Category Archives: Behavior

Tip of the Week: Improving Time-Out Procedures

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Time Out ChairTime-out is often a hotly-debated topic. Is it too punishing? Where should it take place? How long should it last? There are not easy answers to many of these questions. But there are some evidence-based suggestions that may improve a time out procedure should you decide to use one.

  • First, know the function of the behavior! If the child is engaging in the undesirable behavior for escape, then providing “time out” will likely increase the behavior. For instance, if a child gets sent out of the classroom each time he curses, this is effectively a time out from classwork. He may curse because in the past, cursing resulted in escaping from classwork. This is an instance when you would not want to use time out. A time-out may prove to be effective for behaviors that function for attention or access to tangibles. More on that next…
  • Consider a nonexclusion time-out procedure. In the past, we’ve discussed the time-out ribbon here. This is a useful tool for signaling to a learner that they have access to social or tangible reinforcers. If they engage in an inappropriate behavior, the ribbon is removed and they do not have access to social or tangible reinforcers, however they are still able to participate in the lesson or activity you have organized. It also allows them to practice more appropriate behaviors to earn the ribbon back. If the ribbon isn’t the best visual cue for your learner, you could make it anything this is visible for them and clearly delineates when they do and do not have access to reinforcement.
  • Consider the use of a release contingency. This means that a learner is unable to leave time out until a predetermined amount of time has passed without problem behavior. Perhaps if you’re working with a preschool child who has been kicking other children, the release contingency might be that they must sit with “quiet feet” or “feet on the floor” for one full minute before they can go back to play. Your other option is to put in a fixed time contingency, which is best done by setting some sort of timer so the learner can see how much time is remaining in time-out.
  • Combine time out with positive reinforcement procedures. Time-out by itself may result in decreases in behavior only when time out is a possibility. For instance, you may see a decrease in the problem behavior only when the child’s mother is at home, because the father doesn’t use time out. The goal is to decrease the problem behavior across all settings and activities. To that end, it’s helpful to teach appropriate replacement behaviors and reinforce the learner for engaging in those behaviors.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently pursuing her PhD in Applied Behavior Analysis at Endicott College.

“Cooperating with Dental Exams” – Strategies for Parents, by Jennifer Hieminga, MEd, BCBA

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This month’s featured article from ASAT is by the Associate Director of the New Haven Learning Centre in Toronto Jennifer Hieminga, MEd, BCBA, on several research-based strategies for parents to encourage cooperative behavior in their children with ASD during routine dental visits. 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!

My daughter with autism was very resistant during her first dental visit. Are there any steps we can take to help her tolerate a dental exam? We were actively involved in her home-based early intervention program for the last two years and have a working knowledge of ABA. Our daughter’s program is overseen by a board certified behavior analyst.

Answered by Jennifer Hieminga, MEd, BCBA
Associate Director, New Haven Learning Centre, Toronto, Canada

Boy Dental VisitFor many individuals with autism, routine appointments such as medical, dental and haircuts can be extremely difficult to tolerate. There are many factors that may contribute to this intolerance such as novel environments, novel adults, novel or aversive sounds, bright lights, foreign tastes, painful sensations, sitting for long periods of time and physical touch. As a result, many children with autism display noncompliant or avoidant behavior in response to these stimuli or events. Fortunately, there is a growing body of research published in peer-reviewed journals describing effective strategies to target dental toleration. Several different behavior interventions and programs have been used to increase an individual’s tolerance or proximity to an avoided stimulus or event, such as a dental exam. For example, the use of escape and reward contingent on cooperative dental behavior was shown to be effective for some individuals (Allen & Stokes, 1987; Allen, Loiben, Aleen, & Stanley, 1992). Non-contingent escape, in which the child was given periodic breaks during the dental exam, was also effective in decreasing disruptive behavior (O’Callaghan, Allen, Powell, & Salama, 2006). Other strategies such as using distraction and rewards (Stark et al., 1989), providing opportunities for the individuals to participate in the dental exam (Conyers et al., 2004), and employing systematic desensitization procedures (Altabet, 2002) have been shown to be effective. Most recently, Cuvo, Godard, Huckfeldt, and Demattei (2010) used a combination of interventions including, priming DVD, escape extinction, stimulus fading, distracting stimuli, etc. The board certified behavior analyst overseeing your daughter’s program is likely familiar with these procedures.

Clinical practice suggests that dental exams can indeed be modified to teach children with autism component skills related to dental exams (Blitz & Britton, 2010). However, a major challenge to implementing such skill-acquisition programs is the reduced opportunities to actually target these skills. One highly effective way to address this is to create a mock dental exam scenario in your home, as it provides opportunities to teach and practice the skills consistently and frequently. These scenarios should emulate, as best as possible, an actual dental office (e.g., similar tools, sounds, light, reclining chair), making it easier for the skills mastered in the mock teaching scenario to generalize to the dental office exam later on.

Developing a “Cooperates with a Dental Exam” Program
Following is a detailed example of the components involved with creating and implementing a “Cooperates with a dental exam” program.

  1. Speak to your family dentist to identify all the components of the exam with which your child will be required to participate.
  2. Based on the dentist’s input, develop a detailed task analysis outlining each step of the dental exam. See sample task analysis provided in the next section below.
  3. Collect necessary materials required for the exam. Many of these items may be obtained or borrowed from your dentist and may include:
    • Reclining chair (e.g., lazy boy)
    • Dental bib
    • Flouride foam dental plates
    • Electric Toothbrush with round head (to ensure polishing)
    • Dental mask
    • Dental mirror
    • Plastic gloves
    • X-ray plates
    • Flossing pics
  4. Take baseline data to determine your child’s ability to cooperate with each step of the exam and to identify skills that need to be taught. For example, baseline data may indicate there is a skill deficit with tolerating novel noises at the dentist and not with the exam itself. In this situation, a specific program for tolerating novel sounds found in the dental office should be introduced. It cannot be overstated that an intervention to address this area would need to be individualized. However, for the purpose of this reply it will be assumed that your daughter presents with difficulty in all, or the majority of the steps involved in a dental exam.
  5. Lastly, before starting the program, establish highly-potent reinforcers which your daughter will access for correctly responding within this program, and collect the items that you will need to teach this skill.

Continue reading →

Tip of the Week: Consider Behavioral Momentum in Improving Compliance

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If I were to ask you right now, what types of activities does your learner like to do, and what types of activities is your learner resistant to, you’d probably be able to respond pretty quickly to both questions. For instance, you might say, my son loves to practice addition facts, but he is resistant to working on spelling homework. Or you might say, my student enjoys passing out papers in class, but is resistant to lining up with the rest of the class when it’s time to go to lunch.

You can use this information to increase the likelihood of compliance for those tasks your learner does not like. First, let’s call the tasks your learner enjoys high-p tasks (or high probability tasks) and the tasks your learner does not enjoy the low-p tasks (or low probability tasks). Once you have identified high-p and low-p tasks, you can use this information to produce behavioral momentum.

So what might this look like? Let’s take our first example of the learner who liked to practice addition facts, but is resistant to spelling. The conversation might look like this:

Parent: 2 + 4
Son: 6
Parent: 3 + 5
Son: 8
Parent: 4 + 3
Son: 7
Parent: Spell “apple.”
Son: A-P-P-L-E

Behavioral momentum is a quite broad topic. The conversation above is an example of just one element of behavioral momentum: a high-probability (or high-p) request sequence. This is “an antecedent intervention in which two to five easy tasks with a known history of learner compliance (high-p request) are presented in quick succession immediately before requesting the target task, the low-p request” (Cooper, Heron, & Heward, 2007, p. 492).

By providing several sequences such as the one above, you can practice all of the spelling words without fighting him to sit down at the table and practice only spelling for ten to fifteen minutes.

With the example of the young girl who likes to hand out papers but doesn’t like lining up before lunch, it might look something like this:

Teacher: Can you take this paper to Lucy?
Student takes paper to Lucy.
Teacher: Can you give this one to Marcos?
Student takes paper to Marcos.
Teacher: Nice work. Can you stand behind Henry?
Student gets in line behind Henry.

It should be noted that the goal is to move the low-p tasks to high-p tasks. We don’t want the learner to always require two to five high-p tasks before they engage in the low-p task! You can do this by decreasing the number of high-p tasks before giving a low-p task, or by increasing the number of low-p tasks. For instance, maybe the first learner is responding quickly each time his parent gives him a spelling word, so the parent can start giving two spelling words after the series of high-p tasks, then systematically increase the number of spelling words over time.

Overall, the high-p request sequence is an easy-to-implement strategy that can improve compliance and reduce stress for all parties involved.

REFERENCES

Cooper J.O, Heron T.E, & Heward W.L. Applied behavior analysis (2nd ed.) Upper Saddle River, NJ: Pearson, 2007.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently pursuing her PhD in Applied Behavior Analysis at Endicott College.

Tip of the Week: How to Avoid Prompt Dependence in Teaching Students with Autism

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

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

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

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

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

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

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

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

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

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently pursuing her PhD in Applied Behavior Analysis at Endicott College.

Pick of the Week: Save 15% on ALL of our Emotions Flashcards!

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Emotions language cards are great tools for teaching language and facial expressions in a variety of contexts to young learners. Promote discussion about a range of emotions, why people may feel a certain way, and possible responses to these feelings with our collection of emotions flash cards.

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Tip of the Week: The Importance of Identifying the Function of a Behavior

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By: Chance Agrella / Flickr

As a BCBA, I am often asked to address problematic behaviors. One of the most common errors I see in addressing such behaviors is that the adults working with child have not identified the function (or purpose) of the problematic behavior. Decades of research have shown that there are only four functions for any behavior: attention, escape/avoidance, access to a tangible, and automatic reinforcement (or something that just feels good internally, but cannot be observed by outsiders).

The function of the behavior is whatever happens immediately after the behavior, and increases the likelihood that the behavior will occur again in the future. Here are a few examples of the functions, based on the same behavior:

  1. The therapist tells Lisa it’s time to practice tying shoes. Lisa starts biting her own hand. The therapist look shocked and calls in Lisa’s mother, who rubs her back lightly while Lisa ties her shoes then gives her a lot of verbal praise. This is likely an example of a behavior that functions for attention, because the mother comes in and provides both verbal and physical attention while she ties her shoes. Or it could be an example of a behavior that functions for escape or avoidance, since Lisa did not have to tie her shoes immediately once she began biting her hand.
  2. The therapist tells Lisa it’s time to practice tying shoes. Lisa starts biting her own hand. The therapist gently pushes Lisa’s hand down and then introduces a new task. This is an example of a behavior that functions as escape because Lisa does not have to tie her shoes once she begins biting her hand.
  3. The therapist tells Lisa it’s time to practice tying shoes. Lisa starts biting her own hand. The therapist says, “Oh, don’t stress, we’ll take a sensory break,” and gives Lisa a ball to squeeze. This is an example of a behavior maintained by tangible reinforcement. When Lisa began biting her hand she was immediately given access to a preferred item.

You’ll notice that I left out the automatic reinforcement. This is intentional because often, with a diagnosis of Autism Spectrum Disorder, people assume that a behavior is automatically reinforced instead of exploring these three potential functions described above. One way to recognize if a behavior is automatically reinforced is to note if the behavior happens when the child is alone and/or when no demands have been placed on the child. If it’s only happening around other people or when demands are placed, then it is highly unlikely that the behavior is automatically reinforced. For now, we’ll save automatic reinforcement for another blog post.

Identifying which of these functions is maintaining a problem behavior is essential to putting in an effective intervention. But how do you go about doing this?

The first thing you should do is assess! You can do an informal assessment, such as using the Functional Assessment Screening Tool (FAST) which is comprised of 16 questions that can help you quickly determine the function. If this does not provide conclusive results, you can have a BCBA do a formal functional assessment. Once you have identified the function of the behavior, you can change the environment so that not only does the child no longer receive that reinforcement for a problematic behavior, but there are appropriate replacement behaviors they can engage in to access that reinforcement. For more on that, you can look back at the Importance of Replacement Behaviors.

It may be difficult at first to think in terms of “function of behavior,” rather than assigning a reason for the behavior that is based on the child’s diagnosis or based on something happening internally inside the child’s brain that we can’t see (such as, “she’s just frustrated so she’s biting her hand,” or “she doesn’t know how to control herself”). However, once you try it out and experience some success with addressing the true function of behavior, you’ll likely see the beauty of a simple explanation for why we behave.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently pursuing her PhD in Applied Behavior Analysis at Endicott College.

“Increasing Articulation in Children with Autism” by Tracie Lindblad

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Following our last feature on guided playdates, we’ve partnered with the Association for Science in Autism Treatment (ASAT) again this week to bring you an article by Tracie Lindblad, Reg. CASLPO (SLP), MS, MEd, BCBA, on increasing speech intelligibility in children with autism. 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!

How do you increase speech intelligibility (articulation skills) or the variability in the sounds produced by children with autism spectrum disorders?
Answered by Tracie L. Lindblad, Reg. CASLPO (SLP), MS, MEd, BCBA
Approximately 30–50% of individuals with autism spectrum disorder (ASD) remain minimally verbal throughout their lives, with little or no functional speech (National Institutes of Health & National Institute on Deafness and Other Communication Disorders, 2010; Johnson, 2004; Mirenda, 2003). These individuals may rely on more effortful modes of communication such as reaching for desired items, taking another’s hand to gain access, or obtaining the item independent of communication. Attempts to communicate may also take the form of challenging behaviours such as aggression, self-injury, and tantrums.

Parents face a difficult task in choosing a treatment for minimally verbal children with ASD because a wide range of techniques are routinely used by speech-language pathologists and behaviour analysts with varying degrees of success and evidence.

The following table highlights some of the most-commonly implemented interventions to target speech skills and the current evidence base for each.

Increasing Articulation Table 1Increasing Articulation Table 2

Within the fields of behaviour analysis and speech pathology, evidence-based practice (EBP) should shape and guide our treatment decisions. EBP is the integration of:

  • external scientific evidence,
  • clinical expertise/expert opinion, and
  • client/patient/caregiver perspectives.

Principles of EBP can help any professional to provide high-quality services which reflect the interests, values, needs, and choices of the individuals, and promote the best outcomes possible with the current evidence to date. Continue reading →

Tip of the Week: The Importance of Replacement Behaviors

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Recently 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.

Cute little girl isolated, holding a stop sign

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.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently pursuing her PhD in Applied Behavior Analysis at Endicott College.

Tip of the Week: Using Differential Reinforcement of High Rates of Behavior to Increase Preferred Behaviors

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Differential Reinforcement of High Rates of Behavior (DRH) is “reinforcing only after several responses occur at or above a pre-established rate” (Mayer, Sulzer-Azaroff, & Wallace, 2013). There are times when a behavior is already in a student’s repertoire, but you may want to increase the rate of the behavior.

Mother Waking SonFor example, let’s say Harold frequently won’t get up independently on weekdays before school. It’s driving his parents crazy, because they have to drag him out of bed several days a week. You may set up a DRH to increase the rate of him getting up independently. Since Harold currently gets up independently at least one time per week, you would set the goal for two times per week. (You don’t want to set the goal too high, because then Harold might not ever come into contact with reinforcement, and his behavior will likely remain unchanged.) Let Harold know that if he gets up independently two days in a row, you will make his favorite breakfast on the second day. Once Harold has met this goal a few time, increase the requirement for reinforcement. You would move from two days in a row to three days in a row in order to receive his favorite breakfast.

You would continue this until you had reached a pre-arranged goal. It’s important to be realistic in our expectations. You don’t want to change the goal to quickly or make it unreachable. You also don’t want to place higher demands on an individual with disabilities than you do the general population (as discussed in our previous Simplifying the Science article). Many people, for instance, hit the snooze button several times before they actually get up, so it may not be necessary to require an individual with disabilities to wake up the very first time the alarm clock rings 100% of the time.

You may discover that your intervention with Harold is working quite well for a couple weeks, then suddenly stops working. You may need to backtrack a bit, and require fewer consecutive days of independently waking up. Or, you may need to vary the reinforcement. It’s possible that having his favorite breakfast has lost some of its power as a reinforcer.

Finally, after the behavior has reached your goal rate, you should begin to fade the reinforcement entirely. Of course, Harold should still have access to his favorite breakfast, but you should not continue to give it to him on the fifth consecutive day of waking up independently for years to come!

DRH is yet another variation of differential reinforcement that can be very useful for you. It’s also provides an opportunity for a much more positive interaction than introducing punishment to Harold for not waking up independently, and can decrease everyone’s stress levels at the beginning of the day.

References

Mayer, G. Roy, Sulzer-Azaroff-B. & Wallace, M. (2013). Behavior Analysis for Lasting Change-3rd ed. Cornwall-on-Hudson, NY: Sloan Publishing.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently pursuing her PhD in Applied Behavior Analysis at Endicott College.

Pick of the Week: Fidgets Kit – Smooshy, squishy, twisty, bouncy and more!

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Created in conjunction with our behavioral consultant Stacy Asay, LMSW, our Fidgets Kit includes an array of items that can provide a variety of sensory experiences: stretchy, chewy, spiky, twisty, bumpy, twisty, clicky, bouncy and smooshy! This week, get the Fidgets Kit for 15% off* the normal price – just use our promo code FIDGETS at check-out!

Fidget toys can be a great and socially acceptable replacement for stereotypic or repetitive behavior in the classroom or community. Some students find the repetitive action of “fidgeting” to be calming and are then better able to focus on the task at hand. Additionally, some students who have a difficult time staying still are able to sustain sitting behavior for longer periods with less support or prompting when they are manipulating something repeatedly in their hands. We’ve included a variety of items that vary in texture or are manipulated in different ways so that they can be rotated regularly. The components have also been chosen so that they can be worn on the wrist, clipped to a belt, handheld or attached to a piece of clothing.

Use promo code FIDGETS at check-out to save 15%* on the Fidgets Kit this week and start helping your students focus better on their tasks!

*Offer is valid until 11:59pm EST on November 17th, 2015. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at checkout!