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.





6 Sensory Friendly Stocking Stuffers for Under 10 Dollars!

It is so hard to believe that the holiday season is already upon us.  This year just flew by. If you are anything like me, standing in long lines at the mall fighting for the best deals is not how you want to spend your holiday.   While some people enjoy holiday shopping, for busy moms like yourself who have a million things to juggle already, it is probably more stressful than fun. Additionally, kids with Autism often have very limited interests so knowing what to buy your child can make holiday shopping even more frustrating. 

I want to take the mystery out of shopping this holiday season for you. One of the number one questions that parents ask me during the holiday season is what they should get their kids.  There are a few things that i have found that hold true for almost all kids with Autism.

  1. They respond well to toys that provide visual or tactile sensory stimulation. Because many kids with Autism lack complex play skills, they find solace in simple things that either enjoy watching or touching.
  2. You may have to try a dozen different things before your find something that interests your child.
  3. Children often get bored of things very quickly.

That’s why I put together a list of 6 stocking stuffers you can order right from this blogpost that cost less than 10 dollars. While I cannot guarantee they will work for your child, I chose them because they are the most common toys that the children I work with enjoy.  Since none of the toys cost much, there is minimal risk. All of the toys selected will provide your child with some sensory input which is demonstrated to reduce stimming behaviors for some children.

References

Allen, A. P., & Smith, A. P. (2011). A review of the evidence that chewing gum affects stress, alertness and cognition. Journal of Behavioral and Neuroscience Research, 9, 1, 7–23.

Foss-Feig, J. H., Tadin, D., Schauder, K. B., & Cascio, C. J. (2013). A substantial and unexpected enhancement of motion perception in autism. Journal of Neuroscience, 33(19), 8243-8249.

Stalvey, S. and Brasell, H. (2006). Using Stress Balls to Focus the Attention of Sixth-Grade Learners. Journal of At-Risk Issues, 12, 2, 7-16

Just Freaking Eat It- 5 Steps for Exhausted Parents to get your Sensory Child to Eat!

5 Steps for Frustrated Parents to Get Your Sensory Child to Eat

What is food selectivity disorder?

A child has food selectivity disorder when they have a very limited selection of foods that they are willing to eat. Having food selectivity disorder is not the same as a child being a picky eater. Usually children with food selectivity wind up being underweight and/or malnourished as a result of eating such limited foods.

Food selectivity looks different for all children. Some children will only eat food with specific textures like pureed food or baby food. Other children will avoid textures like wet foods. Some kids will only eat salty foods, some only sweet foods and others only foods of a specific color.

Many times, when kids are presented with new foods, they will become extremely upset and refuse to eat. When you force selective eaters to try something new, they will spit it out or gag and make themselves throw up. Often times, they are unable to express why they are rejecting the food which leaves parents wondering what is going on!  You may be offering them cake, cookies, chips or similar things that it may seem like all kids would want to eat! Either way, it is extremely frustrating and rather than dinner being a fun time for families to spend time together, it becomes one of the most dreaded parts of your day.

Why is my child selective about food?

There is no one answer to why a child is selective about eating particular foods. There is a very high correlation between Autism and Sensory Processing Disorder with food selectivity. The most common reason is that sensory eats avoid specific food textures. Apraxia, a motor speech disorder, also can cause children to reject foods at it makes moving food around the mouth a challenge. The good news is, no matter what the cause of the food selectivity there are five simple steps to overcoming it!

Step 1: Encourage your child to Play with Food Food

Allow your child to play with foods that they do not want to eat without requiring them to eat it. The exposure to the foods without the threat of being required to eat them will create a positive association with the foods and will reduce your child’s stress.

If your child doesn’t like solid foods, you can play with cereals, by dumping them in and out of cups and bowls. You can glue pretzels to paper, string pasta, and even include some of you child’s favorite toys in the games such as putting the food in trucks or feeding the food to stuffed toys or dolls. There are limitless possibilities.  Liquid foods can be a little more messy, but with a little creativity and some rags to clean up the mess, there are also tons of options!

Stay on this step as long as necessary! Feel free to also continue it throughout the rest of the steps.  I would encourage you to use several different foods to help with generalization! No matter what, keep it fun! Remember, the goal is to create a positive association!

Step 2: Require Your Child to Kiss the Food

Children will be reluctant to try new foods. However, if you assure them that they will not have to actually eat the food, they will be far more willing to cooperate. In this step, you have the child kiss the food and then they are done! You can tell them ahead of time how many times they will have to kiss the food but you would never ask them to put the food in their mouth! Praise them for doing a really great job once they kiss the food and give them access to their favorite toy or activity before either having them kiss the food again or to go to the next step.

*You may be able to progress through all five steps in one day or you may stay on each step for days or even weeks. Stay on each step until it becomes effortless for your child. Then, move on!

Step 3: Require Your Child to Lick the Food

Step 3 is almost identical to step 2 with the exception that in step 3, they are licking and kissing the food. Like with step 2, you should end the demand, praise them and give them access to their favorite toy or activity every time they lick the food. Also, like with step 2, stay on the step until it becomes easy for the child. Then, they are ready to move to step 4.

Step 4: Require Your Child to Put the Food in his Mouth but Allow them to Spit it Out

In this step, for the first time, you are requiring the child to put the food in their mouths. For many kids, this will be the most difficult step. Be prepared to give them a major reward for trying the food, especially the first time they do it!

This is also the most difficult step for many parents because it may seem counterintuitive to allow your child to spit out the food. The main reason for this that knowing that they can spit it out makes children much more likely to try them. The good news is that more often than not, they wind up realizing the food actually tastes good and they don’t spit it out!  You don’t want to repeat this step too many times for the same food! This step is meant to be a transition to step 5. You don’t want to spend a lot of time on it. It is just an option the first few times a child tries a new food. Keep in mind, there may be some food your child just doesn’t like!

Step 5: Require Your Child to Eat the Food

Once your child has completed the prior four steps, they are ready to eat the food! If they are still a little bit apprehensive, there are things you can do to make mealtime less stressful. My recommendation is to allow them a bit of a favorite food for every few bites when eating a challenging food. Or, if you are comfortable with it, allow them to bring a toy or watch a video during dinner as long as they are eating or you can use a token board and allow them to watch a video or play with their toys after a few bites. However, typically, the key is getting kids to try foods! Usually, once they try them, they realize they actually like them!

Starting School With Autism

Congratulations! Your child is about to start school. It is exciting, but it can also be scary. Sending any child to school for the first time is hard for any parent, sending a child with special needs to school, especially one that has a difficult time communicating can be even scarier. 

Fortunately, there are things that you can do to make the transition easier for you and your child. Here are my best 10 tips.

Tip 1–Prepare Your Child Ahead of Time 

Many children with Autism fear change.  The good news is that once school starts, the consistent structure and schedule will be wonderful for you child. However, while it is new, the change in routine can be challenging for many kids to cope with. This is compounded by the fact that children who are starting school for the first time might not fully understand what is going on and what to expect.

There are some things you can do to help ease your child’s anxiety by preparing them ahead of time.

  • For a few weeks before school expose them to books and videos about school. Talk to them frequently about starting school using language they can understand. Even if it seems like your child may not fully understand the books or videos, show them to them anyway. At the very least, they will create visual associations that could ease their comfort in a new environment.
  • Use social stories to help prepare your child to understand that he will start school. Social stories are short stories that are designed to teach a child how to act in a social situation. They were researched and developed by Dr. Carol Gray in 1993 and since then, dozens of studies have demonstrated their effectiveness. I use them all the time in my private practice working with families like yours.
  • Countdown the days until school with your child. Cross off the days until school on a calendar to provide a visual countdown for your child. This will help make sure they know exactly what to expect . 

Tip 2–Know the Goals on Your Child’s Individualized Education Plan (IEP)

I am going to be real for a minute. You may not like what I have to say but it is true. Your child’s teacher is being handed a stack of IEPs for each and every one of their students. They are long, lengthy legal documents that generate verbose and confusing text that all sounds the same. It is not likely many teachers will read it and actually use it to develop your child’s education program. The more you as a parent know about your child’s IEP, the better they will do in school.

Know what your child’s goals are. Ask the teacher what they are working on and make sure the lessons they choose, address the goals you agreed upon at your child’s IEP meeting. If you haven’t already, make sure you participate in the creation of those goals! Know what support services your child is supposed to receive. Make sure if your child is supposed to be pulled out of the classroom for services such as speech therapy, physical therapy, occupational therapy, that those sessions are actually happening as opposed to the therapists being used as an extra set of hands to pass out snack.

Most often, teachers like myself who work with kids with Autism do it because they are really passionate about helping kids but unfortunately this isn’t always true. You are your child’s best advocate and it is ultimately up to you to make sure their needs are being met. Knowing your child’s IEP will help you to have informed conversations with your child’s teachers and ensure they are aware of his goals.

Tip 3— Take a Tour of The School

Ideally, the first time a child visits their new school and classroom shouldn’t be the first day of school. While every school has different policies, most schools are very accommodating and will let you and your child visit. Sometimes they will even let your child spend part of a day in his future classroom. 

Many times, children with Autism will attend contained classrooms that have children in a fairly broad age range. This means that when they enter school, they will likely see some familiar faces. It will also give your child a chance to get comfortable with their new teacher.

Some people think that children with Autism are not interested in people and as a result, they skip this step. This is simply not true. The fact that children with Autism struggle with knowing how to act in social situations does not mean they don’t desire to create bonds with others. Whether or not they are able to express it, they know the difference between friends and strangers and receive the same comfort we do by seeing a familiar face.

Tip 4— Create a Visual Schedule for Your Child

Children with Autism are visual learners. As a result, schedules are very helpful in knowing what to expect. Most children have difficulty with transitions because they do not know what will happen before or after an activity. Creating a schedule will show them what happens before and after school. This will make them far more comfortable about going to school and will ease their anxiety about coming home. 

Ideally, put something your child enjoys on the schedule right after school such as eating a favorite snack, going to a fun place or time to play with their favorite toy. This will motivate them and give them something fun to think about.

Tip 5— Make Sure Your Teacher is Aware of Your Child’s Sensory Needs and Send in Sensory Toys

Sensory behaviors are part of Autism. These behaviors, technically called stereotypy, can include hand flapping, mouthing objects, spinning car wheels, lining things up, watching parts of a video repetitively, fixating on one toy, holding things in their hands, rubbing their feet on people and countless other behaviors.  Make your teacher aware of what your child’s sensory behaviors are and send in any toys that will help them be more comfortable and focus in school.

For example, if your child uses a chew tube at home because they mouth objects, send it in! It is important your child has it in school. If your child will drink from one specific cup, send it in! If using sensory balls helps your child focus, pack them! Send whatever you think will help your child be more comfortable and successful. Many parents choose not to send things in because they are afraid teachers will judge them or limit access to them. But, most teachers are grateful to have something that works for your child.

Tip 6–Make Sure Teachers and Support Staff Know about Special Accommodations like an Alternative Augmentative Communication (AAC) System.

Many children with Autism will have received some type of service such as early intervention, speech or applied behavior analysis before starting school. This almost always includes the development of an AAC system. An AAC system is a way for a child to communicate while they are learning to talk. This could include a picture board, a formal program such as Picture Exchange Communication System (PECS) or a voice output system such as a Dynabox or iPad app like Poloquo2go. Make sure to send this in and make sure that you child’s teacher is trained on how to use it.

Insist your child be allowed to have access to his communication system all of the time. This is your child’s way of communicating. Taking it away, even putting it out of your child’s reach for a few moments to make more  room on the table for and art project or snack is equivalent to putting a hand over your child’s mouth so they cannot speak. It is never ok.

Tip 7— Get The Same Toys the School Has Ahead of Time

Do your very best to find out what toys, puzzles and books will be in your child’s classroom. Get the same ones and teach him how to play with them. Most behavior problems occur in school when children do not know how to manage or occupy their downtime. 

There is something to be said about kids liking toys that are new and different. That is true, but kids with Autism usually lack some play skills which means without being taught how to play with new toys, they may not be able to. This will result in them spending more time engaging in sensory behaviors or having tantrums.  It is better to make sure they at least know what to do with the toys that will be in their classroom.

Tip 8— Take Advantage of Community Programs to Practice School Skills 

If your child is new to school they may be new to group activities like circle time and art projects. Do everything you can to make sure your child has lots of practice before school starts and school is not your child’s first exposure. They will likely need a lot of practice before they know how to sit and participate. Almost every public library in the nation has a circle time. Call your town’s library and the library in the towns surrounding you and bring your child to as many of them as possible. This is one of the best ways to prepare your child for school activities.  

Tip 9— Send in Your Child’s Reinforcers

Most children with Autism will receive some form of applied behavior analysis (ABA) in the classroom. ABA works by giving your child reinforcers or rewards when they engage in a desired behavior. It helps to show them what a correct response is and know what is expected of them. 

Many times children with Autism are picky and only like a few things. I don’t need to tell you that! How many times have you bought new foods or toys that your child has rejected? It may be really hard for your teacher to find something your child really enjoys. The more motivating a reinforcer is, the more a child will learn, this is always true. One of the best ways you can help your child learn more effectively at school is to send in what reinforcers have worked at home.

Tip 10— Ensure Your Child Has Identification

Every parent’s  biggest fear is that their child does not talk and that there is a possibility that they will wander out of a classroom. I would love to tell you that could never happen but we are all too keenly aware from watching the news that it does. 

If your child wanders, make sure his teachers know and fight to get him a 1:1 aid. If your child cannot communicate his name, your name and your phone number, make sure they are always wearing an identification bracelet. It should identify that they have Autism, their name, your name and your phone number. 

Some parents fear this will stigmatize their child or that they will have a difficult time keeping them on. These two things may be true but it will help keep them safe and that is the most important thing.

It is my hope and prayer these ten tips ease your fears about sending your child to school.  School will be a fun and safe place for your child. He will learn, grow and explore at a whole new level and you will watch him blossom before your eyes.

As a therapist, I can only imagine what it is like to send a child that can’t speak for themselves to school. But, what I can promise you, is if you follow these ten tips, you can be their voice.

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.

Unlock the Code of Enjoying Dining Out as an Autism Family!: Featuring Lenard Zohn

Going to a family restaurant should be an enjoyable experience. A time to relax, enjoy good food and spend time with your family. Let someone else do the cooking and cleaning. Unfortunately, for those of us who have a child with autism dining out can be anxiety provoking and stressful. As parents, we may feel that “all eyes are on us” when our kids exhibit certain behaviors, have outbursts or refuse to sit still. Other diners may be disturbed and the well intentioned wait staff doesn’t really know the best way to help out. Many of us decide it is just not worth the effort and that is unfortunate. We created Autism Eats to bring the fun back to eating out. Our dinner parties are held in private rooms of restaurants or function facilities. Food is served buffet or family style so there is no waiting. Music and lighting are adjusted to accommodate those with sensory sensitivity. These are family dinners and all attending have a loved one on the spectrum so there is no need to apologize, explain or feel uncomfortable. It is an opportunity to enjoy a night out and socialize with others who have many of the same joys and challenges in common.

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.

Teach Your Child an Alternative Communication System While He Is Learning to Talk

Communication is difficult for all children with Autism. After all, it is part of the criterion for diagnosis.  The goal for all parents of children with Autism that they will learn to talk. For many children with Autism, this is possible.   However, sometimes talking comes much later for children with Autism than it does for most other children.

However, just because a child with Autism can’t talk, does not mean they have nothing to say.  Not being able to expresses feelings or even basic desires causes a great deal of frustration for anyone.  You and I can observe this when children have tantrums over something seemingly innocuous but it is something that unless we have experienced we will never fully understand.

When I first started teaching children with Autism, now more than eleven years ago, I wanted to experience what it was like to not be able to communicate so I can relate more with the children I was working with. So, I attended a week long church camping trip where everyone spoke only Spanish.  I realize now, you can’t compare my experience what children with Autism go through, but I can tell you that by day two, I was in my tent crying.

The best advice I can give parents whose children are still learning to talk is to teach them a way they can communicate now. This is called alternative communication. Simply put, alternative communication is a way to communicate other than with vocal language.

Whenever I bring this topic up, parents ask that if teaching their child an alternative communication system might reduce their motivation to learn to talk.  It’s an understandable concern. The good news is, years worth of research demonstrates that the exact opposite is true– teaching your child and alternative communication system can actually help them learn to talk.

There are many alternative communication systems available. It can be as simple as a choice board with photos of objects your child may want or as complex as a computer device or iPad app that can allow your child to have full conversations.  The important thing is that they have some way they can tell you what they want.

It will save your family a lot of heartache and will likely increase the rate in which they acquire spoken language if it is something they are able to do.

References

Anna, L., et al. (2014) Long-Term Effects of PECS on So-cial-Communicative Skills of Children with Autism Spectrum Disorders: A Follow-Up Study. International Journal of Language & Communication Disorders, 49, 478-485.https://doi.org/10.1111/1460-6984.12079

Brady, D. O., & Smouse, A. D. (1978). A simultaneous comparison of three methods of

language training with an autistic child: An experimental single case analysis. Journal of Autism and Childhood Schizophrenia, 8, 271–279.

Flippin, M., Reszka, S. and Watson, L.R. (2010) Effectiveness of the Picture Exchange

Communication System (PECS) on Communication and Speech for Children with Autism Spectrum Disorders: A Meta-Analysis. American Journal of Speech-Language Pathology, 19, 178. https://doi.org/10.1044/1058-0360(2010/09-0022)

Ganz, J.B. & Simpson, R.L. (2004) J Autism Dev Disord 34: 395.

https://doi.org/10.1023/B:JADD.0000037416.59095.d7

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