What are the verbal operants and why do they matter?

Verbal behavior seems like the newest buzz word in the world of Autism. Parents ask me almost every day what it is and how it is different from applied behavior analysis (ABA). Truthfully, it is usually used interchangeably. Technically speaking though, it is the part of ABA that teaches children how to use language to communicate.

Verbal behavior was developed by Skinner back in the 1950’s. Contrary to what many people think, it is not a new term. Truthfully in my personal opinion, which is not a popular one, behavior therapists are being forced to reconcile the dark history of applied behavior analysis and are using new words to create new connotations.  Whether that is true or not, verbal is a critical instructional methodology for kids with Autism.

Children who have only a speech delay benefit largely from speech therapy. Speech therapy will help most kids who do not have any developmental delays with talking as long as they are physically able to. However, children with Autism require more than just speech therapy. That’s because children with Autism by definition have delays in all areas of communication. All people with Autism start off with communication delays.  It is important to note that many people with Autism learn to communicate just as well as any neurotypical person. However, without delays in communication a person cannot get a diagnosis in Autism.

At this point, it is very important to understand a delay in communication is not the same as a delay in language. Language is vocal. Most of communication is non vocal. Early stages of communication includes eye contact, especially using eye contact to initiate and respond to joint attention and using gestures such as pointing.  Reaching or grabbing for something or trying or bringing someone to a desired object is typically not considered communication.

Children with Autism do not use eye contact or gestures to communicate unless they are taught to do so in early childhood development. This is where applied behavior analysis comes in. Applied behavior analysis is most commonly known for its ability to address problem behavior. However, the truth is that in its initial applications, it was primarily used to show a person what a correct response is.


Let’s look at a very basic example of how that works.

Let’s say that an adult puts a button on the table in front of a child. The child has no idea what it is for. The child pressed the button and the adult gives the child a cookie. The child may not initially understand that he was awarded the cookie for pressing the button. However, if the same thing happened five times, eventually they will learn that when they press the button, they get a cookie.  Now, whenever the child wants the cookie, they will press the button.

That’s how ABA works. Behaviors that a child does not know or understand are taught using a highly structured approach. A response is given, the child responds either independently or with help and the behavior is reinforced usually by a child getting an object that they desire. Eventually the child will learn to engage in the behavior and the reinforcement can be faded. Then the child can engage in the behavior independently.

Today applied behavior analysis has many practical implications. However, when using applied behavior analysis to conduct what it is commonly called verbal behavior or simply teaching a child to talk, this is the most basic application.

The main reason that parents seek out ABA is because they want their children to learn to talk. While this is not the only purpose of an ABA program, it is often the main component.   Most often children learn language naturally by hearing others speak. But as stated earlier, children with Autism do not. They require language to be taught to them directly. ABA therapist break down language into some very basic components called operants. By teaching these operants or skills individually, ABA therapist can significantly increase a child’s ability to use language to communicate and after reading this section, so can you.

In behavior therapy, the verbal operants are: a mand, an echoic, a tact and an intraverbal. Once you understand each of these terms, it will be easy to tell them apart and you will know what to teach. In typical language development, they are learned in that order. However, from my personal experience, some children with Autism will follow the progression out of order. This is usually depends on what stimulus a child attends to, what lessons a therapist selects to teach first and whether or not they engage in vocal stereotypy.

Some children with Autism are very vocal even at a very young age. They will repeat almost anything an adult says or they will initiate words independently but they are out of context. These are vocalizations but may not be functional language. That’s why is imperative that a person understands verbal operants. The verbal operants provide a way to know if a child is truly communicating. The following section will explore the different types of verbal operants in detail and give examples of them.

A mand is in simple terms a request. The learner wants something, says what they want and gets what they said. It is triggered by a person’s desire for something. The fancy ABA term for that is specific reinforcement. This is the only operant where reinforcement is specific to what is said. Requesting is one of the main components of language. Children constantly ask for things. Requesting is the most motivating type of language and the one children learn first. Think about it, you get what you say. There is very real tangible consequence when you ask for something that is favorable. Therefore, it should be the first operant taught and initially the one that is focused on the most.

The second operant typically learned is an echoic. In this operant, someone says something that the learner repeats and the learner receives something unrelated to what is said. It is triggered by something someone else says. This is called nonspecific reinforcement. At this point, this probably sounds really confusing so let me give you an example to illustrate. A teacher says. “Say blue.” The child says, “blue” and the teacher says. “Great job.”

Sometimes it is hard to differentiate between mands and echoics when children are first learning mands because therapists will assist or prompt a child to give a correct response by telling them what to say. For example, if a child wants an apple and his therapist says, “say apple,” and the child says, “apple.” If the behavior results in specific reinforcement (the child gets the apple), it is a prompted mand, not an echoic.  Echoics are mostly used in ABA to clean up pronunciations or to teach children to build upon their language by speaking in sentences. It can be an important part of an ABA program but it is the operant that occurs least often naturally in language.

The third verbal operant is a tact. A tact is when a person makes a comment about something they see, touch, smell, taste or hear. This operant is triggered by something in the environment. In order to be considered a tact, the comment must be made about something present. For example. “This tastes great.” “I see a yellow bird.” “I can hear a train.” Once again, reinforcement is non specific.  Some tacts that someone may learn in ABA is to identify an object’s color, features, category, attribute or function. When visuals are used to teach this, such as books, puzzles or flashcards, it is a tact.

The final and fourth verbal operant is an intraverbal. This is the most natural conversational tact that is used in conversation. This is when someone makes a comment or asks a question based upon what another person says without the object they are discussing being present. For example, “What’s your name?” “My name is Jessica?” “My favorite color is pink.” “Cool, my favorite color is blue.” Intraverbals are similar to echoics in that another person triggers the behavior. But it is different because with intraverbals reinforcement is non specific.  It is different from a tact in that there is no visual is present.

In order for anyone to have a fluent conversation, they must be able to use all four verbal operants. The next time you have a conversation, think about this final chapter. You will quickly notice yourself using all four operants in conversation.

The following chart will summarize all the info above just to make sure it is really clear:

References

Cooper, J.O., Heron, T.E., & Heward, W.L. (1987). Applied Behavior Analysis.





An interesting “spin” on Reinforcement.

Applied behavior analysis (ABA) is the most well researched and scientifically validated methods for teaching children with Autism new skills.  It is based upon the behavior principle that what happens before a behavior and what happens after a behavior will determine if it happens again. If a person engages in a behavior and they do not get what they want, they are far less likely to engage in the same behavior again. Conversely, if a behavior results in a desirable consequence, a person is far more likely to repeat the behavior.

A consequence that makes a behavior occur again is called a reinforcer. Most people think that reinforcement is a good thing. However, reinforcement is neither good or bad. It simply makes a behavior occur more often. Sometimes this is good and sometimes it is not.

For example, if Joe hits his mom and gets a cookie immediately after doing so, the next time Joe wants a cookie he will likely hit his mom again.  Obviously, in this case, Joe’s mom would not intend to reinforce hitting by giving him a cookie. However, the cookie served as a reinforcer for hitting and made hitting more likely to occur again.

Let’s say Joe is learning to talk and asked mom for a cookie by getting her attention and saying, “cookie.” Let’s assume mom gave Joe a cookie. In this example, mom would want Joe to ask for things using his words in the future. I this example it is likely a good thing the behavior is reinforced.

In the example above, the behaviors were reinforced by Joe getting something, a cookie.

In this example the cookie served as a reinforcer because it was a desirable consequence for Joe.  This is called positive reinforcement. However, sometimes a behavior can be reinforced when something unpleasant is removed. This is called negative reinforcement.  For example, if a person lowers music because it is too loud, the softer music will serve as a reinforcer. The most common example of negative reinforcement in an ABA therapy session is when a child is provided with a break for completing work. During the break the demands from the child are removed. 

ABA therapists typically use positive reinforcement in two different ways. A reinforcer may be used with a young learner to teach them what a correct response is.  For example, a two-year-old with Autism might be learning to follow the instruction, “Find your nose.” The therapist might say, “touch your nose” and prompt the child to touch his nose. After doing so, the teacher may give the child a small favorite snack.

Initially, the child might now know what the therapist is asking him to do. However, he will learn that when he touches his nose after the therapist says, “touch your nose” something good happens– he gets his favorite snack.  Motivated to get a snack, the child will eventually learn that he is rewarded when he touches his nose after the therapist says touch your nose. Eventually the prompts and reinforcement (snack) can be faded and the child will have learned to follow the instruction touch your nose. 

The second way a therapist may use a reinforcer is to encourage a child to comply with a non preferred instruction by providing them with a reward.  Generally, when a therapist is using a reinforcer in this way, the child is rewarded for either engaging in a behavior or not engaging in a behavior. For example, a child may be rewarded for completing his homework all week. Or, a child may be rewarded for not having any bathroom accidents during the day.

Many people look at this type of reinforcement and think it is bribery. Let’s be honest, there is some truth to that. But, whether we realize it or not, reinforcement is part of everyone’s everyday life, even yours.  Just think of how many people run marathons just for the marathon medal! Most people go to the gym because they want great abs, not because they genuinely enjoy sweating and aching muscles! Finally, would you really go to work if you didn’t get paid? That’s right, the marathon medal, your abs and your paycheck are all reinforcers! Reinforcement is a normal part of social interaction and reinforcers can be very effective for helping children with Autism learn.

In order for an object to be a reinforcer, they must want it.  As you already know, what a child wants is always changing. So, it’s important to check every day to see what will qualify as a reinforcer for your child.

Typically to find out what is a reinforcer for a child, you would conduct a preference assessment.  A preference assessment is just a fancy and over complicated way of saying, find out what a child wants.  For a child that can talk, this may be a simple as asking, “What would you like as reward today if you have nice hands in school? Or “We are going to do your homework and when you are finished you can either watch TV or play outside for fifteen minutes. Which do you prefer?” For a child that is non-verbal, you can hold two objects in your hands and assume the one they reach for is the one they want.

It sounds so simple right! It is and it is not! What a child wants is always changing! On day a child wants pretzels and the next day they have no interest in pretzels and have moved onto to gummy snacks.  One day a child can be enamored by a toy car and by the next day they have lost all interest in it. That’s why it is so important to have a variety of reinforcers available and to rotate them as much as possible. This will keep children from getting bored of them.

From my experience, there are three types of kids that make it particularly difficult to find reinforcers for. The first child is the child who is not really interested in anything. Children with Autism often lack play skills, can have food sensitivities and may not be reinforced by social situations. This can make it really hard to find a reinforcer. If this is the case, establishing items as reinforcers by teaching your child how to play with objects is really critical. Searching for reinforcers will be a full time job. There will be a lot of trial and error. However, it is important to take time to expose your child to new stimulus all the time. Eventually, every child will find something they are interested in. I will admit, there are some children who make this a lot more difficult and frustrating for parents than others. 

The second child is difficult  is the child who is interested in everything. This may come as a surprise. Some of the hardest children to reinforce are the children who are most easy going. They are interested in everything. If you show them a puzzle, they will play with it. If you take it away and show them a car, they will play with the car. If you take away the car and give them some toy animals, they will play with those.  

The reason this presents a challenge is that when you withhold an item they are interested in until they complete a difficult task, they usually just find something else to do. Since all things have an equal value to them, there is no one specific item that will motivate them to put in effort to do something that find challenging or unpleasant.  In this case, it is best to limit access to toys. All toys other than the ones you are using should be out away and out of the reach of the child.

The third child that is difficult to reinforce is the child satiated with, the technical term for getting bored of reinforcers rather quickly.  This was the case for a client recently who was the motivation for writing this blog post.

Her son has learned to use the toilet but he often has accidents especially at home. His mom tried several different reinforcers. They will work for a day or two but then they totally stopped working. After having access to the reward, even for a short period of time, he was bored by it and he no longer was motivated enough to go to the bathroom.

She mentioned he is more motivated to go to the bathroom out of the house then he is in the house. She stated that she thinks that when he is in a public place, he is excited since it is new and different. At home, he is usually engaged with his toys, which are highly preferred activities and as a result, he doesn’t want to take the time to stop playing and use the restroom.

The more she described her son, the more I started to realize that he seems to be reinforced by something new or different. That’s when I suggested she put a different spin on a reinforcer — quite literally!

My initial recommendation was to allow him to select a prize out  of a prize box with several reinforcer options. This worked for about a week. But eventually, he got bored of his choices and had a regression.

I started to wrack my head about how we could make going to the bathroom at home exciting. In the past, I had suggested she use a reinforcer box. Her son was able to pick a prize out of a box every time that he went to the bathroom. However, he would select the same thing over and over and it quickly lost its effectiveness.

That’s when I suggested she try a prize wheel. Every time her son went to the bathroom, he could spin the wheel to see what his prize would be.  This wouldn’t totally solve the problem of reinforcers becoming satiated. But, it added an element of excitement and surprise. The wheel itself could also serve as a reinforcer which will increase the probability of a child complying.

Using a prize wheel is not limited to just potty training. It can have any application. If your child has a hard time keeping his hands to himself in school, you can have him spin the prize wheel when he gets home if you get a good report from the teacher. If you have a hard time motivating your child to try new foods, you can reward them with spinning the prize wheel if he tries new food.The possibilities are endless.

She has ordered her spin wheel and I will report back soon how it goes for him. I did some research on which spin wheels I thought would be the best and I think this one will work really well for you. It is small, only 12 inches so it can easily fit in most homes.  It also is a dry erase spin wheel so you could easily change what is on the wheel based on the time of day, what your child is currently motivated by and what things you have at home. I have included a link to it below. In full disclosure, this is an affiliate link. You are under no obligation to purchase a spinning wheel. However, if you decide to, and use this link, it will cost you the same amount and help me offset the cost of providing this free training for you.

I hope the suggestions in this blog post help you have a better understanding of reinforcement is and why it is such an important part of your child’s education plan. If you decide to try a spin wheel, I would love it if you would comment how well it worked for you on this blog posts.

Why Kids With Autism Often Have Behavior Regressions Right After They Acquire More Language

Does it feel like every time your child takes a step forward in one area, he takes a step backwards in another? Do you find yourself time and time again being confronted with old behavior problems you thought you had gotten past?  Have the strategies that were effective before seemed to stop working? Are you wondering what you are doing wrong? The answer may be both frustrating and a relief — Nothing– This is a common experience that is reported by most parents of children with Autism.

Although the degree may cary, all children with Autism have delayed language.  The number one priority of almost every parent I have ever worked with is that their child is able to learn and and use language. The number one fear that almost any parent has is that they won’t be able to.  

Watching a child be able to get something they want for the first time is one of my favorite parts of working with kids with Autism. The first time it happens, their eyes light up and you can see them experiencing joy. For the first time, they have learned a way of getting what they want without crying or tantruming.

For kids who can’t talk, their world is very limited. Some kids are able to use gestures or take their parents to objects that they want. But, still they are limited to only asking for things they can see.

Have you ever wondered why your child start crying at as restaurant when you gave him a food you know he likes? It is really frustrating, especially if you don’t know why.  As frustrating as it is for parent or teacher, it is even more frustrating for a child.

Imagine you went to your favorite burger joint! You ordered a bacon cheese burger.  You could taste the mouth water meat in your mouth as you waited for it. But when they brought it, they brought you a black bean veggie burger on ice burg lettuce instead of a bun … Now unless you are a vegetarian, you would probably be pretty frustrated. The good news is, you would know how to tell the waiter, that he brought you the wrong thing and your delicious burger would soon be on its way.

Well your child can’t do that. They walk into a restaurant super excited to eat chicken nuggets and pizza shows up.  They would love to be able to say, “No, mom I wanted chicken nuggets.” You would love to be able to ask your child, “What do you want and have them respond.” But that may not be possible. So you gave him what you thought he would want and he cried when he wanted something else.

Since your child can’t talk, they try to use behaviors like a tantrum as a form of communication. Tantrums are frustrating for everyone — teachers, parents and even more importantly children. I have witnessed thousands of tantrums in my life. I have seen hundreds of kids so frustrated that they are not able to get what they want and so many parents just like you ready to pull their hair out because their child just wouldn’t stop.

That’s why one of the first thing that any behavior therapist will work on is reducing tantrums. Simply, your therapist teaches your child- this is not a form of communication. As long as the behavior plan is always carried out in your child’s life and he never gets what he wants as a result of having a tantrum (which is easier said than done), the tantrum will stop.

You will think as a parent you have gotten past the behavior. Really, what you did is teach your child that tantrum is not a form of communication or sometimes it won’t work in a specific situation..

The good news is, most children with Autism will eventually be able to tell us what they want. Whether it is pointing to pictures on a choice board, using PECS, and iPad program such as Proloquo2go or Touch Chat to help them talk or tell us vocally, they will be able to make their needs met.

When this happens initially everyone gets so excited, they give the child exactly what he wants every time they ask. If you ask your child what he wants for a dinner and he replies vocally, “A donut!” You get so excited he answered you for the first time you jump up and down and clap for him and drive to Dunkin Donuts in a blizzard. I have personally spent two hour long sessions doing nothing but having a child come to the table and ask for a break the first time he has learned to say, “I need a break.” instead of running away from the table or having a tantrum.

For a few days, nothing could possibly get your family down. Your child is happy because he is getting exactly what he wants. You are happy because the months or years of sacrifice and running to see therapist has paid off. You literally feel like you just landed a spaceship on the moon and found potable drinking water! But, as exciting as it when your child learns to say words, it quickly becomes an expectation and the thrills wears off.

The fourteenth time your child asks for donut, and the baker’s dozen you bought has run out you say — No!

That moment turns your child’s world completely and utterly upside down.  They have learned that they ask and they get. Your and your therapists have spent years teaching them if they ask they can have what they want and suddenly- the rules have changed!

They asked and they didn’t get! Prior to this moment, your child has never conceived this as possible. This is not how the asking game is supposed to work. They have no idea what to do. Their new communication system is broken. In panic and desperation they try something that has worked in the past — a tantrum!

Does this sound familiar?  At this point, I get a call from every parent– frustrated and in tears. They don’t know what they did wrong. Their child was doing so well. He was communicating and using his words and then suddenly out of nowhere he just stopped and went back to tantrums.

There is good news. You are not alone. This is not uncommon. It is not your fault and most importantly — it will NOT last forever. It will likely last a few days- maybe a week.

Use the exact same procedures to eradicate the tantrum that worked in the past. EXACTLY THE SAME ONES. Let me repeat that to make it clear — EXACTLY — EXACTLY– EXACTLY– the sames ones! They worked in the past and they will work again. Five out of ten parents will tell me at this point- they don’t want to go back to the token board or rewarding good behavior with stickers because they are taking a step backward.

To be blunt, if you do it, in a couple of days your child will realize once again tantrum is not communication and the misbehavior will stop. If you don’t this problem can be drawn out for months and it will create a lot of unnecessary frustration for you and your child.

At this point your child will learn- Sometimes asking me will get what me I want. This is called and intermittent schedule of reinforcement in the made up behavior language that I personally find unnecessarily complicated. But– if you hear the term- that is what your therapist means.

The bottom line kids have to learn to hear no. Read that again — They have to learn it — The implication of this is that they don’t necessarily no how to do it.

Rest assured — they will learn.

So, when your child takes a few steps forward and soon after it feels like you are taking a giant step back- don’t worry and don’t blame yourself. It is an annoying and frustrating but necessary and short lived part of the process.

Here’s What to Do if Your Child Keeps Getting Bored of Their Reinforcers!

Does it feel like every time your child learns a new skill, it is not long before you take a step backwards and the strategies you were using stops working? Are you wondering what you are doing wrong or even if you are the problem? I promise, the problem is not you. In this video I share what the problem is and how to fix it!

What to do If Your Child Keeps Getting Bored of Their Reinforcers!

This week’s blog post is based upon a conversation I had this week with a friend who has a young child with Autism.

With her permission, I will share a bit of her story. Her son has been fully potty trained for almost six months but recently started having accidents again.  It is definitely not a medical issue. It is intentional and a behavior issue. She called me and asked what I suggest she do.With her permission, I will share a bit of her story. Her son has been fully potty trained for almost six months but recently started having accidents again.  It is definitely not a medical issue. It is intentional and a behavior issue. She called me and asked what I suggest she doWith her permission, I will share a bit of her story. Her son has been fully potty trained for almost six months but recently started having accidents again.  It is definitely not a medical issue. It is intentional and a behavior issue. She called me and asked what I suggest she do.

I told her to go back to the basics and start giving him a reward or a reinforcer every time he goes to the bathroom in the potty. It may be frustrating and it certainly seems like a step backwards but sometimes you have to do what you have to do and meet a child where he is.

She heeded my advice and gave him stickers for going to the bathroom in the potty. Then the stickers stopped working. She switched to giving him one of his favorite crackers. It also worked for a few days but stopped working. She tried a third reward and that also stopped working!

She called me back confused and frustrated. To her, it seemed like nothing she was doing was working. To me, the problem was very clear. The reinforcer was becoming satiated. Simply put after getting a reward for a few times, it was no longer exciting and no longer was motivating enough to encourage him to go to the bathroom in the potty.

To fully understand this, let’s imagine you go out to dinner on your birthday to your absolute favorite restaurant. They have amazing bread and you indulge in it with some wine while you are waiting for your appetizers.  When your appetizers come you devour them. By the time your main course arrives, you are already feeling full. Truthfully, you probably could have stopped eating after the appetizers and have been content. Dinner arrives and it is so good, you can’t stop eating. It is there. Even though you are stuffed, you finish it anyway.  After dinner, the waiter comes with a huge slab of chocolate cake singing happy birthday. You are mortified, not only because all attention is on you, but because you would absolutely explode if you took even one bite of that chocolate cake.

Does this mean you no longer like chocolate cake? No, of course not! Does this mean that tomorrow, you won’t want chocolate cake when your co-workers brings one into work for you. Absolutely not!

This example seems almost silly because it is so obvious that sometimes you will want cake and sometimes you won’t.

But, it is the same thing with reinforcers. The best way to understand reinforcers is to substitute the word reinforcer for reward. Something is only a reward if you want it.  Some days your child with want stickers. Some days they will want cookies. Some days they will want to play with their cars. Some days, it may even seem like they just want to torture you and don’t want anything!

When you understand this, it becomes clear why reinforcers stop working. Don’t worry. It’s not just your child and you are not doing something wrong. It’s normal! It happens to everyone.

I can write a really technical article about the hierarchy of reinforcers and preference assessments explaining the science behind all of this. But, it would a lot of technical jargon that would probably put you to sleep.

However, there is one very simple thing you can do that will work every single time that is my best advice about reinforcers. It is so simple that you are going to kick yourself for not thinking of it.

That’s to have a reinforcer box rather than using one reinforcer. Go get a shoe box, put a bunch of different things in it that your child likes and let them pick something out every time they engage in the behavior you are trying to reinforce/reward.

I always encourage parents to go to the dollar store or a store like Party City where you can get a bunch of small things at a really low cost. This will allow you to constantly offer them different things without spending a ton of money. Plus, when they get bored of it, which let’s be honest happens really quickly with kids and toys, you can just throw it out without feeling bad about spending a ton of money. This will help keep your house clutter free.

If your child uses food as a reward or an activity like time on the iPad, you can also have a picture of the item.

If your child only uses activities and larger items, and wouldn’t be reinforced by something small, you can also have a choice board with pictures of objects.

Whatever works for you and your family.

The key to keeping a child on track is to always make sure they actually want the reward and the way to do that is by always varying it!

This simple tip will work every single time! It is virtually guaranteed!

3 Seriously Important but Overlooked Questions to Ask When Choosing an ABA Therapist

Finding the right therapist for your family is one of the most important decisions you will make as a parent. You are trusting your child’s progress, education and future in the hands of the person that will be working for them. The good news is– there are a lot of really great providers out there.  There are a lot of resources with the obvious questions that you would ask a provider. This blog post will highlight three really honest questions you likely would have never thought of asking.

Question 1: How Do You Integrate Families Into the Program?

Research demonstrates that when parents are involved in an ABA program in a positive way, children make more progress. However, many ABA therapist do not include parents in the programs. Some even discourage parent participation.

One of my biggest pet peeves is when therapist tell parents that their children do better when they are not present because they are distracting and ask them to leave the room.  This is simply unacceptable. The only way that an ABA program can work is if all the people in the child’s life are carry out the intervention the same way. Parents are the most important person in any child’s life and a vital part of their educational success.

A good ABA therapist recognizes there are many ways to achieve the same goal. Just because a textbook says an approach will work does not mean that it will work for a family.  A good ABA therapist will ask parents what is most important to them when selecting program goals and will take into account family values and cultures when designing interventions.

For example, many times ABA therapists use food as a reward for good behavior. Some parents are totally okay with this.  Some families are not. The same holds true for the ipad. There is always merit to what approaches an ABA therapist recommends but arguing there is no other approach is a sign of an inexperienced therapist.  A good ABA therapist will accept a parents input and modify what they are doing. If a parent is not comfortable with an intervention, they will not carry it out when the therapists leaves.

An important question to ask a potential ABA therapist is whether or not they modify their methods based upon a family’s culture or preference or use a one size fits all cookie cutter approach.

It is not easy to modify what you are doing all day every day when working with different families. It took me years to master this skill. I used to argue with families all the time that my approach was correct and theirs was wrong because I read a study somewhere that my validated my technique.  Today, I recognize it’s not about whether a strategy could work in theory but whether or not it will work for my client.

Question 2: Are You Willing to Collaborate With Other Professionals?

I am just going to say it. ABA therapists are notoriously arrogant. Research demonstrates that ABA therapist can help up to forty percent of children recover from Autism. ABA is inarguably the most scientifically validated method of treating Autism.  This has lead many therapists to believe or at least act like they are better than all other Autism professionals. The bottom line. Children with Autism have lots of different needs and a good ABA therapist will recognize that other professionals have strengths they do not have and will collaborate with them, listen to them and even use some of their strategies to make sure your child is successful.

For example, many occupational therapists put children on sensory diets. Children with Autism all engage in some form of stereotypy. There is research that demonstrates that accessing some activities that provide a child with sensory input can help to reduce stereotypy. This is not a behavioral technique but I can tell you by first hand that from my observation from my eleven years in the field as well as from reading research, it works. Many ABA therapists will not implement a sensory diet because it is not a behavior technique. Others will argue that they can do it but they can’t “technically” call it a sensory diet and will call it a reinforcement break. A child is not a technicality. They are a person and they need our help. It doesn’t matter what you call a technique or who came up with the idea. If it works for a child- it works.  

This is just one example but things like this will come up over and over!  Make sure your ABA therapist is willing to work with your child’s teacher, their occupational therapist, speech therapist, physical therapist and any other provider your child sees.


Question 3: Do You Stay Up to Date With Research?

This is just one example but things like this will come up over and over!  Make sure your ABA therapist is willing to work with your child’s teacher, their occupational therapist, speech therapist, physical therapist and any other provider your child sees.

I hope these three questions help you find the therapist that is the right fit for your family. Your therapist will be an important part of your life. Healing your child of Autism is a difficult journey. Finding the right person to help your family will make it a little bit easier.

References

Benson, P., Karlof, K., & Siperstein, G. (2008). Maternal involvement in the education of young children with autism spectrum disorder. Autism, 12(47), 47-63, doi: 10.1177/1362361307085269

Case-Smith J, Bryan T. The effects of occupational therapy with sensory integration emphasis on preschool-age children with autism. American Journal of Occupational Therapy. 1999;53:89–497.[PubMed]

Cohen, H., Amerine-Dickens, M. and Smith, T. “Early Intensive Behavioral Treatment: Replication of the UCLA Model in a Community Setting.” Journal of Developmental Pediatrics, 2006; Vol. 27, No. 2: pp145-155

Dawson G., “Behavioral interventions in children and adolescents with autism spectrum disorder: a review of recent findings.” Current Opinion in Pediatrics, 2011; Vol 23: pp 616–620

Dawson, G. et al, “Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model.” Pediatrics, 2010; Vol. 125, No. 1: pp17-23

Fein, D., et al, “Optimal outcome in individuals with a history of autism,” Journal of Child Psychology and

Landa. R. J., and Kalb, L.G., “Long-term Outcomes of Toddlers With Autism Spectrum Disorder Exposes to Short-term Intervention,” Pediatrics 2012;Vol. 130;S186

Linderman TM, Stewart KB. Sensory integrative-based occupational therapy and functional outcomes in young children with pervasive developmental disorders: A single-subject study. American Journal of Occupational Therapy. 1999;53:207–213.

Lovaas O. “Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children.” Journal of Consulting and Clinical Psychology, 1987; Vol. 55, No. 1: pp3-9

Maglione, M.A. et al, “Nonmedical Interventions for Children With ASD: Recommended Guidelines and Further Research Needs,” Pediatrics, 2012;Vol. 130;S169

McEachin J, et al. “Long-Term Outcome for Children With Autism Who Receive Early Intensive Behavioral Treatment.” American Journal on Mental Retardation, 1993; Vol. 97, No. 4: pp 359-372

Ozonoff, S., & Cathcart, K. (1998). Effectiveness of a home program Intervention for young children with autism. Journal of Autism and Developmental Disorders, (1), 25-32. doi:10.1023/A:1026006818310

Pfeiffer, B. A., Koenig, K., Kinnealey, M., Sheppard, M., & Henderson, L. (2011). Effectiveness of sensory integration interventions in children with autism spectrum disorders: a pilot study. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 65(1), 76-85.

Roberts JE, King-Thomas L, Boccia ML. Behavioral indexes of the efficacy of sensory integration therapy. American Journal of Occupational Therapy. 2007;61:555–562.

Schaaf RC, Miller LJ. Occupational therapy using a sensory integrative approach for children with developmental disabilities. Mental Retardation and Developmental Disabilities Research Reviews. 2005;11:143–148.

The Number 1 Reason Behavior Plans Fail

The Number 1 Reason Behavior Plans Fail! This simple mistake, your therapist might be making, could be the reason your child’s behavior plan is not working!!

3 Strategies to Help Your Child With Autism Be Successful in The Community

One of the most common complaints I get from parents is that their children can have a great deal of difficulty when out in the community. This can range from something relatively benign like touching things on the shelf or far more serious like running away from parents or throwing themselves on the floor in the street. Frankly, it is not frustrating for parents when their children struggle in the community but, it can also be very dangerous.

Here are 3 strategies I use with the families I work with that will help increase the likelihood that your child is successful.

Tip 1: Use Visuals To Help Increase a Child’s Success

I find a lot of stress can be alleviated if children know what to expect. I like to use visuals to let children know where they will go before they leave the house or when they are transitioning the community.

I typically suggest keeping a binder ring with pictures of places you commonly go to in the community on your keychain. This will make sure you are always prepared to show your child where they will go. If you are going to multiple places on one trip, you can also use a visual schedule while out in the community. Using a velcro schedule with pictures attached will help kids understand when it is time to transition.  When things come up and you have to go somewhere unplanned, you can also just google the location your cellphone to show them when out.

Example of a Binder Ring With Locations
Example of a Picture Schedule

This may seem easier said than done and honestly, it can be a lot of work.  But, it can save you a lot of frustrating and avoid potentially dangerous situations when out.  

Tip 2: Practice In an Easy Location Before Going to More Difficult Locations

Recently, I had a family hire me to work with their child in the community who would frequently have tantrums in stores. He would throw himself on the floor no matter where they went and refuse to walk.  I suggest we bring a timer and start off by setting it for thirty seconds and giving him a small snack as a reinforcer (reward) when he walks nicely for thirty seconds. First we did it in his backyard! It is a place that is familiar and fun and did not have any negative associations like stores did.

When we did go into the community, we started off on a track to make sure he was in a place that was safe in case he tried to run away or have a tantrum. Then we shifted to stores.  Eventually we were able to increase the time he walked to 40 seconds, 1 minute, 2 minutes, 3 minutes and 5 minutes before he got his snack. Eventually, he didn’t need the timer at all. This whole process took only a few weeks. Now, the family can have trips to the mall and even restaurants without worrying about meltdowns.  This strategy has worked for dozens of the families I have consulted with and I know it will work for you too.

Tip 3: Use social stories.

Social stores are stories that you can read to a child before you go out into the community that will tell them how they are supposed to respond. Let’s remember children with Autism don’t always have the social skills we have and sometimes behavior that looks like naughty is just because they don’t know how they are supposed to act or respond to a situation.  

Being in an unknown situation can also create anxiety.

A social story can be used to help them know that to expect and how they should respond.

It is now that difficult to write and there is really not much to it. Here’s a social story you can use about going to the grocery store

Today, we will go to the grocery store. That’s great. We will get a lot of my favorite foods at the grocery store. There will be a lot of other people there. That’s ok. Mom will be there with me and she will keep me safe. When I am at the grocery store, I will walk nicely without touching things in the isle.  If I walk nicely, it will make Mom very happy. We will only be in the store for a short period of time and then we will leave. When we leave mom, will give me a snack for doing a great job. Going to the grocery store is totally fine!

Being able to participate in community activities can be so stressful for families that have children with Autism. I want you to know you can do all the same activities other families enjoy. It is true that you may have to do some extra work to prepare but your child is capable of enjoying all the things this world has to offer with just a little extra support.

The Number One Reason Why Behavior Plans Don’t Work!

Let’s face it.  Most children with Autism have very limited communication.   For some kids, this results in a lot of wanted behaviors — tantrums, crying, hitting, sometimes even self injury.  Whether or this sounds like it applies to you, if your child has an Autism diagnosis, at some point they will likely have a behavior plan to help reduce a behavior.

IF written correctly and applied consistently, a behavior plan works every time. But- that’s a pretty big IF.  To be honest, there are a number of things that can go wrong when writing a behavior plan. Every child is different! But, there is one mistake that is super common that will ensure a behavior plan fails every time.

It’s when the therapist forgets to teach a replacement behavior for the behavior they are trying to do reduce.

If a child has limited communication, crying may not be their way of being naughty or non compliant. It does not mean they are spoiled, bratty or that as a parent you have done something wrong. Most often, it means that is the only way they have of getting what they want. It is probably even more frustrating for them as it is for you.

If you try to get a child to stop crying to get what they want- you have to teach them another way to achieve the same goal. Us experts call it teaching a functionally equivalent replacement behavior.

For example, if your child cries every time they want to play with the iPad – teaching them it is not okay to cry if they don’t get the iPad is not enough. You have to teach them a way to ask for it!  There are so many alternative communication methods available to children who are still learning to talk. One of them will work for your child.

One of my favorite sayings I have ever heard in my eleven year professional career in the field of Autism is, “Just because a child can’t talk, does not mean they have nothing to say!”

If a therapist keeps this in mind when writing a behavior plan, it will always work.

Who Would Benefit From Applied Behavior Analysis?

Last week, a parent asked me if ABA was only for children who are aggressive. I promptly answered her with a Facebook Live. Later that day, in a meeting I was asked if ABA was only for younger kids who can’t talk. After being in the field of Autism and using ABA as my main modality of practice, I often take for granted that parents know if ABA would be helpful for their children but more and more I am finding that may not be the case.

A common misconception is that ABA only works for younger children. That is simply not true. In simple terms ABA therapists change a behavior by occurring what happened before and after a behavior. That lends itself to be used by anyone at any age. In fact, ABA is not only used when teaching children with Autism. It is used by many companies to increase productivity, by relationship counselors and even by the military. The belief that ABA is only used for younger children exists because at one time, funding to receive services was only available for young children. Thankfully today, more people have access to ABA, at least in the United States.



As a child gets older and gains more skills, ABA does look differently. Initially when a child first starts ABA a lot of time will be spent at a table doing discrete trial training. However, over time ABA will be used to teach more complex skills such as: making a meal, using a budget, making a bed, using a local bus system. ABA adapts to meet every person’s needs and can be used at any age.

 



In Case You Missed It — Here is the Recording of My FB Live: Is ABA Only For Children With Autism Who Are Aggressive?



 



Wondering What People With Autism Who Received ABA Have to Say About It? Here Are Two Podcasts I Have Recorded With Two People Who Were Diagnosed With “Low Functioning Autism” Who Attribute ABA to their Autism Recovery!



Joseph Mohs- Was Diagnosed With Infantile Autism at Birth and Now is a Well Known Speaker in the Field of Autism and a Proponent of ABA



Allison Knight was Diagnosed With Low Functioning Autism. She Received Intensive ABA an Now is an ABA Therapist!

 



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