Community Outings

Participating in community outings is an important skill for children, but can often be overwhelming to practice. Writing a behavior plan can help provide guidance to increase tolerance of community outings for your child.

While creating a plan, it’s important to have contingencies in place to support your child and to facilitate success while in the community. Identifying common places in the community that you and your child frequently encounter is a good place to start. Brainstorming what can go right – or wrong – ahead of time can help everyone involved. Consider a scenario in which a child frequently engages in tantrums while grocery shopping. To begin, we would identify the grocery store that parents typically go to, select a time in which the grocery store is not busy, and plan for specifically challenging aspects of the grocery store (e.g., avoiding the candy aisle). Additionally, collecting baseline data may be helpful while planning for outings. For instance, if baseline data suggest that your child typically begins to demonstrate negative behaviors after 15-minutes of shopping, we may want to design our trips to be 10-minutes long to facilitate success. As your child learns to tolerate these trips, we can systematically increase the length of the outing.

Reinforcement systems are also an important part of the plan. Examples of reinforcers could include small treats delivered throughout the store for appropriate behaviors (e.g., sitting nicely, using an indoor voice), descriptive praise, and a larger reward at the end of a successful trip (e.g., selecting a toy). However, it is important to withhold these rewards if your child engages in inappropriate behaviors while shopping. For instance, while entering the grocery store you may describe to your child that they will receive treats for sitting nicely, and if they walk nicely the entire trip they will get to pick out one item from the toy aisle. If your child engages in a tantrum, we would want to ensure that the child does not receive attention or get to pick out a toy.

As your child becomes successful with the initial steps of the plan, we will want to fade the program to resemble typical trips to the grocery store. Examples of fading could include going to the store at higher-traffic times, increasing the length of trips, reducing the frequency of delivering treats, or providing a toy after every-other trip to the store. Data should be collected (e.g., duration of trip, time of trip, instances of problem behavior) to see whether the child is ready to move on to the next step of the program.

Overall, community outings can be overwhelming, but with a concrete plan we can increase tolerance of outings and facilitate success for our children.

Facilitating Independence

While teaching new skills, we often use prompts. Prompts serve as intermediary steps between the child’s current skill set and the target goal. Although prompts are a necessary aspect of teaching skills, there is a delicate balance between under and over-prompting. If we under-prompt, it will be unlikely that the child will learn the skill. Conversely, if we over-prompt, the child will likely become dependent on the prompt and will thus not be able to complete the skill independently.

Let’s take the example of teaching a child to wash their hands. With this skill, the emphasis is on independence; that is, the goal is for the child to be able to complete each step of hand-washing without the assistance of an adult. If we teach a child to scrub their hands with soap using hand-over-hand prompting they will likely not learn to independently do so as they are not required to make any movements of their own – and are now dependent upon adult help. On the other hand, if we continually use the verbal reminder such as “scrub” to a child that doesn’t know this meaning, they will likely never develop the skill of scrubbing soap – it’s an ineffective prompt. These two types of prompts demonstrate the balance we work towards while prompting to facilitate independence.

Given these concerns, how can we decide what prompt to use to ensure that we are teaching the skill while facilitating independence? One common method is to use a “least-to-most” prompting hierarchy. Least-to-most prompting could include a verbal prompt (i.e., least invasive), a gestural prompt, and a physical prompt (i.e., most invasive). Simply put, least-to-most prompting procedures use the least invasive prompt that facilitates responding from the child. If that prompt does not facilitate the task, then we move up to a slightly more invasive prompt. This process continues until the child completes the task.

In the example of washing hands, we may begin with a verbal prompt of “turn the water on”. Then, after there is no response we may gesture towards the faucet. Then, if the child doesn’t respond again we may gently guide their hands towards the faucet to prompt them to turn it on. As the child begins to learn the skill, we will likely not need to guide them towards the faucet but instead we may be able to simply point towards the faucet. In this example, we have now have taught the child to be more independent with hand washing. Future practice could focus on moving lower and lower on the prompt hierarchy until the child can do so without any reminders from an adult.

While teaching new skills, we want to ensure that the child can complete the task independently. Least-to-most prompting is an effective teaching method to improve independence.

The Importance of Follow Through

Most parents have experienced their fair share of tantrums from their child. Although tantrums serve different purposes, they can often be a form of communicating a child’s wants or needs.

As a pre-school teacher during graduate school, I saw plenty of tantrums. Each semester began with young children being separated from their parents, and these kids often engaged in the one thing that is hardest for parents to see – crying. Typically, parents would rush back in the room to comfort their child. Unsurprisingly, the child would often continue to cry (and more intensely) during future drop-offs; likely because this behavior worked so well with gaining access to their parents!

In these situations, we would suggest that parents provide a comforting good-bye to their child but stay out of the room for the duration of the tantrum. Although a short-term solution for a tantrum is to give in by providing the child with attention, this typically sets a new standard for that child that can result in even more intense tantrums in the future. In this situation, the child can quickly learn that whining didn’t work last time but screaming did, so they will likely scream in the future to get what they want. However, the child will soon learn that their cries no longer result in their parents coming back and they are able to move on to more fun activities in the classroom.

Although this is a specific example of a child being dropped off at pre-school, it can be applied to many relatable instances in a child’s life. Parents may see these challenging behaviors when their child wants to avoid something (e.g., chores, homework), or when they want something that they can’t have (e.g., a cookie before dinner, candy at the store). Despite the differences in these situations, the concept remains the same – if you give in it will likely result in an increased likelihood that the challenging behavior will occur next time. Giving in is a short-term solution that typically results in more intense and problematic behaviors in the future, as it sets a new standard for that behavior (e.g., whining didn’t work but screaming did so I will scream next time I want something).

Summary:

  • There are times that parents are unable to give their children what they want – not out of neglect, but because it is simply not feasible at the time. It is part of the learning process for kid’s to learn when their requests are appropriate or inappropriate.
  • There may be an initial increase in the intensity/duration of the challenging behavior after planned ignoring.
    • This is a sign that what you are doing is working, as there is typically a burst in intensity before the challenging behavior subsides.
  • Pairing reinforcement systems with appropriate behaviors can be a helpful way of decreasing challenging behaviors and increasing appropriate behaviors.
    • For instance, if your child sometimes struggles with transitions you may consider ignoring screaming but providing a highly-preferred item or activity whenever they appropriately transition.
      • Ignore tantrums and always follow-through by ensuring that they transition to the next activity.
      • Provide access to a reinforcer only for appropriate transitions.

Evidence-Based Practice

While reading about Applied Behavior Analysis (ABA), it will quickly become apparent that there is an emphasis on using evidence-based practice. But why is this an essential aspect of ABA?

The short answer is that evidence-based practices work. That is, the teaching procedures have withstood stringent testing and have resulted in clinically significant changes in behavior. However, an emphasis on evidence-based practice goes beyond this; it ensures quality control for our field. This quality control holds behavior analysts to an ethical standard for providing the most effective and efficient teaching protocols.

There are many different types of interventions for children with Autism. In fact, a quick google search for “autism interventions” will yield thousands of results, and it may be difficult to sift through to identify procedures that may work for your child. However, some treatments are more or less effective than others, and behavior analysts (and parents alike) must be able to identify which programs will lead to the best outcomes for their children. Unfortunately, sometimes popular interventions are not always evidence-based.

In the early 1990s, a communication system known as “facilitated communication” (FC) became a popular intervention for increasing communication for children with intellectual and developmental disabilities. The teaching system asserts that children with developmental disabilities have the cognitive ability to communicate, but their diagnosis prevents them to be able to effectively express their thoughts and feelings. FC involves providing the child with a means to communicate (e.g., keyboard, alphabet board), and a therapist-facilitator that gently guides the child’s arm or hand towards the letters. Initially, it seemed like a promising intervention, as children that previously had no means of communicating were forming coherent sentences.

However, controlled studies testing the effectiveness of FC quickly demonstrated that it was an ineffective method. For example, one study investigated FC by showing children and facilitators a series of objects that they were asked to label. Anytime the facilitator saw the same object as the child, the child correctly labeled the object. However, when the child was shown a different object than the facilitator, the child incorrectly labeled the object. Simply put, the children only responded correctly when the facilitator saw the correct image, suggesting that the facilitator was influencing communication – not the child. Similar tests have replicated these findings, providing evidence that the intervention is ineffective at teaching communication skills for children with developmental disabilities.

Despite these findings, FC is still being offered as a communication program for children with Autism. But why is this problematic? Unsurprisingly, using ineffective interventions can be costly, as they take away from the time that the child could be benefiting from evidence-based practices. Therefore, it is in the best interest of our children to provide them with positive outcomes using interventions that have been validated by empirical research.

Citations:
American Psychological Association (November 20th, 2003). Facilitated communication: Sifting the psychological wheat from the chaff. American Psychological Association. Retrieved from http://www.apa.org/research/action/facilitated.aspx

Mostert, M.P. (2001). Facilitated communication since 1995: A review of published studies. Journal of Autism and Developmental Disorders 31, 287-313.

Teaching Appropriate Requesting

Teaching Appropriate Requesting as a Way of Reducing Challenging Behaviors

Often, children with Autism demonstrate a wide variety of ways of communicating their wants and needs. In the earliest form, babies request attention, food, or a diaper change by crying; they quickly learn that most parents will respond to crying. This is a natural form of communication that serves an important purpose for babies. However, after time, most children learn other ways of communicating. For instance, as a baby grows they may learn that they receive lots of attention for walking up to their parents with outstretched arms. This new behavior now replaces crying as an effective way of gaining attention, and is a more socially accepted way of communicating a need for attention.

It can be challenging for parents when their child does not naturally pick up on these more appropriate ways of communicating. Some children may not independently learn these skills, and instead may require extra support and practice to do so.

Limit Challenges & Teach Appropriate Requesting

While teaching children to request, it is important to a) select an appropriate way of communicating that is conducive with their current skill level, b) teach the child the appropriate way of communicating, and c) consistently require the child to request using the more appropriate way. Consider a situation in which a child wants food but does not have the words to communicate. They may go through a variety of behaviors while trying to tell their parents what they want, including pointing, guiding their parents to the kitchen, or trying to open the fridge. If the child does not get what they want (usually because parents are busy guessing what their child wants), we may see the child escalate to whining or crying. At this point, the parent may find the item that the child requested. However, this can be problematic, as we may have now set a “new standard” for that child, such that they may escalate to more extreme behaviors such as whining or crying in the future because they got what they wanted for doing so. Examples like this are often why we see children demonstrate more challenging behaviors when they are attempting to communicate their wants/needs.

It may be beneficial to identify a behavior that is appropriate for the child’s skill level and to begin teaching the child this new way of requesting. For instance, in the example above, the child does not independently vocalize while requesting but may have the fine motor skills to begin learning sign language. Therefore, it may be beneficial to initially prompt the child to sign “eat” as an approximation of the vocal word “eat” before they receive food. Then, once the child is consistently signing “eat”, parents can begin to require this request each time the child wants food, while simultaneously ignoring any inappropriate requests (e.g., whining, crying). By teaching the vocal word or sign “eat”, this allows the caretaker/parent to narrow down what the child wants, he/she is hungry. Once “eat” is being used functionally, specific foods items would be taught.

Although this is a simple description of a complex series of behaviors, the general outline can help parents identify areas in their child’s lives that could benefit from more appropriate communication. Whether the child cries to gain attention from their mother, or the child wants escape from a difficult task, it is important to teach and require appropriate ways of communication.

Summary

Teaching requests to reduce challenging behaviors:

  • Identify what your child wants
  • Identify a skill-appropriate replacement behavior
  • Teach the appropriate replacement behavior
    • Contrive situations for your child to practice this replacement behavior
      • For instance, if you are teaching the child to say “eat” you may consider holding their plate of food and prompting them to say “eat” prior to having each bite. This is a quick way of teaching the association between the word “eat” and receiving food.
    • Ignore the challenging behaviors and prompt the new appropriate behavior.
      • If your child whines for food at any point, do not provide food but instead prompt them to say “eat”. Then, you would immediately provide them with the requested food.