How Occupational Therapy Can Benefit ABA Programs

This month, we’re proud to feature a wonderful piece from the Association for Science in Autism Treatment (ASAT), written by Amy McGinnis Stango, MS, OTR, MS, BCBA, on the benefits of occupational therapy as a supplement to your child’s ABA program. Amy is a nationally registered occupational therapist and board certified behavior analyst, and provides consultative direct and consultative services to families, clinics and schools across the country and internationally. She is also the co-author of Assessing Language and Learning with Pictures (ALL PICS), an assessment tool designed to make administration of the VB-MAPP more accurate, efficient, and cost-effective for schools, clinics, agencies, and private practitioners.

To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!


My child is enrolled in an ABA-based program where he also receives some OT services. How can occupational therapy benefit my child’s ABA program?

Answered by Amy McGinnis Stango, MS, OTR, MS, BCBA

How Occupational Therapy Can Benefit ABA ProgramsOccupational therapy (OT) can be beneficial as a supplemental treatment to your child’s ABA program. The goal of occupational therapy is to support an individual’s health and participation in life through engagement in occupations or everyday tasks (AOTA, 2008). The occupational therapy process begins with an evaluation. The evaluation helps to determine whether your child has met developmental milestones in a wide variety of occupations. The occupational therapy evaluation can help your child’s behavior analyst choose developmentally appropriate goals to be included in his ABA program. The OT evaluation may also be helpful in understanding why a child struggles with a particular task. For example, if your child struggles with handwriting, the evaluation can determine whether this difficulty stems from an inappropriate grasp, poor posture, muscle weakness, visual memory, or lack of eye-hand coordination. Pediatric occupational therapy typically addresses the following domains:

  • Play
  • Activities of Daily Living
  • Education
  • Social Participation

Play is the primary occupation of childhood and is often an area of need for children with autism. Occupational therapy can be effective in helping children learn new play skills (Stagnitti, O’Connor, & Sheppard, 2012). Many pediatric occupational therapists use a play-based approach to their sessions, exposing children to a variety of toys, games, and different ways to play. If your child engages in repetitive play behaviors or has limited interests, the occupational therapist may be helpful in finding other activities that share similar sensory properties of the toys your child already enjoys. Some of the sensory activities used in occupational therapy may function as reinforcers, which could be used in your child’s ABA sessions as well (McGinnis, Blakely, Harvey, Hodges & Rickards, 2013).

Occupational therapists typically include an assessment of activities of daily living (ADLs) as part of the evaluation. ADLs include those basic self-care tasks that an individual performs each day, such as eating, grooming, dressing, and using the bathroom. Occupational therapy can help to build the strength, coordination, and perception skills needed to perform these tasks. For example, if your child has oral motor deficits, occupational therapy can help your child learn the mouth movements necessary for chewing and drinking (Eckman, Williams, Riegel, & Paul, 2008; Gibbons, Williams, & Riegel, 2007). Occupational therapy can also help older children and adolescents learn more advanced ADLs, like independent bathing (Schillam, Beeman & Loshin, 1983). Occupational therapists are trained in identifying multiple ways to perform routine tasks, and can recommend an approach that will work best for your child and can be integrated into your routines at home (Kellegrew, 1998).

As individuals with autism age, occupational therapists can help teach skills that will lead to greater independence at home and in the community (McInerney & McInerney, 1992). These include preparing meals, managing money, shopping and using public transportation. Often these skills are more complex and may require an activity or task analysis that breaks the task down into simpler steps. With extensive training in developing task analyses, occupational therapists can share these analyses with your child’s ABA team so that skills can be taught across settings. If tasks are still difficult, an occupational therapist may recommend adaptive equipment to make a task easier. Occupational therapy can also help your child participate more fully in his or her educational program. Occupational therapy can help young children acquire tasks such as coloring and cutting (Case-Smith, Heaphy, Marr, Galvin, Koch, Ellis, & Perez, 1998), as well as help older children acquire skills such as handwriting (Denton, Cope, & Moser, 2006). If your child has difficulty moving through the school setting or actively participating in movement activities, occupational therapy can help your child develop functional mobility skills. Continue reading

“Expanding Interests in Children with Autism” by Tanya Baynham, MS, BCBA

This month’s featured article from ASAT is by Program Director of the Kansas City Autism Training Center Tanya Baynham, MS, BCBA, on a variety of research-based strategies to help you expand interests in children with autism. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!


My child is doing well with many of his ABA programs, even the ones that focus on the development of play skills. Unfortunately, he doesn’t play with most of the toys that we give him, and he has worked for the same five things since our program began a year ago (marshmallow peeps, Thomas trains, tickles, Wiggles songs, and raisins). What can I do to expand his interests and maybe even get those interests to function as reinforcers for teaching targets?

Answered by Tanya Baynham, MS, BCBA
Program Director, Kansas City Autism Training Center

Little Boy and TrainInherent to a diagnosis of autism is the observation that the child will engage in restricted or repetitive behavior and may also display restricted interests. Expanding those interests, specifically in the areas of toy use and play, is an important programming goal as it can result in a number of positive effects. First, rates of socially appropriate behaviors may increase while rates of inappropriate behaviors may decrease. For example, engaging a child in looking at a book may decrease stereotypic behaviors or passivity (Nuzzolo-Gomez, Leonard, Ortiz, Rivera, & Greer, 2002). Second, interest expansion can lead to new social opportunities for children and promote greater flexibility when bringing them to new environments. For example, a child with a new preference for coloring may be more successful in a restaurant because he will sit and color the menu, or he can attend Sunday school because he will color a picture when directed. Third, the addition of new reinforcers in ABA programs may help prevent satiation or allow you to allocate more highly preferred items for difficult teaching targets and less preferred items for easier targets.

Stocco, Thompson, and Rodriguez (2011) showed that teachers are likely to present fewer options to individuals with restricted interests and will allow them to engage longer with items associated with those restricted interests. The authors suggest one possible reason for this is that teachers might be sensitive to the fact that negative behaviors (e.g., whining, pushing the toy away) are more likely to accompany the presentation of a toy that is not associated with the child’s restricted interest. In general, this sensitivity to the child’s behavior is important in maintaining low rates of problem behavior, but it can potentially limit access to novel experiences or activities. We need to systematically program effective ways to expand a child’s interests without evoking tears and other negative behavior.

Most importantly we, as parents and intervention providers, must make reinforcer expansion a teaching focus and use data to determine whether our procedures are producing change. One recommendation is to first track the number of different toys and activities with which your child engages to identify current patterns. Then, measure the effects of attempts at reinforcer expansion on your child’s behavior. Ala’i-Rosales, Zeug, and Baynham (2008) suggested a variety of measures that can be helpful in determining whether your child’s world is expanding. These measures include the number of toys presented, number of different toys approached/contacted across a week (in and/or out of session), engagement duration with new toys, and affect while engaging with toys. It is sometimes helpful to track changes across specific categories (e.g., social activities, food, social toys, sensory toys, etc.). If, for example, your child only watches Thomas videos, you may narrow the focus to the category “videos” in order to track expansion of interests to different types of videos. Keeping in mind the previous point about a teacher’s role in expanding a child’s interests, you may also want to set goals to ensure changes in adult behavior such as, “Present three new items each day.”

Once data are being taken, it is important to implement procedures likely to expand your child’s interests. One way to expand toy play is to present, or pair, a preferred item with the item you want to become more preferred (Ardoin, Martens, Wolfe, Hilt and Rosenthal, 2004). Here are a few examples:

  • Playing a game: Use peeps as the game pieces in a game you want your child to enjoy, embedding opportunities to eat the peeps at different points during the game.
  • Trying a new activity: Sing a favorite song as you help your child up the ladder of an unfamiliar slide on the playground.
  • Reading a book: Tickle your child before turning each page while reading a book.

A second way to expand interests is to think about why your child might engage in those restricted interests. If he likes Thomas because of the happy face, put Thomas stickers on a ring stacker. If he likes Thomas because of the wheels, present other vehicles with wheels. If your child likes peeps because they blow up in the microwave, put Mentos in a cola bottle or use baking soda to make a volcano. If he likes peeps because they are squishy, use marshmallows in art projects or in a match-by-feel game.

A third way to expand interests is described by Singer-Dudek, Oblak, and Greer (2011), who demonstrated that some children will engage more with a novel toy after simply observing another child receiving reinforcers after playing with it. To apply these findings to your child, give Thomas trains, if they are used as a reinforcer, to a sibling who just played with novel items such as play dough or shaving cream. Continue reading

Pick of the Week: Special Savings on Hooray for Play! Activity Cards

Pretend play offers children an opportunity for perspective taking, problem solving, cooperation, social emotional skill acquisition and language development. Children learn through their experiences and what better way to engage in the largest possible array of activities than through pretend play? For a special price of $12.95 only $4.95, you can get your set of Hooray for Play! and start off the school year with endless learning opportunities through play.

Hooray for Play! is a multi-use deck of 31 beautifully hand-drawn cards that can be implemented initially by parents and educators as an instructional tool and later used by learners independently. This week, we’re offering Hooray for Play! at a special price of only $4.95. No promo code necessary. Get your set of Hooray for Play! at a discounted price while stock lasts!

Hooray for Play! breaks down the components of the 31 individual play schema cards into the three organized sections that provide a memorable framework for sociodramatic play. The Do! Section explains the various roles, Say!! outlines possible scripted statements by the involved actors and Play!!! offers suggestions for props and set-up. An additional card in the set offers suggestions for use that guides users through creative steps in reinforcing learning and play skills.

Get your deck of Hooray for Play! at only $4.95 this week and start making playtime a rewarding and educational experience for your students! Have fun!

The Holidays Are Here?!

The fast approaching holiday break can be stressful with therapists away, a school break and big changes in your child’s schedule making it difficult to maintain a routine.  Why not use the time to expand general knowledge and play skills?

Try to maintain the schedule as much as you can by replacing therapy or school time with activities based on one particular theme.  Take space travel and astronauts as an example and incorporate activities to address all developmental domains and have different “sessions” throughout the holiday vacation.  Depending on the length of the vacation you might choose more than one theme.

I like to start by using short videos to introduce a play schema.  This gets everyone excited about playing by becoming familiar with the specifics of the theme and making it “real”.  You can find videos on the Difflearn YouTube Channel.  Like this one showing a space shuttle lift off!

Next, you could use materials relating to the theme to work on building cognitive skills and expanding the general knowledge base about the topic needed for play.

Here are some ideas:

Parts of Whole – given a picture of an astronaut or space shuttle can the child identify parts both expressively and receptively?  This becomes important when expanding the comments used  during play.  A couple of examples include, “Don’t forget your helmet” or “I think the rocket blasters are broken, let’s fix them!”

Wh Questions – after reading short passages of a book or informational page related to the theme present various Wh Questions for the child to answer.  This improves comprehension and listening skills as well as providing more content for the space play.  You would be surprised at how well a child can do given a new and motivating topic!

Other sessions can include coloring sheets related to the theme you have chosen.  This provides an opportunity to work on task completion, graphomotor and fine motor skills.  You can find countless coloring sheets with a simple search on the internet. Like the ones found here: coloring sheets.

Additionally, you can have an arts and crafts “session” and use up some of those holiday gift boxes and gift wrap tubes to make helmets or space shuttle controls.

Last, it’s time to play!  Gather the whole family or some friends, line up chairs for the space shuttle and put on your gear.  Watch as all the information shared during your “sessions” comes alive during play!

Happy Holidays to All!

Fun (And Learning) In The Sun!

Discrete trial teaching and a home-based ABA program, without a doubt, play an integral part in a child’s ongoing progress.  However, during the summer months here in New York City all I can think about is PLAY. The sun is shining, playgrounds are full of children and there are child friendly events for free all over the city.  I can’t help but seize these summer moments and optimize the huge array of incidental teaching opportunities they provide.  The playground is the perfect place to start to generalize all of the play skills that the child has mastered with you during the year and facilitate them with novel peers.  The headache of trying to schedule play dates during the winter months fades, there are children everywhere you turn, and kids outside ready to make new friends.
The novelty of an outdoor children’s concert playground or sprinklers can be motivating enough to get the child in the mix with other kids.  I find that having the child I am working with take a popular item on the outing can serve as a really powerful icebreaker and readily grab the attention of all the kids there.  Items to consider include; sidewalk chalk, bubbles, water balloons, a foam rocket launcher or a bug kit.  It is easy to rehearse possible scenarios the child might encounter with one of these items in hand and the rehearsal can lead to greater success and less prompting once you are at the playground.

Another programmatic shift that happens for me during the summer is to take time to help the child see the bigger picture.  Many children diagnosed with an autistic spectrum disorder understand the parts of things but may have difficulty conceptualizing ‘the whole’.  For example, if the child is showing an interest in airplanes take some time before heading out to expand on this interest.  I like to sit down with a child and draw out what I call a “Play Map.”  It is a flow chart of all of the things connected to an airplane, drawing arrows to show how all of the parts connect together.   This is a great way to flesh out a larger play schema and rehearse possible play scenarios other children might generate at the playground in relation to the toy airplane.  All of this preparation will ultimately lead to better outcomes at the playground and more fun had by all!