Using the Verbal Behavior Approach to Teach Adolescents and Adults with Autism, Down Syndrome and other Developmental Disabilities

I consulted this week with a client I will call Dan. Unlike most of my other clients who are children with autism, Dan is in his twenties. He attends an adult day training program each day and volunteers with a job coach at various locations such as the hospital laundry.

Over the past three or four yeas since I’ve consulted on Dan’s case, I have learned a lot from him and his parents. I learned about adult services waiting lists, adult day training programs, and job coaches. I also feel that working with Dan has helped me improve my ability to teach others self care and vocational skills.. The most important thing that I continue to learn from Dan during each consultation is the importance teaching children functional skills. After this consultation, for example, I decided to hold an extra reading program we were using at home with my son, Lucas (who is now 13) because it was starting to cause him frustration and was not completely functional. Dan’s last consultation also made me decide to start teaching Lucas to identify numbers past 100 since Dan was sorting music into hymnals and needed to find the spot in between number 345 and 347 to place song number 346.

I believe that all of my previous blogs are applicable to adolescents and adults with autism (as well as other disabilities such as Down Syndrome). One of my blogs about the top three skills all individuals with autism need is particularly relevant: http://verbalbehaviorapproach.blogspot.com/2009/09/big-three-skills-for-individuals-with.html.

Since working with several teenagers and a few adults with autism using the verbal behavior approach, I would recommend the following,  especially if the teens and adults you are working with are not conversational:

1) Read my book (The Verbal Behavior Approach: How to Teach Children with Autism and Related Disorders) and take advantage of many free resources on my web site: http://www.verbalbehaviorapproach.com/. Also read Self Help Skills for People with Autism: http://www.amazon.com/Self-Help-Skills-People-Autism-Systematic/dp/1890627410/ref=pd_sim_b_11.

2) Purchase the VB-MAPP (http://www.avbpress.com/vbmapp-set.html) and complete the assessment (parents will most likely need assistance from a teacher or behavior specialist to complete this assessment). With the assessment complete, you can use this information to prioritize language goals based on your son’s or daughter’s (or client’s) strengths and needs. Self help and vocational goals are very important too and should be a major focus for older children, teens, and adults.

3) Parents may need to locate an advocate to help you navigate the system and to ensure that the transition to adult services is as smooth as possible. To find an advocate, contact your local autism society or mental health association.

Teaching Children with Autism to Greet Others

A few months ago, I evaluated a 4-year-old boy named Bobby. When I said “Hi Bobby,” he replied “Hi Bobby.” My son Lucas (who is now 13) had similar issues when he was younger so I learned strategies to help him overcome this problem well before I became a Behavior Analyst. As a BCBA, I now run into greeting problems fairly frequently so I thought I’d write about some strategies I often use to address this issue.

1) Until you can build the component skills required for greetings, encourage parents, staff and other students to eliminate the child’s name when saying “hi” and “bye.” This way you will prevent the error and the child will be more successful. If someone interacts with the child and does not know this strategy or if they forget and say “Hi Bobby” and get an echo, just have them drop back to “hi” and get a correct echo of “hi.”

2) Next take pictures of all important people in the child’s life who he sees often (i.e. mom, dad, sister, grandma, cousin, friend) and make two sets of these pictures. You will need two copies of each picture since you will want to start with matching picture to picture. Instead of saying “match” or “put with same,” just say “mom” or “mommy” as you hand the picture to the child and point to the identical picture of “mom” while you have him match. If the child is echoic, he might say “mom.” If he does say “mom” you might want to ask “who’s that?” and have him say “mom” as a tact.

3) Once the child can easily tact all the people he sees regularly without any prompts (both in pictures and when the real person is around) and he can also say “hi” and “bye” without prompts, you can try to put greetings together. If the child cannot fluently tact pictures of people who he sees often and/or if you don’t have good echoic control (Child echoes “hi” when someone says “hi” or the child says “ball” when a therapist says “ball”), I think it is probably too early to put greetings together. In this case, just have all people say “hi” and “bye” without the child’s name until the pre-requisites are met.

4) To work on putting the greeting with the name, you’ll need two people. One is the person walking in or out and greeting the child and the other person is used to prompt the child from the side or behind. For example I’m with Bobby so when mom says “Hi Bobby,” I immediately prompt “Hi Mommy.” You will most likely need several prompted trials before systematically fading your prompts.

5) If the child is still having difficulty, you might also consider making a video of people ringing the doorbell and someone opening the door and having each person who comes to the door say “Hi Bobbie.” When viewing the video, an adult should sit and watch the video with the child and prompt the child for each clip as each new person rings the doorbell and the door is opened. This was a key strategy for Lucas and after viewing the video only a few times with prompting, Lucas mastered this skill. The video showed the doorbell ringing, me opening the door then therapist # 1 (Nina) would say “Hi Lucas.” I would prompt “Hi Nina.” On the video, she would ring the bell again, door would open, Nina would again say “Hi Lucas.” This time, Lucas would say “Hi Nina” with a reduced prompt or without a prompt from me. Therapist # 2 (Eric) would then ring the bell for the same type of practice.

6) The two main things to remember when considering teaching greetings are: 1) Make sure the child has the pre-requisite skills for greetings (tacting of people’s names and good echoic control of 2-3 word utterances) and to teach greethings errorlessly as many times as needed using two adults and/or a video.

For more information about teaching greetings, see page 99 of my book, The Verbal Behavior Approach (http://www.verbalbehaviorapproach.com/).

New Blog: HBO film entitled "Temple Grandin"

A new HBO film entitled "Temple Grandin," will premier on February 6th. This movie details the life of animal researcher and autism advocate, Temple Grandin. Here is a blog about the movie which includes an interview with Temple written by a friend of mine, Chantal Sicile-Kira: http://www.huffingtonpost.com/chantal-sicile-kira/temple-grandin-the-hbo-mo_b_420575.html.

I have always found Temple to be incredibly inspirational. For the past few years I have been working with Jodi Goren-Rode and Keystone Pictures to support Jodi’s effort in making a documentary about Temple Grandin. Here is a 5-minute video clip Jodi put together a few years ago available on YouTube: http://www.youtube.com/watch?v=iAu6_Llfh2A. This YouTube clip, which gives an overview of the documentary Jodi is producing, has been viewed over 24,000 times and gives a brief synopsis of the life and work of Temple. As I say in the clip, Temple is probably the most recognized person with autism in the world and has done many great things for the autism community.

I had the privilege of having lunch with Temple a year before I wrote my book. After I told her a little about myself (that I had a son with autism and became a BCBA to help others), she said “You should write a book!” It was an amazing experience to have lunch with Temple and she provided me with much hope and inspiration.

I also met Temple’s mother, Eustacia Cutler a few years later and, after reading my book (The Verbal Behavior Approach), Eustacia wrote the following endorsement which is available on my web site under book endorsements (http://www.verbalbehaviorapproach.com/book3.html) :

“Written with style, warmth and real know-how, Mary Barbera has managed to combine valuable therapeutic advice with her own eloquent story.”

Eustacia Cutler, Author
A Thorn in My Pocket: Temple Grandin's Mother Tells the Family Story

I am excited to see the HBO movie premiering Feb 6th! I’m sure as I watch the movie, I will learn much more about Temple’s life and work.

Getting Children with Autism to Respond to Their Names

I recently conducted a full day assessment on a child I will call Dennis, a 4-year-old with a diagnosis of autism. One the concerns of Dennis' parents was their inability to get his attention by calling his name. As I conducted a VB-MAPP assessment, this was a deficiency in the Listener Responding area and was also an IEP goal not mastered for over a year.

Not responding to name when called can be one of the first hallmark signs of autism.   This is considered a “red flag” on the Modified Checklist for Autism in Toddlers (M-CHAT) and a diagnostic indicator on the Autism Diagnostic Observation Schedule (ADOS). Since many children and adults with autism have difficulty in this area, I thought I would address it in this week’s blog.

I created and have used the following procedure to address this issue with dozens of children with autism and found it to be very successful. The key is to pair the child’s name with improving conditions (reinforcement) since any behavior that is reinforced will maintain or increase. The following is an excerpt from page 106 of my book (The Verbal Behavior Approach).

First, tell everyone in the environment to stop using, or limit the use of the child’s name throughout the day. Most importantly, do not link the child’s name to demands (e.g.: “Dennis, go get your shoes”, “Dennis come here”, etc.) .  Limiting the use of the child’s name will actually help him to learn to respond when his name is called, because he won’t tune it out as part of a long list of demands.

Next gather several of Dennis’ strongest consumable or controllable reinforcers (chips and bubbles, for instance) and go behind him when he’s engaged in another activity. Call his name while standing behind him and then immediately touch his shoulder and hand him a chip or blow bubbles.   Gradually fade your prompts by standing a foot or two further away and by delaying the touching of his shoulder by a second or two. By using this procedure, Dennis will learn that when he hears his name, good things happen.

For the best results, I recommend using this procedure in both home and school environments and also recommend taking data every trial (10 or 20 trials per day) so that your distance and the reinforcement can be systematically faded out as the child becomes successful with responding to his name.

For more information, read my book and/or past blogs available at:  http://www.verbalbehaviorapproach.com/.

The Importance of Conducting a VB Assessment When Completing an FBA

I completed a Functional Behavior Assessment (FBA) recently on 9-year-old boy I’ll call Sam. His mother decided to home school Sam because she was worried that the public school her son attended might call the police if his behaviors continued to escalate.

Sam was diagnosed with high-functioning autism just after the age of three. He was included in general education classes since his IQ was in the normal range. Sam spoke in full sentences and could reportedly read at grade level. Sam’s outbursts, however, were very disturbing to the teachers and other students. While at school, Sam was sent to the principal’s office on multiple occasions and was suspended once when he knocked over a desk.

While an FBA is conducted to analyze the function of problem behaviors, I believe that a big part of an FBA should be dedicated to examining the child’s language and academic skills.   In Sam’s case, his language deficits were very apparent to me as I completed a VB-MAPP assessment, even though he was a puzzle to school district personnel.

Sam displayed defective mands throughout the assessment since almost all of his requests revolved around escaping work. He asked his mom “Can we be done?” and “Is it almost time for a break?” 30 times during a 20-minute work session. During the full day evaluation, Sam also only asked a few general questions starting with words such as “what,” “can” and “does.” I didn’t hear any complex mands for information with “why,” “how,” or “which” questions.

While Sam’s tacts were relatively strong, things fell apart for Sam when he was asked questions and needed to respond intraverbally. When I asked Sam to tell me some animals, foods, colors, and pieces of clothing or asked him simple “what” and “where” type questions, he was fairly accurate. However, when I asked him to tell me some things that are usually red, he looked around the room (looking for something to tact). I then asked him to close his eyes and tell me some things that are usually red and he demonstrated problem behavior. He screamed “Don’t tell me to close my eyes!” Similar problem behaviors were seen when how and why questions were asked.

The VB-MAPP assessment showed major skill deficits in manding for information and in the intraverbal repertoires. Sam’s problem behavior was primarily related to a history of escape from work involving high intraverbal demands. A few of the interventions recommended included the introduction of a token economy system, teaching Sam how to mand for information and using tact to intraverbal transfers to teach him to more effectively answer complex “wh” questions. An SRA program called Language for Thinking as well as a BCBA for six hours per month to oversee programming were also recommended and implemented.

If a student is displaying problem behaviors that are disruptive to his learning or the learning of others, the “problem behavior” box should be checked off on one of the first pages of the IEP. If this box is checked, a FBA needs to be conducted, preferably by a Board Certified Behavior Analyst (BCBA). A Behavior Intervention Plan should also be written and, once staff are trained on the plan (by the person who wrote it), it should be followed closely.  Ongoing analysis and support for staff is also needed.

I believe that assessing the verbal and non-verbal operants as well as all academic areas should be a part of every FBA.  Professionals who conduct FBA’s, as well as other professionals and parents who are working with students with significant problem behaviors need to understand the difference between mands, tacts, and intraverbals and the importance of assessing the verbal and non-verbal operants. A focus on the skill strengths and deficits (and not just on the problem behavior) will help each student with autism reach their full potential.

For more information, read my book (The Verbal Behavior Approach: How to Teach Children with Autism and Related Disorders) and/or check my web site (http://www.verbalbehaviorapproach.com/) for downloadable information at no cost.

Getting Started with the Verbal Behavior Approach

An ongoing challenge is how help parents and professionals get started with the Verbal Behavior Approach. Several months ago I published a short article entitled “Getting Started with the Verbal Behavior Approach” in Autism File magazine I think it is great for both parents and professionals who are brand new to the VB Approach and want a very brief overview. The article appears on the home page of my web site in the lower right hand corner. Here’s the direct link: http://www.verbalbehaviorapproach.com/autism_file.pdf
I do have permission to copy and distribute freely so feel free to pass it along!

In addition, there are many other free resources on my web site including Frequently Asked Questions Regarding VB and Frequently Asked Questions Regarding Potty Training. These two FAQ articles are available in both English and Spanish:  http://www.verbalbehaviorapproach.com/faq.html

Several 30-minute radio shows are also available on my site and listed on the radio page of my site. Here is the link for the radio show list: http://www.verbalbehaviorapproach.com/radio.html.

Go to: http://www.verbalbehaviorapproach.com/ to access information to help you (or a parent or professional you know) get started with the Verbal Behavior Approach.

A Quick Assessment for an Intermediate Learner with Autism

The term “Intermediate Learner” is very subjective and in the ABA/VB field, this usually indicates that the manding, tacting and intraverbal areas on the ABLLS or VB-MAPP are not well developed. While the intermediate learner can mand for basic items and some actions, he or she is usually weak at manding for attention and information. Basic tacts are solid and the child may have hundreds of tacts but usually has difficulty tacting features, functions, actions, prepositions and more abstract concepts. In addition, intraverbals (answering questions with no visuals) are extremely weak. Basically an intermediate learner is usually able to talk but unable to hold a conversation.

My son is now 13 years old and has been an intermediate learner for several years. At this point many would consider Lucas to be at the cusp of an advanced learner in some areas but most of the years since we’ve implemented ABA, my son has been at the intermediate learner level.  Programming for intermediate learners, therefore, has always been an issue of great importance to me.

A few people have made comments such as “Well if Mary is a BCBA and VB works, then why isn’t her son conversational or why isn’t he recovered from autism?” I write about this in Chapter 12 of my book and I suggest that if it were just about how hard you worked to help your child, Lucas (and many other children with autism) would be long recovered. But Lucas remains moderately autistic and, while his language improves, it does so slowly but surely. I equate it to climbing a very huge mountain with a lot of stuff on our backs.

I often encounter vocal children who appear to be an intermediate learners and I need to assess them very quickly without using a lot of materials and without completing a VB-MAPP or ABLLS.  A few years ago I wrote down the steps I usually use to assess these intermediate learners in a few minutes with only a small amount of materials.

This mini-assessment is not all that is needed for these learners but it may help you get started in terms of knowing which children need a more thorough assessment and careful ABA/VB programming. Intermediate Learners (who do not “pass” the mini-assessment below) need a more thorough assessment such as the VB-MAPP and also need very specific programming.  Ideally, these learners should also have access to on-going consultation by a BCBA familiar with intermediate learner ABA/VB programming.

Here are areas I assess:

For language I focus on assessing mostly the tacting and intraverbal repetoires. While I’m assessing these areas as well as some basic academic skills, I’m also listening for the child to spontaneously mand for items, actions, help, attention, and information.

Personal information/Intraverbals
What's your name, how old are you, what's your phone # and address (assess both knowledge and articulation of these).

Tacts of functional items such as chalkboard, stapler, paper towel, toothbrush (pictures and items).

Tacting body parts/clothing (what’s this called (nose)) and actions (what am I doing (clapping))

Tacting features (use real items)....”What's this called?”...chair. “What is this part called?”....legs/back/seat (also assess: computer...keyboard, mouse, screen, phone....cord, buttons, receiver, and car....wheels, roof, door).

Tacting prepositions....Hold a pencil over a book and ask "where's the pencil?" Do the same procedure for in front of/behind/next to/under/in/on ....the answer needs to be “over the book”...not just “over.”

Tacting pronouns....whose shirt (while touching your own shirt....his answer should be "your shirt" or "yours" ...same procedure for my (clothing or body part)....then test Who has the book (you do or I do) ....test boy/girl and he/she too if the child is successful with my/your and I do/you do.

Yes/No tacts....Is this a bed (show him a spoon)......Does this have wheels (show him a car)...Does this have wheels (show him a bed)....Is this blue (show him something that is yellow)

If the student is successful with Yes/No tacts, I then assess Yes/No intraverbals…does a cow say quack, does an airplane fly in the sky, does a boy where a dress.

Intraverbal feature/function/class and Intraverbal Webbing
Tell me a color, tell me another color, tell me something that is yellow, name two things that fly in the sky, close your eyes and tell me some things that are usually red, tell me a vehicle, tell me a hot breakfast food, tell me something with four wheels, what do you do with a sink.

Math abilities...count to 7, give me three, circle four, what is 2 + 3 (no visuals). What time is it? Check tacting money and adding amounts of money (place a quarter and dime on desk…how much money is that?)

Reading/comprehension ....If child can read, have him read a few sentences or pages from a book. While he is reading, note errors and fluency.  After he is finished, ask who, what, where, when, how and why questions regarding the content.

Writing....I ask the child to write his name (looking at pencil grip, spacing, size).  If the child is successful I might ask him to also write some other words or draw a picture.

During the assessment, I also record the child’s ability to mand for items present and note any ability for the child to mand for help, attention or information during the assessment. If he doesn’t spontaneously mand for information then I sabotage the situation (Hide something in the room and tell him..."I have a swedish fish somewhere in this room"....see if he says "where").....I might also hide something in a box or bag and say "I have something in this bag for you" and see if he says "what."  During the assessment, I also look for barriers to learning including issues with instructional control and problem behaviors.  I record all significant problem behaviors and note which operant or skill seemed to trigger the behaviors.

Once this mini-assessment is finished, you should know if the child or adult needs a more thorough VB assessment such as the VB-MAPP. You’ll also have an idea of some programs that might be useful.

For more programming advice, listen to my radio shows on programming: http://www.verbalbehaviorapproach.com/radio.html

More assessment information and programming advice can also be found in my book: The Verbal Behavior Approach: How to Teach Children with Autism and Related Disorders available at: http://www.amazon.com/Verbal-Behavior-Approach-Children-Disorders/dp/1843108526/sr=8-1/qid=1167954419/ref=pd_bbs_sr_1/102-6326506-0064953?ie=UTF8&s=books.