Different Roads to Learning

Gary Mayerson's new book Autism's Declaration Of Independence - Navigating Autism In The Age Of Uncertainty is a fantastic legal resource for ASD families. Order your copy now on our website. 

Today I’m going to clarify the difference between a prompt and a cue through examples. Before we dive in, let’s define:

A prompt is extra support that is added in the form of hints or reminders for a person to achieve success in a skill (Mayer, Sulzer-Azaroff & Wallace, 2012). Usually, the prompt being added does not look like anything relating to the skill.

A cue is something in the environment relating to the skill that naturally reminds the person to do the skill (Bondy, 2017)

For example, if you were to guide your child’s hand to turn on the light, your hand-over-hand support has nothing to do with turning on the light. This is a prompt because you are adding support to teach your child a new skill. However, what if your child entered a dark room and turned on the light? In this case, the darkness of the room is considered your child’s cue to turn on the light.

Prompts are used to teach a new skill like washing your hands, eating with a fork, and doing laundry. As mentioned earlier, these are supports added to help the person learn, but the supports do not relate to the skill. Here are some example prompt types:

Gesture - simple gestures like pointing to the next step (e.g. pointing to the light switch or tapping the light switch)

Model - showing/demonstrating how to complete the task for the learner to imitate (e.g. you turning the light on and then back off for the learner to imitate)

Physical - guiding the learner to do the task through touch (e.g. hand-over-hand to flip on the light switch)

Visual - picture or written instructions (e.g. a picture of a person flipping the light switch)

Verbal - saying the instructions (e.g. “turn on the light”)

These prompts are used initially to teach a skill and then faded so the learner can do the task by themselves without prompts.

Cues are the end goal when fading prompts, so when the learner naturally sees the cue, they will complete the skill they’ve already learned. Think about things you do in everyday life. Cues like hand soap will remind you to wash your hands, or your plate will remind you to grab a fork. Cues will also vary depending on the person and situation. Let me guide you through another cue example:

• What are some cues for you to do laundry?
• Full laundry hamper
• Want to wear a favorite shirt that’s dirty
• Ran out of underwear
• Traveling soon and need to pack

I’m sure the list can go on and on, but notice there are several cues that will tell you to do laundry. All the cues also relate to the skill (doing laundry).

Answered by David Celiberti, PhD, BCBA-D and Nicole Stewart, MSEd, BCBA, LBA-NY Association for Science in Autism Treatment

This is a wonderful and important question! Without a doubt, the long period of service disruption brought about by COVID-19 has been very challenging to families and providers alike. It also brings additional opportunities to observe individuals with autism in their homes, often in differently structured situations, and assess how they manage and function (i.e., what goes well and what does not go well). As a result, missing skills needed at home and skills that you anticipate will be needed once onsite services resume may rise to the top of your priority list. We wrote this article in that spirit. Prior to sharing a non-exhaustive list of possible skills, we would like to offer some considerations on how to use this list to target skills you identify as important to your child at this time.

First and foremost

We strongly encourage you to work with your child’s existing team to set your child up for success and to determine whether teaching should be carried out incidentally or delivered more formally. The complexities and challenges of this time may require you to seek out new sources of support and expertise as well (i.e., consulting with a board-certified behavior analyst) to help make the determination as to how to best target each priority skill.  Be realistic, both with respect to your time and resources, as well as your child’s existing skills and potential. And, of course, be flexible. Finally, give yourself grace.

How do I know which skills are “essential” for my child?

It depends on your child’s age, ability, and your family’s needs. You may notice some missing skills that become readily apparent given that you are with your child 24/7.  For instance, for almost all children, the expectation to keep themselves busy some of the time has greatly increased during this period. For many parents, that has led to the realization that their children may need more direct teaching to acquire and build leisure skills.  In other cases, skills may require more thinking and prioritizing. Think of skills that fill gaps, lead to greater participation, promote safety, and build compliance. Furthermore, COVID-19 has brought to light a brand-new skillset that everyone has had to incorporate into daily routines.  Consider all the new routines you’ve created: carrying hand sanitizer; not leaving the house without your mask; making a more organized grocery list. We have all learned new skills; therefore, reflecting on your own experience may help you identify skills that are relevant for your child, family, and community (e.g., wearing a mask, being more aware of other pedestrians). The post-COVID-19 era will also bring new challenges and opportunities educationally, socially and vocationally. Our work resumés are a helpful framework to guide these considerations. In other words, the questions to ask include, “What skills should my child have on his or her resumé that will help them be more successful now here at home?”, “What skills should my child have on his or her resumé that will help them be more successful once school is back in session onsite?” and “What skills have been necessary in a distanced world, that will probably continue to be needed for some time?”

Teaching

Although beyond the scope of this article, we wanted to provide you with a few topics about which to engage your child’s team.  Please seek the team’s guidance and expertise in the following areas:

1. Assessing present levels with respect to the skill being targeted (and collecting adequate and suitable data);
2. Identifying the goal (e.g., greater consistency, higher quality, independence, speed);
3. Identifying an effective prompt;
4. Fading prompts systematically;
5. Troubleshooting if obstacles or challenges emerge;
6. Determining what type and level of reinforcement to include during the actual teaching; and
7. Planning for generalization and assessing desired carryover.

Following Directions:

• “Come here” or responding to a family term that everyone knows to come together (i.e., “Bubble up”)
• “Stop”
• “Stand here”
• “Stay with me”
• “Come with me”
• “Hands in pockets”
• “Get your mask and put it on”
• “Fix your mask”
• “Put your hands down”
• “Get a tissue”
• “Throw out your tissue.”
• “Use hand sanitizer”
• “Wash your hands and count down from 20”
• “Give ______ space”
• “Keep six feet away”
• Complying with Telehealth and Distance Learning Directions

Activities of Daily Living (ADLs) related to health/safety:

• Thorough washing of hands (front, back, and in between fingers)
• Thorough drying of hands
• Using hand sanitizer
• Tolerating different hand sanitizers and hand soaps
• Putting on a mask
• Tolerating masks for extended periods of time
• Storing or sanitizing a mask safely
• Removing and putting back on mask to eat/drink
• Putting on gloves
• Tolerating gloves for extended periods of time
• Removing gloves and disposing appropriately
• Leaving shoes outside of the house or in an entranceway
• Coughing/sneezing into elbow
• Washing/hand sanitizing after coughs/sneezes
• Cleaning a surface and/or object with a sanitizing wipe
• Using mouthwash
• Having temperature taken
• Compliance with routine medical activities (e.g., swallowing pills, tolerance of band-aids, tolerance for treatment of injuries)

Requests

• Requesting gloves/masks/Personal Protective Equipment (PPE)
• Requesting hug/accepting a refusal
• Requesting a safer greeting (e.g., elbow bumps, fist bumps, air hugs)
• Requesting personal space
• Tolerating delayed access (e.g., “Yes, we can ____but you have to wait.”)
• Tolerating denied access (e.g., “We can’t do ______ but we can _____” or “Not now.” “We are not allowed to share our snack.”)

Self-Management:

• Identifying when to use gloves/mask
• Keeping hands away from face
• Identifying when to use hand sanitizer or wash hands and doing so independently.
• Identifying social distancing cues (e.g., floor markers, one-way signs)
• Not touching buttons or using elbows/pencil/tool to touch buttons/open doors
• Engaging in an incompatible behavior (e.g., walking with hands in pockets)
• Drinking only from one’s own water bottle
• Using a “Leaving the home checklist” (e.g., hand sanitizer, mask, or other PPE items needed outside of the home)
• Following a schedule for a longer period of time
• Following a behavior contract (with simple rules)
• Learning to self-monitor
• Carrying out a broader array of tasks independently
• Being flexible about changes in schedule (both shown visually and/or informed of verbally)

Leisure skills:

• Learning to play with more toys
• Learning to play simple board games/card games
• Tolerating parallel play
• Learning to play cooperatively
• Playing socially distanced games (e.g., charades, Simon says)
• Learning to play video games
• Learning new physical exercises/stretches
• Following a workout or dance video
• Exploring alternatives to current unavailable reinforcers (e.g., watching videos of rollercoasters given amusement park restrictions)

Other home skills:

• Learning new inside chores (e.g., watering plants, making ice, feeding the cat, folding laundry, unloading the dishwasher)
• Learning new outside chores (e.g., weeding, raking, taking the garbage to the curb)
• Helping with home tasks (e.g., using dustpan while another family member sweeps, handing a family member clean dishes from the dishwasher to be put away)
• Preparing a snack
• Problem solving (replacing batteries, replenishing toilet paper) 

Social Skills:

• Identifying and adhering to social distancing space
• Saying, “I wish I could hug you.”
• Practicing other forms of greetings (e.g., a wave, head nod, air hugs)
• Giving and receiving fist bumps and elbow bumps
• Calling/Answering calls and video chats
• Maintaining longer calls/video chats (consider practicing with scripts)
• Playing virtual games 

Technology Skills:

• Logging into Zoom/Google Meet/FaceTime
• Greetings/interactions on a distance platform
• Participating in a video chat for an extended period of time
• Muting and unmuting audio
• Muting and unmuting video
• Responding to instructions on a platform (e.g., “Can’t hear you, you are on mute.” “I can only see your forehead. Can you tilt your screen down?” or “Hold it up so I can see.”)
• Wearing headphones
• Managing passwords
• Troubleshooting technology issues (e.g., rebooting computer)
• Using a broader array of phone skills

Remember, this list is non-exhaustive. While there are so many new skills that need to be learned during this time, or even old skills that have gained new importance, we hope that this list might inspire consideration of these or other skills that are relevant to your child. We encourage you to talk with your child’s team to incorporate new goals that are necessary at this time and that will be helpful moving forward.

Other ASAT articles that may be of interest:

• • Coping with COVID-19: An annotated list of resources for families of individuals with ASD
  • Coping with COVID-19: A non-exhaustive, annotated list of previously published but relevant ASAT articles
  • My child is home with me. Any suggestions for home schooling?
  • What information should I get from the teacher and what can we do to promote carryover during this extended period of home schooling?
  • What input can be provided to the school following an extended period of home schooling?
  • Evidence-based telehealth practice in the time of COVID-19
  • How can I teach telephone skills at home?
  • A review of Autism 24/7: A family guide to learning at home and in the community 

Citation for this article:

Celiberti, D., & Stewart, N. (2020). Clinical Corner: What are some essential skills during this COVID-19 era? Science in Autism Treatment, 17(7).

About The Author

Our brand new social skills curriculum aims to fill an important gap in social skills programs: support and education for pre-verbal and minimally verbal learners with autism and other global delays. In this week's blog post, authors Joanne J. Kim, PhD and Stephanny Freeman, PhD explain how to adapt this innovative new program for telehealth and the COVID-19 era. 

Learn more about Pre-Communication Social Engagement Skills: A Curriculum for Children with Autism Spectrum Disorder and Global Delays

You’ve heard it…

You’re living through it...

We are living in a “new normal” with the novel coronavirus. Across all social spaces, the challenges of remembering to physically distance, wear masks, sanitize our hands, and ultimately learn new ways of being has become a challenge for us all.

Teachers and therapists who work with children with Autism Spectrum Disorder and other global delays are being asked to integrate a new learning platform, and to think more creatively about children who often require more direct face-to-face teaching. Remote learning presents problems for both the teacher/therapist and the child: How do we capture the attention and sustained engagement of children who require added environmental and behavioral supports to access learning opportunities? In return, how are children expected to engage, learn, and generalize educational content?

Parent involvement can be the answer. Parent involvement or participation is widely recognized as a “best practice” strategy in the education of children with ASD (National Research Council, 2001). Parent involvement can take several forms including school-based activities like volunteering in the classroom (not a likely option at the moment) and communicating with teachers, as well as home-based activities like practicing social communication skills (Benson, Karlof, & Siperstein, 2008). Combining both forms can yield an effective way to continue targeting social skills using the PCSES curriculum. Though there may be multiple ways to do so, we describe two ways here.

Method 1:  Parent Education Only

This method involves the professional educating the parent/caregiver through verbal and written information on the target skill, including how to embed the target skill in an appropriate activity as well as a discussion on execution strategies. This option does not involve the child.

For example: Mr. Brown schedules a Zoom meeting with Sam’s mother (primary caregiver). Mr. Brown reviews this week’s social skill target using the screen share function. In fact, Mr. Brown is using the Home Generalization Activity in the PCSES curriculum. A discussion follows on how to modify the example activity to Sam’s home and community settings. Mr. Brown encourages Sam’s mother to do her best and to contact him should any further questions or concerns arise, and sends all reviewed documents via email to Sam’s mother.

Though this method may not result in the fastest progress, research has indicated reduced levels of parental stress as compared to parent-mediated intervention (method 2) as parents are not tasked to act as teachers or therapists with their child, and are free to vary/modify the activity as needed (Kasari et al., 2015).

Method 2: Parent Mediated Intervention

This method involves the professional providing direct parent coaching with the child present. Written information about the target skill may also be provided; however, emphasis is placed on coaching and practicing while the professional is present.

For example. Mr. Brown schedules a Zoom meeting with Jun’s grandmother (primary caregiver). Mr. Brown begins the session by reviewing this week’s target skill and the pre-selected structured activity using the screen share function. As with Sam’s mother, he is using the Home Generalization Activity in the PCSES curriculum. Mr. Brown encourages Jun’s grandmother to facilitate the activity. During this time, Jun’s grandmother is encouraged to stop and ask questions at any time. Mr. Brown also provides direct feedback, coaching tips, and praise to Jun and his grandmother during the activity itself. Once the guided practice is over, Mr. Brown encourages Jun’s grandmother to continue to practice this activity throughout the week, and stresses that he is available for questions at any time. The Home Generalization Activity is emailed to Jun’s grandmother afterwards.

Though direct parent coaching with the child present has been found to be more effective than a parent education only model in improving specific social outcomes, as noted previously, parents/caregivers have reported high levels of maintained stress with this model (Kasari, Gulsrud, Paparella, Hellemann, & Berry, 2015).

As teachers and therapists, it may be wise to select the method of parent involvement that best suits the needs of specific families. Either way, the children that are served will continue to make gains during this time due to teachers’ and therapists’ dedication and fortitude. For this, we thank you.

References

Benson, P., Karlof, K. L., & Siperstein, G. N. (2008). Maternal involvement in the education of young children with autism spectrum disorders. Autism, 12(1), 47-63.

Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology, 83(3), 554.

National Research Council. (2001). Educating children with autism. Washington, DC: National Academies Press.

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In working with individuals with autism, my goal is always to help them move towards independence. Recently, I was speaking with a colleague about an intervention I had done in which a child independently began his bedtime routine (brushing teeth, changing into pajamas, etc.) when his VibraLite watch vibrated at 8PM. When the watch vibrates, he resets it for 8PM the next day. Her response was that she didn’t believe that was truly independent behavior, since he required the prompt of the watch vibration. Many of you reading may agree with my colleague, but I think we must consider independence today in the context of our own behavior.

In the evening, I set an alarm clock, and I only wake up in the morning when it buzzes. When I run out of milk, I’ll put an alert in my Reminders app on my phone. When a friend invites me to lunch, I immediately enter the date in my calendar. All of these are technically examples of prompts, but if I am managing the prompts, I would argue that I am in fact engaging in independent behavior.

When I think about independent behavior, I want the children I work with to one day be able to grocery shop, go to work, eat a meal with a sibling, and more without having another adult facilitate those interactions. I want them to remember the time a movie starts, recognize when clothing needs to be washed, and pay their bills on time without another adult reminding them.

So, that begs the question: what counts as independence? We live in a time in which means we have a plethora of tools at our fingertips that weren’t available even a few years ago. Here are a few things you might want to think about in terms of independence:

• What are the individual’s peers doing? Is it common for their peers to use a technological tool such as an iPad in the behavior you’re targeting? If not what are they using? Would that be an option for your learner?
• What do you use in your day? If I’m using a Reminders app to keep track of my grocery list, then there’s no reason an individual with autism shouldn’t be allowed to do the same!
• What does the research say? Many of the technological tools we use haven’t been out for very long, so it’s only been in the past couple of years that the research base is starting to catch up in terms of appropriate use of tablets, smartphones, and the like. But there’s a lot of good research out there! Take a look at the suggested reading list at the end of this article (and don’t forget to look at the reference lists in those articles to find more research.)
• What does the individual gravitate towards? I have some students who prefer paper and pencil, and others that enjoy using tablets. I’m going to select interventions and tools for independence based on the individual’s own preferences! This may mean you have to try a few things out before you find the best fit.

All in all, I think it’s essential that individuals with autism be held to the same standard as the neurotypical population, not a higher standard when it comes to teaching independence.

Suggested Readings:

de Joode, E., van Heugten, C., Verhey, F., & van Boxtel, M. (2010). Efficacy and usability of assistive technology for patients with cognitive deficits: A systematic review. Clinical rehabilitation, 24(8), 701-714.

Hill, D. A., Belcher, L., Brigman, H. E., Renner, S., & Stephens, B. (2013). The Apple iPad (TM) as an Innovative Employment Support for Young Adults with Autism Spectrum Disorder and Other Developmental Disabilities. Journal of Applied Rehabilitation Counseling, 44(1), 28.

Kagohara, D. M., Sigafoos, J., Achmadi, D., O’Reilly, M., & Lancioni, G. (2012). Teaching children with autism spectrum disorders to check the spelling of words. Research in Autism Spectrum Disorders, 6(1), 304-310.

Kagohara, D. M., van der Meer, L., Ramdoss, S., O’Reilly, M. F., Lancioni, G. E., Davis,
T. N., Rispoli, M., Lang, R., Marschik, P. B., Sutherland, D., Green, V. A., & Sigafoos, J. (2013). Using iPods® and iPads® in teaching programs for individuals with developmental disabilities: A systematic review. Research in Developmental Disabilities, 34(1), 147-156.

Mechling, L. C., Gast, D. L., & Seid, N. H. (2009). Using a personal digital assistant to increase independent task completion by students with autism spectrum disorder. Journal of Autism and Developmental Disorders, 39, 1420-1434.

Uphold, N. M., Douglas, K. H., & Loseke, D. L. (2014). Effects of using an iPod app to manage recreation tasks. Career Development and Transition for Exceptional Individuals, 39(2), 88-98.

Van Laarhoven, T., Johnson, J. W., Van Laarhoven-Myers, T., Grider, K. L., & Grider, K. M. (2009). The effectiveness of using a video iPod as a prompting device in employment settings. Journal of Behavioral Education, 18(2), 119-141.

Wehmeyer, M. L., Palmer, S. B., Shogren, K., Williams-Diehm, K., & Soukup, J. H. (2010). Establishing a causal relationship between intervention to promote self- determination and enhanced student self-determination. The Journal of Special Education, 46(4), 195-210.

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

Recently I was working with a parent who was using a TimeTimer with her son to help him recognize when it was time to get ready for bed. Our plan was to start the timer every night while he was engaged in an activity, show him the timer and have him repeat how many minutes left, then have him tell his mom when the timer went off. For the first couple of weeks, this plan worked beautifully. The boy could see the time elapsing, brought the timer to his mother when it went off, and then started the process to get ready for bed without engaging in tantrum behaviors.

I went in for a parent training session after a month of the intervention and the boy’s mother informed me the timer just wasn’t working any more. As we started talking, I realized that the mother had drifted from our original plan in a way that is quite common. As her son experienced success, she used the timer less frequently. Then, if he was struggling, she would introduce the timer. In effect, she started only using the timer when he was misbehaving, instead of using it as a consistent tool to help him with the bedtime routine.

This type of procedural drift (when there is an unintentional or unplanned change in the procedure outlined for the intervention) is very common for parents, teachers, and ABA therapists. It’s important to understand this type of drift so it can be corrected when it occurs.

Here are a few things to remember when implementing an intervention:

• First, any intervention should include a clear plan for fading the intervention. In the example above, the TimeTimer was an appropriate tool for this particular child, who was only four years old. But we don’t want him to rely on the timer for the duration of childhood! A plan should include how to fade the intervention with specific steps and specific requirements for mastery.

• The use of the TimeTimer is considered an antecedent intervention. This means that we are implementing a change in the environment prior to any problem behaviors to help the child contact reinforcement and experience success. Antecedent interventions should be implemented consistently as part of a routine, not ONLY when a problem behavior occurs. If it is only implemented when the problem behavior occurs, it is no longer an antecedent intervention.

• If we implement a tool (like the TimeTimer) only when problem behavior occurs, it’s possible the tool will become aversive to the child and possibly result in an increased magnitude of the problem behavior.

• Consider using tools for the people implementing to intervention to remind them of the specific steps. For example, you might create a video model and instruct the parent (or other adult implementing the intervention) to watch it every couple days. Or you might post the steps in a clear space to be reviewed regularly.

• Finally, we have to remember that a couple of good days in a row without any instances of problem behavior does not mean that the problem is solved. This is why the first step outlined above is so important. We want to teach the child replacement behaviors and give them lots of opportunities to be successful with it.

Ultimately, we were able to re-implement the procedure with this parent and see more continued success with this particular case. We also decided to post the steps to the intervention on the back of the TimeTimer for easy review on a daily basis.

However, in some cases, you might have to create an entirely new intervention using different tools. The goal is to be clear about the steps of the intervention, and to maintain those steps when implementing the intervention.

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

Recently I was supervising a session in which the current goal was for the child to identify cards by category. The teacher was placing three cards in a messy array, and asking “Where’s the animal?” or “Point to the food.”

When the child got it right, the teacher did a great job of providing reinforcement. However, if the student didn’t respond correctly, the conversation might look like this:

TEACHER: What is this? (Pointing to zebra)

STUDENT: No response.

TEACHER: Come on. You know this one.

STUDENT: Horse?

TEACHER: No. You know this one. Remember we did a puzzle earlier with this animal.

STUDENT: Animal?

TEACHER: What animal? Remember the puzzle?

While the intention of the teacher is understandable, this is not an evidence-based error correction procedure. We don’t want our student practicing errors. Often, you might see your student is making the same error over and over. This means there has been in error in our teaching, and we need to make adjustments. Many times, the error is in how we correct errors.

The example described above is one that I commonly see when supervising. Many of our students don’t have strong listening comprehension skills, so continuing to give clues isn’t teaching our student to respond to “What is this?” but is actually teaching them to respond to some other stimulus. The very first recommendation I had as this teacher’s supervisor was to be clear with the discriminative stimulus.

But how should we correct the student’s initial error? There are several commonly used, evidence-based error correction procedures, but the most effective procedures vary from individual to individual. It’s valuable to assess the evidence-based procedure that is most effective for you individual student prior to beginning teaching procedures. This will make your teaching more effective and efficient.

There is a lot of research about error correction procedures for individuals with autism. Carroll, Joachim, St. Peter, & Robinson (2015) clearly outline four commonly used procedures and explain how to assess an individual’s response to each procedure. Carroll, Owsiany, & Cheatham (2018) utilized a short assessment for determining which of five commonly used procedures may work best for a specific individual. Starting with these two articles can clarify how to best move forward with your students or clients.

Written By Sam Blanco, Phd, LBA, BCBA 

Sam 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

Time-out is often a hotly-debated topic. Is it too punishing? Where should it take place? How long should it last? There are not easy answers to many of these questions. But there are some evidence-based suggestions that may improve a time out procedure should you decide to use one.

• First, know the function of the behavior! If the child is engaging in the undesirable behavior for escape, then providing “time out” will likely increase the behavior. For instance, if a child gets sent out of the classroom each time he curses, this is effectively a time out from classwork. He may curse because in the past, cursing resulted in escaping from classwork. This is an instance when you would not want to use time out. A time-out may prove to be effective for behaviors that function for attention or access to tangibles. More on that next…

• Consider a nonexclusion time-out procedure. In the past, we’ve discussed the time-out ribbon here. This is a useful tool for signaling to a learner that they have access to social or tangible reinforcers. If they engage in an inappropriate behavior, the ribbon is removed and they do not have access to social or tangible reinforcers, however they are still able to participate in the lesson or activity you have organized. It also allows them to practice more appropriate behaviors to earn the ribbon back. If the ribbon isn’t the best visual cue for your learner, you could make it anything this is visible for them and clearly delineates when they do and do not have access to reinforcement.

• Consider the use of a release contingency. This means that a learner is unable to leave time out until a predetermined amount of time has passed without problem behavior. Perhaps if you’re working with a preschool child who has been kicking other children, the release contingency might be that they must sit with “quiet feet” or “feet on the floor” for one full minute before they can go back to play. Your other option is to put in a fixed time contingency, which is best done by setting some sort of timer so the learner can see how much time is remaining in time-out.

• Combine time out with positive reinforcement procedures. Time-out by itself may result in decreases in behavior only when time out is a possibility. For instance, you may see a decrease in the problem behavior only when the child’s mother is at home, because the father doesn’t use time out. The goal is to decrease the problem behavior across all settings and activities. To that end, it’s helpful to teach appropriate replacement behaviors and reinforce the learner for engaging in those behaviors.

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

Understand the difference between speech and language: This is a major distinction that could make a significant impact on the way you write your treatment plans, consult with a clinical team and provide supervision. The importance of this distinction could be compared to a mechanic working on a car or a surgeon working on a body. It is kind of important for them to know which part needs work and what work needs to be done. Right? If not, you might be attempting to fix the breaks when you need a new tire or operating on a toe when the person needs heart surgery. All too often I have seen this scenario in ABA programs and it's kind of a big deal.

Consider speech disorders: It is common for BCBAs and children with autism to struggle with verbal programs. A child might fly through a receptive language program for identifying common objects like ball or cup. But when you start working on imitating sounds or labeling objects, the behaviors go through the roof. In my experience, professionals tend to think this is related to motivation. One might think that increasing reinforcement during these programs could be the answer. Another professional might suggest only working on requesting (manding) with preferred items. I have seen these ideas work just fine in some cases. But if a child is displaying challenging behaviors during speech programs or the rate of skill acquisition in a speech program is not in line with the other skills you are teaching, this is a good indicator there is something more that needs to be addressed aside from motivation, a speech disorder.

Develop relationships with speech-language pathologists (SLP): Depending on your situation, this can be easy or a major challenge. At the end of the day, we all want the same thing: to help a child communicate. We can all agree on that. However, there are often differences between the way an SLP looks at a child and the way a BCBA looks at a child. Many times both professionals are saying the exact same thing, but speaking a different language. This can make it difficult to collaborate effectively for the benefit of a child with a speech disorder. If you have working relationships with SLPs, you are likely to be inspired to refer a child for an evaluation if he or she needs it. You are also likely to seek expert advice when developing speech goals for a child. This collaborative relationship could have a major impact on a child's ability to reach his or her full potential. As you may be aware, some SLPs do not understand your education. your skills or your role. That is common; although it is much better than it was when I entered this field 20 years ago! If you come in contact with an SLP who is not helpful, move on. Keep looking. Do not give up on this. These relationships can mean the difference between a child developing verbal skills or not. That is not a risk any professional should take.

Learn to be comfortable with the chaos: I have been working with BCBAs before a BCBA certification was invented, so I know first hand what types of personalities go into your profession! You are highly structured individuals with a plan from point A to point B. You have your charts and your data and you are ready to go. But speech disorders are not always straight forward. It can be difficult to break everything down the way you want it to and that can be frustrating and uncomfortable. Every single detail may not be controlled and that is okay. Understanding the nature of the speech disorder and how to treat it is much more important than accounting for everything and taking data on it. If you were a surgeon, the most important thing would be to know what body part you were working on and what needed to be fixed. The journey in between is going to be different for every child because they have lots of different body parts working in different ways. If done effectively, it should feel a bit chaotic. Knowing this could help to ease your mind as you work to help your clients reach their full potential.

About The Author

Tara Boyd (formerly Bertone) has worked 23 years with children diagnosed with Autism Spectrum Disorder (ASD) in Applied Behavior Analysis (ABA) programs and multidisciplinary clinics since 1996.

She has a bachelor’s degree in Speech-Language Pathology and Audiology from the University of Nevada Reno, with a minor in Spanish and a master’s degree in Communication Disorders from the University of Minnesota-Twin Cities. After graduating with her master’s in 2001, she started her career as a speech-language pathologist (SLP) providing one-on-one intervention, in addition to social-communication groups for children with ASD.

In 2005, Tara founded Autism Matters, a multidisciplinary clinic dedicated to children with autism and their families. The program provided speech-language therapy, occupational therapy and ABA therapy in the Minneapolis area. She built two locations employing 50+ employees, including speech-language pathologists, occupational therapists, and board-certified behavior analysts.

In 2016, Tara sold Autism Matters to a local healthcare company, relocated full time to the Phoenix area and founded Scottsdale Autism Services DBA Ally Pediatric Therapy. In the fall of 2019, she also sold her interests in this company and set off on a new adventure with Therapy Queen Bee: a company dedicated to training, education, and support for therapists and parents caring for children with special needs.