BHOCE Accreditation

This year has brought on lots of excitement for our organization.  We opened our new office location, grew our service provider family to serve more client families and received our BHCOE Accreditation!

We are thrilled that Autism Services of Kansas is now a Behavioral Center of Excellence.  We want you to celebrate this accreditation with us. What does this mean to you and why is it important?

What is BHCOE Accreditation?

BHCOE stands for Behavioral Health Center of Excellence and it is an international accrediting body created to meet accreditation needs specifically for behavior analysis.

BHCOE Accreditation requirements are regularly reviewed at high, international standards in order to grant accreditation to organizations that directly work with behavioral health and behavioral analysis.

BHCOE Accreditation is a certification given to applied behavior analysis providers when they show that they meet the highest standards of care. In order to continue their BCHOE Accreditation, they must meet an assortment of clinical and administrative standards determined by an independent third-party evaluator.

History of the BHCOE

BHCOE Accreditation began as a five-year project to provide information about quality assurance for behavioral organizations, and transparency for their futures. It has since grown into the international Quality Assurance Standards and BHCOE Accreditation Program.

Since BHCOE’s official establishment in 2015, over 6,900 consumers have been surveyed and 8,375 staff have been surveyed. In 2017, only 57% of organization’s had a first-time pass rate.

What is a Center of Excellence?

A center of excellence is an organization that values clinical quality, staff satisfaction, and parent satisfaction while providing the highest quality of Applied Behavioral Analysis (ABA) services.

This accreditation is earned, not given, as providers are evaluated on a number of measures related to their clinical quality of work and satisfaction. BHCOE Accreditation shows that the organization meets the highest standards of clinical quality and has been verified by a third-party.

A Center of Excellence is an organization that respects its employees and clients, cares about their feedback, and is able to learn internally in order to better serve their community.

What does this mean for you?

Autism Services of Kansas being BHCOE Accredited means that we are indeed providing quality services.  The accreditation was what we imagine an “audit” to entail. They went through all important documents, surveyed staff and clients, and other extensive measures.  Our goal of becoming accredited was to ensure that we are up to par with all Autism Providers across the nation.  Some states require accreditation for autism providers.  Kansas does not, however we hold ourselves to the highest standards.  We will continue to work to improve and refine our practices.  Each family we serve deserves to work with clinicians who are always seeking ways to grow and better serve them.  This is what we will continue to do.

References

BHCOE Accreditation. (2019).  Retrieved from https://bhcoe.org/

Reinforcement

Reinforcement is an important component to learning new skills and behaviors. While some reinforcement is contrived, much reinforcement occurs naturally in our everyday lives. We most often don’t even recognize that it is occurring. Reinforcement occurs when there is a stimulus change immediately following a response and increases the future frequency of that type of behavior in similar situations. More simply put, reinforcement is a process that occurs after the behavior and helps us to learn new skills because it strengthens it.
Reinforcement is part of what we call operant conditioning. Operant conditioning is simply one way we learn, and we learn through either reinforcement or punishment. Let’s look at some examples of naturally occurring reinforcement.

  • A baby reaches her hands towards the mobile and it moves.
  • You push the button on your coffee pot and the coffee starts to brew.
  • You put your keys in your car and it starts.
  • You lather sunscreen on your skin to avoid a sunburn.
  • These are things you might see or do in your everyday life. So how is reinforcement working in these situations you might ask?
  • The mobile moving when the baby reaches her hands increases the frequency of the baby reaching towards the mobile again.
  • Your coffee brewing increases the likelihood you will push the button the next time you want coffee.
  • Your car starting increases the frequency of you putting your keys in the ignition the next time drive.
  • Avoiding the sunburn increases the frequency you will use sunscreen again when in the sun.
Antecedent Behavior

Consequence

Baby sees mobile Reaches hands

Mobile moves/reinforces movement

The key word in all of these situations is INCREASES. The behavior increases which makes it reinforcement.
Reinforcement can also be socially mediated which means that it is must be delivered by another person. This is what we might call “contrived” reinforcement. Often, children with autism need some additional reinforcement to learn new skills and this is okay. Just because a child needs some extra reinforcement now does not mean they will always need that same reinforcement as they continue to grow. The goal of any reinforcement program should focus on fading tangible reinforcement as new skills are learned or problem behaviors decreased. For example, with my own child, I used a sticker chart paired with praise to increase going on the potty. Now that my child is consistently going on the potty, I no longer use the sticker chart and use praise intermittently.

Reinforcement has two categories, primary and secondary reinforcement. Primary reinforcement is reinforcement that is not learned. It is referred to as unconditioned reinforcement. This type of reinforcement refers to things such as food, water, sleep, and air. Secondary reinforcement is conditioned reinforcement. It is conditioned because it is the process of pairing something that was not previously reinforcing with something that is reinforcing such as the primary reinforcement of food. For example, pairing praise with a bite of food makes praise a conditioned reinforcer. With time, you should be able to remove the food and only use praise as a reinforcer because it has been conditioned.

There are two types of reinforcement, positive and negative reinforcement. Positive reinforcement is when you add in or present something after the behavior that increases the future frequency of that behavior. Negative reinforcement is not negative, hence the title. Instead it also increases the future frequency of a behavior because it is reinforcement that removes something aversive to the individual. Let’s look at some examples.

Positive Reinforcement
Child picks up toys and teacher provides praise and a sticker. *This is positive reinforcement because the praise and sticker are added/presented, and it increases picking up toy behavior.
Negative Reinforcement
Child asks for a break from completing homework and parent allows the child to take a 5-minute break. *This is negative reinforcement because the aversive homework is removed, and the child is more likely (increases) to ask for a break the next time he is completing homework.
There are many things you can use for reinforcement, thus there are many different types of reinforcers. Reinforcers can be activities/privileges, tangible items, primary reinforcers such as food, social reinforcement such as praise, and tokens. Tokens signal larger reinforcement later. For example, your child must earn three tokens before picking a larger reinforcer. Tokens can be actual tokens, or they may be stickers, play money, etc. What your child finds reinforcing will be unique to them. Let’s look at some examples.
Activities/Privileges
Games: Board and interactive such as peek a boo, tag, ring around the rosy, etc.
Community outings: going to the park, out to eat, swimming, etc.
Art activities
Singing/music activities
Cooking
Staying up late
Taking a break/down time

Tangible Items
Toys
Books
Sensory items
Household items that your child enjoys

Social Reinforcers
Praise
High fives
Hugs
Back rubs
Thumbs up

Primary Reinforcers
Food
Water
Sleep

Tokens
Sticker chart
Play money (bucks)
Actual tokens

How do you know what is reinforcing to your child? You most likely can already identify your child’s favorite things; however, you may want to do an informal reinforcer assessment to get a better idea of which items are the most reinforcing. To conduct an informal assessment, identify what items your child plays with the most or watch them during play to see what they play with. You can also ask others who know your child well what they think your child likes. For example, asking your child’s teacher what they prefer at school. Once you have identified items that your child prefers, you can pair items and ask them to choose which one they what. Take notes, on the items/activities that your child chooses the most.
When teaching a new skill consider using some of your child’s favorite things as reinforcers to shape the new behavior or skill you want your child to learn. It will be important to cut off reinforcement for problem behavior and reinforce the skills and behaviors you want to see your child engage in. To use your child’s favorite items as reinforcers here are a few general strategies.
Place the items in your child’s view but not in their reach. This may motivate them to ask for the item or engage in the skill you are teaching.
Keep items that you are using as reinforcers put away. Try to only use them during the times you are shaping behavior or teaching new skills. If your child as access to the reinforcing items all of the time, they may get satiated on them and the items will no longer be reinforcing.
Vary up reinforcers. Just because your child likes something one day does not mean it will be what they are motivated for the next. Just as I mentioned above, your child may get satiated with the reinforcers.
When teaching a new skill or shaping a new behavior it is important to remember that you may need to reinforce successive approximations of that behavior. This is shaping. For example, when teaching a child to sit at the table you may first reinforce the child standing at the table, then sitting for 30 seconds, then reinforce only when they sit for 1 minute, etc., until you get to the target goal.
Often in the beginning when teaching a new skill or shaping a new behavior, reinforcement must occur in close approximation to the target behavior. That is, reinforcement should occur immediately after the response and for each response. Once your child starts to become successful for a period of specified time, you can fade reinforcement (i.e. reinforce for a certain number of responses or time).
Reinforcement is perhaps the most important and powerful principle of behavior analysis. It is always in use and sometimes we might accidentally reinforce behaviors that we don’t want to see. However, when reinforcement is used appropriately it can shape any new behavior or skill that you want to see your child engage in. What behavior will you reinforce today?

References
Bearss, K., Johnson, C., Handen, B., Butter, E., Lecavalier, L., Smith, T., Scahill, L. (2018). Parent training for disruptive behavior: the rubi autism network. New York: Oxford University Press.

Chazin, K.T. & Ledford, J.R. (2016). Preference assessments. In Evidence-based instructional practices for young children with autism and other disabilities. Retrieved from http://ebip.vkcsites.org/preference-assessments

Cherry. K. (2019). Positive and negative reinforcement in operant conditioning. Retrieved from https://www.verywellmind.com/what-is-reinforcement-2795414

Cooper, J., Heron, T., & Heward, W. (2007). Applied behavior analysis. New Jersey: Pearson.

Creating Supportive Environments

Perhaps you have noticed or been told that your child “acts” a certain way in one environment and a different way in another. From experience, my own children engage in different behaviors at school than they do at home. I often get asked by parents why this occurs. A good place to start to uncover some answers to this question is by looking at the environment.

From a young age, children quickly learn the expectations and consequences for each environment they are a part of. Examples of different environments include the grocery store, swimming pool, park, home, and school. From a behavioral perspective, we believe that people engage in different behaviors across environments due to the contingencies that are put in place. A contingency is the relationship between two events, the behavior and consequence, and one is “contingent” on the other. Contingencies can be natural or contrived and come in the form of reinforcement or punishment. Here is an example:

Antecedent              Behavior                  Consequence

Child wants juice    Child says “Juice”   Parent gives child juice

This consequence reinforces or strengthens the behavior of appropriately asking for juice. Since the child received the juice, the child is more likely to say “Juice” in the future.

Let’s look at another example…

 Antecedent                                                               Behavior                       Consequence

Parent tells child it is time to take a bath           Child runs away          Delays bath

In this example, the behavior was also reinforced or strengthened because the child was able to delay the bath which is a non-preferred activity. Since the child was able to delay the bath, the child is more likely to run away in the future when it is bath time.

This is an example of how easy it can be to accidentally reinforce the behaviors we do not want to see. In this example, it would be important for the parent to follow through with the request and prompt or guide the child to that bathtub.

Consequences occur after the behavior and all behaviors have a consequence. At times, you may find that you have to be reactive; however, there are many things you can do to your environment to help your child be successful and decrease the chances the problem behavior will occur in the first place.

Often children with autism, need a little extra support to learn the expectations for each environment. While contingencies will always be different across environments, I will discuss some general strategies for creating a supportive environment that can work across the board.

  1. Safety First

Children with autism may engage in unsafe behaviors such as self-injurious behavior, elopement, jumping off of items, and climbing.

  • Ensure the room is set up for maximum safety
  • All items your child is not supposed to have are put up and away
  • Locks and gates can be used to ensure safety
  • Use of visuals such as a stop sign or signs signaling what your child is to do and not do in situations where safety is a factor can be useful.
  1. Structure, Consistency, and Predictability

Children with autism often thrive in structured environments that are high in predictability. There are a variety of ways you can make your environment more structured and predictable.

  • Use a visual schedule
  • Create an expectation visual: List what behaviors you expect from your child at various times of the day.
  • Use a first-then visual to show your child once a nonpreferred activity is complete a preferred or reinforcing activity will be next.
  • Balance nonpreferred/difficult and preferred/easy tasks throughout your child’s day.
  • It may be helpful to break nonpreferred/difficult tasks into smaller steps with reinforcement throughout.
  • It is important to keep a consistent daily schedule (e.g. consistent morning routine, bedtime routine, etc.)
  • Have structured play activities—children with autism may have a difficult time playing independently or appropriately. They may need adult facilitation to model, prompt, and reinforce appropriate skills.
  • Providing your child with reminders and prompts for appropriate behavior can help to encourage the behavior you want to see.

It is okay that children act different from one environment to another. It is not expected that children will act the same at home as they do at school or in another environment because the contingencies are different. However, you can set up each environment to be supportive of the behaviors you would like to see your child engage in.

Citations

Cooper, J., Heron, T., & Heward, W. (2007). Applied behavior analysis. New Jersey: Pearson.

Let’s learn aba (n.d.). Retrieved from https://www.letslearnaba.com/aba-terms/contingencies/

Roane, H., Ringdahl, J., & Falcomata, T. (2015). Clinical and organizational applications of applied behavior analysis. San Diego: Elsevier Inc.

Webster, Jerry. (2019, January 26). Contingency — the Important Relationship Between Behavior and Reinforcement. Retrieved from https://www.thoughtco.com/contingency-behavior-and-reinforcement-3110376

Understanding the Functions of Behavior

A primary purpose of applied behavior analysis (ABA) is to help individuals and families by addressing interfering or challenging behaviors. All kids throw tantrums, whine, or do not comply (follow directions), and so on. Understanding why the behavior is happening is crucial. Once the function (or the ‘why’ of the behavior) is determined, the behavior can be addressed. Today, we will discuss the four functions of behavior and how they are determined.

A common strategy used to determine the function of a behavior is through ABC data. While gathering ABC data, the following questions are needed:

  • What happens before the behavior (the antecedent)?
  • What is the behavior?
  • What happens after the behavior (the consequence)?

Image retrieved from https://medium.com/mah-behavior-support/start-here-roadmap-to-behavior-support-e7747caa295d

To help grasp the concept, let’s look at an example. A girl is crying in the check-out line at the grocery store. Before crying, the girl had asked her mom for candy and her mom said no. The girl continues to cry until her mom changes her mind and ends up buying her the candy. In this situation, the ABC data would be the following:

  • A: Parent says no to buying candy at a grocery store.
  • B: Child cries.
  • C: Child gets candy.

Using this information to find patterns in antecedents and consequences, a hypothesis can be made in regard to why the behavior is happening.

 

The Four Functions of Behavior

  • Attention: We all seek attention and interactions with others. Depending on the child, attention from certain people may be more reinforcing than others (e.g., peers versus teachers). In some cases, children may be seeking attention in any way possible, which includes both positive (e.g., laughing) and negative (e.g., yelling) attention.
  • Escape: When a non-preferred situation, task, or person is present, a child may engage in challenging behavior in order to escape.
  • Access to tangible items: The example above about the girl crying to get a candy bar (tangible item), demonstrates an individual’s behavior that is occurring to get access to some item.
  • Automatic: Some refer to this function as sensory. A behavior’s function is automatic when it is occurring because it is internally reinforcing (e.g., rocking, hand flapping).

 

Image retrieved from https://www.istockphoto.com/vector/vector-illustration-of-a-girl-crying-gm157038653-22295885

Strategies to Use Based on Function

  • Attention
    • Give frequent positive attention (e.g., tell your child “I love how you’re playing!”).
    • Teach appropriate ways to seek attention (e.g., have your child say, “Look at this!” to show you something instead of crying, or give a tap on your arm instead of hitting).
    • Ignore challenging behaviors that are seeking for attention (e.g., a child uses a cuss word that typically is either reprimanded or laughed at, ignore).
  • Escape
    • Teach appropriate ways to escape (e.g., have your child ask, “Can I be all done?” instead of throwing their food on the floor).
    • Follow through with the demand.
    • Teach how to ask for help if a task is difficult.
    • Offer choices.
  • Access to tangible items
    • Teach appropriate ways to ask (e.g., “Can I please have juice?”).
    • Follow through when the answer is no, to teach your child how to accept “no.”
    • Provide warnings when transitioning (e.g., Five more minutes to play video games”).
    • Set limits on access to certain tangibles.
  • Automatic
    • Reinforce behavior that is incompatible with interfering behavior (e.g., keeping hands in lap, instead of picking nose).
    • Provide opportunities for physical exercise/movement breaks.
    • Teach how to request for a break.
    • Teach a replacement behavior (e.g., chewing gum instead of grinding teeth).

It is important to note that a behavior can have multiple functions. For example, a child could be biting to get your attention, to escape from a demand, to get access to an item, or s/he likes how it feels to bite. If you are having any issues when it comes to behavior, be sure to consult a BCBA so a behavior plan can be created and implemented.

 

References

Chazin, K.T. & Ledford, J.R. (2016). Challenging behavior as communication. In Evidence-based

instructional practices for young children with autism and other disabilities.

Pratt, C., & Dubie, M. (2008). Observing behavior using a-b-c data. The Reporter, 14(1), 1-4.

 

March Mand-ness

In honor of March Madness, a sought-out time for avid college basketball fans, we will discuss manding – hence the title of today’s blog March Mand-ness. Manding is a critical skill frequently taught in applied behavior analysis (ABA). To simply define, a mand is a request. Requests can be for an item, activity, attention, information, help, or to stop something aversive. Mands occur due to motivation and reinforcement following the mand. For example, a child who is thirsty might say “water” to their parent, in return the parent gives them a glass of water. In this case, the motivation is being thirsty, the mand is “water,” and the reinforcement is getting a cup of water. Furthermore, learning to mand is very important as challenging behaviors often arise due to being unable to communicate wants and needs. Manding is also crucial to learn for socialization and communication.

Clipart retrieved from http://clipart-library.com/clipart/257147.htm

Basic Steps for Mand Training

  • Select a variety of highly preferred (reinforcing) items and activities. This assists in teaching a diverse set of mands and motivation.
  • Identify target responses. This will vary based on the child’s current skills. For example, sign language or a picture exchange system may be used if the child is non-verbal. For a child who is verbal, the target response may be a single word such as “hug,” “I want hug,” or “Can I have a hug?”

Clipart retrieved from https://pecs-canada.com/pecs/attachment/pecs_phase-v/

  • Maintain motivation throughout teaching, which can be accomplished by varying reinforcers or limiting access to reinforcers.
  • Provide modeling and additional prompts as needed. For example, “if you want this, say ‘ball’” or if using a picture exchange system, guiding the child’s hand to the ball card and placing it in either the parent or therapist’s hand.
  • Fade prompts as soon as possible to facilitate independence. Using the example from step 4, only saying “b—” for a ball or only pointing to the ball card.

Clipart retrieved from http://clipart-library.com/clipart/2086586.htm

Tips and Ideas at Home

  • Encourage your child to mand across all settings (at home, at the grocery store, at grandparents’ house, at the park).
  • Limit access to highly preferred items as this will provide more motivation to get the item.
  • Set up the environment where your child is required to mand (request). For example, placing cookies out of reach to encourage your child to mand for the cookie.
  • Even though you may know what your child wants without them manding, pause before providing the item, attention, etc.,
  • Depending on your child’s skill level, withholding a preferred item/activity until your child appropriately mands. For example, if your child typically screams or hits to get your attention, model or prompt the desired response. Once your child mands appropriately, provide the preferred item/activity (reinforcer).
  • Praise (e.g., “I love how you asked me for juice!”) and deliver the item immediately when your child uses appropriate mands.
  • If you are unsure of what the “just right challenge” response to expect from your child (e.g., “park,” “I want park” or “Can we go to the park?”), consult your BCBA!

In conclusion, providing as many opportunities to mand as possible, will best promote learning and outcomes. Not only is manding a vital skill to learn, it may help decrease challenging behavior and increase communication.

References

Bourret, J., Vollmer, T. R., & Rapp, J. T. (2004). Evaluation of a vocal mand assessment and vocal mand training procedures. Journal of Applied Behavior Analysis37(2), 129-144.

Hozella, W. and Ampuero, M. (2014). Mand Training Basics.

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.