This month’s ASAT feature comes to us from Karen Parenti, MS, PsyD. 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 am a parent of a young man with autism. I also work in the area of law enforcement. What are some important considerations when teaching first responders and law enforcement personnel how to interact with individuals with an autism spectrum disorder?

This is a very important question and one on which many local communities are focused. In addition, treatment of individuals with autism spectrum disorders (ASD) by law enforcement is a common worry for parents. As such, the topic requires training to increase awareness of ASD for first responders and local community members, as well as collaboration between service providers and law enforcement. As in any crisis situation, it is important to focus on positive and preventative approaches, as most behavioral crises with individuals with ASD can be prevented or lessened. To promote awareness on the part of first responders and prevent crises, ASD service providers should proactively prepare individuals with ASD for a possible encounter with emergency personnel and law enforcement using understandable language, pictures, books, or video models about emergencies so they know what to expect and how to respond. Additionally, building rapport and familiarity between individuals with ASD and local police might help ensure the person with ASD perceives the first responder as a helper when a behavioral or medical event occurs. In many cases, situations will arise that require emergency intervention by first responders because of the unique challenges and behavioral escalations that commonly occur with individuals with ASD. Therefore, training for first responders is of the utmost importance.

Police officers expertly respond to a large number and variety of emergency situations on a daily basis. Each emergency situation has its own unique characteristics, and so do the individuals involved in that crisis. First responders and police receive standard and rigorous training on how to respond to emergencies compassionately and effectively. This training, while appropriate and efficient for the vast majority of situations, is not necessarily the best way to respond to a child or adult who is diagnosed with ASD. This can lead to an outcome such as this example of how an unfortunate misunderstanding can result in tragedy.

Whether the emergency is a medical or behavioral crisis, understanding ASD and how someone with ASD might behave is crucial to ensuring a favorable resolution to the incident. Individuals diagnosed with autism may have heightened emotional responses in these volatile and stressful situations. For persons with ASD, emergencies are difficult to comprehend. During these confusing events, a person with ASD may fail to respond to vocal directions, may exhibit a startle response when touched, may run when addressed, or may engage in self-injurious or aggressive behavior.

For emergency responders, interacting with individuals with ASD can be ambiguous and unpredictable. Therefore, it is essential that emergency personnel learn to respond as sensitively and efficiently as possible to individuals diagnosed with ASD, so attempts to speak with or care for the individual does not inadvertently cause the individual’s behavior to escalate. As you may know, this is especially important during a medical crisis because individuals with autism cannot always communicate feelings of pain or discomfort. A person with ASD may already be feeling frustrated and possibly agitated by his or her inability to convey his or her experiences and needs, thus when approached that individual may respond in an unpredictable and unconventional manner. It is important that first responders be prepared for such unusual responses, incongruent emotions, and failure to respond to directives and questions.

In addition to providing police officers and first responders with information about autism symptoms more generally, an important next step is to teach first responders how individuals with ASD might behave in a crisis. In particular, emergency personnel need to understand how individuals with ASD might act when they are agitated, confused, overwhelmed, or in pain.

A Child or an Adult Diagnosed with an Autism Spectrum Disorder May:
• Avoid eye contact.
• Walk away from familial residence or a group home to local pools or other places they enjoy. They may wander into traffic, not understanding environmental dangers.
• Be overstimulated and not comply appropriately to police or first responders’ instructions. For example, they may not respond to directives such as “get out of the street” or “let me see your hands.”
• Become preoccupied with certain objects or interests, such as planes, trains, fire trucks, or movies.
• Repeat or echo phrases, words, or actions.
• Not know how to relate, talk, or play with others.
• Have sensory sensitivity, manifested by stereotypical behaviors which may include covering their ears, flapping their hands, spinning, toe walking, or making unusual noises among others.
• Become agitated due to the disruption in their routine.
• Have unusual reactions to the way things in the environment look, feel, smell, sound, or taste.
• Be nonverbal and unable to communicate effectively.
• If verbal, may have difficulty understanding questions or may respond noncontextually. For example, they may simply script from a movie or speak about their special interests or ask repeated questions about the responder’s personal life.
• Be unable to communicate that they are in pain.

A first responder will be able to interact more appropriately with a person with autism if he or she is able to recognize that the person may have ASD. Once the first responder has learned to make this identification, he or she should become familiar with the following crisis response and intervention safety habits.

Crisis Response and Safety Habits:
• Take 30 seconds to assess the situation and the scene before responding.
• Remain calm.
• Use an even, controlled tone of voice with minimal directives, including simple phrases and visual cues such as pointing or using simple gestures that may be easily understood by minimally verbal individuals.
• Pay close attention to the person’s body language, tone of voice, gestures, and any other signs of potential agitation.
• Practice trauma-informed care and assume that everyone has experienced some type of trauma and is easily startled.
• Respect personal space, except when it is absolutely necessary to approach the person. Remember that getting too close may increase agitation in some individuals with ASD.
• Assess the situation objectively and ask the person or someone familiar with the individual with ASD what he or she wants/needs while maintaining a safe distance.
• Reduce stimulation and allow time and space for the person to process information and requests. For example, it might be helpful to clear the area of additional people, turn off the lights of the emergency vehicles, and eliminate other extraneous noises as possible.
• Be prepared and practice situational awareness. Know your surroundings and the location of the closest exit.
• Deflect aggression and block self-abuse when possible.
• If a physical intervention is necessary because the situation is unsafe, establish control in a safe, non-threatening manner. Remind the person that you are there to help.
• Recruit familiar and trusted persons to assist you in understanding how to approach the individual.

When police officers and first responders receive training in interacting and treating individuals with ASD, incidents in the community may be resolved quicker and more effectively. With quality training, headlines reporting distressing incidents, such as that above, may be a thing of the past. Instead, the type of training discussed here, when offered regularly to our dedicated police officers and first responders, could result in positive approaches similar to this:

Autism awareness is essential for all members of the larger community, but is truly imperative for first responders. In the absence of information, first responders may misinterpret the behavior of a person with ASD, may ascribe hostile intent to agitated behavior, may inadvertently escalate the behavior of the individual, or may fail to safely calm the individual. In cases such as these, there can be dangerous consequences. An opportunity exists for ASD service provider agencies to provide specialized training to local first responders. Providers can contact law enforcement officials and other emergency personnel to offer informational training sessions on a local level. In our experience, the administrators are routinely grateful and accommodating about arranging such training.

First responders need a dual skill set. First, they need accurate information about persons with ASD, including their behavioral characteristics, and secondly, they must use skills to de-escalate the situation when they engage with a person with autism who is in a confused and agitated state. With community outreach, negative outcomes can be averted, bridges can be built, and wider acceptance of persons with ASD can become a reality.

The following resource provides additional information related to first responders:
• Living with Autism – Autism Information for Law Enforcement and other First Responders
• Training for Indiana’s First Responders: Recognizing and Responding Appropriately to Individuals with Autism Spectrum Disorders
• Living with Autism – Autism Information for Law Enforcement and other First Responders
The reader may also be interested in the following ASAT articles:
• Teaching Safety Skills to Adolescents
• Bolting and Neighborhood Safety

Citation for this article:
Parenti, K. (2017). Clinical Corner: First responders’ education in autism. Science in Autism Treatment, 14(4), 6-8.

About The Author

Dr. Karen Parenti serves as the Executive Director of Melmark PA. Karen oversees the development and implementation of programs, as well as the daily operations of Melmark PA. She develops strategic objectives for the Pennsylvania Division, and provides leadership to direct reports in order to assure the achievement of these objectives. Karen also supports the CEO and the Board of Directors through various committees and activities, assuming responsibility for excellence in care and delivery of all services, policy development, quality assurance, risk management, regulatory compliance, and fiscal integrity. Joining Melmark in April 2016, Karen served as Senior Director of Adult Services. In this role, she was responsible for the oversight of all adult day and vocational programs, as well as the adult campus and community residential programs, which include intermediate care facilities that serve individuals with intense medical challenges. She has also served in the role of clinical trainer by teaching crisis prevention and intervention, dual diagnoses, ethics and boundaries, abuse prevention, and behavioral strategies. Karen earned her doctorate degree in clinical psychology, with a concentration in neuropsychology, from Immaculata University. A graduate of York College, Karen also holds a master’s degree in Human Services Administration from Springfield College in Wilmington, Delaware.

Differential Reinforcement of High Rates of Behavior (DRH) is “reinforcing only after several responses occur at or above a pre-established rate” (Mayer, Sulzer-Azaroff, & Wallace, 2013). There are times when a behavior is already in a student’s repertoire, but you may want to increase the rate of the behavior.

For example, let’s say Harold frequently won’t get up independently on weekdays before school. It’s driving his parents crazy, because they have to drag him out of bed several days a week. You may set up a DRH to increase the rate of him getting up independently. Since Harold currently gets up independently at least one time per week, you would set the goal for two times per week. (You don’t want to set the goal too high, because then Harold might not ever come into contact with reinforcement, and his behavior will likely remain unchanged.) Let Harold know that if he gets up independently two days in a row, you will make his favorite breakfast on the second day. Once Harold has met this goal a few time, increase the requirement for reinforcement. You would move from two days in a row to three days in a row in order to receive his favorite breakfast.

You would continue this until you had reached a pre-arranged goal. It’s important to be realistic in our expectations. You don’t want to change the goal to quickly or make it unreachable. You also don’t want to place higher demands on an individual with disabilities than you do the general population (as discussed in our previous Simplifying the Science article). Many people, for instance, hit the snooze button several times before they actually get up, so it may not be necessary to require an individual with disabilities to wake up the very first time the alarm clock rings 100% of the time.

You may discover that your intervention with Harold is working quite well for a couple weeks, then suddenly stops working. You may need to backtrack a bit, and require fewer consecutive days of independently waking up. Or, you may need to vary the reinforcement. It’s possible that having his favorite breakfast has lost some of its power as a reinforcer.

Finally, after the behavior has reached your goal rate, you should begin to fade the reinforcement entirely. Of course, Harold should still have access to his favorite breakfast, but you should not continue to give it to him on the fifth consecutive day of waking up independently for years to come!

DRH is yet another variation of differential reinforcement that can be very useful for you. It’s also provides an opportunity for a much more positive interaction than introducing punishment to Harold for not waking up independently, and can decrease everyone’s stress levels at the beginning of the day.

About The Author

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

This month’s ASAT feature comes to us from Heyde Ramirez, MA, BCBA, LBA and Maria Pantelides, MA, BCBA, LBA. 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! You can read more of our ASAT featured posts here.

My 3-year-old daughter demonstrates symptoms of ASD and a diagnosis is pending.  I am encountering an array of professionals and am wondering who does what and how I can better understand these relationships while advocating for my daughter. 

Answered by Heyde Ramirez, MA, BCBA, LBA and Maria Pantelides, MA, BCBA, LBA

Attentive Behavior Care

Note: This article has been adapted with permission from Attentive Behavior Care and the authors and will be published in the December 2019 issue of Science in Autism Treatment, the monthly publication of the Association for Science in Autism Treatment.

The definition of the word advocate is to speak, plead, or argue in favor of. When you have a child with special needs, one of the biggest roles you will ever undertake is that of being your child’s advocate. As an advocate, you are your daughter’s voice to make sure she is treated fairly, recognized, and afforded access to evidence-based practices, as well as all the services and resources she needs in order to reach her full potential. Naturally, a parent is often the most important advocate although a child can have multiple advocates: for example, a lawyer or another family member.

Things You Should Know

Early intensive intervention will provide your daughter with a path to making the most gains. It will be important that intervention starts as soon as possible following a diagnosis, and is carried out by individuals who utilize best practices based on research.

Be prepared to present facts and documentation in support of getting your daughter’s needs met. It is important that you ask many questions, listen to the answers closely, and take lots of notes. Save all emails so you can refer back to them in the future and have a record of the communications regarding your daughter’s service provision.

It is also important that you know your child’s rights. The disability and mental health systems are complex. Having a knowledgeable “advocate” to assist you can be an invaluable support. Talk to other parents who have walked this path before you so you can learn from their experiences. Each state has their own set of laws and regulations, so it could be helpful to hire a lawyer if needed.

In your journey, you and your daughter will encounter an array of professionals:

Medical Providers

Medical providers will be your go-to resource when it comes to making sure that your child’s medical needs are met. They were probably your first contact, especially since your daughter is not yet in school.  Your child’s medical team may include several types of medical doctors.

Pediatrician/Primary Care Doctor: The pediatrician will oversee and manage your daughter’s health needs and monitor her development. At check-up visits, talk to the pediatrician about your concerns. Remember that your medical providers rely on the information you report.

Keep your pediatrician apprised of progress your daughter is making and any areas where you continue to have concerns.

Pediatric Dentist: The pediatric dentist has been trained to treat children from birth to adolescence. Dental visits can be difficult if your child has autism. Fill in the dentist on your daughter’s needs. Nowadays there are many pediatric dental clinics available that are willing to follow through with behavior intervention plans and work with you to make the dental visit less stressful for your daughter. Ask your pediatrician for a referral or talk with other parents who are happy with their dental care providers (please see a recently published resource list from ASAT).

Psychiatrist/Psychologist: If your daughter demonstrates various symptoms not related to an ASD diagnosis, then contact with a psychiatrist or psychologist would be beneficial. Other diagnoses can be extremely important when it comes to receiving the necessary individualized treatments which may include medication. In some cases, assessment is carried out by a psychologist who typically holds a PhD or a PsyD rather than a medical degree. A psychologist could provide counseling or behavioral treatment for behaviors that occur.

As an advocate for your child, you can seek out a comprehensive psychiatric/psychological evaluation for your child. These evaluations provide important information that should be shared with the entire team. The information provided can include, but is not limited to, direct observations, parental reports, autism diagnostic testing results, IQ testing results, findings from measures of adaptive behavior, other potential diagnoses, and recommendations for treatment. If anything you read is not clear or seems inaccurate, be sure to ask questions.

The School Team

Children spend a large portion of their lives learning, sharing meals, and socializing in school, and teachers, teacher’s assistants, and other school staff will get to know your child on an individual and personal level. The school team will quickly learn about how your child functions in school and what goals might be needed to ensure her success in school. If your daughter were to be diagnosed with ASD, you will likely meet with the school team several times a year at parent-teacher conferences and other meetings such as Individualized Education Plan (IEP) meetings.

Federal law provides for procedural safeguards to ensure your child receives the supports and accommodations needed to help her make progress and work towards her potential. If you feel that your daughter is not making progress or that the school is not meeting her needs, speak up and ask questions! Include related documentation to support or convey your concerns.

Special Education Teacher/General Education Teacher: Depending on the needs of your daughter and what type of classroom she is in, she may receive instruction from a special education teacher and/or a general education teacher. Special education teachers are trained to work with students who present with various disabilities. In general, teachers make themselves formally available to discuss academic growth at least twice a year at parent-teacher conferences. When you have questions or concerns about your daughter’s academic or social progress at school, request extra meetings with teachers or the school team.  If there are barriers in place that are slowing progress, the teacher can work with you and the team in order to address those barriers.

Teacher’s Assistants and Aides (Paraprofessionals): It’s possible for your daughter to have multiple teacher’s aides in the classroom. Their role is to assist the teacher in maintaining a safe and effective teaching environment. They may implement the education and behavior intervention plans developed for your child and/or other accommodations made so that your daughter has the appropriate support to work towards mastery of the goals on her IEP. There can be limitations on what exactly the teacher’s aide can do and this can vary by state. For example, in New York, a teacher’s aide with a teaching assistant certificate is allowed to provide direct instruction to students under the supervision of the certified teacher. You can request that the teacher’s aides also be present during team meetings. They will also know your child very well and may be able to provide additional information on how your daughter is doing.

Related Service Providers

If your child has an Individualized Education Plan (IEP) there is a chance she has a team that includes various therapists such as speech/language, occupational, and physical therapists. In some states, a prescription is necessary to receive a related service, such as occupational therapy. Keep the pediatrician up to date on the information you receive from related service providers.

Speech/Language Pathologists: Speech language pathologists (SLP) are trained to prevent, assess, diagnose, and treat speech, language, and communication disorders in children and adults. Many have also received training to address feeding issues. Whether your child is non-vocal, has difficulties being understood, gags when trying to swallow food, or presents with other communication or speech deficits, a speech/language pathologist can be a great resource and valuable member of the team. You can request that your daughter be evaluated and that goals be developed to increase your daughter’s receptive and expressive communication abilities.

Occupational/Physical therapists: These providers are recommended when your child has motor difficulties completing everyday activities. Occupational and physical therapists do their best to help your child develop and improve their fine and gross motor skills so that they can interact with their environment as independently as possible. Occupational Therapists typically focus on assessment and treatment of activities of daily living (such as eating, dressing, playing) and physical therapists focus on gross motor skills (e.g., walking, climbing stairs).  As an advocate, present your concerns regarding what your child can and cannot do. The aim is always to increase independence. For example, the ability to open a container can actually be life-changing.

ABA Providers

Applied behavior analysis is the treatment of choice for ASD as it is an evidence-based practice. So, you may have contact with providers who specialize in this method. The Board Certified Behavior Analyst (BCBA) and Registered Behavior Technicians (RBT) may be invaluable members of your team, particularly if your daughter is receiving services in the home or in an early intervention setting. Some schools may not have BCBA’s or RBT’s on staff and School Psychologists may be responsible for intervention development.

Board Certified Behavior Analyst (BCBA): The BCBA on your child’s team is responsible for assessing your child’s current ability and any barriers to learning that may be present. A certified behavior analyst conducts functional assessments in order to identify problematic behaviors, the events that trigger them, why behaviors are occurring (e.g., is it to get away from something, to gain access to something), and possible replacement behavior that can be taught. The BCBA on your team may provide you with training so that you can also implement recommended strategies with your child. They are also prepared to work with the team to best serve your child and increase her quality of life. In some cases, the school psychologist will fulfill this role.

Registered Behavior Technician (RBT): Registered Behavior technicians implement the behavior and skill acquisition treatment plan and collect data as directed by the BCBA.

All of these people come together and form a team that also includes the family and of course, your child. As you step into this new role as an advocate for your child, take advantage of supports and resources that are available to you. Members of the team may recommend webinars or other materials that will provide you accurate up-to-date information about the challenges your daughter faces and effective interventions.

Additional Resources

• American Academy of Pediatrics

• Association for Science in Autism Treatment
• Healthy Children.org
• Organization for Autism Research
• Autism Speaks
• Autism New Jersey
• Asperger/Autism Network
• Behavior Analyst Certification Board

For more information about Attentive Behavior Care and how we can help your child, please visit our website and contact us today.

Heyde Ramirez received her Bachelor’s Degree in Psychology and her Master’s Degree in Applied Behavior Analysis from Queens College in 2012. As part of her graduate course work, Heyde worked with students with Autism and subsequently published a study on simultaneous prompting procedures. Following graduation, she became a Board Certified Behavior Analyst (BCBA) and continued to work with individuals with Autism and other developmental disabilities across various settings providing direct therapy, BCBA supervision, parent training, assessment and treatment planning.

Maria Pantelides is a Board-Certified Behavior Analyst and Licensed Behavior Analyst in the states of Connecticut, Maryland, Massachusetts, and New York with over 10 years of experience working with children, teens, and adults with autism and providing ABA services. Maria earned her Bachelor of Arts degree in Psychology with honors and her Masters of Arts degree in General Psychology with a focus in Applied Behavior Analysis, from Queens College, City University of New York. Maria has provided one to one instruction, supervision, training, parent training, and consultation to home and school programs. Maria specialized in the treatment of children with autism in both the home, community, and school setting. Maria is currently a Regional Clinical Director with Attentive Behavior Mental Health Counseling, PC. As Regional Clinical Director she supports and monitors BCBAs, technicians, and families in getting quality ABA services.

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

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

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

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

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

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

Written by Sam Blanco, PhD, LBA, BCBA

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

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

For Preschool & Elementary Children

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

For Teenagers

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

For All Children

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

Written by Sam Blanco, PhD, LBA, BCBA

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

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

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

Here are a few things to consider:

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

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

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

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

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

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

Written by Sam Blanco, PhD, LBA, BCBA

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

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

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

From aacinstitute.org

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

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

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

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

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

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

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

Written by Sam Blanco, PhD, LBA, BCBA

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