Intensive ABA Services
By Mariko Okano, M.A., BCABA
Lovaas Institute - Los Angeles
Research conducted as part of the UCLA Young Autism Project (Lovaas, 1987) focused on treatment for "younger" children under the age of 4 years. Treatment for children with autism often lasts longer than a few years, and oftentimes programming and intervention goals change as the children grow older. How can we teach and prepare older children to be successful in school, home, and community settings?
As children begin an in-home ABA program, the focus is often placed on teaching "learning to learn" behaviors such as non-verbal imitation, verbal imitation, and matching. As children learn these skills and progress through various phases of programming, the "learning to learn" behaviors may change in complexity but continue to rely closely on imitation and matching skills. When a child transitions to the school setting, the importance of these skills is emphasized. Whether a student's placement is in a general education classroom without support, a general education classroom with support, a special day class, or a non-public school, teaching these basic classroom-readiness skills may help ease the transition to school. For example, if a child does not attend to an instruction to line up for recess, he may be prompted to imitate his peers lining up at the door. Or, if the teacher is presenting a step-by-step lesson on the whiteboard and a student is falling behind, she can be prompted to match the teacher's model.
As children progress through elementary and secondary education, most of the curriculum is taught through group instruction, where the teacher stands at the front of the class and presents to students seated either at their desks or on the floor. Attending during a group lesson/ lecture can often be challenging. These challenges may include difficulty comprehending the teacher's words or the material, or being comfortable sitting among a group of peers.
While some children may not be able to fully comprehend material presented during group instruction, it may be helpful to teach appropriate behaviors to a) not distract or stand out from the group, and b) allow them the opportunity to attend to and learn from the teacher. The appropriate behaviors required for attention within a group instructional setting include appropriate sitting/body, quiet behavior, and eye contact. In addition to attention, appropriate behaviors for participation within a group setting include raising hand, waiting to be called upon, and responding when called. It may be possible to teach each of these specific behaviors.
To begin, determine which behavior(s) the child demonstrates and the duration s/he is able to sit (in a chair or on the floor). Consider this a baseline measure and provide positive feedback (reinforcement) at this interval. For example, if a child is able to sit for 30 seconds without engaging in inappropriate behaviors, provide verbal reinforcement every 25-30 seconds in order to keep him/her successful.
Phase 1: Practice group instruction with a desired/motivating topic.
Using preferred stimuli (e.g., The Cat in the Hat) may increase the child's interest and therefore attention to the material being presented. In the first phase, read a story (reduced procedures may include showing pictures, playing music, singing a song) and provide reinforcement at the specified baseline interval (e.g., 25-30 seconds). Acknowledge specific behaviors, e.g., "Nice sitting!" "I love the way you're looking!" "Thanks for listening quietly!" Keep "mock lectures" to relatively short durations to start (1-2 minutes), and increase durations and intervals (e.g., 30 seconds > 40 seconds > 1 minute) as the child demonstrates success.
Phase 2: Practice group instruction with less-desired/less-preferred topics.
Once the child demonstrates success with preferred material, introduce less preferred material (such that may be presented in class) and follow the above procedure.
Phase 3: Practice participation within group instruction.
Once the child demonstrates appropriate sitting and attention across various topics/material, if appropriate, introduce participation. Begin with short lectures of factual information provided within the lecture. For example, "Mike's favorite color is green" or "Whales live in the ocean." Next, ask a question phrased as if it is presented to a group, such as "Who can tell me Mike's favorite color?" or "Who knows where whales live?" and immediately prompt the child to raise his hand (whisper, "Ben, raise your hand"). Provide verbal reinforcement for raising his hand. Systematically increase the duration of the lesson and the amount of material presented. In addition, increase the response requirement such that the child is learning to wait to be called upon and correctly answering the question. It is important to be able to fade the direction instruction prompt ("Ben, raise your hand") in order for the child to demonstrate these responses independently.
Another important classroom skill for older children to learn is working independently. Independent working periods in elementary classrooms may range from 5-45 minutes, and from 15 minutes-1 hour in secondary classrooms. The ability to work independently is an important skill that can be taught to children with varying ability levels.
Begin by selecting 1-3 activities that the child can complete independently. These may include a shape-sorter, puzzle, or matching worksheet. Determine the duration the child is able to complete these tasks without losing attention/interest and without receiving assistance. Consider this a baseline measure and provide positive feedback (reinforcement) at this interval. For example, if a child is able to work for 1 minute without engaging in inappropriate behaviors, provide verbal reinforcement every 50 seconds-1 minute in order to keep him/her successful. Present an initial instruction to cue the child to work quietly and independently (e.g., "Do your worksheet quietly"). Provide immediate reinforcement for beginning the task, and provide ongoing intermittent reinforcement at the specified interval (e.g., 50-60 seconds). Over time, increase the duration of work tasks and the interval at which the child receives reinforcement.
A more complex generalization of basic imitation skills is learning through observation. It may be helpful to teach a child to observe his/her peers and "do the right thing," or "do what your friends are doing," in order to prompt the appropriate behavior without stating it explicitly. Teaching the skill of observational learning will likely help the child in school and community settings.
Tip: Remember to provide reinforcement when the child engages in the target behavior with reduced prompts and when done independently!
Regardless of the child's skill level, it may be helpful to teach him/her to complete simple tasks in order to increase independence. Determine your child's developmental skill level and choose activities accordingly.
Tip: Remember to start with short durations, and increase as the child is successful.
Once the child is able to work independently in a quiet/non-distracting environment, it may be helpful to teach him/her to maintain attention while working in a distracting environment that may mimic a classroom setting. Distractions may include placing objects on the student's desk, placing posters/ flag/ clock around the room, instructors walking around the room, opening/ closing doors, or a television/ radio/ voices in the background.
Tip: Remember to start with one distracter for short durations, and increase as the child is successful.
In addition to academic and classroom-readiness skills, an important component of programs for older children includes self-help/daily living skills. As children become adolescents and teenagers, there should be an emphasis on teaching them independent skills that will help them be successful at home and in the community. Independence within the household may include self-care skills such as toileting, dressing/undressing, grooming, bathing, meal preparation, and chore/task completion. Independence in the community may include street safety, stranger awareness, greeting community helpers, making purchases, and using public transportation.
Once you have determined appropriate functional skills to teach your child, they may be taught with the following considerations:
A task analysis is the breakdown of a skill into specific steps. It is important to conduct a task analysis prior to teaching a skill for two reasons: (1) Determining what the child can/can't do will avoid re-teaching acquired steps, and (2) Breaking down a task into specific steps will allow for challenges to be identified and more easily addressed.
Sample Task Analyses:
Making the bed
Making a sandwich
Once the steps of a task and a baseline measure have been determined, introduce the skill systematically. One effective strategy is using a visual schedule of the steps of a task. A visual schedule may incorporate pictures, word cards, and/or a checklist of steps in a linear sequence. Pairing a visual schedule with verbal, physical, model, gesture, or other prompts will allow these prompts to be faded over time. The goal would be either for the child to complete a task independently with or without the use of a visual schedule. Advanced procedures may include providing a chore list for a child.
Tip: Include fun activities in a chore list in order to reinforce task completion!
Sample chore list:
Initially, it is important to provide reinforcement for completion of each step and transition to the next step. As the child learns each step and demonstrates increased independence, the schedule of reinforcement may be thinned (i.e., reinforcement provided after a longer duration/after completion of more steps). Tip: Try using verbal reinforcement to shape transitions between steps instead of a prompt. For example, say, "Wow, I like the way you're working," or "Nice job moving to Step 2," instead of saying, "Keep going," which may cause the child to become prompt-dependent.
Once skills are acquired in one setting and/or with one person, it is extremely important to generalize these skills across environments, people, and stimuli. In general, and if appropriate, generalization should be built into the teaching process. However, for those children who demonstrate difficulty with maintenance and generalization of skills, generalization may be taught following acquisition of a skill.
Do you have an experience with a creative format to typical programming? Share them with us here
The names of all children in this newsletter have been changed in respect for family confidentiality.
Hand Grenade! Deliver reinforcers like a hand grenade. Instead of giving an M&M, pretend to send it through the air with a whistling sound until it gets to child's mouth then explodes (i.e. you make an exploding sound). Run from the child and toss the (soft) reinforcer back to them.
Reinforcer Presents! Wrap the reinforcer like a real present. Sustain the anticipation by gradually unwrapping across many trials.
When I first heard about ABA and what a home therapy program entailed, my thought was I certainly don't want to be doing this when Charlie is five years old. That was the summer of 1999 and Charlie, who had just turned two years old, had just been diagnosed with autism.