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A Review of Promoting Functional Communication Within the Home

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

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

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

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

Nine Critical Communication Skills

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

Final Thoughts

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

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

Citation for this article:

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

About The Authors

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

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

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By Sam Blanco PhD, BCBA, LBA, Mordechai Meisels MS, BCBA, LBA, Bryan J. Blair, PhD, LABA, BCBA-D, and Laura Leonard MS, BCBA, LBA

As providers of services to people with an autism spectrum disorder (ASD), we are experiencing an unprecedented situation given the impact of COVID-19 on nearly all service providers. As schools, organizations, and individual practitioners work to shift their practice to a virtual service delivery model, it is essential that we maintain a commitment to evidence-based practice. When faced with so much uncertainty, it can be a relief to turn to the research base and identify how to implement best practices within this new model. Research on telehealth provided to individuals with autism has grown in recent years and demonstrated that effective treatment is possible (Ferguson, Craig, & Dounavi, 2019; Peterson, Piazza, Luczynski, & Fisher, 2017; Vismara, McCormick, Young, Nadhan, & Monlux, 2013; Ferguson et al, 2019).

The first priority when implementing services via telehealth is to ensure you are using a HIPAA-compliant platform, such as Doxy.me or WhatsApp. When we approach evidence-based practice, we must focus on three primary areas of research: the basic principles of ABA and its practical applications, applications of telehealth, and other uses of technology in teaching. The good news is that there is a lot of research-based information available to guide us as we change to a telehealth model.

Current research on telehealth for individuals with ASD primarily focuses on parent training and supervision. However, in the current crisis, it is necessary that direct care be provided through telehealth. In order to effectively provide direct care, we are suggesting the following steps in order to appropriately implement telehealth services. 

(1) Assess prerequisite skills and unique needs of the client. An assessment and survey is provided at the end of this article (Appendix A). The BCBA should complete this assessment with parents/caregivers in the room with the client. If the results of the assessment demonstrate that the client does not have the prerequisite skills to participate effectively in interventions delivered remotely (i.e., telehealth), then the prerequisite skills will need to be taught and/or a parent/caregiver will be required to be in the room with the client during direct care. It is also possible that with drastic changes in routines and supports, problem behaviors may have increased or topographies of problem behaviors may have changed. If this is the case, the BCBA should also conduct a functional behavior assessment (FBA). An FBA can effectively be conducted through telehealth (Wacker, et al, 2013). 

There are many options for how a telehealth session can be conducted and how a display (e.g., computer screen) can be presented to the client. In assessing prerequisite skills of the client, it may also be beneficial to conduct a preference assessment of the general set up for the client. For example, does the client respond better when the screen only shows the practitioner’s face, or does the client respond better when the screen shows the practitioner’s face and a token system, etc. There are many options for how the screen is presented to the client. 

(2) Conduct parent training to adequately prepare for telehealth. Prior to any direct care provided by a behavior technician, the BCBA should conduct parent training. There are three goals that should be targeted and met here. First, the BCBA and parent should work together to teach prerequisite skills to the client. If prerequisite skills cannot be taught quickly, then a clear plan should be developed and implemented for how the parent/caregiver will assist with prompting and providing reinforcement during sessions with the BT. The next goal is to identify any potential safety issues and provide guidance on implementation of any interventions. Finally, the parents should be taught what to expect from telehealth and provided with a clear plan for giving feedback to the BCBA throughout the process. 

(3) Identify reinforcers and how reinforcement will be provided. A preference assessment should be conducted with the client utilizing any new options presented through the use of technology as well as identifying any barriers resulting from the use of telehealth. For example, a potential new option might be sharing your screen to show clips of a client’s favorite show on YouTube. A potential barrier might be that a highly reinforcing activity might include social mediation and/or interaction with another person that is not possible unless you’re physically in the room or that the client is unwilling to relinquish a reinforcer when the BT is not physically present in the room.

Speak with the parents (and the client if he/she is capable of participating in the conversation) about specific reinforcers to include in the preference assessment. After the preference assessment is conducted, you should create a clear plan for how reinforcement will be provided. 

One potential option here is the use of a token system. The research-base on using token systems with telehealth is primarily focused on teaching parents how to utilize the token system correctly (Hall, 2018; Machalicek, Lequia, Pinkelman, Knowles, Raulston, Davis, & Alresheed, 2016).  If a token system is currently in place, it may be beneficial to continue with the existing system as long as the necessary materials are in the room with the client and either the client can provide his/her own tokens upon being told to do so by the BT or a person in the room can provide the tokens. Another option is to use existing technology to provide tokens. If you elect to use technology, you can remotely split the computer screen to show a token system on one side of the screen, use built-in capabilities of platforms such as Microsoft Teams to switch control of the screen to the client so he/she can give the token upon correct responding, or use built-in capabilities of platforms to share the screen of an existing token system app. If a token system is being used and earning the requisite number of tokens results in an activity within the client’s room (i.e., access to a preferred toy) you must assess the client’s ability to relinquish the reinforcer. A final possibility here is to incorporate access to preferred videos or songs through the shared screen.

If a token system is not being utilized, a clear plan and schedule of reinforcement should be defined. The plan could include delivery of reinforcement in the form of videos, online games, or apps through the telehealth platform by the BT. If reinforcement includes items that are present in the room with the client (such as edibles or favored toys) then an additional person (such as a parent or older sibling) will be required to be present in the room with the client during sessions. 

If the client responds to vocal praise as a reinforcer during in-person sessions, then it should be determined if vocal praise through the screen is also reinforcing for the client. If it is not, a response-stimulus pairing procedure (Dozier, Iwata, Thomason-Sassi, Worsdell, & Wilson, 2012) should be utilized. 

Sessions with the BT should not begin until the previous steps have been completed and the BT has been trained on both the platform for delivering services and the steps for implementing programs and delivering reinforcement.

(4) Train the BT on how to implement discrete trial instruction through telehealth. Discrete trials training can be implemented as it typically is, though technology can be utilized to streamline the process when images, text, or videos are used. Cummings & Saunders (2019) utilized PowerPoint 2016 to create matching-to-sample trials for use in discrete trial instruction. Blair & Shawler (2019) identified best practices and provided a tutorial for developing and implementing emergent responding through computer-based learning tools. In addition, there are apps such as Kahoot or Quizlet Learn that can be utilized. 

It is essential that any technology components that you introduce are clearly understood by the BCBAs and the BTs. Our recommendation is that brief video models be provided (i.e.,video-supported task analyses)  so that the steps of implementation are clear to all practitioners implementing services. After video models have been viewed, the BT should practice implementing the technology with the parent or the BCBA prior to conducting a direct care session.

If it has been determined that the client does not yet have the prerequisite skills for the BT to implement services through telehealth, the parents should be trained on implementing discrete trials. Hay-Hansson & Eldevik (2013) outlined a procedure for using videoconferencing to train discrete-trial instruction teaching. 

(5) Consider how visual schedules and supports may be used. Visual schedules and supports can be presented on the screen, utilized through a separate app (such as Todo Visual Schedule or Choiceworks), or made with pre-existing materials that are in the home. If you elect to use a separate app for the visual schedule, ensure that the BT has mastered the platform for providing instruction before implementing additional technologies. 

(6) Consider how to implement Active Student Responding (ASR). Drevno, Kimball, Possi, Heward, Gardner, & Barbetta (1994) identify a clear procedure for implementing error corrections during ASRs. With the use of technology as described previously (such as Microsoft PowerPoint) error corrections can be made quickly because they can be built directly into the presentation. 

Ultimately, as you review the suggestions, two things become very clear. First, we must consider the training needs of the client to effectively participate in treatment through telehealth. Second, we must consider the training needs of the practitioners who will be implementing treatment to ensure they can effectively put these practices in place. More than ever, we must assist each other in providing resources: sharing video tutorials for how to implement specific technologies, identifying technologies that will allow us to better implement services, and identifying platforms that reduce response effort and training needs for BCBAs and BTs. 

Download Appendix A: Telehealth Clinical Effectiveness Survey here.

Mordechai Meisels is the Founder and Chief Clinical Officer of Encore Support Services, a leading provider in special education and ABA therapy services.  Under his leadership, Encore quickly expanded across state lines, servicing thousands of children in the Tri-State area. Mordechai’s vast expertise in the behavioral health industry inspired him to fill a critical void with the founding of Hadran Academy, a high school for high functioning autistic youth. In true visionary form, Mordechai combined his background as an expert clinician and passion for technology with the creation of Chorus Software Solutions. As the Founder and CEO of Chorus, Mordechai is committed to creating innovative technology to empower care teams, increase operational efficiency, and ultimately impacting quality of care.  

Dr. Bryan J. Blair is a licensed behavior analyst (MA), Board Certified Behavior Analyst, and is currently an Assistant Professor at Long Island University – Brooklyn where he is also the coordinator of the Applied Behavior Analysis graduate certificate and supervised fieldwork programs.  He has worked with children and adults with developmental disabilities and other clinical disorders for over 15 years in a variety of settings.  For more information or to contact Dr. Blair please see his website:  https://www.bryanjblair.com.

Laura Leonard MS BCBA LBA is the owner and clinical director of ABA TREE, a behavioral health agency in NYC, former ABA director of an early intervention program and current Director of Behavioral Services at a private school in Brooklyn. Laura provides supervision to BACB candidates and is primarily focused on reduction of maladaptive behaviors. www.abatree.org

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

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ABA Essentials: Token Economies!

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Introducing DiffPoints!

You might have noticed that little purple button at the bottom of our site labeled “Check DiffPoints”. What are DiffPoints? We’re glad you asked!
DiffPoints are our way of saying “thank you” for everything you do to stay engaged with Different Roads! Purchases, reviews, and referrals are all ways to earn points that can help you save on future purchases. There are many ways to earn rewards – click on “Check DiffPoints” for more details!
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Go Play! The Importance of Symbolic Play in Early Childhood

Go Play! The Importance of Symbolic Play in Early Childhood

This week’s post comes to us from Stephanny Freeman, PhD and Kristen Hayashida, MEd, BCBA, our partners on the Play Idea Cards app. Play Idea Cards is a full curriculum on teaching play – right in the palm of your hand! Check it out on the Apple App Store

Most adults think of toy play as a natural part of childhood.  When my daughter was born, we were showered with plush animals, tea sets, and dress up clothes for her to use in play.  But what happens when the child does not find toy play to be natural?

Many children on the autism spectrum use toys non-functionally or repetitively.  When I ask parents of children with ASD to tell me about their child’s play they often say “he doesn’t know how to use toys appropriately!”  They then tell me about how the child may spin the wheels on the car while staring at the rotating objects.  They tell me about the specific scripts the child uses to carry out a routine with their toys and subsequent tantrums if the routine is disrupted.  Parents notice how this deficit in play impacts their ability to engage with peers or occupy their free time appropriately.

What is symbolic play? Symbolic play occurs when the child uses objects or actions to represent other objects or actions.  For example, a child using a doll as their baby and rocking the doll to sleep is an act of symbolic play.  The doll is not alive, but the child is representing a baby.  This skill is a core deficit in children with ASD.  This means that they do not “naturally” or “easily” acquire the ability to use toys to represent other things.  Development of symbolic play is crucial in early development and is tied to numerous subsequent skills:

Language: symbolic play is highly correlated to language development.  This means that the better the child’s ability to play representationally, the better the child’s language skills.  There is also emerging evidence to support symbolic play as having a causal relationship to language.  [Explanation].

Social Development: as neurotypical children continue their learning about symbolic play and through symbolic play, children with ASD often struggle to relate to their peers and understand their play schemes.  Some children with ASD may only engage peers in physical play (instead of symbolic play) or they may end up playing alone using their familiar play scripts.

Perspective-taking: symbolic play allows the child early opportunities to take on the perspective of another being.  If a child pretends to be a pirate, they being to talk and think of things a pirate might want/do.  This early practice with perspective-taking allows the child to use this skill when interacting with peers and adults.

Meta-cognition and Problem Solving Skills: meta-cognition is the ability to think about one’s own thinking.  This is an essential skill when solving problems and planning one’s time.  During play kids plan, organize and cognitively process through obstacles and mishaps with their toys.

Emotional Development: through symbolic play, children can practice expressing emotion through the scenes they create.  There is also some evidence suggesting that this early practice contributes to emotion understanding and empathy.

Clearly, children need symbolic play in early childhood for growth and development.  However, for children with ASD the development of symbolic play may be difficult and, even thought of as WORK!

Given the numerous skills that come out of symbolic play, we urge parents of children with ASD to consider the importance of toy play.  Dedicate time and effort to engage your child in symbolic play.  It is usually not easy at first!  It might have been decades since you picked up an action figure and used him to fight off bad guys, but practice with your child.

Parents know that it is part of their job to help their child learn to read and do basic math.  They would not let their child escape those tasks because they are hard.  Please consider PLAY to be just as important and necessary for the child’s development.  Even if it is work at first, insist the child play with you and in time, improvements may come not only in toy play but also in so many other key areas of development.

Jarrold, C., Boucher, J., & Smith, P. (1993). Symbolic play in autism: A review. Journal of

Autism and Developmental Disorders, 23(2), 281-307.


Ungerer, J.A. & Sigman, M. (1981). Symbolic play and language comprehension in autistic

children. Journal of the American Academy of Child Psychiatry, 20, 318-337.

About The Authors

Dr. Stephanny F.N. Freeman is an Associate Clinical Professor in the Department of Child Psychiatry at UCLA and a licensed clinical psychologist. She Co-Directs the Early Childhood Partial Hospitalization (ECPHP) Program at UCLA. Research interests included the social (peers and friendship) and emotional (recognition, empathy, and problem solving) development of children with developmental disabilities. Dr. Freeman also investigates and has published research-based intervention procedures on core deficits for preschool and young children with autism, best practice interdisciplinary interventions for children with autism, and play/social skills development in autism. As director of ECPHP, Dr. Freeman oversees the day-to-day activities of therapists and specialists. She coordinates the evaluation, treatment, and development of appropriate multidisciplinary programs for school-aged children and severely impaired children with autism. She assists parents in developing appropriate educational programs and school-based modifications, behavior education and training, cognitive development, and social/emotional/play development.

Kristen Hayashida, MEd, BCBA currently instructs and nurtures high-functioning with autism at the University of California, Los Angeles, Early Childhood Partial Hospitalization Program (UCLA ECPHP). Serving as head teacher, she helps design and implement comprehensive treatment plans to improve her students’ ability to function in the general education classroom and among their peers of conventional development. Additionally, Kristen is involved in research that examines co-occurring social and behavioral disorders in the clinic population of children with autism spectrum disorders. Kristen has also taught weekly social skills groups for young children with autism. Kristen holds a Masters in Education from the Harvard Graduate School of Education in Human Development and Psychology. She graduated from UCLA with a bachelor’s degree in Sociology with a minor in Applied Developmental Psychology.

Julie Azuma
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It Takes a Team: 4 Steps to Building a Stronger Therapy Team

For students on the Autism spectrum, having a strong and reliable therapy team to support individual needs can be an important factor in student success. When members of a therapy team are collaborating seamlessly, a student is more likely to have high quality support across all areas of development (communication, social, cognitive, play, motor, and adaptive skills).
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