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.

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