Tag Archives: autism spectrum disorder

ABA Journal Club: A Response From Elizabeth A. Drago, M.A., BCBA, LBA

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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.

  • The researchers trained caregivers on a university campus using the BST model prior to home visits. In your current work, would this be a possibility for you? If not, how could you provide this type of training to caregivers? What obstacles can you predict, and how might you address them?

The majority of my clinical practice is primarily situated in home-based settings.  Delivering behavior analytic services in home-based settings presents with a multitude of circumstances contributing to variable rates of success in teaching new skills for both the client and caregivers.  Two variables contributing to such challenges in service delivery is caregiver accessibility and limited service hours allotted, particularly if the services are funded through insurance-based sources.  Formal Behavior Skills Training (BST) often requires time intensive performance and competency- based components, creating a challenge to implement in the home setting at times. With careful planning and caregiver commitment to participation, BST training in the home setting is quite “do-able”.

To address time constraints, a ‘train the trainer’ model or pyramidal training (Pence, St. Peter, & Tetreault, 2012), may be a beneficial strategy to assist in training multiple caregivers as well as contribute to increased proficiency in treatment fidelity.  A pyramidal training model involves a senior trainer (e.g., a behavior analyst) training a small group of staff or caregivers who in turn train other staff or caregivers.  This type of training model may be particularly beneficial to clinicians working in settings where time constraints may be a factor (such as residential services).  

  • Discuss the multiple baseline design used in the study. How does it demonstrate experimental control? What can you determine from a visual analysis of the data?

The researchers in this study utilized a concurrent multiple-baseline-across-modules design to analyze the effects of the BST module training delivered to parents to teach their children mands. Concurrent multiple-baseline-across modules design allows for simultaneous measurement to occur for all clients. Research suggests concurrent measurement controls better for threats to internal validity and result in somewhat stronger inferences than do nonconcurrent designs (Watson and Workman, 1981). Multiple baseline designs are appropriate when target behaviors are not reversible. Use of a concurrent multiple-baseline design to evaluate treatment effectiveness minimizes the ethical concerns related to a withdrawal design. Training skills sequentially using a multiple-baseline-across-modules design is beneficial since it allows trainers to teach skills gradually and gave trainees repeated rehearsal opportunities on previously trained skills. The trainer could also monitor ongoing caregiver performance and make decisions to advance caregivers through the training based on the consistency and accuracy of their performance on trained skills.  Researchers of the study required caregivers to reach specific mastery criterion rates to advance to additional modules in the BST to assess the maintenance of the caregiver’s accuracy of procedural integrity and the child’s mands.

Upon visual analysis of the data, results of the study support effects of a BST model for training caregivers to implement mand training procedures.  In addition, after training, caregivers did not exhibit difficulties generalizing the skills to implement mand training procedures to the child.  Additional training was provided to caregivers during sessions with the child when mastery criterion was not achieved.  The researchers found by staggering the training across modules, caregivers learned to capture and contrive motivating operations contributing to the emergence of spontaneous mands.

  • Part of this study included a measure of whether a competently trained parent could teach their spouse how to implement mand training. Why is this important? Have you implemented similar strategies in your own work?

Training caregivers to effectively generalize behavior analytic treatment strategies and interventions to the child outside of training sessions is one of the goals of family support behavior analytic services.   Strategies to fade out the necessity of behavior analytic services is developed in the client’s treatment plan at the initiation of services.   Delivering BST to a caregiver who demonstrates proficiency of the designated steps is invaluable in the treatment process.  Through BST,  trained caregivers who have demonstrated mastery of a skill, have the ability to train additional caregivers (e.g., grandparents and siblings) in the client’s environment, facilitating generalization of treatment effects. 

In addition, research has supported the finding that providing caregivers with training and education to increase their family member’s functional skills (such as communication) may reduce caregiver stress by increasing the caregiver’s confidence levels (Bebko et al. 1987).  Researchers have also found that parents who reported high levels of confidence in managing their child’s major difficulties and perceived others in the family as similarly successful also reported lower stress rates (Sharpley and Bitsika 1997).

In my practice, I utilize BST to teach caregivers skills related to communication and socialization training and areas of daily living such as toileting, dressing, toothbrushing and community safety.  I recently utilized BST to teach a modified PECS (Picture Exchange Communication System) to a client’s caregivers. After reaching fluency criteria for each step of the target skill, the trained caregiver was capable of effectively training the modified PECS procedure to the second caregiver.  Success rates for each steps of the BST procedure were measured by observation, data collection and data analysis of procedural integrity demonstrated by the second parent during sessions with the client.  Success rates were also measured by data analysis  of the client’s rate of progress in reaching various communication targets via use of the modified PECS taught by caregivers. 

  • This study did include maintenance data. Why is this data valuable? Do you collect maintenance data on the caregiver training you provide?

According to Alberto & Troutman, 2013, ‘maintenance’ is defined as “performing a response over time, even after systematic applied behavior procedures have been withdrawn”.  Maintenance is demonstrated over time when the skill continues to occur after all direct teaching of the particular skill has been discontinued. 

 Maintenance data could also be utilized to assist in shaping additional skills.  For example, prior to teaching a client receptive discrimination skills related to picture identification in a field of 3 stimuli, it is important to evaluate the presence or absence of certain prerequisite skills such as attending, gesturing (i.e., pointing or eye gaze), following direction and ability to identify objects depicted in the array.  Without information gathered from maintenance skill probes (i.e., attending, pointing, tact repertoire, etc.), teaching the skill of receptive discrimination may not be possible if the client has not exhibited mastery of specific prerequisite skills first.

During skill acquisition training, I typically teach a targeted behavior until the recipient exhibits fluency in exhibiting that behavior.  The computer- generated data system I utilize in my practice includes pre-set monitoring schedules of maintenance data based upon a timed schedule.  Maintenance probes are automatically scheduled in a staggered fashion.  For example, if the client exhibits proficiency in engaging in a specific skill during baseline, that skill is automatically scheduled for a maintenance probe on a monthly basis.  If a client reaches fluency of a specific skill after commencement of treatment, the target is scheduled for maintenance in a staggered time frame (i.e., weekly, bi-weekly, monthly, bi-monthly and annually). After the client reaches mastery criterion for annual maintenance, the target is considered ‘closed’.  If at any time the target fails maintenance, the target is added back into treatment.  

If a clinician is teaching skills to fluency, the necessity of relying on maintenance data to determine if the skill remains in that client’s behavior repertoire becomes less relevant. 

  • Consider a particular skill you are teaching one or more clients. What would BST look like to teach caregivers how to implement the necessary procedures for teaching that skill?

A particular skill BST could be utilized to teach is use of utensils during mealtime.

Instruction – For this step, if a client exhibits adequate receptive skills related to vocal/verbal instruction, one may say to the client, “When you eat certain foods, such as spaghetti or vegetables, you use a fork to pick the food up. You wouldn’t use a fork to eat foods such as cereal or pudding.”

If the client does not exhibit adequate receptive language skills, one may describe the skill to the caregiver.  For example: “We teach the skill of eating with utensils to assist with independent functioning.  We will practice this skill first, with a fork and upon reach specific mastery criteria, we will proceed in teaching use of additional utensils, such as a spoon.  It’s best to practice this skill when motivation to eat is high in order to increase rate of reinforcement and eventually, acquisition of mastery criteria (i.e., if the client is hungry, his motivation to follow the rule to use a fork to eat may be higher compared to times when he is not hungry). Reinforcement for use of the fork is naturally built in, as the food he eats with the fork will serve as reinforcement for the targeted behavior.”

Along with vocal/verbal instruction of the BST steps, I may also provide the caregiver with written steps to the procedure to assist with fluency.

Modeling – For this step, during mealtime, I model the steps described above to the caregiver.  I provide a description of each step as the step is being performed to the caregiver.

Rehearsal –For this step, encourage the caregiver to implement the steps to practice the skill.  During these practice sessions, data recording is critical to determine fluency of the practice of the targeted skill.

Feedback – Prior to this step, I discuss with the caregiver the form of feedback they prefer to receive (in-situ feedback or feedback after each trial session has ended).   Throughout my career I have learned the importance of tailoring my delivery of feedback to individual preference (some caregivers prefer feedback while they are performing the step, while others prefer to receive feedback after they have completed the step).  Once I have determined the timing of my feedback, I deliver the feedback in the context agreed upon.

  • The article states, “General instructions were provided prior to baseline, but parents were only able to implement the procedures effectively when full instructions, modeling, rehearsal and feedback were used to train to mastery.” How can you change your current practice to ensure that you are providing the necessary steps to help caregivers master skills they have selected for parent training?

To streamline the often time-intensive process BST requires, I typically stagger the trainings across multiple sessions.  Delivery of insurance-based family training services is generally provided in a time intensive and structured fashion. To meet these stringent guidelines and to ensure I deliver the most effective and efficient services, I provide the caregiver with written and verbal steps to BST across several consecutive sessions.  I review each step with the caregiver and assign weekly assignments to practice specific steps.  During each family training visit, I review and model the steps and request the caregiver to perform the step they worked on the week prior.  After the caregivers reach specific fluency rates in responding accurately,  additional steps are introduced.  

One method of training I may consider including in my caregiver trainings when delivering BST, is use of video modeling.  Video modeling is a teaching procedure that involves an individual viewing a videotaped sample of a model performing a specific, scripted activity or task. Immediately following having viewed the video-based model, the individual is directed to perform the activity or script he or she observed in the video (e.g., MacDonald, Clark, Garrigan, & Vangala, 2005). Use of video modeling may further address time constraints to training that is often a barrier in delivery of home-based services.  Video modeling may also assist in in higher rates of procedural integrity when working with caregivers who learn more effectively through use of visual guides as opposed to textual guides only.

BST is an incredibly invaluable method of teaching new skills.  With careful planning and commitment to learning, caregivers have a unique opportunity to actively participate in their family member’s treatment to help them engage in socially meaningful ways.

References

Alberto, P., & Troutman, A. C. (2013). Applied behavior analysis for teachers. Boston: Pearson.

Bebko JM, Konstantareas MM, Springer J. Parent and professional evaluations of family stress associated with characteristics of autism. Journal of Autism and Developmental Disorders. 1987; 17:565–576.

MacDonald, R., Clark, M., Garrigan, E., &Vangala, M. (2005) Using video modeling to teach pretend play to children with autism. Behavioral Interventions, 20, 225-238. 

Parsons M. B., Rollyson J. H., Reid D. H. Evidence-based staff training: A guide for practitioners. Behavior Analysis in Practice. 2012; 5:2–11. 

Parsons, M. B., Rollyson, J. H., & Reid, D. H. (2013). Teaching Practitioners to Conduct Behavioral Skills Training: A Pyramidal Approach for Training Multiple Human Service Staff. Behavior analysis in practice, 6(2), 4–16. doi:10.1007/BF03391798.

Pence S. T., St. Peter C. C., Tetreault A. S. Increasing accurate preference assessment implementation through pyramidal training. Journal of Applied Behavior Analysis. 2012;45:345–359.

Sharpley, C. F., & Bitsika, V. (1997). Influence of gender, parental health, and perceived expertise of assistance upon stress, anxiety, and depression among parents of children with autism. Journal of Intellectual and Developmental Disability, 22, 19–29.

Watson, Paul & A. Workman, Edward. (1981). The non-concurrent multiple baseline across-individuals design: An extension of the traditional multiple baseline design. Journal of behavior therapy and experimental psychiatry. 12. 257-9.

Elizabeth A. Drago, M.A., BCBA, LBA, is a Board Certified and Licensed Behavior Analyst and a consultant at Proud Moments Therapy located on Long Island, New York and Comprehensive Behavior Supports, located in Brooklyn, NY.  She has over 15 years’ experience working with individuals with developmental and related disabilities and has advanced training in areas of autism, behavior disorders, sleep disorders, intellectual disabilities and positive behavior supports.  As a consultant in home and educational settings, she clinically oversees client cases, provides parent training, implements comprehensive skill assessments and programming goals for children diagnosed with ASD, conducts staff trainings for effective performance improvement practices and behavior analytic practices and procedures. She holds professional memberships in organizations such as New York State Association for Applied Behavior Analysis, Association for Behavior Analysis International, Association of Professional Behavior Analysis.

Elizabeth is a Board member of the New York State Association for Behavior Analysis (NYSABA), serving the role of Representative at Large. She is also an active member of NYSABA’s Legislative Committee, focusing on efforts to remove the licensure scope of practice restriction in Behavior Analysis in New York State. Elizabeth has contributed significantly to disseminating information related to the scope restriction in Behavior Analysis in NYS. Some of Elizabeth’s achievements in these efforts include developing initiatives such as the video series entitled, ‘This is ABA’.  The purpose of the video series is to highlight the effectiveness and applicability of the practice of Behavior Analysis to individuals of varying diagnoses, not only for those diagnosed with an Autism Spectrum Disorder. This video series is currently featured on the NYSABA website.   Elizabeth also works collaboratively with NYSABA’s Executive Director, Mari Wantanbe-Rose in the development and oversight of NYSABA’s Inaugural ABA Ambassador Award. The NYSABA ABA Ambassador Award recognizes future behavior analysts, or students, who help to disseminate the usefulness and versatility of behavior analysis in various settings.

Elizabeth has presented at NYSABA’s annual professional conference on the topics of Systematic Desensitization (2017) and Self-Care for the Behavior Analyst (2018). She has been invited as a speaker at a roundtable meeting at Proud Moments ABA, presenting on the topic of the use of technical jargon when interacting with caregivers. Elizabeth has also been featured in a newsletter (August 2018 edition) generated by Comprehensive Behavior Supports in recognition of the many significant contributions to the agency and families she serves across Long Island as a Licensed and Board Certified Behavior Analyst.  Elizabeth has been a guest speaker on a Behavior Analytic podcase, ‘Behaviorbabe’, hosted by Dr. Amanda Kelly, discussing the NYS licensure law scope restriction on the practice of Behavior Analysis in NYS. Elizabeth received a Bachelor’s Degree in Clinical Psychology from St. John’s University, graduating Summa Cum Laude. She continued her education, earning her Master’s Degree in Clinical Psychology at Teacher’s College, Columbia University, where she received an honors certificate in education and teaching and was a member of Kappa Delta Phi- Honor Society in Education.   Elizabeth attended post-graduate studies at Penn State University, where she completed coursework in Applied Behavior Analysis.  She earned her BCBA certification and licensure in Behavior Analysis in 2014.

ABA Journal Club #5: Caregivers as Interventionists

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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.

There is a wealth of studies demonstrating that training caregivers to implement interventions is valuable for generalization of skills, improved learner outcomes, and decreases caregiver stress. While many teachers, behavior analysts, and other practitioners work to train caregivers; these practitioners are rarely given specific training on how to train caregivers.

In this month’s journal club article, behavior skills training (BST) is utilized to teach caregivers to be interventionists. BST is a model that involves instruction, modeling, rehearsal, and feedback. We hope this article will get you talking about your current level of training with BST and how your organization can improve in training practitioners to teach caregivers to implement behavior analytic strategies.

Loughrey, T. O., Contreras, B. P., Majdalany, L. M., Rudy, N., Sinn, S., Teague, P., … & Harvey, A. C. (2014). Caregivers as interventionists and trainers: Teaching mands to children with developmental disabilities. The Analysis of Verbal Behavior, 30(2), 128-140.

  • The researchers trained caregivers on a university campus using the BST model prior to home visits. In your current work, would this be a possibility for you? If not, how could you provide this type of training to caregivers? What obstacles can you predict, and how might you address them?
  • Discuss the multiple baseline design used in the study. How does it demonstrate experimental control? What can you determine from a visual analysis of the data?
  • Part of this study included a measure of whether a competently trained parent could teach their spouse how to implement mand training. Why is this important? Have you implemented similar strategies in your own work?
  • This study did include maintenance data. Why is this data valuable? Do you collect maintenance data on the caregiver training you provide?
  • Consider a particular skill you are teaching one or more clients. What would BST look like to teach caregivers how to implement the necessary procedures for teaching that skill?
  • The article states, “General instructions were provided prior to baseline, but parents were only able to implement the procedures effectively when full instructions, modeling, rehearsal, and feedback were used to train to mastery.” How can you change your current practice to ensure that you are providing the necessary steps to help caregivers master skills they have selected for parent training?

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.

Your Child’s Autism Diagnosis Long Term

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In the years immediately after a parent learns of a diagnosis of autism, it can be especially challenging to think of your child’s autism diagnosis long term. But as parents advocate for their child, and as practitioners work with the family to create goals for that child, the long term must be considered. Here are a few suggestions to help with considering the long term, while focusing on short-term goals:

  • Create a vision statement. One of my favorite books is From Emotions to Advocacy: The Special Education Survival Guide by Pam Wright and Pete Wright. This book covers everything parents need to know about advocating for a child with special needs. One of the first things they suggest is creating a vision statement. They describe this as “a visual picture that describes your child in the future.” While this exercise may be challenging, it can help hone in on what is important to you, your family, and your child with special needs in the long term.
  • Look at your child’s behaviors, then try to imagine what it might look like if your child is still engaging in that behavior in five or ten years. Often, behaviors that are not problematic at three are highly problematic at 8 or 13 years old. Such behaviors might include hugging people unexpectedly or (for boys) dropping their pants all the way to the ground when urinating (which could result in bullying at older ages). While it is easy to prioritize other behaviors ahead of these, it’s important to remember that the longer a child has engaged in a behavior, the more difficult it may be to change.
  • Talk to practitioners who work with older students. Many practitioners only work with a certain age group of children. While they may be an expert for the age group they work with, it may be helpful to speak with a practitioner who works with older kids and ask what skill deficits they often see, what recommendations they may make, and what skills are essential for independence at older ages.
  • Talk with other parents. Speaking with other parents of children with special needs can be hugely beneficial. Over the years, I’ve worked with hundreds of parents who are spending countless hours focusing on providing the best possible outcomes for their children. And while it’s impossible to prepare for everything that will come in your child’s life, it may be helpful to find out what has blindsided other parents as their children with special needs have grown up.

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

Journal Club #4: RBTs and Interventions

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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, Ph.D., 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.

In my daily work, I supervise Registered Behavior Technicians (RBTs) who are providing the direct care to my clients with autism. The RBT designation is only a few years old, and there are concerns about the training and maintenance of skills for these employees. However, another concern is the low number of people available to provide frontline services for high number of individuals who require it.

The work that RBTs do is important and necessary. It’s important for our field, as well as individual organizations and BCBAs to identify potential problems with the current model of providing treatment, and work to continuously improve upon the model. One way to start the conversation within your own organization is to read the following article and identify ways in which you can address the concerns it brings to light.

Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Smith, T., Harris, S. L., … & Volkmar, F. R. (2017). Concerns about the Registered Behavior Technician™ in relation to effective autism intervention. Behavior Analysis in Practice, 10(2), 154-163.

  • The authors discuss the evolution of the BACB and concerns with certifying behavior analysts prior to the advent of RBTs. What did you think of the concerns identified here? Are these still concerns we have about BCBAs? How are they similar or different than concerns about RBTs?
  • How does the current training of RBTs compare to the training of behavior technicians in early behavior analytic studies?
  • Look at the RBT task list. The authors argue that the current amount of training does not meet standards set forth by research on staff training. How can BCBAs and organizations hiring RBTs support their mastery of the skills on this list?
  • Have you identified concerns with the current model (BCBAs supervising RBTs who provide direct care) that were not mentioned in the article? If so, how have you worked to address those concerns?
  • Discuss the unintended consequences described in the article. Have you seen these consequences in your current setting?
  • Many of the recommendations by the authors include changes the BACB should enact as well as research that should be conducted. How are you able to take a role in these types of recommendations?

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

The founder of ABA Journal Club, 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.

What Is Procedural Fidelity In ABA?

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It is not uncommon for parents or practitioners to implement a new intervention that appears to be working well, then after a few weeks or months report that the intervention has stopped working. Often, the change in behavior in feels like a mystery and leaves people scrambling for a new intervention. But before searching for a new intervention, you should consider the possibility of problems with procedural fidelity, which “refers to the accuracy with which the intervention or treatment is implemented” (Mayer, Sulzer-Azaroff, & Wallace, 2014).

Problems with procedural fidelity in ABA are common, and you will experience more success with your interventions if you take steps to address fidelity at the outset. Here are a few suggestions:

  • Post the steps in a visible spot. Clearly list the steps of the procedure and put them in a spot where you will see them often. This might be on the actual data collection sheet or on the wall. One parent I worked with had a Post-it® note with the steps for our intervention attached to her computer screen. Another parent kept the steps inside the ID part of his wallet, where they were protected and visible each time he opened his wallet.
  • Plan meetings to go over the steps. As part of your intervention, set brief monthly or quarterly meetings to go over the steps of the intervention and be sure everyone is maintaining procedural fidelity.
  • Assess for procedural fidelity. Schedule observations to ensure that each step of the intervention is implemented as described. If you do not have someone who can supervise you, take video of yourself implementing the intervention, watch it and compare your actions to the steps outlined in the intervention plan.
  • Outline steps for systematic fading of the intervention. When implementing an intervention, the goal is to have the learner eventually exhibiting the desirable behavior without prompts or planned reinforcement. Sometimes when a parent or practitioner sees the learner’s behavior improving, they begin to remove the prompts or planned reinforcement before the learner is quite ready for it. By writing a plan for fading the intervention into the plan, you make it clear to everyone involved what the requirements are for each step towards mastery.

REFERENCES

Mayer, G.R., Sulzer-Azaroff, B., & Wallace, M. (2014). Behavior analysis for lasting change (3rd ed.). Cornwall-on-Hudson, NY: Sloan Publishing.

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.

ABA Journal Club #3: Functional Analysis

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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.

Head to our Facebook page to join the discussion and let us know your thoughts!

When I was first starting out in behavior analysis, I was amazed at the simplicity and accuracy of functional analysis. Behaviors that had seemed complex and impossible to change suddenly made sense. I felt ready to create interventions to address those behaviors, and started to see more success in my behavior change procedures. Functional analysis remains one of my favorite topics to teach, and one of the questions I get most often from my graduate students is about ethical concerns in relation to completing a functional analysis for potentially dangerous behaviors. 

This has been a concern in the field, and there is a strong evidence base that identifying, assessing, and treating precursor behaviors is effective in reducing the target problem behavior. For this month, I have selected a paper on this topic.

Herscovitch, B., Roscoe, E. M., Libby, M. E., Bourret, J. C., & Ahearn, W. H. (2009). A procedure for identifying precursors to problem behavior. Journal of Applied Behavior Analysis, 42(3), 697-702.

What is the purpose of the current study? How is it relevant to your current work?

The researchers used both indirect and descriptive methods for identifying precursor responses. What were these methods?

Describe each of the probability measures the researchers used. How were these related to each other? Could these be used in your current setting?

What did the authors find was most probable to occur prior to head-hitting behavior? Why is this information important?

When the researchers conducted the functional analysis on the precursor behavior, was the head-hitting behavior eliminated? Why is this important to recognize? What implications does it have for practitioners?

Identifying the precursor behavior can decrease risk resulting from problem behaviors such as self-injurious behavior or aggression. Can you identify a current problem behavior for one of your clients and create a plan for determining precursor behaviors?

Please note that this particular study has only one participant. Sometimes, behavior analysis as a field is criticized for the use of single-subject studies. You can read this previous post  for more on the topic of single-subject studies.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

The founder of ABA Journal Club, 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.

Leisure Skills for Adults with Autism

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This month’s ASAT feature comes to us from Megan McCarron, MS, BCBA. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

I am a BCBA working in an ABA Teaching Home. I am adept with teaching play skills to younger children but would like some guidance on assessing interests and helping young adults develop hobbies that they can pursue in an independent and meaningful manner.

This is a very important question. There is an abundance of research on how to teach leisure activities using instructional methods such as modeling, video modeling, and activity schedules, moreover, it is vital that careful thought and planning be put into selecting and individualizing leisure activities.

Typically, one’s interests are developed over time via exposure to and interaction with new and varied people, places, and activities. Exposure usually occurs over the course of life without much forethought, resulting in interests that shift and change. Unfortunately, this is often not the case for individuals with autism spectrum disorder (ASD).

There are two key deficits within the diagnostic criteria for ASD that are likely to impact individuals’ exposure to and interaction within varied leisure activities. First, persistent limitations in social communication and social interaction can hinder an individual’s ability to request access to items and activities, and/or to express one’s level of interest. Second, the presence of restricted, repetitive patterns of behavior, interests, or activities may prevent an individual from exploring novel items or activities.

Individuals’ difficulty making or expressing choice limit exposure to new and varied items and activities. Limited interests or those that are markedly different from those of same-aged peers make it that much more difficult to determine ways to expand and develop interests. As a result, careful thought and planning are required to help individuals with autism engage in meaningful leisure activities.

Finding Leisure Activities

Given that there is an unending number of items or leisure activities that could be assessed, it is important to narrow down the field to things that are likely to be of interest before conducting your assessments. A few of these approaches are as follows:

Expand upon current interests. Ask caregivers, teachers, siblings, or others who spend time with the individual to complete an interview, checklist or other type of survey. Create your own questions or use published materials such as the Reinforcer Assessment for Individual with Severe Disabilities (RAISD). Do not immediately discount unusual or idiosyncratic interests. Look to see if there are groups in the community or online that share that interest. If necessary, teach when and where it is okay to engage in preferences that may be annoying to others or are socially stigmatizing. Examples:

Select novel activities that contain components of already preferred activities. Identify common features of known preferences, and then identify novel items or activities that contain the same or similar features. Examples:

Make modifications to existing activities to incorporate the preferred feature of other preferred activities. Examples:

Pair a known interest with a compatible novel activity. Examples:

Identify shared interests. In addition to identifying activities by exploring and expanding upon current interests of the individual, it can be worthwhile to identify interests of the people the individual spends a lot of time with and activities available in the individual’s school, home, and local community. These activities will offer up the opportunity for social interaction with others.

Assessing Activities

Once potential activities are selected, assessments can be conducted to determine how preferred the activities are. While preference assessments are commonly used and talked about in terms of finding reinforcers, they are equally useful for assessing preference levels for potential leisure activities. Initially, free operant assessments are very helpful in terms of assessing potential leisure activities. These can be conducted in the natural environment or a contrived and enriched setting.

Free operant preference assessments can be conducted through direct observation by providing free access to activities without demands, time limits or requirements to use items in a predetermined manner (unless it is a safety issue). Assessments can be conducted in either a natural or contrived setting, as described below (Toner, 2014; Chazin & Ledford, 2016).

Collect data on:

  • Which items/activities the individual interacts with
  • Duration of each interaction
  • Can be helpful to note the individual’s observable signs of positive affect during interactions, such as smiles or laughter
  • If the individual interacts with an item in an unexpected or unusual manner, make note of what he or she did.

Once the free operant assessment data have been collected and ranked in order of which activities were engaged with the most (e.g., by calculating a percentage of time of the observation in which the student engaged in each activity), subsequent paired choice preference assessments or MSWO assessments could be conducted to better assess the individual’s relative preference for activities. With this information, you can make an informed choice about what activities are likely to provide “enjoyment” and thus fit the definition of leisure.

Selecting Teaching Targets for the IEP

It is important to help an individual build a repertoire of activities that can be used to fill the various functions of leisure. Therefore, the activities chosen as a focus of teaching should cover a variety of leisure situations.

  • Social Activities (any activity done with another person).
  • Individual Activity (any activity that can be done alone).
  • Health and Fitness.
  • Longer duration activities.
  • Short duration activities that can be done while waiting (looking at books, magazines, music on phone, etc.)

Some activities may be adaptable enough to be used across several leisure functions. For example, listening to music can be a social or individual activity; it can easily be paired with a variety of health and fitness activities and can be used for short or long durations.

In addition to selecting specific activities/skills for leisure, it is advisable to include an objective in a student’s IEP that targets the individual’s exposure to leisure activities. The goal of this objective would be to have the student continue to try out new activities over three to four opportunities to further expose them to new activities. During the sampling sessions, staff should collect data on duration of engagement, observable signs of affect, and any skill deficits that inhibit engagement.

Considerations for Increasing Functional Independence in Leisure
While identifying preferred activities is a major part of building a leisure repertoire, there are a whole host of skills that can increase an individual’s ability to access and engage in leisure activities as independently as possible.

Ensure the individual has an effective means of communication. An essential skill, regardless of the individual’s vocal verbal ability, is teaching an appropriate way to request access to activities, especially those that are not readily available in the current environment such as requesting to go to the mall or to a specific store (Schneiter & Devine, 2001). Equally important is the ability for an individual to appropriately decline participation and/or end an activity when the activity is not preferred.

Teach prerequisite skills. If a student shows interest in an activity but is not able to fully engage in the activity, it may be necessary to teach the individual specific prerequisite skills. Examples:

If a Sampling Leisure Activities objective has been included in the IEP, the sampling period can be used to help identify what types of prerequisite skills may need to be taught.

  • The individual may need to be taught skills related to any materials or equipment required for an activity. For example, gathering equipment / materials prior to starting the activity; caring for the equipment / materials putting equipment away when finished, and problem solving (e.g., what to do if materials are missing, broken, or need to be replenished).
  • Time management skills, such as identifying when it is time to engage in a leisure activity, selecting an activity that fits the amount of time for leisure, identifying when activities are essential components of increasing independence. Using schedules and calendars can be helpful to structure and prompt leisure activities but may require specific teaching. For example, using a calendar app on a phone can be very useful, but it may be necessary to start off with teaching the student to respond to an alert to engage in an activity and build up to having them enter information into the calendar.

Final Thoughts

Every individual has different interests, abilities, and obstacles to work through in establishing leisure skills. However, building on and expanding from high preference, high availability activities and using evidence-based assessment and teaching strategies to establish independence in leisure activities provides a strong foundation from which to start.

References

Blum-Dimaya, A., Reeve, S. A., Reeve, K. F., & Hoch, H. (2010). Teaching children with autism to play a video game using activity schedules and game-embedded simultaneous video modeling. Education & Treatment of Children, 33(3), 351-370.

Carlile, K. A., Reeve, S. A., Reeve, K. F., & DeBar, R. M. (2013). Using activity schedules on the iPod touch to teach leisure skills to children with autism. Education & Treatment of Children, 36(2), 33-57.

Carr, J. E., Nicolson, A. C., & Higbee, T. S. (2000). Evaluation of a brief multiple-stimulus preference assessment in a naturalistic context. Journal of Applied Behavior Analysis, 33(3), 353-357.

Chan, J. M., Lambdin, L., Van Laarhoven, T., & Johnson J. W. (2013). Teaching leisure skills to an adult with developmental disabilities using a video prompting intervention package. Education and Training in Autism and Developmental Disabilities, 48(3), 412-420.

Chazin, K. T., & Ledford, J. R. (2016). Free operant observation. In Evidence-based instructional practices for young children with autism and other disabilities. Retrieved from http://vkc.mc.vanderbilt.edu/ebip/free-operant

Fisher, W. W., Piazza, C. C., Bowman, L. G., & Amari, A. (1996). Integrating caregiver report with a systematic choice assessment. American Journal on Mental Retardation, 101(1), 15-25.

Google Search. https://www.google.com/search?q=define+leisure&ie=utf-8&oe=utf-8&client=firefox-b-1 (accessed February 5, 2017).

Graff, R. B., & Karsten, A. M. (2012). Assessing preferences of individuals with developmental disabilities: A survey of current practices. Behavior Analysis in Practice, 5(2), 37-48.

MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. (1993). Teaching children with autism to use photographic activity schedules: Maintenance and generalization of complex response chains. Journal of Applied Behavior Analysis, 26(1), 89-97.

Schneiter, R., & Devine, M. A. (2001). Reduction of self-injurious behaviors of an individual with autism: Use of a leisure communication book. Therapeutic Recreation Journal, 35(3), 207-219.

Toner, N. (2014). How do you figure out what motivates your students? Science in Autism Treatment, 11(1), 12-14.

Please use the following format to cite this article:

McCarron, M. (2018). Leisure skills for adults with autism. Science in Autism Treatment, 15(2), 19-26.

About The Author

Megan McCarron M.S., BCBA, LBA (CT) holds a Master of Science Degree in Child Development, is a Board Certified Behavior Analyst, and Licensed Behavior Analyst in the state of Connecticut. She has been in the field of autism treatment since 1992. Megan has experience providing services for children with autism in school, home and community settings. She has worked at Milestones Behavioral Services (formerly, The Connecticut Center for Child Development, Inc.) since 1999. During her time at Milestones, she has served in various capacities. She started out as an instructor and is now a Clinical Director. In addition to her responsibilities in and around Milestones, Megan presents lectures and workshops on autism and Behavior Analysis at local and national conferences.

How Siblings Of Children With Autism Can Help Improve Behaviors

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When I first came across this study, “Behavioral Training for Siblings of Autistic Children,” I was immediately hesitant. There’s something about the idea of sibling-as-therapist that makes me cringe a little bit. When I work with the families of children with autism, the hope is that the siblings of the child with autism still have a childhood without being pushed into the role of caregiver. And I also want the child with autism to have independence and feel like an individual who is heard, which may be more challenging if their siblings are issuing demands just as a parent or teacher would. But as I read the study, I realized that the work they completed had incredible social significance.

In the study, there were three pairs of siblings. The ages of the children with autism ranged from 5 years old to 8 years old. The ages of the siblings ranged from 8 years old to 13 years old. The researchers trained each sibling of a child with autism how to teach basic skills, such as discriminating between different coins, identifying common objects, and spelling short words. As part of this training, the researchers showed videos of one-on-one sessions in which these skills were taught, utilizing techniques such as reinforcement, shaping, and chaining. What the researchers did next was the part that really stood out to me: they discussed with the siblings how to use these techniques in other environments. Finally, the researchers observed the sibling working with their brother/sister with autism and provided coaching on the techniques.

It should be noted here that the goal of the study was not to have the siblings become the teacher of basic skills. Instead, it was to provide a foundation of skills in behavioral techniques for the sibling to use in other settings with the hope of overall improvement in the behaviors of the child with autism. The researchers demonstrated that, after training, the siblings were able to effectively use prompts, reinforcement, and discrete trials to effectively teach new skills. But, perhaps the most meaningful aspects of the study were the changes reported by both siblings and parents. The researchers provide a table showing comments about the sibling with autism before and after the training. One of the most striking comments after the training was, “He gets along better if I know how to ask him” (p. 136). Parents reported that they were pleased with the results and found the training beneficial.

This study provides excellent evidence that structured training for siblings has real potential for making life a little easier for the whole family. The idea isn’t that they become the therapist, but instead that knowledge truly is power.

REFERENCES

Schriebman, L., O’Neill, R.E. & Koegel, R.L. (1983). Behavioral training for siblings of autistic children. Journal of Applied Behavior Analysis. 16(2), 129-138.

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 #2: A Response from Dr. Amanda Kelly

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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. 

Read this month’s discussion questions here!

It is important in our field to maintain an open conversation about ethics. The Professional and Ethical Compliance Code outlines how behavior analysts are expected to conduct themselves, but sometimes situations are not so black and white. And as the world changes, so do the expectations for ethical conduct. In recent years, issues related to social media have been especially relevant. This month, I’ve selected the following article which addresses the special concerns that come up with the use of social media.

The article reviews the codes of ethics for other professions. Why is this valuable for us to do as a profession? Did you learn anything surprising or interesting form this portion of the article?

Any profession runs the risk of becoming too insular if we are not actively pushing ourselves to learn about others and the places where we overlap and intersect. It was interesting to see the parallels, as well as the vast differences, in the ethical codes across professions. It is important to look at the publication dates of each professions ethical code. Codes which were published earlier did not reference social media, for example. This could simply be a reflection of the prevalence of such platforms at the time the codes were written. Some codes were significantly shorter than others and others were substantially longer. The ethical code for Behavior Analysts, as created by the Behavior Analyst Certification Board (BACB) was more elaborate and offered more detail than other professional code of ethics, which were reviewed for the original article. In some ways, it is not surprising given that behavior analysts as scientists and practitioners pride ourselves on being detail-driven; offering clear, observable and measurable operational definitions for the interventions we design, and the behaviors we measure, and aim to change. It is also important to note that our own ethical code was based on codes and ethical guidance issued by other professions. As noted on the BACB website:

In the original version of the Guidelines for Professional Conduct for Behavior Analysts, the authors acknowledged ethics codes from the following organizations: American Anthropological Association, American Educational Research Association, American Psychological Association, American Sociological Association, California Association for Behavior Analysis, Florida Association for Behavior Analysis, National Association of Social Workers, National Association of School Psychologists, and Texas Association for Behavior Analysis. We acknowledge and thank these professional organizations that have provided substantial guidance and clear models from which the Code has evolved.

“A search on an internet search engine for information related to a procedure or scientific concept may yield results as to what that procedure or concept is. The same search on a social media outlet may yield results as to whether or not that procedure or concept should be used (p. 47.) Discuss this difference.

As human beings we are influenced by the opinions of others. This is not specific to behavior analysts, though we are also no exception. The difference between an inquiry in an online journal search engine and a social media platform, is scientific journals will yield factual information, whereas an inquiry on a social media platform is likely to result in access to the opinions and impressions of others. When investigating punishment procedures for example on research platforms, one will find information about procedures, which lead to a reduction in a behavior. That same search on a social media platform may result in a discussion about the potential harmful effects of punishment and condemnation against the use of all punishment procedures. That is not to say that opinions and perspectives of others do not matter, they certainly do. The point here is that opinions are opinions, and an opinion is no replacement for an objective investigation.

Behavior analysts and others interested in the topic may turn to social media to get answers to their questions due to the low response effort involved and the speed of reinforcement. How can we decrease response effort and increase reinforcement for referring to the scientific literature to answer our questions?

Information needs to be accessible for people to come into contact with it. ResearchGate is an excellent way for the scientific community to disseminate their findings to the larger community. On this free site, authors can either public post or privately host publications they have written, without being in violation of any copyright laws. Definitely check it out, if you have not already. You will find access to all of my previous publications, as well as the work of many amazing professionals, at your fingertips, without any paywalls.

This is also where social media can really help disseminate science. There are ways to produce scientifically-sound tidbits of information, which can then be shared in online social media platforms. To those who are creating content, include citations, references, and links to the original publication in your posts. For consumers, be critical of the information that is being provided to you, look for the original source. Some professional organizations (Journal of Applied Behavior Analysis [JABA]) are encouraging authors to create short videos (e.g., YouTube) and to host live discussions (e.g., Facebook Live) about their research. Once you are drawn in, read the publications referenced in the posts. You can also consider reaching out to the researcher. If that is something which interests you, social media has given us access to one another like never before. Consider using social media sites to connect with others, who might have otherwise been inaccessible to you. We are no longer limited by snail mail, geographic barriers, or even time zones. The online world allows us to share information in real-time, or at least much more quickly than in the past. We have a fantastic opportunity, possibly even a responsibility, to use this to our advantage.

The authors provide suggestions for how behavior analysts should behave on social media. Are there any suggestions you might add? Are there ways you can increase the likelihood of other behavior analysts following these suggestions?

Behave like your mother is watching (she probably is). Think of potential employers, clients, and colleagues and what they may think. When we engage online we open ourselves up to a larger audience, which is both exciting and anxiety provoking, when you really think about it. It can be exhausting to have to be “professionally appropriate” in what feels like a personal space. There are certainly protections you can put in place: creating a separate professional page, using privacy features, avoid “friending” co-workers, employees, and clients, etc. However, the best piece of information I can give is to think of the online world as one large coffee shop. Would you speak the things you type? Would you say it the same way? Could your words be misunderstood? Have you actively listened, or was it a one-side soliloquy?

Amanda N. Kelly, PhD, BCBA-D, LBA obtained her bachelor’s degree in Elementary Education, her masters of science in Behavioral Education, and her doctorate in Behavior Analysis. Dr. Kelly has experience working as a paraprofessional, a licensed teacher, a school counselor, and behavior analyst. Over the past two decades, Dr. Kelly has worked in-home settings, public and private schools, residential placements, and community settings for children and adolescents who have social-emotional, cognitive, or behavioral needs.

Dr. Kelly has been recognized for her dissemination and advocacy efforts. In 2012, she was awarded the “Jerry Shook Practitioner of the Year” from the Berkshire Association for Behavior Analysis and Therapy (BABAT) and in 2015, she accepted the “Advocacy Group of the Year” award from Autism Speaks, on behalf of the Hawai’i Association for Behavior Analysis (HABA). In 2016, Dr. Kelly became the first behavior analyst licensed in the state of Hawai’i. Dr. Kelly has served on numerous boards and committees and is currently serving as Legislative Chair for the HABA board and as Secretary on the board of the Hawai’i Disability Rights Center (HDRC).

Dr. Kelly’s dedication and commitment in improving access to educational and medical services has resulted in numerous invited speaking engagements throughout the world, including talks in Canada, Japan, London, and and the Philippines. In addition to her expertise helping families and schools, Dr. Kelly’s interests in behavior analysis extend to dissemination, organizational management, public policy, and sustainable behavior change.

Pick of the Week: Timers!

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Promotion is valid through March 4th, 2019 at 11:59pm EST. Offer cannot be applied to previous purchases, combined with any other offers, transferred, refunded, or redeemed and/or exchanged for cash or credit. Different Roads to Learning reserves the right to change or cancel this promotion at any time.