How do you figure out what motivates your students?

This ASAT feature comes to us from Niall Toner, MA, BCBA of the New York State Institute for Basic Research in Developmental Disabilities. 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 special education teacher working with students with autism. At times I find it difficult to figure out what motivates my students and what they’re interested in. Can you make some suggestions about the best way to do this?

This is an excellent question and one that highlights a challenge often experienced not only by teachers but also by family members of individuals with autism. We know that the interests and preferences of individuals with and without autism vary significantly over time. Also, we know that effective teaching of skills and behavior change are predicated upon the timely use of powerful reinforcement (i.e., positive consequences of skilled behavior that motivate and strengthen that behavior). As discussed below, identifying an individual’s preferences is a critical first step in teaching new skills because these preferences often lead to the identification of powerful reinforcers; but how we do this can be easier said than done, especially when the learner has a limited communication repertoire or very individualized interests. The best way to identify preferences is through ongoing preference assessments.

The value of preference assessments

Since many individuals with autism may have difficulty identifying and communicating their preferences directly, we must consider alternative methods of obtaining this information. At the onset, it is important to keep in mind that what may be rewarding or reinforcing for one individual may not be for another. For example, one child may enjoy bubble play, crackers or a particular cause-and-effect toy while a classmate may find one or more of these uninteresting or even unpleasant. Furthermore, an individual’s preferences change across time. For example, an individual may have demonstrated little use for music at age 11, but she may demonstrate a keen interest in music at age 13.

Preference assessments provide a systematic, data-based approach to evaluating a host of potential interests (e.g., food, toys, activities) for an individual. Although preference assessments do require time and effort up front, their use can decrease the time and energy, required to change behavior in the long run. Research indicates that when caregivers use a presumed preference that, in fact, is not the learner’s actual preference, valuable time, energy and resources are lost (Cooper, Heron, & Heward, 2006).

Types of Preference Assessments

Preference assessment can be conducted in three distinct ways: (1) Interviews and Formal Surveys; (2) Direct observation; and (3) Systematic assessment.

Interviews are a straightforward technique that can be used to gather information quickly. They involve obtaining information from the individual’s parents, siblings, friends, and teachers (and
from the individual, if communicative) by asking both open-ended and comparison questions. Examples of open-ended questions include: “What does he like to do?” “What are his favorite foods?” and “Where does he like to go when he has free time?” Comparison questions might include: “Which does he like better, cookies or crackers?” and “What would he rather do, go for a walk or eat chips?” Resultant information is then compiled in a list and identified items and activities can be piloted out as possible reinforcers.

Formal surveys can also be used to guide these discussions. One widely used survey is the Reinforcement Assessment for Individuals with Severe Disabilities (RAISD; Fisher, Piazza, Bowman, & Amari, 1996). This interview-based survey gathers information about potential reinforcers across a variety of domains (e.g., leisure, food, sounds, smells), and ranks them in order of preference. It should be noted that, although simple and time-efficient, using interviews alone can result in incomplete or inaccurate information. In fact, some studies have shown that, for the same individual, staff interviews did not reveal the same information as using a survey (Parsons & Reid, 1990; Winsor, Piche, & Locke, 1994).

Direct observation involves giving the individual free access to items and/or activities that he or she may like (presumed preferences) and recording the amount of time the individual engages with them. The more time spent with an item or activity, the stronger the presumed preference. In addition, positive affect while engaged with these items and activities could be noted (e.g., smiling, laughing). During these observations, no demands or restrictions are placed on the individual, and the items are never removed. These direct observations can be conducted in an environment enriched with many of the person’s preferred items or in a naturalistic environment such as the person’s classroom or home. Data are recorded over multiple days, and the total time spent on each object or activity will reveal the presumed strongest preferences. Direct observation usually results in more accurate information than interviews but also requires more time and effort.

Systematic assessment involves presenting objects and activities to the individual in a preplanned order to reveal a hierarchy or ranking of preferences. This method requires the most effort, but it is the most accurate. There are many different preference assessments methods, all of which fall into one of the following formats: single item, paired items, and multiple items (Cooper, Heron, & Heward, 2006).

Single item preference assessment (also known as “successive choice”) is the quickest, easiest method. Objects and activities are presented one at a time and each item is presented several times in a random order. After each presentation, data are recorded on duration of engagement with each object or activity.

Paired method or “forced-choice” (Fisher et al., 1992) involves the simultaneous presentation of two items or activities at the same time. All items are paired systematically with every other item in a random order. For each pair of items, the individual is asked to choose one. Since all objects and activities have to be paired together, this method takes significantly longer than the single-item method but will rank in order the strongest to weakest preferences. Researchers found that the paired method was more accurate than the single item method (Pace, Ivancic, Edwards, Iwata & Page, 1985; Paclawskyj & Vollmer, 1995).

The multiple-choice method is an extension of the paired method (DeLeon & Iwata, 1996). Instead of having two items to choose from, there are three or more choices presented at the same time. There are two variations to this method: with and without replacement. In the multiple choice with replacement method, when an object is selected, all other objects are replaced in the next trial. For example, if the individual is given a choice of cookies, crackers, and chips, and he chooses cookies, the cookies will be available for the next trial, but the crackers and chips are replaced with new items. In the without replacement method, the cookies would not be replaced and the choice would only be between the crackers and chips. No new items would be available.

A few final recommendations

When conducting preference assessments, consider testing leisure items/activities and food assessments separately because food tends to motivate individuals more than toys and other leisure items (Bojak & Carr, 1999; DeLeon, Iwata, & Roscoe, 1997). Also, be sure to assess preferences early and often. Preference assessments should be conducted prior to starting any new intervention or behavior change program. And remember that preferences change over time and require continuous exploration. Therefore, assessments should be updated monthly or whenever an individual appears tired of or bored with the preferred items. Keep in mind too, that the identification of one type of preference may provide ideas for other potential reinforcers. For example, if an individual loves a certain type of crunchy cereal, he/she may like other cereals or crunchy snacks. Or if an individual enjoys coloring with crayons, consider exploring whether he/she may enjoy coloring with markers or using finger paints.

Finally, when selecting a preference assessment method, a practitioner or parent should consider the individual’s communication level, the amount of time available for the assessment, and the types of preferred items that will be available. Taken together, these preference assessment methods can provide the valuable information necessary to help motivate and promote behavior change in individuals with autism.

References

Bojak, S. L., & Carr, J. E. (1999). On the displacement of leisure items by food during multiple stimulus preference assessments. Journal of Applied Behavior Analysis, 32, 515-518.

Cooper, J. O., Heron, T. E., & Heward W. L. (2006). Applied Behavior Analysis (2nd ed.). Upper Saddle River, New Jersey: Prentice Hall.

DeLeon, I. G., & Iwata, B. A. (1996). Evaluation of multiple-stimulus presentation format for assessing reinforcer preferences.Journal of Applied Behavior Analysis, 29, 519-533.

DeLeon, I. G., Iwata, B. A., & Roscoe, E. M. (1997). Displacement of leisure reinforcers by food during preference assessments. Journal of Applied Behavior Analysis, 30, 475-484.

Fisher, W. W., Piazza, C. C., Bowman, L. G., & Amari, A. (1996). Integrating caregiver report with a systematic choice assessment. American Journal on Mental Retardation, 101, 15-25.

Fisher, W. W., Piazza, C. C., Bowman, L. G., Hagopian, L. P., Owens, J. C., & Slevin, I. (1992). A comparison of two approaches for identifying reinforcers for persons with severe to profound disabilities. Journal of Applied Behavior Analysis, 25, 491-498.

Pace, G. M., Ivancic, M. T., Edwards, G. L., Iwata, B. A., & Page, T. J. (1985). Assessment of stimulus preference and reinforcer value with profoundly retarded individuals. Journal of Applied Behavior Analysis, 18, 249-255.

Paclawskyj, T. R., & Vollmer, T. R. (1995). Reinforcer assessment for children with developmental disabilities and visual impairments. Journal of Applied Behavior Analysis, 28, 219-224.

Parsons, M. B., & Reid, D. H. (1990). Assessing food preferences among persons with profound mental retardation: Providing opportunities to make choices. Journal of Applied Behavior Analysis, 23, 183-195.

Windsor, J., Piche, L. M., & Locke, P. A. (1994). Preference testing: A comparison of two presentation methods. Research in Developmental Disabilities, 15, 439-455.


About The Author

Niall Toner MA, BCBA, LBA is a licensed behavior analyst and board certified behavior analyst with over 10 years experience working in the fields of applied behavior analysis and developmental disabilities. Niall is currently the Clinical Director for Lifestyles for the Disabled. Prior to the position he served as a consultant to various organizations including the New York City Department of Education. He also held the position of Assistant Director at the Eden II Programs. Niall has presented locally, nationally and internationally. His interests are Preference Assessments and Functional Analysis, which he presents and publishes.

Originally reposted to Different Roads to Learning on September 28, 2017

Self Care for Moms

By Leanne Page; originally posted on Parenting with ABA

When you hear the words “self-care”, what is your reaction? A sigh of relief? Rolling your eyes as it feels like just ONE. MORE. THING.?

As a busy mom, we’ve all heard the expression to put your own oxygen mask on first. But when are we supposed to do that?

Self-care doesn’t have to mean bubble baths and beverages. It doesn’t have to mean shopping or pedicures. So what the heck does it mean then?

The World Health Organization defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider”.

And the American Psychological Association says “Self-care has been defined as providing adequate attention to one’s own physical and psychological wellness. Beyond being an aspirational goal, engaging in self-care has been described as an “ethical imperative”.”

Self care means paying attention to your own wellness- emotional, physical, and psychological. How are YOU doing right now? And the question you’ve heard me encourage you to use before- 6 little magic word: What do you need right now?

Quick and easy ways to improve your physical self-care:

  • Drink more water. Make this easier by using habit stacking. This means take an existing habit and add the step of drinking a glass of water on top of it. In ABA speak, the existing habit becomes the SD for drinking water. When I turn on my coffee maker in the morning, I drink a big glass of water while the coffee machine heats up.
  • Sleep hygiene. Turn off screens earlier in the evening. Go to bed earlier. Remove distractions. Journal before bed. Whatever works for you to promote good sleep!
  • Eat healthy. Instead of focusing on removing certain foods from your diet, just add in one healthy thing a day- like a fruit or vegetable. Habit stack by adding a piece of fruit to your afternoon cup of coffee, tea, or water.

Quick and easy ways to work on your emotional & psychological self-care:

  • Gratitude practice. There is SO much research on the benefits of gratitude practice for your mental health. This doesn’t have to be time consuming or involved. Habit stack by thinking about one thing you are grateful for every time you brush your teeth. Or ask every member of your family what they are grateful for each day (or call it a happy thing or a good thing) every time you all sit down at the kitchen table together.
  • Insert a pause. Just a simple pause throughout your day can help! When you are starting to feel emotionally heightened, pause and take some deep breaths. Insert this pause before you react to your kids or something else. Just giving yourself that moment to breathe and collect your thoughts can be wonderful for your self-care!
  • Schedule alone time. Work with your partner or support system to have a standing date with yourself on the calendar. It may be 20 minutes to sit on the back porch or an hour on the weekend to go to a yoga class. Whatever works for you! Put it on your calendar and treat it like an important appointment. It is important!

If you like bubble baths and wine- feel free to use it for your self-care. But that’s not all that matters! What matters is that you find a way to give yourself a little breather from the mental load of motherhood.

Prioritize yourself- even just in small increments. Learn something new, try a new hobby, read a book, exercise. Find what works for YOU and schedule time for it. Guard that time as an important appointment because you are worth it.

What small ways can you incorporate more self care into your days this week?? Try something and let me know how it goes!

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

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

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

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

Working on the Front Lines of Autism Care

By: Stephanie Tafone, M.A., P.D., Behavior Intervention Specialist at Eden II Programs 

Working on the front lines of Autism care in a residential facility is both rewarding and, at times, challenging. Although our residents depend on us in many ways to teach them how to complete day-to-day tasks, it is important for all staff to recognize and respect that our residents each have their own preferences and interests. Therefore, we always strive to let our residents make as many choices as possible (provided they are healthy choices that do not cause harm to anyone). Just because we as staff might complete a particular task a certain way does not mean it is the “right” or only way to do so. Recognizing and respecting residents’ choices can help avoid negative behaviors or frustration for our residents. Our goal is always to teach and foster independence and self-direction. 

It is always important to build good rapport with our residents so we are in tune with their wants and needs, while also enabling them to better trust us, work with us, and learn from us. Unfortunately, with current staffing crises and funding cuts in residential care settings, one challenge we face is securing long-term, seasoned staff. This type of setting often suffers from a high turnover rate, which this is a matter that needs more global attention, as hardworking, dedicated, and experienced/trained staff are crucial for our population. 

One of the biggest considerations we have on a daily basis, particularly during the global COVID-19 pandemic, is finding creative and entertaining recreational and leisure activities to keep our residents happy and actively engaged. Anyone can become restless and bored with nothing to do, and those with Autism are no different, which is why active engagement is one of our top priorities in a group home setting. When selecting activities, we strive to ensure that each resident’s preferences are considered and incorporated. This includes a combination of both community outings and in-house events/activities. Going into the community on outings can be challenging at times when unpredictable factors (e.g. noise, crowds, etc.) may trigger negative behaviors. However, we do our best to avoid triggering situations by researching and/or visiting the activity or location before our residents experience it in order to help determine if there are any barriers that will prevent it from being an enjoyable and successful outing for all. We also do our best to go prepared on each community outing with preferred items that can be used as a source of redirection and comfort if needed. For example, headphones to drown out noise if it gets too noisy, as well as preferred snacks or drinks if our residents get hungry or thirsty. In the residence, we also strive to think of creative leisure activities, such as dance or karaoke parties, Bingo nights, movie nights, baking, and arts and crafts. Having an enthusiastic and supportive approach, as well as using preferred reinforcers, helps to engage our residents in these activities and increase their interest level. 

In addition to recreational and leisure activities for entertainment and socialization, day-to-day life in the residence is also a learning experience for our residents, as they work on a variety of individualized goals with their assigned staff. Examples of goals may include activities such as participating in a consistent exercise regimen, learning how to independently cook rice or make tea, learning how to independently count money and make purchases, and learning how to independently vacuum or clean one’s room. The selection of a participant’s goals is a collaborative process that involves input from parents/caregivers, input from the participant(s) if possible, and input from the management team at the residence. We strive to ensure that selected goals not only address a skill deficit, but are also aligned with the participant’s interests and will help the participant become more independent in daily living skills. Similarly, participants learn increased independence by participating in various chores around the house, such as setting the table for lunch and dinner, loading and emptying the dishwasher, and doing one’s laundry. Teaching many of these goals and chores can be accomplished through the use of a visual task analysis that breaks the task down into smaller components (i.e. individual steps), which are each depicted in visual images. Visuals are a very helpful teaching technique for those with Autism, who often struggle significantly with understanding verbal language and oral directions. It is also helpful for learning, especially in the initial stages, to use a preferred reinforcer to reward correct completion of steps. In the beginning of learning a new goal or chore, one step may need to be taught for a number of consecutive days until it is mastered and the next step can be taught. 

Overall, working in a residential setting has been a great learning experience and we know that our work has had, and continues to have, a significant influence on our residents’ lives, which is very rewarding for all staff. 

About the Author: 

Stephanie Tafone, M.A., P.D. earned her B.A. in Psychology from St. John’s University before going on to earn her M.A. and Professional Diploma in School Psychology from Kean University. She is currently in the process of completing the requirements to obtain an Advanced Certificate in Applied Behavior Analysis as she pursues national certification. For the past ten years, she has been working with both children and adults with disabilities. She currently works as a behavior intervention specialist at a residential facility serving adults who have been diagnosed with Autism Spectrum Disorder. She also works as a school psychologist serving children with various diagnoses and disabilities, as well as an adjunct professor for courses pertaining to Applied Behavior Analysis, Autism, and Intellectual Disability. 

Whose behavior needed to be fixed? The kids’ or the parents’??

At a recent family meeting, I had put an item on the agenda- listening to mom and dad so we don’t have to repeat ourselves. In the past week, I had noticed that I was having to say things many more items than usual and my husband and I had both raised our voice more often. So I brought this up in a problem solving format with all 4 of us- two kids, my husband, and myself. Everyone was given a chance to propose solutions- no matter how off the wall.

I expected the conversation about listening better to go one of two ways when the kids are allowed to make the call: either all about earning rewards, or about getting trouble. One extreme or the other. But I sat quietly and let my little ones (ages 7 and 4) have the floor and share what they thought would fix this issue we were having. Things started to go down the punishment lane- maybe we should lose allowance when we don’t listen- and I shut that down. I told them that allowance is not tied to their behavior and we wouldn’t be making changes to our allowance system. Then things got interesting. My FOUR year old shared that her pre-kindergarten teacher would say “1, 2, 3, eyes on me” and then the kids would listen to her. So my littlest suggested a change to MY behavior to fix the problem. So the 7 year jumps in and says “Remember how you used to do silly poses to get our attention? Maybe you can do that again.” Again – they wanted to change the PARENTS’ behavior, not their own. I was all in on this train of thought. I suggested I use things I used to do consistently when we were in full-on virtual school mode- clapping patterns, hand gestures, silly voices- to get their attention before asking them to do something. That way they are actually listening the first time and we won’t have to repeat ourselves. As a family, we agreed the solution to the problem of the kids not listening was to make a change to Mom & Dad’s behavior- we would do something to make sure we had their attention FIRST and then tell them whatever we needed them to hear.

This is not a new and noteworthy idea. But it is a good idea! I’ve even written about it before here: https://www.parentingwithaba.org/get-my-kids-to-listen-part-1/. Here’s an excerpt from that to help you (and me) remember: Get their attention first. We have to interrupt whatever is currently going on- and somehow win that battle for attention from something they prefer more than listening to mom giving instructions. I mean, what could be more fun than listening to mom giving instructions? Oh- everything? I see.

  1. Be silly. Interrupt with silliness. Make silly faces, silly poses, or use different voices. Get their attention AND a smile on their face before you even start to give instructions.
  2. Start with a joke, then give the instructions.
  3. Say something absurd. Instead of “Go wash your hands” try “Go wash your earlobes”. Let your kids correct you- now they have said the instructions themselves! “Oh silly me. Wash your hands, not your earlobes!”

By letting the kids help come up with this solution, they’ve been all in. If we do anything to get their attention first, they freeze and make big eyes and stare at us. It’s a little overboard with the dramatics, which I find hilarious and awesome. And when I forget, they will say “1, 2, 3, eyes on me” to me as a reminder. So far things are better in my house with no major reward system, no punishments or loss of allowance, no big drama. We just needed to talk through a problem and whose behavior needed a change? Not the kids. It was the parents’ behavior that was changed this time (and most of the time if we’re honest with ourselves here). What things to do you use to get your kids’ attention? What works for you?

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

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

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

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

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

Parenting For Joy

Editor’s note:  Autism Awareness month is becoming a call to action from the autism and neurodivergent communities for change from the rest of society. In this edited excerpt from their upcoming book with Different Roads, co-authors Shahla Ala’i-Rosales and Peggy Heinkel-Wolfe offer a specific call to action to both parents and professionals—to seek and maintain joy’s radiating energy in our relationships with our children.

Parents have the responsibility of raising their children with autism the best they can. This journey is part of how we all develop as humans—nurturing children in ways that honor their humanity and invite full, rich lives. Ala’i-Rosales and Heinkel-Wolfe’s upcoming book offers a roadmap for a joyful and sustainable parenting journey. The heart of this journey relies on learning, connecting, and loving. Each power informs the other and each amplifies the other. And each power is essential for meaningful and courageous parenting.

Ala’i-Rosales is a researcher, clinician, and associate professor of applied behavior analysis at the University of North Texas. Heinkel-Wolfe is a journalist and parent of an adult son with autism.

Joy gives us wings! ― Abdul-Baha

“Up, up and awaaay!” all three family members said at once, laughing. A young boy’s mother bent over and pulled her toddler close to her feet, tucking her hands under his arms and around his torso. She looked up toward her husband and the camera, broke into a grin, and turned back to look at her son. “Ready?” she said, smiling eagerly. The boy looked up at her, saying “Up . . .” Then he, too, looked up at the camera toward his father before looking back up at his mother to say his version of “away.” She squealed with satisfaction at his words and his gaze, swinging him back and forth under the protection of her long legs and out into the space of the family kitchen. The little boy had the lopsided grin kids often get when they are proud of something they did and know everyone else is, too. The father cheered from behind the camera. As his mother set him back on the floor to start another round, the little boy clapped his hands. This was a fun game.

One might think that the important thing about this moment was the boy’s talking (it was), or him engaging in shared attention with both his mom and dad (it was), or his mom learning when to help him with prompts and how to fade and let him fly on his own (it was), or his parents learning how to break up activities so they will be reinforcing and encourage happy progress (it was) or his parents taking video clips so that they could analyze them to see how they could do things better (it was) or that his family was in such a sweet and collaborative relationship with his intervention team that they wanted to share their progress (it was). Each one of those things is important and together, synergistically, they achieved the ultimate importance: they were happy together.

Shahla has seen many short, joyful home videos from the families she’s worked with over the years. On first viewing, these happy moments look almost magical. And they are, but that joyful magic comes with planning and purpose. Parents and professionals can learn how to approach relationships with their autistic child with intention. Children should, and can, make happy progress across all the places they live, learn, and play–home, school, and clinic. It is often helpful for families and professionals to make short videos of such moments and interactions across places. Back in the clinic or at home, they watch the clips together to talk about what the videos show and discuss what they mean and how the information can give direction. Joyful moments go by fast. Video clips can help us observe all the little things that are happening so we can find ways to expand the moments and the joy.

Let’s imagine another moment. A father and his preschooler are roughhousing on the floor with an oversized pillow. The father raises the pillow high above his head and says “Pop!” To the boy’s laughter and delight, his father drops the pillow on top of him and gently wiggles it as the little boy rolls from side to side. After a few rounds, father raises the pillow and looks at his son expectantly. The boy looks up at his father to say “Pop!” Down comes the wiggly pillow. They continue the game until the father gets a little winded. After all, it is a big pillow. He sits back on his knees for a moment, breathing heavily, but smiling and laughing. He asks his son if he is getting tired. But the boy rolls back over to look up at his dad again, still smiling and points to the pillow with eyebrows raised. Father recovers his energy as quickly as he can. The son has learned new sounds, and the father has learned a game that has motivated his child and how to time the learning. They are both having fun.

The father learned that this game not only encourages his child’s vocal speech but it was also one of the first times his child persisted to keep their interaction going. Their time together was becoming emotionally valuable. The father was learning how to arrange happy activities so that the two of them could move together in harmony. He learned the principles of responding to him with help from the team. He knew how to approach his son with kindness and how to encourage his son’s approach to him and how to keep that momentum going. He understood the importance of his son’s assent in whatever activity they did together. He also recognized his son’s agency—his ability to act independently and make his own choices freely—as well as his own agency as they learned to move together in the world.

In creating the game of pillow pop, parent and child found their own dance. Each moved with their own tune in time and space, and their tunes came together in harmony. When joy guides our choices, each person can be themselves, be together with others, and make progress. We can recognize that individuals have different reinforcers in a joint activity and that there is the potential to also develop and share reinforcers in these joint activities. And with strengthening bonds, this might simply come to mean enjoying being in each other’s company.

In another composite example, we consider a mother gently approaching her toddler with a sock puppet. The little boy is sitting on his knees on top of a bed, looking out the window, and flicking his fingers in his peripheral vision. The mother is oblivious to all of that, the boy is two years old and, although the movements are a little different, he’s doing what toddlers do. She begins to sing a children’s song that incorporates different animal sounds, sounds she discovered that her son loves to explore. After a moment, he joins her in making the animal sounds in the song. Then, he turns toward her and gently places his hands on her face. She’s singing for him. He reciprocates with his gaze and his caress, both actions full of appreciation and tenderness.

Family members might dream of the activities that they will enjoy together with their children as they learn and grow. Mothers and fathers and siblings may not have imagined singing sock puppets, playing pillow pop, or organizing kitchen swing games. But these examples here show the possibilities when we open up to one another and enjoy each other’s company. Our joy in our child and our family helps us rethink what is easy, what is hard, and what is progress. 

All children can learn about the way into joyful relationships and, with grace, the dance continues as they grow up. This dance of human relationships is one that we all compose, first among members of our family, and then our schoolmates and, finally, out in the community. Shahla will always remember a film from the Anne Sullivan School in in Peru. The team knew they could help a young autistic boy at their school, but he would have to learn to ride the city bus across town by himself, including making several transfers along the way. The team worked out a training program for the boy to learn the way on the city buses, but the training program didn’t formally include anyone in the community at large. Still, the drivers and other passengers got to know the boy, this newest traveling member of their community, and they prompted him through the transfers from time to time. Through that shared dance, they amplified the community’s caring relationships. 

When joy is present, we recognize the caring approach of others toward us and the need for kindness in our own approach toward others. We recognize the mutual assent within our togetherness, and the agency each of us enjoys in that togetherness. Joy isn’t a material good, but an energy found in curiosity, truth, affection, and insight. Once we recognize the radiating energy that joy brings, we will notice when it is missing and seek it out. Joy occupies those spaces where we are present and looking for the good. Like hope and love, joy is sacred.

“When there is so much hate and so much resistance to truth and justice, joy is itself is an act of resistance.” ― Nicolas O’Rourke

Photo Credit: Bruno Nascimento c/o Unsplash

Compassionate ABA

Compassion requires three actions: listening, understanding, and acting. ABA is a compassionate practice by definition, because behavior analysts are trained to do each of these actions in very specific ways.

Listening is necessary for consent. Behavior analysts are required by ethical and professional guidelines to ensure informed consent prior to implementing assessment or intervention. Informed consent includes demonstrating that you understand what you are agreeing to, so behavior analysts should be listening to clients and their parents/guardians to determine if this understanding exists. If they are really consenting, clients or their parents/guardians will always be in control of the goals targeted and strategies of intervention.

Understanding occurs through the functional perspective taken by behavior analysts, which means that they take the time to learn and understand why behavior is happening or not happening. After listening to what is important to and for the client, the next step is to assess behavior. Put simply, the behavior analyst endeavors to get into their client’s shoes and figure out why they are acting the way they are acting. The assumption is always that the individual has good reasons for their behavior, and if those actions are going to change, we need to figure out how to replace them or make them less necessary, more efficient, or easier. We assume that people are right about their interactions with the world. If anything needs to change, it is the world, and not the person.

Acting is done through the development of interventions designed to improve the client’s situation and experience, based on the priorities established by the client through listening and consent. Behavior analysts hold social validity to be a very important value, in that not only should behavior change be meaningful and helpful to the individual who is changing their behavior, but the ways in which behavior is changed must also be acceptable. Behavioral interventions are not done to people, but with them, to help them meet their own goals in ways that they find reasonable.

Consent, assessment, and intervention meet the three requirements for compassion – listening to someone to hear what is concerning them, attempting to understand or feel their distress, and then doing something to alleviate their problems. Failure to take steps to listen to concerns and understand behavior takes the “analysis” out of the practice and reduces it to a collection of tricks that sometimes work but often don’t, and sometimes even make things worse. Unfortunately, sometimes poor training or supervision, or simple unethical practice, results in behavior analysis that is not compassionate and that reflects badly on the whole field.

Consider two scenarios that could happen when a well-meaning behavior analyst meets a new client for the first time, and finds that the client engages in high rates of stereotypy:

● Behavior analyst A draws upon her experience and determines that the levels of stereotypy that the client engages in will likely be disruptive in school and other community environments. She informs the family that stereotypy is inappropriate and teaches the parents to implement a comprehensive plan that includes environmental enrichment, positive reinforcement for periods of time when stereotypy does not occur, and asks them to collect data throughout the day on levels of stereotypy. Then she leaves with a promise to return in a week to evaluate their progress. The parents call the agency and say that they don’t think ABA is for them.

● Behavior analyst B has a lengthy conversation with the family about their preferred activities as a family. She asks them what they love to do with their child, and finds that they all enjoy going to the playground but that they usually reserve that activity for chilly days or early evenings and that they have been going less and less. When this is explored a bit further, they share somewhat reluctantly that both parents are uncomfortable when other parents and children stare when their child engages in stereotypy. The behavior analyst asks what they would like to do about this, if anything, or if they feel that their current strategy is working for them. The parents ask if they can think about it, and the behavior analyst agrees to discuss at next week’s meeting. In the meantime, she leaves them with some websites about functional assessment to look over. At the following week’s meeting, the parents say that they would like to prioritize other issues over stereotypy at this time, but they would like to learn more about functional assessment to see if it could help them to understand stereotypy a bit better.

In these scenarios, behavior analyst A provided a set of interventions that are not aversive and potentially not difficult for a trained professional to implement, but perhaps overwhelming to a family newly introduced to ABA. She prioritized the goals for intervention based on her experience rather than the family’s needs and preferences, without taking the time to listen to them and ensure consent. She also did not assess or attempt to understand the behavior and instead attempted to swiftly take action to reduce it. In addition, she did not attempt to determine if the interventions were acceptable to the parents or the child. If the family did choose to continue with her plan, it is possible that stereotypy might have decreased, but it is also possible that her plan would fail to meet the function of the behavior, resulting in unnecessary stress and a poor experience for the child. Ultimately, the family decided that this approach did not fit with their needs and they lost out on all of the potential benefits of well-implemented ABA for other areas of their child’s life, such as improving communication and independence.

By contrast, behavior analyst B moved slowly. She did not start by trying to identify problems, but by listening to the family by exploring their strengths and reinforcers, providing her with knowledge about how to connect with the child and parents and how to create a fun, warm, and enjoyable experience for everyone. She allowed them to share what makes it difficult for them to enjoy those reinforcers, and she opened the door to helping them with this issue if that is what they want. She did not provide a solution without consent or assessment, however. She left them with information and time to think, and the family was comfortable to have her return and continue to explore what would be best for their child in the context of their family. Ultimately, by listening and assessing, this behavior analyst has a chance of eventually acting and providing truly compassionate service and care to this client and family.

Both behavior analysts mean well. Both want what is best for their client. Neither behavior analyst wants to frighten families, make children cry, or take away what they enjoy. Both have rich resources at their disposal, but only one will likely be able to share those resources and meet her goals and the goals of the family. Practicing with compassion keeps communication open, but failure to demonstrate compassion by not listening and not understanding can result in a closed door and a great loss for the family and the field.

When practiced correctly and compassionately, ABA includes several features. First and foremost, there is a continuous emphasis on client and family input. Goals, strategies, and outcome measures are determined in consultation with the individuals who will be affected by the intervention. This includes not only the individual person receiving services, but those who love that person as well. Taking a broad viewpoint that includes the whole family is an important part of compassion.

Next, not only should behavior analysts obtain consent as mentioned earlier, but they should also be sure to get assent from clients who are not able to legally consent. Assent is a less formal version of consent that can be given by children or individuals who have cognitive differences that make it impossible for them to truly consent. Due to the extreme nature of the behavior of some individuals who receive behavior analysis services, at times assent is not obtained for safety reasons. This should only occur during times of crisis when the individual and/or those around them is in true danger. Any such occurrence should be immediately followed by obtaining consent and then conducting assessment and analysis of ways to prevent crises from occurring in the future. Interventions should be acceptable to all parties, including the individual receiving services. Again, many individuals who receive ABA services cannot verbally express assent, but the behavior analyst should be skilled enough to recognize behavioral indicators of assent or lack of assent, and adjust their actions accordingly.

Compassionate behavior analysts are also flexible. They recognize that there are changing circumstances in clients’ and their families’ lives, and that sometimes even effective plans need to be adjusted. They also recognize when sometimes despite their own best intentions, their efforts are not working well and they are willing to step back, reevaluate, and adjust approaches as needed. Behavior analysts should also be honest about what they can offer, their competence and comfort level with what is being asked of them, and how clients and families can best participate in their own services. Finally, it is crucial for behavior analysts to make human connections with the families they serve. Many behavior analysts find it easy to connect with their clients through their reinforcers and successes, but it is also important to maintain a connection with the rest of the people in their clients’ lives by showing interest and concern for them.

One final thought is that compassion can be a two-way street. Behavior analysts can most successfully connect with the client and family when the effort to connect is reciprocated. Although it is up to the behavior analyst to attempt to make the family comfortable in sharing their needs and preferences, sometimes we don’t know what we don’t know. Even the most compassionate and skilled professional might miss something, so families and if possible, clients, should speak up and let them know if that is the case. It is also important to be clear about whether or not consent and assent are being given. If the behavior analyst is not asking for consent, it is perfectly acceptable for the client or family member to pause the interaction and discuss what the limits of implied consent may be in any individual situation. Finally, families who demonstrate flexibility, connection, and honesty in return and who are open about any reservations or discomforts are allowing for the maintenance of a longer-term and more productive relationship, which will only help their loved one more.

References Consulted

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

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

LeBlanc, L. A., Taylor, B. A., & Marchese, N. V. (2019). The training experiences of behavior analysts: Compassionate care and therapeutic relationships with caregivers. Behavior Analysis in Practice, 13, 1-7.

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

About The Author

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

The Importance of Replacement Behaviors

I’ve written several posts about the importance of reinforcement, but now I want to turn my attention to another important concept: replacement behaviors. It can be very easy to slip into the habit of telling kids what NOT to do. “Don’t touch that! Don’t pick your nose! Don’t run!” However, if we can turn it around and tell kids what to do instead we often see higher rates of compliance.

Here are a few examples of replacement behaviors you can teach:

  • A student refuses to speak when he/she does not understand a question. You can teach the student what to say, such as “I don’t understand” or “Can I get help?” Teach through modeling and role playing in one-to-one settings, then generalize it to the classroom or other environments in which the skill is necessary.
  • When you begin a math lesson, one student frequently attempts to run out of the room. Introduce a signal or symbol (such as a holding up a stop sign) to request a break. Initially, you might give the break each time the student uses the sign correctly, then begin to require more and more math work before a break is received. This allows for appropriate and safe breaks without disrupting the rest of the class.
  • When your learner is done with dinner, he pushes his plate into the middle of the table. Teach your learner to instead put items in the sink. You might start with just placing the fork in the sink, then add more and more items until he/she is clearing the table independently. Another replacement behavior may be to use a symbol or signal as in the previous example to request to leave the table, or to teach the learner to say “May I go?”

Replacement behaviors should be simple to implement, should be taught one-on-one with multiple opportunities to practice and be reinforced, and should, if possible, be functionally equivalent to the undesirable behavior. (For example, if a child is engaging in one behavior to escape, the replacement behavior should teach a more appropriate way to escape.)

Sometimes, simply instructing the learner on a replacement behavior makes a huge change, but often you need to combine teaching a replacement behavior with other strategies (such as differential reinforcement). What I do know is that identifying and teaching a replacement behavior is a necessary part of almost any intervention and should not be overlooked.


About The Author

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges and the Senior Clinical Strategist at Encore Support Services.

Focus on Generalization and Maintenance

On more than one occasion, I’ve been in the situation that a student will only demonstrate a skill in my presence. And I’ve heard from other colleagues that they have had similar experiences. This is highly problematic. When it happens with one of my students, there is only one person I can blame: myself.  A skill that a student can only demonstrate in my presence is a pretty useless skill and does nothing to promote independence.

So what do you do when you find yourself in this situation? You reteach, with a focus on generalization. This means that, from the very beginning, you are teaching with a wide variety of materials, varying your instructions, asking other adults to help teach the skill, and demonstrating its use in a variety of environments. Preparing activities takes more time on the front-end for the teacher, but saves a ton of time later because your student is more likely to actually master the skill. (Generalization, after all, does show true mastery.)

Hopefully, you don’t have to do this, though. Hopefully, you’ve focused on generalization from the first time you taught the skill. You may see generalization built into materials you already use, such as 300-Noun List at AVB press.

Another commonly cited issue teachers of children with autism encounter is failure to maintain a skill. In my mind, generalization and maintenance go hand-in-hand, in that they require you to plan ahead and consider how, when, and where you will practice acquired skills. Here are a few tips that may help you with maintenance of skills:

  • Create note cards of all mastered skills. During the course of a session, go through the note cards and set aside any missed questions or activities. You might need to do booster sessions on these. (This can also be an opportunity for extending generalization by presenting the questions with different materials, phrases, environments, or people.)
  • Set an alert on your phone to remind you to do a maintenance test two weeks, four weeks, and eight weeks after the student has mastered the skill.
  • Create a space on your data sheets for maintenance tasks to help you remember not only to build maintenance into your programs, but also to take data on maintenance.

Considering generalization and maintenance from the outset of any teaching procedure is incredibly important. Often, when working with students with special needs, we are working with students who are already one or more grade levels behind their typically developing peers. Failing to teach generalization and maintenance, then having to reteach, is a waste of your students’ time.


Written by Sam Blanco, PhD, LBA, BCBA

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges and the Senior Clinical Strategist at Encore Support Services.

Cultural Competency in ABA Practice

The Behavior Analyst Certification Board (BACB) on their website lists credentialed behavior analysts from 99 countries spanning across 6 continents. Behavior analysts and consumers of behavior analysis are now establishing footprints across the globe. Each of these countries comes with its own set of cultural practices and norms. Leon Megginson, author of Small Business Management said, “it is not the strongest, or the most intelligent who survives, but the one most responsive to change”. Considering the high rates of global migration and the international dissemination that our field desires, practitioners find themselves serving an increasingly diverse population. A recent article in Behavior Analysis in Practice by Andrea Dennison and colleagues highlights the variations in cultural norms, caregiver and practitioner linguistic competencies that a culturally competent ABA therapist must consider when designing a home program.

What are the barriers?

The Professional and Ethical Compliance Code for Behavior Analysts from the Behavior Analyst Certification Board requires that behavior analysts consider the role of culture in service delivery (BACB code 1.05c), involve clients and families in treatment process (BACB code 4.02), and individualize the treatment plan to meet client needs (BACB code 4.03). Yet the BACB Fourth Edition Task List and the upcoming Fifth Edition Task List which define the scope of practice of a credentialed behavior analyst do not make much mention of culture – which means that training programs do not typically include cultural competence. Dennison and colleagues (2019) identified several barriers in ABA treatment for culturally and linguistically diverse families and highlighted ways to overcome them.

Do we hold stereotypes?

With the influence of the media or the people around us, we tend to categorize people into social groups and create a simplified conception of the group based on some assumptions – we create stereotypes and hold prejudices. Implicit biases held by a practitioner towards certain cultural sub-groups may result in a subtle, yet observable bias towards the client, and adversely impact treatment outcomes. Dennison et al (2019) suggest that a practitioner’s “self-reflection and introspection regarding cultural attitudes and practices towards clients” may be a first step towards undoing these biases.

Are we aware of cultural norms?

Practitioners often find themselves in a variety of contexts and situations with varying contingencies. Each culture comes with its own set of learned behaviors, beliefs, and norms. Dennison and colleagues add that some cultures might prefer a warm, informal discussion with a service provider prior to a formal meeting to discuss goals. A violation of this might seem off-putting to the client, and conversely, such an expectation for an informal discussion might catch the analyst unaware. In some cultures even a simple handshake for greeting might be offensive They recommend that practitioners monitor clients for signs of discomfort or displeasure during the course of the treatment to identify whether a cultural norm has been violated.

What to do when a practitioner doesn’t speak the home language of the client?

A language mismatch between the practitioner’s language and the home language of the client might lead to information loss. A client might not be able to completely express their priorities in terms of the services they need. Dennison urges practitioners to make every attempt to invite a bilingual practitioner or interpreter either in-person or online, to future family meetings. Providing the family with access to ABA textbooks written in their home language might be a good way to introduce ABA terminology and lead to better acceptability of services delivered. The authors caution against using loosely translated words; online tools might not be ideal for activities that require precise definitions.

Cultural analysis

“A cultural analysis involves an individual analysis of the cultural factors affecting an individual’s environment and the resulting contingency”, the authors add. A re-assessment of priorities in goals might be warranted, and a cultural analysis might inform what behaviors are identified as the primary targets for intervention. Dennison refers to the importance of social etiquette and the value placed on conflict avoidance in Latin cultures as an example. Measuring social validity might give the analyst information about whether the family sees the behavior change as meaningful.

Empathy grows as we learn

Try not to stigmatize immigrant families as “uncaring” for not seeking services earlier. Several socioeconomic stressors such as lack of housing and transportation availability likely play a role in their decision. The authors urge practitioners to empathize with these families and add that attempts to empathize can be made even if the practitioner and family do not share a common home language.

Finally, the lack of diversity in research with the omission of demographic details such as language and ethnicity of participants in scientific publications overlooks the critical value of such information. This calls for a shift in the field towards intentionally inclusive subject recruitment and the reporting of such information.

A culturally competent behavior analyst is not one who knows everything there is to know about every culture. This would be impossible. It is someone who can acknowledge that patterns of cultural difference may be present, and are then able to view a situation from a different cultural perspective than one’s own. Maintaining a curiosity about each client’s culture, and having an open dialogue with them about their background, ethnicity, and belief system can result in a positive outcome for the client and the analyst.

“If we are going to live with our deepest differences then we must learn about one another.”  ― Deborah J. Levine

References

Dennison, A., Lund, E., Brodhead, M., Mejia, L., Armenta, A., & Leal, J. (2019). Delivering Home-Supported Applied Behavior Analysis Therapies to Culturally and Linguistically Diverse Families. Behavior Analysis in Practice, OnlineFirst, 1-12.


About The Author

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

VB-MAPP vs ABLLS-R: Understanding The Differences

Assessment is the cornerstone of creating appropriate and effective interventions. Two common assessments used for youngsters with autism are the Assessment of Basic Language and Learning Skills-Revised (ABLLS-R) and the Verbal Behavior – Milestones Assessment and Placement Program (VB-MAPP). You’ve likely heard of both the ABLLS-R and the VB-MAPP. While these two assessments are similar in many ways, there are also some big differences that might make one more appropriate for you than the other.

ABLLS-R

The ABLLS-R is made up of two components: the ABLLS™-R  Protocol and the ABLLS™-R Guide. The protocol is comprised of a skill-tracking system, assessing items ranging from listening and language skills to academic and ADL skills. The scoring system is simple, in that each specific skill is broken down into 2-4 levels. You simply mark the level that matches your client’s current skill. The simple organization allows for you to easily track your learner’s progress.

It is important to recognize that the ABLLS-R is more than just the protocol. It also includes the ABLLS-R Guide, which provides instructions for scoring as well as strategies for using the information to develop appropriate goals. Over the years, I have seen many practitioners simply using the protocol without referring to the guide. This is an error that should be corrected, as the guide is a useful resource for parents, teachers, and practitioners. Finally, the ABLLS-R assessed skills that typically develop between approximately ages 2-6.

VB-MAPP

The VB-MAPP is composed of five components.

The Milestones Assessment is comprised of 170 measurable milestones, all based in B.F. Skinner’s analysis of verbal behavior. It focuses primarily on language and social skills, but does include some skills related to academics.

The Barriers Assessment provides a way to assess and measure common barriers to learning experienced by children with language delays. These include barriers such as prompt dependence, impaired social skills, and failure to generalize.

The Transition Assessment provides a way to assess and measure progress towards the child’s ability to move to a less restrictive environment. This portion of the VB-MAPP includes items such as the rate of acquisition for new skills, adaptability to change, and ability to learn from the natural environment.

The fourth component of the VB-MAPP is the Task Analysis and Supporting Skills. This portion goes hand-in-hand with the Milestones Assessment. It is comprised of hundreds of skills that are often directly related to the milestones. It shows the skills that should be taught prior to each milestone and can provide additional information into the child’s current skill level.

The final portion is the VB-MAPP Placement and IEP Goals. This is an in-depth guide for developing IEP goals and identifying interventions based on the results of the other portions of the assessments.  As with the ABLLS-R, I’ve seen many practitioners utilizing the VB-MAPP without referring to the Placement and IEP Goals in the VB-MAPP Guide. This is an error that should be corrected to best use the assessment. The VB-MAPP assesses language skills that typically develop by age 48 months.

VB-MAPP vs ABLLS-R?

It is valuable to receive training in both of these assessments. They are important tools for assessment, especially if you are working with young children.

No matter what assessment you choose, we’ve got you covered! Head to our website and check out our full line of ABLLS-R and VB-MAPP supports, including our exclusive full assessment kits!


About The Author

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges and the Senior Clinical Strategist at Encore Support Services. You can read more of Sam’s posts for Different Roads To Learning when you click here!