When faced with a learner who just isnt learning a skill, is stuck on a target, or persisting with an inappropriate behavior, I often see parents or therapists handling these issues by:
-Stopping the program/intervention
-Going to an easier demand (the child has been stuck on "Say hi" for 3 months, so the therapist moves to just requiring the child to "wave hi").

I see this happen frequently in the home and school settings. The problem with minimizing or removing a demand due to lack of progress is this method assumes that something is wrong with the learner (the child).....The child isnt getting the task because they arent paying attention, they arent cognitively ready for the task, they arent motivated enough, etc. Blaming the child for learning difficulties is backwards, and counterproductive.
ICEL is based in learning theory, and is a tool that can be implemented in classrooms, workplaces/organizations, and especially ABA programs. I use it very often and remind my clients of it all the time.

ICEL stands for:

I- Instruction
C- Curriculum
E- Environment

If you have been working with a child for months on the same skill with little to no success, instead of blaming the child for the lack of progress you need to remember the ICEL technique.

  • Instruction-  Think of this as HOW you teach. Are you using the correct teaching procedure? Are you using proper and powerful reinforcers?  Are your materials of good quality, organized, and appropriate for the targets? Did you take the time to develop instructional control before beginning teaching? Are you properly paired up with the child?
  • Curriculum- Think of this as WHAT you teach. Are you teaching programs that are not too easy or too difficult for the child? Did you gather baseline data on the programs to make sure you are starting on the correct target? Are the programs developmentally appropriate for the child ? Are you teaching programs out of order--meaning that you have two programs that should be taught sequentially, not at the same time ? Before teaching a skill, did you make sure the child has the necessary prerequisites ?
  • Environment- Think of this as WHERE you teach. Look around your learning environment....is it too loud? Too quiet? Too busy? Too hot or too cold in temperature?  Messy, disorganized, or chaotic?
  • Learner- The last thing you should look at when you are having teaching difficulties is the learner, or the student. If I am working with a child and we "hit a wall" with a certain program or task, I am first going to make changes to things I am doing, where we work, when we work, etc. Only after I have made all of these changes will I look at my student as the cause of slow progress.

I speak with many therapists who will make comments like "That intervention you gave us last week isnt working, we need something else". My response is always to remember ICEL, and to look at the learner last not first. Otherwise what may happen is you are constantly changing programs, switching interventions, putting targets on hold, and seeing erratic progress. Often when ICEL is applied correctly it becomes clear that instructor error is the reason for slow progress.

No, not that kind of extinction. :-)

Extinction is a behavioral term that basically means to determine the function/cause of a behavior and then to terminate access to that function in order to extinguish the behavior. You determine what the reinforcement for the behavior is and then you withhold it. There are different types of extinction, such as Tangible Extinction (the child does not receive access to a desired item or activity) and Escape Extinction (the child does not get to avoid or escape a non-preferred task or person). Extinction is used to decrease inappropriate behaviors such as tantrums, screaming, or saliva play. Here's some real life examples of extinction:

  1. Screaming: Your client screams in the car when they want you to turn the radio on. You used to plead with him to stop screaming, now you give no response to the screaming.
  2. Crying/Tantrums: Your client tantrums at restaurants when she is ready to go home. You used to pick her up and leave the restaurant when this happened, now you stay at the restaurant and continue eating.
  3. Excessive scratching: Your client scratches at scabs or wounds excessively to the point of causing harm. You used to tell him not to do this, and sometimes place him in time out. Now you place cotton gloves on his hands so he cannot cause harm by scratching.
Notice in each example that extinction does not mean you stop the behavior. When you apply an extinction procedure the behavior may still happen. For this reason extinction isn't always an appropriate choice for a behavioral intervention. Particularly if you are dealing with very aggressive or self harming behaviors such as headbanging or eye poking.
 In my opinion another reason extinction isn't always appropriate is that it is extremely hard for non-professionals to implement. Many parents tell me that doing an extinction procedure just feels wrong, and counter-intuitive. When doing an extinction procedure consistency must be really strong, so as an ABA professional it will be important to get the family on board with the treatment before you try to implement it.

It might sound like an extinction procedure just means to ignore problem behaviors. There is an important distinction between Ignoring and Extinction. Ignoring is to not give your child attention because they are doing something you dont like or are seeking your attention in an inappropriate way. Extinction is a behavioral technique where you withhold reinforcement when the behavior occurs, so by definition you must know what the reinforcement is. Planned ignoring would only extinguish a behavior if the reinforcement was attention. If your client bites her arm because of sensory input and you ignore that, your ignoring will have no effect on the behavior. The child isn't biting for a reaction so you withholding a reaction doesn't matter.

Another way to understand the difference between Extinction and Ignoring is that extinction procedures will have Extinction Effects. If you are properly implementing an extinction procedure this is what it should look like:

This graphical display shows the course of a behavior after an extinction procedure was applied  *the path of the behavior is what is important here. Try to ignore the "bad behavior" label. This is not my graph :-)

Initially the behavior is occurring at a rate of about 20 occurrences per day. Then the intervention begins. The intervention is clearly effective, as the problem behavior almost immediately drops off in frequency. But that "Honeymoon Period" ends, and the behavior skyrockets to a frequency of 40. Then the behavior makes a gradual decline until it is at a frequency of about 5, before dropping to 0. Some parents or professionals may think at this point that the behavior has been successfully terminated and the extinction procedure can be stopped. However, that's incorrect. After some time passes the behavior pops up again a few times, before decreasing to a very low rate.
This graph is explaining that once you introduce an extinction procedure you will see the Extinction Burst, then a gradual decline in the behavior, then Spontaneous Recovery of the behavior until eventually the behavior is extinguished completely, or occurs at a very low rate.

An extinction burst is a dramatic increase in the frequency/duration/intensity of the problem behavior. I like to explain this to my clients by saying "Its going to get worse before it gets better". From the child's point of view, he/she is doing MORE of the behavior to try and get that reaction they are used to getting.
Spontaneous recovery occurs after the behavior starts to go away and can happen even without reinforcement. You could be doing everything right and all of a sudden the behavior will pop back up. This is normal, and you should expect it. If everyone on the team is being consistent then when spontaneous recovery happens you have nothing to worry about. However if spontaneous recovery occurs and someone reinforces the behavior it may skyrocket again.

There's 1 more extinction effect to explain: Once you determine whats maintaining a behavior and start withholding it, now the child has no way to meet that need. So they may start engaging in new behaviors you haven't seen before. For example you may decide to start an extinction procedure with your 9 year old client for his behavior of teasing his sister. You determine that the function of teasing is attention from his sister. So you teach his sister to stop giving him attention as part of the extinction procedure. The teasing begins to decrease, but now your client has started pushing his sister.

What happened?

The problem is you removed the maintaining variable, but didn't replace it with anything. Your client has no way to get his "attention fix" because his sister no longer gives him the attention reaction he wants when he teases her. So your client starts being aggressive with his sister to get a reaction out of her. The great news is if you know about this you can plan for it. Such as incorporating contingent reinforcement into your extinction plan. Think of contingent as meaning "based on".  Based on certain behaviors, you provide reinforcement. If your client talks to, hugs, or is appropriate towards his sister in any way she is free to give him attention.

When done correctly and consistently extinction is a powerful behavior reduction tool.

**Quick Tip - The extinction burst can mean the behavior increases by frequency, duration, magnitude, etc. It could also mean certain people get targeted more, such as aggression being mainly directed at the teacher, or that in specific settings the behavior is more intense. The "burst" for child A can exhibit very differently than the "burst" for child B.  Have a crisis plan in place that specifically states how to address escalating behavior during an extinction procedure.

A co-worker of mine gave me the idea for this post, while we were discussing how when we initially meet with a family or school we get asked variations of the same questions over and over. Of course, most people don't realize that the questions that come to their mind also come to alot of other peoples minds. I find it somewhat amusing and perfectly normal to get asked the same questions over and over from different families.

I decided to make a brief list of the questions I get asked the most --complete with answers--when I meet with a family or a therapist for the first time. You might see a question or two that you remember asking the first ABA professional you worked with.

FAQ- Families
  1. "What is ABA anyway?": To summarize (because this can be a very short or very long response), "Behavior Analysis" is a behavioral science that researches the most effective ways to reduce or improve a variety of behaviors, such as aggression, communication, self-stimulatory behaviors, etc. "Applied Behavior Analysis" is taking these strongly research supported tools and strategies and applying them to everyday environments to help individuals improve upon their global functioning.
  2. "How much will all of this cost?": There is huge variability in this field when it comes to fees. Many factors effect rates such as location, number of hours per week, size of ABA team, is the program supervised by a BCBA, etc. In my experiences (translation=opinion), an average rate for an ABA therapist is $15 per hour. Average rate for a BCBA is $60 per hour.  The average number of therapy hours needed each week would be between 25-30. Besides private pay, some parents get grants or scholarships from the state or private businesses,  get the school district to pay for ABA, or get reimbursement through their insurance companies to pay for ABA therapy.
  3. "When will this be over/How long will we have to do this?": This is not a question with a quick answer, but new clients ask me this all the time. Which I can completely understand a parent wanting to know when therapy will be done. Let me give you an example of why this is such a hard question to answer: If I start working with a child who is 2, nonverbal, and tantrumming every few hours, we will have lots of intensive goals to target. As that child makes progress and begins to improve in their functioning, could therapy stop? Yes. Do parents typically say "Okay she is talking now, we can stop this"? No. Almost no one says that. Parents then say "Well what about toilet training? What about feeding issues? Can you work on church attendance?", so then the program goals change and evolve into different areas. So I suppose my answer would be, whoever is paying for services can determine at what point therapy is "done", based on how much progress has been achieved.
  4. "Can you get my child to do _____/Can you get my child to stop doing ____?": The short answer is: Probably. ABA is a behavioral method, so anything that is a behavior can potentially be modified by ABA. This includes language, tying shoes, using the toilet, hugging a sister, doing homework, walking the family dog, kicking the cat, cursing, wandering away from the house, etc. If its a behavior then ABA can be used to teach/improve/or reduce it.
  5. "Can you just move into my home/Can we adopt you/Please don't ever leave!": Yes, people really say this to me! This is a completely understandable reaction to a successful treatment method that appears to work like "magic". However, it is my goal as an ABA professional to show a client that I am not a magician and I don't carry a wand in my purse. With proper training they can learn how to apply ABA techniques themselves That way they don't need me to move into their guest room :-) because they know how to do what I do.
  6. "My husband/wife will never follow this.": This is basically a consistency issue. When I meet with one parent and they tell me immediately how the other parent is against ABA, or not fully on board, I explain how critical consistency is to success.  Limited consistency equals limited success. Part of ongoing parent training is emphasizing the need for a team approach and getting everyone on the same page.
  7. "Have you ever cured a child from Autism/Have you ever fixed a child using ABA?":  I don't like to use words such as "cure" or "fix", because my focus is on improvement. What ABA does is help correct deficits, teach skills, and push these children to reach their full potential. Each child's ability to progress during ABA therapy has a lot of influencing factors including: severity of diagnosis, age child began therapy, how intensive was the therapy, the quality of the therapy staff, etc.
  8. "My child currently receives ABA therapy at home. I am considering ___ therapy. Which therapy is the best/Which therapy should I stop doing?": What I would suggest to any parent considering a new therapy or wanting to end a current therapy is look at your child's individual needs. What deficits do they have? What strengths do they have? Focus on therapeutic methods designed to address your child's needs. Look for methods that are empirically supported (research showing the method is effective) across a variety of settings or individuals. Look for methods that include the parents in therapy, and also address behavioral issues. I often see new therapy methods that become very popular but if the child has challenging behavioral issues then they cant participate. If a professional expects to teach a child with Autism, then encountering challenging behaviors is quite likely.

FAQ- Therapists

  1. "How did you get into this field/How can I get into this field?": I explain this a little bit in my Bio, but I stumbled into my career. I didn't plan on ABA as a career when I entered college and I had no knowledge of Autism. In my freshman year of college I started working part time as an ABA therapist and I "caught the bug". I felt like I had the most interesting, amazing job in the world.  I decided I wanted ABA to be my career and not just a PT job, so I began the necessary steps towards becoming a BCBA. If you are interested in ABA as a career I recommend contacting agencies and companies that provide ABA services. I would suggest an agency rather than a family because with an agency you will be provided with training and multiple clients to work with rather than just one client. This field has a massive demand for fun, energetic professionals, so if you think you want to be a Superhero  then I welcome you!
  2. "How much do ABA therapists make?": There is great variability as far as pay depending on your location, if you work for a family vs. an agency, your education and experience, etc. I would estimate (translation= my opinion) that ABA therapists can make anywhere from $12-$20 per hour. BCBA's, Lead Therapists, or Consultants can make anywhere from $25-$60 per hour.
  3. "What is the best/worst company to work for?": Like many ABA therapists, I have worked for different agencies, companies, and schools. There is a high turnover rate in this field. There is no "best or worst" place to work. Any company or agency will have its pros and cons. Decide what is most important to you as an employee and select agencies that have those characteristics. For example, are you comfortable working at a large company with hundreds of employees or do you want to work for a small agency where everyone knows each other? Do you want to work within your local area or do you want to travel to see your clients? Do you want to work with young kids or with adults? Find an agency that has the characteristics important to you, and who respects and values their employees.
  4. "How do you handle rude/resistant/confrontational parents?": Conflicts with parents can happen, and they do happen. Usually there are a ton of internal things happening with that parent, and unfortunately the person they choose to take it out on is you. Another factor that can lead to conflict is many parents of these children also have Autism or some neurological disorder. I have encountered families where the child has Autism, and the parent has Aspergers, or Depression. Dealing with a parent who has an untreated mental disorder is definitely tough. Try to take your feelings out of it and think about what that family may be going through. Talk to the family, explain why you are feeling uncomfortable, and try to resolve the problem. It isn't necessary for the parent to like you for you to do your job, but it is necessary that they respect you and can maintain a professional relationship. If not, you should stop working with that family.
  5. "I have been doing this for X amount of time. Why cant I get hired as a Lead Therapist/How do I get promoted?": This field is unique as far as experience and know-how.  The more children you work with, the more you need to learn and grow and be comfortable with change. Some people describe it like this: "If you've met one child with Autism, then you've met ONE child with Autism".  These kids are all unique individuals and they differ greatly from one another. This field is also rapidly advanced by research and technology, and what was done 5 years ago isn't necessarily done today. When I first started in this field, the technology that can be incorporated into an ABA session today was unheard of. As technology changes, I have to grow and change with it to better serve my clients. I have to stay flexible and be willing to learn and try new things.That is what can be so fascinating about this job, but its also what drives some people crazy about this job. For these reasons, I don't think getting certain degrees or a certain amount of experience means you are automatically qualified to lead, manage, or oversee an ABA program. What I have found is that more innate qualities, such as patience, flexibility, creativity, and leadership skills, are what make a great Lead Therapist or Supervising Therapist. 


ABA Therapy is intended to teach or manage a wide range of skills and/or behaviors including self help skills, motor skills, play skills, problem behavior reduction, etc.

No matter the age of the child, ABA can also prepare children for the classroom environment. When discussing education or the school system, there is a concept called Hidden Curriculum  which refers to an implicit type of instruction that covers "hidden" rules or codes children are expected to know. Examples of hidden curriculum include gender bias, competition, obedience, and the importance of popularity. These examples may not be explicitly taught alongside math and grammar, but they are implicitly taught to children in the school system. Following these unwritten rules is definitely reinforced in the school system, and not following these rules leads to struggles in the typical school system. We can argue whether or not this Hidden Curriculum should exist, and what's wrong with some of the things it teaches, but that won't make it any less real.

For both explicit and hidden curriculum, kids on the spectrum tend to be at a disadvantage when navigating through the school system. Parents often think of school readiness as things like being able to transition successfully, being toilet trained, knowing the alphabet, being able to count, etc. I encourage you to think wider in terms of your child's school readiness. Any ABA program your child is involved in -just like the school system- has explicit curriculum and hidden curriculum. Beyond the programs your child is working on with the ABA therapist, just by receiving therapy the child is learning certain things about motivation, reinforcement, and consequences.

Any ABA program your child is involved in should place an importance on preparing that child for school. I would estimate 75% of my clients are school age. So as a result, I am always thinking about school readiness. It is wonderful if a child is doing well inside the home working with a therapist 1:1. But ultimately the goal is for that child to do well in a classroom:  in a group setting with noise, distraction, a thin schedule of reinforcement, and minimal breaks. As ABA professionals if we do not make a conscious effort to work towards school readiness with our clients then we are doing them a disservice.

Just because your child is very young, does not mean you don't need to be thinking about school readiness. Its always better to start planning for these issues in advance. Whether your child is in public school, private school, or even home-schooled, this is still a topic you want to be thinking about and planning for. 

Children entering the school system, even preschool programs, are expected to have a basic skill set. I interact with, train, and observe teachers all the time and I can tell you honestly: Teachers expect to walk into their classrooms and just teach. Teachers do not expect that classroom instruction will include individualized/ specialized attention to help a child acquire basic skills.  Below are a few examples of skills your child will be expected to demonstrate in order to succeed in school:
  • Staying seated
  • Eye contact
  • Attending to the teacher
  • Tuning out irrelevant stimuli
  • Social skills, peer interaction skills, "Plays nicely with others"
  • Self help skills (to include feeding, grooming, and toileting skills)
  • Learning within a group
This is a very basic list of the type of fundamental skills teachers expect children to have before they enter the classroom.  I know children who are 6, 9, or even 11, and do not have some of the skills on this list. They cannot stay seated in a chair, without someone reminding them to stay in that chair. They do not play nicely with others, unless prompted to do so with a M&M or a Skittle. They do not have the ability to go to the bathroom by themselves, and the therapist must go to the bathroom with them. They do not know how to attend to the teacher and tune out the noise of the air conditioner, aromas coming from the cafeteria, or the loose thread on their shirt.
Does your child possess this basic skill set? If not, share this information with your team of ABA therapists. Every skill here can be taught, and incorporated into an already existing ABA program. Also, every skill here is imperative to school success. A child who cannot learn within a group will be a nuisance to the teacher during Circle Time. A child who cannot share with peers wont have friends at school.

The purpose of school is learning subjects. That is the reality. Schools and teachers may be ill-equipped to intensively teach attending skills, social skills, toilet training, etc. Do not let your child be at a disadvantage. Work on these basic school readiness skills at home, so that when your child is school age they will have a much easier transition into the classroom.

*Recommend Resource: Is Your Child Ready For School?

We all remember playing Simon Says as a child, which is at its core a game of imitation on demand. Someone does an action, and everyone else is supposed to do the same action as long as "Simon Says" was stated first. Imitation skills are so important because the ability to imitate will lead into being able to play/socially interact, learn sign language, be prompted, or just "learn to learn".

Vocal imitation is a program designed to teach a child to vocally imitate on demand. "On demand" is a key distinction. Many kids I begin working with are already babbling or have a few words. However these children cannot produce a sound or word on request. They sing songs all day, but if asked to sing a specific song they wont. Vocal imitation is one of the first few programs I write to start working on language, because young babies learn language by imitating the sounds they hear. From there, mom and dad will talk to the baby/toddler and say things like "SAY mama.....dada....". That is a common part of teaching a young child to talk.
If you have a client or child in either of these situations, then they would benefit from a vocal imitation program.

The ultimate goal of teaching vocal imitation is so the child will learn imitation skills, to get the child's language under instructional control, and to be able to prompt the child. If a child cannot imitate on request their language won't be very useful to them, in terms of other people being able to understand what they want or need. In order to teach the child new and novel labels/words they need to be able to imitate you.

Research supported methods for teaching language to children with Autism include Echoics (this is a Verbal Behavior term for vocal imitation),  stimulus-stimulus pairing, alternative means of communication such as PECS, and shaping. Example of stimulus-stimulus pairing: the child says "Buh" while looking at some bubbles, and you hand the child some bubbles. You reinforce language (even approximations of language) to pair the language with the item. Example of shaping: the child is taught to say "Buh", then "Buh-ll", and finally "Bubbles" in order to receive access to the bubbles. You make the language requirement progressively more difficult over time.

The first step in teaching vocal imitation using  Echoics, would be to teach the child to repeat or echo words/sounds on demand. The therapist would say to the child (with no stimuli present) "Say ball" and the child should respond "Ball". When I write a vocal imitation program for a client, typically I start with simple sounds that come easily off the lips ("Ba"), then more complex sounds, simple words ("Up"), complex words ("Hospital"), and eventually numbers, sentences, and short phrases (such as, "Ready, Set, Go"). There is definitely a hierarchy when writing a vocal imitation program. Depending on the child's current verbal abilities, you want to start where they are and build from there. So if the child is only able to babble, you wouldn't start asking them to say complex words like "Helicopter".
Also, it can be very helpful to consult with a Speech Therapist to find out where to begin when selecting sounds or words. Certain sounds and words develop quicker than others and are easier for children to produce. If you do not have access to a Speech Therapist, then do some research on child development and look at what sounds develop first, and in what order. There is a massive volume of research on baby babble, speech production, and first words.

Some common questions/problems I get asked about in regards to teaching Echoics are:

  1. The child is imitating the entire phrase, not just the target word. If the therapist says "Say ball" the child responds "Say ball". This is a very common problem. I usually fix this by going to a 0 second prompt where once I give the SD  I immediately give the child the correct answer. This would look like: "Say ball. Ball (speak over the child if necessary)". The child should respond "Ball". Another tip is to drop the word "Say" and just say to the child "BALL". Then look expectantly at the child. They should echo you and say "ball".
  2. The child is imitating the echoic, but their articulation is very poor. Instead of "cup" the child says "up". Instead of "zebra" the child says "ee-a". Decide in advance before you begin teaching vocal imitation if you are focusing on vocal production, articulation, or both. I usually go with what the parents want to do. Some parents feel they just want to get the child talking and we can clean up the words later. Other parents feel they dont want the child to "learn" the word incorrectly. Decide this upfront, and either work on articulation with the child or reinforce them for saying the word at all and then fix the pronunciation later. This doesn't have to be an issue if the parents/caregivers are okay with using Shaping techniques. Shaping is an ABA strategy where you reinforce successively closer responses until you get the actual response you want. So if a child can currently say "ah" and I am teaching the word "apple", then in the beginning I will reinforce "ah". Then I will only reinforce "ah-pa", and eventually only "apple". Shaping is a gradual process, where you slowly increase the difficulty of the demand to get the child closer and closer to the terminal goal.
  3. The child isn't imitating at all. This is also a common problem. Its not unusual for an Echoics program to take quite some time before the child starts responding. If a therapist tells me that the child is consistently getting a score of 0 on their Echoics program, that doesn't mean I'm going to automatically yank the program. I had one client not too long ago where we worked for quite some time to get her to say "Up". Everytime I tried to get her to repeat me she would just stare at me and say nothing. After amping up the reinforcement this child quickly began to vocally imitate.  Today that little girl is talking up a storm. So do not get discouraged or frustrated if you have been teaching Echoics for a while with no progress. Stay focused, use powerful reinforcers that change often, and keep at it. 
** Quick tip:  If you have a child or client who is echolalic or babbles, start your vocal imitation program with what they can already say. If they babble, target #1 should be babbling (reinforce ANY babble sound). If they have certain words they use to verbally stim (like saying "monkey" over and over), target #1 should be monkey. The quicker the child can be successful and contact reinforcement, the quicker they will learn to vocally imitate.

If I didn't believe in the potential of the children I work with then I couldn't do my job. As an ABA professional it is imperative that I stay committed to the program and "keep my eye on the prize", no matter how bad it may get or how many issues a client may have. When I first meet with parents I often hear a variation of the statement "You seem so sure...how do you know this will work?". I believe in ABA as a science and a teaching methodology. I have seen what ABA can do to completely change the lives of children and their families.

 I'm used to my optimistic attitude being met with skepticism or just outright disbelief. Usually, its some variation of "I'll give this ABA thing a shot, but I'm not expecting much".

The reason why I can be so confident when discussing with a new client what ABA can do for their child, is because I understand that Progress is Success.  It took me some time get that concept but once I did it made it so much easier to deal with resistant parents.
Parents, please understand that no one can tell you how to "fix" your child. For 1, the child isn't broken. For 2, we professionals are not magicians and we do not carry wands. Do not let a professional make blanket statements to you promising grandiose results, because that's not possible. There are so many variables to an effective ABA program. To name a few, there is the number of hours of therapy per week, the training and quality of the therapists, the amount of programs/skills being taught, effectiveness of reinforcers, etc.

Sometimes professionals who work with special needs children have higher expectations of these children than would be on typical children. That is definitely setting a child up for failure. As parents and therapists it is important to prepare yourself for an uphill battle. There will be good days and bad days. The child may gain skills very rapidly and then regress again. The child may develop concerning behaviors that you do not understand. You may become frustrated, feel hopeless, or feel impatient to get the child "fixed". If a child learned to label 3 words in 4 months, that's success. Their vocabulary has grown by 3 words. Learn to celebrate progress (even small progress) because sometimes during therapy, progress will only come in baby steps. "Perfection" is not a goal, its an unrealistic expectation to place on any child.

Here's a few unrealistic goals that I have helped therapists and/or families get rid of:

  1. Being partially, or "kind of" on board-  This one is a biggie. I come across so many families who don't know this: ABA is a therapeutic method that requires parental and family involvement. That is a fact. I like to explain this to parents by saying "What is most important is what you do when the therapists leave". Family involvement means you know your child's programs/goals, you know what your child has mastered, you know how to prompt your child, etc. 
  2. Ignoring the need for data- The last "A" in ABA stands for Analysis.....as in Data Analysis. ABA is an empirically supported, data driven therapeutic method. That is what makes it so sound, precise, and effective. You will limit the success of ABA therapy if you are not properly collecting data. I get it, I swear I do. Data can be boring, and anti-glamorous... but without data at the core of your ABA program, how do you know when something is mastered? How do you know if an intervention worked?
  3. Expecting others to do the "heavy lifting"-  This may sound similar to point #1, but there is a difference. A family can be on board with the ABA therapy,  but still drop the ball when it comes to the first "A" in ABA, which stands for Applied. Applied basically means we aren't describing theory or discussing hypotheses, we are actually implementing and doing the work. We are rolling up our sleeves, and doing some heavy lifting. I have worked with families who have behavioral interventions in place that they have never implemented on their child. Or, the child has been taught hundreds of mands and the parent still lets the child lead them by the arm to what they want. It is so important as a parent that you feel comfortable doing everything the therapy team does.
Punishment & Consequences......ahhhh.

So much can be said about these two concepts. Unfortunately much of what is said or written is incorrect, outdated, or just wrong.  In some circles (like school systems) punishment may be viewed as a dirty word. Educators, families, and parents believe they understand consequences and punishment, but they really don't. I think anyone who has regular contact with children should have a basic understanding of reinforcement and punishment, but especially if you work with a child with Autism. This is helpful and vital knowledge to have, and can change the way you interact with these children. So lets jump in!

First, here's a definition:

Punishment- Punishment has occurred when a response is followed immediately by a stimulus change that decreases the future frequency of similar responses (Cooper & Heron, 2007, Applied Behavior Analysis).

Sound confusing?? Its really not.

Punishment is part of learning. Every behavior has a consequence to that behavior. Something good happens, something bad happens, or nothing happens. Punishment is a necessary learning tool so that we can learn to avoid things, or not do things at all. If we didn't learn from consequences it would impact our lives in a negative way. For example, if every time you skipped work your boss got very angry and yelled at you but you continued skipping work, sooner or later you will likely be fired. However if after the first time you get yelled at you stop skipping work, then you just learned something important to your well being. Basically, punishment is something intended to make a behavior decrease. We use reinforcement for behaviors we want to see go UP, and we use punishment for behaviors we want to see go DOWN. Its that simple.

Something is labeled a punisher only if it made the behavior go down in the future.  So if a teacher sends  a student to Time Out every day for acting up in class, and after a week the behavior has gone up then Time Out is not a punisher.
Punishment has gotten a very bad connotation and most people think of it as a negative thing intended to cause harm or to hurt a child. That's just not true. There are many kinds of punishment, that can be divided into 2 groups: Positive or Negative. These groups are easy to distinguish if you think of math. Positive means you added something, and negative means you took something away.

Here is a helpful chart (I just love visuals)-
Positive Reinforcement-
Add something to increase a behavior
Negative Reinforcement-
Take away something to increase a behavior
Positive Punishment-
Add something to decrease a behavior
Negative Punishment-
Take away something to decrease a behavior

So based on what most people think about the word "punishment", which one sounds worse- positive punishment or negative punishment?
Negative punishment sounds worse. This is why its important to understand what these concepts actually mean, because doing something "bad" is what most people think of when they hear the word "punishment".  In actuality, positive punishment is the one you want to avoid, which includes things like spankings, electric shock, restraint, or aversives. Professionals in the field of ABA are ethically required to select punishment interventions carefully, judiciously, and to have parent/client consent. Punishment techniques are often only added to a behavior plan after several other options have failed, and it will likely be a form of negative punishment (the child loses access to something), such as Response Cost.

Punishment is a learning tool, just as reinforcement is. When done correctly, punishment can bring about immediate change in behavior. Punishment is not "The Big Bad Wolf" as it gets portrayed in society. However, decades of research and empirical studies have clearly shown that it is always best to rely on reinforcement to bring about a change in behavior, rather than punishment. In other words, first try to find something to INCREASE when looking at behavior change, not just a behavior you want to stop.

 (For anyone interested, I strongly recommend you research the history of ABA, to see how punishment was originally used on children with Autism. Life Magazine article, 1965  This article is not an easy or pleasant read, but it is important to see how far ABA as a field has come. If you have encountered anti-ABA people it is usually because they incorrectly believe that ABA has not evolved from this 1965 article ).

So lets discuss some types of punishment, now that we know what punishment is.
  1.  Reprimands: Yes, this is considered punishment! Remember the definition of a punisher is something that causes the target behavior to decrease. So if your client keeps touching the materials at the table and you say a stern "Hands Down", which causes them to stop touching materials, then "Hands Down" was a form of punishment. Other examples include "No", "Stop that", "Get down", etc.
  2. Response Blocking: This is when the child goes to do something, like push a sibling, and you block them from completing the action. I use blocking all the time, which could be as simple as stepping in between my client and the child they are trying to hit. Blocking is a non- intrusive way to stop a child from successfully engaging in inappropriate behavior.
  3. Over Correction: This is one of my favorite types of punishment. That might sound odd that I have a favorite kind of punishment, but its because whenever I have implemented an over correction technique it works super fast. Basically, over correction is when you OVER react to an inappropriate behavior. For example, if the child throws their cup of milk from the table during dinner, you would have the child go through the entire clean-up process several times in a row. What I really like about over correction is it is very easy to teach to parents.
These are all effective forms of punishment that can be implemented easily by anyone, and can be a necessary component to a behavioral plan. Now I must mention, whenever you are implementing a punishment procedure it is imperative that you think of the behavior plan as a coin. On one side of the coin you have the punishment procedure. If you flip that coin, you must have a schedule of reinforcement so that child has a way to contact a reward. Otherwise you are setting the child up for a lose- lose situation, because they get nothing for good behavior and something for bad behavior. That "something" may prove more important than the "nothing" over time.  Continuing with the example above of the child who throws their cup of milk during dinner, if I was the therapist working with that child I would make sure that she got tons of attention and praise for being on task during dinner. On task could mean eating appropriately, interacting with siblings, passing bowls of food, using her napkin, etc. Then I would remove attention if she threw her milk, and go immediately into the over correction procedure.

So finally, lets address "The Ugly". If done incorrectly, or without adequate supervision by a qualified BCBA punishment can have negative side effects. Issues usually arise from the application of punishment, which is a clinical way of saying HOW the punishment is delivered to the child. Just like with reinforcement, if punishment is delivered too quickly, or too intensely you are likely to cause harm. Here are a few side effects of punishment that everyone should know:

  1. Aggression/Anger/Retaliation (Emotional Response)- This is the one I see the most. In response to a punishment procedure, the child starts to hit, bite, scratch, or pinch, in order to stop the therapist from completing the punishment technique. The child resists being restrained, they fall to the floor and scream when told to go to time out, or they attempt to bite me when I implement an over correction technique. Be prepared that this may happen, and have a crisis plan in place in case the child become aggressive.
  2. Escape/Damaged Relationship/Harm to Rapport Building Process- A large risk to punishment techniques is that they directly destroy the purpose of rapport building: to establish a nurturing, caring relationship with the child. The child may start to avoid you, to fear you, or to become upset/agitated when in your presence. This may take the form of escape, where the child runs from you or attempts to leave the therapy room. This could also look like avoidance, where the child just avoids being near you or around you. Obviously, having a situation where the child is afraid of you is counter productive. The first time you spank your child, you may not see an avoidance or escape response. Just be aware it could happen, and decide upfront if that's a risk you want to take.
  3. Behavioral Contrast- This is an ABA term, that basically means creating a situation where X doesn't occur here , but X occurs over there and may even occur more frequently. Here is a real life example: A therapist gets a child to stop kicking their feet at the work table by immediately removing reinforcement, combined with holding the child's feet still for 5 seconds. Very quickly, feet kicking goes down to 0 occurrences when the therapist is around. However, when the therapist is not around, the child not only kicks when sitting at a table, they kick at near constant rates and the parents don't know how to handle it. What the therapist has actually taught this child is "Don't do that around me". 
Please remember: punishment on its own does not teach anything. Yes, you may reduce or eliminate a behavior but you need to also teach what to do instead of the inappropriate behavior.

Otherwise the learner could just replace the behavior you didn't like with another behavior that you really wont like. An example of this that I see all the time in schools, is a child will begin to run down the hall and a teacher will say "Stop running!". Very quickly the child will stop running. BUT, they may begin to skip, hop, or be inappropriate in some other way. A better way to handle this is to say "Walk please", which tells the child what you want them to do instead of allowing them to decide what their replacement behavior should be.

One of my favorite things to do with a client is Community Outings. Think of these as a way to generalize what is taught at the table, or in one environment, to a real life setting, or another environment. A popular critique of  ABA is that due to the structured nature (1:1, table setting) children become "robotic", meaning they will learn a skill but not actually display the skill unless asked in a specific way. This lack of generalization can sometimes be an issue, but if the ABA program your child or client is in teaches for generalization then this shouldn't be a concern. Generalization can be incorporated into instruction by varying stimuli, doing post checks on mastered targets, using targets the child sees every day (for example, if you are teaching the child to label "cat", use a photo of the family pet), and incorporating Community Outings or NET into the program. It is not enough to teach a child skills until they obtain mastery, and then move on to new targets. What will happen is as the child progresses through their programs, older skills will be forgotten. A successful and well run ABA program always plans for ways to generalize skills the child is learning.

This is an example of poor generalization that I see often: I meet with a family for consultation, and I greet their child by saying "How are you?" or "Whats your name?". What happens most often if the child responds at all, is they reply by saying "Hi". Right away I know that this child needs to work on generalization of skills. If the child was taught how to respond to greetings, without proper generalization they can get to a point where when anyone approaches them they tune out what the person says and just respond with a "Hi".

The point of doing a Community Outing with your child or client is to take current or mastered skills into real life settings to strengthen the skill, and promote generalization. Community Outings also may be necessary with certain clients if the child consistently does poor in a specific place, such as the doctors office or church. A therapist could go with the family to teach them how to address behaviors in a public setting. Beyond that, every Community Outing is also working on social skills. Being appropriate in public, speaking at a proper volume, staying near an adult, etc. These are all important social skills.
Lastly, Community Outings are fun!

 Even though it is still work, I enjoy spending time with the kiddos I work with and taking them to various places in the community. Its almost like a field trip away from the table. These children need to learn how to successfully navigate different public settings, and the younger you start the better for the child. What we as therapists teach at the table is very important, but it is also important that these children can be appropriate in public as well.

Sadly, I have had clients who don't take their child out in public beyond what is necessary because it is very difficult due to the child's behavior. I have had parents tell me "Oh no, we don't take her to the park", or "We haven't eaten inside a restaurant in years". That must be so stressful for a family to have to completely avoid certain places or locations, and to reduce their lives to just the home. Particularly around the holidays, social outings and interactions with family members will happen very frequently. Here are a few tips that I usually share with families who avoid taking their child out in public:

  • Firstly, and this is very important: Do not avoid a place or location because your child is disruptive when you go there.  If you have a BCBA Consultant or a Lead Therapist you are working with, see if they will go to the location with you and provide help. Ask your Consultant for a behavior plan to address the behaviors in public. If every time you go to the park your child has a meltdown when it is time to leave, look at that as a learning opportunity. If you stop going to the park, how will the child learn how to be appropriate at the park? What you should do is go to the park MORE, so the child can have many opportunities to practice being appropriate at the park.
  • Be prepared and organized before you ever leave the house: Have a game plan, and a schedule. Know where you are going, for how long, and either tell your child the game plan or use a picture schedule if possible. Some children enjoy holding a stimmy or fidget in the car, or you can play calming music.
  • Once you are in the store, understand the difference between Reinforcement & Bribery. I see this playing out all around me in stores, malls, and restaurants at least once a week. The difference between bribery and reinforcement is bribery is offering something to the child to stop a behavior once the behavior has already begun. Such as, "If you stop screaming you can have a Snickers bar". Bribery does not work.
  • So I'm sure you are wondering, "If bribery doesn't work, what do I do if the child acts up in the store/mall/restaurant/etc". Firstly, if your child has a current behavior plan in place then ask the Consultant or Lead Therapist how to modify it for public settings. The first rule is, you don't leave the public setting. The reason why is this could actually reinforce the problem behavior if the function is escape. The second rule is to minimize all attention to the behaviors. If your child begins to cry,  falls to the floor, etc, ignore these behaviors. Block as many of the behaviors as you can without giving the child eye contact or making statements such as "Don't do that!". If the child quiets down, even for a second, you can give attention then.

Dealing with behaviors in public can be very difficult, especially nowadays where people have no problem making rude comments or asking questions.

Below are some specific examples of Community Outings. Remember, a Community Outing is an opportunity to generalize the child's learning in a real life setting. It is not "hanging out", or simply taking the child with you while you run errands.

Examples of Community Outings:
  1. Skill: Math/Money. Go to the store and buy something that costs $1. At the register, give the child enough change to equal $1 (such as four quarters) and have them count it out to the cashier. 
  2. Skill: Social Skill/Greetings. Go to Wal Mart (or any store with greeters). Explain your situation to the greeter there and ask if your child can help greet customers. If necessary, prompt the child to make eye contact and wave in addition to saying "Hello".
  3. Skill: Community Signs. If the child is verbal, go for a walk and have them identify various signs in the community by name. If the child is nonverbal, go for a walk and bring a few pictures of community signs with you. When you see a sign, stop and have the child point to the picture that matches the sign in front of them.
  4. Skill: Gross Motor Skills. Take the child to a park or sensory play center (If you are near Atlanta here is a great one : Sensations Therafun). Have the child run, skip, climb, bend, squat, gallop, etc., depending on the specific skills you are targeting.
  5. Skill: Eating Skills/ Self Help. Take the child to a restaurant and order some food. If you are targeting using a straw, order them a drink. If you are targeting using a knife, order them something that can be cut. Prompt the child to keep their area clean while eating, and use napkins as needed.
  6. Skill: Waiting Appropriately/Transitions. Go to a place or setting that the child really loves, such as a favorite toy store. Tell the child before you go in the store that you are going in for 2 minutes only (bring a timer if necessary). Enter the store, and give the child transition warnings that you will be leaving soon, such as "We are leaving in 1 minute". Once 2 minutes has passed, tell the child it is time to go, and leave the store.
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