By Sam Blanco PhD, BCBA, LBA, Mordechai Meisels MS, BCBA, LBA, Bryan J. Blair, PhD, LABA, BCBA-D, and Laura Leonard MS, BCBA, LBA

As providers of services to people with an autism spectrum disorder (ASD), we are experiencing an unprecedented situation given the impact of COVID-19 on nearly all service providers. As schools, organizations, and individual practitioners work to shift their practice to a virtual service delivery model, it is essential that we maintain a commitment to evidence-based practice. When faced with so much uncertainty, it can be a relief to turn to the research base and identify how to implement best practices within this new model. Research on telehealth provided to individuals with autism has grown in recent years and demonstrated that effective treatment is possible (Ferguson, Craig, & Dounavi, 2019; Peterson, Piazza, Luczynski, & Fisher, 2017; Vismara, McCormick, Young, Nadhan, & Monlux, 2013; Ferguson et al, 2019).

The first priority when implementing services via telehealth is to ensure you are using a HIPAA-compliant platform, such as Doxy.me or WhatsApp. When we approach evidence-based practice, we must focus on three primary areas of research: the basic principles of ABA and its practical applications, applications of telehealth, and other uses of technology in teaching. The good news is that there is a lot of research-based information available to guide us as we change to a telehealth model.

Current research on telehealth for individuals with ASD primarily focuses on parent training and supervision. However, in the current crisis, it is necessary that direct care be provided through telehealth. In order to effectively provide direct care, we are suggesting the following steps in order to appropriately implement telehealth services. 

(1) Assess prerequisite skills and unique needs of the client. An assessment and survey is provided at the end of this article (Appendix A). The BCBA should complete this assessment with parents/caregivers in the room with the client. If the results of the assessment demonstrate that the client does not have the prerequisite skills to participate effectively in interventions delivered remotely (i.e., telehealth), then the prerequisite skills will need to be taught and/or a parent/caregiver will be required to be in the room with the client during direct care. It is also possible that with drastic changes in routines and supports, problem behaviors may have increased or topographies of problem behaviors may have changed. If this is the case, the BCBA should also conduct a functional behavior assessment (FBA). An FBA can effectively be conducted through telehealth (Wacker, et al, 2013). 

There are many options for how a telehealth session can be conducted and how a display (e.g., computer screen) can be presented to the client. In assessing prerequisite skills of the client, it may also be beneficial to conduct a preference assessment of the general set up for the client. For example, does the client respond better when the screen only shows the practitioner’s face, or does the client respond better when the screen shows the practitioner’s face and a token system, etc. There are many options for how the screen is presented to the client. 

(2) Conduct parent training to adequately prepare for telehealth. Prior to any direct care provided by a behavior technician, the BCBA should conduct parent training. There are three goals that should be targeted and met here. First, the BCBA and parent should work together to teach prerequisite skills to the client. If prerequisite skills cannot be taught quickly, then a clear plan should be developed and implemented for how the parent/caregiver will assist with prompting and providing reinforcement during sessions with the BT. The next goal is to identify any potential safety issues and provide guidance on implementation of any interventions. Finally, the parents should be taught what to expect from telehealth and provided with a clear plan for giving feedback to the BCBA throughout the process. 

(3) Identify reinforcers and how reinforcement will be provided. A preference assessment should be conducted with the client utilizing any new options presented through the use of technology as well as identifying any barriers resulting from the use of telehealth. For example, a potential new option might be sharing your screen to show clips of a client’s favorite show on YouTube. A potential barrier might be that a highly reinforcing activity might include social mediation and/or interaction with another person that is not possible unless you’re physically in the room or that the client is unwilling to relinquish a reinforcer when the BT is not physically present in the room.

Speak with the parents (and the client if he/she is capable of participating in the conversation) about specific reinforcers to include in the preference assessment. After the preference assessment is conducted, you should create a clear plan for how reinforcement will be provided. 

One potential option here is the use of a token system. The research-base on using token systems with telehealth is primarily focused on teaching parents how to utilize the token system correctly (Hall, 2018; Machalicek, Lequia, Pinkelman, Knowles, Raulston, Davis, & Alresheed, 2016).  If a token system is currently in place, it may be beneficial to continue with the existing system as long as the necessary materials are in the room with the client and either the client can provide his/her own tokens upon being told to do so by the BT or a person in the room can provide the tokens. Another option is to use existing technology to provide tokens. If you elect to use technology, you can remotely split the computer screen to show a token system on one side of the screen, use built-in capabilities of platforms such as Microsoft Teams to switch control of the screen to the client so he/she can give the token upon correct responding, or use built-in capabilities of platforms to share the screen of an existing token system app. If a token system is being used and earning the requisite number of tokens results in an activity within the client’s room (i.e., access to a preferred toy) you must assess the client’s ability to relinquish the reinforcer. A final possibility here is to incorporate access to preferred videos or songs through the shared screen.

If a token system is not being utilized, a clear plan and schedule of reinforcement should be defined. The plan could include delivery of reinforcement in the form of videos, online games, or apps through the telehealth platform by the BT. If reinforcement includes items that are present in the room with the client (such as edibles or favored toys) then an additional person (such as a parent or older sibling) will be required to be present in the room with the client during sessions. 

If the client responds to vocal praise as a reinforcer during in-person sessions, then it should be determined if vocal praise through the screen is also reinforcing for the client. If it is not, a response-stimulus pairing procedure (Dozier, Iwata, Thomason-Sassi, Worsdell, & Wilson, 2012) should be utilized. 

Sessions with the BT should not begin until the previous steps have been completed and the BT has been trained on both the platform for delivering services and the steps for implementing programs and delivering reinforcement.

(4) Train the BT on how to implement discrete trial instruction through telehealth. Discrete trials training can be implemented as it typically is, though technology can be utilized to streamline the process when images, text, or videos are used. Cummings & Saunders (2019) utilized PowerPoint 2016 to create matching-to-sample trials for use in discrete trial instruction. Blair & Shawler (2019) identified best practices and provided a tutorial for developing and implementing emergent responding through computer-based learning tools. In addition, there are apps such as Kahoot or Quizlet Learn that can be utilized. 

It is essential that any technology components that you introduce are clearly understood by the BCBAs and the BTs. Our recommendation is that brief video models be provided (i.e.,video-supported task analyses)  so that the steps of implementation are clear to all practitioners implementing services. After video models have been viewed, the BT should practice implementing the technology with the parent or the BCBA prior to conducting a direct care session.

If it has been determined that the client does not yet have the prerequisite skills for the BT to implement services through telehealth, the parents should be trained on implementing discrete trials. Hay-Hansson & Eldevik (2013) outlined a procedure for using videoconferencing to train discrete-trial instruction teaching. 

(5) Consider how visual schedules and supports may be used. Visual schedules and supports can be presented on the screen, utilized through a separate app (such as Todo Visual Schedule or Choiceworks), or made with pre-existing materials that are in the home. If you elect to use a separate app for the visual schedule, ensure that the BT has mastered the platform for providing instruction before implementing additional technologies. 

(6) Consider how to implement Active Student Responding (ASR). Drevno, Kimball, Possi, Heward, Gardner, & Barbetta (1994) identify a clear procedure for implementing error corrections during ASRs. With the use of technology as described previously (such as Microsoft PowerPoint) error corrections can be made quickly because they can be built directly into the presentation. 

Ultimately, as you review the suggestions, two things become very clear. First, we must consider the training needs of the client to effectively participate in treatment through telehealth. Second, we must consider the training needs of the practitioners who will be implementing treatment to ensure they can effectively put these practices in place. More than ever, we must assist each other in providing resources: sharing video tutorials for how to implement specific technologies, identifying technologies that will allow us to better implement services, and identifying platforms that reduce response effort and training needs for BCBAs and BTs. 

Download Appendix A: Telehealth Clinical Effectiveness Survey here.

Mordechai Meisels is the Founder and Chief Clinical Officer of Encore Support Services, a leading provider in special education and ABA therapy services.  Under his leadership, Encore quickly expanded across state lines, servicing thousands of children in the Tri-State area. Mordechai’s vast expertise in the behavioral health industry inspired him to fill a critical void with the founding of Hadran Academy, a high school for high functioning autistic youth. In true visionary form, Mordechai combined his background as an expert clinician and passion for technology with the creation of Chorus Software Solutions. As the Founder and CEO of Chorus, Mordechai is committed to creating innovative technology to empower care teams, increase operational efficiency, and ultimately impacting quality of care.  

Dr. Bryan J. Blair is a licensed behavior analyst (MA), Board Certified Behavior Analyst, and is currently an Assistant Professor at Long Island University – Brooklyn where he is also the coordinator of the Applied Behavior Analysis graduate certificate and supervised fieldwork programs.  He has worked with children and adults with developmental disabilities and other clinical disorders for over 15 years in a variety of settings.  For more information or to contact Dr. Blair please see his website:  https://www.bryanjblair.com.

Laura Leonard MS BCBA LBA is the owner and clinical director of ABA TREE, a behavioral health agency in NYC, former ABA director of an early intervention program and current Director of Behavioral Services at a private school in Brooklyn. Laura provides supervision to BACB candidates and is primarily focused on reduction of maladaptive behaviors. www.abatree.org

Sam Blanco, PhD, LBA, BCBA is an ABA provider for students ages 3-15 in NYC. Working in education for sixteen 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 she is the Senior Clinical Strategist at Chorus Software Solutions

It’s difficult to know what advice to give when schools are shutting down and parents are faced with an unknown period of time without services. Here are a few ideas for how to approach each day with your child with autism. Our goal is not only to ease this transition (for your child and your entire family) but also to prepare for the upcoming transition when school resumes. 

One note before we jump into suggestions: you should view these suggestions as just that – possible tips to help improve your day. Some of them may not be a great fit for your child or your family; others may spur additional ideas. These should not be viewed as additional requirements or be something that increases your stress.

• First and foremost, try to maintain the small routines as much as possible. For example, have your child still get up and get dressed, instead of making it a pajama day every day. 

• Provide structure. A simple thing you can do for both yourself and your child is to create a schedule for each day. Included in this schedule can be basic routines (get up and eat breakfast,) and new ones (complete work in workbook, do a puzzle,) as well as fun things (choose a movie to watch, dance to music) A visual or written schedule will help everyone with structure during the day.  Don’t forget to add in hand washing regularly as this is the best prevention for spreading the virus.  

• Indicate changes on the calendar or schedule.  Most children with autism prefer structure and routine, so setting this up day one will be helpful.  Oftentimes, explaining to your child, in whatever way they best process information, that you will be home for many weeks may help them no longer wonder. Putting “home” on each day of a kitchen calendar, at least through your school district closing date may allow your child to visually see that school taking place for a period of time.

• Get fresh air.  Whether you take a walk around the block or sit outside and count cars that drive by, being in social isolation does not mean being homebound.  Getting some fresh air, while remaining only with family members can be helpful to everyone.  Depending on your child’s interests, kicking a ball around, using your home swing set, taking a walk or biking can really enhance the day.

• Give yourself breaks. Whatever schedule you make should include some breaks for yourself as well. This might be allowing your child to watch a youtube for 15 minutes in the middle of the day so you can take a little breather. Scheduling it can be helpful for giving your child structure, but also letting yourself know when you get that break! 

• Ask your service providers and teachers for any tips. They may have suggestions for how and when to use reinforcers during this time, or ways you can incorporate maintenance of skills throughout the day. These staff may be able to share websites that your child enjoys and uses in school such as Go Noodle, Epic, or other educational sites.

• Use familiar materials. If possible, access materials used in school that are familiar to your child that may help them stay engaged during times you have other tasks to complete. These might include file folders, task boxes or others. Many items can be printed from websites, such as Teachers Pay Teachers.

• Use technology to increase social time for both yourself and your kids. Set up virtual “playdates” with cousins, friends, etc. You might also consider taking a look at this list from Common Sense Media for multiplayer apps. These include games that can be played by people in the same room or in different locations. 

• Get your child involved. The first step to this is giving your child choices throughout the day. You can also provide some new options. Perhaps there are things you’ve been wanting to do, such as teach your child how to make a couple of basic meals, and you can add these in now. You can also ask your child if they have ideas for things they might want to do during this time. 

• Talk about COVID-19:  You know your child best and if it is appropriate to talk about what coronavirus is or not. If this seems appropriate, the CDC posted some useful information on how to talk to your child about this.  In addition, they created a child friendly video that may help your child understand the virus.

• Make hand washing fun:  Since you will likely do this more often with your child, try to make it fun!  Sing their favorite song while rubbing hands, use soaps that foam or have desired scents, and if appropriate, even play with soap in the kitchen sink, making bubbles or washing preferred toys.  Playing with bubbles will increase handwashing post the activity too!

Finally, the Autism Research Institute is hosting some webinars for parents in how to deal with issues related to changes in schedules and routines due to Coronavirus. You can view their schedule here: https://www.autism.org/webinars-autism/

Our society is facing an unprecedented time and everyone is feeling unsure of what will happen next.  It is important to rely on those who can support you, even if it is virtual.  It sounds cliché, but relying on others to support us in these unknown times can really make a difference.  

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Written By Sam Blanco, Phd, LBA, BCBA and Cheryl Davis, PhD, LABA, BCBA-D

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for sixteen 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 she is the Senior Clinical Strategist at Chorus Software Solutions

Cheryl has been in the field of Applied Behavior Analysis for over 25 years, working with clients with Autism Spectrum Disorders, developmental delays, and social emotional learners.  She consults to parents, public and private schools, as well as supervises BCBA/BCaBA candidates.  Cheryl believes in using progressive ABA techniques in her educational, behavioral and social programming for clients. She is an assistant professor in the ABA program at The Sage Colleges, owner of 7 Dimensions Consulting and co-owner of SupervisorABA.

Many parents choose to “ground” their kids when they make poor decisions. Maybe they lose access to video games for a week, or can’t watch TV for a month. Grounding in and of itself is not necessarily a bad thing. Here are a few considerations:

• If you keep grounding your kid for the same behavior, then grounding is not changing the behavior. Sometimes grounding your child is a default response, but if it’s not working, you might want to consider some other options. You can take a look back at our series on differential reinforcement or our post on noncontingent reinforcement.
• When possible, the consequence should be connected to the behavior. If your child throws a controller, then not having access to video games makes great sense. However, if video games are taken away for any infraction, it may not be the most logical punishment and over time, it may even backfire. If the child is losing video games for everything, then he/she might stop trying to earn video games at all.
• Longer durations of grounding may make you miss out on opportunities for reinforcing appropriate behaviors. Remember that reinforcement is simply any consequence that increases the future likelihood of the behavior. If you have set a rule that your child is grounded from using video games for one year, then you are missing many, many opportunities to teach the appropriate behavior. The same can be said for one month or even for one week. Especially when considering children with autism, they may require multiple trials of the appropriate behavior before you see an increase in the appropriate behavior. In that case, grounding may just not be the best option.
• Longer durations of grounding may backfire if you experience fatigue. Often our kids are experts at asking the same question repeatedly until you finally give in. The last thing you want to do is set a standard that when you say your child is grounded for a week, they are really only grounded until they wear you down.
• Consider a different tactic. This isn’t possible for all behaviors, but if you are seeking a specific appropriate behavior, set a standard that if a certain duration or a certain number of appropriate behaviors results in more access to preferred items and activities. This is sort of the inversion of grounding and may be more successful.

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.

Over the years, I’ve seen several behavior intervention plans written and implemented. Typically, these plans include reinforcement for the desirable behavior, but I see the same mistakes crop up again and again. Here are a few common mistakes in implementing reinforcement to look out for:

Fail to identify individual reinforcers. Hands down, the most common error I see is identifying specific activities or items as reinforcing. For instance, many people love gummy bears, but they make me want to puke. Presenting me with a gummy bear would not increase my future likelihood of engaging in the appropriate behavior! You must account for individual differences and conduct a preference assessment of your learner, then make a plan based on his or her preferences.

Fade reinforcement too quickly. Let’s say you’re working with a child named Harold who draws on the walls with crayon. You implement a reinforcement plan in which he earns praise and attention from his parent each time he draws on paper. The first few days it’s implemented, Harold’s rate of drawing on the wall greatly decreases. Everyone claims that his behavior is “fixed” and suddenly the plan for reinforcement is removed… and Harold begins drawing on the wall once more. I see this sort of pattern frequently (and have even caught myself doing it from time to time). After all, it can be easy to forget to reinforce positive behavior. To address this issue, make a clear plan for fading reinforcement, and use tools such as the MotivAider to help remind you to provide reinforcement for appropriate behavior.

Inconsistent with reinforcement plan. Harriet is writing consistently in a notebook, to the detriment of her interactions with peers. Her teachers implement a DRO, deciding to provide reinforcement for behavior other than the writing. However, the teachers didn’t notify all the adults working with her of the new plan, so Harriet’s behavior persists in certain environments, such as at recess, allowing her to miss multiple opportunities for more appropriate social interaction. To address this issue, make a clear outline of the environments in which the behavior is occurring and what adults are working in those environments. Ensure that all of the adults on that list are fully aware of the plan and kept abreast of any changes.

Don’t reinforce quickly enough. This one can be quite challenging, depending on the behavior and the environment. Let’s saying you’re working with a boy named Huck who curses often. You and your team devise a plan to reinforce appropriate language. You decide to offer him tokens that add up to free time at the end of the school day. However, sometimes as you are handing him a token for appropriate language, he curses again right before the token lands in his hand. Though it was unintentional, the cursing was actually reinforced here. Remember that reinforcement should be delivered as close to the desired behavior as possible. To address this issue, consider your environment and materials and make a plan to increase the speed of delivery.

Fail to make a plan to transfer to natural reinforcers. Ultimately, you don’t want any of these behaviors to change based solely on contrived reinforcement. Making a plan for reinforcement of appropriate behavior is essential, but your ultimate goal is to have the behavior be maintained by naturally occurring reinforcement. To address this issue, the first thing you need to do is identify what that naturally occurring reinforcement might be. For Harold, it might be having his artwork put up in a special place or sharing it with a show and tell. For Harriet it might be the interactions she has with peers on the playground. Once you have identified those reinforcers, you can create a plan for ensuring that the learner contacts those reinforcers over time. This might include pairing the naturally occurring reinforcers with the contrived reinforcers, then fading out the latter.

Ultimately, it’s important to remember that reinforcement is not as simple as it seems. Taking the time to plan on the front end will help with long-term outcomes.

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.

Teaching can be incredibly overwhelming, especially in a special education classroom. Between paperwork, lesson planning, updating bulletin boards, and actually teaching, the day can get pretty hairy. Sometimes, that stress leads to a short temper, which can lead to a punitive classroom environment.

If things seem to be going in the wrong direction in your classroom, the first thing you should do is focus on reinforcement. Here are a few steps to consider:

1. Identify 1-3 behaviors you would like to see your students exhibiting. For instance, maybe you’d like to see an increase in hand-raising (as opposed to calling out.) Clearly define the behaviors you want to see.
2. Set up a contingency for increasing those behaviors. Maybe you’ll wear a MotivAider to give yourself a reminder throughout the day to provide verbal praise to students exhibiting the target behavior. Maybe you’ll have students earn points that they can exchange for other things, such as a homework pass or lunch with the teacher. Maybe you’ll encourage students to recognize each other when they engage in the target behavior.
3. Teach the students about the target behavior(s). Introduce the goals to the students. It’s helpful to create a sign or other visual to remind students about the new goals.

While these are simple steps, providing more verbal praise and other reinforcement can turn around a classroom with too much time spent on reprimands and punishments.

It’s also helpful to remember (especially for new teachers) that you can make changes at any time. One of my mentors in my first year of teaching told me to tell my class we had gotten off track, so we were having a brand new first day of school. (I was teaching fourth and fifth grade students with emotional behavioral disorders.) It was shocking how well that new first day of school went over. The students were excited about the idea of a “fresh start” in the middle of the school year, and it helped me get back on track with creating a more positive learning environment.

Ultimately, the goal is to teach students about appropriate behavior by spending more time showing them what they’re doing right than focusing on what they’re doing wrong.

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.

Holidays can be challenging for everyone in the family. Your to-do lists get longer, your routines are switched around, and all the little stresses can be especially difficult for your child with autism. Here are a few tips to ease the difficulties related to Halloween.

For Preschool & Elementary Children

• Practice – Invite your neighbors to have a “rehearsal” for Halloween so your learner can practice the steps. If this isn’t a possibility for you, it may be helpful to watch youtube videos of trick-or-treating.
• Prepare – Let your child know the trick-or-treating route in advance. In the days leading up to Halloween, make yourself aware of houses to avoid based on decorations that are gory, include excessive lighting, have strobes, or any other aspects that you know will make your learner uncomfortable.

For Teenagers

• Consider alternatives – You may want to join with other parents to throw a Halloween party that is autism-friendly based on the needs of your learner and the needs of other party guests. Another suggestion would be to celebrate with a themed activity, such as Halloween activities at local museums or art institutions.
• Give a task – Let your child have a job such as giving out the treats at the door, managing an activity for younger children, or helping with decorating your home.

For All Children

• Be flexible – Think about what is necessary for your learner, what your learner is interested in, and what success looks like in terms of Halloween. Maybe success means you visit three houses, or maybe success means your learner chose a costume. The idea is to keep it fun.
• Remember it’s okay to stay at home! – You can create your own Halloween tradition that fits your family’s needs. This could include a special movie night, creating Halloween-inspired foods together, or anything that is fun for the whole family.

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.

Several years ago, I was working with a 6-year-old boy we’ll call Terrence. Terrence was diagnosed with autism. He was a very playful child who was generally good-tempered, enjoyed playing with trains and watching TV, and posed few difficult behavior issues for his parents…until the day there was construction on their walk from the grocery store to their apartment and they decided to take a different route home. What happened next is what most people would call a full-blown meltdown: Terrence dropped to the ground, screaming and crying, and refused to move.

Many of the parents I work with have a similar story when it comes to their child with autism and an unexpected change in the routine. The change varies: the favorite flavor of fruit snacks is out of stock at the store or the babysitter greeted the child at the bus instead of the parent or they grew out of the coat they wore the past two winters… In fact, it can be difficult to anticipate exactly what specific routine may be a trigger for your learner. This is precisely why building variability into the routine can be helpful.

Here are a few things to consider:

First, think about the routines that are the most likely to be interrupted. Make a list of these so you can begin thinking about how to address those issues.
Second, work with your team (whether that means family or practitioners that work with your learner) to select 2-3 routines to focus on first.

Discuss how those routines would most likely be interrupted. For instance, a favorite TV show may be interrupted during election season or you may have a family function when the TV show is aired. In teaching your learner to be flexible with changes in routine, you will contrive changes that are likely to occur to give your learner quality practice.

Plan to vary the routine. Essentially, you are setting up the change in routine, but you will be prepared in advance to help your learner behave appropriately. (You’re much more likely to experience some success in this scenario than you would be if a change in routine occurs unexpectedly and/or last minute.)

Give your learner a vocabulary for what is happening. I teach many of my students the term “flexible.” I might say, “I appreciate how you’re being flexible right now” or “Sometimes when plans change we have to be flexible. This means…”

Reinforce appropriate behaviors related to flexibility! You want to be clear when they’ve made an appropriate, flexible response. In the planning phase, you can discuss what appropriate reinforcers might be for the routines you are targeting.

If you build in variations in routine and teach your learner some strategies for being flexible, you and your learner are much more likely to be successful in navigating unexpected changes.

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.

Teaching language skills is one of the most frequent needs for children with autism, but also one of the most misunderstood skillsets amongst both parents and practitioners. The desire to hear your learner speak in full sentences can be overwhelming, making it especially difficult to take a step back and consider what it means to communicate and how communication skills develop in neurotypical children. Many times we get hung up on what a child should be capable of communicating at a certain age, rather than focusing on what they are capable of communicating at this stage of development.

Many practitioners and curricula utilize Brown’s Stages of Language Development.* Brown described the first five stages of language development in terms of the child’s “mean length of utterance” (or MLU) as well as the structure of their utterances.

From aacinstitute.org

Sometimes it is necessary to compare a child to his or her same-age peers in order to receive services or measure progress, but it can be detrimental to focus on what a child should be doing at a specific age instead of supporting them and reinforcing them for progress within their current stage.

Research has suggested that teaching beyond the child’s current stage results in errors, lack of comprehension, and difficulty with retention. Here are some common errors you may have witnessed:

• The child learns the phrase “I want _____ please.” This phrase is fine for “I want juice, please” or “I want Brobee, please,” but it loses meaning when overgeneralized to “I want jump, please” or “I want play, please.” It’s better to allow your learner to acquire hundreds of 1-2 word mands (or requests) before expecting them to speak in simple noun+verb mands.
• The child learns to imitate only when the word “say” is used. Then the child makes statements such as “say how are you today,” as a greeting or “say I’m sorry,” when they bump into someone accidentally. Here, the child clearly has some understanding of when the phrases should be used without understanding the meanings of the individual words within each phrase.
• The child learns easily overgeneralized words such as “more.” This is useful at times, but the child can start using it for everything. Instead of saying “cookie” he’ll say “more.” Instead of saying “train,” he’ll say “more.” And he may say “more” when the desired item is not present, leaving the caregiver frustrated as he/she tries to guess what the child is requesting. Moreover, as language begins to develop, he may misuse it by saying things such as “more up, please.”
• The child learns to say “Hello, how are you today?” upon seeing a person entering a room. A child comes into the classroom and the learner looks up, says “Hello, how are you today?” The child responds, “Great! Look at the cool sticker I got!” Your learner then doesn’t respond at all, or may say “fine,” as he has practiced conversations of greeting.

These are only a few of the common language errors you may see. While you may want your learner to speak in longer sentences, your goal should be to have them communicate effectively. With this goal in mind, it becomes essential to support them at their current stage, which means it’s essential to assess them and understand how to help them make progress.

This is why I always use the VB-MAPP to assess each child and make decisions about language instruction. I need to have a full understanding of how the learner is using language, and then move them through each stage in a clear progression. I may want the child to say “Hello, how are you today?” But when I teach them that, do they understand those individual words? Do they comprehend what today means as opposed to yesterday or tomorrow? Do they generalize the use of “how” to other questions?

As you make treatment decisions for your learner, think about their current stage and talk about how to support your child with both a Speech Language Pathologist and an ABA therapist.

*Brown, R. (1973). A first language: The early stages. London: George Allen & Unwin Ltd.

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.

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

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

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

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

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

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

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

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

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

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

REFERENCES

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

Written by Sam Blanco, 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.