Intensive ABA Services
After presenting a thoughtful, highly educational overview of strategies and principles of applied behavior analysis that are often utilized with children with autism, one of the teachers in the audience brought me back to earth with this comment, "I don't have time to get a degree in ABA, but I like a lot of the ideas that you talked about in your presentation. If you had to remove all the theoretical talk and could only give me the 5 most practical and specific things to do that would probably increase a child's success in school, what would you say?"
Here's what I said.
How's this for unconventional wisdom - too many school activities are finished when a child completes the activity. As important as learning to complete work is, many children learn that the quality of the work is unimportant. Some children will rush through handwriting exercises, complete arts and crafts activities with little attention to coloring or cutting, and generally receive the most reinforcement for the completion of the activity (because they're done with the work!). Instead, look for ways to reward a child for his best effort. Each time a child writes a letter in a handwriting exercise correctly, put a star by the letter. When the child has earned 8 stars, the handwriting exercise is completed. This may require the child to complete only one line of a worksheet, or it may require a second worksheet to finish earning enough stars. If a child continually cuts outside the lines, take the picture away from him as soon as he cuts outside the line and start with a new picture. There are, of course, many other factors to consider including how much prompting the child should be given and how difficult the activity is, but one of the most crucial factors is to constantly reinforce quality work rather than constantly reinforcing completed work.
While visual prompts can be helpful in many situations, they are not always the answer. Many times children can learn to follow routines by imitating what other children are doing or even having other children initially help them. These strategies often require more planning and oversight, but have the added benefit of focusing on additional important skills such as learning to imitate others or learning to listen to one's peers. Other times, a visual will be used to help in the reduction of a behavior (e.g., a picture of lips with a finger over them will be used to remind a child to be quiet during circle time). While these pictures may be helpful over time as a cue for what to do, they are often not sufficient (or even the most important element) to reduce a behavior. More time needs to be spent focusing on the function of the behavior, ways in which the antecedents or consequences to the behavior should change, or new skills that need to be taught. When the answer to a behavior issue is to simply use a visual cue, watch out! There may be other factors to evaluate.
Often if a child is demonstrating difficulty with a task, teachers will come over and repeat the instructions or even rephrase a question. The problem is, understanding language is a deficit for many children with autism, and so relying on it to get across a new concept or to start an activity is not always helpful. For example, a child was once told to make a graph showing how many of each colored cube he had. The child didn't immediately start to work and so the teacher came over to help him with the activity. She explained the instructions again and asked him questions such as, "How many red cubes are there? Where's the number five on the graph? Find your red crayon. Now, color up to that number." While the child could follow each of these instructions, he continued to need help from another adult in the room to keep working. The situation changed when an adult simply began to model what to do. She pointed at the next set of cubes and started counting, "one, two..." The child counted the rest of the cubes. The adult picked up the crayon and made dots on the graph while repeating what was just counted. She then handed the crayon to the child and said, "Color." The child colored that section. Having established this basic procedure, the adult was able to help less with the next set of cubes and the child was fully independent by the last set of cubes. Children are more likely to learn by doing rather than through any verbally-mediated explanation.
Teachers will often repeat questions over and over or end an interaction if a child does not respond. This is very natural. It often seems like the only choice. After all, what do you do if a child doesn't say "hi" back to you? But it also teaches a child that ignoring you is acceptable. In behavioral treatment, the goal is to keep a child successful at least 80% of the time. This means, if a child ignores a question once, he or she needs to be successful with the next four interactions. How does one accomplish this? One way is to make sure to use effective prompts. For example, if the teacher asks a child to identify a picture and the child does not answer the question, the teacher might repeat the question and begin the answer for the child, "tur...," or even give the whole answer, "Say, 'turtle.'" The child may not have been given an opportunity to name the picture on his own, but he was given a more important opportunity to learn that he is expected to answer when a question is asked. What happens if a child won't say anything? Then change the type of response that is required. For example, instead of asking the child to name an animal, tell the child to "touch the turtle" while showing him the picture. Again, prompt if necessary so that the teacher is 80-100% certain the child will respond correctly. Teachers who in the short term ask easier questions, change what they require of a child, and prompt more frequently are often amazed at what a child can do once he is no longer non-responsive.
Children with autism not only need skills to be systematically taught, they often also need those skills to be systematically reviewed. Including review work not only maintains skills, it often serves the added benefit of keeping a child motivated by allowing him to work on some easier tasks while he is also working on new, more difficult tasks. Review work should be monitored so that it is gradually practiced less frequently (and only when a child continues to demonstrate the skill). For example, a child who has learned to identify coins should initially practice identifying those coins at least three times a week. If he continues to respond correctly, he may only need to review the coins one or two times a week, then every other week, and then only monthly. Some skills will, of course, progress faster than others and the time between reviews may be lengthened more quickly.
Looking back, I know there are other things I might have mentioned, such as identifying appropriate reinforcers, taking data, etc., but from a practical standpoint, the five I've listed are things teachers can immediately recognize and apply with dramatic results.
What do you think?
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The names of all children in this newsletter have been changed in respect for family confidentiality.
We're delighted at the feedback we've received so far concerning our efforts to provide a newsletter that serves as a meeting point for families and teachers who wish to dialogue with us about practical ideas based on the Lovaas Model of Applied Behavior Analysis. Below are some of the comments we received for our inaugural edition. We will continue to publish some of the letters in future issues of our newsletter. Letters will remain anonymous unless you tell us how you want to be identified (part or all of: first name, last name, city, state).
Scare Me! Say, "Do this" and make a roar sound. When the child does, act terrified and fall off your own chair. Try other silly actions.
Washing Machine Vibrator! When the washing machine is running, go sit on it to feel the vibration. Imitate drone noises to go with it.
Given the right conditions, ordinary sights and sounds often assume extraordinary significance - a knock on the door, for example.