Different Roads to Learning

This week's blog comes to us from Kate Connell, the creator of the Picture My Picture flashcard collection. Visit our site to learn more! 

Having three boys at home for three months in 2020 I understand the challenge of remote learning. There were certainly moments of chaos and times that felt overwhelming. But in the mix were also many great moments where I observed genuine progress. Those “ah ha” times, when something previously unclear or unknown was understood, were deeply satisfying. To all the parents and carers out there that are remote teaching right now, all power to you. A key lesson that I learnt was that dedicated learning time is more effective when it is fun. Enter – flashcards. 

Why use flashcards at home?

Flashcards are an ideal tool for teaching kids at home because they are visual. Using visuals can increase the rate at which your child learns  as well as their ability to comprehend, remember and retrieve information. You don’t need to be a qualified therapist or teacher to use flashcards.  

What can flashcards teach?

Flashcards can assist with your child’s learning in many ways. They support language development and can also assist with emotional regulation, critical thinking and memory.  

How do I use flashcards at home?

Flashcards are a very flexible teaching tool. A wide range of activities can be applied to the one set.  They are suitable for pre-school children right through to more advanced learners. The types of activities you can use flashcards for include pairing, sorting, naming, describing and performing. 

Pairing activities

The act of pairing, grouping two or more associated things, assists your child’s ability to reason because to successfully make a pair they need to use systematic steps to arrive at a conclusion. 

A set of ‘Go Togethers’ flashcards is a great resource for learning about pairing. It typically consists of pairs of associated images, such as shoe/sock and bowl/spoon. A fun activity is placing four cards on a table and then having your child match the card handed to them (such as the bucket) with the one on the table (such as the spade). You can talk about the cards as you’re playing “Yes! The stamp goes with the envelope.”

Sorting

Sorting things by type (such as color, shape or purpose) is a skill that develops your child’s language and maths abilities. It is crucial for being able to relate, store and recall words. A set of Categories flashcards is ideal for learning how to sort. It typically consists of a range of categories (e.g. transport, furniture, clothes), with a number of cards per category (e.g. bus, plane, motorbike, ferry and car). 

There are many learning activities you can try with Categories. One is placing five cards on a table from five different categories (eg animals, instruments, transport, food and clothes). Then passing your child the remaining cards from these categories, one by one, and asking them to place the card they are holding on top of the card on the table to which it belongs. So the horse goes on top of the dog and the piano goes on top of the violin etc. 

Naming

Enhancing your child’s vocabulary supports their ability to grasp and express ideas clearly. It also enhances their capacity for abstract thinking. A large set of Nouns flashcards is ideally suited to vocabulary building. It typically consists of many different types of nouns such as animals, occupations and locations.

A very simple activity you can do with the Nouns set is to have your child name the image on the card they are shown, such as “Cat” or “Blender”. Once successful, encourage them to create a sentence relating to the image they are shown (eg “The milk is white”). A Nouns Set can also act as a spring-board for discussing topics in detail such as a swimming pool. You might ask “What do you like about going to the swimming pool?” or “What do we need to take to the swimming pool?”

Performing

The act of performing fosters creative self-expression in your child. Performers have to be critical thinkers, problems solvers and good listeners. Performing is particularly helpful when teaching your child how to regulate their emotions so that they’re calmer and better able to navigate relationships. 

Emotions flashcards can be used to encourage performing. You might ask your child to perform the emotion shown on the card or to enact a brief scenario relating to the emotion such as licking an ice cream then dropping it and feeling sad. Or you might enact a scenario yourself such as opening a present and have your child choose the relevant emotion card from a range of cards. 

Flashcards provide a valuable and accessible resource when teaching your child remotely. They can assist with learning in many ways and each set has a multitude of different uses. By keeping it playful and fun you keep your child engaged and with that engagement comes the learning. 

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. 

This piece was originally posted on Dr. Greg Hanley's website and has been shared with permission. Visit his website for more information as well as free resources on ABA for educators and parents: 

https://practicalfunctionalassessment.com

This is today’s ABA when starting therapy with an autistic person, especially one who routinely engages in problem behavior. 

Today’s ABA (applied behavior analysis) is about continually learning about the predilections of the autistic person being served so that preferred learning contexts can be developed en route to developing skills that can be appreciated by the autistic person as well as others. What follows is a guide for those implementing today’s ABA but written for those who are curious about what today’s ABA involves.

Learn by listening.

Ask the autistic person and/or ask people who know and love the autistic person about what he/she/they loves and hates. Be sure to review the love, aversion, and indifference towards activities, objects, furniture, contexts, and especially social interactions. Ask that person about the autistic person’s voice. How do they routinely communicate? And, especially, what are they communicating with their problem behavior? In other words, today’s ABA starts with asking questions, listening, and learning about the autistic person by people who know and love the autistic person.

Learn by creating joy. 

From that conversation, put together a context in which the autistic person will be happy, relaxed, and engaged, one in which they will feel safe and in control. Enrich this space with all of the objects and activities that they love. Don’t be stingy with the stuff–more is better. Be sure to include all the things that they have lost in the past because they could not handle their removal or because they engaged with them in unique, stigmatizing, or disruptive ways.

Do not restrict in any way their freedom to do or move. Keep the door open. Follow their lead, physically and conversationally. Let the autistic person bring other materials to this context, remove materials from this context, reposition objects and people in this context, and essentially redesign it with either their actions or words.

Be sure to create clear signals of your submission (i.e., remove all signals of dominance—hovering too close or standing above them). During this time, avoid all acts of redirection, prompting, teaching, questioning, and language expansion. Be 100% available to the autistic person but do not add your “two-cents” to the situation unless asked. Reserve even praise unless the autistic person initiates by sharing what they are doing or just did with you and you are authentically impressed. Do not supervise the experience; share in it without taking it over in any way.

Respond to all attempts to communicate–this will happen the sooner you stop trying to lead the situation. Help them, for instance, not when they struggle, but when they indicate they would like assistance. Be earnest in your attempts to help even when you are not sure how to do so. Do not let any behavior towards you be ignored; react to their behavior in normal ways, just do not attempt inspire the next interaction—let them lead.

Continue revising the context and your manner of interaction until the autistic person does not want to be anywhere but there. Let them “vote with their feet.” Besides being dignifying and avoiding regrettable physical management, allowing them to leave the space provides good information. Leaving means something important is missing or something aversive is present. Keep working on building and refining the context until the autistic person is happy, relaxed, and engaged for an extended period. Recognize that happy, relaxed, and engaged looks very different for different autistic persons, which is why it is essential that someone who knows and loves the autistic person is present at this and the next step of the process.

In sum, teach the autistic person that you know them, you see them, you hear them, and you are there for them. This is the first and crucial step in today’s ABA.

Learn by empowering.

After you are confident that you can create a safe and engaging context and there is zero probability of any severe problem behavior in this context, it is time to empower the autistic person further and establish trust between you and the autistic person. It starts by clearly signaling that the prevailing conditions are about to change, and for the worse, but be clear and kind about it. Through normal actions and words, make it clear to the autistic person that you would like them to stop what they are doing, set aside their materials, move in a different direction, inhibit any self-stimulatory behavior, and transition to an area in which developmentally appropriate instruction/expectations will commence. Be sure this area of high expectations is set aside to some extent and populated with all the challenging activities and expectations reported by those who know and love this autistic person as important for his/her/their development.

If the autistic person shows any explicit sign of distress, discomfort, or protest in the form of either minor or severe problem behavior while transitioning from essentially their way to your way, acknowledge it immediately and relent. Let the autistic person return to their way and resume following their lead until he/she/they gets back to their version of happy, relaxed, and engaged for a short period.

Repeat this process until it is obvious that the autistic person is empowered and understands that they do not need to comply against their will and they do not need to escalate to escape or avoid the things they don’t want or obtain the things they do want. Teach them that you see them, hear them, and understand them even more now, despite the sometimes lack of precision or general acceptability of their communication.  Teach them to trust you.  In this period, be clear, be alert, be quick, and be consistent. From this resetting of the relationship, you will eventually restore balance and be able reintroduce the ambiguity and challenges of life without problem behavior returning.

Learn while teaching.

The path to a joyous lifestyle for families with autistic persons is paved with skills. The big pavers are play/leisure skills, communication, toleration, and cooperation. Once these are set, the branching paths are endless. Today’s ABA process continues by replacing the behavior revealed in the empowerment phase with an easier one that will be better received by others. The process involves gradually introducing ambiguity as to whether the new communication skill will work and by stretching the periods of cooperation. The pace and aims of this treatment process are continually informed by feedback provided by the autistic person, both in terms of what they say and do. Gone are the days of working through problem behavior and negative emotional responses—those are indictors that the treatment process needs to be adjusted, and not at the team meeting, but at that moment.

This treatment process is one in which the starting point is a happy, relaxed, and engaged autistic person. The themes of I see you, I hear you, I understand you, and I am here for you persist throughout the entire process. It bears repeating that there is no obligation to teach while children are upset in any way or under any duress. Hasty efforts at promoting compliance or assessing the developmental status of an autistic person are not championed in this process. That which is championed is establishing trust, engagement, authenticity, and agency. Cooperation in shared experiences follows. Acknowledged in this process is that skills will be learned both during therapist-, teacher-, and parent-led times as well as during times in which the autistic person is leading. Also recognized is the understanding that developmental assessment is best undertaken once trust and persistence in difficult tasks has been established.

Today’s ABA is trauma-informed. It is to be assumed that any person in the care of a behavior analyst for problem behavior has experienced multiple adverse events, with many exceeding the criteria for acknowledging that trauma has been experienced. By learning through listening; by enriching therapeutic contexts; by building and maintaining trust; by following one’s lead; by relying on personalized contexts in which people are happy, relaxed, and engaged; by listening to communication bids; by not working people through noncompliance or emotional duress; by allowing people to walk away; by making decisions based on performance; and by teaching from joy; today’s ABA is trauma-informed.

Final Reflections

Our world, our country, and yes, our little field of ABA are at all at their own crossroads. The time to reconsider the status quo is now, whether it be as mundane as how to work in an office and socialize in restaurants or as profound as dismantling systemic racism. Our issues in ABA are somewhere in between but I daresay that our issues share challenges associated with getting back to work in the midst of the coronavirus and addressing injustices for people of color, especially black people in America.  Let’s learn from others, especially those expert in public health policy, human rights, and criminal justice as we make our way. But let us not wait any longer to get on the right side of history.

Ours is not to dominate but to de-escalate or better yet prevent escalation in the first place. Ours is not to coerce (thank you Murray Sidman!) but to listen, learn, guide, and coach. Ours is not to redirect, restrain, or merely manage and modify. Ours is to understand, share, and shape. Ours is to prioritize safety, rapport, and the televisibility of what we do above all else. We have proven that meaningful outcomes can follow when we prioritize these things (see www.practicalfunctionalassessment.com ).

To those who do not know this as ABA or who downright despise ABA: I hear you and I understand where the confusion or hatred comes from. I acknowledge that our field has been associated with wrongs on its journey of helping autistic people and members of underserved populations (i.e., those with intellectual disabilities). Our collective attempts at helping are better now than they were, and both research and practice reveal to me that behavior analysts doing better is continuing. I also recognize that improvement is not inevitable just because we embrace a form of scientific method. Values-based movements have been displaced from ABA in the name of science for as long as ABA has been in existence. This is a sad and uncomfortable truth, but one within our power to address if we listen to the voices of dissent that have been marginalized for too long.

ABA has the potential to inflict trauma, and it has the potential to alleviate trauma. I don’t want to wait for some horrific incident being recorded for fundamental change to take place. I have been attempting to correct my mistakes and improve the way I do ABA through research, authentic practice, consulting, and especially listening to other voices outside my choir for many years. I won’t make excuses for my behavior or that of other BCBAs. I simply apologize. I apologize for not doing more, saying more, pushing more, or disrupting more. Consider this a step in the direction towards self-awareness, improvement, transparency, accountability, and an obvious commitment to protecting the rights of those we serve. I hope you will join me on this quickening walk towards a more perfect ABA to help families of autistic persons whose lives are negatively impacted by problem behavior.

About The Author

Dr. Hanley has been applying the principles of learning to improve socially important behaviors of children and adults with and without disabilities for 29 years. He started in direct care and management roles in ICFs/MR (1990-1994), worked on the Neurobehavioral Unit at the Kennedy Krieger Institute (1994-1997), was degreed at the University of Florida (2001), was tenured at the University of Kansas (2006), and developed and directed the Behavior Analysis Doctoral Program and Life Skills Clinic at Western New England University (WNEU; 2007-2019).

Dr. Hanley is a Fellow of the American Psychological Association (Div. 25), past Associate Editor of The Behavior Analyst, and past Editor of Behavior Analysis in Practice and of the Journal of Applied Behavior Analysis. He has published over 100 articles in peer-reviewed journals and book chapters primarily focused on the assessment, treatment, and prevention of problem behavior and sleep problems, teaching strategies for developing life skills, and empirically-derived values for practitioners.

Dr. Hanley currently advises doctoral candidates as a Research Professor at WNEU, serves as an Adjunct Professor of Psychiatry at the University of Massachusetts Medical School, and leads FTF Behavioral, the international training and consulting group based in Worcester, Massachusetts.

This week, Dr. Val Demiri PhD, BCBA-D, LBA offers some helpful advice on how to improve collaboration between professionals from different disciplines.

As professionals, collaborating with others in your work environment is an essential skill that may have been historically overlooked as part of the specific training you received as a behavior analyst. Currently, becoming credentialed as a Board Certified Behavior Analyst (BCBA) does not entail any coursework requirement in collaboration, however collaboration is mentioned as part of the Behavior Analysis Certification Board (BACB) 4th Edition Task List under Section II, and The BACB Code of Ethics as follows:

TASK LIST Section II: Client-Centered Responsibilities
G-06: Provide behavior-analytic services in collaboration with others who support and/or provide services to one’s clients.

BACB CODE: 2.0 – Behavior Analysts responsibility to clients:
2.03 (b) When indicated and professionally appropriate, behavior analysts cooperate
with other professionals, in a manner that is consistent with the philosophical
assumptions and principles of behavior analysis, in order to effectively and
appropriately serve their clients.

BACB CODE: 7.0 Behavior Analysts’ Ethical Responsibility to Colleagues.
Behavior analysts work with colleagues within the profession of behavior analysis and
from other professions and must be aware of these ethical obligations in all situations.
(See also, 10.0 Behavior Analysts’ Ethical Responsibility to the BACB)

These current ethical codes and task lists must be adhered to by behavior analysts and should raise questions on how to obtain the skills required for collaboration. Because we are an evidence-based and empirically oriented field, we may often find ourselves in the midst of conflict when presented with non-behavioral and non-evidence based treatments to our clients that other professions may be using or want to use. How do we resolve the ethical dilemma in the best interest of our client?

One suggestion is to seek supervision and training in collaboration. Over the years, the need for training (both didactic and hands-on) on collaboration with other professions has increased. Perhaps perspective and understanding of other professions and their ideologies are good places to start so that we put ourselves in better positions to present our understanding of what will help our client. Let’s face it, behavior analysis can seem stuffy and arrogant, if not cold, to other professions who pride themselves in helping clients and building connections and who may have little understanding of our field.

The research on collaboration is beginning to emerge within our field (Kelly & Tincani, 2013; Broadhead, 2015) and we can certainly look to fields outside of ABA who have taken it upon themselves to educate their profession on what applied behavior analysis is and how to forge collaborations as well as find common ground between fields (Donaldson & Stahmer, 2014). Donaldson & Stahmer (2014) published an article explaining the philosophy and principles of ABA to the speech and language profession, while also emphasizing common ground, mutual objectives and understanding of ABA. Within our own field, some initial steps in understanding collaboration was undertaken by Kelly and Tincani (2013) who conducted a survey of behavior analysts regarding collaboration using the following definition:

“A component of consultation involving voluntary, interpersonal interactions comprising of two or more professionals engaging in communication modalities for the purposes of shared decision-making and problem solving toward a common goal and resulting in changes to tasks and solutions that would not have been achieved in isolation.”

Not surprisingly, the survey revealed that 67% of respondents reported no coursework with “collaboration” in the coursework title and most surveyed agreed that they would want more training in collaboration (Kelly & Tincani, 2013). Even more striking were findings suggesting that behavior analysts were not necessarily team players during the collaboration process as collaboration was reported to be uni-directional (Kelly and Tincani, 2013). Unfortunately, the lack of collaboration may subsequently create conditions in which interventions are less likely to be implemented, simply because other professionals involved in the care of the client were not part of the decision making for those interventions (Kelly & Tincani, 2013).

More so than ever before, researchers, clinicians and educators find themselves working in settings with diverse professional disciplines that are responsible for treating the same individual. Nowhere is this example made clearer for behavior analysts than the settings in which a host of related services from varying professions are provided to students as part of their Individualized Education Plan (IEP). Understanding the dilemmas that behavior analysts might be faced with in terms of evidence-based interventions that are empirically sound, Broadhead (2015) offered a decision-making model for determining whether or not the proposed non-behavioral treatment is worth addressing. Broadhead (2015) suggested that gaining skills in systematically evaluating whether or not you question a treatment (which runs the risk of eroding relationships) vs. not addressing clearly dangerous and unhelpful therapies that have been debunked, (e.g., facilitated communication) can serve as clear guidance and decision making strategies when faced with such ethical dilemmas.

Understanding collaboration and gaining the skills needed to collaborate across disciplines should be both a professional goal and a goal within our field. In that spirit, the following tips for collaboration are offered:

1) Get to know the profession of others you work with in your setting. Ask for and offer others basic readings about your field, philosophy, and profession.

2) Talk about your own training and how you learned the skills you have and ask questions about training that other professionals have received in their field and how they came to acquire their skill set.

3) Be honest about philosophical underpinnings of how you have been trained (e.g., behaviorism, applied behavior analysis).

4) Discuss common goals you have for your client and how you can collaborate.

5) If appropriate, ask for a demonstration of a strategy or intervention, so you can see for yourself what is being done and offer to show how you would implement interventions for the same goal and discuss the commonalities or differences in strategies.

6) Set regular collaboration meetings and have an agenda where concerns, successes and progress are discussed.

7) Agree on a plan of intervention as a team.

8) Offer help with your skills that are applicable across all fields–such as data collection strategies, graphing, operational definitions, measurement of behavior, skill acquisition and progress.

9) Create a collaboration goal with someone outside your field.

10) Stay open to learning from others without compromising your ethical obligations as a professional and seek supervision.

Board, B. A. C. (2014). Professional and ethical compliance code for behavior analysts.
Brodhead, M.T., (2015). Maintaining Professional Relationships in an Interdisciplinary Setting: Strategies for Navigating Nonbehavioral Treament Recommendations for Individuals with Autism. Behavior Analysis in Practice, 8: 70-78.
Donaldson, A., & Stahmer, A. C. (2014). Team Collaboration: The use of Behavior Principles for serving students with ASD. Language, Speech, and Hearing Services in Schools 45: 261–276
Kelly, A., & Tincani, M. (2013). Collaborative training and practice among applied behavior analysts who support individuals with autism spectrum disorder. Education and Training in Autism and Developmental Disabilities, 120-131.

About The Author

Dr. Demiri received her doctorate in Clinical and School Psychology from Hofstra University in 2004 and her Board Certification in Behavior Analysis (BCBA) from Rutgers University in 2005.  She currently serves as an adjunct professor at Endicott College in the Van Loan School of Graduate & Professional Studies and she is the district-wide behavior specialist at Hopewell Valley Regional School District in New Jersey.  Previously she served as the Assistant Director of Outreach Services at the Douglass Developmental Disabilities Center of Rutgers, The State University of New Jersey, where she spearheaded the Early Intervention Program.  Her professional interests include diagnostic assessments, language and social skills development in individuals with autism spectrum disorders as well as international dissemination of Applied Behavior Analysis.  She has presented on Applied Behavior Analysis and autism locally, nationally and internationally.  Val is the co-author of the book, Jumpstarting Communication Skills in Children with Autism: A Parent’s Guide to Applied Verbal Behavior: Woodbine House.

The ultimate goal for any young adult is to leave home and live an independent life. For individuals with autism, independence may be more difficult to achieve, due to the impact of the disability on most areas of functioning. Regardless of disability, however, it’s important to aim for independence across as many areas as possible, because supports and services change and are often reduced at the time of transition to adulthood (Friedman, Warfield, & Parish, 2013). Most research currently suggests that long-term outcomes are better for those individuals who were diagnosed more recently, possibly due to earlier and more effective interventions (Billstedt, Gillberg, & Gillberg, 2005). This finding should encourage more effort than ever to facilitate independence, because it shows that it is possible, and indeed more likely, with good and early intervention.
What skills are important for transitioning to a more independent adult life? Here are 10 suggestions, and the reasons why.

First, the obvious:

10. Food, eating, and meals
Clearly, we all need to eat to survive, and we need to eat at least a relatively healthy diet most of the time to avoid health issues in the future. Knowing how to make a PB&J sandwich isn’t enough, though – we need to be able to plan meals, shop for the food that we need, have it available when we need it, and make and consume food on a reasonable and healthy schedule.

9. Laundry
Social convention requires neat and clean clothing in most situations (unless you’re at the end of an intense exercise session, or maybe cleaning out an attic). Knowing how to use the washer and dryer aren’t enough. We also need to be able to anticipate when we need to do laundry so that we don’t run out of clean clothes, and we should be able to fold and put clothing away so that it stays neat and presentable. Being able to iron clothing is a good bonus skill.

8. Money management
Being independent means being in charge of your money. Money skills include not just counting, adding, and subtracting, but making change, figuring out tips, and managing at least a simple budget. Other important money skills are using an ATM, writing checks, paying bills on time, and using (and paying off!) a credit card.

7. Cleaning up
A neat, clean home is socially appropriate and also better for one’s health. In addition to knowing how to use a vacuum, how to dust, wash dishes, empty the garbage containers, and organize storage, we should be aware of when these tasks have to be done. Safety around cleaning supplies is also a very important skill.

6. Transportation
Getting to the places that we want and need to go to is an important life skill for independence. For some, this may involve driving, which also includes managing and paying for a car, maintenance of the car, and insurance. For some, public transportation is an option, which involves safety skills as well as knowing the procedures of how to pay, access schedules, and so on. Transportation for people with disabilities is also available in many areas, and requires knowledge of how to access and other procedures.

5. Schedule management
Without schedule management skills, we would miss most of our appointments and commitments, and have difficulty completing projects or meeting our goals. There are many different ways that schedules can be managed, including paper calendars and to-do lists, apps for scheduling and reminders, and timers, alarm clocks, and digital assistants. We need to know what type of schedule management is needed in any given situation, how to access or create systems, and how to use systems over time.

Perhaps less obvious, but just as important:

4. Doctors and dentists
Hopefully this won’t come up too often, but we all get sick now and then, and need a medical professional to help us. Just as important, we should also receive routine health care to prevent illnesses. This skill set can be very complex, and include varied levels of skills, such as finding the right professional, making and keeping and appointment, tolerating any necessary procedures, and following up on advice or prescriptions.

3. Friends
Friendships change and evolve over time, and the friendships of adulthood require different skill sets from those of childhood. Friendship in adulthood may also be complex, and involve many different layers, up to and including romantic relationships and intimacy. The necessary skills for friendships include some very concrete skills like making phone calls, texting, and reciprocating invitations. Less concrete, but still important, skills include tolerating different viewpoints, expressing interest and concern about others, and negotiating plans.

2. Leisure time
Anyone who doesn’t have something enjoyable to do when the demands of everyday life are lifted, such as at the end of a work day, or on a weekend, or even on a family vacation, may wind up engaging in less than acceptable ways of keeping busy. Having age-appropriate, socially-acceptable leisure skills can go a long way towards keeping us out of trouble. Although leisure skills might seem less important to focus teaching resources on than some of the other skill areas here, it can’t be stressed enough that everyone needs something enjoyable to do and to look forward to doing, to be safe, productive, and happy.

1. Getting help
Finally, we all need the crucial skill of being able to get help when we need it. This involves identifying when help is needed, what type of help is needed, how to get it, and then seeking it out. There are multiple opportunities in everyone’s day to seek help – whether by doing an internet search to get information, calling a professional or friend for advice, or asking for assistance in a store or other public place. Having the ability to get help as a core skill can also help to make up for any deficits in the other areas needed for independence.

This is by far not an exhaustive list of areas to address for independence when planning on leaving home, but all of these areas are critical and should be considered well before they are needed. A balanced educational program will hopefully prioritize each of these areas and ensure that functioning is as independent as possible, for a successful outcome!

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).

Yes! Maintaining social relationships while keeping physical distance is both incredibly important yet difficult. But by working on telephone skills with your child, you can both help her maintain important social and conversational skills and also help deepen her relationship with her grandparents and other family members. Since we don’t know your child, we can’t give specific advice, but we’ll share examples of skills that could be taught and a variety of teaching strategies you could use. Finally, we’ll share detailed examples of how you could put it all together.

Many social and pragmatic language skills go into a telephone conversation. You might know exactly which ones your daughter needs to work on based on your observations of her existing phone conversations. If not, you could watch for this during your next few phone calls to identify strengths and deficits.  You can also reach out to your child’s teacher, speech therapist, or behavior analyst, and get their input. Generally, consider starting with some emerging skills (ones that your child can already do to some extent but not really well or not consistently) instead of brand new and difficult skills. This may allow faster progress and more enjoyable phone conversations. Here are some skills that would lend themselves to phone practice. Some of them are skills in using the phone itself; others are general conversation skills that can be practiced on the phone. These examples cover skills for a range of ages and skill levels.

Specific Phone Skills

General Conversation Skills

Once you’ve identified a skill or two, plan out how to practice it. Consider the format and timing of the calls, how you can prepare up front for success, and how to actually teach the skill before and during the call. Since your child will be practicing with a familiar family member, you might even consider redoing the call immediately so that prompted skills can be practiced independently. Here are some ideas in each of those categories. As stated above, keep in mind that since we don’t know your child and can’t give specific advice, it’s up to you and your team to choose which strategies you believe will work best.

Format & Timing

Planning & Preparation

Practice & Call

Putting it Together – Early Language Skills

Here’s an example of how you could put a number of these recommendations together. Let’s imagine that your child is an early learner and you want her to learn to dial the phone, and ask and answer some easy questions.

Format & Timing: She usually sees her grandfather a few times a week and she loves making silly faces with him, so you start by calling him. Since seeing her face is important to her, you choose to use Skype on a table for a bi-weekly call that is scheduled right after dinner on Mondays and Thursdays.

Planning & Preparation: For the skill of dialing, you add pictures of people in her life to your Skype account, so she can tap on the picture of the person she wants to call. For the skill of answering questions, you know that she sometimes, but not always, answers “who” and “what” questions about things and people in her immediate environment like answering, “Who is that?” when a sibling walks in or “What is it?” when she has something interesting. You decide to practice these questions on the phone. You aren’t sure how to teach her to ask questions, so you reach out to her teacher, who suggests that her grandfather put some fun items in a box, and you prompt her to ask, “What’s that?”, so her grandfather will answer and pull the surprise item from the box. Then you talk to her grandfather, and set up a plan for him to have a box with several interesting items in it to talk about.

Practice & Call: During the call, grandfather occasionally brings the box on screen and makes a leading statement like, “Ohh… look what I have!” and waits for her to ask “what is it?” before pulling out the item dramatically. You also ask him to engage in silly faces with her during the call, especially right after she asks or answers a question, in order to reinforce it. You’ve arranged for other household members to walk through the room or make funny noises occasionally, to provide her grandfather the opportunity to ask questions like “Who is that?”.

Putting it Together – Advanced Social Skills

Here’s another example for an older child learning more advanced social skills.

Format & Timing: When she makes a call, she typically starts talking about her interests immediately, so you decide to teach her to start a conversation using the following steps: identify self (e.g., “Hi this is Sarah”), check if it’s a good time to talk (e.g., “Do you have time to chat?”), and ask the conversational partner a small talk question (e.g., “How are you?” or “What are you doing?”). You also have observed that she doesn’t respond to indirect statements or someone’s tone of voice. You noticed this last week, when she asked her brother if he wanted to play a game, and after he sighed heavily and said “oh, fine”, she seemed unaware of his disinterest and started the game enthusiastically.

Planning & Preparation: You sit down with her to develop visual cues for both skills. For the first one of starting a call, you make a list of the steps, and let her write in the examples. You also put a checkbox next to each step so you can mark it off as she does it. For the second skill, you and she make a list together of examples of what someone might say/do in response to an idea or request, what it really means, and how to respond.

Practice & Call: Then you decide to role play together. With the visuals right in front of her, you take turns pretending to be different family members and friends on a call. When the opportunities to use the skills come up, you pause the call immediately after each one to give her feedback on what she did well and what she could do differently. Before the first call with a family member, you share with them the fact that she’s working on reading between the lines, and coach them on providing opportunities for her to practice. You have her put the conversation partner on speakerphone, so that you can prompt by pointing the appropriate part of the visual cue as needed.

As shown above, telephone skills are complex and multifaceted so there are plenty of opportunities for new skill development. As you consider new skills to teach, revisit the suggestions above and think about what types of teaching strategies are best suited for that new target. If your child struggles, consider whether there are perquisite skills that should be targeted first. As always, reach out to the relevant providers on your team for guidance. We hope that, while remaining physically distant, these ideas will help to continue to build your child’s social communication skills and help the family stay socially connected.

Citation for this article:

Glick, C., & Celiberti, D. (2020).  Clinical Corner: How can I teach telephone skills at home?  Science in Autism Treatment, 17(4).

About The Authors

Chante Glick, MEd, BCBA is currently a full time student at Endicott College and a mother to an eighteen-month-old. Throughout her career, she has taught in special education and general education in both public and private schools, run a summer camp for at risk youth and adults with developmental disabilities, provided behavior analytic services to children and adults in a variety of settings, volunteered with the Association for Science in Autism Treatment (ASAT) and WA-GROW (providing training for special education teachers in Mexico) and directed an ABA organization that specialized in in-home programs and school consultation. When not writing papers for her doctoral program, she can be found reading non-fiction, playing with her daughter, or rewatching The West Wing for the billionth time.

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.

Creating a successful behavior intervention is more challenging than it first appears. Below, I’ve listed four essential parts for changing maladaptive behaviors and increasing desired behaviors. Most of the time, when a behavior intervention is not working, one or more of these steps has been neglected.

1.  Find a BCBA or ABA provider who can guide you through the process. Getting help from someone with experience in addressing challenging behaviors is an essential first step. They should be a wealth of information about each of the following steps, provide check-ins and troubleshooting during the intervention process, and maintain data on the behavior to ensure the intervention is working.

2.  Identify the function of the behavior. There are four reasons that any of us behave: attention, escape/avoidance, access to a tangible (such as chips or a toy train), and automatic reinforcement (meaning physical sensations that are not related to social interactions, including sound, taste, touch, or a response to movement). A BCBA can be especially useful in helping to identify the function of the behavior. They may utilize an ABC chart to determine the function, which means they observe the behavior and note its antecedent, what the behavior looks like, and the immediate consequence. If the ABC chart is not helpful, they may perform a more formal Functional Analysis. Before any intervention is put in place, all parties interacting with the child should understand the function (or reason) for the problematic behavior.

3.  Provide a replacement behavior. As a part of the intervention, a replacement behavior should be provided. A BCBA or ABA provider should be able to help you find appropriate replacement behaviors for the problematic behavior. For example, with one student who was chewing his shirt, we introduced a replacement behavior of chewing gum. With another student who was throwing his iPad, we used tape to put an “X” on his desk and taught him to place it on the “X.” The idea is to provide an appropriate behavior that is incompatible with the problematic behavior. But that’s not always possible. For example, one of my former students was banging her head on the table during instruction. We taught her to request a break by touching a picture of a stop sign. Realistically, she was able to bang her head while simultaneously touching the stop sign, but once she learned that she got to escape the activity by touching the stop sign, she stopped banging her head in order to escape. It’s important to note that using the stop sign wouldn’t work for all head-banging behavior, but we had identified the function of the behavior and were able to introduce a replacement behavior that served the same function while meeting the skill level and needs of that individual student.

4.  Provide reinforcement for appropriate behavior. A specific plan for providing reinforcement for use of a replacement behavior and any other desired behaviors is essential. The reinforcement for the appropriate replacement behavior should serve the same function as the problematic behavior. This can sometimes be difficult to achieve, but without this aspect of the intervention, you may see slow success or no success at all.

Again, creating a multi-pronged intervention can be a challenge. It’s important to seek out help and to take a look at research related to the problem behavior you are trying to address. It is possible to create a strong intervention that has a huge impact on your learner, but it must include the aspects listed above to have the highest potential for success.

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

While an ABA professional should be coming in to organize and run your ABA program, as a parent or guardian, there are some simple things you can do to make the time your child spends in a home session more effective. Several tips are here, but it may be unrealistic for you to follow ALL of these tips. Consider your home environment and family’s needs, then implement the tips that are the most feasible for your situation.

Following even one of these tips can make a big difference in your child’s sessions!

1) Make sure all ABA materials are accessible. It’s important to have a system for storing the materials and the binder the ABA providers use. Some families I work with put everything into a box, a dresser drawer, or on a shelf the child cannot reach which is great. If the child utilizes an iPad for communication or reinforcement, be sure it’s available and charged. If any other items are necessary, such as edibles for reinforcement, make sure those are available at the beginning of the session. One parent I worked with used a craft organizer container with a clear plastic lid to store edibles, so when sessions began she’d set it on the table. All the different snacks were already broken into small pieces and organized in the box, freeing up more time for teaching during the session.

2) Keep the area for ABA therapy free from distraction. Remove any items that are highly distracting for your student. Shut windows if you live on a noisy street. Make sure your cell phone is with you. This tip is especially challenging for families that live in studio apartments or have loud neighbors.

3) Limit the number of disruptions from siblings or other family members. As an ABA therapist who is focused on increasing my students’ opportunities for social interaction, I don’t want to discourage the siblings and other family members from coming in. Interruptions should happen from time to time, and it’s important that my students learn to refocus after an interruption. But sometimes it becomes an obstacle to learning when there are consistent interruptions, or if I have to continue to redirect a sibling to other activities. Instead, it’s better to structure activities with siblings and other family members, perhaps by teaching the learner with autism to request the sibling come play or adding it to the student’s activity schedule.

4) When possible, reserve one or more highly motivating activities for ABA sessions. If a child has free access to all his/her motivating activities, then those activities are not as valuable when used in a session, and therefore less motivating. Sessions are most effective when the learner is working for something that they’re highly motivated by. It’s important to note here that I don’t want the child to only have access to fun things during sessions. I also don’t want the parents miss out on opportunities to enjoy motivating activities with the learner. The idea is to save a small number of motivating activities for sessions so the child maintains motivation and focuses on learning. This tip is especially challenging for families when the learner with autism is motivated by only one or two activities or items.

5) Don’t allow the child to engage in their highest motivating activities right before an ABA session. I’ve had more than one case in the past in which I would get to the home and find my student watching his favorite TV show or playing his favorite game on the iPad. What would typically happen is that my student would associate my arrival with the end of his favorite activity, which would lead to crying, refusal to work, and/or attempts to escape. I want my students to be able to watch their favorite shows and play with their favorite games, but our sessions are more effective when those activities don’t take place immediately beforehand.

6) Ask your provider if there are any changes you can make to improve sessions. Every home is different and every child’s needs are different. Your provider may be able to identify small changes for your specific situation that are not mentioned above. Opening that dialogue can be a powerful way to improve your child’s learning outcomes.

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

Different Roads To Learning is thrilled to share ASAT's New Parent Packet, released in January of 2021. This free download offers parents whose children have been recently diagnosed with autism a primer on ASD as well as advice on finding and financing the correct treatment for your child. For more information on ASAT, please visit their website at www.asatonline.org. 

"For 2021, ASAT has introduced a practical guide for parents of a child just diagnosed with autism. Parent members of ASAT have a profound understanding of the weight of a diagnosis on the family and the urgency to find appropriate treatment. As parents, we have all been told by well-meaning professionals that early intervention is key, yet the journey to find appropriate early intervention seems, at first glance, overwhelming and confusing. To ease this enormous burden, our New Parent Packet provides five steps that every new parent can take to efficiently find an appropriate treatment for their child irrespective of country or region. This New Parent Packet is short and to the point; for parents who want to do more research, we have embedded carefully chosen links to use to gain further information when desired. Please share this New Parent Packet with anyone who would benefit from a no-nonsense entry into the world of science-based autism treatment."

 -Sabrina Freeman, PhD

DOWNLOAD THE NEW PARENT PACKET HERE

Recently I began working with a family who has a six year old boy with autism named Austin (all names and identifying details have been changed to protect confidentiality). His mother was describing Austin’s behaviors when he couldn't have something he wanted. She told me about him hitting his parents and younger brother, sweeping all materials off tables and shelves, and throwing himself on the floor. She was worried that he might hurt himself or hurt someone else. She told me that when he started this behavior, they would say, “Stop hitting.” They had been doing this for months, but his behavior had not improved.

Later that week, she sent me a video of Austin having one of his “mega-tantrums.” It was exactly as she described, though there was one important detail she had missed. Austin consistently sought out eye contact and physical contact with both of his parents. If they were moving around to pick up an item, he would move his body and face to maintain eye contact. If one of them sat down, he would quickly clamber into their lap while screaming and pounding their arms or the furniture. If one parent walked out of the room, he would immediately run to the other parent. This behavior was clearly maintained by attention. In order to decrease the behavior, his parents had the very difficult task of ignoring it ahead of them.

The next week I went out to their house to help them practice ignoring the behavior. We put in place a three-pronged plan:

When Austin wanted something he was not allowed to have, he would be given a choice of options. The options should be for preferred activities. For example, if he wants to watch TV but isn't allowed to right now, the parent can say, “Austin, you can play with trains or you can do a puzzle.”
Once Austin starts hitting or screaming, he does not receive any attention. This includes eye contact, physical contact, and verbal prompts/reminders from his parents. The parents can start one of the motivating activities in another location. For this family, the parents sat with the younger brother at the dining room table and the mother read a book out loud.

As I had forewarned the parents, Austin’s behavior initially intensified as he realized he was getting zero attention. He took a box of toys, turned it upside down, and dumped it all over the floor. His mother kept reading to his brother. He ran over to his father and hit his legs while screaming, the father got up and walked away. Then, Austin did something he had never done before. He climbed up onto the table and started walking around on the edge of it.

His mother looked at me and said, “How do I avoid giving him attention for that?” This is when it’s important to consider high-quality attention and low-quality attention. In order to keep him safe, his mother needed to be more proximal. She walked near where he was on the table, but did not pick him up, did not make eye contact, and did not speak to him. (I let her know that if she felt he was very unsafe, she could pick him up and remove him from the table but quickly letting him go, and withholding eye contact and verbal interaction.) She stayed nearby to catch him if he fell, but she did not provide attention for this dangerous behavior. Her proximity (or if she had chosen to pick him up off the table without eye contact or verbal interaction) constitutes low-quality attention. High-quality attention is only saved for appropriate behavior.

Think about what high-quality attention means for a young child: big facial expressions, expressive tones of voice, big movements, and physical contact. Prior to our intervention, Austin was getting all of those types of high-quality attention for inappropriate behaviors. But now he wasn't getting any of that type of attention.

However, Austin had been engaging in inappropriate behaviors for attention for 2-3 years now, so changing this behavior takes a little time. For our first day of the intervention, Austin continued to yell and throw items for 40 minutes before he finally went over to where his mom was sitting and reading aloud the story (actually, the third story in a row). When he was near and quiet, his mom started reading in a wonderfully expressive tone, adding voices to the characters. Austin came closer. When a funny part of the story happened, Austin laughed. And then Austin’s mother encouraged him and his brother to imitate the characters in another part of the story. After he imitated the characters, he sat next to his mom and she put her arm around him. All of these high-quality forms of attention were now being given for appropriate interaction.

Sometimes you have to provide some attention in order to keep a child safe, but think to yourself what is high-quality attention for your learner: it may be tickles, silly faces, expressive speaking, or physical contact. Reserve those things for appropriate behaviors.

A few final notes about this intervention: (1) Austin’s inappropriate behaviors will probably still continue for a little bit longer. I’m certain that he will test it out a few more times, and his parents will have to stick to the intervention in order to completely get rid of what they had deemed as “mega-tantrums”; (2) This intervention only works for behaviors maintained by attention. If you’re uncertain about the function of a behavior, confer with a BCBA or an ABA provider for help; and (3) If you’re not certain you can follow through if the behavior persists for a long time (such as 40 minutes in Austin’s case) then give in the first time the learner asks. For more information on this, look back at my tip on Choosing When to Battle.

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

Helping learners with autism engage successfully with their siblings is an important goal. The ultimate goal should be for both the sibling and the child with autism to initiate interactions without adult direction.

Activities should be reinforcing for both kids in order to increase the likelihood that siblings will independently engage in play without prompts by adults. Try to avoid situations where you are requiring the typically developing sibling to engage in an activity just because it is motivating for the learner with autism.

Don’t expect the sibling to fill the role of “mini-teacher” or “mini-therapist.” While at times the sibling may need to prompt the learner with autism to complete a task or take a turn during a game, when possible be clear that the adult is responsible for guiding the child with autism through activities. The adult can also act as a model for appropriate language and prompting in instances when the sibling is alone with the child with autism. However, your goal is to provide low-pressure play situations for both children. One way to help with this is to introduce activities and games that the learner with autism has mastered so the sibling is less likely to take on the roll as teacher or therapist.

Teach the learner with autism to invite his/her sibling to play. It’s beneficial for both kids if the learner with autism initiates some activities. While introducing games and toys to learners with autism, it’s useful to have highly-motivating games that then become associated with the sibling. This way, when the learner with autism sees the game, he/she automatically thinks of inviting the sibling to play. In ABA terms, the presentation of the game acts as an Sd for inviting the sibling to play.

Allow both kids to have interests that are unshared. It is frequently counterproductive to force play situations. Finding common interests is the key to increasing the likelihood of each child initiating play in the future. If the child with autism is required to participate in un-motivating activities with his/her sibling (or vice versa), the child will begin to associate the sibling with undesirable activities. It is perfectly normal and healthy for both siblings to engage in hobbies, games, and activities that the other is uninterested in.

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.

Are you a practicing Behavior Analyst or a professional who provides ABA treatment for children on the autism spectrum?  Many barriers compete with the child’s ability to generalize concepts, skills and language taught during intervention and can vary as much as the disorder itself. Planned curriculums help to identify what to teach after an appropriate behavioral assessment, but they lack in guiding the practitioner to plan and teach for generalization systematically.

Sometimes we do not know what we are missing, simply because we have not been exposed to something. The R.E.A.L. Model is this exact reference. Please join us on January 20th 2021 at 11:00am PST for this free CEU webinar. Learn how to change your programming to be more efficient and create more flexibility and adaptivity across all of your students!

Here is what will be covered in the 1 hour CEU webinar:

• Participants will be introduced to the REAL Model, including how to plan systematically for generalization throughout ABA programs.

• Learn to describe how to teach for generalization by identifying critical stimuli and troubleshooting across multiple people/trainers, environments, and across response classes (complex skills).

• Teach for generalization by identifying critical stimuli and troubleshooting skills controlled by their verbal community.

• Gain access to some practical planning and data sheets to increase generalization across programs.

Register for your spot at the link below:

https://attendee.gotowebinar.com/register/4445298434661764624

Presented by Mari Ueda-Tao, MA,BCBA

Mari is the Chief Clinical Officer for Applied Behavior Consultants, Inc. (ABC) CA. Working in the field of ABA for almost 20 years with students with Autism Spectrum Disorders and other developmental delays, Mari has worked across ten different countries, spreading Behavior Analysis globally.

This month’s ASAT feature is from Joey Lim, MEd (ABA), BCaBA and Erin Leif, 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!

What is involved in an early intensive ABA program for autism?

Answered by

Joey Lim, MEd (ABA), BCaBA
Beanstalk Child Psychology

Erin Leif, PhD, BCBA-D
Association for Science in Autism Treatment

Initial assessment

An initial assessment should be conducted prior to the design of an intervention program. The assessment process can include formal skills assessments, observation of your child in their natural environment, and an interview with parents and caregivers. Assessments are conducted to identify your child’s strengths, preferences, needs, and skill deficits. Some of the common areas that are assessed include social, language, learning, and personal independence skills. This is an excellent time to make sure your concerns are expressed so that they can be included in the initial goal setting process.

The start of therapy sessions

No two children on the spectrum are alike, so this is why your child’s intervention program will be individualized (i.e., made just for them). The results from the initial assessment as well as parents’ priorities and concerns will guide the development of treatment goals and an individualized intervention plan. Typically, an individualized intervention plan describes the specific skills that will be worked on with your child, how data will be collected to monitor your child’s progress, and information that will allow us to determine when your child has mastered the skill.

There has been an abundance of research demonstrating that intensive ABA programs may result in significant improvement across a range of skills, such as language, adaptive, social, and cognitive skills (Cohen et al. 2006; Eikeseth et al., 2007; Howard et al., 2005). Intensity refers to the number of hours of intervention your child will participate in each week. Your BCBA or supervising professional will recommend an intensity of intervention that is commensurate (i.e., matches) with your child’s strengths and needs, treatment goals, and other life factors such as the age of your child and the time your child spends in other activities. Children who have developmental delays in a range of areas will likely benefit from a more intensive therapy program.

Pairing ourselves with preferred activities

Your child’s Early Intensive Behavior Intervention (EIBI) program will always start with pairing sessions, where it’s ALL about what your child loves and having fun with their new therapist! We enrich the environment with lots of toys, and activities like spins, tickles etc., initially for free (without any demands placed)! We want your child to think of their new therapist as the giver of good things! It is important for therapists to build a positive relationship with your child, and for your child to see them as fun and engaging. When your therapist comes into the room, your child should want to be with them. Research shows that pairing may improve cooperation and acquisition of new skills (Kelly et al., 2015) and reduce the frequency of challenging behavior during therapy sessions (Shillingsburg et al., 2014; Shillingsburg et al., 2018).

Data collection

One of the critical components of EIBI is collecting data. Data on skill acquisition programs and challenging behavior will be recorded during sessions by your child’s therapy team, which consists of your BCBA or supervising professional and the therapists who are trained to work with your child. Your therapy team will analyze the data regularly because these data are used to evaluate your child’s progress and guide the program planning. If the data show that your child is progressing and learning new skills, your team will add new skills to the program and ensure learned skills are generalizing across people, settings, and materials. If the data show that the child is making little or very slow progress, your team will evaluate and modify the program to ensure continued progress.

Teaching new skills

Your child’s therapy program will likely consist of a variety of evidence-based teaching strategies (i.e., strategies that are proven to work). Some skills may be taught using more structured teaching strategies like discrete trial teaching, with an emphasis on breaking skills down into small teachable components and providing lots of practice opportunities. Once new component skills are acquired, they are incorporated into larger, more complex skills. Other skills will be taught in the context of everyday activities, such as play time, meals, and community outings, often using natural environment teaching or shaping and chaining. Most teaching strategies involve the use of prompts to help your child successfully perform the skill, fading of prompts as the child becomes more independent, and lots of positive reinforcement along the way.

Even though there is structure, consistency, and practice in EIBI, therapy sessions should be fun and engaging. We don’t teach skills just at the table – they should be taught anywhere and everywhere (the living room, backyard, playground, and kitchen, just to name a few). The first author still remembers running one entire therapy session at the sink with a child, because she decided she wanted to give her Barbie dolls a spa bath that day. It was during play that we practiced conversational skills, turn-taking, and listening comprehension – all in the context of a fun and natural play activity!

Challenging behavior can get worse before it gets better

One very common goal from parents is to reduce challenging behavior. As fun and engaging as we strive to make our sessions, at times we may see an increase in challenging behavior at the start of an ABA program – as we start asking the child to do things. This typically happens because in the past the child might have had free access to all of their favorite things, along with minimal demands. Now, we’re asking them to do something before having a turn with a favorite toy, for example.

Often the number one priority in early ABA therapy sessions is to teach and reinforce cooperation and establish what we call ‘instructional control.’ Robert Schramm and Megan Miller’s The Seven Steps to Earning Instructional Control is one of our favorite reads, and we highly recommend this book to parents. As we gradually start placing demands on your child, we may see a spike in challenging behavior, which may be escape motivated behavior. Hang in there when that happens, parents! Behavior can get worse before it gets better. However, by using reinforcement effectively and introducing instructions slowly and with support from your therapy team, we can minimize the likelihood of seeing an increase in challenging behavior. In addition, your BCBA or supervising professional will track the frequency of challenging behavior, and will monitor the data closely to make sure any increases in challenging behavior are responded to quickly.

Parent Involvement

Parents are an integral part of their child’s therapy team and are encouraged to be involved in therapy sessions. Research has consistently shown that parents’ participation in programs is key to the success of early intervention programs (Mancil et al., 2006; Ozonoff & Cathcart, 1998). Parental involvement is essential for various reasons. Consistency is the key to behavior change, and it is important that parents are able to implement interventions and teaching strategies in everyday life outside of therapy sessions. It is also essential that parents know which skills their child is learning or has mastered so they can encourage them to use those skills outside of therapy sessions. This will contribute to the generalization of skills across people and environments (i.e., places). For example, if your child is learning to request their preferred items, you can be involved in sessions by keeping the preferred item out of reach and giving it to your child only after they have requested. Outside of therapy sessions, you can then continue to expect your child to request before gaining access to his favorite toy, using the mode of communication they are learning in therapy sessions.

Summary

Starting an early intervention program for your child may seem overwhelming, but you have chosen an intervention that is evidence-based. That means there is plenty of research showing that EIBI delivered using the principles and methods of ABA can result in substantial and sustainable functional improvements for children with autism and related conditions. As you move forward with your program, we encourage you to actively participate, ask lots of questions, and openly share your questions and concerns with your team. This will help your team design and deliver a truly personalized therapy program that reflects your family and child’s goals, values, and needs.

References

Cohen, H., Amerine-Dickens, M., & Smith, T. (2006). Early intensive behavioral treatment: Replication of the UCLA model in a community setting. Developmental and Behavioral Pediatrics, 27, 145–155.

Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2007). Outcome for children with autism who began intensive behavioral treatment between ages 4 and 7: A comparison controlled study. Behavior Modification, 31, 264–278.

Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359–383.

Kelly, A. N., Axe, J. B., Allen, R. F., & Maguire, R. W. (2015). Effects of presession pairing on the challenging behavior and academic responding of children with Autism. Behavioral Interventions, 30, 135-156.

Mancil, G. R., Conroy, M. A., & Nakao, T. (2006). Functional communication training in the natural environment: A pilot investigation with a young child with Autism Spectrum Disorder. Education and Treatment of Children, 29(4), 615-633.

Ozonoff S., & Cathcart, K. (1998). Effectiveness of a home program intervention for young children with autism. Journal of Autism and Developmental Disorders, 28(1), 25-32.

Schramm, R., & Miller, M. (2014). The seven steps to earning instructional control. Pro-ABA.

Shillingsburg, M. A., Bowen, C. N., & Shapiro, S. K. (2014). Increasing social approach and decreasing social avoidance in children with autism spectrum disorder during discrete trial training. Research in Autism Spectrum Disorders, 8, 1443–1453.

Shillingsburg, M. A., Hansen, B., & Wright, M. (2014). Rapport building and instructional fading prior to discrete trial instruction: Moving from child-led play to intensive teaching. Behavior Modification, 43(2), 288-306.

Citation for this article:

Lim, J., & Leif, E. (2020). Clinical Corner: What is involved in an early intensive ABA program for autism?  Science in Autism Treatment, 17(6).

About The Authors

Joey Lim is a BCaBA with a Masters in Education in Applied Behavior Analysis from Monash University in Melbourne, Australia. She is the Director of Early Intervention at Beanstalk Child Psychology, providing behavior analytic services to children with autism and other developmental disabilities in Adelaide, Australia. She is also involved in supervising and training of Registered Behavior Technicians, conducting assessments and designing programs for skill acquisition. Her clinical interests include early intensive behavioral intervention, as well as functional behavior assessment and treatment of sleep problems.

Erin Leif, PhD, BCBA-D is a Senior Lecturer at Monash University in Melbourne, Australia. In this role, she coordinates the Master of Applied Behaviour Analysis program. Prior to joining Monash, Dr Leif provided applied behaviour analytic educational and behaviour support services for children, teens, and adults with autism and developmental disabilities in the USA, the UAE, and Australia. Her clinical interests include early intervention and assessment and treatment of severe behaviour disorders. Her research interests involve evaluating effective tactics for training scientist-practitioners to engage in evidence-based practice in real world settings. Dr Leif is also interested in exploring how behaviour analysts can engage in culturally-sensitive evidence-based practice, and individualized teaching methods and behaviour support strategies to reflect the values, preferences, goals, and aspirations of the direct recipient of services. She is on the board of directors for the Autism Behavioural Intervention Association and the Association for Science in Autism Treatment.