Simplifying the Science: Using SAFMEDS in Applied Behavior Analysis

When I first heard about SAFMEDS, I wondered how they were different from standard use of flashcards. What I learned, in fact, is that the process is quite different, and it’s evidence-based! SAFMEDS is actually an acronym that means “Say All Fast Minute Each Day Shuffled.” (I know, I know…it doesn’t exactly roll off the tongue.) Created by Ogden Lindsley, SAFMEDS are focused specifically on fluency, or, in other words, speed and accuracy.

While there are some things that don’t require fluency, there are many things that do: such as simple multiplication or letter recognition. This means that some tasks I teach my students will require the use of fluency training, which is often completed through the use of SAFMEDS. Lindsley outlined results of his experiments using SAFMEDS with students and demonstrated that this process of instruction resulted in faster acquisition of fluency than other, similar flashcard procedures (Lindsley, 1996) with his work having been replicated many times over.Using SAFMEDS in Applied Behavior Analysis

So, how do you implement SAFMEDS?

First, get your materials together. Create your flashcards. (I typically use index cards where I’ve written the problem on one side and the correct response on the back.) Be sure to get a timer.

From there, the procedure is pretty straight forward:

  • You will have ALL the flashcards available and the student will respond to as many as he/she can in one minute.
  • The student can run the activity on their own, and will likely go much faster if they are the one turning the cards (Lindsley, 1996). The student looks at the card, provides the response, then puts the card in the correct or incorrect pile.
  • The cards should be shuffled between each fluency drill so that the student won’t learn the answers in order.

I’ve used actual flashcards, but also created SAFMEDS sets using different apps and websites. If you’re interested in learning more about implementing this simple strategy for building fluency, you should take a look here for more information.

REFERENCES

Lindsley, O. R. (1996). The four free-operant freedoms. The Behavior Analyst, 19(2), 199.

WRITTEN BY SAM BLANCO, MSED, 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. Sam is currently a PhD candidate in Applied Behavior Analysis at Endicott College. She is also a lecturer in the ABA program at The Sage Colleges.

Simplifying the Science: Choiceworks App – Increase Self-Monitoring and Autonomy in Students with ASD

Finding the appropriate educational setting for individuals with autism can be quite challenging. And in working to provide the least restrictive environment, sometimes students are placed in classrooms where they can do the work but requires additional supports. This makes teaching self-monitoring all the more important as we strive to help our students attain independence in all areas.

A recent study by Miller, Doughty, & Krockover (2015) used an iPad app as part of an intervention to increase self-monitoring for three students with moderate intellectual disabilities in their science class. The goal was to increase autonomy in problem-solving activities linked the science lesson for that day. The app they used was called Choiceworks, which the authors described as: “a daily routine board maker [that] contains prompting tools to assist users through daily tasks. Checklists, schedule boards, activity timers, and a communication board can be developed using this system” (p. 358).

Over the course of a two-week period, each student was provided with three training sessions for how to use the iPad based on a task analysis the authors had devised. Skills taught included swiping, changing the volume, and operating the Choiceworks app. Next, the authors introduced five steps of problem-solving and provided mini-lessons on each of the steps. The authors used stories that required problem-solving, then taught the students how to use the app to navigate through the five steps of problem solving. Finally, the intervention was introduced in the science classroom.

All three students in this study significantly increased their independence in problem-solving. Furthermore, the results were generalized to solving problems related to daily living and were maintained over time.

The results of this study are important for several reasons. First, it demonstrates one method for increasing independence in individuals with developmental disabilities. Second, this increase in independence provides opportunities for more natural peer interaction since the individual with the disability will not have an adult always standing next to them. Finally, using a tool such as an iPad mini (as these researchers did) or iPhone is beneficial because many people are walking around with such devices, allowing individuals with disabilities to use a device to promote independence without increasing the threat of social stigma. The authors clearly show that, when provided with proper instruction, students with developmental disabilities can use the iPad mini to become more independent with both academic and daily living skills.

REFERENCES

Miller, B., Doughty, T., & Krockover, G. (2015). Using science inquiry methods to promote self-determination and problem-solving skills for students with moderate intellectual disability. Education and Training in Autism and Developmental Disabilities, 50(3), 356-368.

WRITTEN BY SAM BLANCO, MSED, BCBA

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

Simplifying the Science: Teaching Hand-Raising to Children with Autism

There are many concerns that come up when considering moving a child with autism to a general education setting. One is that the child with autism may not initiate interactions, which makes it less likely they’ll raise their hand to either ask or answer questions. Hand-raising is an important social behavior in the classroom setting as it facilitates learning as well as teacher-understanding of a child’s comprehension of the current topic. In the general education setting, there is much more group instruction than in the special education setting, which makes hand-raising all the more important. A study by Charania, LeBlanc, Sabanathan, Ktaech, Carr, & Gunby (2010) focuses on this skill, stating “Failure to raise a hand when one could answer means a missed opportunity for reinforcement or error correction, whereas raising a hand when one has no subsequent response to provide could be embarrassing or disruptive to ongoing instruction.”

The participants in the study were three boys with autism, ages 8, 9, and 10 who were preparing to transition from a center-based program to a general education setting and had substantial verbal repertoires as assessed by the VB-MAPP. The researchers recognized that often the boys would know the correct answer to a question posed by the teacher during a group activity, but would not raise their hands to respond. They addressed this by building three successive skills. The goal was to teach the boys to raise their hand when they did know the answer, and keep their hands down when they did not know the answer.

In the first task, the boys were placed together for group instruction. Each child was given an opaque bag with a different item in it. The instructor would ask “Who has the [item]?” The boy with that item would raise his hand. Once this skill was mastered, the second task was introduced. In this task, the instructor would tell one boy a “secret” word, while whispering a greeting to the other two boys. The instructor would then ask “Who knows the secret word?” The boy who heard the secret word would raise his hand. Finally, after mastering the second task, the final task would be introduced. Here, the task involved providing verbal responses to factual questions, such as “What animal has a tail and four legs?”

This successive teaching of skills is important to the acquisition of the target skill. In the first task, there was an auditory and a visual stimulus provided to elicit the target response of hand raising (the question and the object in the bag). In the second task, the visual stimulus was replaced with another auditory stimulus, making it two auditory stimuli (the question and the whispered secret word). Finally, the last task consisted of the auditory stimulus, the question itself. The final task emulated the stimulus that would naturally occur in the classroom to elicit hand-raising.

The authors note in their discussion that “The results suggest the importance of conducting both hand-up and hands-down learning trials to establish discriminated responding, rather than simply reinforcing hand raises on every question (i.e., excessive hand raising during hands-down trials might be just as problematic as a complete lack of hand raising).” The method of successive conditional discrimination can be useful for teaching both children who do not raise their hands when they should or who raise their hands when they shouldn’t. All three boys learned how to raise hands appropriately for each of the three tasks. And while there are many more skills related to hand-raising that the three participants would need to learn, the skills taught in this study are essential to promoting success in the general education environment.

WRITTEN BY SAM BLANCO, MSED, BCBA

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

Simplifying the Science: Teaching Siblings About Behavior

When I first came across this study, Behavioral Training for Siblings of Autistic Children, I was immediately hesitant. There’s something about the idea of sibling-as-therapist that makes me cringe a little bit. When I work with the families of children with autism, the hope is that the siblings of the child with autism still have a childhood without being pushed into the role of caregiver. And I also want the child with autism to have independence and feel like an individual who is heard, which may be more challenging if their siblings are issuing demands just as a parent or teacher would. But as I read the study, I realized that the work they completed had incredible social significance.

Siblings Playing Together BlogIn the study, there were three pairs of siblings. The ages of the children with autism ranged from 5 years old to 8 years old. The ages of the siblings ranged from 8 years old to 13 years old. The researchers trained each sibling of a child with autism how to teach basic skills, such as discriminating between different coins, identifying common objects, and spelling short words. As part of this training, the researchers showed videos of one-on-one sessions in which these skills were taught, utilizing techniques such as reinforcement, shaping, and chaining. What the researchers did next was the part that really stood out to me: they discussed with the siblings how to use these techniques in other environments. Finally, the researchers observed the sibling working with their brother/sister with autism and provided coaching on the techniques.

It should be noted here that the goal of the study was not to have the siblings become the teacher of basic skills. Instead, it was to provide a foundation of skills in behavioral techniques for the sibling to use in other settings with the hope of overall improvement in the behaviors of the child with autism. The researchers demonstrated that, after training, the siblings were able to effectively use prompts, reinforcement, and discrete trials to effectively teach new skills. But, perhaps the most meaningful aspects of the study were the changes reported by both siblings and parents. The researchers provide a table showing comments about the sibling with autism before and after the training. One of the most striking comments after the training was, “He gets along better if I know how to ask him” (p. 136). Parents reported that they were pleased with the results and found the training beneficial.

This study provides excellent evidence that structured training for siblings has real potential for making life a little easier for the whole family. The idea isn’t that they become the therapist, but instead that knowledge truly is power.

References

Schriebman, L., O’Neill, R.E. & Koegel, R.L. (1983). Behavioral training for siblings of autistic children. Journal of Applied Behavior Analysis. 16(2), 129-138.

WRITTEN BY SAM BLANCO, MSED, BCBA

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

Simplifying the Science: Addressing Vocal Stereotypy or “Scripting”

Many parents and teachers struggle with addressing vocal stereotypy or “scripting” in children with autism. Since stereotypy is frequently automatically reinforcing, (meaning that the behavior is maintained by the sensation produced by the behavior) it is especially difficult to address. While this type of behavior does occur in typically developing children (think of a young child singing the same song repeatedly for several weeks or a toddler repeating a newly learned sound) there is concern that this behavior persists in children with autism and other developmental disabilities in such a manner that it interferes with learning.

In 2007, William H. Ahearn, Kathy M. Clark, Rebecca P.F. McDonald and Bo In Chung published a study in the Journal of Applied Behavior Analysis entitled Assessing and Treating Vocal Stereotypy in Children with Autism.” The study defined vocal stereotypy as “any instance of noncontextual or nonfunctional speech and included singing, babbling, repetitive grunts, squeals, and phrases unrelated to the present situation.” It focused on four learners (two boys and two girls) who had autism and were referred for the study because their vocal stereotypy interfered with their ability to learn. The children ranged in age from 3-11. Three of them used speech to communicate while one used PECS.

The study describes potential interventions from previous research before introducing its goal of interrupting the vocal response then redirecting. This is called RIRD – Response Interruption/Redirection. In RIRD, when the child made an inappropriate vocalization, the teacher blocked them by interrupting immediately, then redirecting them to another behavior. The redirection involved prompts for vocal behavior such as saying “Where do you live?” or “Say ‘red.’” When a child made an appropriate vocalization, it was always followed by a teacher comment.

RIRD produced substantially lower rates of stereotypy for all four of the children and an increase in appropriate vocalizations for three of the children. One thing that is striking about these results is that “sessions were 5 min in duration, and two to three sessions were conducted 3 days per week.” This is a degree of time commitment that is replicable in the home or school environments.

If your child or student is presenting with stereotypy that interferes with learning, it is valuable to look at this study, as well as similar studies by Cassella, Sidener, Sidener, & Progar (2011) and Athens, Vollmer, Sloman, & Pipkin (2008). Consult with a BCBA or ABA provider for assistance in implementing the intervention.

Simplifying the Science: Using a MotivAider to Self-Monitor

Teaching independent on-task behavior can be quite challenging when working with any student, but particularly so with some students with autism. In a study published in 2010, researchers Dina Boccuzzi Legge, Ruth M. DeBar & Sheila R. Alber-Morgan implemented and evaluated one way of teaching student to self-monitor their on-task behavior using a MotivAider. (The MotivAider is a simple electronic device that vibrates at timed intervals to provide an individual with a private prompt to engage in a specific behavior. It can be programmed to vibrate on a fixed or variable schedule at different duration and intensity levels.)

In this study, the researchers worked with a fifth grader with autism, a sixth grader with autism, and a fifth grader with cerebral palsy. They taught the boys to wear the MotivAider (calling it a pager) and note a + or a – to indicate their behavior each time the MotivAider vibrated. The behaviors they monitored were all related to being on-task: “eyes on my work,” “in my seat,” and “doing work.” Once each boy consistently rated his behavior upon feeling the vibration, the researchers implemented the intervention.

The MotivAider’s were initially set to vibrate every two minutes. Each time the MotivAider vibrated, the student would mark a + or a for each of the behaviors on a sheet he had on his desk. Prior to the intervention, the average percentages of time each boy was on-task ranged from 26% to 77%. Upon implementation of the intervention, “all three students showed an immediate and substantial increase of on-task behavior ranging consistently from 80% to 100%.

The researchers also included a plan for fading out the use of the MotivAider‘s, changing from a fixed schedule of every two minutes, to an increasing variable schedule. The fading schedules varied for each student. For example, for one student, the fading schedule started with a variable schedule of a vibration about every four minutes, then moved to about every six minutes, then to about every eight minutes, and then to about every ten minutes. The MotivAider was then removed completely.

After the intervention was complete, researchers collected data once a week for three weeks to see if the intervention was maintained. During all three maintenance probes, “all students continued to demonstrate 80%-100% on-task behavior.”

We’ve talked about how to use MotivAider‘s in the past, but I particularly love this intervention because it is feasible for teachers to implement in the classroom, promotes independence in learners with autism, and allows teachers to focus on other issues. Take a look at the study here to get a fuller description of how to implement such an intervention with your students.

For more information about the MotivAider, click here.


WRITTEN BY SAM BLANCO, MSED, BCBA

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

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

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

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

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

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

The intensive toilet training program had 5 components:

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

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

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

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

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

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

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

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

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

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

Simplifying the Science: Are You Giving Your Student Enough Freedom?

One of my favorite research papers was published in the Journal of Applied Behavior Analysis in 1990 by Diane J. Bannerman, Jan B. Sheldon, James A. Sherman, and Alan E. Harchik. The title is Balancing the Right to Habilitation with the Right to Personal Liberties: The Rights of People with Developmental Disabilities to Eat Too Many Doughnuts and Take a Nap. It’s an in-depth look at the level of control practitioners can exert over the individuals they serve, and the implications of that control.

It’s important to consider the ethical implications of requiring the individuals we work with to complete specified exercises at scheduled times, eat a healthy diet for all meals, and limit TV. I have seen situations in which the practitioner is holding the individual with developmental disabilities to a higher standard than they hold themselves! Most of you reading this can probably quickly rattle off the name of the last TV show you “binge-watched” or the delicious ice cream you enjoyed too much of.

So how do we teach making appropriate choices to individuals with developmental disabilities without denying the personal freedoms we all value?

One quote from the paper states, “Not only do people strive for freedom in a broad sense they also enjoy making simple choices, such as whether to engage in unproductive, though harmless, activities, like watching sitcoms on television, eating too many doughnuts, taking time off from work, or taking a nap before dinner.” In an effort to teach our learners independent skills, we often neglect to teach meaningful decision-making that reflects the types of decisions neurotypical adults make every day. Since the paper was originally published, there has been more work done on promoting decision-making skills for learners with developmental disabilities, but the issues described in the paper are still relevant today.

Here are a few key considerations described:

  • We need to consider client preference when creating daily schedules, goals, and access to preferred activities.
  • A client’s refusal to participate in an activity may not be a failure to teach appropriately but an expression of preference.
  • It is important for practitioners to teach choice-making. The paper states, “Many people require teaching to help them discover their own preferences and learn to make responsible choices.” We should consider this as an essential step towards promoting independence in our clients.
  • Inflexible schedules for clients can sometimes be obstacles to opportunities for choice-making.

The paper goes on to cite multiple research articles and laws for both sides of the argument about the right to choice for those with developmental disabilities. You can read the full text here.  Overall, I consider this article to be essential reading for anyone working with clients with disabilities. It provides a lot of information to support its final conclusion that “all people have the right to eat too many doughnuts and take a nap” and we have the responsibility to teach clients how to exercise such freedoms.

WRITTEN BY SAM BLANCO, msed, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

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

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

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

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

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

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

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

Written by Sam Blanco, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.