Tag Archives: autism spectrum disorder

Practical Applications to Culturally Sensitive Treatment – Part I

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By: Nicole Gorden, M.S., BCBA, LBA 

Autism spectrum disorder occurs in individuals from many different cultures and backgrounds. Therefore, cultural competency and sensitivity is imperative for effective delivery of services. To work with autistic learners, is to respect that they are the product of many environments that have shaped them and will continue to shape them throughout their life.

As stated in the most updated ethical code from the BACB, behavior analysts are responsible for incorporating and addressing diversity in practice. For example, the BACB ethical code states that behavior analysts must practice within our scope of competence, maintain competence including cultural responsiveness and diversity. Specifically, providers must “evaluate their own biases and ability to address the needs of individuals with diverse needs/backgrounds” (Ethical Code, 2022, 1.07).

However, what are the practical implementations to culturally sensitive treatment? What does this actually look like in practice? As providers, we are obligated to offer exceptional service delivery with individualized treatment goals. Considering our learner’s cultural background and the impact of their community’s beliefs and attitudes is essential to effective treatment. The following will provide guidance on how providers can apply cultural sensitivity to their clinical decisions in treatment.

Awareness of Own Cultural Biases

Cultural awareness is the first step to providing culturally ethical treatment. Providers should concurrently and habitually engage in practices in which they remain aware of their own predetermined perceptions and acknowledge their own limitations to cultural competency. As mentioned in Fong et. al (2016), “cultural awareness may be important because behavioral patterns that are viewed as problematic in our own culture may be the norm in other cultures”. Due to limitations in diversity within most helping professions, a learner’s provider is often from a different cultural background.

Thus, it is essential to understand the traditions of that culture. As an example, physical punishment may be common practice in some black communities which has been perceived to be deeply rooted in racial trauma (Patton, 2017). It would be insensitive for a provider from a different cultural background to ignore that this practice is a cultural tradition, and thus blame or stigmatize black parents for their choices. Rather, “professionals can offer information about why the practice is harmful but have been told it is necessary, and offer healthier alternatives that produce better outcomes for children, families and communities” (Patton, 2017). Cultural sensitivity is facilitating the development of our programs by checking our own biases and how they may affect our choices in treatment.

Selection of Target Behaviors and Programmatic Materials

A few years ago, a client from Asian descent was transferred to me from another behavior analyst. When assessing the barriers to treatment, my client made minimal progress when asked to identify a fork. Believing that an object, rather than a picture might help, I asked the client’s parents for a fork. When obtaining the fork, the parents expressed that they do not use forks to eat. In their culture, hands and chopsticks are typical eating utensils. Thus, when considering cultural sensitivity, this includes selecting programmatic targets that are common in the client’s environment and the cultural norms.

The teaching materials should be as individualized as the treatment plan too. We should rely on diverse representation in the resources we use in treatment. Providers should use materials that represent the individual’s environment, which is typically a blend of many different ethnicities. When providing resources like visual schedules, do your cartoons or pictures represent the racial identity of your learner? If you are teaching body parts on a doll, do you provide toys that look like your learner? To be a culturally sensitive professional, one should give precedence to ethnic representation to allow the learner to feel validated and treat them with dignity.

The cultural assessment process should be used to inform treatment, specifically when designing the program for validity and selecting targets for skill acquisition (Fong et. al, 2016). When beginning a new lesson or treatment program, it is essential that providers select socially meaningful and significant target goals. However, in selecting these goals for treatment, professionals must consider the cultural norms and needs of the client.

About the Author: 

Nicole Gorden, M.S., BCBA, LBA has over 14 years of experience implementing Applied Behavior Analysis principles with the Autism Population. She currently works for Comprehensive Behavior Supports in Brooklyn, NY.

References:

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. Littleton, CO: Author.

DuBay, M., Watson, L. R., & Zhang, W. (2018). In Search of Culturally Appropriate Autism Interventions: Perspectives of Latino Caregivers. Journal of autism and developmental disorders, 48(5), 1623–1639.

Fong, E. H., Catagnus, R. M., Brodhead, M. T., Quigley, S., & Field, S. (2016). Developing the Cultural Awareness Skills of Behavior Analysts. Behavior analysis in practice, 9(1), 84–94.

Fong, E. H., Ficklin, S., & Lee, H. Y. (2017). Increasing cultural understanding and diversity in applied behavior analysis. Behavior Analysis: Research and Practice, 17(2), 103-113.

Patton, S. (2017, April). Corporal punishment in black communities: Not an intrinsic cultural tradition but racial trauma. CYF News. http://www.apa.org/pi/families/resources/newsletter/2017/04/racial-trauma

Focus on Generalization and Maintenance

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On more than one occasion, I’ve been in the situation that a student will only demonstrate a skill in my presence. And I’ve heard from other colleagues that they have had similar experiences. This is highly problematic. When it happens with one of my students, there is only one person I can blame: myself.  A skill that a student can only demonstrate in my presence is a pretty useless skill and does nothing to promote independence.

So what do you do when you find yourself in this situation? You reteach, with a focus on generalization. This means that, from the very beginning, you are teaching with a wide variety of materials, varying your instructions, asking other adults to help teach the skill, and demonstrating its use in a variety of environments. Preparing activities takes more time on the front-end for the teacher, but saves a ton of time later because your student is more likely to actually master the skill. (Generalization, after all, does show true mastery.)

Hopefully, you don’t have to do this, though. Hopefully, you’ve focused on generalization from the first time you taught the skill. You may see generalization built into materials you already use, such as 300-Noun List at AVB press.

Another commonly cited issue teachers of children with autism encounter is failure to maintain a skill. In my mind, generalization and maintenance go hand-in-hand, in that they require you to plan ahead and consider how, when, and where you will practice acquired skills. Here are a few tips that may help you with maintenance of skills:

  • Create note cards of all mastered skills. During the course of a session, go through the note cards and set aside any missed questions or activities. You might need to do booster sessions on these. (This can also be an opportunity for extending generalization by presenting the questions with different materials, phrases, environments, or people.)
  • Set an alert on your phone to remind you to do a maintenance test two weeks, four weeks, and eight weeks after the student has mastered the skill.
  • Create a space on your data sheets for maintenance tasks to help you remember not only to build maintenance into your programs, but also to take data on maintenance.

Considering generalization and maintenance from the outset of any teaching procedure is incredibly important. Often, when working with students with special needs, we are working with students who are already one or more grade levels behind their typically developing peers. Failing to teach generalization and maintenance, then having to reteach, is a waste of your students’ time.

Written by Sam Blanco, PhD, LBA, BCBA

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

Cultural Competency in ABA Practice

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The Behavior Analyst Certification Board (BACB) on their website lists credentialed behavior analysts from 99 countries spanning across 6 continents. Behavior analysts and consumers of behavior analysis are now establishing footprints across the globe. Each of these countries comes with its own set of cultural practices and norms. Leon Megginson, author of Small Business Management said, “it is not the strongest, or the most intelligent who survives, but the one most responsive to change”. Considering the high rates of global migration and the international dissemination that our field desires, practitioners find themselves serving an increasingly diverse population. A recent article in Behavior Analysis in Practice by Andrea Dennison and colleagues highlights the variations in cultural norms, caregiver and practitioner linguistic competencies that a culturally competent ABA therapist must consider when designing a home program.

What are the barriers?

The Professional and Ethical Compliance Code for Behavior Analysts from the Behavior Analyst Certification Board requires that behavior analysts consider the role of culture in service delivery (BACB code 1.05c), involve clients and families in treatment process (BACB code 4.02), and individualize the treatment plan to meet client needs (BACB code 4.03). Yet the BACB Fourth Edition Task List and the upcoming Fifth Edition Task List which define the scope of practice of a credentialed behavior analyst do not make much mention of culture – which means that training programs do not typically include cultural competence. Dennison and colleagues (2019) identified several barriers in ABA treatment for culturally and linguistically diverse families and highlighted ways to overcome them.

Do we hold stereotypes?

With the influence of the media or the people around us, we tend to categorize people into social groups and create a simplified conception of the group based on some assumptions – we create stereotypes and hold prejudices. Implicit biases held by a practitioner towards certain cultural sub-groups may result in a subtle, yet observable bias towards the client, and adversely impact treatment outcomes. Dennison et al (2019) suggest that a practitioner’s “self-reflection and introspection regarding cultural attitudes and practices towards clients” may be a first step towards undoing these biases.

Are we aware of cultural norms?

Practitioners often find themselves in a variety of contexts and situations with varying contingencies. Each culture comes with its own set of learned behaviors, beliefs, and norms. Dennison and colleagues add that some cultures might prefer a warm, informal discussion with a service provider prior to a formal meeting to discuss goals. A violation of this might seem off-putting to the client, and conversely, such an expectation for an informal discussion might catch the analyst unaware. In some cultures even a simple handshake for greeting might be offensive They recommend that practitioners monitor clients for signs of discomfort or displeasure during the course of the treatment to identify whether a cultural norm has been violated.

What to do when a practitioner doesn’t speak the home language of the client?

A language mismatch between the practitioner’s language and the home language of the client might lead to information loss. A client might not be able to completely express their priorities in terms of the services they need. Dennison urges practitioners to make every attempt to invite a bilingual practitioner or interpreter either in-person or online, to future family meetings. Providing the family with access to ABA textbooks written in their home language might be a good way to introduce ABA terminology and lead to better acceptability of services delivered. The authors caution against using loosely translated words; online tools might not be ideal for activities that require precise definitions.

Cultural analysis

“A cultural analysis involves an individual analysis of the cultural factors affecting an individual’s environment and the resulting contingency”, the authors add. A re-assessment of priorities in goals might be warranted, and a cultural analysis might inform what behaviors are identified as the primary targets for intervention. Dennison refers to the importance of social etiquette and the value placed on conflict avoidance in Latin cultures as an example. Measuring social validity might give the analyst information about whether the family sees the behavior change as meaningful.

Empathy grows as we learn

Try not to stigmatize immigrant families as “uncaring” for not seeking services earlier. Several socioeconomic stressors such as lack of housing and transportation availability likely play a role in their decision. The authors urge practitioners to empathize with these families and add that attempts to empathize can be made even if the practitioner and family do not share a common home language.

Finally, the lack of diversity in research with the omission of demographic details such as language and ethnicity of participants in scientific publications overlooks the critical value of such information. This calls for a shift in the field towards intentionally inclusive subject recruitment and the reporting of such information.

A culturally competent behavior analyst is not one who knows everything there is to know about every culture. This would be impossible. It is someone who can acknowledge that patterns of cultural difference may be present, and are then able to view a situation from a different cultural perspective than one’s own. Maintaining a curiosity about each client’s culture, and having an open dialogue with them about their background, ethnicity, and belief system can result in a positive outcome for the client and the analyst.

“If we are going to live with our deepest differences then we must learn about one another.”  ― Deborah J. Levine

References

Dennison, A., Lund, E., Brodhead, M., Mejia, L., Armenta, A., & Leal, J. (2019). Delivering Home-Supported Applied Behavior Analysis Therapies to Culturally and Linguistically Diverse Families. Behavior Analysis in Practice, OnlineFirst, 1-12.

About The Author

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 provided 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 (BACB) 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.

ABA Journal Club: A Response from Dana Reinecke

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A quote from this week's ABA Journal Club response from Dana Renecke

Welcome back to ABA Journal Club! One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

Check out last week’s discussion questions here!

Behavior analysts engage in many different professional activities, many of which are more or less likely given specific clinical or research settings. For example, some behavior analysts who work with individuals with disabilities are likely to conduct preference assessments and use token economies, while those who work with organizations are less likely to use these technologies. One part of the behavior analyst’s repertoire that is always important, however, is the careful and accurate collection of data. This skill set is necessary for understanding and assessing behavior, as well as for ongoing monitoring of the effectiveness of behavioral interventions. 

It is important to understand not just how to measure behavior, but when to use each type of measure.  LeBlanc, Raetz, Sellers, and Carr (2016) describe some of the critical questions that should be considered when choosing a measurement procedure and offer a clinical decision-making model to guide behavior analysts in making these choices.  This article is useful for helping trainees to practice choosing measurement procedures, and reminding more experienced behavior analysts about the considerations involved in measurement. 

LeBlanc, L. A., Raetz, P. B., Sellers, T. P., & Carr, J. E. (2016). A proposed model for selecting measurement procedures for the assessment and treatment of problem behavior. Behavior analysis in practice, 9(1), 77-83.

Why is this article important for practitioners to read?

Measurement of behavior is one of the most important activities that a behavior analyst engages in.  Without accurate, meaningful measurement, assessment of both behavior and intervention effectiveness is impossible.  Trainees should read this article to learn about the important variables involved in choosing appropriate measurement systems, and more seasoned behavior analysts should read it to remind themselves about those variables.  Even though the article is focused on the measurement of problem behavior, the same principles can be applied to the measurement of behavior targeted for increase.

The model proposed by the authors incorporates several variables (such as observability of behavior and personnel resources.) Are there any other variables you might consider when selecting a measurement procedure?

Length of observation period might be a relevant factor in choosing a measurement procedure.  Consideration of the availability of resources may be influenced by the goal for how much observation is desired.  To use the case example provided by the authors, Joey’s teacher and aide might not be able to continuously record his work engagement throughout the day, but one of them might be able to do so for a limited sample of each day.  They could choose to conduct continuous measurement during a sample interval, and compare it to the longer period of discontinuous measurement to ensure that the discontinuous measure does not result in an over- or under-estimate of behavior. 

Table 1 clearly outlines each form of measurement along with strengths and limitations. Discuss the forms of measurement you frequently use and the limitations to incorporating other forms into your current practice.

As a consultant, I need to measure behavior based on limited samples when I can observe, and I also need to design data collection plans for the staff who are there for the rest of the week.  Staff are often responsible for more than one student, and may not have the resources to conduct continuous event recording.  Behavior is also often not discrete (e.g., crying) or occurs too frequently to count (e.g., stereotypy).  I often use partial-interval recording when I consult in school programs.  This allows for a very easy, non-intrusive overview of the pattern of behavior across the school day.  Another common measure is duration of behavior, because it is also relatively easy to start a timer when behavior begins, and stop it when it ends.  Frequency data are pretty rare in my practice, and reserved for low-frequency behavior that only occurs under specific circumstances.

In Figure 1, the authors provide a flow chart for easily selecting the most appropriate form of measurement. Many of the questions are directly related to observer resources. In this article, the term “resources” relates directly to the ability of personnel to continuously monitor the behavior. Are there any other factors you would consider in relation to personnel? If yes, how do you typically address those factors?

When training staff to collect data, it’s important to acknowledge any unintended bias.  Depending on the staff member’s level of experience, I will conduct more or less frequent IOA to reduce the risk of observer drift, and will also regularly review behavioral definitions to ensure that we are still talking about the same thing.

In discussing the behavior being measured, the authors write: “If the behavior can occur at any time, consider all dimensions of the response and select the ones that are most critically important to fully capture the important features of the behavior and the potential change in the behavior that may occur due to intervention” (p. 81).  How do you determine which dimensions of the response are the most critically important? Can you think of an example?

The importance of each dimension of the behavior will depend on the situation, the behavior, and the target or goal for the behavior.  For example, if a student is able to answer social questions but only does so after a delay, we would want to target, and therefore measure, latency to respond instead of frequency.  Or, a learner might engage in several very brief tantrums throughout the day.  In that case, I would expect that duration would be less important, and frequency a more meaningful measure.  By contrast, if a learner engages in one or two very long tantrums per week, we would want to measure duration and possibly intensity, rather than highlighting frequency.

One of the limitations of this paper is that the model it presents has not been empirically tested. What might such an empirical study look like?

One possible way to validate this model would be to provide several experienced behavior analysts with some case studies, and ask them to use the model to recommend measurement procedures for each case study.  High levels of agreement between the behavior analysts might indicate some validity for the model.  Further validity could be achieved by using the model to select measures, and then conducting those measures and comparing them to true values (e.g., permanent products or continuously-collected event recording).

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).

VB-MAPP vs ABLLS-R: Understanding The Differences

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Assessment is the cornerstone of creating appropriate and effective interventions. Two common assessments used for youngsters with autism are the Assessment of Basic Language and Learning Skills-Revised (ABLLS-R) and the Verbal Behavior – Milestones Assessment and Placement Program (VB-MAPP). You’ve likely heard of both the ABLLS-R and the VB-MAPP. While these two assessments are similar in many ways, there are also some big differences that might make one more appropriate for you than the other.

ABLLS-R

The ABLLS-R is made up of two components: the ABLLS™-R  Protocol and the ABLLS™-R Guide. The protocol is comprised of a skill-tracking system, assessing items ranging from listening and language skills to academic and ADL skills. The scoring system is simple, in that each specific skill is broken down into 2-4 levels. You simply mark the level that matches your client’s current skill. The simple organization allows for you to easily track your learner’s progress.

It is important to recognize that the ABLLS-R is more than just the protocol. It also includes the ABLLS-R Guide, which provides instructions for scoring as well as strategies for using the information to develop appropriate goals. Over the years, I have seen many practitioners simply using the protocol without referring to the guide. This is an error that should be corrected, as the guide is a useful resource for parents, teachers, and practitioners. Finally, the ABLLS-R assessed skills that typically develop between approximately ages 2-6.

VB-MAPP

The VB-MAPP is composed of five components.

The Milestones Assessment is comprised of 170 measurable milestones, all based in B.F. Skinner’s analysis of verbal behavior. It focuses primarily on language and social skills, but does include some skills related to academics.

The Barriers Assessment provides a way to assess and measure common barriers to learning experienced by children with language delays. These include barriers such as prompt dependence, impaired social skills, and failure to generalize.

The Transition Assessment provides a way to assess and measure progress towards the child’s ability to move to a less restrictive environment. This portion of the VB-MAPP includes items such as the rate of acquisition for new skills, adaptability to change, and ability to learn from the natural environment.

The fourth component of the VB-MAPP is the Task Analysis and Supporting Skills. This portion goes hand-in-hand with the Milestones Assessment. It is comprised of hundreds of skills that are often directly related to the milestones. It shows the skills that should be taught prior to each milestone and can provide additional information into the child’s current skill level.

The final portion is the VB-MAPP Placement and IEP Goals. This is an in-depth guide for developing IEP goals and identifying interventions based on the results of the other portions of the assessments.  As with the ABLLS-R, I’ve seen many practitioners utilizing the VB-MAPP without referring to the Placement and IEP Goals in the VB-MAPP Guide. This is an error that should be corrected to best use the assessment. The VB-MAPP assesses language skills that typically develop by age 48 months.

VB-MAPP vs ABLLS-R?

It is valuable to receive training in both of these assessments. They are important tools for assessment, especially if you are working with young children.

No matter what assessment you choose, we’ve got you covered! Head to our website and check out our full line of ABLLS-R and VB-MAPP supports, including our exclusive full assessment kits!

About The Author

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges and the Senior Clinical Strategist at Encore Support Services. You can read more of Sam’s posts for Different Roads To Learning when you click here!

How To Use Contingency Contracts in the Classroom

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As adults, we’re fairly accustomed to contracts for car loans, new employment, or updates to our smartphones. But contracts can also be beneficial in the classroom setting. A contingency contract is defined as “a mutually agreed-upon document between parties (e.g., parent and child) that specifies a contingent relationship between the completion of specified behavior(s) and access to specified reinforcer(s)” (Cooper, Heron, & Heward, 2007). There are several studies that indicate using a contingency classroom can be beneficial in the classroom setting.

Cantrell, Cantrell, Huddleston, & Wooldridge (1969) identified steps in creating contingency contracts:

Interview the parent or guardian of the student.

This allows you to work together to identify problem behaviors to be addressed, identify the contingencies currently maintaining these behaviors, determine the child’s current reinforcers, and establish what reinforcement or punishment procedures will be used.

Use this information to create a clear, complete, and simple contract.

The authors provide examples of how these contracts might look. You can vary the contract based upon the behaviors you are addressing with your student and the student’s ability to comprehend such contracts.

Build data collection into the contract itself.

You can see an example from the article below. For this example, it is clear how points are earned and how the child can utilize those points, and the contract itself is a record of both the points and the child’s behaviors.

An example of a classroom contingency contract from Cantrell, Cantrell, Huddleston, & Wooldridge (1969)

There are clear benefits to utilizing such contingency contracting: building relationships across different environments in which the student lives and works, addressing one or more challenging behaviors simultaneously, and providing opportunities for students to come into contact with reinforcement. You can read the entire article here:

Cantrell, R. P., Cantrell, M. L., Huddleston, C. M., & Wooldridge, R. L. (1969). Contingency contracting with school problems. Journal of Applied Behavior Analysis, 2(3), 215-220.

And much more has been written about contingency contracting. If you’d like to learn more, we suggest taking a look at one or more of the following:

Bailey, J. S., Wolf, M. M., & Phillips, E. L. (1970). Home-based reinforcement and the modification of pre-delinquent’s classroom behavior. Journal of Applied Behavior Analysis, 3(3), 223-233.

Barth, R. (1979). Home-based reinforcement of school behavior: A review and analysis. Review of Educational Research, 49(3), 436-458.

Broughton, S. F., Barton, E. S., & Owen, P. R. (1981). Home based contingency systems for school problems. School Psychology Review, 10(1), 26-36.

Miller, D. L., & Kelley, M. L. (1991). Interventions for improving homework performance: A critical review. School Psychology Quarterly, 6(3), 174.

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WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges. You can read more of Sam’s posts for Different Roads To Learning by clicking here!

ABA Journal Club #8: Performance Diagnostic Checklist

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One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

For many BCBAs, a large part of their role is supervising others in implementing ABA treatment.  In the course of my week I typically supervise 12 different paraprofessionals. Their training needs are highly variable, my time with them is minimal, and in my BCBA coursework I did not receive formal training on how to be an effective supervisor. This is an issue within the field of ABA, and can have a big impact on the services individuals with autism receive.

When I first came across the Performance Diagnostic Checklist – Human Services (PDC-HS) I was ecstatic. It is an easy-to-complete assessment of employee training, and provides clarity for next steps in addressing issues related to employee performance. The article for this month’s ABA Journal Club explains how the PDC-HS was utilized to evaluate training in an early intervention setting.

Carr, J. E., Wilder, D. A., Majdalany, L., Mathisen, D., & Strain, L. A. (2013). An assessment-based solution to a human-service employee performance problem. Behavior Analysis in Practice, 6(1), 16-32.

  1. The PDC-HS is a tool “designed to be used by a behavior analyst during an interview with the employee’s direct supervisor or manager” (p. 20). Is this a reasonable format for your work environment?  
  2. Have you or your organization used the PDC-HS or a different formal tool to evaluate training of staff? What has been your experience with such formal evaluation?
  3. Part of the procedure for this study was to show employees graphed feedback. Is this a strategy you have utilized in the past? If not, how could you utilize it for current skills you are teaching employees?
  4. The dependent measure in this study was cleanliness of the treatment room. This is an important workplace skill, especially if materials for instruction or lost or damaged, if problem behaviors of clients increase while the practitioner is looking for materials, or if the messiness of a room interferes with efficient use of session time. The authors note that systematic replications of their study should include other aspects of training, such as appropriate prompting. If you were to complete a study on the PDC-HS, what training skill would you address? Why?
  5. What are some obstacles in your current setting to implementing the PDC-HS? How can you address those obstacles?
  6. Reread Appendix B, which contains the full PDC-HS. What do you think about the questions they ask? Why are those specific questions asked? Is there anything you would add?
  7. My favorite part of this article is the Intervention Planning portion on pages 30-31. It provides clear direction on what interventions may be appropriate for different training issues along with citations. Why is this an important resource for supervisors?

 [SB1]Link to: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680147/pdf/i1998-1929-6-1-16.pdf

One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

One of my favorite parts of my job is training people who are working to become BCBAs. There is an immense amount of content for my supervisees to learn, and one of the key aspects of this is to understand how to implement all of the new concepts their learning within the context of an actual case. This is often far more challenging than it might appear at first blush. I frequently supervise students pursuing their BCBA, and I require each one of them to read LeBlanc, Raetz, Sellers, & Carr (2016) because it provides a clear model for clinical decision-making.

LeBlanc, L. A., Raetz, P. B., Sellers, T. P., & Carr, J. E. (2016). A proposed model for selecting measurement procedures for the assessment and treatment of problem behavior. Behavior analysis in practice, 9(1), 77-83

  • Why is this article important for practitioners to read?
  • The model proposed by the authors incorporates several variables (such as observability of behavior and personnel resources.) Are there any other variables you might consider when selecting a measurement procedure?
  • Table 1 clearly outlines each form of measurement along with strengths and limitations. Discuss the forms of measurement you frequently use and the limitations to incorporating other forms into your current practice.
  • In Figure 1, the authors provide a flow chart for easily selecting the most appropriate form of measurement. Many of the questions are directly related to observer resources. In this article, the term “resources” relates directly to the ability of personnel to continuously monitor the behavior. Are there any other factors you would consider in relation to personnel? If yes, how do you typically address those factors?
  • In discussing the behavior being measured, the authors write: “If the behavior can occur at any time, consider all dimensions of the response and select the ones that are most critically important to fully capture the important features of the behavior and the potential change in the behavior that may occur due to intervention” (p. 81). How do you determine which dimensions of the response are the most critically important? Can you think of an example?
  • One of the limitations of this paper is that the model it presents has not been empirically tested. What might such an empirical study look like?

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

ABA Journal Club #7: Choice Within Token Systems

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One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

I frequently use the Functional Assessment Interview (O’Neill, Albin, Storey, Horner, & Sprague, 2015) when beginning to assess the function of problem behaviors. One of my favorite questions in this assessment relates to how frequently the individual has choice during the day. Many of the individuals I work with are provided very few, if any, choices during the day. This is one of the first things I often work to change.

The article for July’s ABA Journal Club assesses choice within token systems. This is only one way that choice can be implemented throughout the day, but it’s a nice jumping-off point for discussions of how to increase choice for your clients or students.

Sran, S. K., & Borrero, J. C. (2010). Assessing the value of choice in a token system. Journal of Applied Behavior Analysis, 43(3), 553-557

  1. Why did the authors select to focus on choice within token systems? How is this relevant to your current work environment?
  2. Discuss the procedure used in this research. How could you replicate these procedures with your own clients?
  3. The preference for the opportunity to make choices within the token system varied across individuals. How does this impact treatment decisions you would make for your clients?
  4. How do you currently incorporate choice with the individuals you work with?
  5. What changes can you make in incorporating choice with the individuals you work with?
  6. This article discusses the use of ABA strategies for individuals who do not have autism. Why is this important for us to consider?

O’Neill, R. E., Albin, R. W., Storey, K., Horner, R. H., & Sprague, J. R. (2015). Functional assessment and program development. Nelson Education.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.

ABA Journal Club # 6: A Response From Robyn Catagnus, EdD, LBS, BCBA-D and Elizabeth Hughes Fong, M.A., BCBA, LBS

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One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

This month’s response comes from Robyn Catagnus, EdD, LBS, BCBA-D and Elizabeth Hughes Fong, M.A., BCBA, LBS. Sam’s original blog can be seen here.

  • How does Skinner’s definition of culture differ from how you typically consider culture?

Fong: I think that Skinner did a nice job of linking a person’s actions and beliefs within the context of their environment.  At times, I feel it’s an oversimplification of a term, and behavior analysts should explore (on a deeper level) what that means. It defines culture, but lacks in helping us to understand it, or on a more practical level, what this means for our practice of ABA. I’m in agreement that our histories and the contingencies that we come into contact with shape who we are.  But as clinicians, what does this mean? When I think of culture, I consider things like history, contingencies and the environment in which the person operates, but I also try to draw out more information about what this means for my work as a clinician – if at all.  Culture is deep and rich, and sometimes I feel that relying on just Skinner’s definition doesn’t take all this into consideration. We can take that as a starting point, on how to conceptualize culture, but we need to go further into truly trying to understand what it is. Some interesting articles to review on the topic are: Muchon de Melo, C., & de Rose, J. C. (2013). The concept of culture in skinnerian Radical Behaviorism: Debates and controversies. European Journal of Behavior Analysis, 14(2), 321-328; Glenn, S. S. (2004). Individual behavior, culture, and social change. The Behavior Analyst, 27(2), 133-151.

  • Have you encountered situations in which by cultural contingencies impacted an intervention you planned? What might you have done differently if you could go back in time?

Catagnus: I’d like to share the story of two of my colleagues, Stacee Leatherman and Ashley Knochel. They are both doing really important work in this area that exemplifies this issue. And, you’ll likely see their papers on the topics published soon, so this will be a preview. Stacee was a therapist working with a family from a different country that had immigrated to her local area. She reported at a recent ABAI conference event that she felt ill-prepared by her behavior analytic training to adequately assess and intervene in a culturally appropriate way. The family ultimately left ABA services, and Stacee went to the literature to see what their consulting group could have done to better serve the family. She found almost no relevant empirical research in ABA journals that addressed implementation or culturally adapted interventions with non-Western families of children with Autism. We recently submitted a manuscript presenting her findings and making some recommendations of our own.

Leatherman, S., Catagnus, R. M., Brown, T. W., Moore, J., Torres, I. (2019). A systematic review of strategies to improve treatment services provided by cross-cultural practitioners working with individuals with autism spectrum disorder. (Manuscript in preparation).

Ashlee, along with co-researchers, has conducted one of the rare empirical studies of ABA with non-Western learners (and is submitting this manuscript soon). She was working in Ghana at a school for children with ASD. She helped the teachers implement a common behavior analytic technique, behavior specific praise. She did so in a way that is typical here in her culture in the US, in terms of using language to label the behavior, specifically, vocally, and with excitement. For cultural reasons, the way she’d learned to conduct the procedure in her culture caused a decrease in the desired behavior of working on task! So, she met with the stakeholders in the setting, engaged in culturally sensitive and humble question asking, and was able to collaboratively identify why the commonly used approach was not culturally appropriate or helpful – why it was detrimental to learning. Together, they revised the way the reinforcement was delivered, assured it was culturally correct, and the on-task behavior improved, and the staff reported feeling that Ashley’s interactions were culturally relevant. The outcome, and consultation process, was impactful. This is some of the first empirical data I’ve seen to explain how ABA interventions repeated ‘the way we learned to do them in our own culture’ can negatively impact those we service if we don’t approach the planning and implementation in a culturally interactive and open way.

Knochel, A., Blair, K. C., Sofarelli, R. (2019). Culturally focused classroom staff training to increase praise for Ghanaian students with autism spectrum disorders. (Manuscript in preparation).

  • Do you currently engage in any of the suggestions the authors provide for self-reflection? What has been your experience with self-reflection?

Catagnus: I regularly engage in self-reflection in the forms of mindfulness practice and formal meditation. In fact, I developed a mindfulness and ABA course at TCSPP and get to regularly talk about this with our students. I think and talk about my own cultural frameworks and background regularly, too, because of the types of research and implementation we conduct for culturally relevant pedagogy at the University. Luckily, the work that I do is immersive in terms of cultural topics, and I continue to develop my self-awareness. I also seek out experiences of diversity, by traveling, engaging in study abroad programs for myself and creating them for my students. I’ve worked with amazing local early educators in South Africa, visited cultural and academic sites in Denmark, taken classes in Spain, and am about to do visit Singapore, Malaysia, Vietnam, and Qatar. Developing relationships with people around the world has helped me stay reflective and to grow personally and professionally. Learning never stops for this process.

  • Do your current functional assessments incorporate cultural variables? If not, what can you change to improve your functional assessment process?

Fong: I do not think most FAs incorporate cultural variables. While the principles of ABA might be considered to be universal, the way in which we complete an FA is very Eurocentric.  Most of the places I have worked at present the FAI in English and if another language is required a translator is used. The translator may or may not have the clinical understanding to accurately communicate the question. Also, some of the questions are more direct, closed ended.  Some culture may do better by telling a story. Generally, there are no questions that directly address culture – for example, preference on pronouns, holidays, languages used, the role of the clinician in the family’s mind, background information about caretakers, what behaviors are reinforced/valued by a culture and which are not, etc.  I think incorporating things like this, into FAs would help to make them more culturally sensitive. Maybe each culture, create their own? I will ask clients if there is thing anything else that they feel that I should know, which might be relevant to intervention. Sometimes I prompt for information about language, holidays, manners, norms, preferences, etc. A good article on the topic is: Tanaka-Matsumi, J., Seiden, D. Y., & Lam, K. N. (1996). The Culturally Informed Functional Assessment (CIFA) Interview: A strategy for cross-cultural behavioral practice. Cognitive and Behavioral Practice, 3(2), 215-233.

  • One of the recommendations by the authors is to use readily available resources. What resources are available to you? How can your organization better provide resources to help behavior analysts address cultural variables?

Fong: I like this family therapy book – McGoldrick, M., Giordano, J., & Garcia-Preto, N. (Eds.). (2005). Ethnicity and family therapy. Guilford Press. The Special Interest Groups (SIG) of ABAI are another good resource, I’ve found that people are responsive if you email them questions.  There is also the Culture and Diversity SIG of ABAI. I also tend to look outside the ABA, to fields such as psychology, who have done a superior job addressing the need to examine the role that culture plays in treatment. Recently, there has been an increase in behavior analytic articles and presentations addressing culture, so I try to read those.           

Catagnus: TCSPP has an institutional learning outcome related to diversity, so we embed learning, resources, assignments and outcome measures throughout our program. It is a deeply held value and a strong focus of our program. For this reason, our students often research topics related to culture, diversity, and inclusion. They have access to carefully curated curricular materials like articles, books, lectures, and tutorials on many different related topics. Our classes are regularly evaluated and updated to represent more global perspectives. And, the process of students’ learning is supported from the day they start until graduation, with the goal of developing their own resources and skills in cultural awareness. We are also implementing some innovative advising and learning laboratory programs to further help students connect with personal resources for cultural competence.

  • The authors suggest the use of social validity surveys as one method for addressing cultural values. How can you incorporate this into your current practice?

Fong: I think, by just asking a client/family member/guardian if they agree with the goals and treatment suggestions would be a good start. Incorporating more relevant people into intervention planning would also be a good step.  I tend to get better participation in data collection when I do this, as well (i.e. buy-in).

Catagnus: Bobbie Gallagher and a few of us from TCSPP recently published a paper that addressed the cultural values of females with limited language (LL) and autism (ASD), and their families and nurses. The study was designed to gather social validity about what strategies would be doable, preferable, and acceptable to communicate with women with LL and ASD during a gynecological exam. These women are at risk because, statistically, they don’t access this important health service very often, if at all. The study gathered quantitative and qualitative data about concerns, fears, and preferences for how women could be more effectively and respectfully involved in the process of a diagnostic exam. As Bobbie wrote, “Identifying strategies with a higher rate of social validity, or acceptance of treatment prior to implementation, may assist future researchers in conducting studies on the effectiveness of those strategies.”

Gallagher, B.J., Flynn, S.D., Catagnus, R.M., Griffith, A. (2019). Social validity of strategies to assist females with ASD during gynecological examinations. Journal of Developmental and Physical Disabilities. https://doi.org/10.1007/s10882-018-9654-5

  • The authors state that one limitation of their article is that they did not provide systematic guidelines for working with culturally diverse clients. If you were going to introduce such guidelines, what might you include?

Fong: I think the guidelines I referenced here: Hughes Fong, E., & Tanaka, S. (2013). Multicultural Alliance of Behavior Analysis Standards for Cultural Competence in Behavior Analysis. The International Journal of Behavioral Consultation and Therapy. 8(2): 17-19. Are a good start.  APA did a fantastic job on their guidelines – so again looking at other fields to see what they have done (https://www.apa.org/about/policy/multicultural-guidelines) and learning from other fields would be helpful.

Catagnus: Ashely Knochel, Kwang-Sun Blair, Stacee Leatherman, and I are working on a manuscript now related to this topic. We hope to provide the ABA community with a systematic review of relevant cultural adaptation models, highlighting one that is most useful as a framework to guide the process. We recommend that ABA look to other fields that have created and researched frameworks or developed guidelines. Examples include Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations from the APA, and AMA Code of Medical Ethics’ Opinion on Cultural Sensitivity and Ethnic Disparities in Care.

About The Authors

Dr. Robyn Catagnus is an expert on learning and behavior change. A board-certified behavior analyst, she is an associate professor, associate chair, and former national chair of Behavior Analysis at The Chicago School of Professional Psychology. She’s owned and operated a successful behavior consulting firm and held executive roles in behavioral health and educational technology organizations. As a management consultant and researcher, she also develops human capital initiatives to improve organizational behavior.

Dr. Catagnus’ helps educators promote inclusion, success, performance, and growth. She is a trustee of the Cambridge Center for Behavioral Studies; reviewer for the Diversity in Behavior Analysis section of the APA journal Behavior Analysis: Research and Practice; reviewer for Behavior Analysis in Practice, and former member of the editorial board for Perspectives on Behavior Science. Dr. Catagnus has degrees in instruction and technology, education, leadership and strategy, and a certificate in mindfulness.

Ms. Hughes Fong has over two decades of experience in the fields of behavioral health, education, and management. Her educational background is in clinical and counseling psychology and applied behavior analysis. She is currently a PhD candidate studying Clinical Psychology with a concentration in Forensic Psychology.

In 2011, Ms. Hughes Fong founded Multicultural Alliance of Behavior Analysts (MultiABA), now call the Diversity and Culture SIG. This is a special interest group of the Association of Behavior Analysis International (ABAI). Ms. Hughes Fong is the founder of “Diversity in Behavior Analysis” a section in Behavior Analysis Research and Practice, and serves as an Associate Editor for the journal. Ms. Hughes Fong, also serves on the Executive Committee for the American Psychological Association’s (APA) Division 35, as the Website Coordinator. She has been a reviewer for Behavior Analysis: Research and Practice, Behavior Analysis in Practice, and the National Multicultural Conference and Summit. She is also a “Distinguished Scholar” with the Cambridge Center for Behavioral Studies, and a member Association for Behavior Analysis International (ABAI)  Diversity, Respect, and Inclusion Task Force

In addition, to Ms. Hughes Fong activities, she is a Board-Certified Behavior Analyst and licensed as a Behavior Specialist in Pennsylvania, a trainer in the Pennsylvania Bureau of Autism’s Functional Behavior Analysis training, and has received training certificates in the area of Trauma-Focused Cognitive Behavior Therapy and Trauma-Focused Cognitive Behavior Therapy Childhood Traumatic Grief. In addition, she received her level one certification in Pivotal Response Training and Gottman Couples Therapy. Her primary areas of interest are in the application of ABA to multicultural populations, telehealth, social validity, health and behavior analysis, and examining child custody and parental competency when a child has developmental disabilities.

Identifying the Function of a Behavior

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As a BCBA, I am often asked to address problematic behaviors. One of the most common errors I see in addressing such behaviors is that the adults working with the child have not identified the function (or purpose) of the problematic behavior. Decades of research have shown that there are only four functions for any behavior: attention, escape/avoidance, access to a tangible, and automatic reinforcement (or something that just feels good internally, but cannot be observed by outsiders).

The function of the behavior is whatever happens immediately after the behavior, and increases the likelihood that the behavior will occur again in the future. Here are a few examples of the functions, based on the same behavior:

  1. The therapist tells Lisa it’s time to practice tying shoes. Lisa starts biting her own hand. The therapist look shocked and calls in Lisa’s mother, who rubs her back lightly while Lisa ties her shoes then gives her a lot of verbal praise. This is likely an example of a behavior that functions for attention, because the mother comes in and provides both verbal and physical attention while she ties her shoes. Or it could be an example of a behavior that functions for escape or avoidance, since Lisa did not have to tie her shoes immediately once she began biting her hand.
  2. The therapist tells Lisa it’s time to practice tying shoes. Lisa starts biting her own hand. The therapist gently pushes Lisa’s hand down and then introduces a new task. This is an example of a behavior that functions as escape because Lisa does not have to tie her shoes once she begins biting her hand.
  3. The therapist tells Lisa it’s time to practice tying shoes. Lisa starts biting her own hand. The therapist says, “Oh, don’t stress, we’ll take a sensory break,” and gives Lisa a ball to squeeze. This is an example of a behavior maintained by tangible reinforcement. When Lisa began biting her hand she was immediately given access to a preferred item.

You’ll notice that I left out the automatic reinforcement. This is intentional because often, with a diagnosis of Autism Spectrum Disorder, people assume that a behavior is automatically reinforced instead of exploring these three potential functions described above. One way to recognize if a behavior is automatically reinforced is to note if the behavior happens when the child is alone and/or when no demands have been placed on the child. If it’s only happening around other people or when demands are placed, then it is highly unlikely that the behavior is automatically reinforced. For now, we’ll save automatic reinforcement for another blog post.

Identifying which of these functions is maintaining a problem behavior is essential to putting in an effective intervention. But how do you go about doing this?

The first thing you should do is assess! You can do an informal assessment, such as using the Functional Assessment Screening Tool (FAST) which is comprised of 16 questions that can help you quickly determine the function. If this does not provide conclusive results, you can have a BCBA do a formal functional assessment. Once you have identified the function of the behavior, you can change the environment so that not only does the child no longer receive that reinforcement for a problematic behavior, but there are appropriate replacement behaviors they can engage in to access that reinforcement. For more on that, you can look back at the Importance of Replacement Behaviors.

It may be difficult at first to think in terms of “function of behavior,” rather than assigning a reason for the behavior that is based on the child’s diagnosis or based on something happening internally inside the child’s brain that we can’t see (such as, “she’s just frustrated so she’s biting her hand,” or “she doesn’t know how to control herself”). However, once you try it out and experience some success with addressing the true function of behavior, you’ll likely see the beauty of a simple explanation for why we behave.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.