Meeting Point: Latest From Lovaas

Summer 08

Meeting Point: Latest From Lovaas

Case Study: Leo's Story

By Mariko Okano, M.A., BCABA
Lovaas Institute – Los Angeles

With a nervous smile, holding on tightly to his chair, Leo, along with his two sisters, was hoisted into the air above a crowd of family and friends to celebrate their B'nai Mitzvah. On their 13th birthday, these triplets were celebrating a momentous occasion in their lives.

Earlier that day, Leo and his sisters stood in front of 200 of their closest friends and family and read and recited Hebrew - a difficult task for any new teenager! This was a proud moment for all in attendance, but especially for Leo's parents and former therapists who had spent tireless hours teaching Leo to sit appropriately, listen, make eye contact, talk, read, and write.

As a triplet child, Leo had constant playmates in his two "older" sisters. They were always together, smiling, laughing, and taking their first steps. When Leo and his sisters began a toddler program at the age of 18 months, Leo's parents noticed that he did not make sounds or say words like the other kids. He avoided making eye contact unless someone stood immediately in front of him, and he seemed to only want to play in the sandbox. Leo's parents grew concerned that his development might be delayed, and when he was about two years old, they took him for a hearing assessment. When it was determined his hearing was normal, they went to their pediatrician, who referred them to a neurologist, then a psychologist. Leo was eventually diagnosed with autism when he was two-and-a-half.

Individualized Intervention

Leo began an in-home behavioral program before he turned three years old. Upon starting treatment with the Lovaas Institute, he demonstrated low attention, repetitive behaviors, and said no intelligible words. In his first few years of treatment, Leo learned how to imitate, identify and describe objects, and play with toys and games. Leo was toilet trained and learned how to eat and drink independently. His language came slowly, but there was an improvement in his ability to communicate and a reduction in his interfering behaviors. When Leo began school, he was placed in general education classes with one-to-one support provided by his Lovaas aides. Leo remained in general education through fourth grade, however he demonstrated increased difficulty with comprehending the complex language presented by his teachers, and his verbal and physical stereotypic behaviors impacted his ability to learn in the classroom setting. When he was in third grade, a shift was made to Leo's behavioral program in order to address these concerns.

There were two components of Leo's intervention that significantly impacted his progress. One was a program made of complex instructions to increase his attention to and comprehension of abstract language. The other was an intensive reinforcement system to increase his appropriate behavior and decrease interfering stereotypic behaviors. Leo's repetitive, interfering behaviors, included not responding to instructions or questions, repeating words and phrases, making unintelligible noises, clicking his tongue, squinting his eyes, manipulating his hands, walking on his toes, rocking his body, coughing and yawning excessively, and fidgeting with his hands. In order to reduce these behaviors, an intervention was introduced in which Leo was informed of the appropriate behaviors in which he was expected to engage, and he was provided high rates of reinforcement for the absence of inappropriate behaviors. One by one an interfering behavior was introduced into the system, and one by one, they reduced over time. As Leo demonstrated an increase in overall appropriate behavior, he was able to attend and learn for longer durations.

Having recently acquired discrimination between "wh" questions, Leo was still struggling with his ability to comprehend material presented by his teacher in his fast-paced third-grade classroom. Within his afternoon home sessions, a language comprehension program was introduced in order to increase Leo's ability to attend to and comprehend complex statements. Prior to introduction, Leo demonstrated a baseline measure of three-term receptive comprehension. [A term is considered a part of speech such as a noun, verb, adjective, adverb, preposition, etc. Leo demonstrated he could comprehend three terms receptively, meaning he could respond to instructions that combined three parts of speech (e.g., "Get your shoes and green socks" or "Put the car under the hat").] Over the course of the next several months, Leo and his team worked diligently to systematically increase the number of terms Leo could attend to and comprehend. His parents gathered stimuli from around the house to use for discrimination purposes. Once Leo could comprehend a series of complex instructions, he was taught to describe objects, pictures, and actions using multiple terms. At one point, Leo was able to receptively understand and expressively label up to seven-terms (e.g., understand "Make the tall, fat monkey dance on top of the broken chair"; say, "The spotted dog is sleeping under the long green car"). From there, Leo was required to listen to short stories (with multiple terms) and respond to simple "wh" questions about what he had heard.

Leo's home sessions after school focused on increasing his language comprehension and expression, and teaching him functional self-care/daily-living, independent, and socialization skills. With the help of his instructors and caregivers, Leo learned to shower independently by following a written checklist of steps laminated and taped in his shower, to follow a written schedule to complete his morning, after-school/homework, and bedtime routines, to make his own breakfast of scrambled eggs, and to play video games like other kids his age.

Where is Leo today?

Now a teenager in middle school, Leo splits his day between a special day class and mainstreaming into general education classes for math, social studies, music, art, computers, and physical education. He is accompanied to his general education classes by a school district aide, who receives ongoing training from Leo's Lovaas supervisor. Leo no longer receives one-to-one intervention in his home. His supervisor continues to consult with the school and Leo's family in order to provide assistance with identifying and intervening on challenging behaviors and teaching self-care, language, communication, social, and academic skills. Leo attends Hebrew school and learns from a teacher not trained in behavioral principles, and is tutored after school by the same tutor as his sisters. He is able to walk to school independently, tolerate shopping with his mother, order his own meals in a restaurant, and independently count money from his wallet when making purchases (all skills taught within his home program and reinforced by his parents). Leo plays handball with the kids at school, and looks forward to going to winter and summer camps (now without support!). He is a sweet, funny, happy kid who loves animals, playing "Guitar Hero," spending time with his family, and making his own breakfast!

The names of all children in this newsletter have been changed in respect for family confidentiality.


Puppet Teacher! Have a stuffed puppet praise and tickle the child. Have the puppet give the instructions.

Mandy! Sing Barry Manilow songs with either a good or an outrageously bad voice.

Funky Dancing! Sing and dance to really funky songs. Hold the child in your arms, or on your feet.

Cookie Monster Praise! Practice your imitations of kid show actors, such as Barney, Goofy, or Cookie Monster. Give praise in their voices.

Hair Torture! Lay the child down and gently sweep your hair over their face with "oh, no" or whatever to let them know it is coming.



Harry is in a regular second grade class with minimal support from a confederate aide. One day during reading centers with Harry's teacher, the kids read a story about a messy pig. Harry's teacher asked the kids whether they would want a pig for a pet. All of the kids said "yes," except for Harry. When asked why, he laughed and said if HE were to get another pet, he would get a "riding bull" because it would be a lot more fun than just a messy pig.
- California

4-year-old Deron was playing with a peer, when the peer suddenly announced that he was going to use the bathroom. Deron declared that he, too, was going to use the bathroom and followed his peer. Upon entering the bathroom, Deron worked furiously to pull down his pants. He quickly turned around, only to discover that his peer had beat him to the toilet. Assessing the situation for a brief moment, he nonchalantly stated, "Still go," walked over to the side of the toilet, and began to aim in the small space left by his seated peer...His aim was impeccable.
- California



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