Compassionate ABA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References Consulted

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

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

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

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

About The Author

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

The Joy of Genuine Progress: Remote Teaching and Flashcards

This week’s blog comes to us from Kate Connell, the creator of the Picture My Picture flashcard collection. Visit our site to learn more! 

Having three boys at home for three months in 2020 I understand the challenge of remote learning. There were certainly moments of chaos and times that felt overwhelming. But in the mix were also many great moments where I observed genuine progress. Those “ah ha” times, when something previously unclear or unknown was understood, were deeply satisfying. To all the parents and carers out there that are remote teaching right now, all power to you. A key lesson that I learnt was that dedicated learning time is more effective when it is fun. Enter – flashcards. 

Why use flashcards at home?

Flashcards are an ideal tool for teaching kids at home because they are visual. Using visuals can increase the rate at which your child learns  as well as their ability to comprehend, remember and retrieve information. You don’t need to be a qualified therapist or teacher to use flashcards.  

What can flashcards teach?

Flashcards can assist with your child’s learning in many ways. They support language development and can also assist with emotional regulation, critical thinking and memory.  

How do I use flashcards at home?

Flashcards are a very flexible teaching tool. A wide range of activities can be applied to the one set.  They are suitable for pre-school children right through to more advanced learners. The types of activities you can use flashcards for include pairing, sorting, naming, describing and performing. 

Pairing activities

The act of pairing, grouping two or more associated things, assists your child’s ability to reason because to successfully make a pair they need to use systematic steps to arrive at a conclusion. 

A set of ‘Go Togethers’ flashcards is a great resource for learning about pairing. It typically consists of pairs of associated images, such as shoe/sock and bowl/spoon. A fun activity is placing four cards on a table and then having your child match the card handed to them (such as the bucket) with the one on the table (such as the spade). You can talk about the cards as you’re playing “Yes! The stamp goes with the envelope.”

Sorting

Sorting things by type (such as color, shape or purpose) is a skill that develops your child’s language and maths abilities. It is crucial for being able to relate, store and recall words. A set of Categories flashcards is ideal for learning how to sort. It typically consists of a range of categories (e.g. transport, furniture, clothes), with a number of cards per category (e.g. bus, plane, motorbike, ferry and car). 

There are many learning activities you can try with Categories. One is placing five cards on a table from five different categories (eg animals, instruments, transport, food and clothes). Then passing your child the remaining cards from these categories, one by one, and asking them to place the card they are holding on top of the card on the table to which it belongs. So the horse goes on top of the dog and the piano goes on top of the violin etc. 

Naming

Enhancing your child’s vocabulary supports their ability to grasp and express ideas clearly. It also enhances their capacity for abstract thinking. A large set of Nouns flashcards is ideally suited to vocabulary building. It typically consists of many different types of nouns such as animals, occupations and locations.

A very simple activity you can do with the Nouns set is to have your child name the image on the card they are shown, such as “Cat” or “Blender”. Once successful, encourage them to create a sentence relating to the image they are shown (eg “The milk is white”). A Nouns Set can also act as a spring-board for discussing topics in detail such as a swimming pool. You might ask “What do you like about going to the swimming pool?” or “What do we need to take to the swimming pool?”

Performing

The act of performing fosters creative self-expression in your child. Performers have to be critical thinkers, problems solvers and good listeners. Performing is particularly helpful when teaching your child how to regulate their emotions so that they’re calmer and better able to navigate relationships. 

Emotions flashcards can be used to encourage performing. You might ask your child to perform the emotion shown on the card or to enact a brief scenario relating to the emotion such as licking an ice cream then dropping it and feeling sad. Or you might enact a scenario yourself such as opening a present and have your child choose the relevant emotion card from a range of cards. 

Flashcards provide a valuable and accessible resource when teaching your child remotely. They can assist with learning in many ways and each set has a multitude of different uses. By keeping it playful and fun you keep your child engaged and with that engagement comes the learning. 

About The Author

Kate is the owner of Picture My Picture, an international business which specializes in educational flashcards. She is the mother of three boys, Christopher, Louis and Tom. Christopher is on the spectrum of Autism. The flashcard based teaching program she oversaw in the early years of his life was the inspiration for the business she owns today. 

Focus on Generalization and Maintenance

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

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

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

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

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

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


Written by Sam Blanco, PhD, LBA, BCBA

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

Cultural Competency in ABA Practice

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

What are the barriers?

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

Do we hold stereotypes?

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

Are we aware of cultural norms?

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

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

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

Cultural analysis

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

Empathy grows as we learn

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

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

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

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

References

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


About The Author

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

ABA Journal Club: A Response from Dana Reinecke

A quote from this week's ABA Journal Club response from Dana Renecke

Welcome back to ABA Journal Club! One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

Check out last week’s discussion questions here!

Behavior analysts engage in many different professional activities, many of which are more or less likely given specific clinical or research settings. For example, some behavior analysts who work with individuals with disabilities are likely to conduct preference assessments and use token economies, while those who work with organizations are less likely to use these technologies. One part of the behavior analyst’s repertoire that is always important, however, is the careful and accurate collection of data. This skill set is necessary for understanding and assessing behavior, as well as for ongoing monitoring of the effectiveness of behavioral interventions. 

It is important to understand not just how to measure behavior, but when to use each type of measure.  LeBlanc, Raetz, Sellers, and Carr (2016) describe some of the critical questions that should be considered when choosing a measurement procedure and offer a clinical decision-making model to guide behavior analysts in making these choices.  This article is useful for helping trainees to practice choosing measurement procedures, and reminding more experienced behavior analysts about the considerations involved in measurement. 

LeBlanc, L. A., Raetz, P. B., Sellers, T. P., & Carr, J. E. (2016). A proposed model for selecting measurement procedures for the assessment and treatment of problem behavior. Behavior analysis in practice9(1), 77-83.

Why is this article important for practitioners to read?

Measurement of behavior is one of the most important activities that a behavior analyst engages in.  Without accurate, meaningful measurement, assessment of both behavior and intervention effectiveness is impossible.  Trainees should read this article to learn about the important variables involved in choosing appropriate measurement systems, and more seasoned behavior analysts should read it to remind themselves about those variables.  Even though the article is focused on the measurement of problem behavior, the same principles can be applied to the measurement of behavior targeted for increase.

The model proposed by the authors incorporates several variables (such as observability of behavior and personnel resources.) Are there any other variables you might consider when selecting a measurement procedure?

Length of observation period might be a relevant factor in choosing a measurement procedure.  Consideration of the availability of resources may be influenced by the goal for how much observation is desired.  To use the case example provided by the authors, Joey’s teacher and aide might not be able to continuously record his work engagement throughout the day, but one of them might be able to do so for a limited sample of each day.  They could choose to conduct continuous measurement during a sample interval, and compare it to the longer period of discontinuous measurement to ensure that the discontinuous measure does not result in an over- or under-estimate of behavior. 

Table 1 clearly outlines each form of measurement along with strengths and limitations. Discuss the forms of measurement you frequently use and the limitations to incorporating other forms into your current practice.

As a consultant, I need to measure behavior based on limited samples when I can observe, and I also need to design data collection plans for the staff who are there for the rest of the week.  Staff are often responsible for more than one student, and may not have the resources to conduct continuous event recording.  Behavior is also often not discrete (e.g., crying) or occurs too frequently to count (e.g., stereotypy).  I often use partial-interval recording when I consult in school programs.  This allows for a very easy, non-intrusive overview of the pattern of behavior across the school day.  Another common measure is duration of behavior, because it is also relatively easy to start a timer when behavior begins, and stop it when it ends.  Frequency data are pretty rare in my practice, and reserved for low-frequency behavior that only occurs under specific circumstances.

In Figure 1, the authors provide a flow chart for easily selecting the most appropriate form of measurement. Many of the questions are directly related to observer resources. In this article, the term “resources” relates directly to the ability of personnel to continuously monitor the behavior. Are there any other factors you would consider in relation to personnel? If yes, how do you typically address those factors?

When training staff to collect data, it’s important to acknowledge any unintended bias.  Depending on the staff member’s level of experience, I will conduct more or less frequent IOA to reduce the risk of observer drift, and will also regularly review behavioral definitions to ensure that we are still talking about the same thing.

In discussing the behavior being measured, the authors write: “If the behavior can occur at any time, consider all dimensions of the response and select the ones that are most critically important to fully capture the important features of the behavior and the potential change in the behavior that may occur due to intervention” (p. 81).  How do you determine which dimensions of the response are the most critically important? Can you think of an example?

The importance of each dimension of the behavior will depend on the situation, the behavior, and the target or goal for the behavior.  For example, if a student is able to answer social questions but only does so after a delay, we would want to target, and therefore measure, latency to respond instead of frequency.  Or, a learner might engage in several very brief tantrums throughout the day.  In that case, I would expect that duration would be less important, and frequency a more meaningful measure.  By contrast, if a learner engages in one or two very long tantrums per week, we would want to measure duration and possibly intensity, rather than highlighting frequency.

One of the limitations of this paper is that the model it presents has not been empirically tested. What might such an empirical study look like?

One possible way to validate this model would be to provide several experienced behavior analysts with some case studies, and ask them to use the model to recommend measurement procedures for each case study.  High levels of agreement between the behavior analysts might indicate some validity for the model.  Further validity could be achieved by using the model to select measures, and then conducting those measures and comparing them to true values (e.g., permanent products or continuously-collected event recording).


About The Author

Dana Reinecke, Ph.D., BCBA-D is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA).   Dana is a Core Faculty member in the Applied Behavior Analysis department at Capella University.  She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum, forms, and hours tracking.  Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities. She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism.  Current areas of research include use of technology to support students with and without disabilities, self-management training of college students with disabilities, and online teaching strategies for effective college and graduate education.  Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA).

Misconceptions About Reinforcement

ABA often gets a bad rap due to misunderstandings about reinforcement. In my career alone, I’ve had people tell me that people are not like rats and pigeons, that reinforcement harms intrinsic motivation, and that when I do produce behavior change, it has nothing to do with ABA but with my abilities as a teacher. Today, I’d like to clear up some misconceptions about reinforcement.

Reinforcement is not equivalent to rewards.

Reinforcement is anything that occurs immediately following a behavior that increases the future likelihood of that behavior. For instance, I am more likely to say hello to my neighbor down the street because in the past he has responded by saying “hello” back to me. However, I do not say hello to my next-door neighbor because she has never responded to my greeting. My history of reinforcement with the neighbor down the street increases the likelihood that I will greet him upon seeing him.

Reinforcement occurs in the natural environment all the time, whether we are conscious of it or not.

We are reinforced by paychecks for going to work, by our favorite dessert for visiting a restaurant 30 minutes out of our way, by compliments when we get a new haircut and more. ABA utilizes reinforcement when an individual is not acquiring skills in order to help them learn. And when ABA is implemented correctly, reinforcement should be as close to naturally occurring reinforcers as possible and should be reduced systematically over time to levels that would naturally occur in their environment.

Reinforcement works for dogs and for humans.

The previous two points illustrate that humans do respond to reinforcement, and decades of scientific research back that up. Comparing the work behavior analysts do with humans to the work behavior analysts do with other animals is not far off base. What is off base is using such a comparison to imply that behavior analysts treat people with disabilities like dogs. As with other professionals who work with individuals with disabilities, (such as speech therapists, physical therapists, nurses, etc.) most behavior analysts are professionals who put a lot of time, care, and love into their work.

Reinforcement is individualized.

Everything we do in ABA is individualized because human beings are wonderfully complex creatures that cannot be characterized by statistics, averages, or norms. One of my students may find stickers reinforcing; another may show no interest. One student may find listening to music reinforcing; another may cover his ears and ask me to turn it off. In ABA, we seek to find the items and activities that are motivating for individuals; then use those as tools not only for reinforcement but for increasing skills and broadening interests and opportunities. In an ideal ABA session, my students spend a lot of time engaging with items and activities that they enjoy while also learning and growing.

It’s easy to fall prey to misconceptions about reinforcement, but such misconceptions can make it impossible for us to understand how to alter the environment in order to provide the best possible outcomes for our students. As Skinner put it, “The ideal of behaviorism is to eliminate coercion: to apply controls by changing the environment in such a way as to reinforce the kind of behavior that benefits everyone.”

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WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges. You can read more of Sam’s posts for DRTL here!

ABA Journal Club # 6: A Response From Robyn Catagnus, EdD, LBS, BCBA-D and Elizabeth Hughes Fong, M.A., BCBA, LBS

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

This month’s response comes from Robyn Catagnus, EdD, LBS, BCBA-D and Elizabeth Hughes Fong, M.A., BCBA, LBS. Sam’s original blog can be seen here.

  • How does Skinner’s definition of culture differ from how you typically consider culture?

Fong: I think that Skinner did a nice job of linking a person’s actions and beliefs within the context of their environment.  At times, I feel it’s an oversimplification of a term, and behavior analysts should explore (on a deeper level) what that means. It defines culture, but lacks in helping us to understand it, or on a more practical level, what this means for our practice of ABA. I’m in agreement that our histories and the contingencies that we come into contact with shape who we are.  But as clinicians, what does this mean? When I think of culture, I consider things like history, contingencies and the environment in which the person operates, but I also try to draw out more information about what this means for my work as a clinician – if at all.  Culture is deep and rich, and sometimes I feel that relying on just Skinner’s definition doesn’t take all this into consideration. We can take that as a starting point, on how to conceptualize culture, but we need to go further into truly trying to understand what it is. Some interesting articles to review on the topic are: Muchon de Melo, C., & de Rose, J. C. (2013). The concept of culture in skinnerian Radical Behaviorism: Debates and controversies. European Journal of Behavior Analysis14(2), 321-328; Glenn, S. S. (2004). Individual behavior, culture, and social change. The Behavior Analyst27(2), 133-151.

  • Have you encountered situations in which by cultural contingencies impacted an intervention you planned? What might you have done differently if you could go back in time?

Catagnus: I’d like to share the story of two of my colleagues, Stacee Leatherman and Ashley Knochel. They are both doing really important work in this area that exemplifies this issue. And, you’ll likely see their papers on the topics published soon, so this will be a preview. Stacee was a therapist working with a family from a different country that had immigrated to her local area. She reported at a recent ABAI conference event that she felt ill-prepared by her behavior analytic training to adequately assess and intervene in a culturally appropriate way. The family ultimately left ABA services, and Stacee went to the literature to see what their consulting group could have done to better serve the family. She found almost no relevant empirical research in ABA journals that addressed implementation or culturally adapted interventions with non-Western families of children with Autism. We recently submitted a manuscript presenting her findings and making some recommendations of our own.

Leatherman, S., Catagnus, R. M., Brown, T. W., Moore, J., Torres, I. (2019). A systematic review of strategies to improve treatment services provided by cross-cultural practitioners working with individuals with autism spectrum disorder. (Manuscript in preparation).

Ashlee, along with co-researchers, has conducted one of the rare empirical studies of ABA with non-Western learners (and is submitting this manuscript soon). She was working in Ghana at a school for children with ASD. She helped the teachers implement a common behavior analytic technique, behavior specific praise. She did so in a way that is typical here in her culture in the US, in terms of using language to label the behavior, specifically, vocally, and with excitement. For cultural reasons, the way she’d learned to conduct the procedure in her culture caused a decrease in the desired behavior of working on task! So, she met with the stakeholders in the setting, engaged in culturally sensitive and humble question asking, and was able to collaboratively identify why the commonly used approach was not culturally appropriate or helpful – why it was detrimental to learning. Together, they revised the way the reinforcement was delivered, assured it was culturally correct, and the on-task behavior improved, and the staff reported feeling that Ashley’s interactions were culturally relevant. The outcome, and consultation process, was impactful. This is some of the first empirical data I’ve seen to explain how ABA interventions repeated ‘the way we learned to do them in our own culture’ can negatively impact those we service if we don’t approach the planning and implementation in a culturally interactive and open way.

Knochel, A., Blair, K. C., Sofarelli, R. (2019). Culturally focused classroom staff training to increase praise for Ghanaian students with autism spectrum disorders. (Manuscript in preparation).

  • Do you currently engage in any of the suggestions the authors provide for self-reflection? What has been your experience with self-reflection?

Catagnus: I regularly engage in self-reflection in the forms of mindfulness practice and formal meditation. In fact, I developed a mindfulness and ABA course at TCSPP and get to regularly talk about this with our students. I think and talk about my own cultural frameworks and background regularly, too, because of the types of research and implementation we conduct for culturally relevant pedagogy at the University. Luckily, the work that I do is immersive in terms of cultural topics, and I continue to develop my self-awareness. I also seek out experiences of diversity, by traveling, engaging in study abroad programs for myself and creating them for my students. I’ve worked with amazing local early educators in South Africa, visited cultural and academic sites in Denmark, taken classes in Spain, and am about to do visit Singapore, Malaysia, Vietnam, and Qatar. Developing relationships with people around the world has helped me stay reflective and to grow personally and professionally. Learning never stops for this process.

  • Do your current functional assessments incorporate cultural variables? If not, what can you change to improve your functional assessment process?

Fong: I do not think most FAs incorporate cultural variables. While the principles of ABA might be considered to be universal, the way in which we complete an FA is very Eurocentric.  Most of the places I have worked at present the FAI in English and if another language is required a translator is used. The translator may or may not have the clinical understanding to accurately communicate the question. Also, some of the questions are more direct, closed ended.  Some culture may do better by telling a story. Generally, there are no questions that directly address culture – for example, preference on pronouns, holidays, languages used, the role of the clinician in the family’s mind, background information about caretakers, what behaviors are reinforced/valued by a culture and which are not, etc.  I think incorporating things like this, into FAs would help to make them more culturally sensitive. Maybe each culture, create their own? I will ask clients if there is thing anything else that they feel that I should know, which might be relevant to intervention. Sometimes I prompt for information about language, holidays, manners, norms, preferences, etc. A good article on the topic is: Tanaka-Matsumi, J., Seiden, D. Y., & Lam, K. N. (1996). The Culturally Informed Functional Assessment (CIFA) Interview: A strategy for cross-cultural behavioral practice. Cognitive and Behavioral Practice3(2), 215-233.

  • One of the recommendations by the authors is to use readily available resources. What resources are available to you? How can your organization better provide resources to help behavior analysts address cultural variables?

Fong: I like this family therapy book – McGoldrick, M., Giordano, J., & Garcia-Preto, N. (Eds.). (2005). Ethnicity and family therapy. Guilford Press. The Special Interest Groups (SIG) of ABAI are another good resource, I’ve found that people are responsive if you email them questions.  There is also the Culture and Diversity SIG of ABAI. I also tend to look outside the ABA, to fields such as psychology, who have done a superior job addressing the need to examine the role that culture plays in treatment. Recently, there has been an increase in behavior analytic articles and presentations addressing culture, so I try to read those.           

Catagnus: TCSPP has an institutional learning outcome related to diversity, so we embed learning, resources, assignments and outcome measures throughout our program. It is a deeply held value and a strong focus of our program. For this reason, our students often research topics related to culture, diversity, and inclusion. They have access to carefully curated curricular materials like articles, books, lectures, and tutorials on many different related topics. Our classes are regularly evaluated and updated to represent more global perspectives. And, the process of students’ learning is supported from the day they start until graduation, with the goal of developing their own resources and skills in cultural awareness. We are also implementing some innovative advising and learning laboratory programs to further help students connect with personal resources for cultural competence.

  • The authors suggest the use of social validity surveys as one method for addressing cultural values. How can you incorporate this into your current practice?

Fong: I think, by just asking a client/family member/guardian if they agree with the goals and treatment suggestions would be a good start. Incorporating more relevant people into intervention planning would also be a good step.  I tend to get better participation in data collection when I do this, as well (i.e. buy-in).

Catagnus: Bobbie Gallagher and a few of us from TCSPP recently published a paper that addressed the cultural values of females with limited language (LL) and autism (ASD), and their families and nurses. The study was designed to gather social validity about what strategies would be doable, preferable, and acceptable to communicate with women with LL and ASD during a gynecological exam. These women are at risk because, statistically, they don’t access this important health service very often, if at all. The study gathered quantitative and qualitative data about concerns, fears, and preferences for how women could be more effectively and respectfully involved in the process of a diagnostic exam. As Bobbie wrote, “Identifying strategies with a higher rate of social validity, or acceptance of treatment prior to implementation, may assist future researchers in conducting studies on the effectiveness of those strategies.”

Gallagher, B.J., Flynn, S.D., Catagnus, R.M., Griffith, A. (2019). Social validity of strategies to assist females with ASD during gynecological examinations. Journal of Developmental and Physical Disabilities. https://doi.org/10.1007/s10882-018-9654-5

  • The authors state that one limitation of their article is that they did not provide systematic guidelines for working with culturally diverse clients. If you were going to introduce such guidelines, what might you include?

Fong: I think the guidelines I referenced here: Hughes Fong, E., & Tanaka, S. (2013). Multicultural Alliance of Behavior Analysis Standards for Cultural Competence in Behavior Analysis. The International Journal of Behavioral Consultation and Therapy. 8(2): 17-19. Are a good start.  APA did a fantastic job on their guidelines – so again looking at other fields to see what they have done (https://www.apa.org/about/policy/multicultural-guidelines) and learning from other fields would be helpful.

Catagnus: Ashely Knochel, Kwang-Sun Blair, Stacee Leatherman, and I are working on a manuscript now related to this topic. We hope to provide the ABA community with a systematic review of relevant cultural adaptation models, highlighting one that is most useful as a framework to guide the process. We recommend that ABA look to other fields that have created and researched frameworks or developed guidelines. Examples include Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations from the APA, and AMA Code of Medical Ethics’ Opinion on Cultural Sensitivity and Ethnic Disparities in Care.


About The Authors

Dr. Robyn Catagnus is an expert on learning and behavior change. A board-certified behavior analyst, she is an associate professor, associate chair, and former national chair of Behavior Analysis at The Chicago School of Professional Psychology. She’s owned and operated a successful behavior consulting firm and held executive roles in behavioral health and educational technology organizations. As a management consultant and researcher, she also develops human capital initiatives to improve organizational behavior.

Dr. Catagnus’ helps educators promote inclusion, success, performance, and growth. She is a trustee of the Cambridge Center for Behavioral Studies; reviewer for the Diversity in Behavior Analysis section of the APA journal Behavior Analysis: Research and Practice; reviewer for Behavior Analysis in Practice, and former member of the editorial board for Perspectives on Behavior Science. Dr. Catagnus has degrees in instruction and technology, education, leadership and strategy, and a certificate in mindfulness.

Ms. Hughes Fong has over two decades of experience in the fields of behavioral health, education, and management. Her educational background is in clinical and counseling psychology and applied behavior analysis. She is currently a PhD candidate studying Clinical Psychology with a concentration in Forensic Psychology.

In 2011, Ms. Hughes Fong founded Multicultural Alliance of Behavior Analysts (MultiABA), now call the Diversity and Culture SIG. This is a special interest group of the Association of Behavior Analysis International (ABAI). Ms. Hughes Fong is the founder of “Diversity in Behavior Analysis” a section in Behavior Analysis Research and Practice, and serves as an Associate Editor for the journal. Ms. Hughes Fong, also serves on the Executive Committee for the American Psychological Association’s (APA) Division 35, as the Website Coordinator. She has been a reviewer for Behavior Analysis: Research and Practice, Behavior Analysis in Practice, and the National Multicultural Conference and Summit. She is also a “Distinguished Scholar” with the Cambridge Center for Behavioral Studies, and a member Association for Behavior Analysis International (ABAI)  Diversity, Respect, and Inclusion Task Force

In addition, to Ms. Hughes Fong activities, she is a Board-Certified Behavior Analyst and licensed as a Behavior Specialist in Pennsylvania, a trainer in the Pennsylvania Bureau of Autism’s Functional Behavior Analysis training, and has received training certificates in the area of Trauma-Focused Cognitive Behavior Therapy and Trauma-Focused Cognitive Behavior Therapy Childhood Traumatic Grief. In addition, she received her level one certification in Pivotal Response Training and Gottman Couples Therapy. Her primary areas of interest are in the application of ABA to multicultural populations, telehealth, social validity, health and behavior analysis, and examining child custody and parental competency when a child has developmental disabilities.

ABA Tools of the Trade: A book review from ASAT!

This month’s ASAT feature comes to us from Karrie Lindeman, EdD, BCBA-D, LBA and David Celiberti, PhD, BCBA-D. 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!

Save 20% on ABA Tools of The Trade and our Tools of the Trade kit now through June 17th!

Data collection is the core of the success of our science. Without data, are we are not providing behavior analytic service to our clients; however, data collection can be a scary new journey for many. What do I collect? How do I collect it? What do I put it on? How do I manage the other children in the class? What do I do with the data once I have it? How do the data guide my decision-making? All of these questions pose roadblocks to the individuals attempting the collection.

To date, many training manuals and books have attempted to provide insight and guidance for struggling data-collection newbies. Some of these books have fallen short of delivering a clear and concise message to its readers. ABA Tools of the Trade provides a unique take at explaining the what, why, and most importantly, the “how-to” of data collection.

The authors start off describing the purpose of the book, addressing concerns that teachers and technicians face in the field every day: Why am I doing this? And how can I create easy to navigate data sheets with simple graphs for analyzing after I have collected the data? ABA Tools of the Trade breaks down their material into five sections which simplify the anatomy of a data sheet, review different types of data collection systems available, discuss how to utilize them with simple behavior change procedures, and offer activities to ensure supervisees are competent (huge bonus!). Throughout the sections, the material is organized in a way to help you identify exactly what you need to do, with helpful vignettes providing real-world examples.

The breakdown of the five sections allows the reader to easily find the information they are looking for, along with supporting documents. The first section delves into the Anatomy of Data Collection, describes not only why we collect data, but how to do so in the most simplistic way. This section is great for someone new to data collection or looking to expand their practice. A bonus includes describing different tools that may be helpful in your data collection journey with informative descriptions and visuals. Examples include tally counters, interval timers, and time timers, to name a few. A useful hints page highlights how the specific tools can be matched to the different measures of behavior that need to be tracked.

The second section is the Data Collection Systems sectionwhich describes more complex systems and strategies that work in different settings. It starts off with a comprehensive list of 10 rules of data collection. These rules are extremely important as they lay the groundwork for ethical data collection and reviews potential issues that may arise as you begin to collect data. These include examples of consent issues, confidentiality mishaps, and an important reminder to adhere to state and local laws. Finally, a handy task analysis of data collection steps provides a simple way for readers to grasp the needed components for specific targeted behaviors and wraps up the section.

The third and fourth sections include Behaviors and Simple Behavior Change Systems, which describes the Functional Behavior Assessment and Behavior Intervention Plan process in user-friendly terms. This is a great introduction for those starting out and looking to brush up on appropriate procedures. This section reviews what qualifies as efficient data collection in an FBA and how to analyze results. An added bonus is the discussion on antecedent strategies, which provides the reader with tactics and corresponding examples. Following the breakdown, vignettes of very specific behavioral episodes are provided, which allow the reader to apply the knowledge derived from the reading in everyday situations. Each vignette is followed by a general solution and helpful hints on dealing with the presented issue. For those interested in learning more about the topic, references and recommended readings are provided after all examples. Great source!

The fifth and final section, Supervision Practices, is a bonus for those supervising candidates for board certification in behavior analysis. It is comprehensive, well organized, and synched with the 5th Edition of Task List providing not only lessons but scenarios for practice with corresponding rubrics. Please note, as the Task List is updated, the alphanumeric codes may change. Three phases are addressed:

  • The Pre-Data Collection Phase addresses information gathering from parents and professionals surrounding prior attempts to address behavior (what was implemented and for how long) including defining behavior and determine how best to measure it.
  • The Data Collection Phase involves implementing the data collection system and making timely modifications, as well as proper training of the data collectors and determining an adequate schedule. Interobserver agreement is also addressed.
  • The Post-Data Collection Phase involves reviewing the collected data, preparing for graphic representation, and using data-based decision making.

Given that many newly credentialed BCBAs are assuming a supervisory role for the first time, this section is very helpful. Learning objectives and activities for each lesson are clearly articulated and rubrics are provided to support application and assess the skill level of the supervisee.

This short, well-organized, and easily-accessible resource belongs on the shelves of those first working towards BCBA certification, BCBAs who are starting out, and current BCBAs providing Registered Behavior Technician and BCBA supervision. The content spans all data collection needs, from the very basics on how to ensure those we supervise understand and demonstrate necessary skills from the Task List. It would also be a practical, yet easy supplemental read for students progressing through their coursework in college programs. To maintain quality service, it is imperative to ensure the next generation of BCBAs have the skills necessary to provide and supervise quality service provision. The inclusion of sections related to modifying one’s behavior as well as supervisory considerations only strengthen the utility of this already informative guide. This book is a great resource, and recommended without reservation!


About The Authors

Karrie Lindeman completed her undergraduate degree at C.W. Post University with a major in psychology. She went on to Queens College to complete her Masters in Psychology and advanced certificate in Behavior Analysis. From here, she worked in a school for children with autism for 10 years before moving on to consult in the public school and early intervention setting. Karrie completed her doctorate in learning and teaching at Hofstra University in 2015. She continues to provide direct service, parent training, and consultation in a variety of settings. Karrie is currently the Program Director of the Behavior Analysis program at Touro College in New York City.

David Celiberti, PhD, BCBA-D, is the Executive Director of ASAT and Past-President, a role he served from 2006 to 2012. He is the Co-Editor of ASAT’s monthly publication, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993 and his certification in behavior analysis in 2000. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis (ABA), and early childhood education. He works in private practice and provides consultation to public and private schools and agencies in underserved areas. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. In prior positions, Dr. Celiberti taught courses related to ABA at both undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.

ABA Journal Club: A Response From Elizabeth A. Drago, M.A., BCBA, LBA

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

  • The researchers trained caregivers on a university campus using the BST model prior to home visits. In your current work, would this be a possibility for you? If not, how could you provide this type of training to caregivers? What obstacles can you predict, and how might you address them?

The majority of my clinical practice is primarily situated in home-based settings.  Delivering behavior analytic services in home-based settings presents with a multitude of circumstances contributing to variable rates of success in teaching new skills for both the client and caregivers.  Two variables contributing to such challenges in service delivery is caregiver accessibility and limited service hours allotted, particularly if the services are funded through insurance-based sources.  Formal Behavior Skills Training (BST) often requires time intensive performance and competency- based components, creating a challenge to implement in the home setting at times. With careful planning and caregiver commitment to participation, BST training in the home setting is quite “do-able”.

To address time constraints, a ‘train the trainer’ model or pyramidal training (Pence, St. Peter, & Tetreault, 2012), may be a beneficial strategy to assist in training multiple caregivers as well as contribute to increased proficiency in treatment fidelity.  A pyramidal training model involves a senior trainer (e.g., a behavior analyst) training a small group of staff or caregivers who in turn train other staff or caregivers.  This type of training model may be particularly beneficial to clinicians working in settings where time constraints may be a factor (such as residential services).  

  • Discuss the multiple baseline design used in the study. How does it demonstrate experimental control? What can you determine from a visual analysis of the data?

The researchers in this study utilized a concurrent multiple-baseline-across-modules design to analyze the effects of the BST module training delivered to parents to teach their children mands. Concurrent multiple-baseline-across modules design allows for simultaneous measurement to occur for all clients. Research suggests concurrent measurement controls better for threats to internal validity and result in somewhat stronger inferences than do nonconcurrent designs (Watson and Workman, 1981). Multiple baseline designs are appropriate when target behaviors are not reversible. Use of a concurrent multiple-baseline design to evaluate treatment effectiveness minimizes the ethical concerns related to a withdrawal design. Training skills sequentially using a multiple-baseline-across-modules design is beneficial since it allows trainers to teach skills gradually and gave trainees repeated rehearsal opportunities on previously trained skills. The trainer could also monitor ongoing caregiver performance and make decisions to advance caregivers through the training based on the consistency and accuracy of their performance on trained skills.  Researchers of the study required caregivers to reach specific mastery criterion rates to advance to additional modules in the BST to assess the maintenance of the caregiver’s accuracy of procedural integrity and the child’s mands.

Upon visual analysis of the data, results of the study support effects of a BST model for training caregivers to implement mand training procedures.  In addition, after training, caregivers did not exhibit difficulties generalizing the skills to implement mand training procedures to the child.  Additional training was provided to caregivers during sessions with the child when mastery criterion was not achieved.  The researchers found by staggering the training across modules, caregivers learned to capture and contrive motivating operations contributing to the emergence of spontaneous mands.

  • Part of this study included a measure of whether a competently trained parent could teach their spouse how to implement mand training. Why is this important? Have you implemented similar strategies in your own work?

Training caregivers to effectively generalize behavior analytic treatment strategies and interventions to the child outside of training sessions is one of the goals of family support behavior analytic services.   Strategies to fade out the necessity of behavior analytic services is developed in the client’s treatment plan at the initiation of services.   Delivering BST to a caregiver who demonstrates proficiency of the designated steps is invaluable in the treatment process.  Through BST,  trained caregivers who have demonstrated mastery of a skill, have the ability to train additional caregivers (e.g., grandparents and siblings) in the client’s environment, facilitating generalization of treatment effects. 

In addition, research has supported the finding that providing caregivers with training and education to increase their family member’s functional skills (such as communication) may reduce caregiver stress by increasing the caregiver’s confidence levels (Bebko et al. 1987).  Researchers have also found that parents who reported high levels of confidence in managing their child’s major difficulties and perceived others in the family as similarly successful also reported lower stress rates (Sharpley and Bitsika 1997).

In my practice, I utilize BST to teach caregivers skills related to communication and socialization training and areas of daily living such as toileting, dressing, toothbrushing and community safety.  I recently utilized BST to teach a modified PECS (Picture Exchange Communication System) to a client’s caregivers. After reaching fluency criteria for each step of the target skill, the trained caregiver was capable of effectively training the modified PECS procedure to the second caregiver.  Success rates for each steps of the BST procedure were measured by observation, data collection and data analysis of procedural integrity demonstrated by the second parent during sessions with the client.  Success rates were also measured by data analysis  of the client’s rate of progress in reaching various communication targets via use of the modified PECS taught by caregivers. 

  • This study did include maintenance data. Why is this data valuable? Do you collect maintenance data on the caregiver training you provide?

According to Alberto & Troutman, 2013, ‘maintenance’ is defined as “performing a response over time, even after systematic applied behavior procedures have been withdrawn”.  Maintenance is demonstrated over time when the skill continues to occur after all direct teaching of the particular skill has been discontinued. 

 Maintenance data could also be utilized to assist in shaping additional skills.  For example, prior to teaching a client receptive discrimination skills related to picture identification in a field of 3 stimuli, it is important to evaluate the presence or absence of certain prerequisite skills such as attending, gesturing (i.e., pointing or eye gaze), following direction and ability to identify objects depicted in the array.  Without information gathered from maintenance skill probes (i.e., attending, pointing, tact repertoire, etc.), teaching the skill of receptive discrimination may not be possible if the client has not exhibited mastery of specific prerequisite skills first.

During skill acquisition training, I typically teach a targeted behavior until the recipient exhibits fluency in exhibiting that behavior.  The computer- generated data system I utilize in my practice includes pre-set monitoring schedules of maintenance data based upon a timed schedule.  Maintenance probes are automatically scheduled in a staggered fashion.  For example, if the client exhibits proficiency in engaging in a specific skill during baseline, that skill is automatically scheduled for a maintenance probe on a monthly basis.  If a client reaches fluency of a specific skill after commencement of treatment, the target is scheduled for maintenance in a staggered time frame (i.e., weekly, bi-weekly, monthly, bi-monthly and annually). After the client reaches mastery criterion for annual maintenance, the target is considered ‘closed’.  If at any time the target fails maintenance, the target is added back into treatment.  

If a clinician is teaching skills to fluency, the necessity of relying on maintenance data to determine if the skill remains in that client’s behavior repertoire becomes less relevant. 

  • Consider a particular skill you are teaching one or more clients. What would BST look like to teach caregivers how to implement the necessary procedures for teaching that skill?

A particular skill BST could be utilized to teach is use of utensils during mealtime.

Instruction – For this step, if a client exhibits adequate receptive skills related to vocal/verbal instruction, one may say to the client, “When you eat certain foods, such as spaghetti or vegetables, you use a fork to pick the food up. You wouldn’t use a fork to eat foods such as cereal or pudding.”

If the client does not exhibit adequate receptive language skills, one may describe the skill to the caregiver.  For example: “We teach the skill of eating with utensils to assist with independent functioning.  We will practice this skill first, with a fork and upon reach specific mastery criteria, we will proceed in teaching use of additional utensils, such as a spoon.  It’s best to practice this skill when motivation to eat is high in order to increase rate of reinforcement and eventually, acquisition of mastery criteria (i.e., if the client is hungry, his motivation to follow the rule to use a fork to eat may be higher compared to times when he is not hungry). Reinforcement for use of the fork is naturally built in, as the food he eats with the fork will serve as reinforcement for the targeted behavior.”

Along with vocal/verbal instruction of the BST steps, I may also provide the caregiver with written steps to the procedure to assist with fluency.

Modeling – For this step, during mealtime, I model the steps described above to the caregiver.  I provide a description of each step as the step is being performed to the caregiver.

Rehearsal –For this step, encourage the caregiver to implement the steps to practice the skill.  During these practice sessions, data recording is critical to determine fluency of the practice of the targeted skill.

Feedback – Prior to this step, I discuss with the caregiver the form of feedback they prefer to receive (in-situ feedback or feedback after each trial session has ended).   Throughout my career I have learned the importance of tailoring my delivery of feedback to individual preference (some caregivers prefer feedback while they are performing the step, while others prefer to receive feedback after they have completed the step).  Once I have determined the timing of my feedback, I deliver the feedback in the context agreed upon.

  • The article states, “General instructions were provided prior to baseline, but parents were only able to implement the procedures effectively when full instructions, modeling, rehearsal and feedback were used to train to mastery.” How can you change your current practice to ensure that you are providing the necessary steps to help caregivers master skills they have selected for parent training?

To streamline the often time-intensive process BST requires, I typically stagger the trainings across multiple sessions.  Delivery of insurance-based family training services is generally provided in a time intensive and structured fashion. To meet these stringent guidelines and to ensure I deliver the most effective and efficient services, I provide the caregiver with written and verbal steps to BST across several consecutive sessions.  I review each step with the caregiver and assign weekly assignments to practice specific steps.  During each family training visit, I review and model the steps and request the caregiver to perform the step they worked on the week prior.  After the caregivers reach specific fluency rates in responding accurately,  additional steps are introduced.  

One method of training I may consider including in my caregiver trainings when delivering BST, is use of video modeling.  Video modeling is a teaching procedure that involves an individual viewing a videotaped sample of a model performing a specific, scripted activity or task. Immediately following having viewed the video-based model, the individual is directed to perform the activity or script he or she observed in the video (e.g., MacDonald, Clark, Garrigan, & Vangala, 2005). Use of video modeling may further address time constraints to training that is often a barrier in delivery of home-based services.  Video modeling may also assist in in higher rates of procedural integrity when working with caregivers who learn more effectively through use of visual guides as opposed to textual guides only.

BST is an incredibly invaluable method of teaching new skills.  With careful planning and commitment to learning, caregivers have a unique opportunity to actively participate in their family member’s treatment to help them engage in socially meaningful ways.

References

Alberto, P., & Troutman, A. C. (2013). Applied behavior analysis for teachers. Boston: Pearson.

Bebko JM, Konstantareas MM, Springer J. Parent and professional evaluations of family stress associated with characteristics of autism. Journal of Autism and Developmental Disorders. 1987; 17:565–576.

MacDonald, R., Clark, M., Garrigan, E., &Vangala, M. (2005) Using video modeling to teach pretend play to children with autism. Behavioral Interventions, 20, 225-238. 

Parsons M. B., Rollyson J. H., Reid D. H. Evidence-based staff training: A guide for practitioners. Behavior Analysis in Practice. 2012; 5:2–11. 

Parsons, M. B., Rollyson, J. H., & Reid, D. H. (2013). Teaching Practitioners to Conduct Behavioral Skills Training: A Pyramidal Approach for Training Multiple Human Service Staff. Behavior analysis in practice6(2), 4–16. doi:10.1007/BF03391798.

Pence S. T., St. Peter C. C., Tetreault A. S. Increasing accurate preference assessment implementation through pyramidal training. Journal of Applied Behavior Analysis. 2012;45:345–359.

Sharpley, C. F., & Bitsika, V. (1997). Influence of gender, parental health, and perceived expertise of assistance upon stress, anxiety, and depression among parents of children with autism. Journal of Intellectual and Developmental Disability, 22, 19–29.

Watson, Paul & A. Workman, Edward. (1981). The non-concurrent multiple baseline across-individuals design: An extension of the traditional multiple baseline design. Journal of behavior therapy and experimental psychiatry. 12. 257-9.


Elizabeth A. Drago, M.A., BCBA, LBA, is a Board Certified and Licensed Behavior Analyst and a consultant at Proud Moments Therapy located on Long Island, New York and Comprehensive Behavior Supports, located in Brooklyn, NY.  She has over 15 years’ experience working with individuals with developmental and related disabilities and has advanced training in areas of autism, behavior disorders, sleep disorders, intellectual disabilities and positive behavior supports.  As a consultant in home and educational settings, she clinically oversees client cases, provides parent training, implements comprehensive skill assessments and programming goals for children diagnosed with ASD, conducts staff trainings for effective performance improvement practices and behavior analytic practices and procedures. She holds professional memberships in organizations such as New York State Association for Applied Behavior Analysis, Association for Behavior Analysis International, Association of Professional Behavior Analysis.

Elizabeth is a Board member of the New York State Association for Behavior Analysis (NYSABA), serving the role of Representative at Large. She is also an active member of NYSABA’s Legislative Committee, focusing on efforts to remove the licensure scope of practice restriction in Behavior Analysis in New York State. Elizabeth has contributed significantly to disseminating information related to the scope restriction in Behavior Analysis in NYS. Some of Elizabeth’s achievements in these efforts include developing initiatives such as the video series entitled, ‘This is ABA’.  The purpose of the video series is to highlight the effectiveness and applicability of the practice of Behavior Analysis to individuals of varying diagnoses, not only for those diagnosed with an Autism Spectrum Disorder. This video series is currently featured on the NYSABA website.   Elizabeth also works collaboratively with NYSABA’s Executive Director, Mari Wantanbe-Rose in the development and oversight of NYSABA’s Inaugural ABA Ambassador Award. The NYSABA ABA Ambassador Award recognizes future behavior analysts, or students, who help to disseminate the usefulness and versatility of behavior analysis in various settings.

Elizabeth has presented at NYSABA’s annual professional conference on the topics of Systematic Desensitization (2017) and Self-Care for the Behavior Analyst (2018). She has been invited as a speaker at a roundtable meeting at Proud Moments ABA, presenting on the topic of the use of technical jargon when interacting with caregivers. Elizabeth has also been featured in a newsletter (August 2018 edition) generated by Comprehensive Behavior Supports in recognition of the many significant contributions to the agency and families she serves across Long Island as a Licensed and Board Certified Behavior Analyst.  Elizabeth has been a guest speaker on a Behavior Analytic podcase, ‘Behaviorbabe’, hosted by Dr. Amanda Kelly, discussing the NYS licensure law scope restriction on the practice of Behavior Analysis in NYS. Elizabeth received a Bachelor’s Degree in Clinical Psychology from St. John’s University, graduating Summa Cum Laude. She continued her education, earning her Master’s Degree in Clinical Psychology at Teacher’s College, Columbia University, where she received an honors certificate in education and teaching and was a member of Kappa Delta Phi- Honor Society in Education.   Elizabeth attended post-graduate studies at Penn State University, where she completed coursework in Applied Behavior Analysis.  She earned her BCBA certification and licensure in Behavior Analysis in 2014.

Your Child’s Autism Diagnosis Long Term

In the years immediately after a parent learns of a diagnosis of autism, it can be especially challenging to think of your child’s autism diagnosis long term. But as parents advocate for their child, and as practitioners work with the family to create goals for that child, the long term must be considered. Here are a few suggestions to help with considering the long term, while focusing on short-term goals:

  • Create a vision statement. One of my favorite books is From Emotions to Advocacy: The Special Education Survival Guide by Pam Wright and Pete Wright. This book covers everything parents need to know about advocating for a child with special needs. One of the first things they suggest is creating a vision statement. They describe this as “a visual picture that describes your child in the future.” While this exercise may be challenging, it can help hone in on what is important to you, your family, and your child with special needs in the long term.
  • Look at your child’s behaviors, then try to imagine what it might look like if your child is still engaging in that behavior in five or ten years. Often, behaviors that are not problematic at three are highly problematic at 8 or 13 years old. Such behaviors might include hugging people unexpectedly or (for boys) dropping their pants all the way to the ground when urinating (which could result in bullying at older ages). While it is easy to prioritize other behaviors ahead of these, it’s important to remember that the longer a child has engaged in a behavior, the more difficult it may be to change.
  • Talk to practitioners who work with older students. Many practitioners only work with a certain age group of children. While they may be an expert for the age group they work with, it may be helpful to speak with a practitioner who works with older kids and ask what skill deficits they often see, what recommendations they may make, and what skills are essential for independence at older ages.
  • Talk with other parents. Speaking with other parents of children with special needs can be hugely beneficial. Over the years, I’ve worked with hundreds of parents who are spending countless hours focusing on providing the best possible outcomes for their children. And while it’s impossible to prepare for everything that will come in your child’s life, it may be helpful to find out what has blindsided other parents as their children with special needs have grown up.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges