How Do We Measure Effectiveness?

This month’s ASAT feature comes to us from Dr. Daniel W. Mruzek, PhD, BCBA-D, Associate Professor, University of Rochester Medical Center. 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!

Marketers of purported interventions for autism spectrum disorder (ASD), whether they are pills, devices, or exercises, claim that their products are effective. As proof, they point to any number of measures some valid, some questionable, and some potentially misleading. Given that many of these “treatments” may be costly, ineffective and even dangerous, it is good to consider what constitutes legitimate measures of therapeutic benefit. How will we know if the intervention actually works?


A first step when presented with a potential treatment option is to investigate its scientific record. One can certainly ask the marketer (or therapist, interventionist, clinician, etc.) for examples of peer-reviewed studies examining the effectiveness of their recommended intervention. Indeed, this can be a great first step. An honest marketer will be glad to give you what they have in this regard or freely disclose that none exist. A good second step is to consult with a trusted professional (e.g., physician, psychologist, or behavior analyst who knows your family member), in order to get an objective appraisal of the intervention. If, after this first level of investigation is completed, a decision is made to pursue a particular intervention for a family member there are additional questions that one can ask the marketer prior to implementation that may prove very helpful in determining effectiveness after the intervention has been employed. These include the following:


Question 1: “What behaviors should change as a result of the intervention?”
Virtually any ASD intervention that is truly effective will result in observable change in behavior. For example, a speech intervention may very well result in increased spoken language (e.g., novel words, greater rate of utterances). An academic intervention should result in specific new academic skills (e.g., greater independent proficiency with particular math operations). An exercise purported to decrease the occurrence of challenging behavior will, if effective, result in a lower rate of specific challenging behaviors (e.g., tantrums, self-injury). As “consumers” of ASD interventions, you and your family member have every right to expect that the marketer will identify specific, objective, and measurable changes in behaviors that indicate treatment efficacy. Scientists refer to such definitions as “operational definitions” – these are definitions that are written using observable and measurable terms. If the marketer insists on using ill-defined, “fuzzy” descriptions of treatment benefit (e.g., “increased sense of well-being”, “greater focus and intentionality”, an increased “inner balance” or “regulation”), then “Buyer Beware!” These kinds of outcome goals will leave you guessing about treatment effect. Insist that operational definitions of target behaviors be agreed upon prior to start of intervention.

Question 2: “How will these behavior changes be measured?”
Behavior change is often gradual and variable. Behavior change often occurs in “fits and starts” (i.e., the change is variable). Also, our perception of behavior change can be impacted by any number of events (e.g., the co-occurrence of other therapies, our expectations for change). Therefore, it is the marketer’s responsibility to offer up a plan for collecting data regarding any change in the identified “target” behaviors. Usually, it is best to record numerical data (e.g., number of new words spoken by the individual, duration [in minutes] of tantrums, etc.) The use of numerical data to measure the change of operationally defined target behaviors is one of the best ways for a treatment team to elevate their discussion above opinion, conjecture and misrepresentation. If a pill, therapy or gadget is helpful, there is almost assuredly a change in behavior. And, that change is almost always quantifiable. Setting up a system to collect these numerical data prior to the initiation of the new intervention is a key to objective evaluation of intervention. Don’t do intervention without it.


Question 3: “When will we look at these intervention data and how will they be presented?”
Of course, it is not enough to collect data; these data need to be regularly reviewed by the team! One of the best ways to organize data is “graphically”, such as plotting points on a graph, so that they can be inspected visually. This gives the team a chance to monitor overall rates or levels of target behaviors, as well as identify possible trends (i.e., the “direction” of the data over time, such as decreasing or increasing rates) and look for change that may occur after the start of the new intervention. Note that the review of treatment data is generally a team process, meaning that relevant members of the team, including the clinicians (or educators), parents, the individual with ASD (as appropriate) often should look at these data together. Science is a communal process, and this is one of the things that makes it a powerful agent of change.


An interventionist with background in behavior analysis can set up strategies for evaluating a possible treatment effect. For example, in order to gage the effectiveness of a new intervention, a team may elect to use a “reversal design”, in which the target behaviors are monitored with and without the intervention in place. If, for example, a team wishes to assess the helpfulness of a weighted blanket in promoting a child’s healthful sleep through the night, data regarding duration of sleep and number of times out of bed might be looked at during a week with the blanket available at bedtime and week without the blanket available. Another strategy is to use the intervention on “odd” days and not use it on “even” days. Data from both “odd” and “even” days can be graphed for visual inspection, and, if the intervention is helpful, a “gap” will appear between the data sets representing the two conditions. These strategies are not complex, but they give the team an opportunity to objectively appraise whether or not a specific intervention is helpful that is much better than informal observation. Few things are as clarifying in a team discussion as plotted data placed on the table of a team meeting.


If the marketer does not answer these questions directly and satisfactorily, consider turning to a trusted professional (e.g., psychologist, physician or behavior analyst) for help. Families have a right to know whether their hard-earned money, as well as their time and energy, are being spent wisely. Asking these questions “up front” when confronted with a new intervention idea will help. Marketers have a responsibility to present their evidence – both the “state-of-the-science” as reflected in peer-reviewed research, as well as their plans to measure the potential effectiveness of their intervention for the individual whom they are serving.


Speaking of measuring treatment effectiveness, fellow ASAT board member Eric Larsson offers his considerations regarding the use of standardized measures (e.g., IQ) as outcome measures in treatment research (next article; page 20). Though this might be a little out of context for some of our readers, for those of us who rely on direct interpretations of peer-reviewed studies in our work (e.g., researchers, clinicians), Dr. Larsson describes the limitations of sole reliance on change in standardized measures is assessing the scientific validation of an intervention.


Please use the following format to cite this article:
Mruzek, D.W. (2014). ASD intervention: How do we measure effectiveness? Science in Autism Treatment, 11(3), 20-21


About The Author
Daniel W. Mruzek, Ph.D., BCBA-D is an Associate Professor at the University of Rochester Medical Center (URMC), Division of Neurodevelopmental and Behavioral Pediatrics in western New York. He received his doctoral training in Psychology at the Ohio State University and is a former Program Director at the Groden Center in Providence, Rhode Island. Currently, he is an associate professor and serves as a clinician and consultant, training school teams and supporting families of children with autism and other developmental disabilities.


Mruzek coordinates his division’s psychology postdoctoral fellowship program in developmental disabilities and is an adjunct faculty member in the University of Rochester Warner School of Education. He is actively involved as a researcher on several externally funded autism intervention research studies and has authored and co-authored more than 20 peer-reviewed articles and book chapters on autism and other developmental disabilities. Dr. Mruzek is on the editorial board for the journals Focus on Autism and Other Developmental Disabilities, Behavior Analysis in Practice, Journal of Mental Health Research in Developmental Disabilities, and Intellectual and Developmental Disabilities. Dr. Mruzek is a former member of the Board of Directors of the Association for Science in Autism Treatment.

Technology Do’s (and one Don’t!)

Technology can be a great addition to an educational or behaviorally supportive program for individuals with autism. It may be used as a powerful reinforcer for some, can facilitate language and communication, and help to organize and present visual and auditory cues efficiently. Items like tablets and smart phones also tend to be highly acceptable to learners, parents, and society as a whole. We have come a long way from the days of Velcro, laminate, and tackle boxes full of reinforcers! In some cases, the entire array of tools needed to support and teach may be included in a single device.

As great as technology may be for learners with autism, their families, and their teachers, however, there are some cautions that need to be observed. Here are some suggestions to make sure that technology is used effectively and does not have any detrimental effects.

1. Do carefully evaluate the functionality of the technology for the individual. Like any behavioral intervention, technology is not one-size-fits-all, and may not be appropriate for every use for every learner. Choose the type and application of technology that works best for the individual. Collect data on the success of the technology intervention, and make adjustments as needed.

2. Do teach alternative strategies that don’t rely on technology, to prepare for times when technology may be unavailable, broken, or inappropriate. Practice occasionally not using technology, so that when the inevitable happens (e.g., power outage, broken tablet, etc.), the individual is prepared and has some coping strategies.

3. Do monitor for safety and appropriate usage. Many apps are so easy for learners to use that they can easily connect with other people, make purchases, or share personal information without parents or teachers noticing. Devices that connect to the internet via wi-fi or data plans must be carefully monitored for such activity.

4. Do teach learners to manage their devices independently. Learners should know how to charge devices, set alarms and reminders, and use other apps for self-management. Technology isn’t just for fun; it’s become a part of life for most of us, and learners can benefit the same as anyone else.

5. Don’t use technology for technology’s sake. If it doesn’t serve a real purpose for teaching or behavioral support, it should not be in use. Any application of technology in teaching or behavioral interventions should be clearly defined, conceptually systematic, and precisely planned.


About The Author

Dana Reinecke, PhD, 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 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, 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), and is currently serving as President (2017-2018).

Explaining Decision to Use Science-based Autism Treatments

This month’s ASAT feature comes to us from David Celiberti, PhD, BCBA-D and Pamela Feliciano, PhD. 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!

 

“I have decided to rely on science-based treatments for my child with autism. Now, how do I explain this to friends and relatives who insist I try something “cutting edge?”

 

We certainly respect any individual’s right to his or her own opinion, and certainly for parents of children with autism to make decisions for their child regarding treatment; however, we believe that scientific evidence and the use of objective data should guide treatment options for all diseases and conditions, and autism is no exception. The late Senator Patrick Moynihan eloquently said, “Everyone is entitled to their own opinions, but not their own facts.” It is simply a matter of fact that theories, hypotheses, and testimonials do not provide adequate information to guide treatment decisions.

When friends or acquaintances hear about our experiences with autism, quite often the first thing they ask is, “What is your opinion of vaccines?” despite the retraction of Andrew Wakefield’s article by the Lancet (a very rare occurrence by this highly reputable journal). Sadly, the vaccine debate has long distracted the autism community from important discussions such as how best to help children already diagnosed with autism realize their fullest potential and live a happy and meaningful life.

In an ideal world, all treatment providers would make a commitment to science and evidence-based practices, and all members of the journalism community would make a commitment to responsible journalism. Until these ideals become the norm, those who do understand science-based treatments must do what they can to inform and educate others about the benefits of scientifically validated treatment, and the use of data to guide decision-making when assessing the benefits of any and all treatments.

Although applied behavior analysis is the treatment for autism with the most scientific support, we are rarely ever asked our opinion of this therapy, or if it is effective. Instead, every few months or so, some “new” treatment (or “repackaging” of a known treatment) will gain the attention of consumers. Given the large numbers of television reports, newspaper articles, blogs, and websites putting forth “miracle cures” and “breakthroughs,” it is not surprising that parents frequently receive advice and suggestions from extended family members, neighbors, and co-workers, particularly after a news item is broadcast, printed, or otherwise disseminated. Many of these individuals have the best intentions and are eager to share what they believe is “cutting edge” information about autism. In other cases, the advice is sometimes provided in a manner that comes across as critical of what you are choosing to do or not do for your child (i.e., it may be implied that you are not doing enough as a parent to help your child with autism).

If the information is offered by a more casual acquaintance, it may be best to simply thank him or her for their interest and concern and move on; however, such a strategy may not fare as well with individuals with whom you have a closer relationship. In these cases, you might consider sharing the following:

     • There are dozens of “miracle cures” and “breakthroughs” (i.e., pseudoscience) for autism that manage to receive widespread media attention, even if they have not been proven effective. In fact, there are over 500 treatments touted to address autism;

     • It is important to be critical of all available information, regardless of the source, and to recognize that not all information on the Internet is reliable and accurate;

     • There is a large body of scientific research published in peer-reviewed journals and carried out by hundreds of researchers that supports the choices that you have made;

     • Numerous task forces (some are listed at the end) have looked closely and objectively at the available research and have determined that the vast majority of autism treatments lack any scientific support and, in fact, some may be harmful;

     • Autism treatment is a multi-million dollar industry, and many treatment proponents rely heavily on sensationalism and extraordinary claims to “sell” their products;

     • Interventions that are actually shown to be the most effective often receive the least amount of media attention; and

     • For most other medical conditions, a provider that disregards proven intervention and uses a fringe treatment may actually be sued for malpractice (you may even consider drawing an analogy to a medical condition of particular interest to the person providing the advice).

Of course, you may also consider addressing this matter proactively. This would involve clarifying your choices and commitment to science-based treatment to more significant family members and friends on your terms and at your convenience. It may be helpful to view this tactic as a series of tiny conversations. You may even consider sharing links to websites such as the Association for Science in Autism Treatment (ASAT), which will help your family members and friends separate the wheat from the chaff. We would like to draw your attention to a few sections of ASAT’s website that bear relevance to this discussion.

     • Learn more about specific treatments

     • Summaries of published research articles

     • Making sense of autism treatments: Weighing the evidence

     • Recommendations of expert panels and task forces

Finally, ASAT’s newsletter, Science in Autism Treatment, is a free publication, so encourage your friends and family to subscribe.

It is our hope that the information shared above may help your friends and family better understand the role that science should play in the treatment of autism, the need for objective data to drive decision making, how to better identify pseudoscience, and perhaps most importantly, why parents must be such savvy consumers.


David Celiberti, PhD, BCBA-D is the part time Executive Director of ASAT and Past-President, a role he served from 2006 and 2012. He is the Co-Editor of ASAT’s newsletter, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis, and early childhood education, and been an active participant in local fundraising initiatives to support after school programming for economically disadvantaged children. 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 applied behavior analysis (ABA) at both the undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.

Pamela Feliciano, PhD, joined the Simons Foundation in 2013 and serves as the scientific director of SPARK (Simons Foundation Powering Autism Research through Knowledge) and is a senior scientist at SFARI. SPARK is a SFARI initiative that seeks to accelerate autism research through a vibrant and informative online platform (SPARKforAutism.org). Previously, Feliciano worked as a senior editor at Nature Genetics, where she was responsible for managing the peer review process of research publications in all areas of genetics. Feliciano holds a B.S. from Cornell University, an M.S. from New York University and a Ph.D. in developmental biology from Stanford University. Feliciano is also the mother of an adolescent boy with autism spectrum disorder.

Easy Data Collection for the Classroom

This week we have an introduction to our newest book from one of the authors, Sam Blanco PHD, LBA, BCBA. ABA Tools of the Trade is available now!

 

From the beginning of my career, I have loved data collection. Not only does it help me track what interventions are working and how quickly my students are learning, it also provides excellent structure and organization of what needs to be done on a daily basis. Much of this love of data collection was influenced by my colleague Val Demiri. While Val and I both looked at data as a way to make our lives easier, for many of our colleagues, data appeared to be more of an obstacle than a useful tool. So we set out to change that.

 

We’re both so thrilled about the release of ABA Tools of the Trade: Easy Data Collection for the Classroom. Our goal is to make data collection easier, more useful, and possible considering the many tasks a teacher is already doing on a daily basis in their classroom. Here are few things we’re really excited to have in the book:

 

  • An overview of some of our favorite tools for data collection, including why we love them and when they might be useful for you

 

  • An easy-to-use guide based on the specific behavior challenges you are currently facing, with suggestions for data collection and recommended readings

 

  • A task analysis of the data collection process that breaks down each step for pre-data collection phase, data collection phase, and post-data collection phase

 

  • A wealth of strategies to use to address problem behavior before they occur

 

  • An entire section devoted to BCBA Supervision that not only aligns with Task List 5 but also contains lesson plans and rubrics for assessing supervisees

 

We hope that by making data collection methods more accessible, we can motivate you to appreciate tools for data collection as much as we do!


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.

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.

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.