A Perspective on Today’s ABA

This piece was originally posted on Dr. Greg Hanley’s website and has been shared with permission. Visit his website for more information as well as free resources on ABA for educators and parents: https://practicalfunctionalassessment.com

This is today’s ABA when starting therapy with an autistic person, especially one who routinely engages in problem behavior. 

Today’s ABA (applied behavior analysis) is about continually learning about the predilections of the autistic person being served so that preferred learning contexts can be developed en route to developing skills that can be appreciated by the autistic person as well as others. What follows is a guide for those implementing today’s ABA but written for those who are curious about what today’s ABA involves.

Learn by listening.

Ask the autistic person and/or ask people who know and love the autistic person about what he/she/they loves and hates. Be sure to review the love, aversion, and indifference towards activities, objects, furniture, contexts, and especially social interactions. Ask that person about the autistic person’s voice. How do they routinely communicate? And, especially, what are they communicating with their problem behavior? In other words, today’s ABA starts with asking questions, listening, and learning about the autistic person by people who know and love the autistic person.

Learn by creating joy.

From that conversation, put together a context in which the autistic person will be happy, relaxed, and engaged, one in which they will feel safe and in control. Enrich this space with all of the objects and activities that they love. Don’t be stingy with the stuff–more is better. Be sure to include all the things that they have lost in the past because they could not handle their removal or because they engaged with them in unique, stigmatizing, or disruptive ways.

Do not restrict in any way their freedom to do or move. Keep the door open. Follow their lead, physically and conversationally. Let the autistic person bring other materials to this context, remove materials from this context, reposition objects and people in this context, and essentially redesign it with either their actions or words.

Be sure to create clear signals of your submission (i.e., remove all signals of dominance—hovering too close or standing above them). During this time, avoid all acts of redirection, prompting, teaching, questioning, and language expansion. Be 100% available to the autistic person but do not add your “two-cents” to the situation unless asked. Reserve even praise unless the autistic person initiates by sharing what they are doing or just did with you and you are authentically impressed. Do not supervise the experience; share in it without taking it over in any way.

Respond to all attempts to communicate–this will happen the sooner you stop trying to lead the situation. Help them, for instance, not when they struggle, but when they indicate they would like assistance. Be earnest in your attempts to help even when you are not sure how to do so. Do not let any behavior towards you be ignored; react to their behavior in normal ways, just do not attempt inspire the next interaction—let them lead.

Continue revising the context and your manner of interaction until the autistic person does not want to be anywhere but there. Let them “vote with their feet.” Besides being dignifying and avoiding regrettable physical management, allowing them to leave the space provides good information. Leaving means something important is missing or something aversive is present. Keep working on building and refining the context until the autistic person is happy, relaxed, and engaged for an extended period. Recognize that happy, relaxed, and engaged looks very different for different autistic persons, which is why it is essential that someone who knows and loves the autistic person is present at this and the next step of the process.

In sum, teach the autistic person that you know them, you see them, you hear them, and you are there for them. This is the first and crucial step in today’s ABA.

Learn by empowering.

After you are confident that you can create a safe and engaging context and there is zero probability of any severe problem behavior in this context, it is time to empower the autistic person further and establish trust between you and the autistic person. It starts by clearly signaling that the prevailing conditions are about to change, and for the worse, but be clear and kind about it. Through normal actions and words, make it clear to the autistic person that you would like them to stop what they are doing, set aside their materials, move in a different direction, inhibit any self-stimulatory behavior, and transition to an area in which developmentally appropriate instruction/expectations will commence. Be sure this area of high expectations is set aside to some extent and populated with all the challenging activities and expectations reported by those who know and love this autistic person as important for his/her/their development.

If the autistic person shows any explicit sign of distress, discomfort, or protest in the form of either minor or severe problem behavior while transitioning from essentially their way to your way, acknowledge it immediately and relent. Let the autistic person return to their way and resume following their lead until he/she/they gets back to their version of happy, relaxed, and engaged for a short period.

Repeat this process until it is obvious that the autistic person is empowered and understands that they do not need to comply against their will and they do not need to escalate to escape or avoid the things they don’t want or obtain the things they do want. Teach them that you see them, hear them, and understand them even more now, despite the sometimes lack of precision or general acceptability of their communication.  Teach them to trust you.  In this period, be clear, be alert, be quick, and be consistent. From this resetting of the relationship, you will eventually restore balance and be able reintroduce the ambiguity and challenges of life without problem behavior returning.

Learn while teaching.

The path to a joyous lifestyle for families with autistic persons is paved with skills. The big pavers are play/leisure skills, communication, toleration, and cooperation. Once these are set, the branching paths are endless. Today’s ABA process continues by replacing the behavior revealed in the empowerment phase with an easier one that will be better received by others. The process involves gradually introducing ambiguity as to whether the new communication skill will work and by stretching the periods of cooperation. The pace and aims of this treatment process are continually informed by feedback provided by the autistic person, both in terms of what they say and do. Gone are the days of working through problem behavior and negative emotional responses—those are indictors that the treatment process needs to be adjusted, and not at the team meeting, but at that moment.

This treatment process is one in which the starting point is a happy, relaxed, and engaged autistic person. The themes of I see you, I hear you, I understand you, and I am here for you persist throughout the entire process. It bears repeating that there is no obligation to teach while children are upset in any way or under any duress. Hasty efforts at promoting compliance or assessing the developmental status of an autistic person are not championed in this process. That which is championed is establishing trust, engagement, authenticity, and agency. Cooperation in shared experiences follows. Acknowledged in this process is that skills will be learned both during therapist-, teacher-, and parent-led times as well as during times in which the autistic person is leading. Also recognized is the understanding that developmental assessment is best undertaken once trust and persistence in difficult tasks has been established.

Today’s ABA is trauma-informed. It is to be assumed that any person in the care of a behavior analyst for problem behavior has experienced multiple adverse events, with many exceeding the criteria for acknowledging that trauma has been experienced. By learning through listening; by enriching therapeutic contexts; by building and maintaining trust; by following one’s lead; by relying on personalized contexts in which people are happy, relaxed, and engaged; by listening to communication bids; by not working people through noncompliance or emotional duress; by allowing people to walk away; by making decisions based on performance; and by teaching from joy; today’s ABA is trauma-informed.

Final Reflections

Our world, our country, and yes, our little field of ABA are at all at their own crossroads. The time to reconsider the status quo is now, whether it be as mundane as how to work in an office and socialize in restaurants or as profound as dismantling systemic racism. Our issues in ABA are somewhere in between but I daresay that our issues share challenges associated with getting back to work in the midst of the coronavirus and addressing injustices for people of color, especially black people in America.  Let’s learn from others, especially those expert in public health policy, human rights, and criminal justice as we make our way. But let us not wait any longer to get on the right side of history.

Ours is not to dominate but to de-escalate or better yet prevent escalation in the first place. Ours is not to coerce (thank you Murray Sidman!) but to listen, learn, guide, and coach. Ours is not to redirect, restrain, or merely manage and modify. Ours is to understand, share, and shape. Ours is to prioritize safety, rapport, and the televisibility of what we do above all else. We have proven that meaningful outcomes can follow when we prioritize these things (see www.practicalfunctionalassessment.com ).

To those who do not know this as ABA or who downright despise ABA: I hear you and I understand where the confusion or hatred comes from. I acknowledge that our field has been associated with wrongs on its journey of helping autistic people and members of underserved populations (i.e., those with intellectual disabilities). Our collective attempts at helping are better now than they were, and both research and practice reveal to me that behavior analysts doing better is continuing. I also recognize that improvement is not inevitable just because we embrace a form of scientific method. Values-based movements have been displaced from ABA in the name of science for as long as ABA has been in existence. This is a sad and uncomfortable truth, but one within our power to address if we listen to the voices of dissent that have been marginalized for too long.

ABA has the potential to inflict trauma, and it has the potential to alleviate trauma. I don’t want to wait for some horrific incident being recorded for fundamental change to take place. I have been attempting to correct my mistakes and improve the way I do ABA through research, authentic practice, consulting, and especially listening to other voices outside my choir for many years. I won’t make excuses for my behavior or that of other BCBAs. I simply apologize. I apologize for not doing more, saying more, pushing more, or disrupting more. Consider this a step in the direction towards self-awareness, improvement, transparency, accountability, and an obvious commitment to protecting the rights of those we serve. I hope you will join me on this quickening walk towards a more perfect ABA to help families of autistic persons whose lives are negatively impacted by problem behavior.

About The Author

Dr. Hanley has been applying the principles of learning to improve socially important behaviors of children and adults with and without disabilities for 29 years. He started in direct care and management roles in ICFs/MR (1990-1994), worked on the Neurobehavioral Unit at the Kennedy Krieger Institute (1994-1997), was degreed at the University of Florida (2001), was tenured at the University of Kansas (2006), and developed and directed the Behavior Analysis Doctoral Program and Life Skills Clinic at Western New England University (WNEU; 2007-2019).

Dr. Hanley is a Fellow of the American Psychological Association (Div. 25), past Associate Editor of The Behavior Analyst, and past Editor of Behavior Analysis in Practice and of the Journal of Applied Behavior Analysis. He has published over 100 articles in peer-reviewed journals and book chapters primarily focused on the assessment, treatment, and prevention of problem behavior and sleep problems, teaching strategies for developing life skills, and empirically-derived values for practitioners.

Dr. Hanley currently advises doctoral candidates as a Research Professor at WNEU, serves as an Adjunct Professor of Psychiatry at the University of Massachusetts Medical School, and leads FTF Behavioral, the international training and consulting group based in Worcester, Massachusetts.

Posted in ABA

How can I teach telephone skills at home?

This month’s ASAT feature is from Chante Glick, MEd, BCBA, LBA and David Celiberti, PhD, BCBA-D. 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!

My child can no longer attend school or therapies due to COVID-19, and we are staying home to avoid transmission of the virus. I’d like my child to remain connected to her grandparents and other family members during this uncertain time, but she isn’t great at talking on the phone. Her grandparents would be so happy to be able to talk with her. Is there anything I can do to help her learn to have phone conversations?

Answered by Chante Glick, MEd, BCBA, LBA and David Celiberti, PhD, BCBA-D
Association for Science in Autism Treatment

Yes! Maintaining social relationships while keeping physical distance is both incredibly important yet difficult. But by working on telephone skills with your child, you can both help her maintain important social and conversational skills and also help deepen her relationship with her grandparents and other family members. Since we don’t know your child, we can’t give specific advice, but we’ll share examples of skills that could be taught and a variety of teaching strategies you could use. Finally, we’ll share detailed examples of how you could put it all together.

Many social and pragmatic language skills go into a telephone conversation. You might know exactly which ones your daughter needs to work on based on your observations of her existing phone conversations. If not, you could watch for this during your next few phone calls to identify strengths and deficits.  You can also reach out to your child’s teacher, speech therapist, or behavior analyst, and get their input. Generally, consider starting with some emerging skills (ones that your child can already do to some extent but not really well or not consistently) instead of brand new and difficult skills. This may allow faster progress and more enjoyable phone conversations. Here are some skills that would lend themselves to phone practice. Some of them are skills in using the phone itself; others are general conversation skills that can be practiced on the phone. These examples cover skills for a range of ages and skill levels.

Specific Phone Skills

Dialing the phone●     Dialing a number
●     Finding and tapping a name
●     Finding and tapping a picture
●     Hanging up if there is no answer (see below for messages)
Beginning a conversation●     Saying “hello” via voice or communication system (consider a video chat if your child uses sign or gestures)
●     Learning a sequence of identifying self, asking for conversation partner, checking if it’s a good time to talk, asking how they are
Answering a call●     Picking up a ringing phone
●     Responding to partner’s questions (e.g., “Is this Annie?”)
●     Passing phone to requested person
Messages●     Writing down a message
●     After hearing a message, walking to a parent and relaying the message
●     Leaving a message on a voicemail
Making calls for specific purposes●     Ordering food
●     Asking for information (e.g., “Do you have any eggs?” or “What time do you close?”)
Ending a phone conversation●     Saying goodbye
●     Explaining why you need to go (e.g., “My mom’s calling me for dinner…”)
●     Reciprocating expressions of affection (e.g., “I love you too.” “Me too.”)
●     Hanging up the phone/Disconnecting call
Safety Skills●     Answering calls when other family members aren’t home (should she answer the phone, only answer calls from people she knows, or only answer calls from parents)?
●     Checking in with family members at designated times
●     Calling 911 or other emergency numbers
●     Responding to inappropriate questions (e.g., “Are you home alone?”) or marketing and spam calls

General Conversation Skills

Answering questions●     Answering yes/no questions “Did you go to school today?”
●     Answering WH questions about a tangible item shared via video conference “What did Grandma send you?” (while opening a gift)
●     Answering WH questions about past events “What did you have for breakfast?”
●     Answering WH questions about future events “What are you going to have for lunch?”
Trading Statements and Questions●     Saying, “I’m having pizza” when a partner says, “I’m having spaghetti for dinner.”
●     When a partner says “What did you do today?”, answering “I played outside… What did you do today?
Asking Follow Up Questions●     Asking “What?” when the partner says, “Guess what.”
●     Asking “What’s wrong?” when a partner says, “I am not feeling well.”
●     Asking “What did you have?” when the partner says, “I made a delicious breakfast.”
●     Asking “What did you watch?  when a partner says, “I watched a very funny thing on TV.”
Changing Topics●     Introducing a new topic (e.g., “I want to tell you about what I saw outside.”)
●     Discussing the new topic that the conversational partner brings up.
●     Waiting for a break in conversation and politely changing the topic.
Repairing Conversations●     Repeating self when asked “What did you say?”
●     Increasing volume when told “I can’t hear you.”
●     Asking a partner to repeat themself “What did you say? I couldn’t hear you…”
●     Asking clarifying questions “Did you say you are mad?…. Oh, sad.”
Reading Between the Lines●     Identifying conversation partners’ emotion from their tone of voice.
●     Identifying meaning of indirect statements (e.g., responding to “Well, I’m kinda busy…” as meaning “I can’t talk right now”).

Once you’ve identified a skill or two, plan out how to practice it. Consider the format and timing of the calls, how you can prepare up front for success, and how to actually teach the skill before and during the call. Since your child will be practicing with a familiar family member, you might even consider redoing the call immediately so that prompted skills can be practiced independently. Here are some ideas in each of those categories. As stated above, keep in mind that since we don’t know your child and can’t give specific advice, it’s up to you and your team to choose which strategies you believe will work best.

Format & Timing

Conversation Partner●     Start with someone your child knows well and enjoys spending time with.
●     Start with someone who communicates easily with your child.
●     Only after a few successful conversations, move onto other people.
●     If your child has been receiving ABA or SLP services, check if they are providing telehealth services. Calling with them would be a great way to practice the first couple calls.
Length and Time●     Set up regular, ongoing scheduled calls, so you don’t have to plan each one separately. The calls are more likely to happen this way with less effort.
●     Call frequently! This is both good for skill building and for keeping social relationships close.
●     Keep the calls short initially. End on a positive note, leaving both parties looking forward to the next call.
●     If desired, increase the duration of the call over time. One strategy to increase the length of the call is to have you or the conversation partner ask “What are some things you might want to talk about right now?”  These can even be written down initially.
Format of Call●     Use a speaker phone. By hearing both sides of the conversation, you’ll be better able to help your child be successful.
●     For some learners, a video chat may be more effective than an audio-only call. It’s also more personal and family members may appreciate the face to face interaction. Try Facetime on an iPhone, Duo on Android, or Skype on a computer.
●     If getting a family member set up with an app or account is daunting, there are web-based alternatives such as Linkello that don’t require any sign up or downloads.
●     Check out Marco Polo. It’s a video chat app that can be used asynchronously. Whenever you are available, you record a video call. When your conversation partner is available, they watch the video and reply. This has the benefit of not having to schedule specific times for phone calls. It has an added educational benefit of being able to listen to the video message multiple times and have your child practice their reply before recording it. There are some special features with which you child can experiment such as filters, voice effect, and doodles which can be accessed to make the practice more reinforcing (more fun!).

Planning & Preparation

Break Down the Skill●     Before starting, break down the skill into the details of exactly what you want your child to do, how well, and when.
●     Write down the steps of the skill in as much detail as you can. For example, if you want to teach your child to “not end the conversation abruptly” you might decide that means they should do the following steps: 1. Say, “I need to go now”, 2. Wait for a reply, 3. Say “goodbye”, 4. Wait for a reply, 5. Hang up the phone.
●     Write down “how well” you expect it to be done. For example, if you want your child to have longer conversations, decide how long of a conversation you expect. If you want your child to answer questions that grandma asks, decide whether you expect complete sentences or single word answers, and correct answers or just their best attempt.
●     Write down when the skill should be done, being as specific as possible. If the skill is changing the topic of conversation, you might decide that the child should change the topic when there has been a lull of 3-5 seconds in the conversation.
Make a Visual Cue●     Put the key information from your break down of the skill, and create a visual for your child. This can be used to prompt them during a call or to review how they did afterwards.
●     If the skill is a long series of steps, the visual could be a list of steps to follow, either in words or images.
●     If the skill should be repeated throughout the conversation, the visual could be a reminder of what to do, and check boxes to mark each time it is done.
Plan Some Content●     Think of a number of interesting conversation topics you can introduce if needed to keep the call going. Better yet, let your child help make this list.
●     If your child’s conversation skills are just beginning or if they dislike the phone, find some preferred activities that could be done over the phone or video chat. If your child and a grandparent like to read books or sing songs together, consider doing that for a portion of the call.
Enlist the Conversation Partner’s Help●     Let the person you’ll be calling know what skills the child will be working on
●     Tell them how they can help provide opportunities for practice such as asking a lot of questions, giving the child adequate time to answer.
●     Tell them how they can reward the child for using their new skills such as praising their efforts.

Practice & Call

Practice Prior to the Call●     Practice the skill in person without a phone.
●     Practice it on the phone with a family member in a different room.
●     Practice it in a role play, taking turns in different roles.
●     During practice, use the visual you created to prepare the child for what to do before starting, remind the child of what to do during the practice, and review how they did after the practice.
Prompt During the Call●     Place initial calls on speaker phone so you can prompt (assist your child in trying the new skill).
●     Model the exact thing you want your child to do and let them imitate it.  (e.g., “Say, ‘Are you busy?’”. Modeling is most helpful in the early stages of learning a skill.
●     Use the visual cue you created and/or, for children who read, write out prompts on the fly (e.g., point to card that says “Ask what Grandpa is doing”).
●     For a child with more advanced language skills, try a low level verbal cue, or hint (e.g. you say, “I wonder if the snow melted at Grandma’s house.” to prompt your child to ask Grandma if it melted.).
Provide Feedback●     During the call, find a way to celebrate when your child uses a skill successfully that doesn’t completely interrupt the call. This might be a gesture (thumbs up), a physical interaction (a high five) or a star on a chart or token board.
●     After the call, provide your child feedback. Provide praise for skills done correctly, and additional practice where mistakes were made.
●     Consider whether your child is adequately motivated to do their best on the call. If not, you might add an extra incentive in addition to the praise.

Putting it Together – Early Language Skills

Here’s an example of how you could put a number of these recommendations together. Let’s imagine that your child is an early learner and you want her to learn to dial the phone, and ask and answer some easy questions.

Format & Timing: She usually sees her grandfather a few times a week and she loves making silly faces with him, so you start by calling him. Since seeing her face is important to her, you choose to use Skype on a table for a bi-weekly call that is scheduled right after dinner on Mondays and Thursdays.

Planning & Preparation: For the skill of dialing, you add pictures of people in her life to your Skype account, so she can tap on the picture of the person she wants to call. For the skill of answering questions, you know that she sometimes, but not always, answers “who” and “what” questions about things and people in her immediate environment like answering, “Who is that?” when a sibling walks in or “What is it?” when she has something interesting. You decide to practice these questions on the phone. You aren’t sure how to teach her to ask questions, so you reach out to her teacher, who suggests that her grandfather put some fun items in a box, and you prompt her to ask, “What’s that?”, so her grandfather will answer and pull the surprise item from the box. Then you talk to her grandfather, and set up a plan for him to have a box with several interesting items in it to talk about.

Practice & Call: During the call, grandfather occasionally brings the box on screen and makes a leading statement like, “Ohh… look what I have!” and waits for her to ask “what is it?” before pulling out the item dramatically. You also ask him to engage in silly faces with her during the call, especially right after she asks or answers a question, in order to reinforce it. You’ve arranged for other household members to walk through the room or make funny noises occasionally, to provide her grandfather the opportunity to ask questions like “Who is that?”.

Putting it Together – Advanced Social Skills

Here’s another example for an older child learning more advanced social skills.

Format & Timing: When she makes a call, she typically starts talking about her interests immediately, so you decide to teach her to start a conversation using the following steps: identify self (e.g., “Hi this is Sarah”), check if it’s a good time to talk (e.g., “Do you have time to chat?”), and ask the conversational partner a small talk question (e.g., “How are you?” or “What are you doing?”). You also have observed that she doesn’t respond to indirect statements or someone’s tone of voice. You noticed this last week, when she asked her brother if he wanted to play a game, and after he sighed heavily and said “oh, fine”, she seemed unaware of his disinterest and started the game enthusiastically.

Planning & Preparation: You sit down with her to develop visual cues for both skills. For the first one of starting a call, you make a list of the steps, and let her write in the examples. You also put a checkbox next to each step so you can mark it off as she does it. For the second skill, you and she make a list together of examples of what someone might say/do in response to an idea or request, what it really means, and how to respond.

Practice & Call: Then you decide to role play together. With the visuals right in front of her, you take turns pretending to be different family members and friends on a call. When the opportunities to use the skills come up, you pause the call immediately after each one to give her feedback on what she did well and what she could do differently. Before the first call with a family member, you share with them the fact that she’s working on reading between the lines, and coach them on providing opportunities for her to practice. You have her put the conversation partner on speakerphone, so that you can prompt by pointing the appropriate part of the visual cue as needed.

As shown above, telephone skills are complex and multifaceted so there are plenty of opportunities for new skill development. As you consider new skills to teach, revisit the suggestions above and think about what types of teaching strategies are best suited for that new target. If your child struggles, consider whether there are perquisite skills that should be targeted first. As always, reach out to the relevant providers on your team for guidance. We hope that, while remaining physically distant, these ideas will help to continue to build your child’s social communication skills and help the family stay socially connected.

Citation for this article:

Glick, C., & Celiberti, D. (2020).  Clinical Corner: How can I teach telephone skills at home?  Science in Autism Treatment, 17(4).

About The Authors

Chante Glick, MEd, BCBA is currently a full time student at Endicott College and a mother to an eighteen-month-old. Throughout her career, she has taught in special education and general education in both public and private schools, run a summer camp for at risk youth and adults with developmental disabilities, provided behavior analytic services to children and adults in a variety of settings, volunteered with the Association for Science in Autism Treatment (ASAT) and WA-GROW (providing training for special education teachers in Mexico) and directed an ABA organization that specialized in in-home programs and school consultation. When not writing papers for her doctoral program, she can be found reading non-fiction, playing with her daughter, or rewatching The West Wing for the billionth time.

David Celiberti, PhD, BCBA-D,is the Executive Director of ASAT and Past-President, a role he served from 2006 to 2012. He is the Editor of ASAT’s monthly publication, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993 and his certification in behavior analysis in 2000. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis (ABA), and early childhood education. He works in private practice and provides consultation to public and private schools and agencies in underserved areas. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. In prior positions, Dr. Celiberti taught courses related to ABA at both undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.

Posted in ABA

Teach For Generalization With The R.E.A.L. Model!

Do you want to just teach skills or teach meaningful responses?

Many ABA practitioners and parents struggle to generalize learned skills, whether to parents or other people, to school, community or natural environments. Sometimes they question — will this child ever really learn this behavior? I mean, REALLY do this behavior. Like when it actually counts?!?!

One of the first clients I have ever worked with transferred from another provider. He had received intensive ABA programming for 2 years. He had already acquired a number of skills — colors, numbers, letters, matching, categorization, even self-help skills. Yet, nothing was functional. If the question wasn’t given in the same format (e.g., touch this, where’s red, wash hands) he would not demonstrate the skill. He lacked the ability to generalize to the natural environment…where it actually counted! It led me to ask myself….

  • Does ABA just create robots? Am I creating a robot? Are all of the responses just rote? When should the behavior occur? Does it?
  • Will this individual’s ABA program result in being able to join a typical classroom?
  • Will this child recognize his hands are dirty and wash them with complete independence?
  • Will this child respond to greetings when in the community with someone she’s never seen before?
  • Will this child interact with their peers when no trainer is present?
  • Will all of these skills being targeted actually result in a meaningful way?

“ABA is not a commodity, but a whole treatment process designed to address all aspects of a child’s life, ultimately improving the overall quality. Generalization should be viewed as an active process of ‘skills learning’ which also requires a systematic approach to teaching.”

Brenda Terzich-Garland, author and creator of The R.E.A.L. Model.

All of these questions can be answered in the new book, The R.E.A.L. Model, Rethinking Generalization: A Practitioner’s Guide to Teach for Generalization in ABA Treatment for Autism and Other Disabilities.

Here are some take home points:

  • We live in an ever changing world, you need to program for this. The R.E.A.L. Model sets up a very practical way to plan for generalization.
  • You must plan for Generalization across trainers, stimuli, environments and to the verbal community. The R.E.A.L. Model gives you a systematic way to plan for generalization in a simple step by step manner, across five unique levels of generalization. Each level has specific guidelines,
  • You must plan for Generalization systematically and from the very start of programming. The R.E.A.L. Model focuses on Case Formulation within the Assessment Process, as well as a unique Real Matrix to plan for generalization throughout ABA programming.

Sometimes we do not know what we are missing, simply because we have not been exposed to something. The R.E.A.L. Model is this exact reference. Pick up a copy today to forever change your programming to be more efficient and create more flexibility and adaptivity across all programs!


Mari is the Chief Clinical Officer for Applied Behavior Consultants, Inc. (ABC) CA. Working in the field of ABA for almost 20 years with students with Autism Spectrum Disorders and other developmental delays, Mari has worked across ten different countries, spreading Behavior Analysis globally.

What information should I get from the teacher and what can we do to promote carryover during this extended period of home schooling?

My son’s school is closed for the next few months.  What information should I get from the teacher in order to effectively teach my son, and what can we do to promote carryover from school to home?

Answered by Mary Jane Weiss, PhD, BCBA-D and David Celiberti, PhD, BCBA-D

As we all know, we have been thrust into a world in which education for individuals with ASD is occurring at home, and the instructors are largely parents like yourselves. Planning carefully for home instruction may smooth the process and may also lessen the loss of skills or reduce behavioral challenges that could occur with reduced time in school. In preparing for potentially months of at-home instruction, we encourage you to coordinate efforts with the school staff and get the information you need to maximize success.

While home-school, collaboration is certainly not novel or unexpected, it is indeed quite different now.  For some parents, this may be the first time that they have been thrust into or officially recognized as having a significant instructional role.  For others, for whom instruction might be an already assumed role, instruction is likely more extensive, more time-consuming, and may be complicated by other changes in schedule and lifestyle.  For example, you may need to balance working at home with child-care and instructional responsibilities for multiple children.  In addition, the disruption in routines and community-based opportunities may be creating additional behavioral challenges for the individual with ASD.  Furthermore, conveying information about the COVID-19 pandemic may be challenging, because our understanding of it is a moving target and because it is difficult to explain the health concerns, social distancing, and other needed safeguards in developmentally appropriate and understandable way. For more information, please see a related article in this issue that provides resources for this important discussion.

Given your question, our reply focuses on the here and now of transitioning into the schooling-from-home change. The most important aspect of this transition will be learning more from your child’s teacher about a number of elements of schooling that will help inform home efforts.

Start with Goals

What are the priorities?

What are the goals that should be worked on now?  Which goals are most crucial from a functionality perspective; in other words, which goals are most useful/what skills are most needed?  In all likelihood, the teacher will recommend prioritizing skills that will be used in environments in the near future, promote independence, and focus on daily living skills.  Some high priority skills might still need to be taught, while others might need to be maintained or generalized to the home setting. Finally, the current situation might warrant new priorities as well.  In addition, if challenging behaviors are a significant historical or current concern, be sure to ask for teacher support to carry out proactive strategies that may reduce risk, to understand the behavior plan, and to familiarize yourself with the best de-escalation strategies for your son.

Make a list of goals to be continued, goals to be modified, and goals to be placed on hold

It is likely that the high priority goals will be identified as needing continued practice at home.  It may be that some of these goals are being actively taught, and are not yet mastered. Working with the teacher to understand how those skills were practiced at school will be helpful.  It may be possible to use technology as an advantage as well, by having sessions in which the teacher observes your instructional sessions, coaches you in prompting procedures, and makes suggestions about materials or other elements of the instruction.

Some skills may be important/prioritized, but were progressing slowly.  Perhaps these skills were already a concern before the closure of school.  Your son’s teacher might be able to problem-solve and strategize about specific adjustments that can be attempted.  Perhaps the materials can be altered, the sequence of steps can be changed, different prompts can be embedded or expectations can be adjusted.  This may be an excellent time for telehealth meetings, in which the teacher can observe the difficulties and suggest modifications.

On the other hand, this may not be the time to work on skills that have not been proceeding smoothly and that are not identified as priorities.  These skills might be placed on hold, until more thorough troubleshooting is possible.  If something is placed on hold now, it would be prudent to revisit that decision at a later time.

Focus on the maintenance of skills

Preserving established skills is crucial at this time, particularly given all the changes that your son is experiencing.  Without practice, some skills may weaken or even disappear from your son’s skill set.  To prevent this, work with the teacher on a list of essential skills to be practiced.  Ask the teacher how often they should be practiced daily or weekly schedules for practicing the skills that have been identified as essential.  Since maintenance skills are generally easier, and associated with less frustration, talk to the teacher about when to practice these skills or what contexts might be best for practice.  For example, perhaps it would make sense to begin instructional sessions with maintenance tasks. This would increase motivation and build momentum for your son, particularly when fatigue may be an issue.

Consider the changes in goals in the context of the IEP/IHP

Consider the changes that are being made while in a short-term planning mode.  One or more goals might be put on hold for a month or so, at which point it will be revisited. Furthermore, new needs may render it difficult to do justice to all of the existing goals and the team may need to prioritize.   With this all in mind, the assessment of what needs to be changed in the annual plan should be done in a methodical and strategic manner with your family’s wants and needs at the forefront.

Focus on Motivation:

Understand how your son was motivated at school

What reinforcement system did they use at school?  What  reinforcers were most motivating? Is there access at home to those items? It may be possible to adopt some of the elements of the motivational system that was used at school.  The familiarity and structure of the system might appeal to your son, and it may help him understand the expectations for work and for reinforcement.

Strategize about how motivation can be addressed at home

What elements of the plan are manageable at home?  In order to use an item or activity as a reinforcer, access to it needs to be restricted when it hasn’t been earned. Consider whether it’s possible to limit this access given the comprehensive changes in all of our daily routines. How can you go about identifying reinforcers that might be able to use?

Speak with the teacher about how to help the learner understand the availability/unavailability of various activities, settings, etc. Perhaps you can use symbols or strategies used at school that help with comprehending this concept.

To identify new motivators, talk with the teacher about the best way to find something new.  Perhaps you can make several items available in a free play context, and see what items are attractive to your child, to see what new items interest your child, and to see if your child is drawn to any of them. Perhaps offering items in a choice context is helpful. Another option is to present several new items or activities and see which he chooses, repeating the choice a few times to see if he consistently chooses the same one. Ask your son’s teachers about how they provide reinforcement to him, so that you can present instruction similarly, and in a way your son understands.

Consider Logistics

What is possible for the family in terms of direct instruction?

Discuss your availability and the ability to allocate time to teaching.  Be realistic. Parents will have differing abilities and preferences for instructing at home, and many different models can work.  Work with your teacher to come up with a model that works best for your family and revisit if, and when, needed.  Think about the day in chunks of time and activities.  What times provide the best opportunities for instruction or maintenance of skills?  Perhaps meal preparation and clean up are excellent teaching times.  Maybe the evening is better for you for leisure skill training, as your own work demands are low then.

Consider what materials you have to use and what you still need.  Families may not have needed materials available to them, and may be unsure about how to create them.  The school staff may be able to provide or share them, or even create duplicate materials for home.  Some materials can be sent electronically as well.

What about parent’s role supporting virtual instruction?

If your son is having virtual sessions with teachers, it might be helpful to discuss exactly how you should support him during these sessions.  Is it important or necessary to be available?  What are the strategies that might promote success?  For example, should the same quiet location be used each day?  Should this location be reserved for “school” only?  It might be best not to select the location where he also watches television, for example. Should visual reminders of the behaviors expected be displayed?  Are there prerequisite skills that should be practiced outside of the session or reviewed just prior to the session?  Communicating with the teacher about these details will help make virtual instruction sessions go more smoothly and successfully.


The closure of schools is an unprecedented opportunity for generalization training.

Ordinarily, generalization training is something we discuss around goals, people, or settings.  We actively identify goals for generalization, working to transfer skills to the home and community, and across parents and others.  In this context, generalization training has been radically increased, as all skills must be demonstrated and worked on in the home setting.

Consider the times and activities that promote the very best opportunities for generalization training. Consider identifying specific skills that will be addressed within daily functional routines.  Perhaps breakfast will include unloading the dishwasher, measuring, following a checklist for independently making breakfast, or cleaning the table.  Perhaps the routine after dinner will include loading the dishwasher, cleaning pots, wiping the counters, setting the table for breakfast, and planning the next evening’s dinner.  Goals can be embedded into these time frames, which may also make it easier to allocate time in your own schedule for instruction.  Perhaps a turn taking goal can be integrated into family game night, where the learner takes turns with siblings.  Perhaps a pizza preparation goal can be extended into a family pizza night.

Some Final Thoughts

This is a challenging time, and flexibility, creativity, and patience are needed in considering how to adapt your son’s program under these circumstances.  To launch the move to home instruction most successfully, talk with your child’s team about the goals that were being worked on.  Be sure you understand exactly how those skills were being taught, and discuss ways they may need to be modified at home.  Work with your child’s provider to identify the priorities, and then develop methods for assessing whether skills will be continued, modified, or placed on hold.  Remember that such changes are temporary and can be revisited when the team is next able to convene, for example.  Focus too, on understanding all you can about how your child’s instructional team motivates your child.  What are the items they find most interesting?  How have they identified new items of interest?  Ask them for tips on identifying new motivating materials and for managing reduced motivation.  Be flexible about how and when you intervene and instruct; many different models can work.  Finally, view this as an ultimate immersion in generalization training; it may accelerate transfer of skills in ways we would not have otherwise seen.

Finally, it is important for all of this to be viewed through the lens of this extraordinary time.  We are all faced with unprecedented challenges, and the need for adaptation is extreme.  Parents need to consider the entire family’s needs and their own health.  The most important thing for parents is to support the family in a way that sustains everyone in safety and harmony.  Be gentle on yourself and flexible with your goals.

Citation for this article:

Weiss, M. J., & Celiberti, D. (2020).  A Clinical Corner on home schooling during COVID-19: What information should I get from the teacher and how I can promote carryover? Science in Autism Treatment, 17(4).

Mary Jane Weiss, Ph.D., BCBA-D, LABA, is a Professor at Endicott College, where she has been for 9 years, and where she serves as the Executive Director of ABA and Autism Programs, including directing the Ph.D. Program in ABA. Dr. Weiss also does research with the team at
Melmark. She has worked in the field of ABA and Autism for over 35years. She received her Ph.D. in Clinical Psychology from Rutgers University in 1990 and she became a Board Certified Behavior Analyst in 2000. She previously worked for 16 years at the Douglass Developmental Disabilities Center at Rutgers University. Her clinical and research interests center on defining best practice ABA techniques, exploring ways to enhance the ethical conduct of practitioners, teaching social skills to learners with autism, training staff to be optimally effective at instruction and at collaboration, and maximizing family members’ expertise and
adaptation.  She is on the board of ASAT.

David Celiberti, PhD, BCBA-D, is the Executive Director of ASAT and Past-President, a role he served from 2006 to 2012. He is the Editor of ASAT’s monthly publication, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993 and his certification in behavior analysis in 2000. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis (ABA), and early childhood education. He works in private practice and provides consultation to public and private schools and agencies in underserved areas. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. In prior positions, Dr. Celiberti taught courses related to ABA at both undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.

Posted in ABA

Successful Generalization and ABA

Successful generalization is best taught at the very core of a structured well planned ABA Program.  Students on the autism spectrum have many barriers interfering with generalization of learned skills in areas like communication and language, academics, play, or social situations.

The wide range of skill deficits and barriers for each ASD child affects each differently.

ABA gives practitioners the framework necessary to critically analyze the variables that lead to behavior, but systematic programming in how to teach for generalization deserves the same attention and specificity that curriculum development has received for treating ASD.

Many individuals with ASD have difficulties generalizing from a structured learning environment to the “real world” independent of their functioning level. This is likely due to the degree they are affected by the disorder and their individual learning styles, which, in turn, affects their rate of acquisition, maintenance, and generalization of new concepts.

To simply rely on teaching structured skills puts practitioners in a “train and hope” situation when addressing generalization.

Practitioners can plan and effectively train for generalized behavior change by using The R.E.A.L Model, Rethinking Generalization: Recreating Environments to Accelerate Learning. The R.E.A.L. Model teaches for generalization using a unique 5 level process, which systematically changes environmental antecedents and consequences in order to increase skill acquisition and generalization.

R.E.A.L Model Levels of Generalization

Level 1: The R.E.A.L. Model begins in level 1 focusing on the behavioral process to teach for generalization during stimulus discrimination training of concepts and the teaching of skill acquisition taught in a highly structured environment.

Level 2: In level 2, the process continues with systematically introducing stimuli and contingencies within a structured teaching setting focusing on stimulus generalization in the teaching of concept formation.

Level 3: At level 3, behavioral persistence and retention becomes the focus when training for generalization across settings and time as stimuli and conditions from the natural environment are introduced from a structured to a semi-structured teaching setting.

Level 4: As concepts, skills, and language are acquired at mastery, targets are moved to level 4 where special emphasis is on bridging concepts and skills and bringing behaviors under multiple control with daily routines. The focus is on teaching for generalization of complex repertoires the child will use in the natural environment in the shaping of behavioral cusps.

Level 5: Finally, Level 5 focuses on the teaching of social repertoires generalization on the verbal community. Emphasis of teaching is on social competence and flexibility while training the needed social skills in play and communication when the child interacts with peers, family, and the community.

ABA is not a commodity, but a scientific evidenced-based discipline informed by the principles of behavior analysis and generalization is crucial for treatment effectiveness and social validity. By teaching for generalization alongside and within a structured  ABA program, we can prepare a new generation of learners for success.

About The Author

Brenda J. Terzich-Garland is the author of Rethinking Generalization, The R.E.AL. Model: Recreating Environments to Accelerate Learning, published in 2020. Ms. Terzich-Garland received her Masters degree in Psychology (with a concentration in Behavior Analysis) from the California State University, Sacramento and is Board Certified Behavior Analyst.  She is Co-founder and Trustee, Chief Clinical Officer and Vice-President/CEO of Applied Behavior Consultants, Inc. (ABC, Inc) and has been an officer of the California Association for Behavior Analysis.  Ms. Terzich-Garland also has been certified by Pyramid Educational Consultants, Inc. as a PECS Supervisor and Implementer.  She is a member of the International Association for Behavior Analysis (ABA), California Association for Behavior Analysis (Cal-ABA) and has served as a Board Member for the B.F. Skinner Foundation. 

Posted in ABA

My child is home with me. Any suggestions for home schooling?

This month’s ASAT feature is from Marcia Questel, MSEd, BCBA. 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!

My daughter’s school is closed due to COVID-19. Her teacher and I have been in contact about what I can do to support her learning. Do you have suggestions to increase the success of my home schooling efforts?

Answered by Marcia Questel, MSEd, BCBA
Clinical Director of Robinson Center for Learning
Consultant for 121 Learning Works, LLC

Since the arrival of COVID-19 across the nation and around the world, many parents, like you, are now home 24/7 with their children with autism. At first, school closures may have led parents to envision days filled with the freedom and flexibility to spend increased quality time with their children. By now, parents everywhere are coming to grips with how they are going to teach their children at home (some for the first time) with very limited resources or support. They may be struggling with financial instability, worrying about when they will return to work, filing for unemployment, or juggling working from home— all while homeschooling.

So many parents are overwhelmed with demands to provide structure for their families while remaining flexible with their ever-changing situation. They are trying to keep their children safe and healthy while attempting to engage and entertain them and figuring out how to allow socially-distant interactions with their friends. Parents are learning to balance teaching their children academics without neglecting their emotional and mental health needs. They are doing all of this and simultaneously striving to maintain a sense of security and calm. Still, the typical demands remain. Beyond addressing all of these new challenges, they continue to manage their homes, prepare even more meals, balance their new budgets, perhaps even work from home, and still hope to make room for increased quality time together.

While some families may still be able to receive in-person services, many parents and providers are attempting to maintain a strict quarantine. This has led to a reduction— or entire removal— of crucial intervention services including, but not limited to, a wide range of special education services, behavioral consultations, speech therapy, group therapy sessions, and more. Although this may be supported by remote “telehealth” provisions, the swift and wide-sweeping changes to children’s routines may lead to a wide array of behavioral and emotional challenges. Parents of children with autism may be faced with many concerns related to increased screen time and sedentary activities, dietary issues, unwanted behaviors, compliance issues, rigidity, and/or emotional dysregulation— with service disruption causing an enormous upheaval. My colleagues and I at 121 Learning Works and the Robinson Center for Learning are happy to provide the following suggestions and resources to help during these challenging times. Here are some quick tips to help you make the most of these days out of schools/center-based programs:

  • Establish a Routine: You’ve probably all heard it by now, right? Establishing a routine during times of emergencies is extremely important and beneficial for children regardless of neurological differences. Furthermore, it helps the entire family to pass the increased time at home with some amount of structure. This benefits the quality of life for everyone. While you and your children might enjoy some extra down time, a rough schedule will keep everyone moving, oriented, and focused. Go ahead and give yourself and your kids plenty of breaks and time to have fun – but build it into an overarching structure. Some parents and caregivers find it helpful to make a daily schedule (8:30-9:00 breakfast, 9:00-9:30 hygiene and getting dressed, 9:30-10:00 math, etc.). There are a lot of examples of these online and instructions on how to implement them (see the link in #12). When conducting the routine, make sure that you utilize pictures and/or text along with your verbal reminders to provide the most salient information that resonates with your child, as every child is different.

Here is an example:

autism home schooling activity

A note of support for the schedule: Make sure that you provide plenty of support throughout the first several days! Be prepared to provide immediate prompting and assistance, which may at first feel like it is more than your child usually needs. At this time, he or she may struggle with consistency or compliance due to the upheaval in their routine. While your child may be fully capable of certain skills, remaining available to provide a bit more support and/or reinforcement for these skills may promote smooth completion and help to prevent errors.

Parents should remain focused on chaining skills to the previous and next steps. This proactive approach should help to yield a more successful completion of the activity schedule and, with practice, become a more fluid and more rapid routine.

But, remember, don’t sacrifice great learning moments in order to stick to rigid structure. That’s where Tip #2 comes in:

  • Flexibility: This is also a time where your child’s education can be entirely individualized. Take advantage of that! If they become interested in an activity and it is taking up more time because you’re expanding on the topic, they are asking questions, or they need more time because they are struggling a bit, allow the extra time. Avoid rushing them through it. You may find that you need to back up, slow it down, or teach a prerequisite skill. Go ahead! You have plenty of time! At school, teachers spend time doing things such as handing out materials, getting the class settled, dealing with interruptions, collecting materials, etc. that you do not have to deal with. Research shows that their “time on task” at school isn’t nearly the entire 6 hours (Organisation for Economic Co-operation and Development, OECD, 2014). You can teach your lessons much faster with only your children. This gives you more time to teach more precisely to their needs, preferences, and interests – moving faster or slower as they need you to. Be flexible!
  • Approaching Tasks: Once you’ve decided on your schedule (keeping it loose), you need to show your child that this homeschooling thing isn’t going to be too aversive. First, before you start anything, focus on the approach to any new task as a separate opportunity to provide reinforcement, rather than focusing on the actual task itself. It is important that your child receives positive feedback for simply accepting that there is a new type of demand coming and engaging in compliant behaviors with a willing demeanor. Teaching washing dishes? Maybe starting with just putting soap on a sponge is enough on the first day. Learning to make the bed? Prompting everything but the last step of putting the pillow at the head of the bed may be reasonable. Think of this like being proud of yourself for simply going to the gym for the first time rather than getting hung up on how many minutes you lasted on a piece of equipment. All of this is new and simply engaging in any responses to new demands is reason to celebrate. Start slowly.

If you are teaching an academic skill, or something that requires sitting, get your child to the table or desk with an engaging and short task, or even access to a preferred activity! Perhaps you want to look up a quick science experiment (like the one in this video about soap getting rid of viruses!) or do a brief assignment that is in their “wheelhouse,” something that they are good at and in which they have confidence. No matter what, avoid starting off with hard work that you must struggle through with them. This is a learning experience for everyone! Get started on the right foot and try to make it light and fun whenever you can.

Note that throughout this article, the emphasis is on helping children feel successful and establishing norms, it’s not about attempting to teach so many skills as fast as possible. Pace yourself. This will help to alleviate your and their anxiety and help everyone involved to feel more successful. Reviewing previously learned skills throughout the first several days is completely acceptable and beneficial, especially if you’re able to incorporate them into a work schedule as described above.

  • Explore: Use this list of free resources to find many online learning tools! So many companies on that list and this one, called “Coronacation!,” are offering free subscriptions to websites like Headsprout, and special programs like Scholastic’s free daily courses and their list of “learn at home” projects.. Many of the resources listed typically have a monthly fee. Take advantage of these being free right now! Also, many museums are offering virtual tours (like the National Museum of Natural History); aquariums and zoos are offering live streams, and there is even a list of thirty virtual field trips that kids can take, to provide immersive learning experiences while we are all stuck at home. If you’re like me, you might feel overwhelmed at how much is actually out there to explore versus how much time is in the day (while also juggling all of the things mentioned in the introduction). It is not expected that you will click all of the links or read all of the lists. Just remember that they’re here when you need them and, when you do have a moment, take that time to explore. You’ll be pleasantly surprised at what is out there for you to utilize within your teaching right now.
  • Use Themes: One way to use those sites is when you’re creating a conceptual theme in your lesson plans. Teaching with themes can be really beneficial to tie all of the information togetherFor example, if you were teaching about life or water cycles, you could start with an English Language Arts (ELA) section with non-fiction information to read and write about. Then, you could read a fictional story about a chick or caterpillar. The sites above have incredible online books with vibrant pictures and audible text. In math, count eggs or do addition by popping open plastic eggs with different numbers of pom poms inside. Then, you could explore a virtual zoo or aquarium. When you go out for your walk for your Physical Education (PE) section, talk about the clouds in the water cycle or try to find evidence of a life cycle. Themes keep children engaged in the topic, build up the concept in a multi-faceted way, and engage all of the senses with various learning experiences. Think of ways to build themes when you can and don’t forget to incorporate topics into PLAY! Making learning fun whenever possible is important for promoting engagement and connecting separate ideas into “big picture” concepts. Play, as shown in the following example, provides opportunities that allow a child to own the material and use it, to demonstrate their understanding, and may help to reveal any blind spots that the instructor didn’t plan for in an otherwise didactic delivery.

Here is one example of teaching through play experiences: In this video, you will see the results of teaching several skills including opposites and problem solving. To begin, the main “problem” is the classic emergency “The floor is lava!” This child has recently learned that ice can cool things down and that heat melts ice. He is learning to solve problems creatively and to engage in longer scenes of pretend play, including displaying feats of strength and superpowers. He suggests that an “Ice gun” can cool the lava down, but the result is a very slippery floor! The following consequences lead to the need for more problem solving and understanding of opposites, while hysterical fun ensues.

For more engaging teaching videos, subscribe to our channel on YouTube!

  • Exercise: Exercise and fresh air are mandatory components of the school day. Children in the United States are required by law to have physical education and recess periods. Be sure to take breaks to dance, play in the backyard, go for a quick walk only if it is safe to do so (even 5 to 10 minutes will help!), do a short workout video from YouTube (such as Go Noodle Pump It Up!), or do some yard work. It is important that children get exercise, not just for their physical health, but for their mental fitness and emotional wellbeing. Check out Five Keys to Keeping Your Kids Active and Healthy at Home and Exercise Tips to Help Kids, Teens and Families Stay Balanced at Home. You’ll find that you have a much easier time teaching them, that their attention is better, and that they have an elevated mood. Not to mention, it will entice them to drink water, which is especially important during this viral outbreak.
  • Try to Regulate Diet and Sleep: Throughout this time of school closures and social distancing, it’s easy to fall into unhealthy routines and habits. Are your kids making poor choices? Establish some rules NOW so that you can all get used to them. The first few days might be hard, but everyone will acclimate over time, and some of the rules that seemed difficult to adjust to will eventually become the “new normal.” Make meals that include plenty of protein to keep kids fuller for longer periods of time. Remaining active (learning through themes and play, and exercising) can help to stave off cravings that occur when children are sedentary or bored. Also, try to keep sleep and wake times consistent. Planning for good “sleep hygiene” is vital because a solid night of sleep can make all of the difference for everyone in the family (that exercise component can help to improve sleep, and vice versa). For more on improving sleep, diet, and exercise, you will find helpful resources following this link by Autism Speaks. If you fail to promote the best of these for a day or two, don’t worry! This has been hard for everyone. Just start fresh!
  • Patience and Grace: We need two giant helpings of these every day. Start your day with some deep breathing or children’s yoga videos. Maybe your children can kick off their day with a favorite game or physical activity to get them started off in a good mood. When things go off the rails, and they will, simply pause and reset. It’s ok. Even the best educators are home with their own kids figuring out what to do on the fly. Be patient with yourself. Be graceful towards yourself. Then, you will have an easier time expressing these qualities to your children and you’ll set an example of how we handle crises.
  • Any Questions or Concerns? Avoid keeping these to yourself. As is almost always the case, there are others with those same questions who would also benefit from you asking. This may mean that you raise these concerns to your remote educator or clinician. Doing so provides an opportunity for them to appreciate that particular concern (you may be the second or third parent to bring the issue up) and they can, in turn, discuss what they’ve learned from other parents so far. This would help these professionals to serve you and the broader community better. It is likely that this unprecedented situation is providing novel windows of opportunity for teaching your child, but there are also many new challenges to face. Therefore, the next point is vital for you as an individual, for your family and community, and for the broader good of society.
  • Make sure that you form a virtual circle of support around you and your family. We are hearing so much about how communities are coming together in quite inspirational ways. From neighbors in Italy joining in song from their balconies, to the families celebrating birthdays with drive by caravans, many people are out there trying to support one another. They’re doing it for their loved ones but they’re also doing it for their own mental health – to feel connected and to beat back the encroaching worry that this may go on longer than they originally thought. Know that you are not alone and that there are many people willing to support you during this difficult time. Bringing your friends, family, clinicians, and telehealth providers into your circle will help to ensure that you are supported. It is crucial that you continue facilitating open lines of communication with those that you typically had physical contact with, through remote options like phone calls and video chats. Doing this will benefit everyone while we all get through this difficult time together. Right now, SPAN has many great resources for families, including weekly discussions.
  •  For links to scheduling assistance and examples, ready-to-print schedule formats, as well as many more resources regarding COVID-19 and other topics, please see this list of related links created by Amy Redwine for the Robinson Center for Learning and 121 Learning Works. For more information about these programs, other resources, and services provided, please visit the websites linked above.

Some references related to this article:

Benner, M., Partelow, L. (2017) Reimagining the school day: Innovative strategies for teaching and learning. Center for American Progress. https://www.americanprogress.org/issues/education-k-12/reports/2017/02/23/426723/reimagining-the-school-day/

Heitz, R. P., Schrock, J. C., Payne, T. W., & Engle, R. W. (2008). Effects of incentive on working memory capacity: Behavioral and pupillometric data. Psychophysiology, 45(1), 119-129.

Esterman, M., Noonan, S. K., Rosenberg, M., & DeGutis, J. (2013). In the zone or zoning out? Tracking behavioral and neural fluctuations during sustained attention. Cerebral cortex, 23(11), 2712-2723.

Lim, J., Lo, J. C., & Chee, M. W. (2017). Assessing the benefits of napping and short rest breaks on processing speed in sleep‐restricted adolescents. Journal of sleep research, 26(2), 219-226.

Massar, S. A., Lim, J., Sasmita, K., & Chee, M. W. (2019). Sleep deprivation increases the costs of attentional effort: Performance, preference and pupil size. Neuropsychologia, 123, 169-177.

Mavilidi, M. F., Drew, R., Morgan, P. J., Lubans, D. R., Schmidt, M., & Riley, N. (2020). Effects of different types of classroom physical activity breaks on children’s on‐task behaviour, academic achievement and cognition. Acta Paediatrica, 109(1), 158-165.

OECD (2014), “Indicator D4: How much time do teachers spend teaching?”, in Education at a Glance 2014: OECD Indicators, OECD Publishing. http://dx.doi.org/10.1787/888933120005

Stapp, A. C., & Karr, J. K. (2018). Effect of Recess on Fifth Grade Students’ Time On-Task in an Elementary Classroom. International Electronic Journal of Elementary Education, 10(4), 449-456.

Teng, J., Massar, S. A., Tandi, J., & Lim, J. (2019). Pace yourself: Neural activation and connectivity changes over time vary by task type and pacing. Brain and cognition, 137, 103629.

Citation for this article:

Questel, M. (2020). Clinical Corner: My child is home with me. Any suggestions for home schooling? Science in Autism Treatment, 17(4).

About The Author

Marcia Questel is a BCBA with a Master’s degree in Special Education (Concentration – Autism) and Graduate Certificate in Applied Behavior Analysis from Long Island University. She obtained her Bachelor’s degree in Developmental Psychology with a focus on autism and other developmental disorders, where her passion for researching executive functioning and Theory of Mind began. Her journey in this field started 18 years ago while volunteering in an early intervention center. It was at that time that autism became a part of her, and her family’s, life. Since then, she has been dedicated to the autism community, finding the best practices in the field, and serving families. Previously, Marcia provided 1:1 instruction, managed an autism center in New York, and taught piano to children with autism and their siblings. Marcia is currently working in private practice, providing consultation to families and school faculty, and is a Content Editor for ASAT’s monthly publication, Science in Autism Treatment. In response to the current climate, she is conducting survey research regarding access to telehealth during the COVID-19 pandemic, engaging in telehealth services through 121 Learning Works, and is creating supportive content for parents and professionals.

Posted in ABA

Five Misconceptions About ABA

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As a career behavior analyst who has learned, taught, and practiced in the field for over 25 years, I have heard many mischaracterizations of Applied Behavior Analysis (ABA). These are not new, but they are pervasive, divisive, and most importantly, may lead to people not accessing supports that could be life-changing for themselves and their families.  Here are five misconceptions that I still hear, and my considered response to each.

1. ABA is abusive

It is heart-breaking that this misconception still exists.  Yes, ABA professionals have engaged in abusive behavior towards individuals with disabilities.  So have doctors, priests, parents, teachers, psychologists, and literally anyone else in any position of power.  That doesn’t mean that medicine, religion, parenting, education, or psychology are abusive.  It doesn’t mean that the abusive practices were part of the practice of behavior analysis. 

The Professional and Ethical Compliance Code for Behavior Analysts clearly outlines behavior analysts’ responsibility to clients, which includes holding client rights in the highest regard, respectfully assessing behavior, obtaining informed consent for all assessments and interventions, and avoiding restrictive and harmful procedures (BACB, 2014).  If a behavior analyst is abusive towards a client, they should be reported and certification should be revoked, just as in any profession where abuse can occur.  Abusive acts are not part of the practice of ABA.

2. ABA is a treatment for autism spectrum disorder (ASD)

Although very frequently associated with the treatment of ASD, to say that ABA is a treatment for ASD is a gross misconception (Chiesa, 2006).  ABA is a science that leads to technology that is useful for teaching skills that are lacking and for helping people to overcome behavioral challenges.  That ABA is frequently applied to such teaching for individuals with ASD reflects the demonstrated effectiveness of these technologies in supporting individuals with ASD (NAC, 2009), and not that it is only effective for ASD.  

In fact, ABA is defined by its principles and methods (Lerman, Iwata, & Hanley, 2013) and not by the populations that it serves.  Decades of research have demonstrated that ABA is an effective means of helping people with a variety of concerns, including those resulting from various disabilities (e.g., ADHD, learning disabilities, intellectual disabilities), lifestyle and health challenges (e.g., obesity, medication adherence, addiction), organizational needs (e.g., staff training, safety), and even stages of life (e.g., parenting, geriatrics).  In short, ABA can help with any kind of behavior of any kind of person.

3. ABA is only for people with severe impairments 

This misconception is related to a view of ABA as a treatment of ASD.  Even within the ASD community, there is misunderstanding about the many levels of support that ABA can provide.  I have heard that students were “too high-functioning for ABA” and that some students have “graduated from ABA.”  The fact is that if anyone is learning anything, it is because of the principles of behavior, whether or not they are labeled as ABA in these situations.  

To appreciate how a systematic and well-supervised application of ABA technologies can help people at all levels of life, one needs only to look at the vast research on ABA in a variety of educational and organizational environments.  If ABA can teach a non-verbal child with ASD to speak, and also teach a college student to stay organized, what can it not do?

4. ABA violates autonomy and human rights

Sadly, the assumption is often made that behavior analysts force people to change their behavior against their will.  This could not be further from the truth.  If a behavior analyst is following the ethical code, then they are obtaining client input and informed consent for all behavior change procedures (BACB, 2014).  If a behavior analyst is not obtaining informed consent and failing to tailor the program to the clients’ needs, wishes, and preferences, then they are practicing unethically.  The ultimate goal of any ABA intervention is to fade out added supports and promote independence given the same supports and strategies that others in the natural environment benefit from.  For example, a token board might be implemented to support a child in learning from his teacher, but the goal is for that token board to eventually be systematically removed and for the child to learn from his teacher through the same naturally-occurring reinforcers as same-age peers (e.g., praise, grades, feeling of accomplishment).  To take a more extreme viewpoint, the ultimate goal of teaching someone to use the bathroom independently is to improve the likelihood of freedom, dignity, and safety for that person for a lifetime.

5. ABA leads to robotic, scripted responding

This misconception comes from the misuse of ABA strategies by poorly-trained, unethical providers.  Unfortunately, the terminology associated with ABA can be misused, such that consumers may have a hard time discriminating true ABA strategies (that are conceptually systematic with the science) from those that are mislabeled as ABA.  The scope of this discussion is much broader than can be addressed here, but the basic lesson is that ABA is not something that can be photocopied out of a book or downloaded from a website and applied to everyone in the same way.  Here are some red flags to watch out for as potential indicators that an intervention is not truly based in the science of behavior analysis:

  • Extensive/excessive drilling; all intervention is 1:1, knee-to-knee, table-top
  • No data collection, or data collected but not assessed
  • Scripting of learner responses without plans for generalization
  • Infrequent assessment of preferences (or not at all)
  • Intervention is combined with other strategies or is practiced for limited time periods (e.g., “we do ABA for 1 hour per day”)
  • Intervention is limited to one setting, with little or no parent/caregiver training or involvement
  • Behavior reduction without prior assessment and proper consents

Hopefully misconceptions like these and others can be reduced by continuously representing ABA as an ethical, effective science.  True to the values of ABA, by spending more time talking about what ABA is, we can spend less time explaining what it is not.


Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for behavior analysts. Littleton, CO: Author.

Chiesa, M.  (2006).  ABA is Not a Therapy for ASD.  In M. Keenan, M. Henderson, K. P. Kerr and K. Dillenburger (Eds.) Applied Behaviour Analysis and ASD:  Building a Future Together (pp. 225-240).  Jessica Kingsley.  

Lerman, D. C., Iwata, B. A., & Hanley, G. P. (2013). Applied behavior analysis. In G. J. Madden (Ed.), Handbook of applied behavior analysis: Vol. 1. Methods and principles (pp. 81–104). Washington, DC: American Psychological Association.

National ASD Center (2009). National Standards Report. Randolph, MA.

About The Author

Dana Reinecke, Ph.D., BCBA-D is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA).   Dana is a Core Faculty member in the Applied Behavior Analysis department at Capella University.  She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum, forms, and hours tracking.  Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities. She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism.  Current areas of research include use of technology to support students with and without disabilities, self-management training of college students with disabilities, and online teaching strategies for effective college and graduate education.  Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA).

Posted in ABA

Coping with COVID-19: An annotated list of resources for families of individuals with ASD

Compiled by Maithri Sivaraman, MSc, BCBA and David Celiberti, PhD, BCBA-D

Association for Science in Autism Treatment

Compiled byMaithri Sivaraman, MSc, BCBA and David Celiberti, PhD, BCBA-DAssociation for Science in Autism Treatment

“You can’t always control what goes on outside; but you can always control what goes on inside.”

– Wayne Dyer, EdD

The COVID-19 pandemic has led to significant disruption in services, changes to routines and structure, and an array of challenges associated with social distancing. Couple all of that with the reality that many parents are working from home, managing the home-schooling of other siblings in the family, and learning new technologies and platforms. Any of these can be a significant source of stress for parents of individuals with autism. 

Fortunately, a number of organizations have created helpful resources and tools that we have compiled into an annotated list. Prior to highlighting these resources, we want to share a few suggestions and strategies. Many of these are echoed in the resources highlighted below.

1.      Make time to talk to your child about the situation. Think of the discussion with them as a series of small conversations. Be truthful, avoid sugar-coating the situation, and be prepared to deal with their fears. 

2.      Check-in with them to ensure their understanding and revisit conversations and topics as needed. Focus on being supportive and offering the kind of comfort your child needs. For some children with autism this might mean being able to ask repetitive questions about the situation; for others it might be physical comfort or needing concrete plans and structure.

3.      Remember how much of an important role model you are to your child and other members of your family. To paraphrase Mahatma Gandhi, “Be the change you want to see in your family.”

4.      Catch your children being good. Reinforce cooperative behavior, flexibility, patience, kindness to others, healthy communication, and a sense of humor with behavior-specific praise (e.g., “I was so proud of you when you………”).

5.      Allow yourself enough private time to process what you might be going through so you have the resources to be there for your family.

6.      Monitor and limit what your children hear on television. News on the television or internet might be too vivid for them and lead to more confusion and fear. Don’t rely on the news to give them the information for which they may be looking.

7.      As we move from a more immediate situation to a longer term one, develop a mindset in which each new week will reflect new strategies, new “work-arounds,” and lessons learned. We are all adjusting as we go.

What follows is a non-exhaustive list of coping for the general population:

*  Crisis Management Institute offers a curriculum with new weekly content to help parents talk to kids about COVID-19. This week by week format will help make the adjustment period easier to manage and perhaps lead to lifestyle changes for your entire family. Topics include:  Attitude affects outcome (Week 1); Managing anxiety (Week 2); Coping with an uncertain future (Week 3); Empowerment (Week 4); Filling time when kids are home (Week 5); and Distinguishing fact from hype (Week 6).

Child Mind Institute’s resources for parents during the COVID-19 pandemic is an excellent addition to this list. They offer tips to handle children’s anxiety that might arise from knowledge about the virus, to tantrums or meltdowns that occur due to schedule changes or transitions. Some of their materials are also available in Spanish.

You will also find a Symptom Checker which presents questions about various behaviors to see if they align with specific psychiatric and learning disorders. Although the Symptom Checker is not a substitute for a formal and thorough assessment by a professional, it may suggest possible diagnoses that can lead to a follow up conversation with your child’s pediatrician or other health care provider. Please note that changes in behavior that follow the stressful experiences associated with COVID-19 may not be indicative of a new disorder and actually reflect some adjustment challenges related to the pandemic and the disruption and changes associated with it.

* The CDC offers resources and concrete suggestions for parents to discuss emergency situations, such as the COVID-19 with their children. There are also specific tips for younger children, and an activity sheet that targets emotions experienced during an emergency. The activity may also be suitable for children with autism due to its visual nature. These materials are also available in Spanish. Additionally, the CDC provides a helpful list of possible reactions to expect from children of each age group. These are not specific to COVID-19 but address emergency situations in general. This article offers information that is COVID-19 specific and offers both general strategies and developmentally suitable talking points.

* The National Association of School Psychologists and National Association of School Nurses have created a booklet that offers specific tips for parents regarding how to have the COVID-19 talk with children. Specifically, they recommend monitoring TV viewing and access to social media.

UNICEF offers specific DOs and DONTs while talking with children about the virus. For instance, they recommend using the words “acquiring or contracting the virus,” and avoiding saying “transmitting” or “spreading” as the latter assigns blame and indicates intentional transmission. They also offer 8 tips on supporting your child, and emphasize that parents first take care of themselves. Specific strategies for teachers are provided, for children of all ages ranging from preschool to secondary, and some of these can also be tried at home, and adapted to suit children with special needs.

* The National Child Traumatic Stress Network has put together a parent guide to handle the physical and emotional stress in the family during the COVID-19 outbreak, and provide suggestions for scheduling and planning family activities during the pandemic. A separate section emphasizes self-care and coping strategies, and ways to seek additional help.

* The Substance Abuse and Mental Health Services Administration created a comprehensive fact sheet that offers strategies for helping children manage stress during an infectious disease outbreak. It also provides tips geared toward varying age groups.

ChildTrends provide information laid out much like our article here. A number of helpful suggestions are provided followed by a comprehensive set of links showcasing resources for both children and parents.

* Challenging times call for creative solutions. Since the pandemic will likely impact community travel for the near future, we wanted to include this short piece published in the Huffington Post about adapting birthday parties. 

Resources specific for individuals with special needs:

* The International OCD foundation provides a comprehensive list of ideas for parents of youth with OCD, and handling questions that their children might have. This resource provides general suggestions and strategies specific to discussions with a child with OCD.

Autism Speaks offers several helpful resources for parents, educators and health professionals working with children with ASD. Particularly useful are Dr. Peter Faustiono’s tips for the autism community, and a flu teaching story for children with several clear pictures. The story is also available in Hungarian and Korean at the moment. The printable handwashing routine with empty spaces to plug in pictures of the child at the end of the story is an excellent visual tool.

* A resource packet collated by the Autism Focused Intervention Resources and Modules provides support for individuals with autism during uncertain times. Their suggestions broadly fall under seven categories – support and understanding, offering opportunities for expression, coping and calming skills, maintaining routines, building new routines, fostering connections, and changing behaviors.* Autism New Jersey has gathered a range of resources on their website titled “coronavirus hub”, where they offer information about telehealth, service delivery, employment and financial concerns, and tips for families, among others. The tips for families include a webinar on managing problem behavior at home, a coronavirus story for children, mindfulness and self-care activities, and ways to manage disrupted routines.

* SPAN Parent Advocacy Network have compiled a comprehensive list of resources for families during the COVID-19 crisis. They offer links related to education, health, activities for children and youth, self-care information and multilingual resources. The page is updated continuously with new links, and also lists national, state, and county level resources and information from the government.

Schools and service providers were not prepared for the impact of this pandemic and are learning how to navigate this new way of working with families and delivering services. Service providers and families are making collaborative efforts to find optimal and effective solutions and workarounds for disruptions to services brought on by the present scenario. We are all in this together and together we will figure out how best to meet the needs of our children.

Citation for this article:

Sivaraman, M., & Celiberti, D. (2020). Coping with COVID-19: An annotated list of resources for families of individuals with ASD. Science in Autism Treatment, 17(4).

Maithri Sivaraman is a BCBA with a Masters in Psychology from the University of Madras and holds a Graduate Certificate in ABA from the University of North Texas. She is currently a doctoral student in Psychology at Ghent University, Belgium. Prior to this position, Maithri owned and operated the Tendrils Centre for Autism providing behavior analytic services to children with autism and other developmental disabilities in Chennai, India. She is the recipient of a dissemination grant from the Behavior Analysis Certification Board’s (BACB) Committee of Philanthropy to train caregivers in function-based assessments and intervention for problem behavior in India. She has presented papers at international conferences, published articles  in peer-reviewed journals and has authored a column for the ‘Autism Network’, India’s quarterly autism journal. She is the International Dissemination Coordinator of the Association for Science in Autism Treatment (ASAT) and a member of the Distinguished Scholars Group of the Cambridge Center for Behavioral Studies.

David Celiberti, PhD, BCBA-D, is the Executive Director of ASAT and Past-President, a role he served from 2006 to 2012. He is the Editor of ASAT’s monthly publication, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993 and his certification in behavior analysis in 2000. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis (ABA), and early childhood education. He works in private practice and provides consultation to public and private schools and agencies in underserved areas. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. In prior positions, Dr. Celiberti taught courses related to ABA at both undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.

Posted in ABA

A Letter From Our Founder

Dear Families of ASD Children and Friends, 

We usually celebrate Autism Awareness in the month of April, but this year during the unprecedented pandemic our families are facing the challenge to provide supports for their ASD children.  Whether it’s continuing their school programs at home or creating more positive behavior, our ASD families are facing enormous challenges each day.

 In the 1990’s, a listserv called the Me List was created for parents who believed in Applied Behavior Analysis as the evidenced based intervention that works. There were few school programs, parents had to do it themselves. Through the Me List, we learned about what was helpful to our children and our families. We all came together from across the country and beyond to share what worked, so that others could benefit from our experiences Different Roads became an ABA resource due to the suggestions of these parents and what they had learned from their home programs.

This month, we’d like to honor the spirit of the original Me Listers who inspired the creation of Different Roads to Learning. We wish be able to help you in some small way find something that will help you get through the weeks to come.  It is with that spirit we extend this sale, in the hope that it will help you and your families and the children whose lives we hope to improve. If you have questions on science-based treatments or are having trouble sourcing supports for your learners please reach out to us. Our hearts and thoughts are with you.  ​

About The Author

When her daughter was diagnosed with autism at the age of six, Julie Azuma started Different Roads To Learning to support parents running ABA programs in their homes. Since then, schools across the country use Applied Behavior Analysis and Verbal Behavior in both contained and inclusion classrooms. Tens of thousands of children have been mainstreamed by the age of 5. Our children are more capable in every way. Today, we are proud that our mission remains to provide the most effective, informative, affordable and appropriate materials to support the students with Autism Spectrum Disorder in their social and academic growth. 

Posted in ABA


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Download Appendix A: Telehealth Clinical Effectiveness Survey here.

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

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

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

Sam Blanco, PhD, LBA, BCBA is an ABA provider for students ages 3-15 in NYC. Working in education for sixteen years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges, and she is the Senior Clinical Strategist at Chorus Software Solutions

Posted in ABA