Teaching Children and Adults with Autism to Answer “Yes” and “No”

The ability to respond “yes” or “no” to questions is a very complex skill involving different operants. It has been my experience that a child needs to master yes/no mands (Answering yes or no to “Do you want a cookie?”) before you should attempt to introduce yes/no tacts (Is this a bed?) or yes/no intraverbals (Does a cow say quack?). Assessing yes/no within each operant is a good place to start.

I've done a lot of work with teaching yes/no mands to my son with autism as well as several other children. Teaching a child to say “no” or to respond with a head shake NO can be taught early to replace problem behavior such as crying or pushing items away but teaching a child to say “yes” should not be done until important prerequisites are in place.

I recommend not teaching "yes" mands until the child is spontaneously manding for dozens of items in and out of sight and manding for several actions too. I've see many children who have a defective yes mand because someone taught them to answer “yes” too early. The main issue is that they say "yes" when someone offers them something (Do you want candy or Do you want a tickle) but they cannot ask for those items (candy) or actions (tickle) spontaneously by using the item or action name. This often leads to problem behavior.

Once children can spontaneously mand for many items and actions out of sight, this is how I start teaching yes/no mands. First, I gather three things the child loves (and will almost always mand for or take) and three things they don't like and would usually push away (raisins or another non-preferred food item and certain videos). I then use these items during short (10-15 minute) yes/no mand sessions. I ask “Do you want a ___?” while holding one item and prompting yes/no and doing a transfer trial. For some children I have used textual prompts which are the written words "yes" and "no.” Textual and/or verbal prompts need to be faded carefully though by using transfer trials.

Here is an example of a prompted trial followed by a transfer trial:

Hold up a raisin (non-preferred) and say “Do you want a raisin?” prompt NO verbally, with a head shake and/or the word NO written on an index card. The child needs to say or head shake “no.” Then immediately complete the transfer trial by taking away the textual prompt (if used) and asking the question again “Do you want a raisin?” The child says “no” without any prompt and the item is removed.

I create many contrived situations, alternate between things they want and don’t want, and take trial by trial data during these short yes/no mand sessions. Once this skill is solid with the 6 items (3 items they like and 3 items they don’t like) in sight, I then specifically work on generalizing to other items and moving mastered items out of sight.

You also have to be careful about not accepting sloppy responses such as "pretzel, yes." The answer has to be yes or no when teaching yes/no mands. Be careful also not to overuse yes/no questions outside of these yes/no mand sessions when the child is just learning this skill. Otherwise, the child may lose the ability to spontaneously mand for items.

Yes/No tacting (answering “Is this a pen?” or “Is this blue?” or “Am I standing?”) is a much harder skill and should not be introduced until the child can indicate yes/no for mand items out of sight (Do you want ketchup on your hot dog? Or Do you want ice cream?). He or she also needs a solid tacting repertoire for items, features, actions, etc.

For children with the ability to respond yes or no with manding but who have yes/no tacting difficulty, I have had success with teaching yes/no tacts within the mand frame. When my son was learning to tact yes and no and would mand for cheerios spontaneously, I pulled out cheerios and asked "Are these cheerios?" He said "yes" and then got the cheerios. Once he had this skill solid I pulled out a different box of cereal when he manded for cheerios and said "Are these cheerios"....then he said “no” and I pulled out another box and asked "Are these cheerios?" and he said “no” then I finally pulled out the cheerios. Eventually (and in random order) the answer was “yes” and he received the cheerios. I then moved on to presenting yes/no tacts with flash cards without a mand component. When I started with flashcards I used “Is this an apple?” as the only question and had a mixed pile of apples and other things that were very different from apples. Once yes/no tacts are mastered (Is this a bed?, Is this a car? as you present random pictures), you’ll need to also teach children to respond to yes or no to tacts involving feature, function and class (“Does this have wheels?” or “Can you eat this?”).

For yes/no intraverbals, it is important that the instructor know the answer to the question they are asking. For example, asking “Have you ever been on a boat?” is not a good question if you don’t know whether the student has ever been on a boat. There are many children and adults with autism who answer “yes” often (and incorrectly) because they don’t understand complex language. For this reason, I usually don’t focus on teaching intraverbal yes/no responses. I directly teach yes/no mands and tacts and let the intraverbal yes/no responses develop more gradually (and only teach basic, functional and important yes/no intraverbals).

For more information about improving verbal behavior in children and adults with autism, go to my web site: http://www.vbapproach.com/.

Programming for Happiness in Clients with Autism

I attended a Keynote presentation last fall at the Autism New Jersey conference where Dennis Reid, PhD, BCBA spoke about the importance of programming for (and measuring) happiness in clients with autism.

During one of the activities, the participants spent 3 minutes writing down every choice we made that morning prior to arriving at the conference. We had the choice of whether to hit the snooze alarm, what to wear, what we wanted to eat and drink, whether we wanted to bring a jacket along, where to park, where to sit, etc.

Basically he made the point that we have many choices throughout our days and that choices lead to happiness. He also pointed out that our children and clients with autism have few choices.

As Dr. Reid suggested, I have now begun to measure and count behaviors such as smiles and laughs and I give more choices than ever before.  I, of course, continue to focus heavily on pairing and manding as well as reducing problem behaviors in my effort to program for happiness.  Since seeing this presentation, I feel strongly that we need to provide our clients with many choices throughout the day and should consider happiness as an important (and attainable) goal.

For more information about pairing, manding and measuring behaviors, go to http://www.vbapproach.com/ and read my book:  The Verbal Behavior Approach:  How to Teach Children with Autism and Related Disorders.

Mia’s Journey with the Verbal Behavior Approach

I am happy to announce a series of you tube clips that I posted a few days ago that may make getting started with the Verbal Behavior Approach a little easier for both parents and professionals! There are now three short (6-8 minute) You Tube clips on the assessment and beginning ABA/VB intervention for Mia, a 2 year old lgirl recently diagnosed with PDD-NOS.

I have permission from Mia's parents to post these clips on you tube so that others may benefit from my work with Mia. Hopefully these clips will be the first three in a series of videos that I will post as Mia makes progress!

Clip #1 shows Mia's problem behaviors and poor instructional control at baseline. Clip #2 demonstrates for parents and professionals what to do to help Mia and Clip #3 shows me reviewing Mia's VB-MAPP and Barriers with her mother. All three clips were filmed during a 3-hour initial assessment in June 2010.
Clip #4 was filmed in July 2010 and shows progress in 3 weeks.
Here are the links:

Clip #1/Mia's Baseline Problem Behavior: http://www.youtube.com/watch?v=FCbBLhLjoXA

Clip #2/ABA/VB Interventions to Start Immediately: http://www.youtube.com/watch?v=rPUII8DWlCo

Clip #3/VB-MAPP: http://www.youtube.com/watch?v=8zgn3Tqy8nM

Clip #4/Progress after 3 weeks:  http://www.youtube.com/watch?v=665jj4i29Ag

I’m looking forward to watching Mia progress on her journey with ABA/VB! For more information about the Verbal Behavior Approach, go to: http://www.verbalbehaviorapproach.com/

TAGteach and Autism

Last spring a friend of mine asked me if I had ever heard of TAGteach. When I said that I hadn’t, she asked me if I knew anything about clicker training for animals. I was familiar with the concept of using audible markers with animals, thinking mostly of the whistle blowing at Sea World to signal to the dolphin that the move was correct and that the dolphin would be receiving reinforcement soon. My friend explained that TAGteach used the same principles of positive reinforcement, conditioned reinforcement and shaping as clicker training. She also told me that TAGteach was being used at her son’s school for children with autism. I was intrigued by the concept and assumed that the “A” in TAG stood for autism but I was wrong.

The acronym TAG means Teaching with Acoustical Guidance and was used first with gymnasts, not children with special needs. It all started when Theresa McKeon purchased a horse in 2005 and had difficulty training it. She went on-line and learned about Karen Pryor’s clicker training technology. Theresa used clicker training until the horse was calmer and then sold it. In the process of using clicker training with her horse, Theresa, a national gymnastics coach, decided that clickers might be very helpful to her young students. When a gymnast had difficulty with a handstand, for instance, the skills of the handstand could be broken down and each skill could be taught separately. When one of the students got her feet to the 12 o’clock position or put her arms over her ears, the coach could click to signal that the position was correct.

In her book, Reaching the Animal Mind, Karen Pryor describes her experience in visiting Theresa’s gym for the first time. After the parents of the gymnasts complained that they didn’t like the use of animal clicker training with their children, Theresa and  Joan Orr (the co-founder of TAGteach) made the decision to change the name to TAGteach instead of clicker training when the technology is applied to humans. This simple semantic change worked to ease the concerns of the gymnasts’ parents and TAGteach began to spread to dancing, golf, other sports and eventually to special education. To view videos of TAGteach from Karen Pryor’s Reaching the Animal Mind web site, go to:  http://reachingtheanimalmind.com/chapter_11.html.

Dr. Julie Vargas (BF Skinner’s daughter) also wrote an excellent book, Behavior Analysis for Effective Teaching, which highlights some applications of TAGteach to children with autism. In addition TAGteach has a great web site (http://www.tagteach.com/), a Yahoo group, Facebook page, and an excellent e-learning program I completed last summer. I highly recommend the e-learning program and/or a live 2-day TAGteach seminar to anyone and everyone!

In preparation for a symposium on TAGteach at the ABA International Conference in Texas, I used TAGteach to teach my son, Lucas, how to tie shoes.  It took about 1 ½ hours in total over a few weeks and I will be presenting data and this video in Texas. Here is a you tube video as a sneak peak: http://www.youtube.com/watch?v=6K2FsjICr34

To learn more about TAGteach, check out the books listed above and/or http://www.tagteach.com/. For those of you who will be in Texas for the ABAI conference over Memorial Day Weekend, you can learn more about this technology by attending the TAGteach symposium #379 held on 5/31/10 at 10:30am where I will be presenting on TAGteach and Autism.

Visit my web site:  http://www.verbalbehaviorapproach.com/ for more information about me or my book and/or join The Verbal Behavior Approach Facebook fan page:  http://www.facebook.com/pages/The-Verbal-Behavior-Approach/183142072329?ref=mf.

Teaching Children with Autism to Indicate When They Are in Pain

I recently received a question related to my last blog on the importance of looking at medical issues before treating problem behavior. The question a few weeks ago was “How do you teach children with autism and severe language impairments to indicate they are in pain and to tell you where the pain is coming from?” I remember asking a very similar question to Lori Frost (co-creator of the Picture Exchange Communication System – PECS) years ago when I attended an introductory PECS workshop. Lori’s response was to make sure you label and preferably have your child label (with speech, PECS, or sign) when he has something visible that is obviously hurting him. In other words, when your child has a skinned knee or when he gets a bee sting, make a big deal out of labeling the pain for him. This is an important step with the goal that eventually your child will be able tell you he has internal pain which you can’t see such as a head ache or belly pain.

For a non-vocal or minimally vocal child, you might try -- Boo Boo (with a Band-Aid picture card or the words) on my ______________ or my _________ hurts and have your child fill in the body part by speaking or choosing a picture of a body part from an array. Even if your child is speaking, he or she might need added visual supports to learn this concept. To teach the labeling of pain, I would also recommend you try to put a real Band-Aid on a large picture of a boy (on various body parts) and have your child fill in the blank --boo boo on the boy's ___________ or the boy’s ________ hurts. You could also use the same idea to teach this concept with a simple talking device and/ or with sign language. I have found that receptive body parts and tacting body parts are usually prerequisite skills for labeling pain so I would also recommend working on these programs when your child is not in pain.

I believe the ability to label pain is an important skill which can and should be taught. For more information including details about my book (The Verbal Behavior Approach: How to Teach Children with Autism and Related Disorders), check out my web site: http://www.verbalbehaviorapproach.com/.

The Importance of Ruling Out Medical Issues Before Treating Problem Behaviors

As both a Registered Nurse and a Board Certified Behavior Analyst (BCBA), I find myself frequently reminding people that some behaviors are caused by medical issues and cannot effectively be treated behaviorally.

Here is a little review of the four main functions of problem behavior. Two functions are Socially Mediated which means that other people have been involved in the past that have reinforced the behaviors. The other two functions are Automatic which means that no other person needs to be involved. The child or adult engages in problem behavior because the behaviors are automatically reinforcing. Here are the four main functions broken down further:

1) Socially Mediated Positive Reinforcement (Attention/Access to Tangibles). In the past when the child engaged in problem behaviors, things were ADDED such as attention and tangibles.

2) Socially Mediated Negative Reinforcement (Escape from Demands). In the past when the child engaged in problem behaviors demands were REMOVED (or delayed or made easier).

3) Automatic Positive Reinforcement (Self Stimulation). The child engages in problem behavior because in the past when they have engaged in this behavior pleasure/reinforcement has been ADDED.

4) Automatic Negative Reinforcement (Pain Attenuation). The child engages in problem behavior because in the past when they have engaged in the behavior, pain was REMOVED (or lessened).

In Chapter 2 of my book (The Verbal Behavior Approach), I cover the first three functions in pretty much detail but I don’t explain Automatic Negative Reinforcement too well except to mention that children with problem behaviors which come on suddenly or which you suspect might be medical should see a physician. In many cases, however, it is difficult for you or any physician to determine if a problem behavior is caused by a medical problem, especially in children with autism who cannot fully communicate about pain or discomfort.

I had an experience with my own son in the past few weeks since I wrote my last blog which I decided to write about to illustrate the importance of looking at medical issues when evaluating a child for the first time or when an established client experiences problem behaviors which start abruptly or increase without a clear explanation.

Lucas, who is 13 and has moderate autism, showed an increase in self injurious behavior (SIB) over the past few months. While in the past he would occasionally bite his knuckle at school, the rate and intensity of his knuckle bites went up significantly (from approximately one knuckle bite a day at school to 10 knuckle bites occurring both at home and school). This increase occurred in the past two months and at times, in addition to the knuckle bites, Lucas would sometimes hit his head and cry.

Lucas’ teacher and aid at school kept careful ABC data and the behaviors usually appeared to be related to access to tangibles and/or escape. But the demands were not higher than usual and sometimes he would engage in problem behavior without a clear antecedent. The professionals who worked with Lucas for years were all concerned that his behaviors were worse than ever. I was concerned too and noticed that sometimes at home when he engaged in problem behaviors, he cried real tears (and engaged in SIB) while on reinforcement. At these times when I asked him what was wrong, he would almost always say “eyes” but I didn’t know if he was saying eyes because he was crying or if he was truly in pain.

I finally took him to the pediatrician who agreed to do a battery of blood tests and a CAT scan of his head and sinuses. Because we knew Lucas wouldn’t tolerate a CAT scan without sedation, the doctor had to arrange a CAT scan with anesthesia. The MD and I agreed that is everything came back normal; we would chalk up Lucas’ problem behaviors to puberty and treat it behaviorally.

While the blood work and CAT scan of the head were within normal limits, Lucas’ sinus CAT scan showed “sinus disease” which has responded well to antibiotics and allergy medicine. I’m happy to report that Lucas’ problem behaviors are now back to baseline and we will work hard to implement behavior procedures to get rid of his SIB altogether.

For more information about reducing problem behaviors in children with autism, please read Chapter 2 of my book (http://www.verbalbehaviorapproach.com/), listen to a radio show on reducing problem behavior (http://old.autismone.org/radio/?archive=5729) and/or read my previous blogs.

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.