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/.

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.

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

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.

What are the Differences Between the ABLLS and the VB-MAPP?

I received a question on my blog two weeks ago asking about the differences between the ABLLS and the VB-MAPP. This week I’ll address this question.

The Assessment of Basic Language and Learning Skills, otherwise known as the ABLLS, was written by Dr. James Partington and Dr. Mark Sundberg in 1998. The ABLLS was not written as a “stand alone” book. Instead, it is one of three books that were written to go together. Many people (including me) credit the publication of Drs. Sundberg and Partington’s three-book collection (including the ABLLS) with the creation of the Verbal Behavior Approach.   Without the ABLLS, my son with autism who is 13 years old would not have progressed to the point he is now and I most likely would not have become a BCBA or written my book. I am therefore eternally grateful to Drs. Sundberg and Partington for publishing the ABLLS.

The Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) was written by Dr. Mark Sundberg and published by AVB Press (http://www.avbpress.com/) in 2008. This newer assessment tool has many advantages over the ABLLS.

Some of the things that I like better about the VB-MAPP include: 1) Skills as well as barriers are assessed; 2) The tool was field tested with over 150 typical children and dozens of children with autism; 3) There are three clear levels in the MAPP so you can gauge the skills of a child with autism with age ranges of typically developing children; 4) Once the VB-MAPP is completed, the boxes can be added up to obtain a score (making progress more objective and the tool more appealing to researchers); 5) Practitioners who use the VB-MAPP are more likely to develop a balanced program with emphasis on improving the child’s deficits without further splintering skills; 6) The MAPP contains a transition assessment which is helpful in making decisions about the level of inclusion or group instruction that may be appropriate; and 7) I find the VB- MAPP to be easier to administer.

Both the VB-MAPP and ABLLS can be used as assessments, curricula, as well as skills tracking guides. Both tools consist of a series of boxes (although the MAPP has far fewer boxes) requiring completion by an adult who is familiar with the child and, more importantly, knows how to assess skills accurately. The initial assessment using the VB-MAPP or ABLLS can take hours to complete, especially if the learner has more advanced skills.

They are both great tools for a consultant trained in the Verbal Behavior Approach, but for a parent without any background in ABA, the VB-MAPP and the ABLLS can be very overwhelming. In order to assess accurately using one of these tools and program most effectively for your child, consultation with a BCBA familiar with Skinner’s Analysis of Verbal Behavior is strongly advised.

The ABLLS, ABLLS-R (A revised ABLLS published by Dr. Partington in 2006) and the VB MAPP assessment tools are all available at http://www.difflearn.com/ and information regarding BCBA’s can be found at http://www.bacb.com/. After completion of a thorough ABA/VB assessment, lots of programming advice can be found in my book: The Verbal Behavior Approach: How to Teach Children with Autism and Related Disorders (http://www.verbalbehaviorapproach.com/).