Emotions and Empathy

Two myths about autism related to emotions are that 1) people with autism do not feel or express any emotion and 2) people with autism cannot understand emotions of others (Autism Speaks, 2018). However, if you have ever had the pleasure of spending time with someone who has autism, I am certain you recognize the complete misconception of these myths. It is critical to recognize that people with autism DO have emotions and CAN understand the emotions of others. Depending on the individual’s abilities, they might need support, like ABA, to help them better perceive their emotions and also increase their awareness on how others feel, including how to recognize and interpret nonverbal cues (e.g., raised eyebrows, sighs, furrowed brow, etc.) associated with many emotions. Today, we will discuss how both ABA address emotions and empathy, as well as, some tips to try at home!

Addressing Emotions in Applied Behavior Analysis  

  • The first step is to teach the child how to label (tact) emotions through pictures/videos and demonstration. For example, a therapist makes a sad face and asks, “How do I feel?” Or while watching the movie Frozen, and Olaf is smiling asks, “How do you think Olaf feels?”
  • This is frequently paired with teaching the child how to produce different facial expressions. For example, a therapist says, “show me mad” and the child shows a mad facial expression. To increase self-awareness, incorporating a mirror can be helpful so that the child can see exactly what their expression looks like.  
Once the child is able to consistently produce facial expressions related to different emotions in contrived situations, and label other people’s emotions, the next step is to teach the child how to identify their own emotions in the natural context. For example, a therapist asks, “How do you feel?” while a child is laughing and prompts him/her to say, “I’m happy!”  The ultimate goal is for the child to independently label their own emotions across a variety of situations.

                                                                                                         I’m so happy!  

Addressing Empathy in Applied Behavior Analysis

  • Empathy is a social interaction skill that involves understanding what another person is feeling and taking the other person’s point of view into account. Understanding emotions, both in others and in themselves are prerequisites to learning empathy.
  • There are four behaviors associated with empathy: verbal statements (e.g., “Are you okay?”) intonation of voice (e.g., sad intonation), facial expressions (e.g., lowered eyebrows) and gestures (e.g., placing palm gently on person’s arm) (Argott, Townsend, & Poulson, 2017). All of these examples would be expected responses if you saw someone hurt.
  • Techniques used to teach these behaviors include role-playing a variety of situations, social stories and/or social scripts, and natural environmental teaching.

Retrieved from dreamstime.com (Boy helping another kid.)

Tips and Ideas at Home

  • Model empathy with others and with your child. We all learn not only by doing but also watching others.
  • Label your child’s emotions while it is occurring. For example, if your child is upset because he/she cannot go to Target, say “I see you’re frustrated…”
  • Connect behaviors with feelings. For example, say “Your sister is upset because you took her toy.” or asking, “Why do you think your sister is upset?”
  • Encourage your child to help others. For example, if brother is picking up toys that he was playing with, have his sibling help put the toys away too. 

In conclusion, empathy is not an easy skill to develop and requires many sub-skills. Regardless if a child has autism or not, empathy is a skill that has to be fostered and cultivated. With it being the month of February, it is a very fitting time to focus on emotions and empathy. Happy Valentine’s Day!

                                                                                   References

11 Myths About Autism. (2018). Retrieved from https://www.autismspeaks.org/blog/11-myths-about-autism

Argott, P.J., Townsend, D.B., & Poulson, C.L.  (2017).  Acquisition and generalization of complex empathetic responses among children with autism.  Behavior Analysis in Practice, 10, 107-117.  doi: 10.1007/s40617-016-0171-7

For Families: 5 Tips for Cultivating Empathy. (2018). Retrieved from https://mcc.gse.harvard.edu/resources-for-families/5-tips-cultivating-empathy

Targeting Joint Attention

Joint attention is commonly targeted in applied behavior analysis (ABA) as it is a skill that is often difficult for children with autism. So, what exactly is joint attention? Joint attention is “the act of sharing an experience of an object or event with another person” (White et al., 2011). In other words, it is when two or more people are focused on the same thing. For example, if you are walking with someone at the park and say, “Look! A dog!” the expectation is that the other person would look in the direction you are looking in, towards the dog. Joint attention is an important milestone as it is critical for language acquisition, social development, and learning. It is used on a daily basis to enjoy moments with others (Paparella & Freeman, 2015). For example, how often do you show someone a funny video from Facebook? Or order food at a restaurant? Both require joint attention whether or not we realize it. Today, we will discuss both how ABA addresses joint attention and some tips to try at home!

Joint Attention picture retrieved from http://autilius.pl/en/about/joint-attention/.

Addressing Joint Attention in ABA

  • Joint attention involves different aspects of attention which includes orienting, sustaining and shifting attention (Patten & Watson, 2011).
    • Orienting attention: turning toward a stimulus
    • Sustaining attention: maintain attention on a stimulus
    • Shifting attention: disengaging from one stimulus and reorienting to a new stimulus

*A stimulus is any object or event that provokes a response.

  • Joint attention requires the ability to respond and initiate. When initiating joint attention, a person typically uses either sounds or words such as “Look!” or “Mom!” along with a gesture (e.g., pointing) or eye gaze. 
  • Since there are many subskills to joint attention, there are many ways joint attention is taught.  Using the prompt hierarchy, reinforcement, repeated practice, and shaping are some frequent strategies used. Here are some examples of each:
  • Prompt hierarchy: If teaching a child to respond to their name (a subskill of joint attention), saying a child’s name while also presenting a loved activity or item. This teaches the child that by responding to their name, s/he receives something positive.  However, the end goal is for the child to respond on their own (independently) without any prompts
  • Reinforcement: Hiding a highly preferred toy and then saying “Look!” while pointing to the toy. If the child looks, the child is reinforced for looking by getting access to the toy. 
  • Repeated practice: Practicing as often as possible through incidental teaching. For example, if a child wants crackers, waiting for the child to give eye contact before giving them the crackers (see October 2018’s post for more information – Limitless Teaching Opportunities).
  • Shaping: First encouraging the child to touch a person’s hand to gain their attention, then by saying their name (e.g. “Mom”), next saying their name and giving eye contact, etc.

Tips and Ideas at Home

  • Read books together. Try to select books that are developmentally appropriate to your child. While looking at a book together, draw attention to pictures by pointing and labeling what you see (Paparella & Freeman, 2015). Try starting with books that incorporate what is most motivating for your child.
  • Play peek-a-boo and give praise when your child looks at you.
  • Use your child’s favorite toys by holding it near your face and calling your child’s name. Once he/she looks, give praise and access to the toy.
  • Play catch or roll a ball back and forth. Before throwing/rolling the ball, say something like “Here it comes!”
  • Blow bubbles together and point/comment on the bubbles. Give praise and excitement when child responds and/or initiates your attention!
  • Sing songs together that include actions like “Wheels on the Bus,” “Itsy Bitsy Spider,” or “Baby Shark.”

In conclusion, the amount of opportunities to work on joint attention within our everyday life is unlimited.  As with majority of skills, teaching this skill can be fun by using preferred items, games and songs!

                                                                                   References

Paparella, T., & Freeman, S. F. (2015). Methods to improve joint attention in young children

with autism: a review. Pediatric health, medicine and therapeutics6, 65.

Patten, E., & Watson, L. R. (2011). Interventions targeting attention in young children with

autism. American Journal of Speech-Language Pathology.

White, P. J., O’Reilly, M., Streusand, W., Levine, A., Sigafoos, J., Lancioni, G., … & Aguilar, J.

(2011). Best practices for teaching joint attention: A systematic review of the   intervention literature. Research in Autism Spectrum Disorders5(4), 1283-1295.

Learn to Play, Play to Learn

Playing is an integral part of daily life for children. Through playing, all aspects of development can be promoted. For example, social skills such as sharing, cooperation, and turn-taking can be targeted while playing with a peer or family member (Lantz, 2001). Play takes many forms such as running, playing hide and seek, making art, or playing dress up. In today’s blog, we will discuss the different stages of play, how behavior therapists may encourage play, and ideas on how to promote play at home.

Stages of Play (Pathways, 2018)

1)      Unoccupied Play – This is when a child explores and discovers how their body moves (e.g., moving their arms, legs, feet, hands).

2)      Solitary Play – This is when a child plays alone and may include engaging with a toy.

3)      Spectator/Onlooker Behavior – This occurs when a child starts to watch other children play.

4)      Parallel Play – This is when a child plays beside or near other children but does not play with them.

5)      Associate Play – This is when a child interacts with others while playing mainly to give, take, and share toys. However, the amount of interaction is minimal.

6)      Cooperative Play – This is when a child plays and engages with others in the same activity.

ABA Interventions

1)      Natural Environment Teaching (NET) – This teaching method involves commenting on items/activities the child chooses to do. The goal is to increase a child’s verbal behavior, as well as expand their verbal responses. For example, if a child was playing with cars, saying “Wow! Your car is going so fast! Should my car go fast or slow?”

2)      Video Modeling – This teaching methodology has been found effective to teach children with autism a variety of skills. Video modeling is when adults or peers are recorded while acting out the targeted skill (e.g., playing with baby dolls). The goal is for the student to imitate the observed actions from the video to learn the skill (MacDonald, Mansfield, Wiltz, & Ahearn, 2009).

3)      Scripts – This is a specific visual strategy often used to promote social-communicative interaction while playing. Research has shown scripts are effective in enhancing interaction among children sociodramatic play (Goldstein & Cisar, 1992). Once scripts are learned, spontaneous responses are facilitated.

ErinoakKids Centre for Treatment and Development (2012). Sample Play Script.

 Retrieved from https://www.erinoakkids.ca/ErinoakKids/media/EOK_Documents/Autism_Resources/Teaching-Play-Skills.pdf

Other Visual Examples –

Memorizing the Moments. (2013, June 17). Block Building Templates. Retrieved from http://www.memorizingthemoments.com/2013/06/block-building-templates.html?m=1

Christine Reeve (2013-2018). Playground Schedule. Retrieved from https://www.teacherspayteachers.com/Product/Playground-Schedule-and-Script-Freebie-Autism-Special-Education-923613

Tips and Ideas at Home

  • Be sure to build play time within your child’s schedule.
  • Model how to play with the materials and/or toys. For example, if playing with play dough, show your child how you are making three balls to stack on each other to make a snowman. Ask them if they can make a snowman too.
  • As the holidays are near and you might be considering what to get your child, think about presents that could encourage your child’s play, based on their current developmental skills.
  • Set screen limits.
  • Get creative! Set up obstacle courses, build a fort out of blankets, decorate cookies, make slime.
  • If available, consider attending a play group.
  • Consider enrolling your child in an organized activity (e.g., gymnastics, karate).

In conclusion, playing is essential for all children’s development. Through play, children socialize, learn, and have fun! As Mr. Rogers said, “Play gives children a chance to practice what they are learning.”  Hopefully the holiday break provides some extra opportunities for playing and family time! Happy Holidays!

References

ErinoakKids Center for Treatment and Development. (2012). Teaching Play Skills to Children with Autism.

Goldstein, H., & Cisar, C. L. (1992). Promoting interaction during sociodramatic play: Teaching scripts to typical preschoolers and classmates with disabilities. Journal of applied behavior analysis25(2), 265-280.

Lantz, J. (2001). Play time: An examination of play intervention strategies for children with autism spectrum disorders. The Reporter, 6(3), 1-7, 24.

MacDonald, R., Sacramone, S., Mansfield, R., Wiltz, K., & Ahearn, W. H. (2009). Using video modeling to teach reciprocal pretend play to children with autism. Journal of Applied Behavior Analysis42(1), 43-55.

6 Stages of Play: How Kids Learn to Play. (n.d.). Retrieved from

How Kids Learn to Play: 6 Stages of Play Development

 

Promoting Smoother Transitions

Transitions are an inevitable aspect of life as they occur throughout the day and in all settings – at home, school, work, and in the community. According to Merriam-Webster, a transition is defined as a “passage from one state, stage, subject, or place to another: CHANGE.” Transitions typically require an individual to: 1) stop an activity, 2) move locations, and 3) begin something new. Transitions are difficult for many children, triggering undesired behaviors. Thus, it is critical to target transitions and add some ease to everyday life.

 Below are a few focal interventions often implemented:

1)      Priming – Priming occurs when a student is given the opportunity to preview activities or given information ahead of time. This promotes predictability. Depending on the student, priming could occur an entire day before the activity or shortly before the activity. An example of priming is when schools provide an opportunity for students to meet their teacher, see their classroom, and find out who is in their classroom before the first day of school.  

2)      Social Stories – Some students greatly benefit from incorporating social stories about transitions and/or unexpected events. Social stories can be used as a method for priming and preparing the student for what is going to happen, whether it is for an anticipated change (holidays, appointments), a day-to-day transition (brushing teeth, getting dressed), or major transitions (changing schools, becoming a sibling).

 

 

3)      Visual Schedules – Visual schedules incorporate pictures, text, and/or icons. It provides a student a schedule of what tasks and activities to expect throughout a certain time period (e.g., entire day, at school, after school, bedtime routine). If there is a change in the routine schedule, it is possible to use priming and the visual schedule to prepare the student for what is going to happen. For example, if grandma is coming over after lunch (something that typically does not happen routinely), then putting a picture of grandma after the lunch icon and telling the student “after lunch, grandma is coming.” A behavior therapist can help determine what type of visual schedule will best support your child as there are many different versions.                 

Tips and strategies to use at home and in the community:

          Try to plan ahead and provide cues before a transition is going to occur, whether it is simply “time for a bath after dinner” to practicing what happens at a birthday party before going to it (e.g., singing happy birthday, opening presents).

          Use a visual timer so the child can see how much time is left before the transition. There are many visual timer apps for smartphones/tablets ranging from free to $1.99 or one can be bought for $25-30 on Amazon.

 

          Use positive reinforcement (verbal praise) after transitions (e.g., “I love how you cleaned up and went to the table!”

          Provide adequate time for child to finish task or activity to prevent frustration of not being able to finish.

          Practice, practice, practice! 

In conclusion, with practice and support, transitions may become smoother! As a child improves with transitions, there will be a reduction in the amount of transition time required, how much prompting is required, less undesired behaviors and most importantly, increase more successful participation within daily life and in the community!

 

References

 

Hume. (2008). Transition Time: Helping Individuals on the Autism Spectrum Move Successfully

from One Activity to Another. The Reporter 13(2), 6-10.

 

Lupiani, N. (2014, December 29). Social Stories for Transitions & Unexpected Events. Retrieved

from https://www.storyboardthat.com/articles/e/transitions-social-story

 

Ostrosky, M. M., Jung, E. Y., & Hemmeter, M. L. (n.d.). Elping Children Make Transitions

between Activities. Center on the Social and Emotional Foundations for Early Learning.

 

Transition. (n.d.). Retrieved from https://www.merriam-webster.com/dictionary/transition

 

Limitless Teaching Opportunities

In applied behavior analysis, two of the most predominate methodologies include discrete trial training (DTT) and incidental teaching. Core features of DTT include repetition and sequenced instruction, in order to target certain skills, while on the other hand, incidental teaching involves elaborating on what a child initiates (Weiss, 2005). Today, we will be discussing the latter.

So, what is incidental teaching?
– The teacher arranges opportunities or sets the environment to encourages the learner’s interest.
– It is child-initiated, which means once the environment is arranged, the teacher waits for the student to initiate interaction.
– Once the child either asks or makes a comment about the item/topic, the teacher prompts an elaboration.
– After the child responds, the teacher provides reinforcement (e.g., teacher gives him/her the item, attention, etc., for what he/she has initiated).

Why is it used?
– It is an effective way of teaching a variety of language and conversation skills, including the ability to initiate interactions.
– It provides learning opportunities where the skills naturally occur.
– It promotes generalization.
– Seems less like “work” for child as the child is initiating and therefore, motivated.

Examples of incidental teaching:
– Child loves apple juice. Dad is pouring a glass of apple juice that is out of reach, yet near the child. Child reaches for juice, dad prompts “J—-,” child says “juice,” dad gives child juice to reinforce the elaborated response. (This demonstrates an example of controlling access to item and moving item closer to student/child).
– Mom is pushing child on a swing. Mom stops pushing child and waits for the child to ask for more pushes. (This demonstrates an example of starting a preferred activity and then stopping).
– Therapist brings in special farm animal toys. Child asks for toys, therapist gives child toys. Child says, “Duck.” Therapist responds with, “A yellow duck!” as the child moves duck around. (This demonstrates an example of using items of special interest to student).

It is important to prompt the child to produce just a slightly more complex level of their current language skills. For example, if child says single words, model 2 words. Once a child is using 2-3 word sentences, prompt for more complete sentences by adding adjectives (e.g., colors, shapes, size, numbers), adverbs (e.g., fast, slow, soft, rough), and prepositions (e.g., in, on under, next to, behind). For example, if a child is asking for help they may first say “help,” and then, “Help me,” to “Can I have help?”

An example of an interaction in incidental teaching. Illustration by Tale Hendnes.

In conclusion, learning may occur in a highly structured and systematic manner or be embedded into our day to day lives. While ABA therapist are trained in using incidental teaching, really anyone can do it. You may already be doing it without realizing it! Regardless, it is important to recognize the idea that learning can occur at any time or place and with incidental teaching, any opportunity can be turned into a learning moment!

References

Comprehensive Guide to Autism – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/An-example-of-an-interaction-in-incidental-teaching-Illustration-by-Tale-Hendnes_fig2_268443242

Hart, B. M., & Risley, T. R. (1982). How to use incidental teaching for elaborating language. Austin, TX: Pro-Ed.

Weiss, M. J. (2005). Comprehensive ABA programs: Integrating and evaluating the implementation of varied instructional approaches. The Behavior Analyst Today, 6(4), 249.

Addressing Writing Skills

Despite the immense growth of typing and texting in our technology-driven world, writing skills remain essential. Children use writing skills both for fun and academic purposes. In order to scribble, color, trace, copy, or write, writing skills are required. If a child is having trouble with writing, not only could coloring or completing written school work be affected, but other fine motor tasks (movements using smaller muscles in the hands, fingers, wrists) could also be difficult for the child to complete (e.g., getting dressed, holding a cup, various play activities). Therefore, if we notice writing skills as a concern, we will address this through a variety of researched based interventions.

Below are a few focal interventions often implemented:

Prompt Fading – Prompt fading involves starting with the level of prompt the child currently needs and fading prompts until the child learns the writing skill independently. For example, the therapist may begin with using hand-over-hand physical prompts to help teach a child to hold a crayon correctly to color. Next, the therapist might prompt the child by modeling how to hold the crayon and color within the lines. Once the child is able to model the therapist, the therapist may just need to remind the child to stay within the lines when coloring (a verbal prompt) until the child independently colors within the lines.

Chaining – This is used to breakdown a task that requires multiple steps. For example, when learning to trace, copy, or write one’s name, breaking it down into small steps by first teaching only one letter in the child’s name such as the last letter (if using backward chaining) can be helpful. If the child’s name was “Carl” you would have “Car_” already written and the child would first learn the letter “l.” Once this was learned, the letters “Ca__” would already be written and the child would then learn to write both “r” and “l.” The next step would be for only “C____” to be written out, and the child would then learn to write “a,” “r,” and “l.” Lastly, the child learns to write his whole name, “Carl.”

Backward-Chaining/Trace, Imitate, Copy, Memory Worksheet (Klee, I. C., McLaughlin, T. F., Derby, K. M., Donica, D. K., Weber, K. P., & Kalb, G., 2015, p. 63)

Handwriting Without Tears is a common program used to teach handwriting that incorporates a variety of strategies.  An example of one strategy is through verbal prompts and utilizing the program’s language to help with formation of numbers and letters (e.g., writing an R – “Big line, little curve, little line”). Another strategy is through visual prompts. For example, some Handwriting Without Tears worksheets provide a smiley face to indicate where the child should begin writing.

Writing Without Tears Worksheets id#0 Worksheet. (n.d.).

Writing Without Tears Worksheets id#0 Worksheet. (n.d.).

Besides these interventions, there are many other ways to practice fine motor/writing skills such as:

  • Create a necklace/bracelet (can be modified by using different sizes of beads or string thickness)
  • Play-doh
  • Games (e.g. Connect Four, Pop the Pig, card games like Uno)
  • Shaving cream (e.g., draw pictures, practice writing shapes/letter/words, play tic-tac-toe)
  • iPad apps (e.g., iWrite Words, Letter School, HWT – Wet Dry Try, Alphabet Tracing – Free) Having the child use a stylus can work on holding a writing utensil.
  • Cooking (e.g., make chocolate chip cookies and encourage child to pick up chocolate chips using only their “pinchers” – thumb and index finger)

To conclude, a tip to promote a child to use their fingers and work on fine motor skill is to give a child small, broken crayons to color, draw, and/or write. This way children are required to use their fingers, instead of grabbing it with their fist.

 

References

Carlson, B., Mclaughlin, T. F., Derby, K. M., & Blecher, J. (2017). Teaching preschool children with autism and developmental delays to write. Electronic Journal of Research in   Education Psychology,7(17). doi:10.25115/ejrep.v7i17.1313

Klee, I. C., McLaughlin, T. F., Derby, K. M., Donica, D. K., Weber, K. P., & Kalb, G. (2015). Using Handwriting Without Tears® and a modified copy, cover, compare through chaining to teach name writing to a preschooler with developmental delays to write his                           name. IJAR1(3), 59-65.

MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. (2001). Prompts and prompt-fading strategies for people with autism. Making a  difference: Behavioral intervention for autism, 37-50.

Writing Without Tears Worksheets id#0 Worksheet. (n.d.). Retrieved from   http://bookmarkurl.info/worksheet/writing-without-tears-worksheets-0.html

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.