Across multiple industries, staffing deficits are a big problem right now.
There are many different explanations for this, but certainly in a post-COVID world all of us are redefining work, evaluating our priorities, and learning how precious our time is…..if people are unhappy at work/in their career, it makes sense that the past 2 years would push them to DO something about that.
But let’s talk about RBT’s, specifically.
The RBT credential is an entry level position into this field. When a clinician company hops, it is usually for a different BCBA position. After all, there was tremendous time, energy, money, and schooling that went into the decision to become a BCBA, so most will try a new company out before trying a new profession.
For RBT’s though, many are not that connected to the field. They may still be figuring out if this is what they want to do long-term. Or, they may already know that they plan to pursue education, mental health, counseling, or other degrees, and are working as a RBT now for valuable experience. The point being, its often true that RBT’s not just company hop, but industry hop/leave the field. Especially right now, when the impacts of quarantine and the pandemic are still lingering. Client cancelations, health scares (e.g. sessions canceled for a week until a clear COVID test), companies lowering rates or decreasing benefits to ease financial strain, funders decreasing reimbursement rates, etc. All of this contributes to the experience of the RBT.
I mean, just look at current gas prices. If you think that isn’t impacting the job satisfaction of RBT’s who spend most of their day driving from client to client, then you are deluding yourself.
So, what can be done?
Why Do RBTs Leave?
What is often attempted is increasing incentives. Things like: pizza day, bonuses, raffle drawings, trivia nights, casual Fridays, referral bonuses, public recognition/”Shout Outs” from management, use of a company iPad, etc.
Here’s the problem though: did anyone ask for that?
What are your frontline staff asking for? When people leave, WHY did they leave? When people turn down an offer, or decline moving forward in the interview process, WHY did they lose interest? What happened? When staff complain or bring up concerns, are they addressed and resolved? Or bounced from person to person in the company? Is management toxic to deal with, unprofessional/gossipy (especially in center based settings), incompetent, etc.? Toxic managers are one of the largest reasons why people leave otherwise good companies.
When I speak with unhappy RBT supervisees, the issues they describe to me tend to be systemic/management level problems (meaning, the supervisee cannot fix the issue), or a symptom of RBT mistreatment/low regard.
For example:
Low pay/Pay rate has not budged since hire/Low hours (hired as FT but only working PT hours)
Client cancelations or schedule changes that cause loss of income
Poor fit to clients on caseload/Working outside of clinical competency
Not supported by BCBA/Minimal supervision
Issues with admin or management (rude, unprofessional, incompetent, etc.)/Inaccessible owner, management, or HR/Management does not support or “back” the RBT when there are issues with the client parent
No company policy on parent involvement or participation/No company policy on respecting the staff or employees/No consequences when client families regularly arrive late to sessions or cancel frequently
Excessive driving (only client is 2 hours away)
No benefits/No healthcare due to unable to maintain FT hours
Company does not provide needed equipment and supplies to perform job/RBT must provide their own supplies
Being expected to do extra work for free (required to train new hires for free)
Insufficient training on company required technology (required to use data software, but minimal training on it or support when it isn’t working correctly)
If I was working with a client, and providing access to pizza, gift cards, and trivia nights, but the target behavior was not improving, my conclusion would be that I need to reevaluate my reinforcers. Looks like they aren’t so reinforcing after all!
Okay, then let’s apply that same conclusion to our workforce. If they are continuing to quit in large numbers, the reinforcers and motivating variables are lacking. Something is wrong, something is off. And as owners, bosses, managers, and stakeholders in this conversation (supervising BCBAs may not actively hire or employ RBTs, but we can certainly advocate and speak up for them in the workplace) we need to do better for our highly important RBT workforce.
So, what do RBTs want?
Heck, I don’t know. 😊
You need to ask THEM that. Individually. Consistently. Intentionally. At the onset of employment. As well as on a recurring basis once they take the job.
Don’t wait for people to become unhappy and dissatisfied and only then start pouring on the incentives, gift cards, and bonuses. Be proactive and intentional about building a strong workforce, demonstrating value (link), and probing individual employee preferences and reinforcers, so that the workplace can be an enjoyable setting (and reinforcing stimulus) for the people wo work there.
…… Or it’s highly likely they won’t work there for long.
“I’ve been providing ABA therapy services to young children with Autism since early 2003. My career in ABA began when I stumbled upon a flyer on my college campus for what I assumed was a babysitting job. The job turned out to be an entry level ABA therapy position working with an adorable little boy with Autism. This would prove to be the unplanned beginning of a passionate career for me.
From those early days in the field, I am now an author, blogger, Consultant/Supervisor, and I regularly lead intensive training sessions for ABA staff and parents. If you are interested in my consultation services, or just have questions about the blog: contact me here.”
“This is hard” is a statement I often hear from families both in the midst of intervention, and pre-intervention during the assessment phase.
Families without support and services find it hard helping their Autistic child navigate the world, and families in the midst of therapies and interventions find generalizing them to be hard.
It’s hard to consistently generalize an intervention plan outside in the home, on the weekends, on Sunday at the grocery store, on vacation at Grandma’s house, or at 6am on a Saturday when your child only slept 2 hours.
But its also hard to supervise/monitor your child 24-7, to break up sibling fights all day long because your child can’t share, to find quality childcare options when your child is highly aggressive, or to figure out if your child is ill or sick when they can’t tell you.
Both are hard.
It is rarely a discussion of hard vs easy, and much more common is a decision regarding which “hard” is acceptable. Yes, toilet training is hard work. On the flip side, changing an 8 year-olds diaper isn’t exactly easy. Nor is it easy to afford to buy diapers for that many years.
Yes, teaching your child to use utensils instead of eating with their hands is hard. On the flip side, restricted diet and issues around mealtimes can be made worse if the child will only eat finger foods (typically, starches and carbs). That is also hard.
Yes, it is hard to consistently follow a Behavior Plan when in public with your child. On the flip side, being asked to leave locations, having friends ask that you not visit, or being scared someone will call the police on your child during a public outburst, is a hard reality to live out.
You have to decide which “hard” to accept.
I intentionally use the phrase “intervention plan” and not “ABA therapy”, because maybe your child isn’t receiving ABA services. Maybe you don’t want that, or can’t access it.
But are they receiving Speech services? OT? PT? In special education at school? Attending an Autism preschool program?
If so, these are all interventions designed to minimize developmental delays and target current deficits.
Whatever kind of intervention your child participates in, there are a few components that tend to be the same across different therapies:
1. Consistency. In order to be effective, the intervention must be applied consistently. Frequent staff turnover, frequently canceling appointments, or other issues like this can negatively impact results.
2. Training must carry over to the home setting/caregivers. There is no way to generalize the intervention if you have no idea what it is.
3. Caregiver Participation. In order for #2 to happen, the caregivers must be willing and available to participate in the intervention/treatment plan.
4. Focus on progress vs miracles. Progress can be slow, it can be up and down, and at times it can mean treading water. Sometimes an absence of regression IS progress. If you have sky high expectations of the intervention process, this can cause “provider hopping” where families move from one agency, provider, or intervention to the next looking for magic. That just is not how quality, ethical treatment works.
5. Individualized Intervention. It doesn’t matter if your child receives 30 minutes of Speech each week, or 15 hours of ABA. Are the treatment goals and the teaching methodology suitable and appropriate for your child? “Cookie-cutter” intervention is when treatment is applied in a lazy, vague, and generic way across multiple clients. In order for intervention to be effective, it must meet your child where they are and incorporate their unique interests and motivation(s).
About The Author: Tameika Meadows, BCBA
“I’ve been providing ABA therapy services to young children with Autism since early 2003. My career in ABA began when I stumbled upon a flyer on my college campus for what I assumed was a babysitting job. The job turned out to be an entry level ABA therapy position working with an adorable little boy with Autism. This would prove to be the unplanned beginning of a passionate career for me.
From those early days in the field, I am now an author, blogger, Consultant/Supervisor, and I regularly lead intensive training sessions for ABA staff and parents. If you are interested in my consultation services, or just have questions about the blog: contact me here.”
By Mariela Vargas-Irwin, PSYD, BCBA-D, LABA, Executive Director of ABLS
Every day was hard with 5-year-old Tony. He would purposely find ways to annoy others and just did not seem to respond to consequences. The school tested him and said that there was nothing wrong; in fact, they said he was gifted.
Another child, Latoya, was never the same after being in a car accident. She cried all night and refused to get into any car. She also seemed to be unable to play with any of her previously preferred toys for long and had frequent tantrums.
Then there was 10-year-old Maria, who didn’t seem to be making any progress at school. She had an intellectual disability and her Individualized Education Program looked good on paper. However, she was becoming more aggressive each day and her language continued to be very limited.
Finally, Autumn, 2 years old, was in a fog. She stopped saying mama and dada, cried for no apparent reason, and ran in circles all the time.
Developmental and behavioral concerns about your children, such as those listed above, can be extremely distressing. Of course, you would do anything for your child!
But where to start?
What Tools Do I Need?
The first step is to consult your pediatrician. They will be able to rule out any possible medical problems and are more likely than a specialist to be able to see you quickly. Once a physical cause for your concerns is ruled out, your pediatrician will most likely refer you to a psychologist for an assessment. There are, however, several kinds of assessments that can be conducted.
A Comprehensive Diagnostic Assessment will include a cognitive and an adaptive assessment. It may include both norm-referenced assessments that compare children to others, as well as criterion-referenced tests that compare students to themselves. A Comprehensive Diagnostic assessment may result in a diagnosis such as Autism or Attention Deficit Hyperactivity Disorder.
The psychologist or a behavior analyst may also perform a Functional Behavior Assessment. A Functional Behavior Assessment examines the functions of the behavior via direct and indirect methods helping guide the development of a Behavior Support Plan.
Another type of assessment that may be helpful is a Program Assessment. A Program Assessment includes a visit to your child’s school to determine whether their needs are being met and their Individualized Education Program is being implemented properly.
Lastly, a Neuropsychological Assessment examines executive functioning skills, attention, and memory, in addition to cognitive and adaptive skills.
How Would Assessments Help My Child?
To speak to the above examples, Tony would need a Comprehensive Diagnostic Assessment and a Functional Assessment to ascertain the function of his aggressive and disruptive behavior. The fact that he is gifted intellectually does not rule out that he may be struggling with Attention Deficit Disorder with Hyperactivity, Autism, or Post Traumatic Stress Disorder.
Latoya would need a neuropsychological assessment that will examine executive functions, language, and attention to ascertain the impact of the accident on her neuropsychological functions. Typically, a complete neuropsychological assessment is conducted immediately after the accident and then repeated every six months.
Meanwhile, Maria would require a Program Assessment to determine whether her school program is meeting her needs. This assessment should include a complete review of her progress reports in addition to a visit to her school. She may also need a Functional Assessment of her aggressive behavior at home.
Lastly, Autumn urgently needs a Comprehensive Diagnostic Assessment to rule out Autism. If she does have Autism, she will need intensive early behavior analytic intervention to be implemented as soon as possible so time is of the essence.
Whatever the assessment process holds for your learner, it is important that the instruments used are both reliable and valid, and ideally they would be able to be utilized to track progress over time. Every child is different; therefore, no assessment process will proceed identically.
About the Author
Dr. Mariela Vargas obtained her doctoral degree from Rutgers University, completed her internship at Boston Children’s Hospital, and pursued post-doctoral training at the Baker Children’s Center. She has over thirty years of experience working with children with autism and other developmental disorders with behavioral challenges. Dr. Vargas has worked as a home-based behavioral therapist, overseen home-based programs, designed training protocols for ABA therapists and supervisors, and consulted with families and schools. She was the second president of the Massachusetts Association for Behavior Analysis and has presented in numerous national and international Autism and ABA conferences. A licensed Psychologist and Board Certified Behavior Analyst, she is the founder and executive director of Applied Behavioral Learning Services (ABLS). Her interests include inclusion, psychometrics, social skills, and executive behavior.
This month’s ASAT feature comes to us from Judith Ursitti. 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!
Judith Ursitti, Mother of Jack
I love this young man with all of my heart. I worry about his future. He has so much to offer this world. But frequently, I read things that seem like they deny the realities of valuable humans like him.
He’s not a savant. He doesn’t type. He gets up in the morning and gets ready for school. He works hard every day, striving for connection and independence, supported by a team of loving therapists.
Speech, OT, PT, ABA,… All of it aimed at empowering him. He runs and swims after school. Exercise is such great medicine. He’s not into TV or movies, really. He spends no time on the internet. He loves listening to music on his iPad. Lately, it’s been Katy Perry and Kanye.
He was diagnosed with autism at age two. He was diagnosed with a severe intellectual disability at nine. A diagnosis of OCD came a little later. This combination of alphabet soup brings a lot of pain and struggle. He’s hurt himself. He’s hurt me. It can be hard.
He loves and is loved. He likes to swing as high as the swing will go. He loves to go to the store. He loves to go to Outback Steakhouse and eat wings. He loves his sister and is sometimes annoyed with her. He likes to hang close. He also likes to be left alone.
He hums and rocks and paces. He laughs. He enjoys looking in the mirror and making goofy faces. He screams loudly over and over and laughs and laughs and laughs. He is authentic. Refreshingly so.
He is not the prom king. He is not represented in research or the media very much. It’s very hard for researchers to include people like him in their work. His sensory challenges, his inability to read or write or speak leave him on the periphery of autistic representation.
I have many autistic friends with various profiles. They are some of my favorite people. Truly. The truth is his severity makes him really different than them. I’m not even certain that the shared diagnosis is accurate. But hey, I’m not a scientist.
But I do think this is such a compelling reason to work really hard to conduct research for people like him. Individualized supports and services can really help human beings like him.
What’s the point of my rambling? Please just know that when you hear the word autism, or you read something by autistic authors representing the autism community, it’s generally not inclusive of people like my son. This needs to change. His experience matters.
He and so many others like him need inclusion, acceptance, and support, particularly from their own community. They desperately need research to provide answers and to improve their quality of life.
The ongoing balance of joy and pain is part of the human experience. But his version of it weighs heavily on him. He deserves peace. Please don’t forget about people like him.
About the Author:
Judith Ursitti is Vice President of Government Affairs for the Council of Autism Service Providers (CASP). A CPA by training, she spent a decade working in tax accounting. She became immersed in the world of autism advocacy when her son, Jack, was diagnosed at age 2. Since his diagnosis, she has worked on the passage, implementation, and enforcement of autism-related legislation nationwide. She worked for Autism Speaks as their director of state government affairs for over a decade. She has served on the Massachusetts Autism Commission, where she co-chaired the Commission’s 14-22/Employment Subcommittee. She also serves as the public policy chair of the National Council on Severe Autism and is the co-founder of the Profound Autism Alliance. She frequently writes about autism advocacy and her experiences parenting a son with profound autism.with autism.
Citation for this article:
Ursitti, J. (2022). Jack matters, too: A mother’s perspective on her son’s place in the autism community. Science in Autism Treatment, 19(7).
Setting IEP goals for autistic learners can be incredibly difficult, especially when you’re working with emerging communicators. At the beginning of my career, assessment tools were limited and I found out along the way the goals I set for my students were unclear and hard to measure. Assessment, collaboration and functional goals are all important pieces of the puzzle for setting up your student and the therapy for success.
Standardized tests are commonly used in the classroom, but they are so tricky because they often do not give us the snapshot of skills we need for autistic learners. Assessment tools I recommend if you have access are the VB-MAPP and the Functional Communication Profile. If you don’t yet have access or need to start on a more basic level, I like to look for specific early learner skills. These are those small basic skills that lead to learning bigger skills and tasks. These are measurable communication skills that start in even really young learners such as labeling, verbal imitation, intraverbal skills like filling in the blank, matching, and group listening.
When you have brought all the pieces together, it’s time to set the vision for their communication programming. I have 5 questions for you to ask as a part of my practical and systematic approach to establishing functional goals for your autistic learner.
What behavior are we targeting?
Is it appropriate for our client?
How is this goal specific?
Is the goal observable?
What does mastery look like?
No matter the skill level, the age, or the context of your therapy practice, this approach will help you consider all the important pieces behind each goal. If you’re a parent, this can help you know what questions to ask your therapist and IEP team to ensure the right goals are being observed and measured for your child. As a part of this episode, I have included a downloadable link for my IEP Goal Bank, be sure to check it out as you work with your team and parents to set specific, actionable IEP goals for your autistic learners.
Rose Griffin, SLP, BCBA is dedicated to helping SLPs and other professionals provide systematic language instruction with ease. Working with students with autism and other complex communication disorders can be challenging. Rose has dedicated herself to helping by providing professional development and real life examples of what she does in her daily practice. See her podcast, blog, and collaboration opportunities at www.abaspeech.org
By: May Chriseline Beaubrun, MEd, BCBA (Brett DiNovi & Associates)
Prior to offering some global suggestions, I wanted to highlight some of the available research that explains of the unique experiences of Black families of children with autism. Although autism does not discriminate (across race, ethnicity, culture, socio-economic status, etc.), diagnosis, access to resources, treatment options, and culturally competent care can vary vastly for Black families with children with autism (Čolić et al., 2021). For example, Black children with intellectual disabilities receive an autism diagnosis an average of six months later than comparable white children (Dryden, 2020). Mandell et al. (2002) found that Black parents on average made three times more visits to doctors to obtain an autism spectrum disorder (ASD) diagnosis than their white counterparts. Dyer (2018) found that Black parents had seen multiple specialists before their children finally received a diagnosis. These setbacks in diagnosing Black children translate into a delay in skill acquisition, reduced access to early intervention, and an increased risk of challenging behaviors (Čolić et al., 2021). Also, an estimated 47 percent of Black autistic children also have an intellectual disability, compared to 27 percent of white children (Dattaro, 2020); and these delays in autism diagnosis may be a contributing factor in the high rate of intellectual disability among Black autistic children in the United States.
Constantino et al. (2020) examined the experiences of Black families affected by ASD in the United States. The researchers found that Black families were concerned about a child’s development, language, or behavior. The study consisted of interviews of 584 parents of Black children with autism. The authors compiled timelines of the Black families’ experiences, including the developmental outcomes of the autistic children and their siblings. The following sections describe the two most important findings:
Timeline To Diagnosis: The authors found a three-year delay in diagnosis. The parents first noted concerns about their child’s development around 23 months of age; told a professional six months later; and did not receive an autism diagnosis until their child was over 5 years old.
Timeline to Treatment: More than a third of the families reported long wait times to see a professional; 14 percent made at least six visits to specialists before their child was diagnosed. Nearly a third said that a lack of available professionals contributed to the diagnostic delay.
Additional Barriers: More critical than the timing of diagnosis is educating Black families about the signs of ASD. This means that due to the lack of educational information and programs for Black parents in their community, they had to learn about ASD by themselves, very often through the internet (Burkett et al., 2015; Lovelace et al., 2018). The internet is useful for accessing quick information, such as directions, office hours, etc., but can be dangerous when researching treatment options (see this article for more information). Additionally, the disparities continue beyond the time of diagnosis to access to intervention services (Constantino et al., 2020). For example, in the Čolić et al. (2021) article, Black parents reported that practitioners would assume that they did not have private insurance. When assuming someone does not have insurance, they may not be offered the benefits of treatment options that are available.. Also, as reported in Čolić et al. (2021), community-based instruction was often not offered in the belief that their neighborhood was dangerous and violent. Beyond getting a diagnosis, these confounding variables continue to impact Black families’ ability to access services.
Intellectual Disability Disproportionality – Disproportionality refers to a situation in which a particular group (e.g., racial, ethnic, etc.) are represented at a higher or lower percentage than their percentage in the general population. Although the diagnostic prevalence of autism is approximately the same across races (Mandell et al., 2009), there is a disproportionality of Black children who have a diagnosis of autism and have an intellectual disability. Similar to the findings of Dattaro (2020), the U.S. Centers for Disease Control and Prevention, show that 22% of white children with autism also have an intellectual disability but among African American children, the rate of intellectual disability in those with autism is over 44% (Dryden, 2020).
Poverty – Poverty which disproportionately affects Black families in the U.S, is associated with worse cognitive outcomes (Constantino, 2020). However, there are no links between the autistic children’s intelligence quotient (IQ) and their family’s income or parents’ education, meaning the increased prevalence of intellectual disability among Black autistic children cannot be attributed to poverty (Sohn, 2020).
Quality of Treatment: In the Magaña, Parish, and Son (2015) article, data from the 2005-2006 and 2009-2010 National Survey of Children with Special Health Care Needs were analyzed. The results indicated that racial and ethnic disparities in the quality of provider interactions were significant in both the 2005-2006 and 2009-2010 surveys, and were found to be unchanged over time. More so, these racial and ethnic disparities in healthcare quality were found to be unchanged over time. Black families were less likely than white and Latino families to feel that their provider helped them feel like a partner. They were also less likely to feel that the provider spent enough time with them; that the provider was sensitive to their family’s values; and that the provider listened to them. In my opinion, this is still a relevant issue and remains to be unchanged.
I hope I was successful sharing some of the recent research that shines a light on the myriad challenges facing Black families. I would like to now turn our attention to the final part of your question: how can myself and my colleagues better meet the needs of Black families I serve? Čolić et al (2021) identify four main areas where ABA practitioners should be especially sensitive to move towards culturally responsive ABA practice (a) build knowledge about Black cultural values, (b) show care and strengthen partnerships, (c) create culturally relevant interventions, and (d) be aware of one’s own prejudice and cultural values.
Build Knowledge about Black Cultural Values: During the initial intake and throughout the treatment, ABA practitioners, like yourself, can learn about the Black families’ culture, such as family dynamics, religious and spiritual beliefs, self-care, etc. and incorporate these considerations into treatment planning. Families should be included in the process which in term will lead to improved outcomes and program efficacy (Mathur & Rodriguez, 2021).
Show Care and Strengthen Partnerships: ABA practitioners must recognize the potential barriers Black families may have had to overcome prior to even requesting and accessing your services. Training on cultural diversity and cultural humility is needed to provide culturally responsive services. The families should feel comfortable advocating for changes to programs without feeling judged (Mathur & Rodriguez, 2021).
Create Culturally Relevant Interventions: When developing and implementing treatment goals, ABA practitioners should increase cultural humility. For example, when creating materials such as icons and pictures for communication, rule cards, visual cues, etc. the skin tone should represent that of the client, including a Black individual. When creating classroom rules and expectations, consider culturally responsive behavior management so that all students with equitable opportunities for learning. For example, use proactive language that is clear and reflects the student and the family voice.
Be Aware of One’s Own Prejudice and Cultural Values: ABA practitioners should recognize the impact that implicit bias and racism have on the efficacy and efficiency of behavioral analytic support services (Mathur & Rodriguez, 2021). Training in cultural humility should also include ABA practitioners recognizing their own implicit bias. Fong et al. (2016) illustrated how assumptions based on culture can impact a behavior analyst’s effectiveness with families of diverse backgrounds. Rather than make assumpations, seek sonculatation and supervision as needed. Treating one black family makes a practioner experienced in treating with one black family. For example, using a teaching set of community helpers who are all white males contributes to white supremacy.
Addressing the issues in the timing of diagnosis and the quality and quantity of treatment may help resolve disproportionately of Black children who have a diagnosis of autism and have an intellectual disability. I remain concerned about the implicit bias of providers that goes unchallenged, and that Black families will continue to feel unheard and not receive the same type of treatment as their white and Latino counterparts. As a BCBA, I am advocating for culturally responsive ABA practice.
References
Burkett, K., Morris, E., Manning-Courtney, P., Anthony, J., & Shambley-Ebron, D. (2015). African American families on autism diagnosis and treatment: The influence of culture. Journal of Autism and Developmental Disorders, 45(10), 3244–3254. https://doi.org/10.1007/s10803-015-2482-x.
Constantino, J. N., Abbacchi, A. M., Saulnier, C., Klaiman, C., Mandell, D. S., Zhang, Y., … & Geschwind, D. H. (2020). Timing of the diagnosis of autism in African American children. Pediatrics, 146(3).
Fong, E. H., Catagnus, R. M., Brodhead, M. T., Quigley, S., & Field, S. (2016). Developing the cultural awareness skills of behavior analysts. Behavior Analysis in Practice, 9(1), 84-94. https://doi.org/10.1007/s40617-016-0111-6.
Lovelace, T. S., Tamayo, S., & Robertson, R. E. (2018). Experiences of African American mothers of sons with autism spectrum disorder: Lessons for improving service delivery. Education and Training in Autism and Developmental Disabilities, 53(1), 3-16.
Mandell, D. S., Wiggins, L. D., Carpenter, L. A., Daniels, J., DiGuiseppi, C., Durkin, M. S., Giarelli, E., Morrier, M. J., Nicholas, J. S., Pinto-Martin, J. A., Shattuck, P. T., Thomas, K. C., Yeargin-Allsopp, M., & Kirby, R. S. (2009). Racial/ethnic disparities in the identification of children with autism spectrum disorders. American Journal of Public Health, 99(3), 493-498. https://doi.org/10.2105/AJPH.2007.131243
Magaña, S., Parish, S. L., & Son, E. (2015). Have racial and ethnic disparities in the quality of health care relationships changed for children with developmental disabilities and ASD?. American Journal on Intellectual and Developmental Disabilities, 120(6), 504-513.
Mathur, S. K., & Rodriguez, K. A. (2021). Cultural Responsiveness Curriculum for behavior analysts: A meaningful step toward social justice. Behavior Analysis in Practice, 1-9.
Beaubrun, M (2022). Clinical Corner: Understanding the needs of Black families of children with autism. Science in Autism Treatment, 19(4)
Author Bio: May Chriseline Beaubrun has been a Board Certified Behavior Analyst for over 10 years. She is currently the Director of Diversity & Training at Brett DiNovi & Associates. She has worked with children and adults with various cognitive, developmental, and physical disabilities in a variety of settings (e.g., clinic, hospital, home, school). She has completed program evaluations; developed skill acquisition programs to teach academic areas, cognitive functioning, social skills, language and communication, and adaptive skills; provided parent training; conducted functional behavior assessments (FBA); developed Behavior Intervention Plans (BIP), program evaluations and provided staff training to various levels of professionals. May has presented at the annual Autism New Jersey convention (formerly Center for Outreach and Services for the Autism Community) as well as Association for Behavior Analysis International, New Jersey Association for Behavior Analysis, and California Association for Behavior Analysis. May also was an adjunct professor at Philadelphia College of Osteopathic Medicine. May contributed a chapter to the text, A Scientific Framework for Compassion and Social Justice, on behavior analysis and urban planning. May’s areas of interest include cultural responsiveness and social justice.
Hey, it’s still the middle of Summer! Why are we talking about back to school already? Put down that pumpkin spice and get in the pool!
But seriously . . . like it or not, back to school is coming. Some students look forward to returning to school with anticipation, and some with dread. Some students who receive special education services attend school year-round. Even for these students, back-to-school may be an adjustment because the summer session may be characterized by shorter days, more recreational activities, different staff, and end a good few weeks before school restarts for the academic year.
For all children, it’s a good idea to start anticipating going back to school with some time for adjustment and planning. For students with special needs, this is especially important, as changes can be challenging. Here are some ideas for helping to ease that transition:
Talk about school and highlight the fun and exciting things they will get to do. Remember what was most reinforcing at school for your child last year, and help them to remember that, too. Did they love PE or music or art? Are they especially talented in math or writing? Do they have certain friends they like to play with at recess? Is the cafeteria pizza their absolute favorite? Is the walk to and from school something they enjoy?
Provide information about the coming year as you are able to. If your child will be starting school in a new building, make arrangements to visit the building a few times over the summer. Most schools will have these visit days or orientations arranged for all students, but you may be able to request an extra visit or two for a child who would benefit from some additional exposure.
When you make those visits, take some pictures and use them to develop a book or poster with your child that they can refer to as the summer progresses. Don’t just refer to the pictures if your child expresses anxiety or disappointment about school starting, but as a regular activity to build familiarity and (hopefully) anticipation.
Pay attention to your family sleep schedule. Sometimes the summer schedule can get a little loose, which may be great for everyone. We can all benefit from sleeping on our own natural schedule, but if that natural schedule departs in a big way from what will be needed during the school year you will want to start to gradually shift it back. To make the change less abrupt, in the weeks before school starts again, start to wake your child a bit earlier every day and get them to bed a bit earlier each night.
If your child is always an early waker, you might want to take advantage of a more relaxed summer schedule to focus on building independence in the morning routines. During the busy school year it can be challenging to take the time to let your child learn to do things independently, but summer is a great time to let them dress themselves, brush their own hair, and do other self-care tasks with your supervision.
Consider the routines that make your school-year mornings work well, and continue to practice them during less-stressful summer mornings. Keeping a reasonably structured routine throughout the summer, or reintroducing it a few weeks before school starts, can help everyone to adjust to the return to school more smoothly.
If possible, connect with parents of some of your child’s classmates and see if you can get them together over the summer. If social skills are difficult for your child, keep these playdates short and sweet. Try meeting up in enjoyable locations like the park or beach, and letting kids parallel play so that they are used to seeing each other. Pair these little gatherings with favorite snacks, fun activities that can be done together or alone (bubbles, sidewalk chalk, play-doh, jumping through a sprinkler), and remind the children that they will be seeing each other and playing more together when school starts.
For some children, school represents a return to certain demands that may not be present during the summer. If your child has sensitivities around clothing or food, you may be able to accommodate these more when they are not in school. While this is absolutely fine to do, it can be difficult if they need to abruptly shift back to different expectations when school starts again. Children who love to stay in their pajamas or bathing suits might be unhappy about school clothes, or those who get used to a hot, home-cooked lunch might not appreciate going back to sandwiches. Keeping some of these expectations part of the summer rotation can ease that stress. To whatever extent it feels comfortable and fair for your child and your family, continued exposure to school-year conventions are going to make the return to school easier for everyone.
We can all remember that going back to school is both exciting and challenging for everyone. In addition to cheering your child on as they return to a new school year and possible new challenges and triumphs, it’s equally important to be empathetic about disappointment that summer vacation is ending, and anxieties about upcoming changes. Compassionately addressing your child’s reactions to returning to school, whatever they may be, includes listening, understanding, and helping. What this looks like will be different for each child, but as a parent you have the knowledge of your unique child’s needs and strengths to provide compassionate support.
About the Author:
Dana Reinecke, Ph.D., BCBA-D is a New York State Licensed Psychologist and Licensed Behavior Analyst (LBA). Dana is an Assistant Program Director in the Applied Behavior Analysis department at Capella University, overseeing the PhD in Behavior Analysis program and mentoring doctoral learners. She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum and documentation. Dana has provided training and consultation to school districts, private schools, agencies, and families for individuals with disabilities. She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism. Current areas of research include use of technology to support students with and without disabilities, self-management training of college students with disabilities, and online teaching strategies for effective college and graduate education. Dana is a Past President of the New York State Association for Behavior Analysis (NYSABA).
Consider the different types of technology we use in our everyday lives. For example, most individuals use cell phones and computers daily. But did you know that many technology features we commonly use were initially designed for individuals with disabilities? These are called mainstream derivatives of assistive technology (AT). Take your cell phone, for example. Texting was originally intended for people with hearing challenges, and screen enlargement was initially designed for those with vision problems. As the demand for technology has increased, many AT features have become standard for all users.
Individuals with disabilities have the right to access environments that are available to all people. Accommodations are changes to conditions that provide access to the environment. AT devices are examples of accommodations that may be necessary for individuals with disabilities to allow them to overcome or circumvent barriers to their learning and living environments.
AT is defined by the Individuals with Disabilities Education Improvement Act (IDEA) in two parts: AT Technology and AT Devices. AT identifies the equipment that supports the individual in a specific area (e.g., communication, organization, activities of daily living). AT Services refer to the support or services needed to use the devices effectively. Both are integral parts of AT. For example, an individual cannot benefit from using a computer (AT device) if their caregivers and teachers have not taught them how to use it (AT Service).
The AT continuum consists of No-tech, Low-Tech, Mid-Tech, and High-Tech options designed to meet the needs of all learners:
• No-tech refers to unaided systems where an individual does not require anything beyond their body. Examples of No-Tech AT are vocalizations, verbalizations, eye gaze, or facial expressions.
• Low-Tech devices are generally comprised of materials that are easily obtainable, easy to use, low cost, and do not require a power source. Examples include graphic organizers, visual schedules, post-it notes, and manipulatives.
• Mid-tech devices, not used as often as low-tech or high-tech devices, generally require a power source. A simple switch, digital recorder, or adapted keyboard are examples of Mid-tech AT.
• High-Tech AT options are more complex, expensive to make or buy, and are usually programmable, such as a computer, iPad, AAC device, or electric wheelchair. Currently, much of AT is computerized and requires training to be used effectively.
Which type of AT is right for your child? Consider each level of AT to determine the best and most practical option for your child in their specific environment. The goal is always to foster independence. Ask, “Can your child perform the skill or task without AT?” If the answer is yes, then no AT is needed. If the answer is no, move through the continuum to find the technology that best supports their needs. Remember that high-tech devices are not necessarily superior to low and mid-tech devices. They tend to be costly and are not as easy to modify. A low-tech device is designed with simplicity and can provide users with flexibility and independence. For example, a student may benefit from using a low-tech pencil grip or a finger-spacing tool for writing rather than a high-tech mapping software or smartpen tool. Similarly, a student with organizational challenges and working memory issues may become overwhelmed with a high-tech application found on an iPad or tablet and benefit from a basic, teacher-constructed graphic organizer. In contrast, there are times when a high-tech device is the best AT choice for the learner. For example, a child may require an AAC device or application to communicate and access language.
When choosing a device, consider your child’s individual needs, the device’s practicality, and the user’s preferences and interests. Your child can benefit from using AT as it allows them to build strengths and address challenges. Remember that AT is most effective when learners are excited and motivated to incorporate its use into their learning repertoire.
Does your child have big reactions when you tell them no? Is the word no sometimes or often a trigger for your child leading to all kinds of problem behaviors?
We have to tell our kids no. No- do not run into traffic. No- do not touch a hot stove. And no- do not stray outside of the boundaries we have set as your parents. Take all the freedom you want within these boundaries, but no don’t stray.
But are there other ways to get your point across without the word no itself. If we can avoid the word that triggers the big reactions, maybe, just maybe we can avoid those meltdowns completely and spend our efforts focused on teaching and building up the good stuff.
What are some other ways to say no?
Not right now.
You can do (this) instead.
Maybe another time.
We have to do ____ right now.
Sure you can (do/have) that after you do (this) first.
Please do (this) instead.
I wish we could, but…
I’m afraid not.
I don’t think so.
Bummer! Not right now.
That’s not possible right now.
What a great idea, but not right now.
If you are telling your child to stop doing something or no, don’t do that action, try flipping your phrasing to what they CAN do instead.
From this
To that
No running.
Walk.
No jumping on the couch.
Sit on the couch.
No candy before dinner.
You can have candy at or after dinner.
No yelling.
Use your inside voice.
No grabbing.
Ask your sibling for a turn with the toy.
If the word no has been conditioned to cause an over the top reaction from your child, stop using the word no. Use other alternatives that get the same point across.
Whenever you find yourself about to say no, try to reframe it to tell your child what they can do or have instead. Give choices as much as possible.
Can I have some candy?
You can have some grapes or a banana.
Can we go to the park?
We can play trains or lego at home right now.
Child is running around the house.
You can walk in the house or run in the backyard.
No means no. But other wording also means no and is associated with a learning history of problem behavior. If something super simple like changing up our wording can help us move more quickly past the problem behavior- why not try it?! We want to spend our time and energy on teaching the more appropriate ways to communicate wants and needs instead of just dealing with problems.
Leanne Page, MEd, BCBA, is the author of Parenting with Science: Behavior Analysis Saves Mom’s Sanity. As a Behavior Analyst and a mom of two little girls, she wanted to share behavior analysis with a population who could really use it- parents!
Leanne has worked with children with disabilities for over 10 years. She earned both her Bachelor’s and Master’s degrees from Texas A&M University. She also completed ABA coursework through the University of North Texas before earning her BCBA certification in 2011. Leanne has worked as a special educator of both elementary and high school self-contained, inclusion, general education, and resource settings.
Leanne also has managed a center providing ABA services to children in 1:1 and small group settings. She has extensive experience in school and teacher training, therapist training, parent training, and providing direct services to children and families in a center-based or in-home therapy setting.
Leanne is now located in Dallas, Texas and is available for: distance BCBA and BCaBA supervision, parent training, speaking opportunities, and consultation. She can be reached via Facebook or at Lpagebcba@gmail.com.
By: Catherine L. McHugh, MA, BCBA, LBA and Thomas Zane, PhD, BCBA-D Department of Applied Behavioral Science, University of Kansas
Historically, teaching a communicative repertoire to children or individuals with autism spectrum disorder (ASD) and intellectual and developmental disabilities (IDD) focused on vocal verbal speech and modeling a speech sound with the hopes of the individual being able to imitate that sound (Charlop-Christy et al., 2002). However, prompting vocal verbal behavior is limited in comparison to a physical motor movement. Unless the individual has the ability to imitate, teaching speech sounds may be difficult (Bondy & Frost, 2001). Sign language is one potentially excellent option for teaching an alternative modality for communication. However, it also requires the individual to be able to attend to and imitate, as well as discriminate, very fine motor movements (Shwartz et al., 1998). For individuals with ASD and IDD, this may be a skill deficit making it very difficult to learn complex language. Therefore, Andy Bondy and Lori Frost turned their attention to exploring different modalities of communication that may better lend themselves to prompting and therefore result in greater contact with reinforcers. At the time of the development of Picture Exchange Communication System (PECS; Bondy & Frost, 2001), picture pointing was emerging as a form of communication; however, the individual may point to and cover the picture (i.e., preventing the communication partner from being able to see the image selected). Or they may touch the picture when no one is attending to them and therefore miss an opportunity for reinforcement resulting in possible extinction of the behavior. Bondy and Frost (2001) wanted to focus more on the communication exchange that occurs in language, so they developed a communication modality that teaches the individual to select a picture, pick it up, and place it in the hand of the communicative partner. This allows the teacher or caregiver to use physical prompts for communication and reduce the number of required prerequisite skills of the learner.
According to the seminal article by Bondy and Frost (2001), there are six steps of teaching PECS. The first focuses on the physical exchange and how to communicate. It teaches the learner the basic exchange of communication (i.e., expressing an idea to another person via the exchange of a symbol). Once the individual masters the exchange, the second step is referred to as the distance and persistence phase. This phase tests the durability of the communicative response, focusing on increasing the distance and response effort of communication such that the learner may have to travel and recruit the attention of the partner in order to contact reinforcement, as well as travel in order to access the symbols themselves. The third phase focuses on discrimination between symbols such that as more pictures are added to their system, they are able to find and exchange the picture that corresponds to the item they want. The fourth phase involves increasing the mean length of utterance and using phrases such as “I want” or “I see”. This allows the learner to move from mands (i.e., requesting) to perhaps engaging in tacts (i.e., labeling) or intraverbals (i.e., responding to questions). Phase five teaches the learner how to use PECS to answer questions and finally, phase six teaches commenting. As mentioned, not all phases need to be taught or mastered. Phase one is the building block for the remaining phases, but teaching the fundamental phase 1 exchange can have major implications for communication and other areas of the individual’s life. There are articles and manuals on how to use and teach PECS (e.g., Charlop-Christy et al., 2002; Conklin & Mayer, 2011; Frost, 2002; Paden et al., 2012; Schwartz et al., 1998), but the question remains, is there science behind PECS?
The existing research literature on PECS is vast and focuses on different phases and aspects of the system across populations with various skill sets and goals. Fortunately, researchers have produced several meta-analyses and review papers, so they will be summarized here.
For example, Preston and Carter (2009) reviewed the literature on PECS and found studies that utilized both randomized control trials (RCT) and single subject designs. The authors noted that, at the time, there had been only three experiments using RCTs and concluded that the methodology and data were insufficient for drawing any conclusions on the efficacy of PECS and encouraged future researchers to conduct more research in this area. However, Preston and Carter also noted that there was supporting evidence for PECS provided across the experiments that incorporated single subject research design methodologies. In conclusion, they found preliminary support for PECS as a communication modality for children and adults with ASD and IDD who have little or no vocal verbal language.
Sulzer-Azaroff et al. (2009) reviewed 34 peer-reviewed publications on PECS. This review included children and adult participants working with caregivers, teachers, and parents. Sulzer-Azaroff and colleagues reported that the results suggested that PECS was effective in teaching individuals who previously had no or limited functional communication, how to communicate. Most of these individuals learned new requests and some learned the more advanced phases in which they learned to describe things. When they reviewed articles that compared PECS to another modality, Sulzer-Azaroff et al. (2009) noted that the participants performed the same or better with PECS (e.g., Adkins & Axelrod, 2002). Overall, the results of this literature review further supported the use of PECS for teaching communication to non-speaking individuals.
Hart and Banda (2010) conducted a meta-analysis of the single subject research design studies on PECS. They reviewed 13 published studies and found that teaching PECS increased functional communication for all but 1 participant. They also noted some reasons why it might have been so successful for this population. First, the basic PECS procedure incorporates motivating operations (MO; Poling, Lotfizadeh, & Edwards, 2017) for teaching requests. The use of MOs presumes to increase the value of the reinforcer thereby increasing the likelihood of the individual engaging in the exchange in order to access the items. This contingency is very salient and likely a major reason why so many are able to acquire phase one of PECS so quickly. Therefore, PECS has the ability to teach someone abstract concepts using more salient stimuli and behaviors.
Schreibman and Stahmer (2014) conducted a randomized control comparison of the effects of verbal and pictorial communication on spoken language for children with autism. This study included 19 randomly assigned 2.5-year old’s who had a diagnosis of ASD that had fewer than 10 spoken words at the onset of the intervention. Participants in this study acquired about 90 spoken words on average after 6 months and about 120 spoken words after 9 months following intervention, showing strong evidence of the effectiveness of PECS.
According to these and more recent work on PECS, it appears that there is science to support the use of PECS for teaching communication to individuals with ASD and IDD across the lifespan. What is also interesting about PECS is some of the affected collateral behaviors (i.e., behaviors that were not directly targeted in the intervention) that are noted in these and other studies. First, there are some reports of vocalizations emerging while teaching PECS (e.g., Greenberg et al., 2014; Hart & Banda, 2010; Sulzer-Azaroff et al., 2009). For example, Greenberg et al. (2013) studied the amount and pattern of their participants’ vocalizations before and after PECS training. In study 1, the experimenters measured spontaneous vocalizations during and after PECS training. They saw an increase in vocalizations when compared to baseline. In study 2, participants who demonstrated limited vocalizations after study 1 were exposed to a procedure that included a time-delay prompt (i.e., waiting 3 seconds after the picture exchange to deliver the item to see if they would emit a vocalization) and verbal prompting procedures. Results of study 2 suggest that spontaneous vocalizations increased and occurred with every exchange. These results were quite promising and addressed the concern that if caregivers teach an individual to use PECS, they might not learn to vocalize. This does not seem to be the case. The emergence of vocalizations may be due to a variety of factors and is an empirical question that researchers should continue to study.
Another possible benefit of teaching PECS was reported by Hart and Banda (2010), who noted that in the studies they reviewed, there was a decrease in problem behavior for the participants who learned PECS. This is likely due to the fact that the individuals are learning functional communication skills. Functional communication training (FCT) is a procedure that teaches individuals a more appropriate way to request (i.e., communication rather and problem behavior) access to their reinforcers (Tiger et al., 2008). FCT can include a variety of communication modalities, but picture exchange is commonly used in the literature (e.g., Tiger et al., 2008). During FCT, the individual receives access to their reinforcer for a communicative response and no longer receives it for problem behavior. Therefore, they are taught a new way to get the things they need and want without engaging in problem behavior. One can also look at this from a response effort perspective. Communication is much less effort than engaging in physical aggression. Therefore, once PECS is acquired, the child may prefer this response that requires less effort and results in their preferred items.
Conclusions and Future Research
Numerous literature reviews and individual research studies provided evidence to strongly suggest that PECS can be considered an evidenced-based procedure. So, parents and caregivers can confidently use PECS to establish and shape communication in their children, with confidence that improvements are likely to be made. Furthermore, there are manuals that are both clear and comprehensive to guide the implementation of each step of the system.
Given that, continued research to establish whether or not PECS works seems unnecessary. Instead, researchers involved in studying this communication system could extend what is known about PECS along different variables and dimensions. For example, more research could be done on the extent of generalization and maintenance of PECS acquisition. Another area to address would be the preference of communication modality – that is, studying what influences an individual to select different communication systems, such as PECS, signs, or speech. Although some small n studies have been done on this (e.g., Tincani, 2004), it remains a very fruitful avenue to explore. Finally, it would be helpful to develop a more comprehensive literature based on the issue of whether the acquisition of PECS is responsible for a reduction in behavior problems and a spontaneous increase in spontaneous vocalizations.
The experimental research shows that PECS is an evidenced-based procedure. When working with individuals with communication impairments, PECS can be used to establish foundational or complex communication. Since communication deficits are one of the common symptoms of ASD, this particular procedure is a very welcomed and needed intervention approach.
About the Authors
Catherine McHugh, M.A., BCBA, LBA-KS is a doctoral student in Dr. Claudia Dozier’s lab at the University of Kansas in the Applied Behavioral Science Department. She a Board-Certified Behavior Analyst and a Licensed Behavior Analyst in the state of Kansas. Catherine completed her Masters of Applied Disability Studies and then a Masters of Arts with a focus in Applied Behavior Analysis at Brock University, St. Catharines, Ontario, Canada. She is the Vice President of the Graduate Student Organization for the Applied Behavioral Science Department at the University of Kansas. Catherine has worked with individuals with intellectual and developmental disabilities across the lifespan from children to older adults who engage in severe problem behavior.
Dr. Thomas Zane is a Professor of Practice and the Director of Online Programs in Behavior Analysis in the Department of Applied Behavioral Science at the University of Kansas. Dr. Zane earned his Bachelor’s and Master’s degree in psychology at Western Michigan University and his doctorate in Applied Behavior Analysis at West Virginia University. He has served as a Post-Doctorate Research Associate at the University of Massachusetts and as a Research Scientist at Johns Hopkins University Department of Psychiatry. Dr. Zane serves on the Executive Board of the Cambridge Center for Behavioral Studies, the international organization that represents the field of behavior analysis. He is also a member of the Scientific Council of the Organization of Autism Research, a group that funds innovative research in Autism Spectrum Disorders. Dr. Zane has been past President of the Ethics Special Interest Group of the International Association for Behavior Analysis. His research interests include online learning, evidenced-based practice in autism, and the philosophy of science and radical behaviorism. He is particularly interested in why some behavior analysts drift from the code and the importance of adhering to choosing scientifically-supported treatments in clinical and educational work.
References
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Citation for this article:
McHugh, C. L., & Zane, T. (2022). Picture Exchange Communication System: Is there science behind that? Science in Autism Treatment, 19(5).
