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A Review of Promoting Functional Communication Within the Home

This month’s ASAT feature is a review of Promoting Functional Communication Within The Home ( Bondy, A., Horton, C. & Frost, L.) by Kaitlyn Evoy, BA, and  David Celiberti, PhD, BCBA-D. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

The ongoing COVID-19 pandemic has created an abrupt and enduring disruption to the educational programs of countless children with autism spectrum disorders (ASD) and with little preparation, placed parents in a primary instructional role. For any number of circumstances, such as outbreaks in their communities, parents are often required to assume or resume this role. We applaud Andy Bondy, Catherine Horton, and Lori Frost for writing this comprehensive and useful article at a time when so many were struggling with creating meaningful experiences for our learners and their families. To put the authors’ swift effort in perspective, their article was published online on May 12, 2020 and was accessible in PDF form at no cost to the reader. The authors purposefully used language to promote understanding by all readers by removing unnecessary jargon, using abundant practical examples, and explaining complex concepts in accessible ways.

These authors highlight nine critical communication skills as a response to the COVID-19 crisis and the subsequent increased time children were/are spending at home. These critical communication skills encompass both speaker and listener roles and were highlighted because of their relevance and necessity for everyday functioning.  Furthermore, helping children to use these skills reliably and competently may lessen frustration and reduce or eliminate the need to engage in other ways to get those needs met (e.g., challenging behaviors).

The authors describe and elaborate upon each of the nine skill areas. The summaries include the rationale for prioritizing that skill, useful teaching strategies, commonly faced problems, and possible solutions. The article reviews the process for assessing current performance levels for the nine skills and offers tips to caregivers through this effort. For assessment of present levels, a checklist is provided with specific examples of phrases and/or subcategories. For example, the authors separated “request reinforcers” into edibles, toys, and activities. The skill of responding to directions is broken down into the two distinct areas of visual and oral directions. Authors elaborate on these two areas and provide examples for each (i.e., “come here,” “stop,” and “sit down” for oral directions). The tips given to parents and other caregivers include prioritizing activities and routines that are of the highest need for an increase in functional communication and using these core areas as a basis for overall instruction. In short, the authors emphasize targeting most immediate needs as a means to improve overall communication skills.

Nine Critical Communication Skills

  1. Requesting Reinforcers: We wholeheartedly agree with the authors that the skill of requesting reinforcers is of paramount importance. The authors suggest that parents should start with discerning what is reinforcing for a child before working on this skill. Rather than conducting preference assessments finding one item or activity on its own, the authors recommend trying combinations of items to create more motivating rewards. They also recommend re-creating situations as needed, setting realistic goals, raising expectations carefully, and using different levels of motivating reinforcers in an intentional and strategic manner. For instance, if the task is routine and not challenging, the reinforcer should not be the most highly motivating one.
  2. Requesting Help/Assistance: The authors aptly note that this skill is one that all children and adults will need in their lives. They recommend increasing levels of difficulty over time to promote mastery. Start with tasks which are easier to solve. When the child can ask for help in less challenging situations, increase the level of difficulty. It is important to gauge their frustration levels and be willing to decrease the demand when warranted. As stated above, the authors remind readers to re-create situations to create clean learning opportunities rather than address them amidst a challenging behavior.
  3. Requesting a Break: Asking for a break when overwhelmed or tired is another critically important skill for all of us, and we appreciate the authors inclusion of this skill. When working on newer, challenging skills with your child, it is essential that they can ask for a break when needed. This can decrease physically aggressive behavior, self-injurious behavior, and other problematic behaviors. The authors recommend that parents should work on this skill before frustrations reach crisis levels. Once you have an understanding (baseline) of tasks/work time your children can consistently do without needing a break, you can slowly increase the number of tasks and/or work time. Perhaps one of the most important points that the authors raise with respect to break requests is that parents should not rely on their hunches as to when a break is needed and provide one in the absence of a direct request, but rather give children the tools to request a break themselves on their own terms.  In addition to the suggestions offered by the authors, we would recommend working towards a more elaborate response (“I need a break. I am tired.” or “Can we stop? My stomach hurts.”).
  4. RejectingWe agree that learning to reject appropriately is an essential skill and can be critical in decreasing maladaptive behaviors. Being able to reject, refuse, or withdraw consent is another important skill that will be needed throughout one’s life. If children are not able to reject situations, activities, or items, this can lead to frustration and challenging behavior. The most important thing to remember when teaching this skill, is to always honor their rejection.  Furthermore, new skills such as this require abundant and consistent reinforcement. As with the teaching of other communication skills, caregivers can increase the difficulty by including situations, activities, or items that have a higher chance or severity of dislike.
  5. Affirming/Accepting: As with rejection, affirmation is a communication skill needed for everyday life. The authors were right to include this in this resource. Answering “yes” is also an important communication skill. This is especially true when options are difficult to show or when situations arise that a caregiver can’t prepare for ahead of time. When teaching children to differentiate between “no” and “yes,” try teaching them separately before giving them both as options.
  6. Responding to “Wait” or “No”: This is particularly relevant during the pandemic given that many preferred activities may be less available during times of social distancing. We commend the authors for including this challenging, yet inevitable skill in their article and for making the important distinction between learning to accept delayed versus denied gratification. Learning to wait is a challenging skill, particularly when the duration of time needed to wait is not clear. Although difficult, waiting and accepting an unwanted answer are important skills in situations that children will often encounter. This skill can be difficult for caregivers to increase complexity.  The authors recommend predicting negative responses, coping with them, and being willing to reset the challenge. The authors also highlight three essential elements to consider, and we refer the reader to the article to learn more.
  7. Following Directions: In addition to the obvious benefits of being able to follow directions, there are also possible risks when children cannot follow directions, especially in safety situations. To promote skill acquisition, the authors recommend starting with tasks that are more desirable for the child (e.g., accessing a favored item).
  8. Following a Schedule: Although the above skills involve the expression of communication, following a schedule is necessary and can be an essential tool for creating a predictable environment, as well as for learning to tolerate changes in those schedules. Visuals help children anticipate expectations and learn independence. The authors also discuss how schedules can vary in terms of the number of tasks/activities as well as descriptive factors. For example, scheduled items can be represented by physical objects, pictures, or words. Once children are able to follow a schedule, parents can introduce planned changes (the authors refer to this as a “surprise”) in order to increase tolerance of unexpected changes that naturally occur.
  9. Transitions: We appreciate the decision to discuss transitioning as an essential functional communication skill. Transitioning between activities and coping with unexpected transitions can be particularly challenging for children with autism. Parents can prepare children for transitions, but not all changes can be predicted. Like many of the skills noted above, frequent practice is needed. The authors suggest that parents showcase upcoming reinforcers as a way to promote successful transitions across activities. This recommendation may be a helpful strategy for many families particularly when the next activity is not inherently rewarding.

Final Thoughts

Parents and other caregivers need support, guidance, and accessible information in providing instruction to their children in the home environment. The COVID-19 crisis disrupted children’s lives, including therapies targeting functional communication. This comprehensive, useful, and easily accessible article aids in breaking down the main areas of functional communication and actionable steps for caregivers to take to work on each of these areas. Although beyond the scope of this brief article, we would also like to draw attention to a few other skills such as initiating and responding to greetings; and expressing feelings, discomfort, fatigue, and sickness.

As a resource, this very accessible article is valuable to other stakeholders besides the target audience of caregivers. Teachers, therapists, and other educational staff can use these critical functional communication skills to assess current overall functioning and target areas for improvement.  Now that onsite service delivery has resumed, the advice given to caregivers throughout Bondy, Horton, and Frost’s article bears much relevance for education and other therapies in the school environment.

Citation for this article:

Evoy, K., & Celiberti, D. (2022). Review of Promoting functional communication within the homeScience in Autism Treatment, 19(1).

About The Authors

Kaitlyn Evoy, BA is a special education teacher with a Bachelor’s degree in Special Education, and she holds a Learning Behavior Specialist-1 Certification in Illinois. She obtained her Bachelor’s degree from Lewis University in 2014, and she is currently studying Autism and Other Pervasive Developmental Disorders at Johns Hopkins University. Kaitlyn is drawn towards the study of evidence-based practices and their execution in classroom environments. She is an Extern at the Association of Science in Autism Treatment focusing on dissemination to teachers and other educational support staff. 

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

 

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Working on the Front Lines of Autism Care

 

By: Stephanie Tafone, M.A., P.D., Behavior Intervention Specialist at Eden II Programs 

Working on the front lines of Autism care in a residential facility is both rewarding and, at times, challenging. Although our residents depend on us in many ways to teach them how to complete day-to-day tasks, it is important for all staff to recognize and respect that our residents each have their own preferences and interests. Therefore, we always strive to let our residents make as many choices as possible (provided they are healthy choices that do not cause harm to anyone). Just because we as staff might complete a particular task a certain way does not mean it is the “right” or only way to do so. Recognizing and respecting residents’ choices can help avoid negative behaviors or frustration for our residents. Our goal is always to teach and foster independence and self-direction. 

It is always important to build good rapport with our residents so we are in tune with their wants and needs, while also enabling them to better trust us, work with us, and learn from us. Unfortunately, with current staffing crises and funding cuts in residential care settings, one challenge we face is securing long-term, seasoned staff. This type of setting often suffers from a high turnover rate, which this is a matter that needs more global attention, as hardworking, dedicated, and experienced/trained staff are crucial for our population. 

One of the biggest considerations we have on a daily basis, particularly during the global COVID-19 pandemic, is finding creative and entertaining recreational and leisure activities to keep our residents happy and actively engaged. Anyone can become restless and bored with nothing to do, and those with Autism are no different, which is why active engagement is one of our top priorities in a group home setting. When selecting activities, we strive to ensure that each resident’s preferences are considered and incorporated. This includes a combination of both community outings and in-house events/activities. Going into the community on outings can be challenging at times when unpredictable factors (e.g. noise, crowds, etc.) may trigger negative behaviors. However, we do our best to avoid triggering situations by researching and/or visiting the activity or location before our residents experience it in order to help determine if there are any barriers that will prevent it from being an enjoyable and successful outing for all. We also do our best to go prepared on each community outing with preferred items that can be used as a source of redirection and comfort if needed. For example, headphones to drown out noise if it gets too noisy, as well as preferred snacks or drinks if our residents get hungry or thirsty. In the residence, we also strive to think of creative leisure activities, such as dance or karaoke parties, Bingo nights, movie nights, baking, and arts and crafts. Having an enthusiastic and supportive approach, as well as using preferred reinforcers, helps to engage our residents in these activities and increase their interest level. 

In addition to recreational and leisure activities for entertainment and socialization, day-to-day life in the residence is also a learning experience for our residents, as they work on a variety of individualized goals with their assigned staff. Examples of goals may include activities such as participating in a consistent exercise regimen, learning how to independently cook rice or make tea, learning how to independently count money and make purchases, and learning how to independently vacuum or clean one’s room. The selection of a participant’s goals is a collaborative process that involves input from parents/caregivers, input from the participant(s) if possible, and input from the management team at the residence. We strive to ensure that selected goals not only address a skill deficit, but are also aligned with the participant’s interests and will help the participant become more independent in daily living skills. Similarly, participants learn increased independence by participating in various chores around the house, such as setting the table for lunch and dinner, loading and emptying the dishwasher, and doing one’s laundry. Teaching many of these goals and chores can be accomplished through the use of a visual task analysis that breaks the task down into smaller components (i.e. individual steps), which are each depicted in visual images. Visuals are a very helpful teaching technique for those with Autism, who often struggle significantly with understanding verbal language and oral directions. It is also helpful for learning, especially in the initial stages, to use a preferred reinforcer to reward correct completion of steps. In the beginning of learning a new goal or chore, one step may need to be taught for a number of consecutive days until it is mastered and the next step can be taught. 

Overall, working in a residential setting has been a great learning experience and we know that our work has had, and continues to have, a significant influence on our residents’ lives, which is very rewarding for all staff. 

About the Author: 

Stephanie Tafone, M.A., P.D. earned her B.A. in Psychology from St. John's University before going on to earn her M.A. and Professional Diploma in School Psychology from Kean University. She is currently in the process of completing the requirements to obtain an Advanced Certificate in Applied Behavior Analysis as she pursues national certification. For the past ten years, she has been working with both children and adults with disabilities. She currently works as a behavior intervention specialist at a residential facility serving adults who have been diagnosed with Autism Spectrum Disorder. She also works as a school psychologist serving children with various diagnoses and disabilities, as well as an adjunct professor for courses pertaining to Applied Behavior Analysis, Autism, and Intellectual Disability. 

 

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"This Is Hard"

"This is hard" is a statement I often hear from families both in the midst of intervention, and pre-intervention during the assessment phase.

Families without support and services find it hard helping their Autistic child navigate the world, and families in the midst of therapies and interventions find generalizing them to be hard.

It's hard to consistently generalize an intervention plan outside in the home, on the weekends, on Sunday at the grocery store, on vacation at Grandma's house, or at 6am on a Saturday when your child only slept 2 hours.

But its also hard to supervise/monitor your child 24-7, to break up sibling fights all day long because your child can't share, to find quality childcare options when your child is highly aggressive, or to figure out if your child is ill or sick when they can't tell you.

Both are hard.

It is rarely a discussion of hard vs easy, and much more common is a decision regarding which "hard" is acceptable. Yes, toilet training is hard work. On the flip side, changing an 8 year-olds diaper isn't exactly easy. Nor is it easy to afford to buy diapers for that many years.

Yes, teaching your child to use utensils instead of eating with their hands is hard. On the flip side, restricted diet and issues around mealtimes can be made worse if the child will only eat finger foods (typically, starches and carbs). That is also hard.

Yes, it is hard to consistently follow a Behavior Plan when in public with your child. On the flip side, being asked to leave locations, having friends ask that you not visit, or being scared someone will call the police on your child during a public outburst, is a hard reality to live out.

You have to decide which "hard" to accept.

I intentionally use the phrase "intervention plan" and not "ABA therapy", because maybe your child isn't receiving ABA services. Maybe you don't want that, or can't access it.

But are they receiving Speech services? OT? PT? In special education at school? Attending an Autism preschool program?

If so, these are all interventions designed to minimize developmental delays and target current deficits.

Whatever kind of intervention your child participates in, there are a few components that tend to be the same across different therapies:

 

1. Consistency. In order to be effective, the intervention must be applied consistently. Frequent staff turnover, frequently canceling appointments, or other issues like this can negatively impact results.

2. Training must carry over to the home setting/caregivers. There is no way to generalize the intervention if you have no idea what it is.

3. Caregiver Participation. In order for #2 to happen, the caregivers must be willing and available to participate in the intervention/treatment plan.

4. Focus on progress vs miracles. Progress can be slow, it can be up and down, and at times it can mean treading water. Sometimes an absence of regression IS progress. If you have sky high expectations of the intervention process, this can cause "provider hopping" where families move from one agency, provider, or intervention to the next looking for magic. That just is not how quality, ethical treatment works.

5. Individualized Intervention. It doesn't matter if your child receives 30 minutes of Speech each week, or 15 hours of ABA. Are the treatment goals and the teaching methodology suitable and appropriate for your child? "Cookie-cutter" intervention is when treatment is applied in a lazy, vague, and generic way across multiple clients. In order for intervention to be effective, it must meet your child where they are and incorporate their unique interests and motivation(s).

About The Author: Tameika Meadows, BCBA

“I’ve been providing ABA therapy services to young children with Autism since early 2003. My career in ABA began when I stumbled upon a flyer on my college campus for what I assumed was a babysitting job. The job turned out to be an entry level ABA therapy position working with an adorable little boy with Autism. This would prove to be the unplanned beginning of a passionate career for me.

From those early days in the field, I am now an author, blogger, Consultant/Supervisor, and I regularly lead intensive training sessions for ABA staff and parents. If you are interested in my consultation services, or just have questions about the blog: contact me here.”

This piece originally appeared at www.iloveaba.com

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A Parent's Guide to ABA Facilities

When a child first gets diagnosed with Autism, parents are often overwhelmed. A good doctor will give a prescription for ABA therapy as well as other necessary therapies such as Speech, OT,  PT, Feeding, etc. However, of those therapies, the one that is usually not familiar is ABA. A simple Google search or, even worse, joining a Facebook group is going to lead a parent down a path full of controversy, fear mongering, and misinformation. This will often leave parents very leery of any ABA facility they meet with, or completely turned off from the best medically-proved therapy for young Autistic children.

So I created a list of questions for parents to ask potential ABA facilities to find the best match for their family. After all, they’re entrusting you with their child for hours upon hours. The child is often non-verbal and unable to tell you how their day was. So a parent must trust the facility completely. In writing this list for autism behavior centers, I also kept in mind the warnings/worries of abuse touted by certain internet groups, in hopes to appease them should they come across this list. Parents can use this list in their ABA search and clinics can have this list on hand for parents, and their potential answers ready.

1) Do you force eye contact or stop unharmful stims? This is one of the top citations of “abuse” from certain internet groups. Some parents don’t want to force eye contact and view their child’s non-harmful, non-disruptive stims as a beautiful part of their personality.

 

2) How do you avoid meltdowns? Knowing that you are going to avoid meltdowns will help parents feel far more comfortable about sending their child.

 

3) Do you ever withhold food? Even neurotypical kids are picky. Us “Autism Parents” are usually self-conscious about the fact that our kids survive on pretzels and Pediasure. Telling a child “No chicken nuggets until you’ve finished your green beans” will probably mean a hungry child, and an unhappy parent.

 

4) How do you handle naps? With the diagnostic age of Autism getting increasingly lower, children are starting ABA before they are ready to phase out of naps. Having a plan in place for nap time will make a parent know their child is getting their needs met.

 

5) What are your parent training session requirements? ABA is a fantastic therapy, but without the parents upholding it at home, it’s pretty hard to fully instill the methodology and give the child all the help they deserve Parent training lets parents feel more involved in their child’s therapy which is essential!

 

6) What are the requirements of your staff? Parents researching ABA facilities are shocked to hear you only need a high school diploma to be an RBT. If you have a higher standard for your staff of any sort, parents will feel more comfortable sending their children to your facility.

 

7) What will my child’s daily schedule look like? Knowing what a child does throughout the day helps a parent make the decision for what works best for their child.

 

8) How do you incorporate academics? Many parents are choosing between ABA and Preschool. Being able to tell parents your ABA facilitates some sort of Academics (We focus on writing, the alphabet, etc) will make the decision far easier!

 

9) How do you prevent harmful stims? Parents recoil at the thought of their child being restrained. What are your rules around touching kids? How do you keep our child from harming themselves, or anyone else?

 

10) How do you communicate with me? My child can’t tell me about his day. So I need his therapists to do so. What are you doing to tell me about his day? What he ate? Did he name? Diaper changes? Injuries? The more communication, the better!

 

This list for ABA facilities isn’t comprehensive. It won’t work for every facility. However, these are the questions I have found most parents want the answers to in order to find the best facility for their kids. And to feel they aren’t sending their children to an “abusive” environment.

 

About the Author:

Cassie Hauschildt is the mother of her Autistic son, Percival, who was diagnosed at 20 months old. Since his diagnosis, she has become an advocate for autistic children. She dedicates her time to mentoring parents of autistic kids through the tough first few months post-diagnosis. She also is trying to get rid of the negativity surrounding ABA therapy. She does this through humor, while using real talk, on her TikTok @AnotherAutismMom. She also runs “The Dino and Nuggets Corner” Facebook Group.

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Picky or Problem?

Its common, its common, its common.

That is the first thing that needs to be said to any caregiver who ended up here while researching "picky eater" + Autism. You are not the only one experiencing this.

Autistic individuals (because this is not just an issue for children) exhibit higher rates of food refusal, and a more limited food repertoire, when compared to typically developing individuals (Bandini et al, 2010).

Examples? Sure.

Across my clients, I regularly see issues with:

Rigidity around meals (where to sit at the table, what plate to eat off, which spoon to use, must have the tablet in order to eat)

Food refusal challenging behavior (throwing plates, flinging cups to the floor, spitting food out, tantrums, pouring liquids out onto the floor)

Highly selective food intake (daily diet consists of less than 10 foods, likes chicken nuggets but only from a specific fast food place, will only take specific liquid from a specific sippy cup or bottle)

To define the term, a picky eater can be described as regularly refusing foods, or consistently only eating the same foods with little to no variation permitted.

Many parents of toddlers deal with a picky eating phase at some point or another, and often the child outgrows it.

So, what is the critical determining factor when it comes to Autism that tips the scale from someone who is just "picky" to a serious health problem and concern? Usually, it is a combination of variables that must be examined and weighed:

How old is the individual? If out of the toddler phase, how frequently is this issue happening (weekly? daily? or only at holiday meals?)

Does food refusal occur with challenging or aggressive behavior?

Is this impacting school/daycare, or the ability to go into community locations?

Will the individual skip several consecutive meals (refuse to eat across more than one day)?

Is this impacting the individual's weight, organs, toileting/digestion, skin, hair, or nutrition? Is your doctor concerned?

The key factor for seeking out intervention for this issue is when the food selectivity is causing harm to the individual. When any specific behavior impacts the health/body of the person exhibiting it, that is clinically referred to as a "self-injurious" behavior. Self-injurious behaviors should not be ignored, and often require intervention and treatment.

So what to do? 

 It may be helpful to reframe the way we view picky eaters. Sometimes families can view this behavior as their child willfully choosing to make meals a dreadful adventure. Choosing to be difficult and fling plates across the room in order to cause chaos. However, challenging behaviors often occur for complex or multifaceted reasons. Some Autistics use the term "sensory eater" and not "picky eater" to describe this issue, and explain it like this:  

"Picky eaters don’t like a variety of foods, much like the sensory eater. However, when picky eaters try new foods, it doesn’t cause a sensory overload....There is a sensitivity to textures, where children can only handle one texture, such as smooth, pureed foods. In this case, they might be able to eat yogurt, however, hand them a bag of chips or a slice of turkey and they immediately begin to gag" (www.researchautism.org).

If a specific food texture, smell, sight, or tactile experience is causing significant distress, if there are tooth or gum issues making eating painful or uncomfortable, if the individual has trouble swallowing, or if unknown allergies are present, making digestion painful or uncomfortable, doesn't it make sense for the individual to refuse a food (or eventually, any food that looks like THAT food) or exhibit excessive selectivity? Now, imagine the individual has no means to communicate how food makes them feel. Doesn't it make sense that they may cry, spit, hit or punch, or fling a plate onto the floor? 

When seeking out Feeding Intervention (which is a clinical specialty), it is important to first obtain medical rule out. This means first speaking with your doctor to discuss the issue, and see if the individual's health has been impacted. The doctor may also be able to make a referral to a qualified specialist.

Not every professional will be trained in feeding interventions, so this isn't as simple as just asking the current therapist to also target feeding. I see families do that a lot, without also asking about the therapist's qualifications to address this issue. 

It probably doesn't need to be said, but feeding challenges can have serious health complications and you don't want to gamble on unproven treatments, untrained professionals, or questionable practices. Not only could they harm your child, they could worsen/ingrain the problem even further.

SLPs, BCBAs, OTs, Healthcare professionals, and Multi-Disciplinary clinics or facilities, can all incorporate feeding intervention into therapy goals. The Children's Healthcare of Atlanta recommends the following step-by-step process for initiating feeding intervention/feeding therapy:

  • Medical Screening
  • Behavioral Evaluation
  • Nutrition Assessment
  • Oral-Motor Skills Assessment

Remember, before seeking out therapy or treatment talk to your doctor first. Also, any feeding intervention that occurs on-site will need a caregiver training portion where the parents are taught how to implement the procedure at home/in the community.

 

About The Author: Tameika Meadows, BCBA

“I’ve been providing ABA therapy services to young children with Autism since early 2003. My career in ABA began when I stumbled upon a flyer on my college campus for what I assumed was a babysitting job. The job turned out to be an entry level ABA therapy position working with an adorable little boy with Autism. This would prove to be the unplanned beginning of a passionate career for me.

From those early days in the field, I am now an author, blogger, Consultant/Supervisor, and I regularly lead intensive training sessions for ABA staff and parents. If you are interested in my consultation services, or just have questions about the blog: contact me here.”

 

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When should a functional analysis be done and who should do it?

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

I am the parent of a student with autism who has developed some challenging behavior at school and the team has suggested a more formal assessment. What is meant by “functional analysis?” When should this be done and who should do it?

Answered by Robert LaRue, PhD, BCBA-D
Douglass Developmental Disabilities Center and Rutgers Center for Adult Autism Services

Prior to a discussion about functional analysis, it is important to make the distinction between functional analysis and functional assessment. Functional assessment represents a variety of techniques and strategies used to gather information about the cause (or “function”) of challenging behavior. This information is used to maximize the effectiveness and efficiency of behavioral support. There are three broad categories of functional assessment. One category involves talking to caregivers (e.g., parents, teachers) about why problem behavior occurs (i.e., interviews and rating scales). The second type is referred to as descriptive assessment, which involves observing behavior and collecting data regarding the events that precede problem behavior (antecedents) and the events that follow problem behavior (consequences). The third type of functional assessment is functional analysis, which is a more thorough assessment procedure described in more detail below.

What is a Functional Analysis?

A functional analysis (FA) is a specific type of functional assessment that involves the direct manipulation of antecedents and/or consequences to identify why problem behavior occurs (Iwata et al., 1982/1994). In other words, a practitioner conducting an FA directly tests the hypothesis in an experimental manner, rather than waiting for the behavior to occur naturally. For example, if a practitioner wanted to see if problem behavior was maintained by attention from others, they might withhold attention for a brief period of time (e.g., acting distracted) and then provide it if and when problem behavior occurs. As with other forms of functional assessment, the purpose of an FA is to identify why problem behavior occurs. What distinguishes FA from other forms of functional assessment is that FAs involve making deliberate, short-term, and systematic changes to the environment to evaluate the effects of different conditions on the target behavior(s).

In an FA, a practitioner arranges “conditions” that are common in the natural environment (e.g., a teacher presenting non-preferred work tasks, a distracted teacher or parent not attending to a child). While there are many ways to individualize FA conditions, there are four or five conditions that are typically run as part of the assessment.

  • Social Attention: The attention condition is a test to determine if problem behavior occurs to access social attention from others. In this condition, attention is typically withheld (e.g., a therapist acts distracted) and is provided following target behavior for a brief period of time (e.g., 20-30 seconds). This might take the form of a reprimand (e.g., “Stop doing that!”) or soothing comments (e.g., “It’s going to be ok.”). If the individual engages in high rates of inappropriate behavior in this condition as compared to the control condition, it indicates that social attention functions as reinforcement for maladaptive behavior.
  • Tangible: The tangible condition is another test to determine if problem behavior is maintained by access to preferred items or activities. In this condition, access to preferred items is typically withheld (e.g., a toy is removed) and is provided following target behavior. If the individual engages in high rates of inappropriate behavior in this condition, it indicates that problem behavior occurs to access preferred items.
  • Escape: The escape condition is a test to determine if problem behavior occurs to escape demands. In this condition, a nonpreferred activity is typically presented (e.g., school work) and a break (escape) is provided following target behavior for a brief period of time (e.g., 20-30 seconds). If the individual engages in high rates of inappropriate behavior in this condition, it indicates that escape is a reinforcer for maladaptive behavior.
  • Alone or Ignore: The alone or ignore condition is a test for to determine if problem behavior occurs for nonsocial reasons. In other words, the behavior (e.g., hand flapping, repeating words or phrases) is likely to occur when they are by themselves. In this condition, the individual is usually left alone for some period of time to see if the behavior persists when no one else is present. If the behavior persists while no one else is present, it suggests that they are not engaging in the behavior for social reasons. This is sometimes referred to as “automatic reinforcement”. In cases where the behavior is potentially dangerous, or if the individual cannot be left alone, an ignore condition can be implemented where the therapist remains in the room, but does not interact.
  • Control: The control (or toy play) condition serves as the comparison for all of the other conditions. In this condition, the individual has free access to social attention, preferred items/activities, and no demands are present. As such, there is usually very little motivation to engage in problem behavior.

When conducting a traditional FA, each of these conditions are usually conducted at least three to five times, with each session lasting 5 to 15 minutes. Sessions are typically alternated until a clear pattern emerges.

FAs represent the most sophisticated and empirically-supported functional assessment procedures. There are hundreds of studies validating the use of FAs for identifying the function of problem behavior (for a review, see Beavers et al., 2013). In addition, interventions that are based on the results of FAs have consistently been shown to be more effective than those that are not (e.g., Carr & Durand, 1985). In recent years, FA procedures have evolved to become more manageable in educational settings, with modifications that provide results in less time and fewer instances of challenging behavior (e.g., Bloom et al., 2011, Hanley et al., 2014; LaRue et al, 2010; Northup et al., 1991; Smith & Churchill, 2002; Thomasson-Sassi, et al., 2011).

When Should an FA be Conducted?

From a clinical standpoint, functional assessments should be conducted when the student‘s behavior interferes with their own learning or the learning of others, presents a danger to self or others, or the behavior results in suspension or interim placement in an alternative setting approaching 10 total days. FA is a specific procedure for conducting these functional assessments. There are no specific guidelines for when practitioners should use functional analyses rather than other types of assessment. Typically, the use of FA procedures is determined by the skill level of the practitioner, the resources available to the practitioner, and the setting itself.

Who Should Conduct an FA?

Conducting FAs does require a high level of expertise to be done effectively. FAs should be conducted by individuals with experience using the procedures (or while supervised by someone with experience). Many (though not all) people who have board certification in behavior analysis (BCBA) have experience conducting FAs. Consumers should ask practitioners about their level of experience and comfort prior to starting these analyses.

Summary

Functional assessments are an essential tool for identifying why problem behavior occurs. Functional analysis is a specific type of functional assessment that is incredibly effective for this purpose. In fact, hundreds of studies have shown FAs to be effective for identifying why problem behavior occurs. In recent decades, user-friendly ways to conduct FAs have emerged, which has made their use more common in educational settings. Most BCBAs should have training to implement FAs safely and efficiently. The use of these procedures can lead to effective, function-based treatments that improve outcomes for children and adults who have behavioral difficulties.

Citations:

Beavers, G. A., Iwata, B. A., & Lerman, D. C. (2013). Thirty years of research on the functional analysis of problem behavior. Journal of Applied Behavior Analysis, 46(1), 1-21.

Bloom, S. E, Iwata, B. A, Fritz, J. N, Roscoe, E. M., & Carreau, A. B. (2011). Classroom application of a trial-based functional analysis. Journal of Applied Behavior Analysis, 44, 19-31.

Carr, E. G., & Durand V. M. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18, 111-126.

Hanley, G. P., Jin, C. S., Vanselow, N. R., & Hanratty, L. A. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments. Journal of Applied Behavior Analysis, 47, 16-36.

Iwata, B. A., Dorsey M. F., Slifer K. J., Bauman K. E., & Richman, G. S. (1982/1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27(2), 197-209.

LaRue, R. H., Lenard, K., Weiss, M. J., Bamond, M., Palmieri, M., & Kelley, M. E. (2010). Comparison of traditional and trial-based methodologies for conducting functional analyses. Research in Developmental Disabilities, 31, 480-487.

Northup, J., Wacker, D., Sasso, G., Steege, M., Cigrand, K., Cook, J., & DeRaad, A. (1991). A brief functional analysis of aggressive and alternative behavior in an outclinic setting. Journal of Applied Behavior Analysis, 24(3), 509-22.

Smith, R. G., & Churchill, R. M. (2002). Identification of environmental determinants of behavior disorders through functional analysis of precursor behaviors. Journal of Applied Behavior Analysis35(2), 125-136.

Thomason-Sassi, J. L., Iwata, B. A., Neidert, P. L., & Roscoe, E. M. (2011). Response latency as an index of response strength during functional analyses of problem behavior. Journal of Applied Behavior Analysis, 44(1), 51-67.

Citation for this article:

LaRue, R. (2021). Clinical Corner: When should a functional analysis be done and who should do it? Science in Autism Treatment, 18(12).

About the Author

Robert H. LaRue, Ph.D., BCBA-D is a Clinical Professor at the Graduate School of Applied and Professional Psychology (GSAPP) at Rutgers University. He earned a dual doctorate in biological and school psychology from Louisiana State University in 2002. He completed his predoctoral internship with the Kennedy Krieger Institute at Johns Hopkins University and a postdoctoral fellowship with the Marcus Institute (now the Marcus Autism Center) at Emory University. He currently serves as the Director of Behavioral Services at the Douglass Developmental Disabilities Center (DDDC) and the Rutgers Center for Adult Autism Services (RCAAS), where provides consultative support for students and staff providing intensive behavioral services to students and adults within the Centers. His research interests include the assessment and treatment of maladaptive behavior, improving transitional outcomes for adolescents and adults with ASD, the use of behavioral economics in intervention, and the evaluation of psychotropic medications used with at-risk populations. He has authored articles in peer-reviewed journals, written several book chapters, and presented at national and international conferences.

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Whose behavior needed to be fixed? The kids’ or the parents’??

At a recent family meeting, I had put an item on the agenda- listening to mom and dad so we don’t have to repeat ourselves. In the past week, I had noticed that I was having to say things many more items than usual and my husband and I had both raised our voice more often. So I brought this up in a problem solving format with all 4 of us- two kids, my husband, and myself. Everyone was given a chance to propose solutions- no matter how off the wall.
I expected the conversation about listening better to go one of two ways when the kids are allowed to make the call: either all about earning rewards, or about getting trouble. One extreme or the other. But I sat quietly and let my little ones (ages 7 and 4) have the floor and share what they thought would fix this issue we were having. Things started to go down the punishment lane- maybe we should lose allowance when we don’t listen- and I shut that down. I told them that allowance is not tied to their behavior and we wouldn’t be making changes to our allowance system. Then things got interesting. My FOUR year old shared that her pre-kindergarten teacher would say “1, 2, 3, eyes on me” and then the kids would listen to her. So my littlest suggested a change to MY behavior to fix the problem. So the 7 year jumps in and says “Remember how you used to do silly poses to get our attention? Maybe you can do that again.” Again - they wanted to change the PARENTS’ behavior, not their own. I was all in on this train of thought. I suggested I use things I used to do consistently when we were in full on virtual school mode- clapping patterns, hand gestures, silly voices- to get their attention before asking them to do something. That way they are actually listening the first time and we won’t have to repeat ourselves. As a family, we agreed the solution to the problem of the kids not listening was to make a change to Mom & Dad’s behavior- we would do something to make sure we had their attention FIRST and then tell them whatever we needed them to hear.
This is not a new and noteworthy idea. But it is a good idea! I’ve even written about it before here: https://www.parentingwithaba.org/get-my-kids-to-listen-part-1/. Here’s an excerpt from that to help you (and me) remember: Get their attention first. We have to interrupt whatever is currently going on- and somehow win that battle for attention from something they prefer more than listening to mom giving instructions. I mean, what could be more fun than listening to mom giving instructions? Oh- everything? I see.

 

  • Be silly. Interrupt with silliness. Make silly faces, silly poses, or use different voices. Get their attention AND a smile on their face before you even start to give instructions.
  • Start with a joke, then give the instructions.
  • Say something absurd. Instead of “Go wash your hands” try “Go wash your earlobes”. Let your kids correct you- now they have said the instructions themselves! “Oh silly me. Wash your hands, not your earlobes!”
By letting the kids help come up with this solution, they’ve been all in. If we do anything to get their attention first, they freeze and make big eyes and stare at us. It’s a little overboard with the dramatics, which I find hilarious and awesome. And when I forget, they will say “1, 2, 3, eyes on me” to me as a reminder. So far things are better in my house with no major reward system, no punishments or loss of allowance, no big drama. We just needed to talk through a problem and whose behavior needed a change? Not the kids. It was the parents’ behavior that was changed this time (and most of the time if we’re honest with ourselves here). What things to do you use to get your kids’ attention? What works for you?

 

 

Leanne Page, MEd, BCBA, is the author of Parenting with Science: Behavior Analysis Saves Mom’s Sanity. As a Behavior Analyst and a mom of two little girls, she wanted to share behavior analysis with a population who could really use it- parents!

Leanne’s writing can be found in Parenting with Science and Parenting with ABA as well as a few other sites. She is a monthly contributor to bSci21.com, guest host for the Dr. Kim Live show, and has contributed to other websites as well.

Leanne has worked with children with disabilities for over 10 years. She earned both her Bachelor’s and Master’s degrees from Texas A&M University. She also completed ABA coursework through the University of North Texas before earning her BCBA certification in 2011. Leanne has worked as a special educator of both elementary and high school self-contained, inclusion, general education, and resource settings.

Leanne also has managed a center providing ABA services to children in 1:1 and small group settings. She has extensive experience in school and teacher training, therapist training, parent training, and providing direct services to children and families in a center-based or in-home therapy setting.

Leanne is now located in Dallas, Texas and is available for: distance BCBA and BCaBA supervision, parent training, speaking opportunities, and consultation. She can be reached via Facebook or at Lpagebcba@gmail.com.

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Beyond Light Up Toys

There are many things that I would love to change about the treatment of individuals with Autism Spectrum Disorder. One of them is the notion that all kids with ASD are motivated by the same things. Certainly, some kids with autism love light up toys, squeezes, or music, but that’s true of the population at large. After all, I am mesmerized by Christmas lights, love a good head massage, and have songs I listen to on repeat.

The issue with the assumption that all kids with ASD are motivated by these small number of things is that it can lead to some very specific problems, such as practitioners trying out a smaller number of toys or activities with the child, practitioners depending solely on “sensory toys” for reinforcers instead of working to expand the number of reinforcers a child responds to, or the larger community making assumptions about the preferences of the child. Furthermore, there is evidence that the broader the range of reinforcers is for a child, the better the learning outcomes (Klintwall & Eikeseth, 2012.) Failing to think beyond the stereotypes about the interests of kids with ASD impedes their ability to learn and develop new skills.

The children I’ve worked with over the years have varied interests, ranging from dinosaurs and maps to bean bag toss and board games. And while some of the kids I work with love light up toys or trains, it’s important that we don’t take a whole swath of the population and decide that they all have similar interests. It doesn’t serve their skill development or our potential to develop real relationships with people with ASD.

As a practitioner, here are some important questions to ask yourself in relation to reinforcers and developing interests:

• Have you conducted a preference assessment? This should be one of the first things you do whenever you start a new case, and something you should continue to do informally.

• Have you talked to the client and/or the parents about what interests they would like to develop? If the client is able to discuss goals and interests with you, you should definitely be having that conversation with them. You should also talk to the parents about their goals. Perhaps they have seen some interest in one area that they would like to further develop. It’s also possible that there are specific family activities or traditions they would like their child to enjoy with the family.

• Have you read about this topic? A great place to start is Chapter 3 of the book A Work in Progress. It clearly explains how to use reinforcers and expand the reinforcer repertoire. There is also a ton of research out there about reinforcement. Take the time to search journals such as Journal of Applied Behavior Analysis and Journal of Developmental Disabilities.

Klintwall, L., & Eikeseth, S. (2012). Number and controllability of reinforcers as predictors of individual outcome for children with autism receiving early and intensive behavioral intervention: A preliminary study. Research in Autism Spectrum Disorders, 6(1), 493-499.


McEachin, J. & Leaf, R. B. (1999). A work in progress: Behavior management strategies and a curriculum for intensive behavioral treatment of autism. New York: DRL Books.

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

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Flashcards: Prompting for Success

My own introduction to prompting and fading

I was first introduced to the idea of prompting and fading when I co-ordinated a home based early learning program for my eldest son, Christopher, who is on the spectrum of autism. I soon came to appreciate how important these strategies were and are in supporting his learning. We are now into his teenage years and whilst the skills he is learning are far more complex compared with those early years, the use and importance of prompting and fading remains unchanged.

About prompting.

A prompt is a cue (or hint) given to a student to encourage them to learn a new skill. There is extensive evidence to support my own experience that prompting is a highly effective way of teaching. An example of this evidence is noted at the end of this article.

Flashcards and prompting

A lot of the work we did around prompting with Christopher in the early years of his life related to the use of flashcards. We used them to expand his vocabulary, articulate words clearly and put together sentences. We also used them to build his academic skills in literacy and numeracy and his capacity for problem solving.

The different types of prompts

There are five different types of prompts and we used all of them in our flashcard based activities. These prompts are ranked accordingly to the level of support they offer, with 1 being the most supportive and five the least.

  1. Full physical
    Example: I placed my hand over Christopher’s hand and guided him to place the flashcard he was holding over the associated one on the table - so the image of the sock was placed on top of the shoe, rather than on the image of the bed or the bowl
  2. Partial physical
    Example: I gently touched Christopher’s shoulder - to indicate it was time for him to respond to my request of naming the flashcard I was showing him.
  3. Modelling
    Example: I sorted the flashcards on the table into groups - animal, transport and instrument. I then shuffled the cards and asked Christopher to sort them in the same way
  4. Gestural
    Example: I nodded as he started to place the letter A next to the image of the apple. It provided him with the encouragement and confidence to continue with B and C.
  5. Positional
    Example: I placed two associated cards on the table next to one another so that Christopher could connect the two – so the picture of the fork was next to the picture of the person eating and the picture of the bed was next to the picture of the person sleeping

 

The goal is to select the type of prompt that is the least intrusive and results in the student providing the correct response. So, if a modelling prompt is not working then a partial or full physical prompt should be tried.

Why prompts need to be faded

Whilst prompts are a great teaching strategy, it is equally important that they be faded over time. You might ask why. The answer is so that the student doesn’t become dependent on the prompt. We were mindful of this in Christopher’s early learning program. There were instances where we started with a full hand over hand prompt. We then faded to a gestural prompt (by pointing at the flashcard) before omitting the prompt all together.

I like to think of prompting and fading as stepping stones on the way to independence with a new skill. Christopher and I have trod on those stones for a number of years now and going forward I know there will be more. I hope there will be more, As I’m so appreciative of the opportunities for learning they ultimately afford my son.

1 Hayes, D., (2013) The Use of Prompting as an Evidence Based Strategy to Support children with ASD in School Settings in New Zealand. ERIC 1-5

 

About The Author 

Kate is the owner of Picture My Picture, an international business which specializes in educational flashcards. She is the mother of three boys, Christopher, Louis and Tom. Christopher is on the spectrum of Autism. The flashcard based teaching program she oversaw in the early years of his life was the inspiration for the business she owns today. 

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ABA and Reinforcement

Reinforcement is the foundation of ABA. However, there is a lot of misunderstanding about how reinforcement strategies should be utilized in ABA sessions. Our goal with the new set of Practical ABA modules for maintaining RBT skills is to focus in on basic skills related to pairing and reinforcement.
The work of our Behavior Technicians is incredibly challenging. We are asking them to implement interventions, teach new skills, address challenging behaviors, and collect data. The emphasis on all of these tasks frequently takes over sessions, reducing appropriate and individualized implementation of reinforcement. This module includes details about the initial pairing process, pre-session pairing, increasing the reinforcer repertoire, conducting preference assessments, utilizing differential reinforcement strategies, and using schedules of reinforcement. 
We hope this resource makes it easier for supervisors to teach and maintain skills related to reinforcement. 
Sam Blanco, PhD, LBA, BCBA is an ABA provider for students ages 3-15 in NYC. Working in education for sixteen years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges, and she is the Senior Clinical Strategist at Chorus Software Solutions.
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Could Teaching Environments Affect Solving Problem Behaviors?

A few years ago, I went in to observe an ABA therapist I was supervising. The first thing I noticed when I walked in to observe was that she did her entire session at a long wooden table, sitting side-by-side with her student. She was working with a ten-year-old girl. One of her goals was to increase eye contact during conversation, but her student wasn’t making much progress in this area. She had consulted the research and was considering a new behavior intervention plan, and wanted my input before doing so. I wondered could teaching environments affect solving problem behaviors?

After watching for about ten minutes, I asked if we could change the seating arrangement. We moved her student to the end of the table, then had the therapist sit next to her, but on the perpendicular side. This way, eye contact was much easier as they were able to face each other. The student’s eye contact improved instantly with a small environmental change. (Of course, once we made the environmental change, we worked together to address other changes that could be made to encourage eye contact.)

Environmental changes can be a quick and simple solution to some problem behaviors. Here are some questions to consider in order to alter the environment effectively:

Is it possible that a change in furnishings could change the behavior?

For example, moving a child’s locker closer to the classroom door may decrease tardiness, putting a child’s desk in the furthest corner from the door may decrease opportunities for elopement, or giving your child a shorter chair that allows them to put their feet on the ground may decrease the amount of times they kick their sibling from across the table. You may also want to consider partitions that allow for personal space, clearly-marked spaces for organizing materials, proximity to students and distractions (such as windows or the hallway).

Can you add something to the environment to change the behavior?

For example, your student may be able to focus better on independent work if you provide noise-canceling headphones, line up correctly if a square for him/her to stand is taped to the floor, or your child may be more efficient with completing chores if they’re allowed to listen to their favorite music while doing so. I’ve also seen some cases in which the teacher wears a microphone that wirelessly links to a student’s headphones, increasing that student’s ability to attend to the teacher’s instruction.

Will decreasing access to materials impact the behavior? 

For example, removing visuals such as posters and student work may increase your student’s ability to attend or locking materials in a closet when not in use may decrease your student’s ability to destroy or damage materials.

Will increasing access to materials impact the behavior? 

For example, making a box of pre-sharpened pencils may decrease the behavior of getting up frequently to sharpen pencils. (I recently visited a classroom in which the teacher put pre-sharpened pencils in a straw dispenser on her desk, and each week one student was assigned the job of sharpening pencils at the end of the day).

Whenever you do make changes to the environment, you may want to consider if the changes require fading. 

For example, if I make a square on the floor out of tape to teach my student where to stand in the line, I will want to fade that out over time to increase their independence.

A final consideration is that whatever impact you expect the environmental change to have should be clearly defined and measured. Take data to ensure that the intervention is working so you can make adjustments as necessary.

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About The Author

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

 

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Teaching Independence

One of the most important goals of behavioral intervention is to increase independence.  Teachers, parents, and behavior analysts are almost always focused on teaching individuals how to do things or access what they need on their own, without support from others, and without prompt dependence.  Prompt dependence refers to the situation when a learner’s behavior is dependent on stimuli in addition to the teaching or natural environment events that would ideally control the occurrence and non-occurrence of behavior.  Of course, there are times when it is perfectly fine to rely on someone else for your wants and needs.  Most people are not trained in everything they might need to have done in their lives, so we rely on dentists for our dental care, mechanics for our car maintenance, and lawyers for legal advice.  We do, however, want to be able to brush and floss, drive our cars, know when we need appointments, make those appointments, and understand how to access expert solutions as needed - all independently.  Prompt dependence is a problem when it limits the person’s independence, if they find relying on others distressing, and/or if the needed supports are limited in availability. 

Here are some examples that might reflect problematic prompt dependence:

  • Your student looks at you for confirmation or correction before saying or writing an answer in academic tasks
  • If you don’t follow your child into the bathroom and narrate his actions, he may miss a step
  • You tell your student how to unpack their bag and hang up their coat every morning without waiting for them to do it on their own
  • Your client needs to be told to take a bite of her favorite food, or she will sit and wait or even cry because she is hungry - even if the food is easily reached

Prompt dependence can be avoided by starting from a good operational definition of the behavior to be taught or increased.  If the goal is independence, then that should be part of the way the behavior is defined.  In most cases, what we are looking to teach should be independent, not perfect.  Considering two of the examples above, students are not expected to get every answer correct in school, especially when doing work in school or at home on their own.  It would probably be preferable for the student to independently say or write a wrong answer, than to wait for prompting.  Similarly, although bathroom routines are important and should be done with accuracy most or all of the time, the person who relies on this level of prompting in the bathroom is likely to face greater dangers as they get older and family members are no longer able to provide this support.  Unless the behavior being taught presents a high level of risk if there is error, independence should probably be as, if not more, important than accuracy.

Independence can be included in the definition of target behavior by adding considerations such as latency to respond, level of assistance, and specific controlling stimuli to the usual description of topography (what the behavior should look and/or sound like).  To take the third example, “Jordan will hang up their coat and unpack their backpack” can be adjusted to “Jordan will hang up their coat and unpack their backpack within 5 minutes of entering the classroom, with no prompting, upon hearing the second bell.”  This enables the teacher or interventionist to shape to a clear goal that will give Jordan the autonomy to start their day independently, rather than simply with a hung-up coat and unpacked backpack that was mostly due to an adult’s prompting. 

Prompt dependence often occurs because of an overuse of verbal prompts, which leads to an association between behavior and the prompting person, rather than the natural or environmental cues that generally facilitate the behavior in the target environment.  In the example of the child who does not eat her favorite food without instruction, eating has come under the control of a person rather than hunger or the presence of food. It’s not reasonable or necessary to try to avoid verbal prompts entirely, but we can be cautious about overusing verbal prompts.  If verbal prompts seem like nagging, coaxing, or bribing, they are probably problematic. Strategies for teaching independence such as repeating or rephrasing instructions, asking leading questions, and talking through steps may also lead to prompt dependence if they are overused, so use them thoughtfully and not routinely.

The dependence on another person to deliver prompts can be transferred to other types of prompts that are less problematic.  Most very successful, functional, independent people rely on prompts such as calendars, reminder apps, alarms, planners, emails, texts, and to do lists.  These prompts are usually perfectly fine to be dependent on, because they are under the control of the person using them.  Unless they become dysfunctional in some way, these sorts of prompts can be used without limit.  We can teach our learners to use these prompts instead of relying on people to deliver prompts as an important step toward independence.  Other pivotal responses that can lead to greater independence include referencing lists, using a schedule, telling time, and observing and modeling from what others are doing.  Teaching someone to ask for help is also a great way to facilitate independence, because then prompts can be delivered only as needed - when they are asked for by the individual.

Finally, self-management is a crucial skill that can be taught to facilitate independence.  Self-management involves transferring control of behavior from external stimuli to the learner, by teaching the learner to engage in specific strategies.  These strategies for teaching independence include self-monitoring, or noticing and recording one’s own behavior, and self-reinforcement.  When someone learns to self-manage, they learn a skill set that can be applied to every area of life for increased autonomy and dignity.

 

About The Author

Dana Reinecke 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 and Associate Chair in the Applied Behavior Analysis department at Capella University. She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum and documentation. Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities. She has presented original research and workshops on the treatment of autism and applications of ABA at regional, national, and international conferences. 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 and online teaching strategies for effective college and graduate education. Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA), and is currently serving as Past President (2019-2020).

 

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