009). Establishing the prerequisites for normal language. In R. A. Rehfeldt, Y. Barnes-Holmes, & S.C. Hayes (Eds.), Derived relational responding applications for learners with autism and other developmental disabilities: A progressive guide to change (7-24). Oakland, CA: New Harbinger Publications, Inc.


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.

Technology Do’s (and one Don’t!)

Technology can be a great addition to an educational or behaviorally supportive program for individuals with autism. It may be used as a powerful reinforcer for some, can facilitate language and communication, and help to organize and present visual and auditory cues efficiently. Items like tablets and smart phones also tend to be highly acceptable to learners, parents, and society as a whole. We have come a long way from the days of Velcro, laminate, and tackle boxes full of reinforcers! In some cases, the entire array of tools needed to support and teach may be included in a single device.

As great as technology may be for learners with autism, their families, and their teachers, however, there are some cautions that need to be observed. Here are some suggestions to make sure that technology is used effectively and does not have any detrimental effects.

1. Do carefully evaluate the functionality of the technology for the individual. Like any behavioral intervention, technology is not one-size-fits-all, and may not be appropriate for every use for every learner. Choose the type and application of technology that works best for the individual. Collect data on the success of the technology intervention, and make adjustments as needed.

2. Do teach alternative strategies that don’t rely on technology, to prepare for times when technology may be unavailable, broken, or inappropriate. Practice occasionally not using technology, so that when the inevitable happens (e.g., power outage, broken tablet, etc.), the individual is prepared and has some coping strategies.

3. Do monitor for safety and appropriate usage. Many apps are so easy for learners to use that they can easily connect with other people, make purchases, or share personal information without parents or teachers noticing. Devices that connect to the internet via wi-fi or data plans must be carefully monitored for such activity.

4. Do teach learners to manage their devices independently. Learners should know how to charge devices, set alarms and reminders, and use other apps for self-management. Technology isn’t just for fun; it’s become a part of life for most of us, and learners can benefit the same as anyone else.

5. Don’t use technology for technology’s sake. If it doesn’t serve a real purpose for teaching or behavioral support, it should not be in use. Any application of technology in teaching or behavioral interventions should be clearly defined, conceptually systematic, and precisely planned.


About The Author

Dana Reinecke, PhD, 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), and is currently serving as President (2017-2018).

Beyond Light Up Toys

There are many things that I would love to change about the treatment of individuals with Autism Spectrum Disorder. One of them is the notion that all kids with ASD are motivated by the same things. Certainly, some kids with autism love light up toys, squeezes, or music, but that’s true of the population at large. After all, I am mesmerized by Christmas lights, love a good head massage, and have songs I listen to on repeat.
The issue with the assumption that all kids with ASD are motivated by these small number of things is that it can lead to some very specific problems, such as practitioners trying out a smaller number of toys or activities with the child, practitioners depending solely on “sensory toys” for reinforcers instead of working to expand the number of reinforcers a child responds to, or the larger community making assumptions about the preferences of the child. Furthermore, there is evidence that the broader the range of reinforcers is for a child, the better the learning outcomes (Klintwall & Eikeseth, 2012.) Failing to think beyond the stereotypes about the interests of kids with ASD impedes their ability to learn and develop new skills.

The children I’ve worked with over the years have varied interests, ranging from dinosaurs and maps to bean bag toss and board games. And while some of the kids I work with love light up toys or trains, it’s important that we don’t take a whole swath of the population and decide that they all have similar interests. It doesn’t serve their skill development or our potential to develop real relationships with people with ASD.
As a practitioner, here are some important questions to ask yourself in relation to reinforcers and developing interests:

• Have you conducted a preference assessment? This should be one of the first things you do whenever you start a new case, and something you should continue to do informally.

• Have you talked to the client and/or the parents about what interests they would like to develop? If the client is able to discuss goals and interests with you, you should definitely be having that conversation with them. You should also talk to the parents about their goals. Perhaps they have seen some interest in one area that they would like to further develop. It’s also possible that there are specific family activities or traditions they would like their child to enjoy with the family.

• Have you read about this topic? A great place to start is Chapter 3 of the book A Work in Progress. It clearly explains how to use reinforcers and expand the reinforcer repertoire. There is also a ton of research out there about reinforcement. Take the time to search journals such as Journal of Applied Behavior Analysis and Journal of Developmental Disabilities.

Klintwall, L., & Eikeseth, S. (2012). Number and controllability of reinforcers as predictors of individual outcome for children with autism receiving early and intensive behavioral intervention: A preliminary study. Research in Autism Spectrum Disorders, 6(1), 493-499.
McEachin, J. & Leaf, R. B. (1999). A work in progress: Behavior management strategies and a curriculum for intensive behavioral treatment of autism. New York: DRL Books.


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.

Preparing For The Holidays

While the holidays can be a very fun and exciting time, they often tend to disrupt regular routines. A disruption in routines can frequently lead to added stress, anxiety, and behavioral difficulties for individuals with autism and their families. So how can you maintain the fun in holidays but also manage the major changes in routine? Here are a few ideas that may be helpful:

Use and/or modify tools your child already utilizes well. If your child uses an activity schedule, calendar, or some kind of app to prepare for transitions and upcoming events; be sure to include new icons, symbols, or preparation for the events related to holidays.
Practice the event. It may be possible for you to role play an event such as a larger family dinner, loud music, or the arrival of a someone dressed up as a character (such as Santa Claus.)
Take the time to list out what may be unique or new. While you cannot prepare for everything, it’s valuable to consider what your child may not have encountered in the past. For example, will there be lit candles within reach? Will there be appealing items your child is required to leave alone? Once you’ve brainstormed a bit, you’ll be better able to respond appropriately.
Enlist some help. If there is a family member or friend who will be present and can help if you need it, ask for their help beforehand and be specific. This might be asking them to engage your child in an activity for a short period of time, or running interference for you when your distant aunt approaches with a litany of rude questions about autism.
Make sure your child has an appropriate way to request a break. Whether your child is verbal or nonverbal, it’s helpful to teach them an appropriate way to exit a situation that is uncomfortable. This is a skill you can practice at home and use in other environments as well.
Recognize your successes. The holidays can be a stressful time, but they can also be a great indicator of just how far your child has come. Relatives you haven’t seen in a year are far more likely to see the difference in your child’s growth than you are, since you’ve seen that steady growth from day to day. It can be a wonderful time to step back and acknowledge just how hard you have all worked in previous months.

These are simple steps that may be helpful in reducing stress during the holidays. Do you have special tips for how you prepare?


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.

Double Up!

Learn all about our newest game Double Up from creator Rosemarie Griffin, CCC/SLP, BCBA! 

If you are working with older students, I know that you have probably struggled with finding materials that were age appropriate. I am a school based speech language pathologist and board certified analyst. I created Double Up to help my students strengthen their vocabulary and leisure skills.  

If you are a special education teacher, speech language pathologist, board certified behavior analyst or parent – you will love Double Up. This product can be used with students who are non-verbal and by students who are conversational. A no prep social skills activity for mixed groups!!

Double Up includes 4 different games and 144 vocabulary cards. It can be played with as few as one person or as many as 4 people. Vocabulary terms focus on the areas of leisure and hygiene. The first person to fill up their board- yells “Double Up” and they are the winner.  Read below for skills that you can work on when playing Double Up.

Matching – If you have students who would benefit from matching identical pictures, you can do that easily with double up! Just pass out the game boards of the same color. Get the matching vocabulary cards and you are ready to go. Each student picks a card and matches to their board. If they don’t have the card they pick – they can pass it to the person who does have it. If students are able to ask they can ask who has the card. For example, “who has the picture of reading?”

Associations – Students can work on matching items by association. If you pass out the purple leisure noun boards, get out the red leisure action vocabulary cards. You will turn over a leisure action ( i.e. reading), if you have the picture of the book on your board – you match it! If someone else has the book – you can pass it to them or ask “who has the book?” A great way to play for students who understand word associations.

Turn Taking – Double Up allows for practice with turn taking. Picking a card and taking your card is a functional leisure skill. The format of this game, allows for many opportunities to take your turn and wait while others take their turn.

Waiting – If you play Double Up as a 4 person game- your students will have to wait for their peers to take a turn. This is a natural way to work on the skill of waiting. Waiting can be so very difficult for our students and this is a great way to embed work on this skill. 

Independent Work. Double Up also makes a functional independent work task. A student could take one board from the double up game and the matching cards. They would match the identical cards for an independent work task. The pictures are functional and age appropriate, so not only are students work on increasing their duration with an independent task, they are being exposed to words that are important to them!

Conversation Skills – The pictures in double up lend themselves to conversation. You can discuss the vocabulary terms with the students. “Have you lifted weights before?” “Have you been camping?” The conversation opportunities are endless! 


About the Author

Rosemarie Griffin, MA, CCC/SLP BCBA, is an ASHA certified Speech-Language Pathologist and a Board Certified Behavior Analyst. She divides her time between a public school and a private school for students with autism in Ohio. She’s presented at the national, state and local level about systematic and collaborative language instruction for students with autism. Her professional mission is to help all students expand their communication step by step. She can be reached at www.abaspeech.org, on Facebook or Instagram. 

3 Ways To Fade Prompts

Prompts are ways we help our learners demonstrate new skills. We use prompts to get our students to greet a peer, flush the toilet, name the color blue, and clap their hands. Prompts are something we add to the situation because the natural or teaching cue was not enough to cause the student to respond. The natural cue of being finished using the toilet was not a strong enough reminder to flush the toilet so we added the verbal prompt, “flush the toilet” and the student now responds. Prompts are important but fading them is just as important.  Prompt fading needs to be planned from the start and an integral and essential component to the plan. Unless you are committing to following that child around for the rest of his life and tell him to flush the toilet – prompt fading is essential.

Some rules for prompt fading:

* Plan it out from the start.
* Train your staff.
* Do it gradually.
* If incorrect responding begins, return to last prompt level.

1. Least to Most Prompt Fading

Like we discussed in Monday’s post, least to most prompting involves starting with the least intrusive prompts and moving up in the prompting hierarchy. This can be beneficial because it gives students to the opportunity to be independent and you are only providing as much prompting as needed. This is a strategy we tend to use naturally. When you meet a your friend’s toddler you put out your hand to give a high five. If she doesn’t respond you say, “give high five.” If she still doesn’t respond you move her hand to your hand to give a high five. This is a natural method of prompting. When using this method, ideally the prompts will be somewhat self fading. If you are always starting at the least intrusive prompt, your students will have the opportunity to demonstrate independence. As the student begins to learn the task, he will need less and less prompts to perform it correctly.

Some key tips for using this prompt fading procedure:

  • allow wait time; if you do not provide wait time you may be providing more prompts than needed and taking away the opportunity for the student to respond correctly
  • take data; data is key to track progress. Every time you utilize this prompting method – note the level of prompt you used. You want to see that your student is requiring less intrusive prompts as time goes on. This will help avoid prompt dependence.
  • use high powered reinforcers; use an item that is actually a reinforcer that your student wants to work for. The sooner he demonstrates the skills, the sooner he gets the reinforcer.

2. Most to Least Prompt Fading

 

Most to Least prompt fading is another effective method of using prompts. With this method you start the most intrusive prompts and gradually fade to less intrusive prompts. The prompt fading is build right in. However, sometimes people forget that and in their head rename this most to most prompting. The key to errorless learning and using the most intrusive prompts first is that you fade the prompts out. The idea behind most to least prompting is that students will contact reinforcement right away and you will avoid errors and the students developing any incorrect habits.

How to fade prompts in Most to Least Prompting:

  • set criteria for changing prompts; once your student hits a particular number of days or sessions or trials at a particular prompt level, fade to the next level; take data to track progress
  • once you hit the criteria move to the next type of prompt; refer to our prompt hierarchy or order that is in Monday’s post. Move up the list to less and less intrusive prompts.
  • fade magnitude than switch prompt type; before you switch from a gestural to a verbal prompt adjust the magnitude of the prompt. A dramatic point to an object is different that a nod of your head.

Data is critically important for avoiding prompt dependence. You want to set a criteria ahead of time and take data to make sure you are sticking with the criteria. The criteria you set will depend on the student and the task. Maybe you want 3 consecutive days with each prompt level. If you are taking data you can ensure that you are sticking to that schedule. If errors begin occurring, go back a prompt level. The data will guide your implementation of this procedure. If you are fading too quickly, your data will tell you!

Prompt fading isn’t scary. Plan ahead and make sure you train your staff. This is a group endeavor! 

3. Time Delay

 

One effective way we can fade prompts is using a time delay. A time delay inserts a set amount of time between the natural or teaching cue and our prompt. When utilizing a time delay, start with a zero second (i.e. no) time delay – so it will basically be like errorless teaching. For the first few trials, give the prompt right away so the student knows how to respond. Then after several trials, increase the time delay. For example, you may start with 2 seconds. If the student does not respond within 2 seconds – provide the prompt. If the student responds before the 2 seconds, provide loads of reinforcement. Once the student is successful and responding under the 2 seconds for several trials, increase the time delay. Now wait until 4 seconds to provide the prompt. Continue on. If the student does not respond with the 4 second time delay, move back to the 2 second time delay.

The key to time delay is planning and data. Set the criterion ahead of time. Plan how many sessions you will do at 0 seconds before moving to the first time delay. Determine what the mastery criteria is – how many times do you want the student to respond within the time delay before increasing the time delay length? Take data on this. It can easily and quickly get confusing if you don’t have a data sheet to track what you are doing. Write the plan in simple terms at the top of your data sheet. I like to track prompted correct (PC), prompted incorrect (PI), unprompted correct (UC), and unprompted incorrect (UI) using those abbreviations on my data sheet. If the student responds before the prompt it is counted as unprompted and if it’s after the prompt it is prompted!

There is no magic number of trials or days you should stay within the 0 second or 2 second time delay. It depends on the student’s level of functioning and the difficulty of the task. This is where data majorly comes in to play. If you’ve moved along too quickly, you will know and you can scale back.

Time delay works really well with verbal prompts. Another key component to time delay working successfully is making sure the reinforcement you give for the unprompted responses is better than the reinforcement for prompted responses. So if Johnny responds before the time delay and says the color blue on his own – give him 3 m&ms and praise but if you are using a 2 second time delay and he doesn’t respond and you provide the verbal prompt “bl…” and then he says blue only provide praise. You want the independent responses to be getting more reinforcement so your student is motivated to engage in those responses more!


About The Author 

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