“Optimism is the faith that leads to achievement. Nothing can be done without hope and confidence.”

– Helen Keller, 1880-1968

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Tameika Meadows, BCBA

I loooove teaching Task Completion, it’s such a great skill to teach that can benefit a child across multiple settings.

Task Completion is a program that teaches a child to complete tasks independently for a specified amount of time. Beyond that, Task Completion teaches appropriate leisure skills. A lack of "down time" activities to engage with, or the ability to select and attend to a free play activity can be an issue for children with ASD. Instead of finding something to do that the caregivers or parents would deem appropriate, many children may engage in problem behavior or repetitive behaviors.
Once taught to mastery, Task Completion is a great tool that can be used by parents for when they need their child independently engaged in an appropriate activity. Such as when Dad is on the phone, when Mom needs to do the laundry, when big brother has friends over and doesn’t want his baby brother interrupting, during transition times, during down times, in the classroom, etc. This program also teaches children to follow a timed schedule, follow directions, complete tasks in serial order, attending skills, appropriate waiting, etc.

 I would recommend Task Completion as a program for children who:

 -Already have some toy play skills, but very few functional leisure skills

-Have difficulty with transitions or unstructured times in the home or classroom

-Need someone to engage with them in order for them to attend to a toy or object

-Have many attention seeking behaviors/Seek attention in inappropriate ways
-Spend their down time in destructive ways, such as jumping off furniture, eating non-food items off the floor, or breaking things

Task Completion does have a few prerequisites. The child needs to be able to wait, must already have some toy play skills, must understand delayed reinforcement, must have a good number of mastered skills, and the parents need to be on board with this program. The way I write this program, in order for the child to master the skill (and for the program to be closed) each parent must be able to run Task Completion by themselves. So this particular program requires significant parental involvement.

Here is how a visual of what Task Completion looks like:

The therapist places tasks into a set of clear shelves, and sets a timer for a specific amount of time. Next the therapist gives the SD and starts the timer. The child should pull out the 1^st drawer, take it to the table and sit down, empty the drawer, complete the task, put the task back in the drawer, and return the drawer to the shelves. At that point the child either continues moving through drawers, or goes and sits back down until the timer goes off. Task Completion is not finished until the timer goes off. 

*Task Completion Tips:

•  Materials Needed: Clear plastic shelves, a variety of mastered tasks, a variety of reinforcers, a timer, a desk or table where the child completes the task. I usually get these clear shelves from Wal-Mart, they're around $8. You can buy them with or without wheels, it doesn't matter.

• The tasks placed in the drawer need to be mastered tasks that the child can complete independently. Pick tasks that have a clear start and stop, and don’t need instructions. A lump of Play Dough would be a poor choice, because it isn’t explicitly clear what to do with it. A string and beads are a better choice, because its clear the child is supposed to place the beads on the string.

• When first teaching this program, you can reinforce the child after they are completely finished or you can reinforce at the end and the beginning. What that usually looks like is I will place a small edible reinforcer on top of the drawers, and the child can grab the reinforcer before they pull out the 1^st drawer. This also works well for children who delay beginning Task Completion, and you have to physically guide them to start working.

• After you have been teaching the program for a while and have a few drawers, you can place reinforcers directly in the drawers. The 1^st drawer could be a task, 2^nd drawer is a reinforcer, and 3^rd drawer is a task. This builds reinforcement into the program. You could even place a child's favorite play object or a sensory box in a drawer, and use that as a reinforcer.

• After you give the SD and start the timer, do not say anything to the child until the program is completely finished. Use nonverbal prompting as necessary. The reason for this is so the child learns they are expected to do the program independently (without you participating).

• As the child begins to learn the program, the therapist should fade further and further into the background. On drawer 1, you may need to be right by the child to ensure compliance. By drawer 3, you should be standing across the room and by drawer 5 or 6 you should be able to move freely in and out of the room as the child stays engaged with the Task Completion program.

• Teaching Task Completion can be ripe with problem behavior. Sometimes the child will move very slowly to try and “ride out the clock”. Other times, as soon I give the SD the child drops to the floor and refuses to move. Some children are perfectionists, and get upset if the timer goes off before they have finished their task. They may scream and then throw the drawer across the room. Have a plan for addressing issues such as these that may pop up. Also, always take a look at your reinforcement to make sure it is valuable enough.

Once taught to mastery, Task Completion can consist of anywhere from 1 drawer to 12 drawers…or even more.  It just depends on the setting. Most homes only need children to stay independently engaged with a leisure activity for 15-20 minutes at a time, across the day, so that mom and dad can do laundry, cook dinner, help other children with their homework, etc. 

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Tameika Meadows, BCBA

If you have a money tree in your backyard this post isn’t for you. Also, please drop me an email and let me know where you found a money tree.

Thanks.

In my Frequently Asked Questions post, I briefly touched on different ways families can pay for ABA. If you are a regular reader of my blog then by now you know that an ABA program needs at a minimum:

-Staff/Therapists
-Consultant/BCBA
-Supplies (table and chair, paper, pens,binders, etc)
-Teaching Materials (reinforcers, flashcards, data sheets, timers, clipboards, etc).

Everything on that list has recurring cost. For example, supplies aren’t purchased one time, and then you’re done. Some of the best clinical programs I have seen are SUPER materials heavy, with hundreds of flashcards, visuals, etc.
 Let’s look at that list again for a typical month:

 *(Estimated for a 20 hour per week in-home ABA program with 2 therapists and 1 Consultant)

-Staff $2400

-Consultant $4000

-Supplies $400

-Materials $600

Monthly Cost: $7400

For one year, a basic ABA program could cost somewhere around $80K. That doesn’t include additional costs like medications/supplements, other therapies, private school, etc. I don't know about you, but the families I know simply cannot afford that.

As an ABA professional there are many aspects of my job that can just be heartbreaking. It’s very difficult to see a child who desperately needs therapy go without services because of cost, or to work with a family who must suddenly stop therapy because of cost. In this country we have a long way to go in terms of understanding the critical need for Autism services. Although it is statistically clear that Autism rates have risen, the treatment accessibility has remained mainly open to the financially well-off. Not helping matters any is the reality that the pool of professionals available to offer ABA therapy is quite small compared to the demand (and that small pool gets reduced as the child ages). Add to all of this a seriously hurting economy and parents are left to wonder who exactly is going to pay for this much needed therapy. 

This is such an important topic that I want to be very careful in saying that I am NOT an insurance coverage expert. I'm not the final word on financial resources for ABA therapy. I am happy to share the information that I have but be sure to research what is available in your area, as much of this information differs from state to state.

 For the international readers of my blog I do not know much about financial resources for ABA Therapy outside of the US. I would suggest you talk with other parents in your area, do research online, and check with your insurance company and see what options you have. If you are financially able, you may want to consider moving to a country that has mandated laws regarding Autism and Autism therapies.

Financial Options

• Private Pay- Private pay means paying out of pocket for therapy. Be sure to ask the provider if they use a sliding scale for private pay clients. Also, please note that if you are wanting to receive private pay services from a company/provider who normally only works with insurance clients, they may expect you to pay what the insurance company pays. The reason why being, if they charge you a lower rate then they would have to reduce what they pay the staff and Consultant who work on your case. With private pay, your payment may be due at the end of the month, or even per session. Also, some individual providers do not accept check payment. Keep in mind that if you pay for therapists to provide therapy in your home some of that cost may be tax deductible. Contact your tax preparer to find out if you can claim any costs of ABA therapy, including staff salaries or therapy materials.
• Scholarships/Grants/Waivers- These are funding sources available from the state, Autism agencies, or non profits that give stipends or grants to families for ABA therapy (such as Easter Seals). There is usually a precise paperwork process to request these monies, and typically a waiting list. If you live in GA, there is a link below to funding sources available for parents of varying income levels. Even if these stipend amounts are small, trust me: every little bit helps! Sometimes multiple grants or waivers can be applied for by the same family, each year.Also, sometimes ABA companies will reserve a "scholarship" spot for needy families. It may only cover limited services, but still ask about this option.
• Loans- Some families secure loans from banks, organizations, or family members to cover the cost of therapy. When considering loan options always look for low interest rates and know the details of the re-payment plan.
• School Funding – Many families have children who receive free ABA therapy at school, although usually this does not include wrap around services (meaning they will not come into the home to help you). You also need to know who is supervising and managing the ABA program at the school. Is it a teacher? A BCBA? The Special Education Director? Be sure to ask how that person is qualified to manage an ABA program. If your child’s school does not provide ABA therapy, they might have an Autism program or Autism classrooms. In some instances, parents have been able to successfully petition the school system to pay for ABA therapy in the home. This was no easy accomplishment and in some cases took litigation, but I have seen it happen.
• Respite Providers/Students – You can minimize salary cost by hiring college students or respite providers to provide therapy. Many states have respite agencies that will send individuals to your home to provide respite care at low cost, or no cost. These respite providers may have an ABA background, in which case they could work with your child. Another option is to use the providers sent out by early intervention agencies in your state. In GA, the early intervention agency is called Babies Cant Wait. If your child is not meeting developmental milestones and is under age 3, they are eligible to receive services in the home from a Special Instructor at no cost to you. Some of these Instructors may provide ABA therapy and some may not. If you decide to hire college students they may get course/internship credit for working with your child, and you wouldn’t have to pay them. I would suggest contacting the Education, Social Work, and Psychology departments of college campuses near you to gather a pool of students. With all of these options you would still need a Consultant to oversee the quality of the program and provide training.
•   Insurance – This refers to private insurance or employer provided insurance and is the most common funding source today, yet its also the most difficult to obtain. Take a look at this map: 

      The green states have enacted laws to require insurance companies to pay for ABA therapy. The red and yellow states are working towards laws but are currently only at a bill level regarding legislation, and the blue states are not pursuing legislation at all. As you can see, depending on where you live insurance coverage might be a great option or a nonexistent option. Further complicating matters is even if you live in a green state you still may be unable to get insurance to cover your child’s therapy. This is because of something called “Self Funded Insurance Plans”. A self funded insurance plan is when the company you work for pools their own money together to pay claims rather than contracting with an insurance company. That means it is up to individual companies to offer ABA therapy on their insurance plan or not. The only way to know whether your insurance is self-funded is to ask your employer.  The insurance issue is much more complicated and complex than I can explain here. If you live in a state that does not mandate insurance companies cover ABA, know that this issue is currently being lobbied for around the country.  Even for families who can get insurance to pay for ABA therapy, there are still many flaws in the system. Some insurance companies will only pay for services provided by a licensed Psychologist, only pay for a minimal amount of therapy each month, or  make it extremely difficult for BCBA's to get reimbursed for services rendered ...thats another thing, if you want insurance funding you typically have to hire a BCBA. Many insurance companies are new to working with ABA providers and don't quite know how to categorize us, so they routinely deny our claims. That means the BCBA may regularly wait 45-90 days to get paid for their services. That can really deter a BCBA from accepting insurance clients, and you may be responsible for payment of the claim if the insurance company refuses to pay.

• Run a Program Yourself! – I always present this option to parents, because you are in the best position to take the reins of your child's therapy. Especially with the economy crisis right now and the insurance mess; this is the most realistic option for many parents. In my post on How To Start An ABA Program I described the steps parents can take to run an ABA program. For many reasons families cannot always hire staff  to  provide in-home therapy. For the international readers of my blog, this option may be the best pick for you. I have a client located outside of the US and they live in an area where there are no Autism schools, services, or professionals. Where they live, information and knowledge about Autism is extremely minimal. What this family chose to do was run an in-home therapy program themselves, to fight for advocacy in their country, and to hold seminars open to the public to raise awareness. The mother provides her own son with intensive ABA therapy per week, and also trains individuals (relatives, babysitters, etc.) as needed on basic ABA knowledge. The out of pocket costs for this family includes consultation, supplies, and materials. They make much of the materials and supplies they use, so that also brings costs down. Is it difficult for a parent to be their own child’s therapist? Absolutely. But is it possible? Definitely. I hope the example of this family can be a source of inspiration. If you live in an area where ABA resources don't exist,  please don’t think all hope is lost. If no funding options are available to you, I encourage you to get on the floor, pull out those flashcards, and start teaching your child yourself. 

Helpful Links:

• http://www.autismvotes.org/site/c.frKNI3PCImE/b.3909853/k.BE44/Home.htm
• http://www.wrightslaw.com/info/ei.index.htm
•  http://www.tricare.mil/ - For military families only
•  http://www.autismhealthinsurance.org/
• http://www.tacanow.org/family-resources/start-an-in-home-therapy-program/
• http://www.autismspeaks.org/family-services/grants
• Who Pays for ABA Programs?
• http://p2pga.org/roadmap/insurance/insurancemedicalinsurance.htm
  
  CARD Resource: Insurance Funding & Autism
   
  
  
  
  

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Tameika Meadows, BCBA

"The whole purpose of education is to turn mirrors into windows".

Sydney J. Harris, 1917-1986

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Tameika Meadows, BCBA

After my post about How to Interview ABA Therapists, I started receiving questions from ABA professionals about what they should be asking during an interview.

For both parents and the therapists the interview process is a time to discuss details of the position, pay and benefits, expectations, qualifications and background, etc. Just as parents are responsible for making expectations clear during the interview process, therapists are responsible for evaluating these expectations and determining if they can meet them. This post is specifically for ABA professionals who work in the home with clients.

There are basically two different roles an ABA therapist can inhabit: an Employee or an Independent Contractor. If you have a supervisor or work for a company you are an employee. If you work for yourself, you are independent.

 (You can work for a company or agency and be considered an independent contractor. To reduce confusion, in this post the term "independent contractor" refers only to people who work directly for families)

When I started in this field I was an independent. I worked directly for families and I didn’t have a direct supervisor. That means I was responsible for finding work, setting pay criteria, marketing myself, and creating my own employment contract.

There are pros and cons to either role; it just depends on what works for you. Some therapists prefer working for themselves, and others like the advantages of being under a company. It’s a personal decision.

The interview/hiring process looks a little different depending on if you are an employee or an independent. Employees typically are given policies to adhere to; they don’t get to create them. So I will move straight to talking about independents. 

For independents, your role and the responsibilities of your position should be clear before you ever begin working with the family. I talk to many therapists who work in the home and are dissatisfied with pay, hours, communication, etc. If these issues are discussed before you ever begin work, it is much easier to find areas of compromise. For example, if you are going on vacation for 2 weeks who will cover your sessions? Have you discussed that with the family? The day before your vacation starts is not the ideal time to have that discussion. Some families are not used to having employees working for them in their home, so they may not know how to interview you. They may not know what issues need to be discussed, or what needs to be put in writing. As an ABA professional it is your responsibility to inform and educate the family during this process. You are not just the more knowledgeable one when it comes to behavior and ABA, you are probably the more knowledgeable one about the hiring process. Below are some hiring/interview tips for both employees and independents:

Independents

• The most important part of the interview is finding out from the family exactly what the position entails. What are the hours, what is the pay rate, what are the job responsibilities, what expectations does the family have of you, what programs does the child have, how many therapists are on the team, is there a Lead therapist, who writes/creates the programs, who writes/creates the behavior interventions, what ABA methodology is the family using, how is training provided to you (if it is provided at all), etc. I suggest arriving to the interview with a list of questions to ask the family about the position.
• Directly after discussing the position, it is important to talk about policies. Think of policies as “The Rules”. You and the family together need to create policies that are satisfactory to both of you. Examples of important policies to discuss include: Sick days, vacation pay (if either you or the family go on vacation), cancelling sessions, pay raises, benefits, audio/video recording of sessions, mileage reimbursement, can you administer medications, etc. As awkward as it may be to discuss these issues with a family you may have just met, imagine how much more awkward it is to talk about overtime pay after you stay an extra 2 hours at the home one night. Take any anxiety or nervousness out of it and make sure to discuss these issues before you accept the position. I also suggest you get these policies in writing.
• The next area of importance includes several things which can all be lumped together under “Boundaries”. It is important, from day one, to establish clear boundaries with the family. It is unfair to work with a family for several months and then suddenly inform them you aren’t comfortable with something. If you know there are duties you are not willing to do make that clear from the beginning. That is what creating boundaries is all about. It tells the parents when something is outside of your comfort zone. If you are a new therapist you may not know what your boundaries are yet. Even if you don’t know what they are you can inform families during the hiring process that if something makes you feel uncomfortable/ is outside of your job description, you wont do it. A boundary of mine is I don’t babysit siblings while I am working with my client. I have had negative experiences in the past where a parent has left me home alone with all their children, and was it awkward to ask them not to do that? Yes! However, it isnt fair for my client to receive 10-15% of my attention and focus because I'm busy babysitting their siblings.

Employees

• If you are an employee, there isn’t really an interview process with your clients. You are assigned a caseload and you go out and start seeing clients.  It can still be helpful to discuss with your company or supervisor what the policies are, get a full job description in writing, and discuss how clients are declined. Declining a client is basically when you decide for whatever reason that you no longer want to work with a family. Usually if you make the decision before you ever meet the family, it’s a very easy process to decline a client. However once you start working on the case some companies make it very difficult for you to be removed from it. The emphasis can be on what works best for the company, and not for you, the actual therapist. Changing a caseload is typically a decision made by your supervisor(s), not you. In addition to asking about these issues you should also find out how conflicts are handled. Conflict can come in the form of therapist/therapist, supervisor/therapist, or family/therapist. Whichever type of relationship the conflict occurs in, it can seriously affect your ability to do your job and decrease your job satisfaction. As a professional it is always your responsibility to try and repair any difficult relationships and resolve conflict on your own first. Sometimes that isn’t enough to defuse a negative situation, especially if your conflict is with a parent or therapist you see regularly. At that point, what is the protocol for handling conflict? Can you ask to be removed from a case, and if so, will you receive a replacement case? Can you request a different supervisor without being penalized? These are all important questions you need to ask.

Whether you work independently for 1 family, or for a large company with a caseload of 10 clients, it is your responsibility to know the specific duties of your position, and all policies and regulations. The client-therapist relationship is only improved by open and ongoing communication from day one.

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Tameika Meadows, BCBA

If just reading "potty training" makes you tense and nervous,  then you probably are currently struggling with the toilet training process, or you have a child who will begin the process soon. Teaching any child to move from freely voiding in a diaper or pull-up to using a toilet is a difficult process. Now toss into that situation a child who has ASD, and potty training can go from being challenging to being a frustrating and stressful experience for the entire household.

Children with Autism may have challenges in the areas of language/communication, sensory processing, social skills/social thinking, and behavior control that need to be taken into consideration when formulating a potty training program. Other issues such as motor planning, sensory needs (feeling a full bladder or a wet diaper), communication abilities, and preference for predictability and routine may make potty training more difficult. It is also common to see an increase in problem behaviors during potty training, or to see an emergence of new behaviors at this time.

It is hard to predict which kids will struggle with potty training and which will not. I have potty trained some clients in days. Other clients it took years before they were consistently successful. The amount of time needed to teach this skill to a point of independence will vary. Before you actually start potty training you can’t know with certainty what the process will be like. So the best approach is to be prepared and informed before you ever begin.

First, it’s important to redefine the potty training process. You may have other children you have successfully potty trained, you may have potty trained nieces or nephews, or maybe you have friends who have told you exactly what to expect. Throw all of those expectations out the window. 
Realize that your child with Autism is unique, and the techniques that worked for your nephew may, or may not, work for your child with Autism. 

A few potty training tips:

• Children with Autism might take much longer to show interest in the potty or display signs of readiness than other children
• Children with Autism may have fear or anxiety about using a toilet which could be exhibited through severe problem behaviors
• Children with Autism may find a visual schedule helpful to remember the steps for using the bathroom
• Children with Autism may need to be separately trained to stay dry through the night, even after they are potty trained
• Children with Autism may need to be separately trained to defecate in a toilet, even after they are potty trained to urinate in a toilet
• Children with Autism may need to be separately trained to request the bathroom (asking for the bathroom in a public place rather than voiding in their pants)
• Children with Autism may decline to use unknown toilets, such as public bathrooms at a mall
• It is critical to rule out medical issues as a reason for difficulties with bowel training. If the child has intestinal issues, chronic diarrhea or constipation, or is compacted with fecal matter, they are not “choosing” to have messy bowel accidents. They are not in control of their bowels, and any punishment or consequences will simply confuse or anger the child. A sign of underlying medical issues is a child with loose, watery stools, a child who does not defecate often (defecates 1-3 times per week), a child with a hard, distended belly, or a child with allergies. If any of these issues are going on, seek medical treatment before continuing.

This post is not going to be a step-by-step guide to potty training any child with Autism.  Just like when teaching any other skill, the approach must be individualized to the child and to their needs.

 What is important is to individualize any technique used to the specific child, to create motivation to use the toilet (copious amounts of liquids, or take them to the toilet shortly after meals), and focus on reinforcement for voids rather than punishment for accidents.

The most important things you can do before you begin potty training your child with Autism is decide on the approach you want to use and stick to it.


Toileting research:

• Azrin N., Foxx R. Toilet training in less than a day. New York: Simon and Schuster; 1974.
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• Blum N. J., Taubman B., Nemeth N. Relationship between age at initiation of toilet training and duration of training: A prospective study. Pediatrics. 2003;111:810–814. 
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• Luiseli J. Teaching toileting skills in a public school setting to a child with pervasive developmental disorder. Journal of Behavior Therapy and Experimental Psychiatry. 1997;28:163–168.
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• McManus M., Derby K. M., Dewolf E., McLaughlin T. F. An evaluation of an ın-school and home based toilet training program for a child with fragile X syndrome. International Journal of Special Education. 2003;18:73–79.
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• Stadtler A., Gorsky P., Brazelton T. B. Toilet training methods: Clinical interventions and recommendations. Pediatrics. 1999;103:1359–1361. 

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Tameika Meadows, BCBA

"Train up a child in the way he should go, and when he is old he will not depart from it". Proverbs 22:6

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Tameika Meadows, BCBA

ABA programming refers to skill acquisition. The priority skills to teach should focus on the core deficits of Autism: communication, social interaction, and widening narrow interests and activities. The programs selected for instruction should answer the question "What does this individual need to know in order to be as independent and successful as possible?".

ABA professionals aren’t the only ones who need to know how to write programs. Parents also can benefit from this knowledge, especially if you are a parent providing ABA therapy to your child. Programs can be written for all kinds of skills: brushing teeth, greeting people, table manners, potty training, sharing, counting, reading, one step instruction, etc.

 I typically use the ABLLS-R assessment tool, which then guides my program writing. I will refer to the ABLLS-R in this post simply because it is the tool I use the most. Some people use other assessment tools, such as the VB-MAPP, or the Vineland. If you are unfamiliar with the assessment process, check out my post about the ABLLS-R which gives a general overview. I have my own program writing style that has evolved over the years. It isn’t unusual for 2 different professionals to take the same goal and teach it in two different ways. For every goal you can think of, there are multiple ways to take the child from not knowing the skill, to knowing the skill. Program writing is definitely a skill that takes time to learn, but understanding the basic steps makes the process much easier.

Program Writing Steps

1. Prioritize what to teach first: After you assess the child you are left with an inventory of their strengths and deficits.  This large inventory is then narrowed down into specific skills to begin teaching. This process is child specific because it will vary depending on the child’s age, level of functioning, issues most important to the family, is the child in school or not, etc. The programs I write for a nonverbal 2 year old will be very different from the programs I write for a high functioning 7 year old. How many skills you select will also vary, but typically you want to consider the child’s ability to work for extended periods of time, and how many hours of therapy per week the child is receiving. If a child only gets 3 hours of ABA per week, they don’t have enough time to work on 25 programs. There also is somewhat of a hierarchy of needs to address. Its more critical that a child be able to communicate than play with a doll. When in doubt, make skill deficits that impact communication or inhibit learning the most important.
2. Write an objective for each program: Think of the objective as your long term goal and keep it broad. A good rule of thumb for the objective is to think about what the child would be able to learn in 6 months. “Child will be able to share with a peer for a minimum of 1 minute with only gestural prompting necessary” is a solid objective. You will then need to create mini goals to work up to the objective, such as teaching the child to tolerate being near peers, to share for 10 seconds, to share for 25 seconds, etc.
3. Each objective needs an active targets list: There are two types of targets: active and mastered. An active target is what you are currently working on, and includes skills the child does not know yet. A mastered target is a skill the child has been taught, or already knows at the time of assessment. If the objective is “Child will be able to share with peers”, then the active targets are the small steps towards that goal. Look at the objective you created, and then think of how you can break it down into small, discrete steps. If you are using the ABLLS-R it will actually list an objective and a few active targets for each skill. There are also appendices in the back of the ABLLS-R manual that list sample active targets.
4. Decide on your measurement of mastery: In order to get a child to a point of mastery, you need to decide how they will demonstrate to you that they are competent in a skill. Typically, most ABA programs use the standard of “80% or higher across 3-4 consecutive sessions”. However, sometimes you need to use a different measurement system. Nothing about ABA should be cookie-cutter, so dont feel stuck in that “80% or higher across 3-4 consecutive sessions” rut. For example if the child is being taught to safely cross the street, only 80% success could be extremely dangerous.
5. Plan for maintenance of mastered targets: It isn’t enough to write a program, teach a skill, and then move on to the next program. A common characteristic of Autism is difficulty generalizing skills, which over time can cause a learned skill to be lost. When writing a program you need to be thinking “How will I generalize this skill to various settings, materials, people, etc?” There are many ways to plan for generalization and maintenance. A way I regularly plan for generalization is to “Teach Loosely”. Teaching loosely means that I will intentionally vary where I teach, when I teach, the materials I use, and if possible who does the teaching.  A favorite technique I like to use for maintenance is: Get a small card filing box. Take a stack of index cards and write a mastered target on each card. During each session, grab a few cards out of the box and ask the child a mastered target. If they still have the skill,  move on to the next card. If they do not still have the skill, take the card out of the box as it may need to be taught again. At the end of the session put the cards you used in the back of the box so you will pull different cards the next day. The great thing about this technique is anyone can do it. I love using strategies that the whole household can implement. If the child gets a new babysitter who doesn’t know how to engage them, give the babysitter the box of mastered targets and a few reinforcers. This way anyone can target maintenance of skills.

This may seem like a LOT of work, and it is :-)

But trust me, it isn’t impossible to learn how to write ABA programs. There are resources out there for parents or inexperienced professionals to use that will guide program writing, or even write the programs for you. Two resources I can recommend are the Catherine Maurice guide, and the webABLLS. The webABLLS is a completely online version of the ABBLS-R assessment tool, and you plug in your child’s strengths and deficits and then print out pre-written programs. I know many parents who use this tool.
There are also companies that sell pre-written blank programs to be used in an ABA program. However, problems can arise when using “automated” tools like these if you don’t understand how to tweak or modify programs, such as unintentionally teaching skills out of order or not knowing what to do when progress stalls. Most of these program tools are just "program shells" that still need to be individualized and revised before they are ready to use. In other words: Don’t expect shortcuts.
It is fine to use software or books/manuals to help you write programs but be aware that you will still likely need professional assistance.

*Here is a helpful program writing visual aid-


A correctly written program goal should include:

Who	Will do “X”	Under what Conditions	Level of Proficiency	Measured by whom & measurement methods & Materials
Example: Tameika	will respond to 5 one-step instructions	when instructed by an adult in an home, school, or community setting	with 90% accuracy or higher, across three sessions	Measured by direct staff through frequency data collection

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Tameika Meadows, BCBA