Autism Awareness Month Interview Series: Creating Positive Change in ASD Treatment Through Science, Support and Education with David Celiberti, PhD, BCBA-D

Posted on April 30, 2015 by Different Roads to Learning

We couldn’t be more thrilled to wrap up our Autism Awareness Month Interview Series with David Celiberti, PhD, BCBA. Dr. David Celiberti is the Executive Director of the Association for Science in Autism Treatment (ASAT) and provides consultation to public and private schools and agencies in the U.S. and Canada. Here, Dr. Celiberti shares his wealth of knowledge and experience in creating positive change in autism treatments through scientific research and high-quality education and support.

Don’t forget to check out the other interviews from our Autism Awareness Month Interview Series here!

Creating Positive Change in ASD Treatment
Through Science, Support, and Education
with David Celiberti, PhD, BCBA-D

SAM BLANCO: I consider the Association for Science in Autism Treatment (ASAT) to be an invaluable resource for both parents and practitioners. You serve as the Executive Director. Before we discuss ASAT, can you tell us a bit about your background?

DAVID CELIBERTI: First and foremost, thank you for the opportunity to participate in this interview, particularly as you are asking about topics that are near and dear to my heart. I have been fortunate to have a career in the treatment of autism spectrum disorders (ASD) where the journey has been just as reinforcing as the destination. I continually urge young people to work hard at finding a career path consistent with their passions. Among my many reinforcers in the field of ASD treatment are interactions with parents and siblings who did not choose a life that included ASD, but still love unconditionally, roll up their sleeves and embrace powerful roles as agents of change. Additionally reinforcing has been my collaboration with myriad professionals, particularly those who are grounded in, and informed by, science. Perhaps most inspiring, though, are the individuals with ASD themselves who work so hard to acquire new skills, learn effective strategies for negotiating their experiences, and remind us daily that science-based treatments, such as applied behavior analysis (ABA), truly make a difference.

I currently serve as the halftime Executive Director of ASAT. I view this role not as a job but as a “lifestyle”, and I am so proud of what ASAT accomplishes every year, even with a tiny operating budget. We have an incredible board of directors from diverse professional backgrounds such as special education, behavior analysis, psychology, social work, sociology, law, medicine, speech-language pathology, computer science, family advocacy and business. Many of our board members have family members with ASD. Their commitment to helping other families and professionals find a clearer path to effective intervention is astounding to me. We also have scores of volunteer coordinators, externs, and an active Media Watch team who do much of the “heavy lifting”, helping ASAT remain productive, current, and responsive to the needs of the autism community.

SB: For those out there who aren’t familiar with ASAT, can you talk a little bit more about the organization’s mission and why it continues to be such an essential resource?

DC: With respect to our mission, we improve the quality of life for individuals with ASD and their families by promoting the use of safe, effective treatments, which are grounded in science, for people with ASD. As you know, there are over 400 treatments for autism, with the vast majority lacking any semblance of scientific support. We achieve our mission by sharing accurate, scientifically-sound information with professionals, parents and journalists; and by countering inaccurate or unsubstantiated information regarding autism and its treatment as it comes up. Unfortunately, there is so much out there which distracts consumers from making the best possible choices. Our overarching goal is to help parents and providers become savvy consumers of information who can truly discriminate science from pseudoscience. This means being armed with the knowledge to ask practitioners and marketers of ASD interventions critically important questions related to the state of their science, consult with knowledgeable and impartial professionals about potential treatments, and establish methods for assessing the benefits of treatments when they are adopted by the family and their intervention team. It is absolutely heartbreaking that autism treatment has become the type of business in which parents of children with autism must work so hard just to sort through so many options and mixed messages just in order to help their sons and daughters.

For more information, your readers can visit ASAT’s comprehensive website at www.asatonline.org. On the website, they will find extensive information about the scientific support (or lack thereof) behind the full array of treatments proposed for autism; resources and guidelines on how to make informed choices and weigh evidence in selecting treatment options, and information for various groups such as parents of newly diagnosed children, parents of older individuals, teachers, medical providers, and members of the media community. We encourage people to revisit ASAT’s website often, as information about autism treatments is frequently updated to reflect the latest research, and new content is routinely added.

ASAT also publishes a free quarterly newsletter, Science in Autism Treatment. Sign-up information is available at https://asatonline.org/signup. The quarterly e-newsletter features:

Invited articles by leading advocates of science-based treatment;
A Clinical Corner which responds to frequently asked questions about autism treatment;
A Consumer Corner which recommends resources that can guide and inform treatment decisions;
A Focus on Science column which is designed to empower families to make educated treatment decisions by highlighting those elements that constitute science-based interventions as well as warning signs of unsubstantiated treatment;
Detailed summaries of specific treatments for autism;
Book reviews;
Highlights of our Media Watch efforts and discussion of accurate, and inaccurate, portrayals of autism and its treatment by the media;
Reviews of published research to help consumers and professionals understand and gain access to the science;
Critiques of policy statements related to autism treatment; and
Interviews with those who advance science-based treatment and confront pseudoscience.

Finally, your readers can also follow us on Facebook and on Twitter at @asatonline.

SB: You have dedicated a lot of your time to providing services for underserved populations, from direct services to organizing fundraisers that support organizations that serve economically disadvantaged children. Why is this an important area of work for you?

DC: When I was in graduate school in the late 1980s and early 1990s at Rutgers University under the mentorship of Dr. Sandra Harris, I was struck that only a tiny percentage of students with ASD were receiving the lion’s share of the available expertise and resources. This disparity was troubling to me as I recognized that there were scores of other children with ASD who were receiving “generic” special education services which did not yet incorporate state-of-the-art behavior analytic intervention. My hope was to one day dedicate a portion of my time to supporting students with ASD in inner city communities. As my career unfolded, I had the opportunity to work at the Rutgers Autism Program, where part of my duties focused on outreach. I started working in rural Maine in 1997, helping public schools develop and implement educational programs to students with ASD, and have now returned over 110 times! It is not that urban setting that I had envisioned as an idyllic graduate student; however, I quickly realized how rewarding it was to provide services in geographic areas that did not have the existing resources, and to assist public schools in providing high quality educational experiences.

Hoboken, New Jersey, where I live, is home to a significant number of economically disadvantaged students. I began to seek collaborative relationships between ASAT and other local organizations which focused on poverty. The common thread was the importance of providing children with meaningful, socially valid and effective opportunities to realize their fullest potential despite the myriad obstacles that they face. That resonated well with me as someone whose career focuses on the treatment of ASD. To date, my fundraising efforts have benefited four Hoboken-based organizations combating the barriers associated with poverty.

SB: I would like to go back to your reference about public school programs. In your view, what are some of the key elements of a high quality education for students with autism?

DC: This is such an important question! In a nutshell, a high-quality education would include the following elements:

Be truly individualized – An educational plan should truly fit the child like a glove fits a hand. Services should not be about what a provider likes to do, but rather what the student needs, as determined through ongoing, valid assessment.
Be comprehensive – A high quality education targets the full array of skills that will promote success at home, school and community and uses a wide range of techniques based on science that are well fitted to the skills being targeted.
Keep the future in mind when selecting goals – The skills needed to be successful and marketable in the next setting (be that a particular job or even Mr. Walker’s 4th grade classroom) must be identified and addressed.
Use well conceptualized behavior management strategies – When addressing challenging behavior, these strategies should take into account the underlying function of the behavior, include carefully selected antecedent and consequence based supports, and build skills to help students better meet their needs in a way which promotes their day-to-day independence and opportunities.
Consider and offer inclusion opportunities carefully – Ensure that it occurs with the appropriate supports and is delivered by adequately trained staff. Social skill development does not occur through pure exposure alone; rather, skill acquisition occurs when inclusion is approached as a systematic, individualized process, with proper supports, monitoring of data, and a goal of challenging the individual with ASD while not overwhelming them, or inadvertently creating isolation.
Carefully implement instruction, including modifications and accommodations – Promote early success and carryover, identify and use powerful motivators, and consider how to motivate students to work hard, to learn new skills, and to minimize frustration.
Allocate resources thoughtfully – Intervention and teaching-team members need solid training in order to implement teaching procedures and services. Regularly scheduled team meeting promote coordination, particularly when multiple disciplines are involved.
Engage parents – Not only is it important to continually seek input from parents about treatment priorities and goal selection, parents benefit from the training, collaboration, and information that will enable them to embrace their role as a co-pilot in their child’s intervention. This support should include siblings, grandparents, and other significant individuals for whom parents consent to their involvement. Engagement should occur throughout the educational journey and be adjusted to face the unique needs and challenges at each point in time.
Take data collection seriously – Ongoing data collection enables one to objectively assess progress, make timely adjustments, and remain accountable to those we serve. No provider should get a “pass” on data collection.
Start early and get it right from the start! – We know that early intervention can make an incredible difference. Don’t squander precious time on interventions that are not time-tested and research based.

SB: You’ve been instrumental in implementing change in many aspects of our field of ABA and ASD treatment in general. Do you have your thoughts on two or three areas that you think need to be addressed differently? How can we improve our work there?

DC: There is certainly room for improvement. Promoting science and science-based interventions such as ABA is not an area in which we have been very successful. Media representations tend to favor less science-based treatments, perhaps because their promoters use more sensationalized language when describing both their methods and their outcomes. Behavior analysts must take a closer look at how they market their work so that their outcomes can be more understandable and appreciated by various stakeholders (e.g., media, funding sources, consumers). We must also be more proactive in helping the media approach autism treatment in a more accurate manner.

Autism is clearly a spectrum disorder. In recent years, we have seen many higher functioning persons with ASD who have been very vocal; generously sharing their views about the appropriateness of treatment. Although their views and perspectives are important, I worry that the public, policy makers, and other important stakeholders may take these views as applicable to the entire spectrum. I believe this has the potential to do parents a tremendous disservice when they try to acquire the resources, tools, and experiences which will enable their son or daughter (who may not be on the upper end of the spectrum) to realize his or her fullest potential. On the other hand, one important take-away message is the importance of cultivating and celebrating the strengths of individuals with ASD rather than approach our work from a pure deficit model.

Another significant concern is that the hundreds of thousands of children with ASD who were diagnosed in the last two decades are growing up and becoming hundreds of thousands of young adults with ASD; as a society, we are failing them. When children with ASD turn twenty-one, funding for services drastically changes. As a result, there are very few quality programs for adults. We are facing a crisis in the field, with a scarcity of services for adults with ASD and the absence of a clear strategy for closing the gap between the ever-increasing need, and an unprepared supply of resources. Autism awareness must include important conversations about how we can help adults with ASD live and work independently, develop meaningful relationships, reduce challenging behaviors that may limit opportunities, access faith communities, and enjoy the array of recreational pursuits which are available within their communities. Those are important conversations to have and these conversations should translate into actionable items at every level of service delivery.

SB: With Autism Awareness month drawing to a close, what would you like the general public to know about autism treatment?

DC: Even though ASD is no longer the rare disorder it once was, each person with ASD is unique. Efforts to help them realize their fullest potential should be individualized to meet the specific needs of each individual with ASD across settings such as home, school, community and the workplace; and informed by input from the individual, as well as his or her family.

Do not believe everything you hear. There are dozens of purported “miracle cures” and “breakthroughs” for ASD which receive widespread media attention, even if they have not been proven effective. Sadly, effective treatments rarely gain media attention.

On a related vein, do not believe everything you read. Not all information on the internet is reliable and accurate, and celebrities are neither trained nor equipped to define or guide ASD treatment even though many appear comfortable in that role. On the other hand, there is a large body of research published in peer-reviewed scientific journals which should guide autism treatment. Visit our website to learn more at www.asatonline.org.

Lastly, there is hope and tremendous opportunity. With the right treatment, individuals with autism can lead happy and fulfilling lives. Research indicates that interventions such as ABA can effectively help children and adults with ASD realize their fullest potential. As stated earlier, we know that early and intensive behavioral intervention can make a huge difference, both with respect to human potential and significant cost savings across the lifespan.

SB: How can the general public make a positive difference?

DC: It cannot be overstated that it takes a village to help individuals with ASD learn to enjoy and benefit from all that their communities have to offer. Every member of the public can make a difference in supporting individuals with ASD and their families. There are so many positive ways the public can help. Although I will share several examples here, this list is by no means exhaustive:

If you have a family member or a neighbor who has a child with ASD, ask specifically how you may be helpful (e.g., assist with siblings, offer play dates, help with transportation to therapies, or provide an empathic ear).
If you see a family struggle in the community, do not stare, comment, or judge. In some cases, it may be appropriate to go over and assist (e.g., “I see you are helping your little guy, may I help you put your bags in the car?”). Family members may take you up on your kind offer or may just decline.
If your children are interested, inquire if there are opportunities for them to help classmates with ASD at their school (e.g., becoming a lunch buddy, peer tutor). This is particularly beneficial in the later grades when opportunities for students with ASD to interact meaningfully with their typically-developing peers is lessened.
At school board meetings encourage board members to learn about best practices in special education which are scientifically validated. Inquire if special education resources are being spent on interventions that lack scientific support or are not being spent on those that do possess such support (e.g., ABA). In fact, a research basis should inform most decisions.
Some faith communities are very welcoming to families of individuals with ASD, whereas others are not. Discuss this within your place of worship. Identify steps that can be taken to help individuals with ASD participate in their religious communities in a positive and meaningful manner. This applies to both religious ceremonies, as well as day to day participation.
Encourage organizations to be more accepting of persons with ASD and to take appropriate steps to learn how to create meaningful inclusion opportunities (e.g., seeking out information, soliciting training and education, learning from others who are doing this with success).
If you are involved with youth sports or other extracurricular activities, offer to coach and/or mentor a player with ASD.
Encourage your town or city to provide and/or create recreational opportunities that include individuals with ASD as there is often a tendency to focus only on separate experiences.
Support ASD organizations that put science first. Research how your donations are used.

ABOUT DAVID CELIBERTI, PHD, BCBA-D

DCeliberti Dr. David Celiberti is the Executive Director of the Association for Science in Autism Treatment (ASAT). He previously served as the President of the Board of Directors of ASAT from 2006 through 2012. In response to the increasing number of parents attending professional conferences to learn about applied behavior analysis, he also founded the Parent-Professional Partnership SIG for the Association for Behavior Analysis International in 2000 and served as its Co-President until 2014. He had also served as President of the Autism Special Interest Group (SIG) from 1998 to 2006. He currently sits on a number of Advisory Boards in the area of autism, as well as in early childhood education. He has organized fundraising initiatives to support afterschool programming for economically disadvantaged children in Northern New Jersey. Dr. Celiberti is in private practice and provides consultation to public and private schools and agencies in the U.S. and Canada. He received his Ph.D. in clinical psychology from Rutgers University in 1993. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. He has taught courses related to ABA at both the undergraduate and graduate levels, supervised individuals pursuing their BCBA and BCaBA, and in prior positions had conducted research in the areas of applied behavior analysis, family intervention, and autism.

Autism Awareness Month Interview Series: Behavior Analysis and Speech Pathology: The Perfect Pairing for Speech Acquisition with Barbara Esch, BCBA-D, CCC-SLP

Posted on April 23, 2015 by Different Roads to Learning

This week, we are absolutely honored to bring you an exclusive interview with the esteemed Barbara Esch, BCBA-D, CCC-SLP. Dr. Esch has made incredible contributions to the fields of both Behavior Analysis and Speech Pathology. In this interview with Sam Blanco, Dr. Esch shares important teaching techniques on developing language, setting developmentally appropriate goals, and addressing feeding issues. An enormous thank you to Dr. Esch for her invaluable insight.

Don’t forget to check out the other interviews in our Autism Awareness Month Interview Series here.

Behavior Analysis and Speech Pathology: The Perfect Pairing for Speech Acquisition
with Barbara Esch, BCBA-D, CCC-SLP

SAM BLANCO: As someone who is both an SLP and BCBA, how do you envision the two fields collaborating?

BARBARA ESCH: Professionals in each field, behavior analysis and speech pathology, bring unique and critical information and skills to an instructional team. Behavior analysis offers a science-based technology based on our field’s theoretical perspective, which allows us to analyze the contexts in which learning occurs (i.e., antecedent and consequent events) as well as to identify faulty learning and to efficiently remediate error responses and to remove possible obstacles to further skill acquisition. Of particular importance in understanding and teaching language skills is Skinner’s analysis of verbal behavior (Skinner, 1957). This analysis provides us with the critically important understanding of how we acquire language skills; it dispels the faulty notion that the words we say, in a connected language context, are stored in our head someplace to be retrieved when we need them; rather, we say them as a function of the related environmental context, as mands, tacts, and as other verbal operants. This analysis is absent from traditional language assessments (for a discussion of this topic, see Esch, Lalonde, & Esch, 2009), so the field of behavior analysis fills this gap and provides not only a conceptual analysis but also a powerful teaching technology that allows us to extend language learning from one context (e.g., mand) to another (e.g., intraverbal).

Speech pathologists have specialized information and skills regarding the physical system that controls speech sound production, voice quality, swallowing, and, to some degree, hearing. The instructional team benefits from an SLP’s in-depth knowledge of how speech occurs, the physiology of the speech-production system, and how we move our vocalization musculature to produce various speech sounds. Speech pathologists know how to help speech learners make these movements more fluently. They understand the speech requirements for this fluency (i.e., co-articulation) and this expertise allows them to pinpoint specific speech targets in a logical hierarchy of speech sound acquisition.

SB: In the past, you have written that “Speech Language Pathologists are ideal professionals to be included on an ABA team.” Can you share why you think this is true? What steps can SLPs and ABA providers take to promote shared input on goal-setting and program-creation for clients?

BE: Yes, as you suggest, that comment was in the context of shared goals (“Speech language pathologists are ideal professionals to be included on an ABA team since its members are focused on providing effective and efficient instruction, much of which is geared toward speech and language acquisition.” (See https://www.asatonline.org/researfch-treatment/clinical-corner/integrating-aba-and-speech-pathology/)

An ABA team is an instructional team that uses applied behavior analysis to promote student learning. As such, effective team members are knowledgeable in the principles of learning and are skilled at applying the technological procedures that derive from those principles (for example, reinforcement, prompting, prompt fading, shaping, discrimination training, and so on).

There are several steps SLPs and ABA providers can take to promote shared input in designing and carrying out instructional programs for their clients. First, it’s important to recognize that all professionals on an “ABA team,” by definition, should be knowledgeable and skilled in delivering this technology during instruction. That is, members of the ABA team should consider themselves “ABA providers” if they are applying behavior analysis (i.e., ABA) to the delivery of instruction. Thus, teachers, SLPs, technicians, parents, other therapists, behavior analysts, and any others on the team can all be considered “ABA providers” to the extent that they are knowledgeable and effective “appliers” of the learning technology from the field of behavior analysis. Next, each professional can resist the urge to claim ownership over the program and its development. I think the best way to do this is to acknowledge areas of expertise that each member brings to the team and to work together to bring their varied expertise to bear on program development. As an ABA team, goal setting should occur within the context of a behavior analytic perspective. The process can be enriched through the collaborative input of all team members. So, another way team members can promote shared input is to support other team members in learning cross-disciplinary skills or at least in familiarizing themselves with the special expertise of each individual team member.

SB: Developing verbal skills for children with autism is an important goal for everyone involved with the student. Can you describe the first steps you use in selecting developmentally appropriate goals for a particular student?

BE: The VB-MAPP (Sundberg, 2008) is a strong resource in pinpointing developmentally appropriate goals for learners with skills at the pre-school level. This assessment identifies milestones and component skills in 16 critical verbal and non-verbal areas as well as providing an assessment of existing learning barriers that may preclude the acquisition of these important foundation skills. When I look at a child’s VB-MAPP, some priority areas that seem to be “king-pin skills” are imitation, mand, play/leisure, and listener responding. That is, these are some of the first skills I like to see in place as “supporting skills” for the others. If a child can imitate, then I know s/he values people and their attention (thus, we can teach social skills as well as address many of the learning barriers that may be present). Also, since echoing is a type of imitation, I’m encouraged if a child who isn’t yet speaking is beginning at least to imitate gross- and/or fine-motor models. If a child can imitate, then we can teach him/her to mand (either through speech, sign, or picture selection) and, thus, establish language as powerful and personally beneficial. If a child has play/leisure skills, then all the items connected with those play skills are potential reinforcers for other skill learning. This, in turn, can strengthen learning to persist at a task (i.e., stronger reinforcer value for instructional items/activities); this task persistence allows a child to effectively access other instruction from teachers. If a child can respond as a listener, then we can expand his/her cooperation and follow through with more complex instructions, eventually leading to responding both verbally and non-verbally after time delays (i.e., remembering). So, the “king-pin” skills, although not exclusively important, are strong supports for further learning.

SB: You developed the Early Echoic Skills Assessment for the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). Can you describe the development of this tool and how practitioners should best utilize it?

BE: Dr. Mark Sundberg, author of the VB-MAPP (Sundberg, 2008), was interested in providing an assessment tool (and placement guide) that aligned with typical development of children from birth to 4 years. He wanted to include an echoic assessment that would reflect the details of this vocal skill for children in this age range and asked me if I would provide it. The Early Echoic Skills Assessment (EESA) is a criterion-referenced assessment of skills in echoing 1-, 2-, and 3-syllables in various vowel and consonant combinations, utilizing those consonants that would be expected developmentally from birth through 30 months. (Note: Echoic skills are only tested and reported on the VB-MAPP at Levels 1 and 2 because, by 30 months of age, these skills typically have been acquired; thus, there are no EESA items tested at VB-MAPP Level 3.)

The EESA can be helpful for clinicians and practitioners by pinpointing two critical skills: (1) echoic consistency and accuracy and (2) syllable fluency. For echoic consistency, we want to know if the child consistently says anything after an echoic model. If an echoic*, regardless of its accuracy, does not occur consistently (e.g., at least 90% of the time), then treatment can start with simply differentially reinforcing any vocal response that follows an auditory model, without regard for the accuracy of that response. In other words, the first skill to establish in speech training is to “say something” when the teacher asks you to. The next task, informed by the EESA, would be to determine the accuracy of the echoic response. That is, how closely does the child’s response match the vowels and consonants of the teacher’s model? An accurate description of any discrepancies here can serve as a template for target identification.

Finally, the EESA tells us if there is a fluency breakdown in terms of the child’s ability to repeat multiple syllables on one breath at a connected speech rate of about 3 syllables per second. This fluency is critical for normal-sounding speech, but we often see a teaching error related to this that makes fluency less likely to develop. Let’s say that you ask a child to repeat a 3-syllable utterance (e.g., computer, cookie please, let’s go play, where’s daddy?) and s/he omits one or more of the syllables. Often, when practitioners (teachers, parents, therapists) notice that a child omits some of the syllables in a phrase, they will break the phrase apart and reinforce the separate segments. For example, they might instruct the child: “say let’s” (good!), “say go” (that’s right!), “say play” (good job!). This is essentially training the child to emit 1-syllable utterances at a time and doesn’t increase the likelihood that the child will say “Let’s go play” as a unit nor that the phrase will ever occur as normal fluent speech. So, the EESA allows us to pinpoint the child’s current skill in terms of how many syllables s/he can say easily without omitting whole syllables, and it informs the next steps. Thus, treatment can focus on reinforcing, first, easy-to-produce consonant/vowel combinations in phrases of increasing syllable length and then, after that, increasing the phonemic complexity of these consonant/vowel combinations in even longer syllable-length vocalizations.

*An “incorrect echoic” is technically, according to a verbal behavior analysis, not an echoic at all. But this technicality will be set aside for this discussion, to make it easier to understand the 2 critical skills that are often missing in early speech learners: first, repeating a vocal model consistently, and then, repeating it accurately.

SB: Many parents and practitioners struggle with feeding issues in their learners with autism. Are there resources that you would recommend? Do you have tips/suggestions for them?

BE: You’ve identified one of the most challenging issues for parents and teachers of children with autism. Of course, it’s imperative first to rule out any medical concerns related to eating (accepting food, chewing it, swallowing it, and digesting it). So, the child’s pediatrician and other health-care professionals would be key initial contacts in moving forward to identify and resolve feeding issues. If no medical concerns are identified and behavioral treatment is not contraindicated, then it’s important to identify the behaviors related to feeding that have brought this concern to the forefront. Many children are picky eaters (e.g., no veggies; only sweet food) and some have unusual preferences (e.g., no food touching other food on the plate; no red food). Another common issue is texture preferences (e.g., nothing chunky that requires chewing). Some children accept so little food that their nutrition is compromised. Still others will accept food but keep it packed in their mouths and won’t swallow it. And, of course, many children engage in problem behavior that interferes with appropriate feeding (e.g., refusal to sit at the table, refusal to self-feed, refusal to open mouth, crying/tantrums during mealtime).

Fortunately, the behavior analytic literature is replete with research into on feeding issues. Much of this research comes from Dr. Cathleen Piazza, her colleagues, and her students over the years. Dr. Piazza is currently Director of the Pediatric Feeding Disorders Program at Munroe-Meyer Institute at the University of Nebraska Medical Center in Omaha, NE. Another well-published behavioral researcher in pediatric feeding disorders is Dr. Meeta Patel, a former colleague of Dr. Piazza and founder and executive director of Clinic 4 Kidz. The collective work of Drs. Piazza and Patel and others, much of which can be found in the Journal of Applied Behavior Analysis, has greatly informed the assessment and behavioral treatment of feeding disorders.

These are references for some of Dr. Piazza’s work (from her website):

Publications (within the last 5 years)

Rivas, K. M., Piazza, C. C., Roane, H. S., Volkert, V. M., Stewart, V., Kadey, H. J., & Groff, R. A. (in press). Analysis of self-feeding in children with feeding disorders. Journal of Applied Behavior Analysis, 47(4), 710-722.

Wilkins, J. W., Piazza, C. C., Groff, R. A., Volkert, V. M., Kozisek, J. M., & Milnes, S. M. (in press). Utensil manipulation during initial treatment of pediatric feeding problems. Journal of Applied Behavior Analysis, 47(4), 694-709.

Groff, R. A., Piazza, C. C., Volkert, V. M., & Jostad, C. M. (in press). Syringe fading as treatment for feeding refusal. Journal of Applied Behavior Analysis. 47(4), 834-839.

Volkert, V. M., Peterson, K. M., Zeleny, J. R., & Piazza, C. C. (2014). A clinical protocol to increase chewing and assess mastication in children with feeding disorders. Behavior Modification, 38(5), 705-29.

Bachmeyer, M. H., Gulotta, C. S., & Piazza, C. C. (2013). Liquid to baby food fading in the treatment of food refusal. Behavioral Interventions, 28(4), 281-298.

Kadey, H., Piazza, C. C., Rivas, K. M., & Zeleny, J. (2013). An evaluation of texture manipulations to increase swallowing. Journal of Applied Behavior Analysis, 46(2), 539-543.

Volkert, V. M., Piazza, C. C., Vaz, P. C. M., & Frese, J. (2013). A pilot study to increase chewing in children with feeding disorders. Behavior Modification, 37, 391-408.

Addison, L. R., Piazza, C. C., Patel, M. R., Bachmeyer, M. H., Rivas, K. M., Milnes, S. M., & Oddo, J. (2012). A comparison of sensory integrative and behavioral therapies as treatment for pediatric feeding disorders. Journal of Applied Behavior Analysis, 45, 455-471.

Vaz, P. C. M., Piazza, C. C., Stewart, V., Volkert, V. M., Groff, R. A., & Patel, M. R. (2012). Using a chaser to decrease packing in children with feeding disorders. Journal of Applied Behavior Analysis, 45, 97-105.

Dempsey, J., Piazza, C. C., Groff, R. A., & Kozisek, J. M. (2011). A flipped spoon and chin prompt to increase mouth clean. Journal of Applied Behavior Analysis, 44, 949-954.

LaRue, R. H., Stewart, V., Piazza, C. C., & Volkert, V. M. (2011). Escape as reinforcement and escape extinction in the treatment of feeding problems. Journal of Applied Behavior Analysis, 44, 719-735.

Groff, R. A., Piazza, C. C., Zeleny, J. R., & Dempsey, J. R. (2011). Spoon-to-cup fading as treatment for cup drinking in a child with intestinal failure. Journal of Applied Behavior Analysis, 44, 949-954.

Wilkins, J. W., Piazza, C. C., Groff, R. A., & Vaz, P. C. M. (2011). Chin prompt plus re-presentation as treatment for expulsion in children with feeding disorders. Journal of Applied Behavior Analysis, 44, 513-522.

Vaz, P. C. M., Volkert, V. M., & Piazza, C. C. (2011). Using negative reinforcement to increase self-feeding in a child with food selectivity. Journal of Applied Behavior Analysis, 44, 915-920.

Rivas, K. R., Piazza, C. C., Kadey, H. J., Volkert, V. M., & Stewart, V. (2011). Sequential treatment of a feeding problem using a pacifier and flipped spoon. Journal of Applied Behavior Analysis, 44, 387-391.

Volkert, V. M., Vaz, P. C. M., Piazza, C. C., Frese, J., & Barnett, L. (2011). Using a flipped spoon to decrease packing in children with feeding disorders. Journal of Applied Behavior Analysis, 44, 617-621.

Tang, B., Piazza, C. C., Dolezal, D., & Stein, M. T. (2011). Severe feeding disorder and malnutrition in two children with autism. Journal of Developmental and Behavioral Pediatrics. 32(3), 264-267.

Rivas, K. D., Piazza, C. C., Patel, M. R., & Bachmeyer, M. H. (2010). Spoon distance fading with and without escape extinction as treatment for food refusal. Journal of Applied Behavior Analysis, 43, 673-683.

SB: You’ve published research about behavioral treatments for early speech acquisition. Can you briefly describe your research? What do you think are important research questions in this area for the future?

BE: There are few behavioral treatments for early speech learners (i.e., individuals who haven’t acquired speech as would be developmentally typical). Further, the research on these treatments is not particularly robust at this point; either there is a paucity of studies available or the outcomes are inconsistent. It’s an area ripe for research because we need effective and efficient ways to jump start vocal behavior in individuals who haven’t yet acquired an echoic response. It’s not too difficult to teach someone to talk if they will repeat when asked to “say ___,” but without that echoic response, we must work to establish vocalizing in general as a “preferred activity,” producing a “preferred stimulus” that automatically reinforces the vocalizing that produced those sounds (i.e., babbling, vocal play). If we have that, then we can bring those vocalizations under the control of direct contingencies of reinforcement, as functional verbal behavior (e.g., mands, tacts). This post-babbling speech training is critical, because parents, teachers, and other caregivers in the child’s verbal community need to have their own vocal-verbal behavior reinforced by the child’s speech responses to them. Without that reciprocal interaction of vocalizing in context (i.e., speaker/listener), the frequency of functional speech interactions can spiral downward with resulting isolation for both speakers and listeners.

So, the first step in teaching speech to non-vocal learners is to establish an available pool of varied vocalizations that the child readily says that can then be reinforced by the child’s verbal community. Following the earlier work of behavioral researchers (e.g., Miguel, Carr, Michael, 2002; Sundberg, Michael, Partington, & Sundberg, 1996; Yoon & Bennett, 2000; Yoon & Feliciano, 2007), my colleagues and I have reported investigations (Esch, Carr, & Michael, 2005; Esch, Carr, & Grow, 2009; Petursdottir, Carp, Matthies, & Esch, 2011) of stimulus-stimulus pairing (SSP), a conditioning treatment aimed at increasing vocalizations in non-vocal or low-vocal learners by pairing certain sounds with preferred items/activities. As mentioned, if SSP induces vocalizations, the goal is then to apply direct reinforcement to establish these vocal responses as mands, tacts, echoics, and other verbal language skills. Another behavioral treatment is vocal variability (VV) training, aimed at increasing novel and varied vocalizations in speech learners who may emit some vocalizations but that tend to be repetitive (i.e., invariant). However, to date, there are only 2 published VV studies with low-vocal speech learners (Esch, Esch, & Love, 2009; Koehler-Platten, Grow, Schulze, & Bertone, 2013), although we have some research that has investigated increasing the variability of rote language responses with already-competent speakers (Lee et al., 2002; Susa & Schlinger, 2012).

In an effort to increase speech in non-vocal children, other studies have looked at comparisons of SSP with operant discrimination training (Lepper, Petursdottir, & Esch, 2013) and preceding echoic trials with a series of gross- and fine-motor imitation opportunities (i.e., RMIA procedures reported by Ross & Greer, 2003; Tsiouri & Greer, 2007). Investigations such as these may yield useful treatments for early speech learners.

There is much we don’t know about why children fail to learn to talk. We assume that success in speech learning is based on (a) hearing and attending to human voice, (b) valuing those sounds and combinations of sounds via a previous conditioning history, and (c) possessing a physical system that produces sounds similar to those with the conditioning history (i.e., the sounds of the child’s verbal community). If we assume that the child’s speech-producing mechanism (c above) is intact, then we can focus our research efforts on (a) and (b). In fact, SSP and VV training are targeted at increasing “sound value” and RMIA studies are aimed at increasing attending and responding to (i.e., imitating) rapid visual and auditory models. In a discussion related to these skill sets, Petursdottir et al. (2011) offer several important areas for future research. One is that of determining whether human speech (the auditory stimuli in speech training) is, indeed, a preferred stimulus for the learner (that is, does it “sound good” to the child?). Another is to identify the effects of such stimuli on the vocal responses of the speech learner. If the speech sounds of a child’s environment lacks reinforcing value, then what do we need to pair it with and in what conditioning procedure to ensure that it becomes a “preferred stimulus” that the early speech learner can produce himself by making those sounds? Another topic is the salience of auditory vocal stimuli; this has not been adequately measured and identified. It would be helpful to know whether a speech learner has, indeed, observed relevant speech sounds such that these are discriminable and evoke responding.

Additional Reading

Esch, B. E., LaLonde, K. B., & Esch, J. W. (2010). Speech and language assessment: A verbal behavior analysis. The Journal of Speech-Language Pathology and Applied Behavior Analysis, 5, 166-191.

Skinner, B. F. (1957). Verbal behavior. New York: Appleton-Century-Crofts.

Sundberg, M. L. (2008). VB-MAPP: Verbal behavior milestones assessment and placement program. Concord, CA: AVB Press.

ABOUT BARBARA ESCH, BCBA-D, CCC-SLP

Dr. Barbara Esch, BCBA-D, CCC-SLP, is a behavior analyst and speech pathologist with more than 30 years of experience in behavioral interventions for individuals with developmental disabilities. She has worked in school, home, clinic, and hospital settings. Her workshops, training symposia, and research have been presented in the United States, Europe, and Australia, and focus on the use of behavioral procedures to improve speech, language, and feeding skills for individuals of all ages with a wide range of medical and educational diagnoses. Esch received her PhD in applied behavior analysis from Western Michigan University and her MA in speech pathology from Michigan State University. She is the author of the Early Echoic Skills Assessment, part of the Verbal Behavior Milestones Assessment and Placement Program: VB-MAPP (Sundberg, 2008). She is the founder and past chairperson of the Speech Pathology Special Interest Group of the Association for Behavior Analysis International. Her research on behavioral treatments for early speech acquisition appears in The Analysis of Verbal Behavior and the Journal of Applied Behavior Analysis. Esch is co-owner of Esch Behavior Consultants, Inc., a consulting company specializing in behavioral treatments for individuals with severe communication delays.

Autism Awareness Month Interview Series: Getting the Services Your Child with Autism is Legally Entitled To with Gary S. Mayerson, JD

Posted on April 16, 2015 by Different Roads to Learning

This week, our exclusive interview series with BCBA Sam Blanco features the renowned Gary Mayerson, JD, founder of Mayerson & Associates, the very first civil rights law firm in the nation dedicated to representing individuals with autism and related developmental disorders. In this interview, he reveals valuable advice for parents and caregivers on how to find and obtain the services their children are entitled to.

Getting the Services Your Child with Autism is Legally Entitled To
with Gary S. Mayerson, JD

SAM BLANCO: Can you address any common misconceptions related to IDEA or LRE?

GARY MAYERSON: The federal IDEA statute is governed primarily by what is “appropriate” for the student, as opposed to what is “best” or “optimal.” Unfortunately, the IDEA statute does not define the word “appropriate” and that confusion accounts for many of the conflicts that will arise between parents and school districts, who are obligated to provide a FAPE (a “free and appropriate public education”). On the other hand, LRE, otherwise known as “least restrictive environment,” is one of the few “maximizing” provisions in the IDEA statute. LRE is Congress’ mandate that students with disabilities be educated with their non-disabled peers to the “maximum extent appropriate,” even if doing so requires supplemental aids and services. The LRE mandate requires school districts to consider what is known as “the full continuum” and not rely upon “one size fits all” special education classrooms.

SB: What is the most important piece of advice you can give to parents as they begin the process of finding an appropriate school placement for their child?

GM: The best advice I could give parents who are just getting started is to seek out the best possible baseline of assessments and evaluations to tease out the strengths and challenges, identify and address any interfering behaviors, and hopefully get a good sense as to how their child learns, i.e., what kinds of programs are likely to be effective or not. Without the benefit of solid evaluations, the discussion at the IEP meeting will likely be relegated to “this is what the parents want.” When parents are able to provide quality evaluations, the discussion is elevated to “this is what professionals are recommending.” School districts are far more likely to take action based on the recommendation(s) of experts. Early intervention is always best. Accordingly, once evaluations and assessments are available to guide intervention, services should start ASAP. Parents of children diagnosed on the autism spectrum who are just getting started will find very useful information at www.autismspeaks.org. Autism Speaks offers an online “100 Days Kit” to help parents wade through the initial time frame following a diagnosis.

SB: Many parents struggle with the costs associated with autism. What advice do you have for them to alleviate some of the expenses?

GM: This is a thorny topic because even families with significant financial resources will struggle to pay for the daunting cost of effective programming where autism is the core disability. Today, most states (including New York) have enacted insurance reform, which means that many intervention services will be covered by private insurance, typically limited to an annual cap of approximately $40,000 or so. Parents should also consider obtaining home and community based services by filing for a “Medicaid waiver.” In addition to accessing insurance benefits and applying for a Medicaid waiver, families should register with early intervention (“birth to three”) and later, with their Committee on Preschool Education (3-5) and later, with their Committee on Special Education (5-21) to secure a public program. If, however, the public program is not appropriate or adequate, with timely advance notice, parents can file for a hearing to seek to obtain reimbursement or other funding for services and programming that is appropriate. Even short of a lawsuit, if parents are unhappy with the school district’s evaluation, they can request an “independent (private) evaluation” at the expense of the school district.

SB: Do you have recommendations for how parents keep track of records for legal purposes?

GM: Good record keeping is absolutely essential for parents. A great low tech, low cost method every parent should employ– keeping a $.99 notebook “log” of all your conversations with evaluators, school district personnel and providers. Everything important needs to be confirmed and documented in writing. This, however, does not mean sending a letter by certified mail. Faxes are just fine (but be sure to keep the fax transmittal confirmation), as are emails. Make sure to save every notice, letter and communication. For the IEP meeting, parents should either take good notes or, in situations where distrust has arisen, consider tape recording the meeting. Parents who observe schools that are being recommended by the school district also should record their observations, both good and bad.

SB: What resources do you recommend for parents to educate themselves about their legal rights?

GM: While there often is no substitute for seeking the assistance of an experienced attorney or other advocate, there actually are a number of good resources for parents to turn to in order to become better informed as to their child’s rights and entitlements. Parents, for example, will find useful information at www.wrightslaw.com and at www.mayerslaw.com. Our law firm invites parents to sign up for the firm’s quarterly informational newsletter. In addition, parents should carefully review the “parental rights” booklet that all school districts are required to provide in the context of the IEP process. Parents can also contact their local SEPTA or PTA. Finally, each state’s department of education will post, online, valuable information that parents can access free of charge, 24/7.

SB: Do you discuss estate planning for parents of children with special needs? When do you advise parents to begin making those plans?

GM: Parents of special needs children live with constant worry, knowing that they will not be able to live and protect their child forever. All parents–even those without any financial resources–should have a will that addresses estate planning issues, and the question of who will take over the parental role when the parent is no longer around to do so. Parents with financial resources, or who expect to come into money in the future, need to engage counsel to set up a “special needs trust” for their child—so as to allow the child to receive Medicaid and Social Security benefits without endangering the estate when such benefits are accessed. It is never too early to discuss estate planning issues, and too many parents overlook estate planning issues until it is too late. Parents also should timely commence guardianship proceedings well before the child reaches the age of majority (18 in most jurisdictions). Otherwise, a child who reaches the age of majority without a guardianship order may leave the jurisdiction and put themselves in danger with parents being left with little, if any, legal recourse. This is not to say, however, that obtaining guardianship is a given. Obtaining guardianship requires a showing, deemed acceptable to the court, that the child is incapable of making their own decisions.

SB: Can you describe legal considerations across the lifespan? For instance, what should the preschooler’s parents be considering as opposed to the teenager’s parent?

GM: The perspective and legal considerations when a child is a preschooler are different than when a child reaches his or her teens. While learning can and will continue into adulthood, most scientists and educators are in agreement that the same effort will produce greater learning, with a greater “rate of acquisition,” when the same child is younger. For this reason, judges and hearing officers are most comfortable “investing” significant public resources in the younger child. Because of the value of “early intervention,” parents need to obtain a diagnosis and classification as soon as possible. This means obtaining quality assessments that come with specific recommendations. Parents of children at the preschool age should thus timely receive the services and service levels that are being recommended by professionals. When the child enters his or her teens, that child still may require intensive services. However, as mandated by federal and state law, when a child is about to turn 16 (15 in New York), the IEP is supposed to shift into high gear with “transition” assessments, vocational training, and post-secondary outcomes. At all stages, parents should make sure that educators and service providers are promoting “generalization,” and that increased independence and self –sufficiency is the constant beacon on the horizon.

ABOUT GARY S. MAYERSON, JD

Gary Mayerson is a graduate of the Georgetown University Law Center and the S.I. Newhouse School of Public Communications at Syracuse University. In early 2000, Gary founded Mayerson & Associates as the very first civil rights law firm in the nation dedicated to representing individuals with autism and related developmental disorders.

Gary speaks regularly at national conferences and major universities and has testified before Congress on the subject of the federal Individuals with Disabilities Education Improvement Act (“IDEIA”). At the invitation of the United Nations, Gary spoke on the subject of facilitating inclusive education. Gary is well published in the field and is the author of How To Compromise With Your School District Without Compromising Your Child (DRL Books 2005), the “Legal Considerations” chapter appearing in the Second Edition of Dr. Donna Geffner’s book, Auditory Processing Disorders (2013), and the “Autism in the Courtroom” chapter appearing in the Fourth Edition of Dr. Fred R. Volkmar’s seminal treatise, Autism and Pervasive Developmental Disorders (2014).

Gary has been interviewed by the Today Show (NBC), Dan Rather (HDNet), Katie Couric, CNN, HLN, ABC, NPR, New York Magazine, the Wall Street Journal, Congressional Quarterly Researcher and the New York Times, among other media. In 2014, after being peer-nominated and vetted across 12 factors by an attorney led research team, Gary was named by Super Lawyers Magazine as one of the top attorneys in the New York metropolitan area.

In addition to the U.S. Supreme Court, Gary is admitted to the Second Circuit Court of Appeals, the Third Circuit Court of Appeals, the Fifth Circuit Court of Appeals, the Sixth Circuit Court of Appeals, the Seventh Circuit Court of Appeals, the Tenth Circuit Court of Appeals, and the Eleventh Circuit Court of Appeals.

Gary is responsible for more than sixty reported federal court decisions, including Deal v. Hamilton County, the very first autism case to ever reach the U.S. Supreme Court. Gary’s work also was instrumental in T.K. v. NYCDOE (bullying recognized as a “FAPE” deprivation), R.E. v. NYCDOE and C.F. v. NYCDOE (cases rejecting school district’s attempts to rely upon “impermissible retrospective evidence” at trial), T.M. v. Cornwall (least restrictive environment mandate as applied to ESY), L.B. v. Nebo School District (pertaining to “supported inclusion” and Congress’ “least restrictive environment” mandate), V.S. v. NYCDOE (parents have a procedural right to evaluate the school assignment) and Starego v. NJSIAA, a federal court settlement affording Anthony Starego, a 19-year-old high school placekicker with autism, an unprecedented fifth season of interscholastic competition (incredibly, that additional season had a storybook ending, with Anthony and his team going on to win the 2013 State Championship 26-15 after Anthony contributed points from two successful field goals!).

Gary has served on the national board of Autism Speaks since its inception in 2005 and founded its Federal Legal Appeals Project, a pro bono initiative at the federal level. In addition, Gary serves on the Boards of JobPath, a not-for-profit based in Manhattan that is dedicated to securing and supporting meaningful employment opportunities for adults with autism, and ALUT, Israel’s largest autism not-for-profit. Gary also serves on the Professional Advisory Board of the New England Center for Children (NECC), a residential school for students with autism located in Southborough, Massachusetts.

Gary testified before the New York City Council in support of “Avonte’s Law,” a safety enhancement measure introduced by Councilmember Rob Cornegy that, once fully implemented, will provide an additional layer of protection for students with autism who have a propensity to wander. Most recently, Gary and attorneys Maria McGinley and Jacqueline DeVore worked behind the scenes to help secure a conditional pardon from the Governor of Virginia for “Neli” Latson, a young man with autism, previously placed in solitary confinement, who is now receiving the therapeutic treatment that he needs.

Autism Awareness Month Interview Series: Developing Social Skills With Young Learners with Mary Jane Weiss, PhD, BCBA-D

Posted on April 9, 2015 by Different Roads to Learning

This week, we’re excited to share the second installment in our series of exclusive interviews with autism experts for the month of April, featuring Mary Jane Weiss, PhD, BCBA-D. In this interview with BCBA Sam Blanco, Dr. Weiss discusses some of the most effective ways for parents and practitioners to develop social skills in young children, as well as some of the most common errors that are made in teaching these important skills.

Developing Social Skills with Young Learners
with Mary Jane Weiss, PhD, BCBA-D

SAM BLANCO: What advice do you have for parents of young learners who are concerned about social skills?

MARY JANE WEISS: Well, we all need to be concerned about social skills. One related issue is social motivation. If a learner is socially interested, social skill training is considerably easier. If not, we need to work on making social interaction meaningful and rewarding. What are the favorite activities of this child? How can we embed ourselves into them? Can we teach manding for them so that we grant access? Can we create social routines within them? How can we make something that is not yet social begin to be social?

SB: What are activities parents can engage in to help their learners develop stronger social skills?

MJW: Parents are in a great position to teach social skills, because there are endless opportunities to use as teaching moments. Think of requesting: there are countless moments in every day to work on requesting – food, drinks, snacks, tissues, a ball, to go outside, to play a game, to make a silly face…Imitation too is so easy to work on and the list of things to imitate is long. Can your child imitate how you clean the table, sweep the floor, load the dishwasher, open the mail, help a younger sibling do a puzzle? And joint attention: capture the unusual moments in every day and create a social exchange around them!

SB: When considering social skills for young learners, what are the first skills you focus upon?

MJW: Imitation, Joint Attention, Manding… I think we have to start with these. They are core socio-communicative skills. Many higher order skills require these foundations. And I think we need to focus on pairing ourselves with great things to naturally build approach behaviors and naturally reduce avoidance behaviors.

SB: Many parents and practitioners are concerned about eye contact. Can you talk about that skill? Why is it important? Do you start with eye contact?

MJW: There are many opinions about this. I was trained to be aware of the ways in which eye contact can be trained to be non-functional. For example, if we ask for eye contact before every instruction, we run the risk that learners will depend on that cue in order to attend/be ready for ANY OTHER instruction. That is not a desired outcome. On the other hand, the absence of eye contact is very stigmatizing, and does not invite social bids. Here are some ideas for making it functional:

Build eye contact through engaging playful interaction.
Try not to over-rely on any attentional cue (but especially not “look at me”).
Experiment with more natural ways to get eye contact on command (e.g., in response to name or given as a group instruction to all).

SB: Are there any common mistakes you see in teaching social skills?

MJW: YES, thanks for asking that question! The biggest mistake I have seen is teaching social skills in rote and contrived situations that do not represent natural experiences. When we teach a list of social questions, we are not necessarily helping learners to develop social conversation skills. We do not ask people their name, address, favorite food, and siblings’ names as conversation (beyond the first day of meeting someone!). We need to teach CONTEXT. We do not ask someone about their weekend each time we see them on Monday. We only do that the FIRST time. Sensitivity to context is often absent from social skill instruction.

Also, I see people focusing on responsivity to questions. We need to broaden the responsivity training. In fact, many social exchanges start with comments. Someone comments about something, and we respond with comments or questions. Most children with autism are taught to respond to questions. Sometimes, they do not even realize that a comment is a social opportunity.

Finally, we need to teach INITIATION skills. How do we start a conversation, ask someone to play with us, ask for something we need, request to join a game? We have to balance our instruction in responding with instruction in initiation!

SB: There’s a common misconception that ABA is solely teaching skills at a table in discrete trials. How can ABA be useful in teaching social skills?

MJW: ABA can be useful in teaching a wide variety of social skills well beyond DTI! I really like the work on scripts. I also like the way Jed Baker has outlined social skills training for non-vocal learners. I absolutely love the Crafting Connections curriculum; it is so focused on socially valid skills.

SB: What resources do you recommend to parents?

MJW: There are several curricular resources that I think can be useful. Some of my favorite books are:

The Social Skills Picture Book: Teaching play, emotion, and communication to children with autism
Jed Baker (Author)
ISBN: 978-1885477910, Publication Date: 2003

Building Social Relationships: A Systematic Approach to Teaching Social Interaction Skills to Children and Adolescents with Autism Spectrum Disorders and Other Social Difficulties
Scott Bellini (Author)
ISBN: 978-1931282949, Publication Date: 2006

Social Skills for Teenagers with Developmental and Autism Spectrum Disorders: The PEERS Treatment Manual
Elizabeth A. Laugeson and Fred Frankel (Authors)
ISBN: 978-0415872034, Publication Date: May 20, 2010

Teaching Conversation to Children With Autism: Scripts And Script Fading
Lynn E. McClannahan and Patricia J. Ph.D. Krantz (Authors)
ISBN: 978-1890627324, Publication Date: 2005

Crafting Connections: Contemporary applied behavior analysis (ABA) for enriching the social lives of persons with Autism Spectrum Disorder
Mitchell Taubman, Ron Leaf, and John McEachin (Authors)
ISBN: 978-0975585993, Publication Date: 2011

I also really like the book series below:

Joy Berry series of books (Help Me Be Good series)
Cheri Meiners series of books (Learning to Get Along series)

SB: Is there any particular assessment you recommend practitioners use to assess social skills?

MJW: There are a variety of assessments that target social skills. Some are useful for group interaction (e.g., the ABLLS-R has a section on classroom relevant skills……). The VB-MAPP has some elements that are very socially relevant, including the Barriers Assessment and the Transitions Assessment. Those assessments help to identify individuals that may be ready for more group instruction or more naturalized instruction.

SB: Are there any particular studies you direct practitioners to that are related to social skills training for individuals with autism?

MJW: I really like the work of Justin Leaf and his colleagues at Autism Partnership. Their elegant studies have been real contributions to the empirical literature. Bridget Taylor has also done some excellent work, including in some centrally important areas such as joint attention.

ABOUT MARY JANE WEISS, PHD, BCBA-D

Mary Jane Weiss, Ph.D., BCBA-D has been working as a behavior analyst serving people with autism for over 25 years. She received her Ph.D. in Clinical Psychology from Rutgers University in 1990, and became a Board Certified Behavior Analyst in 2000. She is currently a Professor of Education at Endicott College, where she directs the graduate programs in ABA and Autism. She previously served as an Associate Professor at the Graduate School of Applied and Professional Psychology at Rutgers University, and as Director of Research and Training and as Clinical Director of the Douglass Developmental Disabilities Center at Rutgers University for 16 years. Her clinical and research interests center on defining best practice ABA techniques, on evaluating the impact of ABA in learners with autism spectrum disorders, and in maximizing family members’ expertise and adaptation. She is a regular presenter at regional and national conferences on topics relevant to ABA and autism. She is a past president of the Autism Special Interest Group of the Association for Behavior Analysis, a former member of the Association of Professional Behavior Analysts Board of Directors, and she currently serves on the ethics review committee of the Behavior Analyst Certification Board, on the Scientific Council of the Organization for Autism Research, on the Legislative Affairs Committee of the New Jersey Association for Behavior Analysis, and on the Board of Trustees of Autism NJ.

Autism Awareness Month Interview Series: Essentials of Verbal Behavior with Mark Sundberg, PhD, BCBA-D

Posted on April 1, 2015 by Different Roads to Learning

Today marks the start of Autism Awareness Month. This year, we’re thrilled to introduce a series of exclusive interviews with renowned experts on topics that are of interest and importance to both parents and professionals working with students on the autism spectrum. We can’t think of a better way to kick off this series than with an information-packed interview with Mark Sundberg, PhD, BCBA on the Essentials of Verbal Behavior.

Dr. Sundberg hardly needs an introduction. He is the author of the VB-MAPP, Teaching Language to Children with Autism and Other Developmental Disabilities, and co-author of the original ABLLS. Additionally, he has published over 50 professional papers and 4 book chapters and taught more than 80 university courses on behavior analysis, verbal behavior, sign language, and child development. He is a licensed psychologist with over 40 years of clinical experience.

We’re honored that Dr. Sundberg agreed to kick off Autism Awareness Month here at Different Roads and answer these questions on Verbal Behavior from BCBA Sam Blanco. A big thank you to Cindy Sundberg as well for her help with the interview.

Essentials of Verbal Behavior
with Mark Sundberg, PhD, BCBA-D

SAM BLANCO: There is often confusion about what differentiates ABA and Verbal Behavior. Can you tell us what Verbal Behavior is and how it relates to ABA?

MARK SUNDBERG: In the 1950s B. F. Skinner published the book Science and Human Behavior (1953). In that book he described how the basic concepts and principles of behavior analysis could be applied to human behavior. This book is credited for starting the field of Applied Behavior Analysis (ABA) (Morris, Smith, & Altus, 2005). A few years later Skinner published the book Verbal Behavior (1957) which contained a detailed analysis of language, a topic he addressed frequently in Science and Human Behavior and other writings. The verbal behavior (VB) approach (or ABA/VB) to autism treatment is based on these two Skinner books, and over 60 years of conceptual and empirical research that has evolved primarily from this original material.

Regarding the similarities and differences between ABA and VB, first they both make use of the same principles, procedures, and research basis of behavior analysis (Skinner, 1953). That is, they both use the basic procedures of prompting, fading, shaping, reinforcing, and so on (cf. Cooper, Heron, & Heward, 2007). The primary difference between the two approaches is the analysis of language that underlies the assessment and intervention programs. The VB approach makes use of Skinner’s (1957) behavioral analysis of language along with ABA principles and procedures, while most ABA and cognitive-based programs use the traditional expressive and receptive framework of language. Although this seems to be changing in that more ABA approaches and outcome studies are incorporating aspects of Skinner’s analysis (e.g., manding) into their intervention programs (e.g., the Sallows & Graupner, 2005 outcome study).

The main advantage of Skinner’s treatment of language for children with autism is that he breaks down expressive language more thoroughly and functionally. He suggests that the “mand,” “tact,” and “intraverbal,” are functionally different from each other because they are controlled by different environmental variables. For example, the mand is under the functional control of motivational variables (what a child wants), while the tact is under the functional control of nonverbal discriminative stimuli (what a child sees, hears, etc., but may not want). It is not uncommon to encounter children with autism who have dozens of words as tacts, but no words as mands (their mands may occur in the form of tantrums or other negative behavior). In the traditional analysis of expressive language this distinction between the mand and the tact is not made, thus a resulting intervention program may not completely or accurately address a child’s needs. These important differences in verbal skills are not typically assessed by most of the common assessment tools used for children with autism (Esch, LaLonde, & Esch, 2010). For more details on the value of incorporating Skinner’s (1957) analysis of verbal behavior into ABA programs, the reader is referred to Petursdottir and Carr (2011) and Sundberg and Michael (2001).

SB: Can you tell us a bit about developing the VB-MAPP? It must have been quite an undertaking!

MS: I’ve been working on applying Skinner’s (1957) analysis of verbal behavior to language assessment and intervention since the 1970s when I was one of Jack Michael’s graduate students at Western Michigan University. This topic became the foundation of my doctoral dissertation (Sundberg, 1980), and has been the main focus of my professional career. The VB-MAPP was designed to be an assessment tool that is comprehensive, precise, developmentally matched, and functionally valuable to the child. As a result, the information obtained from the VB-MAPP can assist in IEP planning and help to establish intervention priorities, and serve as a curriculum guide for the program. The VB-MAPP is also designed to serve as a dependent measure in empirical research, and outcome research. In addition, problem behavior and various other “barriers” impact learning and should be assessed along with language, learning, and social skills. If left unattended, these barriers can slow down a child’s skill acquisition or possibly bring any gains to a complete standstill, and leave the child susceptible to other problems. Thus, the VB-MAPP also contains an assessment of 24 barriers that might affect a child (e.g., escape and avoidance, prompt dependency, demand weakens motivation).

The VB-MAPP has greatly benefited over the years from the many parents and professionals who have provided feedback or conducted field-testing with typical children and children with special needs in schools, homes, clinics, and community settings. This feedback and field-testing provided us with a wealth of information that influenced many aspects of the VB-MAPP, such as checks for generalization throughout the assessment, tips for the tester, more information in the Guide about the skills being assessed, and a placement program to provide general direction for intervention and IEP development. Our own field-testing activities also helped us with many of the improvements, such as the refinement of the sequence and validity of the intraverbal assessment (e.g., Sundberg & Sundberg, 2011), and separating play skills into independent play and social play for a tighter assessment of this area. In addition, there is now a more extensive body of conceptual and empirical research that has advanced our overall understanding of language acquisition and the treatment of autism.

We were also fortunate to have Barbara Esch, Ph.D., CCC-SLP, BCBA-D include her Early Echoic Skills Assessment to the VB-MAPP. Her tool presents a state-of-the-art method to quickly assess a child’s echoic repertoire, and it fits well within the VB-MAPP. The VB-MAPP also contains a short transition assessment that resulted from many years of consulting to special education classrooms and attending IEPs. We thought it would be useful to create a piece of the assessment that could help to determine what type of educational format might best suit an individual child (e.g., 1:1 vs. small group instruction, inclusion). The targeted milestones in the VB-MAPP have been carefully chosen and matched to those of typically developing children, thus providing a clearer picture of how a child with autism is performing. We aligned the VB-MAPP with standardized, and well-respected assessments, including the APES, Bayley-III, PLS-IV, and the Vineland-II. As a result of these various features, the VB-MAPP moves beyond just an assessment of basic skills to a more thorough and functional assessment of the whole child.

The work on the VB-MAPP and making ABA and verbal behavior understandable and accessible continues to be an on-going process. After the VB-MAPP was published in late 2008, we received interest from professionals wanting electronic versions and foreign language translations. The VB-MAPP is now also available as an app and web-based format, as well as in several different languages including Chinese, French, Italian, Polish, Russian, and Spanish, with other languages in various stages of development.

SB: For a learner who is just developing language, what does research show is the appropriate developmental order for teaching verbal skills? (For example, do you teach “I want _______” to a learner who only has ten words?)

MS: The design of the VB-MAPP directly addresses the issue of using typical developmental milestones as a framework for the assessment and the intervention program. For example, it is common to have adjectives, prepositions, and answering WH questions on an IEP for a child who may only have a 30-word vocabulary. Developmentally, that small of a vocabulary size indicates that the child may not be ready for tasks that require the child to modify nouns with their properties or location, let alone answer WH questions about them. Likewise, adding carrier phrases such as “I want” to a mand may be of little value to a child who only has ten words. The child would probably benefit more from first learning more mands and tacts. There are many aspects to developing a child’s verbal skills, even though the learning patterns demonstrated by typical children can guide us, each child is different and still requires an individual analysis of what curriculum sequence might work best for him.

SB: Why is it important for a learner to have a certain number of mands before moving on to other verbal skills?

MS: There is no magic number of mands. My point (from Skinner) has been that manding is the only type of verbal behavior that directly benefits the child. Mands allow a child to get access to things and activities that are important to him. That’s motivating for the child, and increases chances that he will initiate verbal interactions and emit language in a more natural way, as well as participate in other instructional activities. The other types of verbal behavior (e.g., echoic, tacting) don’t have the same effect. I have found repeatedly that it is often quite easy to establish a mand for a nonverbal child (especially using sign language or PECS), and it becomes much easier to use this newly established rapport to teach the child other skills. A variety of different verbal skills are necessary for a functional communication repertoire. Sooner or later the child must learn other language skills such as tacts, intraverbals, and listener skills. My tendency to encourage practitioners to emphasize the mand has been mainly due to its value to the child, but also to offset the historical tendency by many ABA programs to ignore the mand, teach it late in an intervention program, not appreciate the difference between motivational control and stimulus control, or assume that the mand will just emerge from other types of training.

SB: How do you measure verbal behavior?

MS: Verbal behavior can be measured by using many of the same recording systems common to behavior analysis (e.g., Cooper, Heron, & Heward, 2007), such as rate, frequency, time samples, discontinuous measurement, etc. However, it is important to carefully identify all the antecedent variables that are involved. For example, it is not enough to simply record that a child says the word “ball” 10 times in a 1-hour period. The measurement system, like all ABC recording systems, must also include the antecedent sources of control that evoked that response. If the ball is present, the response is part tact, if an EO for the ball is present, the response is part mand, if an echoic prompt is given, the response is part echoic, and so on. A child who emits “ball” 10 times as an echoic is not behaving in the same way as a child who emits “ball” 10 times as a mand or tact. In short, a verbal behavior measurement system not only records the topography of responses, but their function as well. Thus, there may be several different data sheets that all measure a child’s acquisition of the word “ball,” but each differ in important ways (e.g., “ball” as a tact vs. “ball” as an intraverbal). More detail on measuring and recording verbal behavior can be found throughout the VB-MAPP Guide, as well as in Sundberg & Partington (1998).

SB: One resource I frequently use is the 300 Common Nouns list. Can you talk about how this list is useful?

MS: The goal of the list is to take some of the guesswork and randomness out of selecting new targets for vocabulary development by providing a group of common nouns that young typically developing children might acquire. In addition, the lists are designed to track the acquisition of a new word (e.g., spoon) across a variety of conditions. For example, there are columns for both tacting and listener skills, as well as for generalization and more complex demonstrations of a skill. The list also provides the basis for moving an individual word to more complex types of verbal behavior. For example, when adding a verb or an adjective to a noun (e.g., “white plastic spoon”) staff should cautiously select nouns that have been acquired and generalized as identified by the data entered on the list. Movement to intraverbal and LRFFC tasks should also involve nouns that have been mastered and the list provides an initial guide for making this progression. There is a common verbs list as well posted in the downloads section at www.avbpress.com.

SB: What recommendations do you have for a parent or practitioner who is first encountering verbal behavior?

MS: Language and the ability to communicate is perhaps the single most important aspect of human behavior, correspondingly, it is quite complex. Language is a part of everyday life and can be taught not only in formal (discrete) sessions, but in everyday activities including play, bath time, arts and crafts, in the grocery store, and while out on a family drive. Our book “Teaching Language to Children with Autism or Other Developmental Disabilities” (Sundberg & Partington, 1998) was designed to be an easy-to-understand application of Skinner’s analysis, and I would recommend that book, or other user-friendly VB books (Barbera, 2007; Weiss & Demiri, 2011). In addition, there are websites that contain tips, materials, data sheets, YouTube videos, and a variety of other material that can be useful for helping parents and teachers to understand how to apply a behavioral analysis of language in an ABA program.

ABOUT MARK SUNDBERG, PHD, BCBA-D

Mark Sundberg Mark L. Sundberg, Ph.D., BCBA-D received his doctorate degree in Applied Behavior Analysis from Western Michigan University (1980), under the direction of Dr. Jack Michael. He is the author of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP), and co-author of the original ABLLS and the book Teaching Language to Children with Autism or Other Developmental Disabilities. He has published over 50 professional papers and 4 book chapters. He is the founder and past editor of the journal The Analysis of Verbal Behavior, a twice past-president of The Northern California Association for Behavior Analysis, a past-chair of the Publication Board of ABAI, and has served on the Board of Directors of the B. F. Skinner Foundation. Dr. Sundberg has given hundreds of conference presentations and workshops nationally and internationally, and taught 80 college and university courses on behavior analysis, verbal behavior, sign language, and child development. He is a licensed psychologist with over 40 years of clinical experience who consults for public and private schools that serve children with autism. His awards include the 2001 “Distinguished Psychology Department Alumnus Award” from Western Michigan University, and the 2013 “Jack Michael Outstanding Contributions in Verbal Behavior Award” from ABAI’s Verbal Behavior Special Interest Group.

References
Barbera, M. L. (2007). The verbal behavior approach. London: Jessica Kingsley Publishers.

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.).
Upper Saddle River, NJ: Merrill/Prentice-Hall.

Esch, B. E., LaLonde, K. B., & Esch, J. W. (2010). Speech and language assessment: A verbal behavior analysis. The Journal of Speech-Language Pathology and Applied Behavior Analysis, 5, 166-191.

Morris, E. K., Smith, N. G., & Altus, D. E. (2005). B. F. Skinner’s contributions to applied behavior analysis. The Behavior Analyst, 28, 99-131.

Petursdottir A. I., & Carr J. E. (2011). A review of recommendations for sequencing receptive and expressive language instruction. Journal of Applied Behavior Analysis, 44, 859–876.

Skinner, B. F. (1953). Science and human behavior. New York: Free Press.

Skinner, B. F. (1957). Verbal behavior. New York: Appleton-Century-Crofts.

Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal on Mental Retardation, 110,
417-438.

Sundberg, M. L. (1980). Developing a verbal repertoire using sign language and Skinner’s analysis of verbal behavior. Unpublished doctoral dissertation, Western Michigan University.

Sundberg, M. L., & Michael, J. (2001). The benefits of Skinner’s analysis of verbal behavior for children with autism. Behavior Modification, 25, 698-724.

Sundberg, M. L., & Partington, J. W. (1998). Teaching language to children with autism or other developmental disabilities. Concord, CA: AVB Press.

Sundberg M. L., & Sundberg, C. A. (2011). Intraverbal behavior and verbal conditional discriminations in typically developing children and children with autism. The Analysis of Verbal Behavior, 27, 23–43.

Weiss, M. J., & Demiri, V. (2011). Jumpstarting communication skills in children with autism. Bethesda, MD: Woodbine House.

ABOUT DAVID CELIBERTI, PHD, BCBA-D

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ABOUT BARBARA ESCH, BCBA-D, CCC-SLP

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ABOUT GARY S. MAYERSON, JD

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ABOUT MARY JANE WEISS, PHD, BCBA-D

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ABOUT MARK SUNDBERG, PHD, BCBA-D

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