Autism: February 2010

Taken from http://blog.navigationbehavioralconsulting.com/

understanding the ablls-r part 5: section e vocal imitation

I would like to make it very clear that reading this series DOES NOT replace formal training on the ABLLS-R and that anyone using the ABLLS-R should read the companion guide as well prior to using the assessment. Here is the link for purchasing the ABLLS-R and/or Companion Guide Additionally, what you will find below is all based on my OWN experience. As far as I know there is limited to no research to support my suggestions. I made theses suggestions and provided these explanations based on my experience with how clients acquired skills and what worked best for my purposes. Always remember to invdividualize programming for your child/client and consult the research. The information that I am sharing here is to provide a basic skeleton for people who are not familiar with the sections of the ABLLS. Hopefully after reading this series you will have a better understanding of what skills are targeted in each section of the ABLLS, how to combine goals when possible, and what the typical progression of skills is like for children on the spectrum. "Typical" progression means that typically the skills are easier when done in this order however this is not always true. For instance, sometimes you will have a child who is highly verbal but does not listen well so it is easier to teach them expressive tasks first then receptive. If any providers/parents who read this blog have suggestions on other ways to combine/target/organize goals, please do share

ABLLS-R Section E – Vocal Imitation

Focus: The focus of this section is on basic vocal imitation then advanced vocal imitation.

Skill Progression: imitating basic sounds imitating sound combinations imitating words matching the model exactly imitation of phrases imitation of number sequences repeating a message to a person/spontaneous imitation.

When/how to implement: This program obviously cannot be started unless the child is making vocalizations. The program can be implemented with basic sounds if you start using the sounds the child already makes. It is very tricky to implement and hard to reinforce. We typically informally target imitation during mand training first. Once the child is making sounds/words reliably for preferred items then you can target sounds. Some clients do better with sounds and some do better with words start with what you client does better with. Vocal imitation may be an ongoing programming in order to improve articulation of words as the child has difficulty with annunciating them.

Goals that can be combined:

E1/E3/E8/E9/E10/E12 – all of these goals focus on imitation of sounds or words. They can be combined in a vocal imitation program. For targets use the resources listed above, resources from the speech teacher, and work on sounds/words you hear the child have difficulty with. Always start with sounds/words you hear the child say then move onto novel sounds/words.
E2/E4/E5/E6/E7 – These all focus on advanced imitation of sounds. You might want to target these before targeting words if you have a client that has difficulty saying words. Each goal can be a target in an advanced imitation of sounds program. A lot of the children probe out of these goals.
E15/E16/E17 – These focus on advanced imitation of sounds and words. You want to wait to target these until the child is reliably imitating a variety of sounds and words.

Posted by Megan DeLeon BCBA at 2/3/2010 8:46 AM | Add Comment

convincing your school to allow aba

A parent asked me for advice on how to convince a school system to use ABA so I am going to attempt to answer that question in this blog.

I have to admit that this topic is not something that I am in any way an expert on. I have attended aWrightslaw Workshop and read some of his books and materials on his web site. I lived in Florida the past few years and the school system in Bay County had two BCBAs working for their Autism Program and their classrooms were set up using the principles of behavior analysis so I don't have much practice convincing schools to use ABA. My recommendations are going to be based mostly on opinion with a few resources sprinkled in.

My first piece of advice is straight from Wrightslaw but also from my own experiences over the years: BUILD A RELATIONSHIP WITH THE SCHOOLS. The old saying "you get more bees with honey" is so very true. I know it can be tempting to go into meetings with the school on the defensive and with an attitude, but I can guarantee you this will probably not get you anywhere! Instead go in with a smile on your face and ready to listen to what your school is offering. Praise them for all of their hard work (even if there hasn't been much hardwork) and make a lot of statements such as "I am so happy that you have my son's best interest in mind" "You all are wonderful for what you do, you have such patience" etc This will help when trying to make your point later.

The next piece of advice I have is: HAVE YOUR DATA READY. Hopefully you have already been receiving some ABA before starting school or at least while in school. It is very important for you or your behavior analyst to have the raw data and a nice data summary of skills mastered since starting ABA. An ABLLS-R grid or VB-MAPP grid would be nice too in order to show skill progression. A nice way to summarize the data would be a cumulative graph of skills mastered by month or week. If you need help making this graph please let me know. Another nice summary of data would be anything showing reductions in behaviors such as tantrums. There are two reasons for having data: one it is hard to argue with data it is very objective. The second is the schools are required by law to use evidence based methods so if you have data to show this method is working for your child, and you say you would like for these same methods to be used in school because of the "data based decision making requirement."

I also recommend following all of the tips set out by Wrightslaw in the book From Emotions to Advocacy. Pete Wright and his wife have been working in this area for a long time and their book is based on their experiences with the schools so it only makes sense to follow their recommendations.

My biggest recommendation is to try breaking things down a bit. Maybe the school has already been resistant to ABA or maybe they have misconceptions about ABA or have no idea what ABA is. It might be more helpful to recommend techniques rather than asking directly for ABA. For instance, request that your child's IEP goals be derived from the ABLLS/VB-MAPP (you could tell the school that you were looking up IEP goal developing resources and came across the ABLLS/VB-MAPP or you could offer a few of your own IEP goals looking at the ABLLS/VB-MAPP yourself or having your behavior analyst make recommendations. It is important if you do this though to share the ideas with the team prior to the IEP so they don't think you are springing it on them and if the school is really resistant you might not want to say how you came up with those ideas) or that your child receive access to preferred items contingent on performance (typically this would be called reinforcement) or that your child receive assistance and have tasks broken down (prompting and shaping). It might be much easier to directly add in notes/parent requests like this then to ask for an overhaul of their system. If they see these things working, it might also help for some buy in for future additions of ABA methodologies.

I would also recommend referring them to the following reports/resources that show that ABA is THE established method for teaching children with autism. Because of the data based decision making requirement showing them these resources will help. Some suggestions on how you could bring these up "I know you all have (child's name) best interest in mind and I recently came across these reports that detail which autism interventions are effective and which ones are not. I thought they would be helpful for you all when deciding what interventions to use. I know you have to use data based decision making so hopefully these reports will help you all to decide what methods are evidence based. Who knows the reports might even help the school district to avoid law suits in the future ***don't say that if you are planning on suing the school and/or make sure to say it in a joking tone!***Here are the reports:

Maine's Report

National Autism Center's Standards Project Conclusions

National Autism Center's Standards Project Overview

National Autism Center's Standards Project Full Report

National Autism Center's Evidence Based Practice and Autism in the Schools ***I haven't read this yet but it is probably the best one!

I would also recommend this book for yourself and teachers because it lays out what methods are necessary for autistic children to thrive in the classroom. While you can't force the school to use ABA, they do have to use evidence based practice and this book is another summary of what practices are evidenced based for autistic children. Educating Children with Autism

If you all have any behavior analysts in the area, I would also recommend seeing if any of them would do a free workshop for teachers where they show videos and basic techniques in order to get some more buy in from the school system.

Those are my recommendations. I hope they are helpful. I will leave you all with this Success story from Wrightslaw about how one mom was able to get ABA for her child from the schools. Also, if you have any specific questions related to this topic, please feel free to ask and I will give my input on the more specific questions as well.

Posted by Megan DeLeon BCBA at 2/2/2010 7:02 PM | View Comments (2) | Add Comment

understanding the ablls-r part 4: imitation

ABLLS-R Section D – Motor Imitation

Focus: Teaching basic and advanced imitation skills. Imitation is a skill learned very early on by typically developing children and it is a prerequisite skill for learning a lot of other skills.

Skill Progression: basic imitation imitation of facial/mouth movements  advance imitation matching model exactly  imitation of sequence of actions/combining imitation with vocals spontaneous and delayed imitation

When/how to target: A basic imitation program for motor movement and object imitation should be included at the very beginning of programming. More advanced imitation skills can be targeted as soon as basic imitation is mastered but only if the child attends well. Sometimes the child also needs to be tested to see if the more advanced imitation is frustrating. If it is you want to hold off on teaching it for a few months, and then try to introduce again. Also, make sure to use the phrase “do this”. The biggest mistake I see with this program is the instructor saying the action “clap” or “push car” instead of “do this.” If you tell the child what you want him/her to do, then the child might not even be attending to your movements. The child might just hear the phrase and do the action. The whole point of imitation is for the child to attend to a model and then imitate. You want them to learn that the phrase “do this” means do what I am doing.

Goals that can be combined:

D1/2 – Both of these target imitating with objects. The first is in isolation and the second is with discrimination. You can either have a column on the program sheet for mastery of both ways or you can have it understood in the program protocol that targets start in isolation then are put in discrimination before being mastered. Some children don’t need the isolation portion. Doing in discrimination means you have the object and 2 other objects so the child has to watch what you do with the object and discriminate from the field which object to use. It is important that your objects are identical at first to make discrimination easier. For instance, if you are doing imitation of pushing a car; you should both have the same exact car.
D3/4/5/9 – these all deal with imitation of different body parts. Combine them into a motor imitation program and make sure to target a variety of movements. Use movements that are distinctly different at first. For instance clapping and stomping because these movements involve different parts of the body.
D10/D11/D14 – these all deal with facial and oral movements. Combine into one program and target AFTER body part imitation is mastered unless you have a child who spontaneously imitates facial movements. A mirror is often helpful for this program.
D12 – this isn’t combined with anything but its fine motor skills and typically you want the child to be able to do the movement but do it a few times in a row to build endurance. So instead of touching pointers together have the target be touches pointers together five times. Then you would say the child scores correct if he will follow the instruction “do this” touch pointers 5x in a row.
D6/D15/D16/D17/D21/D22 – These all deal with advanced motor imitation. They can be combined into an advanced imitation program and each goal can be targeted as a target in the order of the ABLLS.

Posted by Megan DeLeon BCBA at 2/2/2010 7:14 AM | Add Comment

parent question about joint attention and referencing

Parent Question about Referencing and Joint Attention

A while ago a parent asked me about the difference between referencing and Joint Attention. Joint Attention is a relatively new concept in the behavioral literature with a few studies being conducted prior to this century but most studies occurring within the past 10 years. Because of this, the skill and techniques to teach the skill is a little trickier to explain. Research is still being conducted on effective ways to teach Joint Attention which I will discuss later in this blog. While I do focus on teaching Joint Attention with my clients, I also decided to send this question to some of my BCBA colleagues to get their input on the topic as well. First I will provide my response and then responses from 2 other BCBAs who kindly shared their input on the topic.

When I first read this question, my initial response was simply: Joint attention is a more complex skill whereas referencing is one of the precursor skills that a child would need in order to engage in Joint Attention. I didn’t have much more of an explanation than that but after reading input from my colleagues, I am now better able to explain what I meant.

Steve Ward, BCBA provided an excellent explanation of the difference between referencing and Joint Attention. He also provided some of the techniques that he uses for teaching Joint Attention. Here is Steve’s response:

Referencing refers to looking at others, especially others' eyes, for a variety of reasons, including things like: attending to name, looking for information about the location of a reinforcer, waiting for the answer to a question, checking for emotional reactions, etc.

Joint attention is a higher skill than simple referencing, requiring the learner to:

Demonstrate motivation to direct anothers' attention to an item or event,
Recruit that person's attention,
Direct that attention toward the item/event,
Monitor that person's attention to assure that it is fixed on the relevant item or event.

It is very important to note that this should not be called "joint attention" if the motivation is merely to receivethe relevant item. It is only “joint attention” if the motivation is to share the experience of the item with the other person.

In terms of skills, I frequently start teaching joint attention by establishing all of the components of the skill under motivation for tangible gain (e.g., the learner wants a cookie). I'll begin by requiring attention mands, teaching learners to point at reinforcers that are out of reach, and teaching them to repair the actions of a deficient listener. One exception to this is a learner who either naturally demonstrates, or can easily be taught, that our reactions to items/events is very interesting to them. In that case, I use that natural motivation to shape responses that direct my attention to an item/event. Another program I'll introduce is essentially a very early version of "show-and-tell", particularly for items a learner has produced, about which they can brag. I use a lot of reinforcement for this bragging, preferably social, but tangible if necessary.

For simple referencing, the first thing I do, especially during pairing, is capture as many spontaneous demonstrations of referencing as possible, and look for ways to contextually reinforce. I may walk around with small tangible reinforcers and occasionally say the learner's name, and reinforce looking toward me within a second or 2. I sometimes play "Hide-the-prize" (taken from RDI). I can almost always establish strong referencing by playing Red Light/Green Light (described in the play book I mentioned). For slightly more advanced learners, I can usually get some referencing by teaching Hotter/Colder (also described in the play book).

-Steve Ward, BCBA www.wholechildconsulting.com (352)425-2063

I would like to thank Steve for his excellent description and explanation of some activities to do to help develop Joint Attention and Referencing skills. I also would recommend using activities from RDI (Relationship Development Intervention). It is important to note that there are not very many studies (at least that I know of) indicating the effectiveness of the RDI protocol but the exercises in the RDI book serve as wonderful ideas for relationship developing programs to do with a child. For each activity in the book, there is also a description of which skills the activity is targeting such as eye contact, gaze shifting, etc.

Toby Stahlschmidt-Kah, M.A., BCBA also provided me with a powerpoint and poster presentation that she did which focused on a literature review of Joint Attention. A summary of the presentation is below:

Research on Joint Attention started in the 1970s, however the focus has shifted over time from defining Joint Attention to determining techniques on how to teach Joint Attention
Some points on Joint Attention from a behavioral perspective:

The initiative behavior observed at the beginning of a JA behavioural chain such as gaze shifting, could be seen as a mand for someone else’s behaviour of attending ‘to’ an object which is different, than a mand ‘for’ an object.
Contingencies of behaviour are important to demonstrate this concept.
A change in motivating variables sets the occasion for different behaviours.
The likelihood a child will or will not look to an adult at the onset of the interesting event, is contingent on whether or not the adult-mediated consequence has a positive value for the child, and also depends on the individual’s learning history; if in the past looking to an adult has yielded reinforcing effects

Both form and function define JA behavior. This means that you cannot just teach a child to look at an object and then look at you and call this joint attention. In order to have really taught the skill of JA the child must be looking from the object to the person in order to determine if the person is sharing in the experience.

Toby’s presentation also included references to some of the studies that have been done regarding techniques to teach Joint Attention. Below is the description of these studies from Toby’s presentation:

Pierce and Schriebman (1995) found that Pivotal Response training led to gains in JA for 4th graders diagnosed with autism.
Leekam, Hunniesett, & Moore (1998) shaped JA Gaze shifting responding by using remote controlled boxes with flip opening lids. The trainer would flip the lid on the box if the child followed their gaze. At first, the lid was flipped regardless of whether the child looked in the right direction. Then, the lid was only flipped if the child followed the experimenter’s gaze.
Baker (2000) incorporated ritualistic behaviors into games that were played with the autistic children’s siblings. The study showed that positive supported and coordinated JA increased during the intervention and were maintained at 1 and 3 month follow-ups
Hwang & Hughes (2000) used social interactive training to increase JA for 3 preverbal autistic children. The training consisted of imitation of participant’s actions, presenting an expectant look, and naturally occurring reinforcement. The JA behaviors did not generalize though.
Tsuchiya & Yamamoto (2001) presented preferred stimuli passing behind an adult who was facing the child. Guiding the examiner to look at the objects, referential looking, pointing and declarative responses all increased.
Whalen & Schreibman (2003) used response training with 11 children teaching them 6 levels of skills: hand on object, tapping on object, showing of object, eye contact, following a point, and following a gaze to increase JA.
Robins, Dickerson, and Stribling (2004) used a Robot to increase JA for 3 children with autism. The children interacted with the robot and their ability to follow pointing and gaze of the examiner increased.

Toby also sent me a description of how she focuses on Joint Attention and an article about Joint Attention. I have pasted her response here:

Something I really focus on when teaching JA, is the three-way relationship. For example the child is taught to look from me, to the item they are showing, and back to me. This is very different than a 2-way, where the child looks from me to an item, or from an item to me. I've used techniques from Per Holth (2005) for teaching JA. The article can be found here:http://www.eric.ed.gov:80/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/44/a8/82.pdf

-Toby Stahlschmidt-Kah, M.A., BCBA Email: tskbxservices@istar.ca

I would like to thank Toby for her thorough review of the literature on JA. It is important to note that Toby’s review included studies up to 2005. More studies on JA and techniques to teach JA can be found in the behavioral literature.

Here are some additional articles and other resources regarding Joint Attention:

Article about the importance of Joint Attention and techniques to use to increase social interactions, motivation, and Joint Attention from a Speech Therapist’s perspective: http://speech-language-pathology-audiology.advanceweb.com/Editorial/Content/Editorial.aspx?CC=116835
Another blog about Joint Attention and how a teacher is using technology to develop JAhttp://techpsych.blogspot.com/2009/03/establishing-joint-attention-with.html
Pivotal Response Treatments for Autism book by Koegal and Koegal ttp://www.amazon.com/Pivotal-Response-Treatments-Autism-Communication/dp/1557668191/ref=sr_1_1?ie=UTF8&s=books&qid=1264539179&sr=8-1
Overcoming Autism book by Koegal http://www.amazon.com/Overcoming-Autism-Finding-Strategies-Transform/dp/0143034685/ref=pd_bxgy_b_img_b
Relationship Development Intervention book by Gutstein http://www.amazon.com/Relationship-Development-Intervention-Young-Children/dp/1843107147/ref=sr_1_1?ie=UTF8&s=books&qid=1264539346&sr=1-1

Posted by Megan DeLeon BCBA at 2/1/2010 6:53 PM | Add Comment

understanding the ablls-r part 3: receptive lanugage

ABLLS-R Section C – Receptive Language

Focus: The focus in this area is on developing the child’s ability to follow directions and identify things receptively.

Skill Progression: follow instructions to do preferred activities follow instructions to touch common itemsfollow instructions in routine situations select objects/select pictures/identify body parts/identify clothingdiscriminate instructions/follow gaze/follow hand signals/follow instructions to go to person select adjectives/select associations/select feature/select function/select class/demonstrate actions with objects selecting 2 items/select community helpers/select environmental sounds select items from larger picture/selecting items based on specific characteristics/two step instructions  select prepositions/select pronouns/select emotions/select non-examples/select same

different

When/How to target: most of the programs in this section need to be targeted formally. Most of these programs won’t be targeted until the child has mastered a few goals in section B. When first starting with a child you will target C3 – attending to a reinforcing item. You will also target following instructions to do preferred activities and touch common items before targeting the rest of the goals. For this area, you will move through the goals mostly in the order given. Sometimes will we introduce the feature, function, class sections earlier so that the child can learn to sort and start doing them expressively but the child needs to be ready for this. You also typically don’t want to target C9 doing simple motor action until the child has mastered a few imitation items. This is so that you know the child can actual do the actions. If you have a child that has shown the actions in the natural environment you might start with naturally occurring instructions prior to mastery of a few imitation targets. Prior to implementing a goal make sure that it there isn’t a similar one in section B that you should be implementing first.

Goals that can be combined:

C2/C6/C7 – Both of these target following instructions during activities. One is doing the preferred activity within context and one targets doing out of context and the last one targets following instructions during a routine. For this you would have 2 columns and show mastery in and out of context. You would also start with preferred activities then move to routines. For routines you wouldn’t target out of context.
C3 is often combined with A3 in an attending program.
C4/C5 – these both target touching an item. One is a reinforcing item and the other is common item. For this program you only have the item and you say “touch” You should start with reinforcing items then move to non-reinforcing items.
C10/11/12/13/14 – these all deal with selecting items. The goals start with selecting reinforcing items and then moves to common objects and pictures. These can be combined such that you have columns for mastery of picture and object. Then you would target reinforcing items in isolation then with distracters then common items in isolation and with distracters. Use the same items you used for matching. You may be able to probe this goal for some children.
C15/C21 – these both target body parts. One is touching body parts on self and one is on others or in pictures. IF the child is advanced enough you can teach them body parts on self and others at the same time. Have a column for mastery of both.
C27/28/29/30 – these all deal with going to a person and some other criteria. Each of the goals can be targeted in one program.

Posted by Megan DeLeon BCBA at 2/1/2010 9:28 AM | Add Comment

understanding the ablls-r part 2: section b visual performance

ABLLS-R Section B – Visual Performance:

Focus: the focus is on developing a learners visual perceptive skills by starting with basic visual tasks and building up to more advanced tasks.

Skill Progression: Students progression in this area varies depending on their strengths typically our clients progress in a different order than the ABLLS in this section: Simple 3 piece puzzles/matching/shape sortersort non-identical items more advanced puzzles/block imitation  match associate pics/match patterns/sort feature function class delayed finding a sample/delayed replication of a sequence/extend patterns  seriation/picture sequences/mazes

When/how to target: Most of the programs in this program need to be written as formal programs. Make sure to assess your child’s visual strengths when deciding which goals to implement. You definitely want to start with easier items such as 3 piece puzzles, matching, and shape sorter when first starting with a client. You don’t want to do sorting feature, function, and class until the child has learned these receptively or expressively. You also don’t want to do patterns until the child knows at least their colors. The child must have good attending skills before doing most of these goals.

Goals that can be combined:

B1/B10/B11/B14/B15 – All of these goals target puzzles. You can combine them into a puzzles program and make sure to follow the sequence described in the ABLLS. Start with small puzzles and build up to more complex. Best way to teach puzzles is to chain the pieces. This means have the child either do the first 2 pieces of the puzzle and nothing else and then slowly add in pieces or have the whole puzzle done except the first piece and have the child put in that piece then build up the number of missing pieces (all of the puzzle is done except the first 2 pieces, then first three pieces, etc)
B3/B4/B5/B6 – All of these goals target matching. You can combine them into a matching program. Have a column on the target sheet for each style of matching: object to object, picture to picture, object to picture, picture to object. Determine which order to teach based on the child’s performance. Some do better with objects, some do better with pictures, some do better with an object and a picture. Make sure to start with identical items/pictures first.
B13/B22 – These both target patterns. Start with matching the pattern then do extending the pattern. This can be done by having intro/mastery columns for each. You can do all the sequences matching first then extend or you can run both at the same time and target the extension once the sequence is mastered matching.
B9/B12/B23 – These all target block design. I tend to do blocks slightly different from the ABLLS. I prefer to do block imitation with base + number of blocks, imitating block structures (car, rocket, etc), and hidden block designs (building the structure then hiding it to see if the child can build the structure without seeing it).

Posted by Megan DeLeon BCBA at 1/31/2010 6:05 PM | Add Comment

misrepresentation and why it is not just wrong but harmful

I debated even writing this blog because I should probably just let the video slip away but I think it is my duty as a behavior analyst to educate people when I see something that misrepresents the field of behavior analysis. I received this video yesterday advertising the Son Rise Program. I am willing to admit that I do not know that much about this treatment but I do know that it is greatly misrepresenting the field of behavior analysis in this video. I am hoping to try to keep this organized but I might start to babble as this is a somewhat emotional post for me. I am going to analyze why it is wrong for Son Rise to not just advertise their program but mislead people about ABA, additionally I will explain why their statement about ABA being robotic and focusing ONLY on extinguishing behaviors is false, lastly I will attempt to show how Son Rise is most likely making use of behavioral techniques but just calling it something else.

Misleading Parents is Harmful

My first issue with this ad is how harmful it is for parents. Parents of newly diagnosed children might see this ad and then adamantly refuse to incorporate ABA. How far the parent goes with this will determine the harm caused but if a parent sees this and says "I do not want a robotic child" and absolutely refuses anything presented as "behavioral" or "aba." And this parent is fortunate enough to live in a school district that offers ABA and makes large gains with the children in their schools but the parent refuses it because of this video. I am hoping that it won't happen but it is possible.

It is one thing to advertise your program and explain what your program does. If a parent connects with the core ideas of your program and wants to use it, then that is fine. BUT trying to separate your program from ABA, put down ABA (the only established intervention for autism) and say it is better than ABA and/or that it is nothing like ABA when they have large similarities is a completely different thing (I will explain the similarities below).

The other thing that is harmful about this ad is that they are clearly ADVERTISING a treatment instead of EDUCATING about a treatment option. In an area like autism parents should be looking for the most EFFECTIVE treatment, not which treatment is advertised best. If a person is trying to choose between a mac/pc, their lives aren't going to be totally changed regardless of which computer they pick. But a if a parent is trying to choose a treatment/intervention to help their child live the highest quality of life possible, and they see an ad like this, and they shun the ONLY ESTABLISHED intervention for Autism, their lives will be changed dramatically and for the most part it won't be for the better. Obviously if the parent still incorporates the same techniques as ABA but under the guise of Son Rise, then it might not be that much of an issue but if the parent completely disregards ABA for fear of a robotic child, then they might not make the same type of progress. For instance, if they have a child who engages in self injurious behavior or severe tantrums or extreme aggression and the parent doesn't have an understanding of identifying the function of the behavior and the environmental variables preceding the behavior and doesn't have the knowledge to implement a procedure that will decrease this behavior and teach the child the functional skills he/she needs in order to engage in a safer behavior to achieve the same result of their originally dangerous behavior, then the child will not make as much progress. Bring in a BCBA, have them analyze the situation and come up with an effective plan, and the child will make more gains because he/she is no longer engaging in the dangerous behavior. Don't bring in a BCBA and JUST focus on building a relationship, and the child is likely going to continue to engage in the dangerous behavior.

On ABA being Robotic

This is a myth about ABA that has been around for a long time. There are definitely a few practitioners out there who do not effectively apply the methods of ABA and the child may engage in scripted or robotic behavior. It is important to note that these practitioners typically received their primary training in a field OTHER THAN behavior analysis. This does not mean that ABA always leads to robotic behavior. The early application of the principles of behavior as an intervention for children with autism may have led to robotic behavior but that is hardly the case now. Basically the comparison in this commercial would be like the MAC commercials comparing the current MAC to the first ever version of a PC. Sure LOVAAS first applied the principles, they didn't look much at motivation or relationships and the parents were not involved but that was over 40 years ago and at the time the alternative was the children ended up in institutions. The fact that Lovaas was able to apply the principles and achieve 48% results of the children being indistinguishable from their peers, is HUGE. There was nothing like this at the time. And that result was PRIOR to the plethora of research that now exists on how to make the application of priniciples that Lovaas used EVEN MORE EFFECTIVE. It isn't like Lovaas achieved those results 40 years ago and then everything stopped. Lovaas didn't apply all of the current research at that time and now current research has identified hundreds of other techniques to use. It is also important to consider that for some children/adults with autism who may be robotic/scripted and they received a well programmed intervention, most likely the alternative would be no talking or interactions at all. Some language is better than no language. Especially if it allows a person to enhance their quality of life and ability to functionally communicate in their environment. I am not saying that robotic/scripted behavior is "good enough" but sometimes it is the only result. What I mean here is that sometimes multiple procedures/techniques will be used and a child still engages in robotic/scripted behavior but this behavior is better than no language or way to communicate.

On ABA only focusing on extinguishing behaviors

This statement is false in so many ways. I have mentioned many times before that if a behavior analyst comes into your house or school or other environment and tells you what will be worked on without asking for your input and your approval, then you do not have a well qualified BCBA. One of the main tenets and ethical guidelines of being a BCBA is that you must address socially valid behaviors, work on what the client/parent would like to work on, and receive approval before applying an intervention. If a BCBA is focusing on extinguishing a behavior it is either because the parent has asked them too or the behavior is interfering with the learning process (which they would still have to get approval from the parent before implementing the procedure) either because the behavior is dangerous or interferes with attending. BCBAs also don't just focus on extinguishing the behavior, they focus on determining why the behavior is occurring in the first place and how to replace that behavior with a behavior that would be more functionally appropriate. For instance if a child tantrums every time someone asks them to do something, teaching the child to say "I don't want to" or "can I do it later" or hold up a card to signal they don't want to do the task. This is much more appropriate than an hour long tantrum. Or if a child engages in stimulatory behavior and the parents/therapists are not able to work on teaching the child because of this, then BCBAs will focus on teaching the child either a replacement for the stim that is more socially appropriate if the parents want this or at least when it is "ok" to engage in the stimulatory behavior. Typically "ok" times are during breaks or in certain parts of the house depending on the stimulatory behavior.

Comparing Son-Rise and ABA

As I mentioned above I have never been trained in Son-Rise so my comparison is solely based on what they discuss on their website. I determined the best way to make this comparison is to use the "Principles" section of Son-Rise's website and compare it to ABA/Behavioral Techniques (taken from Association for Scientific Autism Treatment and Florida's Association for Behavior Analysis page about Autism and ABA and The Journal for Applied Behavior Analysis).

Principle

Son-Rise

ABA

Autism is not a behavioral disorder

Explained as a neurological disorder.

"Behavioral challenges" exist because of

relational deficits. *I would like to note the

terminology in this heading makes it appear

that people who promote a behavioral

approach would be doing so in error

because autism is not a behavioral disorder.

To me they purposely use this terminology

to separate their approach from ABA.

Autism is explained almost exactly the same way as

a neurobehavioral (meaning that it is neurological

but is diagnosed based on symptoms that are

behavioral) disorder. The ASAT site also explains that

there is an impairment in communication/social skills.

BCBAs might say that a "behavioral challenge" exists

because of a relational deficit but only if the child does

not possess certain skills related to relationship

building such as joint attention, reciprocal interactions,

etc. BCBAs go way beyond just saying that everything

is due to "relational deficits" they provide an actual

analysis of the "challenge" to determine the environmental

aspects, skill deficits, and any other factors that might

result in the behavior occurring. The behavior analyst then

focuses on not only teaching the skills that are lacking but

also arranging the environment and other factors to set

the child up for success and make skill acquisition

much more likely and less frustrating.

Motivation Not Repetition Holds the Key to all Learning

Explained as determining the child's motivation and

using this to teach the child the skills he/she needs.

*I would also like to point out that this is statement

also seems to be an attack on ABA. The site says that

some interventions require endless repetition. It appears

as though Son-Rise has not stayed on top of

the advances made in intervention practice for ABA in the

last 40 years. As I said, when Lovaas first applied the

principles, this was the way he did it. But it was

the only way that worked at the time and

research has come a long way since then. Additionally,

regardless of having the child's motivation, repetition to

a degree will be necessary. It will depend on the child

how much repetition is necessary but EVERYONE learns

through repetition. I surely do not remember how to

do calculus a class a took for 1 year in high school but

I do remember how to add, subtract, multiply, and divide,

skills that were practiced year after year starting in 1st

grade.

Motivation has been a key focus in the field of behavior

analysis since its origins. Behavior analysis heavily focuses

on using positive reinforcement to acquire and maintain skills.

Simply providing reinforcement after a behavior, is not nearly

as effective as capturing the child's motivation prior to

presenting the task in the first place. A quick search in the

Journal of Applied Behavior Analysis (JABA)

for "motivation" reveals

470+ articles dating back as far as 1969 (many years

before the Son-Rise program was even developed). In fact

Keller and Schoenfeld (1950) described the establishing

operation as a "motivational variable" 60 years ago.

Additionally Jack Michael focused heavily on this topic

starting in 1982 and to date there are many well known

behavior analysts who research the area of motivation.

It is very rare to find a behavior analyst who does not work

off the child's motivation. People who have not been formally

trained in ABA who still follow Lovaas' early work might

make this error. Or you will find some behavior analysts

who are not good at identifying and capturing the motivation

of the child but it is still a main principle and tenet of

the field and it is even a large section of the task list

that we study and are tested on in order to become

board certified.

Your Child's "Stimming" Behaviors have Important Meaning and Value

Explained as having deep acceptance and respect for

the children. Instead of stopping repetitive behavior, it

is recommended to join in the repetitive behavior. This in

turn leads to the development of social skills, eye contact,

and interaction. This sounds very nice and almost makes

me want to try it. The problem is, there is absolutely

no data to support this claim. I am very curious to know

what is done if a child starts stimming during instructional

time. Does the instruction end and the therapist joins

in on the stimming? For some children this might be ok.

But what if a child uses this as an escape from learning

and never learns the skills that they need to learn? I am

not saying stimming should always be stopped or that

parents should not join in with their children's stimming

behavior. I am simply saying that there isn't research

to date to suggest that this beneficial. Based on current

research though I can tell you that there are plenty

of children who still developed social skills despite their

parents not joining on the stimulatory behavior. I also see

where it could be beneficial especially if you have a

child who literally has not interests beyond stimulatory

behavior. You could use their interest in this behavior

as means for developing first interactions. But all you are

really doing here is working off the child's motivation which

is really nothing new. The parent could either work off the

child's interest in a toy, or work of their interest in

stimming but you are still doing the same thing. And what

is recommended when the stimming is interfering

with the learning process or it is dangerous?

The websites I am using as a reference do not include an

explanation of responding specifically to stimming behavior.

However, behavior analysts analyze this behavior just like

they would "challenging" behavior. Very specific steps

are taken in order to determine why the child is engaging

in the stimulatory behavior, what input the child is receiving

from the behavior, if the behavior is not safe what would

be an appropriate replacement behavior that would give

the same sensory input, how to provide the child with the

sensory input throughout the day so that when it is time to

learn, play, and interact with their world the child has received

enough of the sensory input that he/she is able to focus.

Additionally, another search on JABA over 200 articles on

stereotypy (stimming) and automatically reinforcing

behaviors (stimming). Of these articles multiple interventions

are recommended not just "joining" but interventions

that will be effective in helping the child focus and engage

in the world around them. One recent article that jumped out

at me was published in 2009 and focused on rumination.

Rumination is when a child regurgitates food and then chews

and swallows it again. This is technically a stim because it

is automatically reinforcing. I would be really curious to know

how "joining" in this stim would help the child with this

dangerous behavior? Rhine and Tarbox (2009) successfully

used chewing gum as an alternative replacement behavior

for the rumination. The autistic child's rumination decreased

significantly during times where he was given gum to chew.

This stimulatory behavior had resulted in the child losing

several teeth because of severe decay.

The Parent is the Child's Best Resource

Explained as focusing time and energy on training the

parents so that they have the skills to work with and

direct their child's programming.

Parent training is a heavy focus for ABA as well. Research

on how to do effective parent training dates back to 1969

as well. A JABA search revealed 330 articles on parent training.

I will admit that when the principles of behavior

analysis were first applied as an intervention for autism, there

was very little focus on training the parents. I am not

entirely sure of the reasoning for this but even today

parents will receive the training so that they have the skills

to work with their child but they still opt to hire behavior

analysts or professionals supervised by behavior analyst

to work with their children. Part of this is because of the time

involved, most parents are working all day so the therapist

work with the child while the parent is at work. However,

it is extremely important that the parents are able

to apply principles of behavior in the natural environment

and can practice skills with their child even if someone

else is providing most of the instruction to the child. Recent

advances in parent training include the website

Rethink Autism where parents can watch videos of sessions

and learn more about how to work with their child.

Additionally, there are several books that teach parents

how to work with their children using the principles

of behavior analysis. And of course there are hundreds

of providers and clinics designed to teach parents how to

use the principles of behavior analysis.

Your Child Can Progress in the Right Environment

Described as setting up the environment so that it is

not overly stimulating and so that the play room reduces

the "control" issues that often arise.

As I have already mentioned behavior analysis heavily

focuses on the setting up the environment to result

in optimal learning for your child. Behavior analysts provide

recommendations to the parents on how to structure

not only the play room/work environment to reduce

distractions and "control" issues but they analyze down

to the bone everything about the environment when

necessary. The analyses can be as thorough as looking

at the type of demand, number of demands presented,

combination of demands presented, wording of the demand,

presentation of the demand, prompts used, person

presenting the demand, time of day, day of the week, etc.

Behavior analysts are highly trained and skilled in providing

environmental assessments. This is another large

section on the task list for the test that behavior analysts

take in order to become certified. A search on JABA turned up

almost 500 articles discussing setting events and ecological

assessments, which refers to setting up the right environment.

Parents and Professionals are most effective when they feel comfortable with their child

Described as having confidence in the child and

focusing on the child's potential.

Behavior analysts would agree with this statement as well.

All of the programming and training produced by behavior

analysts focus on the child's potential and determining

the most effective ways to assist the child in acquiring

skills. In fact, behavior analysts are often brought in

by parents and schools who have lost hope and the

behavior analysts are able to regain the parents/teachers

confidence in the child when they see what the child

is capable of.

The last principle refers to the Son Rise program being combined with other interventions such as bio-med, sensory integration, and auditory integration. While ABA can be combined with these methods and has been, most behavior analysts will help the parent evaluate each of these interventions first to determine the effectiveness of the intervention because to date research does not support the use of these treatments. Looking at the table above, it should be quite clear that at least the principles of Son Rise are not different from ABA except that they might be lacking. By this I mean, both interventions agree with the main heading of the principle but ABA tends to go beyond the basic explanation given by Son Rise. All children on the spectrum are different so while one child's "behavioral challenges" might be the result of relational deficits, ABA recognizes that this is not the ONLY reason and can go far beyond the analysis presented by Son Rise. Additionally, simply modifying the environmental arrangement of a room might be enough for some children but for others a more in depth ecological assessment and analysis might need to be done in order to determine why a child is not acquiring a skill.

In Summary

To summarize this very long blog, when I set out to write it I honestly didn't know how similar or different from ABA Son-Rise's principles would be but after looking at their home page it is quite clear that both interventions incorporate similar principles. This makes their advertisement even more disheartening because they are trying to convince parents that Son Rise is not in any way similar to ABA and in reality their core principles are exactly some of the principles incorporated in the field of behavior analysis. To top it off, Son-Rise is not empirically validated and ABA is and Son Rise seems very basic where as ABA is not. Son Rise might work for some children who do not engage in high rates of task avoidance, self injury, etc that would call for a more in depth analysis but it will not work for the child who requires the type of knowledge that behavior analysts possess. I also don't mind that Son Rise describes the same principles and techniques of employed by behavior analysts using different terminology. I am criticizing their practice of doing that and then trying to say that Son Rise is nothing like ABA and it is better than ABA. The other sad thing to me is that while Son-Rise is trying to separate itself from ABA and say it is completely different, they are wasting their time. They are basically re-inventing the wheel by not looking at what the field of behavior analysis has known for longer than Son Rise has even been around. On the flip side of that being that the people running Son Rise do truly care and are working hard to help children on the spectrum, if they took a more collaborative approach, they could share with our field novel techniques and methods that they have discovered. Instead they are creating a divide which in the end simply results in hurting the children. Learning and skill acquisition is an area where multiple techniques and methods will be developed but if people are not collaborative in sharing the creative and innovative techniques that they have devised and the data to support that these techniques really do work, the children ultimately lose out because they are not given the most effective interventions.

Posted by Megan DeLeon BCBA at 1/29/2010 8:28 AM | Add Comment

new series: understanding the ablls-r section a cooperation and reinforcer effectiveness

I recently came across a document I made for Florida State graduate students to help the become acquainted with the ABLLS-R. I decided that it would be nice to post the document here. I am breaking it down by section though so that there is not too much information at one time. I would like to make it very clear that reading this series DOES NOT replace formal training on the ABLLS-R and that anyone using the ABLLS-R should read the companion guide as well prior to using the assessment. Here is the link for purchasing the ABLLS-R and/or Companion Guide Additionally, what you will find below is all based on my OWN experience. As far as I know there is limited to no research to support my suggestions. I made theses suggestions and provided these explanations based on my experience with how clients acquired skills and what worked best for my purposes. Always remember to invdividualize programming for your child/client and consult the research. The information that I am sharing here is to provide a basic skeleton for people who are not familiar with the sections of the ABLLS. Hopefully after reading this series you will have a better understanding of what skills are targeted in each section of the ABLLS, how to combine goals when possible, and what the typical progression of skills is like for children on the spectrum. "Typical" progression means that typically the skills are easier when done in this order however this is not always true. For instance, sometimes you will have a child who is highly verbal but does not listen well so it is easier to teach them expressive tasks first then receptive. If any providers/parents who read this blog have suggestions on other ways to combine/target/organize goals, please do share

ABLLS-R Cooperation and Reinforcer Effectiveness Section A

Focus: gaining cooperation with learners by starting with compliance regarding immediate access to reinforcing items.

Skill Progression: compliance with preferred activities/items  responding with immediate reinforcement fading reinforcement  performing for multiple people and with a variety of reinforcers.

When/How to target: typically targeted with new clients, non-compliant clients, early learners using compliance training. More advanced goals such as fading reinforcement and working for multiple reinforcers can be targeted informally and are usually done with learners who have been receiving instruction for a longer amount of time

Goals that can be combined: A3 Look at non-reinforcing item is typically combined with C3 look at reinforcing item in an attending program.

Posted by Megan DeLeon BCBA at 1/28/2010 7:05 PM | View Comments (1) | Add Comment

Friday, February 5, 2010

Free Resources

ABA Links/Resources

Thursday, February 4, 2010

Understanding the ABLLS-R

understanding the ablls-r part 5: section e vocal imitation

convincing your school to allow aba

understanding the ablls-r part 4: imitation

parent question about joint attention and referencing

understanding the ablls-r part 3: receptive lanugage

understanding the ablls-r part 2: section b visual performance

misrepresentation and why it is not just wrong but harmful

new series: understanding the ablls-r section a cooperation and reinforcer effectiveness

Facebook Badge

Followers

Friday, February 5, 2010

Free Resources

ABA Links/Resources

Thursday, February 4, 2010

Facebook Badge

Followers

Subscribe To Behavior Matters