Category Archives: From the Experts

Autism Awareness Month Interview Series: Essentials of Verbal Behavior with Mark Sundberg, PhD, BCBA-D

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Today marks the start of Autism Awareness Month. This year, we’re thrilled to introduce a series of exclusive interviews with renowned experts on topics that are of interest and importance to both parents and professionals working with students on the autism spectrum. We can’t think of a better way to kick off this series than with an information-packed interview with Mark Sundberg, PhD, BCBA on the Essentials of Verbal Behavior.

Dr. Sundberg hardly needs an introduction. He is the author of the VB-MAPP, Teaching Language to Children with Autism and Other Developmental Disabilities, and co-author of the original ABLLS. Additionally, he has published over 50 professional papers and 4 book chapters and taught more than 80 university courses on behavior analysis, verbal behavior, sign language, and child development. He is a licensed psychologist with over 40 years of clinical experience.

We’re honored that Dr. Sundberg agreed to kick off Autism Awareness Month here at Different Roads and answer these questions on Verbal Behavior from BCBA Sam Blanco. A big thank you to Cindy Sundberg as well for her help with the interview.

Essentials of Verbal Behavior
with Mark Sundberg, PhD, BCBA-D

SAM BLANCO: There is often confusion about what differentiates ABA and Verbal Behavior. Can you tell us what Verbal Behavior is and how it relates to ABA?

MARK SUNDBERG: In the 1950s B. F. Skinner published the book Science and Human Behavior (1953). In that book he described how the basic concepts and principles of behavior analysis could be applied to human behavior. This book is credited for starting the field of Applied Behavior Analysis (ABA) (Morris, Smith, & Altus, 2005). A few years later Skinner published the book Verbal Behavior (1957) which contained a detailed analysis of language, a topic he addressed frequently in Science and Human Behavior and other writings. The verbal behavior (VB) approach (or ABA/VB) to autism treatment is based on these two Skinner books, and over 60 years of conceptual and empirical research that has evolved primarily from this original material.

Regarding the similarities and differences between ABA and VB, first they both make use of the same principles, procedures, and research basis of behavior analysis (Skinner, 1953). That is, they both use the basic procedures of prompting, fading, shaping, reinforcing, and so on (cf. Cooper, Heron, & Heward, 2007). The primary difference between the two approaches is the analysis of language that underlies the assessment and intervention programs. The VB approach makes use of Skinner’s (1957) behavioral analysis of language along with ABA principles and procedures, while most ABA and cognitive-based programs use the traditional expressive and receptive framework of language. Although this seems to be changing in that more ABA approaches and outcome studies are incorporating aspects of Skinner’s analysis (e.g., manding) into their intervention programs (e.g., the Sallows & Graupner, 2005 outcome study).

The main advantage of Skinner’s treatment of language for children with autism is that he breaks down expressive language more thoroughly and functionally. He suggests that the “mand,” “tact,” and “intraverbal,” are functionally different from each other because they are controlled by different environmental variables. For example, the mand is under the functional control of motivational variables (what a child wants), while the tact is under the functional control of nonverbal discriminative stimuli (what a child sees, hears, etc., but may not want). It is not uncommon to encounter children with autism who have dozens of words as tacts, but no words as mands (their mands may occur in the form of tantrums or other negative behavior). In the traditional analysis of expressive language this distinction between the mand and the tact is not made, thus a resulting intervention program may not completely or accurately address a child’s needs. These important differences in verbal skills are not typically assessed by most of the common assessment tools used for children with autism (Esch, LaLonde, & Esch, 2010). For more details on the value of incorporating Skinner’s (1957) analysis of verbal behavior into ABA programs, the reader is referred to Petursdottir and Carr (2011) and Sundberg and Michael (2001).

SB: Can you tell us a bit about developing the VB-MAPP? It must have been quite an undertaking!

MS: I’ve been working on applying Skinner’s (1957) analysis of verbal behavior to language assessment and intervention since the 1970s when I was one of Jack Michael’s graduate students at Western Michigan University. This topic became the foundation of my doctoral dissertation (Sundberg, 1980), and has been the main focus of my professional career. The VB-MAPP was designed to be an assessment tool that is comprehensive, precise, developmentally matched, and functionally valuable to the child. As a result, the information obtained from the VB-MAPP can assist in IEP planning and help to establish intervention priorities, and serve as a curriculum guide for the program. The VB-MAPP is also designed to serve as a dependent measure in empirical research, and outcome research. In addition, problem behavior and various other “barriers” impact learning and should be assessed along with language, learning, and social skills. If left unattended, these barriers can slow down a child’s skill acquisition or possibly bring any gains to a complete standstill, and leave the child susceptible to other problems. Thus, the VB-MAPP also contains an assessment of 24 barriers that might affect a child (e.g., escape and avoidance, prompt dependency, demand weakens motivation).

The VB-MAPP has greatly benefited over the years from the many parents and professionals who have provided feedback or conducted field-testing with typical children and children with special needs in schools, homes, clinics, and community settings. This feedback and field-testing provided us with a wealth of information that influenced many aspects of the VB-MAPP, such as checks for generalization throughout the assessment, tips for the tester, more information in the Guide about the skills being assessed, and a placement program to provide general direction for intervention and IEP development. Our own field-testing activities also helped us with many of the improvements, such as the refinement of the sequence and validity of the intraverbal assessment (e.g., Sundberg & Sundberg, 2011), and separating play skills into independent play and social play for a tighter assessment of this area. In addition, there is now a more extensive body of conceptual and empirical research that has advanced our overall understanding of language acquisition and the treatment of autism.

We were also fortunate to have Barbara Esch, Ph.D., CCC-SLP, BCBA-D include her Early Echoic Skills Assessment to the VB-MAPP. Her tool presents a state-of-the-art method to quickly assess a child’s echoic repertoire, and it fits well within the VB-MAPP. The VB-MAPP also contains a short transition assessment that resulted from many years of consulting to special education classrooms and attending IEPs. We thought it would be useful to create a piece of the assessment that could help to determine what type of educational format might best suit an individual child (e.g., 1:1 vs. small group instruction, inclusion). The targeted milestones in the VB-MAPP have been carefully chosen and matched to those of typically developing children, thus providing a clearer picture of how a child with autism is performing. We aligned the VB-MAPP with standardized, and well-respected assessments, including the APES, Bayley-III, PLS-IV, and the Vineland-II. As a result of these various features, the VB-MAPP moves beyond just an assessment of basic skills to a more thorough and functional assessment of the whole child.

The work on the VB-MAPP and making ABA and verbal behavior understandable and accessible continues to be an on-going process. After the VB-MAPP was published in late 2008, we received interest from professionals wanting electronic versions and foreign language translations. The VB-MAPP is now also available as an app and web-based format, as well as in several different languages including Chinese, French, Italian, Polish, Russian, and Spanish, with other languages in various stages of development.

SB: For a learner who is just developing language, what does research show is the appropriate developmental order for teaching verbal skills? (For example, do you teach “I want _______” to a learner who only has ten words?)

MS: The design of the VB-MAPP directly addresses the issue of using typical developmental milestones as a framework for the assessment and the intervention program. For example, it is common to have adjectives, prepositions, and answering WH questions on an IEP for a child who may only have a 30-word vocabulary. Developmentally, that small of a vocabulary size indicates that the child may not be ready for tasks that require the child to modify nouns with their properties or location, let alone answer WH questions about them. Likewise, adding carrier phrases such as “I want” to a mand may be of little value to a child who only has ten words. The child would probably benefit more from first learning more mands and tacts. There are many aspects to developing a child’s verbal skills, even though the learning patterns demonstrated by typical children can guide us, each child is different and still requires an individual analysis of what curriculum sequence might work best for him.

SB: Why is it important for a learner to have a certain number of mands before moving on to other verbal skills?

MS: There is no magic number of mands. My point (from Skinner) has been that manding is the only type of verbal behavior that directly benefits the child. Mands allow a child to get access to things and activities that are important to him. That’s motivating for the child, and increases chances that he will initiate verbal interactions and emit language in a more natural way, as well as participate in other instructional activities. The other types of verbal behavior (e.g., echoic, tacting) don’t have the same effect. I have found repeatedly that it is often quite easy to establish a mand for a nonverbal child (especially using sign language or PECS), and it becomes much easier to use this newly established rapport to teach the child other skills. A variety of different verbal skills are necessary for a functional communication repertoire. Sooner or later the child must learn other language skills such as tacts, intraverbals, and listener skills. My tendency to encourage practitioners to emphasize the mand has been mainly due to its value to the child, but also to offset the historical tendency by many ABA programs to ignore the mand, teach it late in an intervention program, not appreciate the difference between motivational control and stimulus control, or assume that the mand will just emerge from other types of training.

SB: How do you measure verbal behavior?

MS: Verbal behavior can be measured by using many of the same recording systems common to behavior analysis (e.g., Cooper, Heron, & Heward, 2007), such as rate, frequency, time samples, discontinuous measurement, etc. However, it is important to carefully identify all the antecedent variables that are involved. For example, it is not enough to simply record that a child says the word “ball” 10 times in a 1-hour period. The measurement system, like all ABC recording systems, must also include the antecedent sources of control that evoked that response. If the ball is present, the response is part tact, if an EO for the ball is present, the response is part mand, if an echoic prompt is given, the response is part echoic, and so on. A child who emits “ball” 10 times as an echoic is not behaving in the same way as a child who emits “ball” 10 times as a mand or tact. In short, a verbal behavior measurement system not only records the topography of responses, but their function as well. Thus, there may be several different data sheets that all measure a child’s acquisition of the word “ball,” but each differ in important ways (e.g., “ball” as a tact vs. “ball” as an intraverbal). More detail on measuring and recording verbal behavior can be found throughout the VB-MAPP Guide, as well as in Sundberg & Partington (1998).

SB: One resource I frequently use is the 300 Common Nouns list. Can you talk about how this list is useful?

MS: The goal of the list is to take some of the guesswork and randomness out of selecting new targets for vocabulary development by providing a group of common nouns that young typically developing children might acquire. In addition, the lists are designed to track the acquisition of a new word (e.g., spoon) across a variety of conditions. For example, there are columns for both tacting and listener skills, as well as for generalization and more complex demonstrations of a skill. The list also provides the basis for moving an individual word to more complex types of verbal behavior. For example, when adding a verb or an adjective to a noun (e.g., “white plastic spoon”) staff should cautiously select nouns that have been acquired and generalized as identified by the data entered on the list. Movement to intraverbal and LRFFC tasks should also involve nouns that have been mastered and the list provides an initial guide for making this progression. There is a common verbs list as well posted in the downloads section at www.avbpress.com.

SB: What recommendations do you have for a parent or practitioner who is first encountering verbal behavior?

MS: Language and the ability to communicate is perhaps the single most important aspect of human behavior, correspondingly, it is quite complex. Language is a part of everyday life and can be taught not only in formal (discrete) sessions, but in everyday activities including play, bath time, arts and crafts, in the grocery store, and while out on a family drive. Our book “Teaching Language to Children with Autism or Other Developmental Disabilities” (Sundberg & Partington, 1998) was designed to be an easy-to-understand application of Skinner’s analysis, and I would recommend that book, or other user-friendly VB books (Barbera, 2007; Weiss & Demiri, 2011). In addition, there are websites that contain tips, materials, data sheets, YouTube videos, and a variety of other material that can be useful for helping parents and teachers to understand how to apply a behavioral analysis of language in an ABA program.

ABOUT MARK SUNDBERG, PHD, BCBA-D

Mark SundbergMark L. Sundberg, Ph.D., BCBA-D received his doctorate degree in Applied Behavior Analysis from Western Michigan University (1980), under the direction of Dr. Jack Michael. He is the author of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP), and co-author of the original ABLLS and the book Teaching Language to Children with Autism or Other Developmental Disabilities. He has published over 50 professional papers and 4 book chapters. He is the founder and past editor of the journal The Analysis of Verbal Behavior, a twice past-president of The Northern California Association for Behavior Analysis, a past-chair of the Publication Board of ABAI, and has served on the Board of Directors of the B. F. Skinner Foundation. Dr. Sundberg has given hundreds of conference presentations and workshops nationally and internationally, and taught 80 college and university courses on behavior analysis, verbal behavior, sign language, and child development. He is a licensed psychologist with over 40 years of clinical experience who consults for public and private schools that serve children with autism. His awards include the 2001 “Distinguished Psychology Department Alumnus Award” from Western Michigan University, and the 2013 “Jack Michael Outstanding Contributions in Verbal Behavior Award” from ABAI’s Verbal Behavior Special Interest Group.

References
Barbera, M. L. (2007). The verbal behavior approach. London: Jessica Kingsley Publishers.

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

Esch, B. E., LaLonde, K. B., & Esch, J. W. (2010). Speech and language assessment: A verbal behavior analysis. The Journal of Speech-Language Pathology and Applied Behavior Analysis, 5, 166-191.

Morris, E. K., Smith, N. G., & Altus, D. E. (2005). B. F. Skinner’s contributions to applied behavior analysis. The Behavior Analyst, 28, 99-131.

Petursdottir A. I., & Carr J. E. (2011). A review of recommendations for sequencing receptive and expressive language instruction. Journal of Applied Behavior Analysis, 44, 859–876.

Skinner, B. F. (1953). Science and human behavior. New York: Free Press.

Skinner, B. F. (1957). Verbal behavior. New York: Appleton-Century-Crofts.

Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal on Mental Retardation, 110,
417-438.

Sundberg, M. L. (1980). Developing a verbal repertoire using sign language and Skinner’s analysis of verbal behavior. Unpublished doctoral dissertation, Western Michigan University.

Sundberg, M. L., & Michael, J. (2001). The benefits of Skinner’s analysis of verbal behavior for children with autism. Behavior Modification, 25, 698-724.

Sundberg, M. L., & Partington, J. W. (1998). Teaching language to children with autism or other developmental disabilities. Concord, CA: AVB Press.

Sundberg M. L., & Sundberg, C. A. (2011). Intraverbal behavior and verbal conditional discriminations in typically developing children and children with autism. The Analysis of Verbal Behavior, 27, 23–43.

Weiss, M. J., & Demiri, V. (2011). Jumpstarting communication skills in children with autism. Bethesda, MD: Woodbine House.

Guest Article: Tips on Encouraging Picky Eaters

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This week, we’re thrilled to share some exclusive tips from Julia Singer Katz at the Kutest Kids Early Intervention Center on how to deal with picky eaters, from using colors and schedules to modeling good habits.

Don’t let picky eating ruin meal time or divide your family at the dinner table. Encouraging healthy eating habits with a stubborn child requires patience with a firm touch. Here at Kutest Kids Early Intervention Center, our therapists are all too familiar with this phenomenon and would like share some common tips. Begin by setting the stage for healthy choices, thereby helping your child overcome their picky habits with a few key strategies.

Start With a Schedule.  Hungry kids are often less picky than those that have been snacking on junk foods all day. Scheduling snack time – and sticking to it – ensures your kids are hungry when a healthy meal is served. Don’t just schedule snacks, though. Having breakfast, lunch and dinner at regular times further encourages kids to eat only when the food is available.

Skip the Junk.  A pantry or fridge full of unhealthy options further encourages picky eating. What kid is going to fill up on broccoli when they know there are ice cream and chips just a few steps away? If the only options are healthy options, a hungry child is more likely to choose those with few complaints. Keep the healthy snacks accessible – cut up carrot and veggie sticks and keep raw fruit washed and cubed for easy serving.

Add Some Healthy Elements.  Even the most adventurous eater may turn up their nose to a completely unfamiliar food. Instead of making a full change out of the gate, begin by introducing healthier elements to their favorite dishes. Try oven-baked chicken fingers with a whole-meal coating instead of processed and fried nuggets. Mix in some shredded zucchini with their macaroni and cheese. Add fruit to a no-sugar cereal. Small changes can win over a picky eater.

Eat the Colors.  Most kids respond well to games and challenges. Brightly colored foods, such as vegetables and fruits are healthier than most dull and bland-colored foods. Make a game out of eating as many colors in a day as possible! This may encourage an otherwise picky eater to eat more vegetables and to try new foods.

Loosen Up the Rules.  A strict clean-your-plate rule does more harm than good. In the end, it just encourages over-eating while also making the dinner table a place of stress and tears. Allow your kids to decide when they are full. If they want a snack later, it’s not an issue if you have a scheduled after-dinner snack time, and they only have access to healthy snacks.

Model Good Eating Habits.  Often, picky eating is a learned behavior. Only serve foods that you will eat, and don’t complain about any food within the child’s hearing. Have meals at the table, and never encourage mindless snacking while watching television.

Many kids naturally go through phases of picky eating. Keeping unhealthy food to a minimum and only serving it as an occasional treat will help your family weather these finicky moments.

WRITTEN BY JULIA SINGER KATZ, MSS, LSW

Julia Singer Katz MSS, LSW is the Supervisor of Clinical Program Development at the Kutest Kids Early Intervention Agency, an all-inclusive therapy center in Philadelphia. She’s very passionate about helping each child reach his or her fullest potential and making a difference in the community.

Guest Article: “Speech-Language Pathology and ABA – Can’t We All Just Get Along?” by Danielle McCormick, MA, CCC-SLP

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We’re excited to share with you an exclusive article “Speech Language Pathology and Applied Behavior Analysis: Can’t We All Just Get Along?” by co-founder of Bridge Kids of New York, Danielle McCormick, MA, CCC-SLP, with contributions by Ashley Stahl, MSEd. In this article, Danielle shares with us her quirky and humorous opinions on the importance of combining traditional speech-language pathology practices and those of Applied Behavior Analysis.

SLP-ABA

I have vivid memories of a professor in graduate school essentially condemning the field of Applied Behavior Analysis (ABA) as the most “robotic” and “unnatural” way to help a child learn communication skills. As a passionate and dedicated Speech-Language Pathologist (SLP), I took these words to heart and kept them with me as I continued my career. That was until my first job as a Clinical Fellow at an Early Intervention center—that (insert gasp!) followed the principles of ABA. This center was also filled with the most diverse, beautiful children I have ever known, many of whom were diagnosed with Autism Spectrum Disorder—my passion. I had to take this job!

As if starting my first job in New York City was not daunting enough, here I was surrounded by the enemy—the big, bad ABA therapists! As a newbie who was still building confidence in my field, and having been trained to always respect other professionals (especially those who are above you in the pecking order), I took a backseat and opened my ears and eyes to the ABA that was happening all around me. The voice of my graduate professor was ringing still in my ears, so in my sessions, I made sure there was to be absolutely no ABA (at least I thought at the time!). If they wanted to “do ABA” in the classrooms, that was their business, but I wanted nothing to do with it!

Except—wait a minute—how did they teach that child to start pointing so quickly?

As time went on, I started to notice that some of my children were exhibiting extreme interfering behavior that I had not been trained to deal with. I was lost and did not know how to support these learners. Much to my relief, in came my super hero colleagues wearing ABA capes, telling me exactly what to do and why to do it.

 

Tips for Costumes & Trick-or-Treating for Kids on the Spectrum: Getting Ready for Halloween

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October means it’s time for trips to pumpkin patches, ghastly goblin decorations, and candy corns galore. So what better time than now to share this wonderful guest article about getting ready for Halloween by BCBA Claudia Mármol.  Claudia shares with us a few tips on how to make dressing up and trick-or-treating as seamless as possible for a child on the spectrum.

_______________________________________________ 

Wouldn’t it be fun to have your child dress up in their favorite TV character or have them pick up their costume for this Halloween? Most parents would answer “Yes” to the above question, as we all dream of having our child walk down the streets and go trick-or-treating. Thus, as much as children enjoy this holiday, so do adults. However, we have to keep in mind that children with autism and related disorders have sensitivity to certain stimuli such as textures, colors, smells, loud noises, and such that make wearing a typical Halloween costume difficult.

Below, you will find some helpful tips to keep in mind before we try to make our child wear all sorts of costumes, masks, make-up, wigs, and the like:

  • Try to avoid masks or anything on their heads: Since children dislike certain textures, their costume should not include anything that will disturb their head and/or skin (such as masks, make-up and/or excessive facial paint, big hats). These also become uncomfortable to carry, fade after a few hours, and can even be a little scary for our little ones, so avoid them as much as possible.
  • Make it comfortable: Whether your child will be trick-or-treating or not, make sure that the length of the costume (both legs and arms) is not too long for him/her as to impede their ability to walk and run with their friends. Also, keep in mind the material of the costume and the weather (i.e., avoid materials that will make your child sweat). I would suggest having a cotton costume and having a back-up plan, such as a Halloween-inspired shirt in case your child does not want to remain in his/her costume
  • Try it on before it’s that special day: In order to avoid a meltdown on Halloween night, have your child wear his/her costume around the house so that he/she gets used to wearing it and feels comfortable in it. Also choose shoes that your child can comfortably walk in to ensure that he/she will be okay during trick-or-treating.
  • Choose something FUN for them: Have your child take part in this special holiday by having them choose what they want to dress up as, but always keeping in mind the above stated. Here are some additional ideas and all-time favorites for Halloween:
    • Favorite TV/Movie Characters, such as Disney characters and super heroes.
    • Halloween favorites, such as witches, ghosts, wizards, and monsters.
    • Others: Animals and insects, such as cats, ladybugs, bees, dogs, and spiders are all simple yet fit the occasion!

Here are other tips to ease the difficulties related to Halloween:

  • Practice the trick-or-treating route in advance: In the days leading up to Halloween, walk with your child around your neighborhood and note his/her reaction. If your child feels scared with some decorations that include excessive lighting, have strobes or scary monsters, ghosts, and witches, then you will know to avoid these houses on Halloween.
  • Consider alternatives: If your child is not the one to walk around and may not like the Halloween decorations, then you may want to join with other parents so that you can host a Halloween party that is autism-friendly. If you don’t want to host a party, then consider attending a mall, local children museums, or any child friendly location that will have a themed activity.
  • It’s okay to stay home: If you think your child will not enjoy the Halloween festivities of going trick-or-treating and dressing up as something, then stay home. You can have your own Halloween fun by watching a movie, creating Halloween-inspired foods together, as well as arts and crafts that will get your child involved (stay tuned for our other post on Halloween Arts & Crafts).

Thus, Halloween should be a fun holiday for all of us! But do know that it can be a scary time for some children, so keep in mind all of the tips discussed above and be aware that comfort is key for your child’s happiness.

WRITTEN BY CLAUDIA MARMOL, BCBA

Claudia Mármol is a Board Certified Behavior Analyst (BCBA) and the founder of Heal the World Behavioral Services, a private ABA center that provides quality ABA therapy to children diagnosed with autism and related disorders in South Florida. Since 2007, Claudia has worked with numerous children of various ethnicities, backgrounds, and related disorders as well as typical children exhibiting problem behaviors in clinical settings, family homes, and schools. Claudia specializes in the development, implementation, and supervision of Verbal Behavior Programs in both English and Spanish.

Guest Article: Tackling Tantrums by Bridge Kids of New York

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For parents, it can be difficult and frustrating to help their children through tantrums. We’re pleased to share with you a second guest post by Bridge Kids of New York (BKNY), who shares with us a few (humorous) words of advice on tackling tantrums.

T-A-N-T-R-U-M-S
by Bridge Kids of New York

Young girl indoors cryingHere at BKNY, parents reach out to us for support in a variety of areas. Not surprisingly, one of the most popular reasons we hear from parents is for support in managing tantrums! Why is this not surprising? Well, it’s not surprising because very few of us will make it through life without ever throwing a tantrum! We’ve all been there, right? Whether you were 5 or 35, you’ve most likely engaged in a tantrum. For our little ones, who are still learning about rules, expectations, effective behavior, and self-control, it makes sense that we will periodically see a tantrum—it’s often part of the learning process. So, for all of our parents out there who are tackling tantrums, here are a few words of advice for you:

Take a deep breath
Analyze why the tantrum is occurring and Avoid reinforcing it
Neutral tone and affect
Tune out the bystanders
Remember the big picture
Understand that this is a learning moment for your child
Make objective decisions rather than emotional ones
Stop beating yourself up

Take a deep breath.
Tantrums can be stressful for everyone involved! As a parent, it may be emotionally difficult, frustrating, or potentially embarrassing to work through a massive tantrum with your child–these are common emotions! But here’s the thing: when your child is mid-tantrum and about as far away from calm as possible, that’s when it’s the most important for us to be calm. After all, someone has to be! Whatever emotions you feel in these moments are perfectly valid—acknowledge them—then take a deep breath and try to release them. One of the most important things you can do for your child during a tantrum is to remain calm

Analyze why the tantrum is occurring and Avoid reinforcing it.
All behavior occurs for a reason. Whether or not you fully understand your child’s tantrum, rest assured that there is a function behind it. In order to handle it appropriately and use proactive measures in the future, we need to analyze what is going on. We need you to become a tantrum detective! Think about what happened right before your child’s tantrum (i.e. the antecedent). Were you talking on the phone instead of paying attention to her? Did he have to share a favorite toy with another child? Did you ask him to do something challenging? Looking at what happened right before will probably give you some information about why the tantrum is happening. Thinking about (and potentially reconsidering) how you typically respond in these situations may also help. Once you determine why the tantrum is occurring, the next step is to not give into it. So, if your child is tantrumming in the middle of the grocery store because you said “no” to the box of over-processed chocolate cereal, you want to make sure that you do not give in and buy the cereal. If you cave during a tantrum, you will likely reinforce that behavior and see it again in the future. So do your best to stay strong!

Neutral tone and affect.
We’re all human and it’s natural to lose our cool from time to time under stressful circumstances. Tantrums can get the best of you sometimes! In these moments, try to remind yourself to use a neutral tone and affect. Let your face and your voice send the message that you are unphased by the tantrum (even if you don’t totally feel that way on the inside!). Channel your inner actor (we’re in NYC after all!) and put on your game face!


Tune out the bystanders.
Let’s be honest, a tantrum that occurs in your home feels very different than a tantrum that occurs in public. When you are out in the community, there may be additional safety concerns (e.g. running into the street), worries about disturbing others (e.g. crying in a restaurant or movie theater), and, perhaps the most challenging of all, those darn judgmental bystanders! You know the ones we’re talking about. Those people who either can’t relate to what you and your child are going through, or the ones who pretend like they can’t relate because, after all, their children NEVER, EVER, EVER had tantrums (read: sarcasm). Then, there are also the people who get involved, thinking they’re helping you, but are actually making the situation worse. You know these people too—the sweet older lady who tells your child that Mommy will buy him a candy bar if he stops crying—you’ve met her, right? Unfortunately, you cannot always control what other people will say, do, or think. But, fortunately, you can control what YOU will say, do, and think! In these moments, do your best to turn OFF your listening ears and do what you know is right for your child.

Remember the big picture.
Okay, so here were are in the middle of a huge tantrum. Could you make that tantrum stop in a matter of minutes or even seconds? Yes, in many cases you probably could. All you have to do is give in. If your child is tantrumming because you told her you would not buy that candy bar in the checkout line, you could probably put a quick end to it by just caving and giving her the candy. And that option can be pretty tempting sometimes! This is where we urge you to remember the big picture and think long-term. The goal is not to stop that particular tantrum in that particular moment—the goal is to reduce those tantrums from happening in the long-run. We want to decrease the behavior that interferes with your child’s success and increase the behavior that supports it—that’s not going to happen by giving in. Caving in the middle of a tantrum may stop it in the moment, but ultimately it will teach your child that throwing a tantrum is an effective way to get what he wants. So the next time he wants something, he’s likely to resort to that behavior again. As you can imagine, this may easily turn into a cycle of increasing tantrums. Although it’s easier said than done, try to remember the big picture—you’ll thank yourself later!

Understand that this is a learning moment for your child.
Every moment of every day is a learning moment. This applies to all of us, by the way, not only our children! Believe it or not, your child is actually learning during those tantrums. He is learning all kinds of things, in fact! Your child is learning whether or not Mommy really means the things she says. She’s learning whether or not you are consistent. He’s learning about rules and limits, or lack thereof. She’s learning what behaviors are going to be effective and what behaviors are not. He’s learning how to respond to undesired situations, like not getting what he wants. The list could go on and on! So remember this when your child is having a tantrum and focus on teaching the things you actually WANT to teach! Furthermore, remember that learning is hard sometimes. It’s okay for your child to struggle a little bit in the learning process—you (and we!) are there to be his teachers.

Make objective decisions rather than emotional ones.
We’ll start this one by acknowledging that it can sometimes feel nearly impossible to be objective during a massive tantrum, especially when in public. To the best of your ability, set your emotions aside and try not to take it personally. Your child’s tantrum is happening for a reason and that reason is most likely not about trying to hurt your feelings. So, take a moment to have a mini out-of-body experience, away from your emotions, and try to look at the situation as an outsider. Remember, you want to analyze what is really happening—unfortunately, those pesky emotions can really cloud your judgment. Try to let your choices and reactions be based on facts rather than on feelings.

Stop beating yourself up!
You are not a bad parent. Your child is not a bad kid. You are not the only parent whose child has tantrums (despite those ridiculous people who make you feel like you are!) In fact, your child’s tantrum may actually be the result of you being a good parent and setting limits. You do not have to be perfect every second of every day. You can make mistakes and so can your child. It’s okay. This is a part of the process. Chin up, thumbs up, you got this!

Note: If your child engages in behavior that is dangerous to himself or others, we suggest that you consult an appropriate medical professional as well a Board Certified Behavior Analyst (BCBA) immediately. Safety should always be the first priority. Feel free to reach out to our behavior team and/or attend one of our Tackling Tantrums workshops for more information on understanding and changing behavior!

WRITTEN BY BRIDGE KIDS OF NEW YORK, LLC

Bridge Kids of New York, LLC is a multidisciplinary team of professionals who strive to improve the quality of everyday living for the children and families they serve, providing each family with progressive services that merge evidence-based practices with play-based and social instruction. To find out more, contact them here or email info@bridgekidsny.com.

Simplifying the Science: Parent-Conducted Toilet Training for Kids with Autism

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For many of the families I work with, toilet training their child with autism becomes a long, painful process. I typically recommend the Rapid Toilet Training (RTT) protocol developed by Azrin & Foxx (1971) but many parents struggle to maintain implementation without the presence of a behavior therapist or toilet training specialist. And while Azrin & Foxx’s results have been replicated in other studies, RTT has primarily been used in educational and outpatient settings, and the amount of time it has taken to complete toilet training has been longer than in the initial study.

This is why I was especially excited to come across the study by Kroeger & Sorensen (2010) about “A parent training model for toilet training children with autism,” which is based on Azrin & Foxx’s initial study with some key modifications. This study focuses on parent-conducted toilet training in the home and was completed with two children with autism.

As mentioned in previous blog posts, the best interventions usually are multi-pronged approaches. This is no different. While there are multiple steps involved, it’s important to recognize that one of these children was fully toilet trained in 4 days, and the other in 11 days. Both children maintained toilet training skills when researchers checked in at 2 weeks, 6 months, and 3 years. Setting aside a few days or a couple of weeks to complete this intensive protocol may be intimidating at first, but achieving similar results as the two children in the study has a huge impact on the life of your child and the entire family.

Prior to starting the intervention, they received medical consent and clearance from the children’s attending developmental pediatricians. They then performed a preference assessment (the RAISD) to determine reinforcers. The study then states that “The families were asked to restrict the children’s access to these reinforcers for a minimum of 3 days prior to implementing the intensive training treatment protocol.”

The intensive toilet training program had 5 components:

Increased fluids: In consultation with a pediatrician, the study states that “parents were instructed to increase the children’s access to fluids for 3 days prior to implementing the training.” This increase in fluid intake continued until 6:00 PM on the first day of training.

Toilet scheduled sitting: Since the protocol was completed in the privacy of the children’s homes, the children were able to remain undressed from the waist down while being toilet trained. The children were continuously seated on the toilet, then able to leave the toilet for voiding in the toilet, or for brief “stretching” breaks. As they achieved higher frequency of appropriate voiding in the toilet, the amount of time spent on the toilet decreased and the amount of time escaping the toilet increased. (The schedule for fading out time seated on the toilet is detailed in Table 1 of the study.) Also, while seated on the toilet, the child was able to play with preferred items, but not the most preferred items.

Reinforcement for continent voids: According to the study, “If the child successfully voided while on a scheduled sit, they were provided immediate reinforcement (primary edible reinforcement and planned escape to a preferred activity). If the child self-initiated a void while on a break, he was provided immediate reinforcement and a new break time was begun after the self-initiated break.”

Redirection for accidents: When accidents occur, a neutral verbal redirection was provided, such as “We go pee on the toilet” and then the child was physically redirected back to the toilet. Once they were on the toilet, a scheduled sit was begun.

Chair scheduled sitting: Once the child began to experience success with voiding on the toilet, a chair was placed next to the toilet. During scheduled sits, the child would sit on the chair. If he began to void on the chair, the study states that he “was provided with the least intrusive, minimal, physical prompt. When he independently moved from the chair to the toilet to void three consecutive times, the chair was systematically moved away from the toilet in 2-feet increments.”

The study goes into further detail on each of these five components, as well as how to generalize the skill and how parents were trained in the protocol. The study made modifications to the Azrin & Foxx study to make it easier to apply in the home setting for parents, and it removed any form of punishment.

While this is a comprehensive toilet training program that requires a high level of time and attention from the parents, it is set up to help parents achieve results in a relatively short period of time.

The study states, “Parents of incontinent children with developmental disabilities report higher personal stress and distress likely related to the toileting problems presented by their children than parents of toilet trained children with developmental disabilities. It could be deduced then that continence training not only increases associated hygiene factors and access to activities and placements, but also increases the quality of life for the parents by reducing stress and subsequently for other family members such as siblings as corollary recipients of the distress” (Macias et al., 2006).

The potential to improve the quality of life for both your child with autism and your entire family is worth the challenge of implementing this protocol.

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.

Pilot Study Finds that Parent-led Early Intervention Can Reduce Autism Symptoms in Babies

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Autism symptoms can display in babies as young as 6 months old. A new pilot study at the UC Davis MIND Institute found that parents could reduce symptoms of autism in babies under 12 months by using intervention treatments in the home as detailed in the Early Denver Start Model.

As reported in a recent Huffington Post article, the study involved parents and their babies between 7 and 15 months of age in a 12 week-long treatment conducted by parents in home-like environments. The treatment was based on the Early Denver Start Model and revolved around parent-child interactions, such as bathing, feeding, playing, and reading. Four comparison groups were also included: Those who were at a higher risk for autism because of an affected sibling; those who were at low risk; those who had developed autism by age 3; and those with early symptoms who received treatment at a later age.

At the start of the study, all babies displayed early signs of autism, such as low interest in interactions and repetitive behaviors, which increased by around 9 months. However, by 18 to 36 months of age, the children in the treatment group produced lower autism severity scores than the comparison groups who did not go through the treatment.

The Huffington Post article “Pilot Intervention Eliminates Autism Symptoms In Babies” highlights the importance of early intervention in autism treatment. While this research is highly preliminary, the findings show that therapy and early intervention are key factors in treating infants and children with early signs of autism, and possibly in reducing them altogether. This study offers hope for parents and professionals in helping their children succeed with more tools and resources for the earliest stages of autism.

Read more about the pilot study on Huffington Post here.

Simplifying the Science: Using Evidenced-Based Practices to Increase Food Variety for Children with Autism

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An essential part of ABA is providing evidence-based treatment. Research is consistently being done all around the world to determine best practices for working with learners with autism, as well as addressing many issues outside of the realm of special education. This week, we’re pleased to introduce the first in a new month series: Simplifying the Science. In this feature, BCBA Sam Blanco will highlight one paper from the world of research to help provide you with a deeper resource base. She’ll delve into the study and offer some strategies on how the findings apply to your programming needs. Our hope is that these monthly tips will shed a different light for you on the importance of looking to research for guidance.

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When faced with feeding issues, many parents or caregivers may not consider seeking out help from a BCBA or behavior analyst. There is a tendency to associate ABA with sitting at a table and completing discrete trials, but this is only one tool in a behavior analyst’s extensive toolkit. Whether you are providing intervention for feeding issues or seeking more information, it is essential to look to scientific research for help.

There are several studies available about feeding issues, and many of these studies are specific to feeding issues in individuals with autism. One such study was published in 2010 in the Journal of Applied Behavior Analysis (JABA) by Hildur Valdimarsdóttir, Lilja Ýr Halldórsdóttir, and Zuilma Gabriela SigurÐardóttir. “Increasing the Variety of Foods Consumed by a Picky Eater: Generalization of Effects Across Caregivers and Settings” provides one detailed case in which a five-year-old boy with autism refused to eat anything beyond meatballs, fishballs, fruits, and cereal. While his school had had some success with getting him to eat a few new items, the boy’s parents were unable to reproduce the same results at home.

The intervention the researchers used involved multiple steps that would require the assistance of a BCBA or skilled behavior analyst if you wanted to replicate it at home. In order to increase the number of foods this boy ate, the intervention included several behavioral techniques such as escape extinction (not allowing the child to escape mealtime upon refusing to eat or engaging in inappropriate behavior), stimulus fading (setting goals of increasing difficulty), and a schedule of reinforcement (frequency of reinforcement for appropriate behavior) that was systematically thinned as the child experienced success. By the end of the intervention, the boy was consuming 39 new, “non-preferred” foods, including 14 vegetables.

You can read the research study here, which I recommend you share with your child’s ABA provider. I also suggest taking a peek at the references listed at the end for insight into other resources. This particular study is of a five-year-old boy with autism, but you may find studies that are more relevant for your particular child.

In the end, when you’re feeling at a loss for strategies on improving your child’s eating, there is a lot of research out there. It takes time to go through it and set up a similar system for your own child, but the end result can have a huge impact on your child’s health as well as the stress-level in your home during mealtimes. It is definitely worth the effort to attain more information.

Written by Sam Blanco, 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.

Guest Article: “Wandering and Autism” by Sarah Kupferschmidt, MA, BCBA

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There are compelling statistics today that highlight the need to address the issue of our children wandering and going missing.  The safety of chidren with autism is an enormous concern for parents and caregivers alike.  Last month, we shared BCBA Sam Blanco’s interview with Gary Weitzen on safety, wandering, and emergency planning for individuals on the spectrum.  This week, we’re thrilled to bring you a guest article by Sarah Kupferschmidt, MA, BCBA. Sarah has written a wonderfully informative article on how to use the Behavior Skills Training framework to teach your child help-seeking behavior in cases of wandering.
Wandering and Autism
by Sarah Kupferschmidt, MA, BCBA

We seem to be hearing about more and more cases of children with autism wandering and going missing in the media.  In some of these cases the children were reunited safely with their families, but in many unfortunate instances, tragedy ensued.  There is evidence to suggest that this may be more common than most people realize.   The Interactive Autism Network (IAN) and the Kennedy Krieger Institute published a study in 2012, in the Journal of Pediatricson this very topic.  According to the study,  49% of the parents that were interviewed reported that their child with autism had wandered or bolted.  Moreover, more than half of those children that did wander actually went missing.  Compelling numbers aside, what I found even more important about the results of this study was that for obvious reasons parents reported that they were experiencing high levels of stress related to the prospect of their child wandering, but, they were also feeling helpless to a certain extent because they felt that they did not know what they could do about the wandering.

The good news in all of this is that there is hope for those families.  There are ways that we may be able to help prevent children with autism from going missing in the event that they do wander. Behavioral Skills Training (BST), which is a framework based on Applied Behavior Analysis, has been shown to be effective in teaching a variety of different skills to individuals with and/or without a disability.  Specifically, it has been shown to be effective in teaching help-seeking behavior in children with autism (Bergstrom, R., Najdowski, A.C., Tarbox, J., 2012).   This framework involves breaking a complex skill like “seeking help when lost” into its component parts and teaching the child to engage in those behaviors when relevant. For example,   in the article mentioned above, children with autism were taught what to do if they were lost in a store. The help-seeking behavior was broken down into the following steps:
  1. Shout out for the person you are with (e.g., “Mom” or “Dad”)
  2. Look for and walk over to store employee
  3. Tell the employee, “I’m lost”
These steps were taught using the BST framework which includes the following critical elements:
  1. Instructions: Explaining to the child what they should do
  2. Modeling:  Showing the child what they should do
  3. Rehearsal: Practicing with the child
  4. Feedback: Providing feedback to the child on how they did

Each of these steps are fairly self-explanatory.  The instructions step is simply telling the child in words what they should do.  Perhaps you could include some visuals when you are reviewing the steps of what they should do when they get lost.  The next step is showing them how it should be done.  I typically use video models but it is possible to demonstrate it live if you don’t have a recording device.  The next steps are critical in the development of this new skill.  Set up a safe situation with the child where you can go out in the community and practice the three steps.  You could bring the visuals along with you if your child needed that little bit of extra help.  If your child did all three steps correctly it is important to praise them immediately and to let them know what they did well.  If they missed one or more of the steps let them know what they did well and remind them of what they need to do differently next time.  For example, you might say “nice job shouting out for mom or dad, next time, don’t forget to tell the cashier you are lost”.  These steps would be practiced until your child was able to do it fluently.

While the BST framework has evidence to support its use, it is important to remember that every child is unique and has different strengths and weaknesses.  In my experience, the children that would do well in this type of program have certain pre-requisite skills.  Ideally, they would already be able to follow simple instructions, have the ability to imitate, and the ability to identify strangers and familiar people.  While children with autism may be at higher risk for wandering, there are things that we can teach parents/teachers to do to help reduce the risk for compromised safety and/or harm that are grounded in ABA.  If you are worried about your child’s risk for wandering, then I would recommend you contact a local Board Certified Behavior Analyst (BCBA) that can assist you in determining if a program such as the one described above would be suitable for you and your child.

About the Author

Sarah Kupferschmidt is a Board Certified Behavior Analyst (BCBA) who has worked with hundreds of children with autism and their families across Ontario. She has had the privilege of supervising ABA programs and training clinical staff in those programs.  Currently Sarah offers parent coaching and workshops to teach parents but also educators on the most effective ways to teach children using the principles of ABA.  She is also a part-time faculty member at Mohawk College in the Autism Behavioral Science program, in the social sciences program at McMaster University, and an Adjunct Professor at Sage Graduate School.  Sarah is CEO and co-Founder of Special Appucations Inc., which is a company that creates educational products that help maximize the learning potential for children with autism because they are designed using the principles of ABA.  Sarah has appeared as a guest on CP24, CHCH news, Hamilton Life and the Scott Thompson radio show as an authority on autism.

On the Need for Crisis Intervention Training: A Guest Article by Bobby Newman, PhD, BCBA

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Last week, we discussed a comprehensive checklist for parents in placing their children in the right school environment. Service providers in special education programs play a vital role in students’ daily lives at school and are expected to understand certain protocols when behavioral difficulties arise. We couldn’t think of a more appropriate article than that of Bobby Newman, PhD, BCBA to shed light on this need for crisis intervention training in order to ensure the best learning environment for students.

On the Need for Crisis Intervention Training
by Bobby Newman, PhD, BCBA-D

It was one of those moments in life that seemed scripted. A colleague and I were being given a tour of a public school, a prospective placement for a student of my colleagues. The student in question had a history of aggressive behavior towards staff and bolting from the classroom towards the street. How such physical crises were going to be addressed was thus a major concern of mine. I asked the tour guide, the principal of the school, how such matters were handled and whether staff were formally trained in any crisis intervention philosophy and techniques. She informed me that they were not, but that there were “informal things that staff had taught one another.”

As if on cue, at that very moment a student came sprinting past us, with a staff member in pursuit. The staff member reached out and grabbed the sprinting student by the back of the collar, effectively stopping him by choking him with his shirt. My usual flimsy professionalism couldn’t survive this seemingly scripted moment, not to mention the loud choking noise, and I asked, “Is that one of the things staff have shown each other?”

Further questioning revealed that when students had serious outbursts, 911 was called. My mind went to Chicago where in 2012, police were called to the home of a child with autism during a behavioral crisis with tragic results. Very little else needed to be known to determine that the student’s parents would never agree to this school placement, and I couldn’t say that I blamed them.

Crisis intervention is one of those very sensitive issues in the field of developmental disabilities. There are people who want to ban the physical portion of crisis intervention training, either due to liability concerns or perhaps due to abuse concerns. I will agree that the potential for abuse exists if staff are allowed to put their hands on students/consumers. I will argue, however, that the possibility of abuse is much greater if we do not train and if we do not have formalized systems in place, or at least for mass exclusions of people from less restrictive settings due to the inability to maintain them there safely in such environments. Let me develop my argument:

  • Due to the nature of some developmental disabilities (e.g., difficulty in developing communication skills or sensory defensiveness), behavior that is not typical of same age peers can occur.
  • This behavior may sometimes take forms that can be dangerous to the person engaging in them (e.g., running into hazards or self-injurious behavior) or dangerous to those around them (e.g., aggression towards others or environmentally dangerous behavior such as object destruction).
  • At such times, we may be facing a “crisis,” when injury to self or others is imminent and probable and “crisis intervention” (verbal and possibly eventually physical) may be necessary to keep everyone physically safe. The guiding idea behind crisis intervention is to keep everyone safe. This includes the person engaging in the behavior, peers, and staff.

I wish to emphasize that a crisis is NOT an everyday occurrence. A crisis should not be routine, it should arise as a relatively infrequent occurrence that needs to be dealt with via crisis intervention protocols at that moment. I wish to distinguish crisis intervention from “behavior treatment plans,” which must be in place for behavior we often see from the individual in question. If you’re doing crisis intervention frequently, then this a matter for discussion of alterations to behavior management plans or resource allocation/availability. Crisis intervention is not a consequence meant to change the probability of behavior via a punishment contingency, and any physical interventions where one must put their hands on a student should be a last resort.

Even with this caveat in place, some would make the argument that crisis intervention training should not be provided, that it gives staff permission to be overly physical with students. While I will grant such a possibility exists, as I always tell my ethics classes, the argument about what you are not willing to do is not enough. One must be prepare to answer, “and then what?” Suppose staff were not trained. When a crisis occurred, they would be left with “doing the best they can” or otherwise improvising in the moment. Given this set of circumstances, staff would respond in their own ways to crises and injuries and abuse become probable, not just possible, as staff panic or lash out with whatever self-defense techniques they can think of or act in keeping with a faulty knowledge of body mechanics or physical hazards (witness the “choke stop” described above).

To summarize, the implications of the “do not train” argument are:

  • I know there will be crises due to the behavioral history and repertoires of the students in the program
  • I’m concerned about liability or staff becoming heavy-handed, so I’d rather not train people to safely deal with the crisis, I’d rather trust to their natural impulses or an “unofficial” policy/procedure that has grown up within the program.

What must be appreciated is that good crisis intervention training systems are based on sound behavioral principles, providing the supports the individual needs, rather than on controlling the behavior of the individual physically. The vast majority of crisis intervention training is based upon preventative measures that aim to teach the individual self-control and alternate behaviors, and to create settings that are not likely to create crises in the first place, rather than sheer physical intervention. Should a physical intervention be needed, safety is a foremost concern. Techniques are performed in such a way as to attempt to minimize injury. No technique, for example, is meant to cause pain, is meant to scare, uses impact for behavior control, or moves a limb beyond its normal range of motion.

To sum up the basic argument:

  • We know behavioral crises that can lead to serious injury may occur
  • If we do not train people, we are trusting the staff member’s individual reactions or “unofficial policy’ that cannot be traced or analyzed as it is unofficial.
  • If we do train people, however, we can create standards of conduct and accountability and we can aim at program design that avoids the need for physical intervention.

This seems to me to be our best bet for creating programs that are humane, not emotionally reactive, and encourage the development of effective problem solving strategies that rely on behavioral interventions, rather than relying on physical intervention by staff to keep everyone safe. This seems to me to be most consistent with ethical practice of Applied Behavior Analysis.

About the Author

Bobby Newman is a doctoral level Board Certified Behavior Analyst and Licensed Psychologist. Bobby is the first author on twelve books and has published over two dozen articles in professional journals, as well as numerous popular magazine articles and has hosted two series of radio call-in shows. Bobby is the Past-President of the Association for Science in Autism Treatment and the New York State Association for Behavior Analysis. A popular speaker, Bobby also provides direct treatment, staff training and consultation around the world, and has been honored for this work by several parents and professional groups. Bobby is a SCIP-R (Strategies for Crisis Intervention and Prevention, Revised) instructor and has published a manual to accompany crisis intervention training (Gentle Redirection of Aggressive and Destructive Behavior). In addition to his other clinical work, Bobby teaches non-violent crisis intervention philosophy and techniques for schools, agencies and families.