I Love ABA!

Welcome to my blog all about Applied Behavior Analysis!

This blog is about my experiences, thoughts, and opinions on ABA. My career as an ABA provider is definitely a passion and a joy, and I love what I do.

This is a personal blog: The views and opinions expressed here represent my own and not those of the people, institutions, or organizations that I may be affiliated with.

Friday, October 14, 2016

The NR Blues

Photo source: www.hamermetalart.com, www.393communications.com

What’s “NR” you ask? A common way to collect data after a trial in which the learner not only did not give a correct response, but didn’t respond at all, is to score “no response” (NR).
While motor actions can be prompted if the learner does not do anything, vocal responses cannot. I say to my staff all the time, “we can’t reach into his/her throat and pull out words”. So if you say to your client “What color is the sun? YELLOW” and they just stare at you, then that was a “no response” trial.

Many, many moons ago I worked at an early intervention clinic. We had one client in particular there, let’s call him Sam. Sam was the bane of my existence for a while, because he made me feel like an incompetent idiot.
 See, Sam was a very bright little boy with the most beautiful smile who could sing songs, answer questions, do simple academic tasks, and engage in various play skills. But then, Sam would hit a wall in his responding. He would remove all eye contact, stop smiling, and just stare blankly at…nothing. I haven’t met anyone since who could be looking directly at you, yet not looking at you at the same time. When Sam got like that he would not emit any of his target responses independently. This meant all motor actions were prompted, and good luck trying to do anything that required vocalizing. I just did not know what to do when this would happen, and it made me nervous to work with Sam because I knew it would happen at some point.

Sam is who I think about when I am working with staff who are having a hard time “connecting” with a client in the session. I can absolutely relate to how it feels to bring your A-game, put on your animated face, and get a lot of nothing in return. It’s frustrating, and makes you doubt your skills.

When correct responding disappears from the session, some clients may turn super silly and distractible, or some may have a spike in aggression. Just between you and me, I would much rather deal with one of those scenarios. It’s the completely checked- out individual that I find to be the most difficult…..it is kind of like your clients body remained in the chair, but the rest of them got up, walked out of the building, and is headed somewhere FAR more exciting.

So if you are working with a Sam or two, here are a few things that definitely do not work, are ineffective, and should be avoided:

·         *Waiting the client out – I have seen a few therapists try this one, and usually the client is perfectly content to keep staring into space as you wait them out.
·        * Continue teaching/Keep up the status quo – Think of it like this, if your client has completely stopped any correct responding and you just keep plugging away: Is learning happening?
·       *  Speak louder – Sound silly? I see it a lot, and back in the day I was guilty of this one too.
·       *  “Saaaam…..Sam!....Helloooooo, Sam?” – If your client is not responding to demands to touch, give, open, or talk, odds are they also will not respond to their name being called.

Now that we got all the stuff that does not work out of the way, I really only have one suggestion for what you SHOULD try when those non- responsive blues kick in. It may be just one suggestion, but it can look about 900 different ways depending on the learner. 

Change something about YOU.

What my staff usually say to me (and how I used to look at this back in the day) is: “I tried this, and that, and this, and Sam just won’t attend/listen/respond! I don’t know what else to do to get him to (insert whatever response the therapist is expecting)”.

What I am suggesting, is flip that statement on its head and instead ask yourself: “What can I do differently that will motivate Sam to respond? Am I interesting? Am I reinforcing? Would I want to attend to me? Is this program interesting? Are these materials engaging? When did I last reinforce any of his behavior? Is my frustration/annoyance showing on my face? Does my voice sound irritated? Am I moving through targets too quickly? Too slowly? How can I be more fun?”.

See the difference? Instead of unintentionally blaming Sam for his lack of responding, first blame yourself. Then, look at your options and start trying them out to see what is effective.  I am a big fan of “Let’s try this and see what happens”. Even if you try something and it fails, you just learned 1 thing that does NOT work. Which is still progress.

** Recommended Reading: 

Wednesday, October 5, 2016

"He's doing just fine!"

Photo source: www.mymetroparents.com, www.autism.lovetoknow.com

Here is a very, VERY, common experience that I have when meeting with the teachers of a client:

"Oh, he is doing just GREAT this year! We aren't having any problems"
"Nope, we aren't seeing ANY of that at school"
"What social skill deficits??"
"Sometimes I have to tell him to do something over and over, but other than that everything's fine!"

For ABA therapists/BCBA's who see clients at school, OR your client receives non-ABA therapies (such as OT or Speech) sometimes it can feel like we are speaking 2 different languages or talking about 2 completely different children. Have you ever experienced that? I have, and continue to experience it.

I think first of all it is helpful to put yourself in the shoes of the non-ABA professional. They may not share your perspective, methodology, or clinical training. Also, they may not have as much history of your client as you do. Just think about one of your clients and what they are like at home. Now think about that same client at school. If you were the teacher and never saw that child at home, what would you think about their capabilities? See what I mean?

So once you understand that the teacher could have a different experience of your client, next it is important to make sure everyone has similar levels of expectation. I find pretty often that if I am meeting with a client's school team and having one of those "Are we talking about the same kid" moments, its a good idea to back up and address Expectations.
From working closely with my clients and seeing them in a 1:1 therapy setting, I get to know how well they can perform. I know how many words they can say, how many colors they can name, and how quickly they can come out of a tantrum. The school team does not always have the opportunity to get to know your client this intimately, so you have to share what you know! I might be sitting in a meeting thinking that my client can do FAR more than work on tracing letters, but the teacher may be sitting in that same meeting thinking that tracing letters is a perfectly reasonable goal. So a great place to start bridging the gap between the ABA team and the school team is by outlining expectations. What is expected of the child? Are the goals developmentally appropriate? Are the goals challenging enough based on what the child can do in a 1:1 setting? Are non- academic milestones being addressed, like socializing with peers or waiting to access reinforcement?

Here are a few more tips that I have found helpful when working collaboratively with school staff:
  1. Provide a brief snapshot of information to the school team that summarizes what goals are being worked on during home therapy. I have found it can also be helpful to share video clips of therapy sessions, because some teachers I interact with have no idea what happens during an ABA therapy session. The may not know that my client is fully capable of sitting quietly, labeling animals, or manding for reinforcers.
  2. Consider sharing resources on basic ways to maximize teaching, such as how to deliver reinforcement or how to deliver a demand. Now, the last thing you want to do is alienate or offend the school team. A teacher with 25 years experience will not want to be told how to deliver a demand. So use polite, respectful language. For example, "Here is a brief handout that lists some strategies we have found to be very successful when working with Jared at home".
  3. Use specific examples and concrete, simple language (translation: NO jargon) to help the teachers pick up on skill deficits they may be overlooking. A problem I see often is the teacher will state that my client is doing so well that they don't need the ABA therapist in the classroom. I then have to, tactfully, point out that the very reason my client is doing so well is because the ABA therapist is in the classroom. Realize that the teacher may not pick up on everything the ABA therapist is doing to keep the client moving through their school day.
  4. Give the teacher immediate feedback (if possible). To give in the moment feedback you need to be in the classroom on a regular basis. If you aren't allowed in the classroom, you can still ask the teacher specific questions to draw out detailed information and then give them feedback based on that information. If you are able to be in the classroom, then definitely grab opportunities to prompt the teacher and quickly praise, OR to gently alert the teacher when to intervene. For example: "Ms Katie, you told Jared to clean up the blocks and instead he went over to the kitchen center. This would be a great time to use that gestural prompt I showed you". 
  5. Sometimes the teachers really are not having difficulty with your client inside the classroom, but its because demands are avoided and problem behavior is not corrected. Examples - Teachers avoid calling on your client, taking items away from your client, or redirecting perspective behaviors. In order to avoid vocal protest or a tantrum, demands become optional requests.
  6. Data is your friend. Some of the experiences I reflect on where the teachers were super adamant that my client was doing "just fine", required a bit more elbow grease than just some handouts and gentle prompting. In those situations I would observe in the classroom and collect data on a specific behavior, such as prompt instruction following. Its one thing to tell a teacher that they are regularly dropping demands. Its a much more powerful thing to show the teacher on a data sheet that during a 2 hour observation they dropped 15 demands. Again, remember your goal is not to alienate or offend. Once you hit the teacher with the data, follow up with help or support. For example, "When we work with Alice at home we have a specific procedure for gaining prompt compliance. Can I show it to you?"

Hopefully, your take away from this post is that when you have those "Are we talking about the same kid?" moments that you are not alone!
 It's important to remember that professionals from other fields have differing viewpoints about learning and behavior, and even if you think a behavior is very maladaptive they may not see it as a problem.
Its just realistic to expect that non-ABA professionals will not think the way you think, which means they won't share your perspective. The key is approaching people with a motivation of collaboration, not division, and to show the school staff that you are there to help.


Increasing teacher intervention implementation in general education settings through consultation and performance feedback. Noell, George H.; Witt, Joseph C.; Gilbertson, Donna N.; Ranier, Deborah D.; Freeland, Jennifer T. School Psychology Quarterly, Vol 12(1), 1997, 77-88

Tuesday, September 20, 2016

Choosing ABA Therapy Stimuli

Photo Source: www.toysrus.com, www.terapeak.com

...“Get some flashcards”

Most everyone involved with an ABA program has heard that sentence from someone, at some point, while starting up services. While the goals for treatment will vary, the intensity of treatment will vary, and the duration of treatment will definitely vary, its common that the materials needed for ABA therapy are pretty similar from one client to the next.

Here’s the problem with that though: how much information did you receive about how to select therapy materials? Not how to organize them or what materials to use, but how to tell the difference between appropriate stimuli and inappropriate stimuli. What I often see is this is an area that gets skipped over or quickly mentioned, and many therapists are using inappropriate materials to teach skills….and then wondering why the child is making no progress. Or as I refer to it, the child has a data sheet full of eggs (that’s a score of “0”).

Yes, accurate and precise teaching is important. Quality clinical supervision and oversight is important. Evidence based methodology is important. I am not minimizing any of these treatment components, I am just shining a light on an area I often see lacking: the selection of appropriate therapy stimuli.

Hopefully this will help you make some changes in how you teach, and improve the materials you use regularly. I suspect that if you take the time to review the materials you are using you may find large room for improvement…. which will only benefit your clients.

And look, I even made you a lovely table :-)

Overly distracting (too colorful, oversized, tiny, busy background, etc.)
Use PEC images or purchased cards only
Word + image flashcards (unless you are intentionally targeting this)
Present stimuli in the same array across trials/Always put the correct response in the same spot
Glance at or hover your hand over the correct response

Cards should be simple and only contain what you are teaching (if teaching the client to tact “apple”, the card should not be an apple tree, a basket full of apples, or a photo of Mickey Mouse holding an apple)
Generalization is key: use multiple examples
Making your own materials is always helpful to be able to use real-life examples (if teaching “bed”, the photo is of the client’s actual bed)
Avoid inadvertent prompting!
Laminate everything (rough sessions happen)
3D Toys/Manipulatives
Not fully controllable /too distracting (example: if using a toy bus to teach the tact “bus”, you pick a bus that sings songs, has multiple buttons that make the bus talk, etc.)
Select manipulatives that are too fun to touch or feel
Using known reinforcers to teach skills (unless you are intentionally targeting this)
Present stimuli in the same array across trials/Always put the correct response in the same spot
Glance at or hover your hand over the correct response

Pick objects that YOU can control during teaching/that are minimally distracting
Avoid objects that blink, vibrate, buzz, are scented, etc.
Be aware that using 3D items found in the home can pair that object to demand situations
Generalization is key: use multiple examples
Avoid inadvertent prompting!
Maintain control of your materials (client cannot pause mid-trial to play with the materials)
Look around and grab whatever is near you to reinforce appropriate responding
Each session bring out the same tired item/toy that the client worked for once, and assume they will always want to earn that
Silently hand the client a reinforcer and ignore them as they interact with it (silently collect your data)
Conduct frequent Reinforcer Preference Assessments
Pair novel reinforcers with known reinforcers to gradually expand what the client finds reinforcing
Avoid satiation on a reinforcer (switch ‘em up!)
Always pair tangible reinforcement with social praise, so praise can be shaped into a reinforcer on its own
Pair yourself with reinforcement breaks by talking to the client, giving tickles, or joining their play
Magical-Mary-Poppins-Good-Time-Happiness Bag
Show up to sessions empty handed
Expect the parents/family to provide a wide array of materials and reinforcers
Assume the client wants to work to earn things that are always at their house

Put together your own therapist “goodie bag” and bring it to sessions
Include a mix of reinforcers, sensory items/toys, and other fun things (crayons, glitter glue, etc.)
Be aware that some families/households don’t have toys, don’t own an iPad, etc.
Understand that you now control access to things the client can only earn when you are present
Regularly change the content of your goodie bag

*Free Staff Resource/Handout

*Source: (this is an amazing article)