Using ABA to Teach Functional Self-Help Skills to Children with Autism and Other Developmental Disorders

Many people are confused about how to use ABA to teach functional, multi-step skills such as putting on shoes, washing hands, or setting a table. Several years ago I was consulting in a classroom and we were working with a 14 year-old girl with Down Syndrome who was minimally vocal. We were focused on trying to teach her to mand for items when her teacher jumped in and asked if we could help the girl learn how to set a table since this was a goal on her IEP.

Following the teacher’s motivation, I switched gears and told her that we could use ABA to teach her student how to set a table. I went on to explain that a multi-step skill like setting the table is taught much differently than teaching a child to mand for or tact items. When the teacher pointed me toward the table setting supplies, I began asking questions such as “Should she set the table for 2 or 4 people?” and “Do you want her to carry the plates over with the silverware on top or should she carry just the plates over first?” The teacher said she didn’t know and that she just wanted her to set the table.

For chained skills, the first step is to create a task analysis. This involves writing down each step of the skill in order. If there is more than one adult working with a child on a skill, it is important that the task list be created with everyone’s input and this needs to be followed closely. For hand washing, for example, you’ll need to decide if adults are going to prompt the child to pump the soap 3, 4, or 5 times and for setting the table, it needs to be decided in advance how the child should proceed with each step. Once the task analysis is created, the key to teaching these skills is that, in most cases, adults should use gentle physical prompts from behind and NO vocal prompting.

Chapter 11 of my book (The Verbal Behavior Approach available at: http://www.amazon.com/Verbal-Behavior-Approach-ChildrenDisorders/dp/1843108526/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1205440059&sr=8-1) covers the basics of teaching chained skills using hand washing as the example.

There is another book which I would also recommend reading to learn how to teach these skills called Self Help Skills for People with Autism. This book is available at: http://www.amazon.com/Self-Help-Skills-People-Autism-Systematic/dp/1890627410.

One other resource that is excellent is a self-care checklist developed by Dr. Mark Sundberg available as a supplement to the VB-MAPP. You can download this free checklist at: http://site.avbpress.com/VB-MAPP_Supplement-Self-care.pdf. This will help you assess your child’s self-help skills and assist you with prioritizing which skills should be taught first.

Once you assess your child’s self-help abilities, I recommend you start with easy-to-prompt skills such as putting on shoes or hand washing so you can practice your skills by getting behind your child. For hand washing, I suggest you stand directly behind the child with your arms around the child gently prompting his hands. As the child turns on the water and pumps the soap dispenser three times, for instance, you can feel how much physical prompting is needed and guide his hands from behind. You should also be able to feel when prompting for each step can be faded.

Avoid vocal language during the teaching of chained tasks. This is not the time to be asking the child to tact “soap” or to be questioning “what step is next?” During multi-step self-care, leisure and/or vocational tasks, you should remain silent and provide as much gentle physical guidance from behind as is needed for the child to be successful with each step of the task.

Consistent prompting and prompt fading will be most effective when the adults working with the child take data and make decisions based on the data. Don’t forget about reinforcement too since teaching these tasks can involve high demands.

If the child you are working with seems uninterested or avoidant of the task, your goal may not be to teach the whole task. Instead you may need to start with the last step of the task first followed by high reinforcement and then fade in the other steps gradually and systematically.

For more information, visit my web site:  http://www.verbalbehaviorapproach.com/

Why do Students with Autism Have Such a Difficult Time with Transitions?

Imagine you are at the beach on a beautiful sunny day having a cold drink and reading a great book. On a scale of 1 to 10 with 10 being the most reinforcing activity, you would rate being at the beach on this day to be a 10. Without warning, I abruptly come up to you and say “all done beach, time to load heavy boxes in a truck.” You would most likely not like this at all and might start displaying problem behaviors in the form of arguing, stomping you feet, and slamming your chair onto the sand. You might even refuse to leave your preferred activity and literally dig your heels into the sand. What I want to illustrate is that we all have problems with transitioning from high preferred to low preferred activities. The key is to ease transitions by not asking a child to transition from a 10 (a highly preferred activity) to a 2 (work) constantly throughout their day. I will briefly describe five techniques to ease transitions.

1) Dangle the carrot (the reinforcement) before problem behavior occurs.

In the beach example above, if I would have come up to you and offered you $50 to help me load 5 heavy boxes in the truck that would have been fine but waiting to offer cash until you start stomping your feet and refusing to move is a very bad idea. Remember any behavior that is reinforced will maintain or go up. Propose the reinforcement while you place the demand to transition not after problem behavior occurs.

2) Don’t physically move a student from one location to another (even if they are small enough to carry or move).

I wouldn’t even think about physically dragging you off the beach to help me load heavy boxes as this could lead to me getting arrested for assault. It amazes me that some people try to physically move students with autism from one activity to the next. If you try to prompt the child to move and he or she resists with equal but opposite pressure, this is considered a physical restraint. If you are currently using too much physical guidance for transitions, you need to stop and implement some other appropriate interventions.

3) Whenever possible, give choices.

If I would have come up and stated that I needed help with some heavy boxes and asked you when would be a good time for you to transition, you would probably have been a lot more cooperative. You may have suggested that we load the boxes when you finished your drink or after you read to the end of the chapter in the great book you were reading. We make a lot of choices throughout the day, especially when we are faced with difficult or unpleasant tasks. We need to give our students with autism as many choices as possible to ease transitions.

4) Sandwich harder activities between two preferred activities and consider using schedules and timers.

Some students benefit from visual schedules and the use of timers to indicate that one activity is over and a new one is beginning. The use of a “promise” reinforcer is also successful for many students. A promise reinforcer is used when it is time to transition to a less preferred area. The child is approached with a favorite toy or a small edible reinforcer and this is used as the “carrot” and a visual reminder that reinforcement is available for a smooth transition. Some students need several small edible reinforcers on the way to a less preferred area. It is also important that all the hard activities are spread out throughout the day and placed in between reinforcing activities. In the beach example, if you knew that you would be at the beach from 1 to 4 pm then you would spend 10 minutes helping to load boxes in a truck followed by going home for pizza, the task of loading boxes would not have been such a big deal.

5) Make sure all “work” stations are paired with reinforcement and avoid the word work whenever you can.

Some of the best classrooms and home programs I have seen have strong reinforcers at every “work” area. Each area has some electronic device (a computer, DVD player, or music box) as well as a separate box of toys and items kept on top of a rolling cart that can go with the student and his instructional materials to each area. I often tell professionals and parents to avoid the word “work” for students who have difficulty with transitions and to spend a few minutes at the beginning of each session pairing yourself and the materials with reinforcement. If students are not running towards the next activity or at least moving there without problem behavior, your demands are too high and/or your reinforcement is too low.

Check out chapter 2 and 4 of my book (The Verbal Behavior Approach) for more tips on easing transitions! http://www.verbalbehaviorapproach.com/.



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The Pennsylvania Verbal Behavior Project

As many of you know I’ve been the Lead Behavior Analyst for the PA Verbal Behavior Project since 2003. I always receive a lot of questions about the Project so I wanted to give some basic information via this blog.

The PA VB Project started in 2002-3 school year with two pilot classrooms in the Wilkes-Barre PA area.  The main goal of the Project is to establish public school classrooms that provide teaching procedures using Applied Behavior Analysis and the Analysis of Verbal Behavior to improve communication, social and other relevant skills for students with autism.

The Project has grown over the years and we now serve over 100 public school autism classrooms throughout the State of PA. The Project is supported solely by the PA Department of Education and provides three main services. Each Project classroom receives: 1) training; 2) some materials such as Language Builder Cards, VB-MAPP protocols, and Direct Instruction Materials; and 3) on site guided practice by Board Certified Behavior Analysts (BCBA’s) and those studying to become BCBA’s. The largest parts of our budget has and will always be on site coaching since studies show that most people retain little information and are not able to apply much after lecture alone.

The VB Project does have some outcome data based on a site review checklist and student assessment scores and we have presented this data at the last several International ABA conferences. This year we will have even more outcome data since we are now using the VB-MAPP for all of our 600+ students. Hopefully this data will be published in the future.

Check out this youtube video about the PA Verbal Behavior Project:

http://www.youtube.com/watch?v=JCkYqW1GDdo

Here is a free downloadable parent handbook too:

http://www.pattan.net/files/Autism/VB-FamHandbk062209.pdf

Contact http://www.pattan.net/ for more information about the PA VB Project.

Getting ABA/VB Services Started in Your Child’s School

There are lots of ways to try to educate school staff on the principles of ABA/Verbal Behavior and get this type of programming in place within educational settings. Bringing in a knowledgeable speaker on the topic of ABA/VB is probably the most common way to begin. This can often "jump-start" enthusiasm for ABA/VB but will take time and money to sponsor a speaker. If you have a local autism support group or autism school with some ability to bring in a speaker, you may want to try to get that agency to sponsor or co-sponsor a workshop.

Many parents and professionals have said my book (The Verbal Behavior Approach) gave them a great overview of the concepts so for relatively little investment, some parents have purchased multiple copies of my book for their child’s teacher, SLP, OT, and paraprofessionals.

But if education professionals are not motivated to read the book or attend a workshop, you could be wasting your money. And, even if they do hear a knowledgeable speaker present on ABA/VB and/or read my book, they still will most likely have difficulty applying the concepts.

Without on-going consultation and support, it is usually very difficult for teachers to learn how to apply ABA/VB concepts to correctly program and teach children on the autism spectrum. Some schools who agree to provide an initial training on ABA/VB will also contract with the trainer or another qualified Board Certified Behavior Analyst (BCBA) to provide on-going consultative support for a particular classroom or school. This is often a very good situation with program oversight provided for the entire classroom of students and training and guidance for the staff.

If you have difficulty getting things going in your child's classroom or school, another strategy is to start small and focus on getting ABA/VB for your child only (not for the whole classroom). One way to get things started for an individual child is to try to get a BCBA with VB expertise in your child's IEP for a specified period of time each month (i.e. 4, 6, or 8 hours) for program oversight. Putting staff training (for example 6 hours before anyone new works with the child) in the IEP also can also be essential and the BCBA whose services are the IEP can provide that training.

Having the BCBA hours within one child's IEP may not change the entire classroom immediately but over time it might. Plus, if these services are in your child's IEP, the BCBA and staff training requirements will follow the student to middle school and then to high school. This may mean that you won't have to start your advocacy efforts over again as the child transitions and as staff come and go over the years. Getting BCBA services and staff training in the IEP may be difficult but since the IEP legally drives services, I believe it might be something worth pursuing.

For more information, check http://www.verbalbehaviorapproach.com/. 

ABA and the Verbal Behavior Approach for Children with “High Functioning” Autism

I am often asked if ABA/VB is appropriate for children or adults with High Functioning Autism (HFA). Since my book is geared more towards helping adults learn how to teach early learners, many parents and professionals think that ABA and specifically the Verbal Behavior Approach is not appropriate for “higher functioning” children.

First I want to say that I really try to avoid using the terms “high functioning” and “low functioning” to describe learners with autism. I explain why I prefer not to use these terms in chapter 12 of my book but very simply it is the same reason I wouldn’t label a typical child or adult as “smart” or “stupid.” All of us are smart in some areas but not so smart in other areas. It is unfair for us to put children with autism in boxes and to try to classify kids as either high functioning or low functioning. Instead we need to assess the child’s strengths and weaknesses. An individualized ABA/VB program should capitalize on the child’s strengths while helping him or her overcome weaknesses.

I spend at least half of my consultation time with children that most people would consider to be “high functioning.” These children look pretty indistinguishable in the community and some of these kids are even able to hold decent conversations. But most if not all of the high language learners I work with still have language deficits and social skill weaknesses that are in need of serious ABA/VB programming. Many of these students also have dyslexia and other learning disabilities too and this often complicates programming. Because of these skill deficits, all of the students I work with on a regular basis need a fine balance between demands and reinforcement.

ABA is the science of changing socially significant behavior and, in my opinion, is often mistakenly overlooked for children and adults with “high-functioning autism.” Check out my book (The Verbal Behavior Approach) specifically chapters 2 and 12 for more information about using ABA/VB techniques to teach children with autism, regardless where they fall on the spectrum by visiting my web site:(http://www.verbalbehaviorapproach.com/).

Teaching Non-Vocal and Minimally Vocal Children with Autism

For children who do not yet speak, I usually recommend teaching 3-5 signs at a time and to teach these signs as mands first. Many of these signed mands will need hundreds of practice trials before a child will be able to request an item using a sign without assistance. Careful prompting and prompt fading across many trials per day is usually needed.

To teach a child to mand using sign language, hold out a preferred item and make sure the child wants the item by giving a “freebie” and/or looking for a reach, eye gaze, or smile. If the child does not want the item, you should not proceed. If the child wants the item and has some ability to imitate, I would then recommend you model the sign.

If the child cannot yet imitate, check for the motivation (MO) and then take the child’s hands and help him or her perform the sign. After the child performs the correct sign (with an imitative or physical prompt), deliver the reinforcer. Each time you or the child signs the word and when you deliver the reinforcer, it is important to say the item name.

I would also focus on trying to increase vocalizations by using simple inset puzzles or two sets of identical first word flash cards you can buy at the Dollar Store. As you hand the child a pig puzzle piece or a picture of a pig to match with the pig picture on the table, say the word “pig” three times (pig, pig, pig) as you hand the child the pig and as the child puts the pig in the puzzle or matches the picture.  If the child says the word as he is matching, give lots of extra reinforcement but don’t worry if no words are heard during the activity. Bombarding your child with many single words a day is key so continue these activities daily.

My book (The Verbal Behavior Approach ) especially chapter six should be particularly helpful in learning more about teaching non-vocal and minimally vocal children. Check http://www.verbalbehaviorapproach.com/ for more information and listen to a free radio show on this topic at:  http://www.autismone.org/content/2008-02-08-120000-mary-lynch-barbera-rn-msn-bcba

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/).