“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, Blog Author

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, Blog Author

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, Blog Author

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

Sydney J. Harris, 1917-1986

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Tameika Meadows, BCBA, Blog Author

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

The interview process is a time to discuss details of the position, pay and benefits, expectations, qualifications and background, etc. ABA professionals are responsible for evaluating the expectations of the position and determining if they can meet them. This post  may be more or less applicable to your situation, depending on your ABA work setting (school- based, home -based, etc.).

Firstly, if you didn't already know please be aware that direct staff (staff who require a supervisor to perform their role) cannot work as independent contractors according to the governmental definition of a "contractor". If you are an ABA therapist working directly for a family, I am speaking to you.

Also for best practices, and especially if you are a RBT, you really SHOULD be working under a BCBA or BCaBA (who is under a BCBA). For clinical supervision and case oversight the best case scenario is the tiered service delivery model where there is a supervisor overseeing the work of the direct staff.
Yes, there are employers who try to shirk or entirely skip over this model but I don't recommend it. You will find yourself in a position you aren't quite qualified for, with little to no support or training.


Without consulting an attorney to write this post for me, I will summarize greatly and explain the difference between an ABA Contractor & an ABA Employee:

Basically, as a contractor you work for you. You can work independently or choose to contract with companies, which just as it sounds will require you sign an employment contract.
*Tip: Read over that contract suuuuper carefully. I have turned down many a position based on horribly written contracts that the company refused to modify. As a contractor you do have autonomy to set your schedule/hours, are responsible for your own materials, supplies, taxes, etc. Your income is not taxed and you are not entitled to any benefits.

For an employee position, it's basically the opposite of everything I just said about contractors. Some companies will just require you sign an offer letter, but other companies still require employment contracts even of employees. Your income is taxed, you are eligible for company benefits (depending on what is offered), etc.

I hear from many people in the field who want to know how to "break out on their own" and start working independently, as a contractor. There is no quickie answer to this, it varies depending on the laws/licensure where you reside, your ideal work setting, your familiarity with business ownership, etc. Contracting is not for the faint of heart, and I don't recommend you jump right into it the second you gain BCBA certification. Give yourself some time to learn and develop your skillset before considering working independently.

There are pros and cons to being an employee or being a contractor; it just depends on what works for you. Some therapists prefer working for themselves, and others like the advantages of being within a company.....even the "Big Box" ABA companies, which I personally tend to avoid.

The interview/hiring process can look very different depending on if you are an employee or an contractor. Also, the larger the company typically the more steps that are added to the interview process.

Below are some general hiring/interview tips for both employees and contractors. Keep in mind that some information won't be applicable to you, depending on your work setting:

Contracting

• Ask to review the employment contract. Keep in mind that everything is negotiable, and if you are told it is NOT negotiable: that's a problem.
• Explain upfront if you have other clients, especially if in the same area. Many companies may ask you to sign a non-compete clause which will severely impact your ability to hold other contracts.
• Ask about client materials and supplies. Even for contractors some companies will still provide you with materials, while others will not.
• Don't drive all over the place for free. While contractors are usually not eligible for company benefits (like mileage), you can demand a higher pay rate for excessive travel/drive time.
• Be sure you understand what the non-solicitation clause includes. If you leave a company due to dissatisfaction, you may be unable to work with any staff or clients of that company for years to come.
• Since you are not eligible for overtime, be very clear on how many hours per week you will be working (including admin hours, which typically are unpaid).
• Is remote/telehealth work a possibility?
• How often do you get paid? Monthly, weekly, bi-weekly? Don't be surprised if your contract states monthly payments, this isn't unusual for contractors.
• Who maintains your professional liability insurance, you or the company?
• How long will credentialing take? Be prepared that depending on the funder this can take MONTHS....are you expected to just sit around until then?
• Who is your go-to person? You likely will not have a direct supervisor, so who do you contact with questions or concerns? If it's the owner, how available is this person?
• Since contractors are often hourly and not salaried, be sure to discuss what happens if your hours unexpectedly dip or change, such as if you lose half your caseload. Trust me, it happens.

Employees

• You likely will need to adhere to company policies and procedures, which can be numerous and comprehensive. Ask questions about any policies you don't understand and be assertive about any procedures you disagree with.
• Are you PT or FT? If FT, what happens to your benefits if your hours fluctuate or dip unexpectedly? 
• Is the position hourly or salaried? If salaried, ask about billable hour requirements.
• Is admin time paid? How many hours per week are alotted for it? Is there a clinic/work site where you can complete admin tasks? 
• Are you able to decline/turn down cases? If so, what is that process? How quickly will those hours be replaced? 
• Who is your direct supervisor and how often can you meet face to face with this person?
• Are company trainings paid time? If no, then is your attendance optional?
• If you require supervision to earn a credential or certification, will you be charged for this (some companies will lower your pay rate while you are being supervised)? Do you have to stay with the company a minimum length of time post-certification? 
• How do promotions and bonuses work, and how often can they occur?

More great interview questions to ask:

1. When the interviewer says "So what questions do you have for me?" ALWAYS have questions ready. It makes you appear uncaring or disinterested when you don't.
2. Don't leave the interview not knowing what the pay rate is. If you are a contractor, they typically will ask what you charge. If you are an employee, you typically will be told a pay rate. If you feel the rate is low based on your education and experience, say so! You may not be able to negotiate, but a quality interviewer will explain the reason for the low pay rate (not just say "Well, that's what we pay").
3. Ask about company culture and how staff are made to feel valued/appreciated. Ask for specific examples, don't accept a vague response.
4. Avoid obvious questions that are answered on the company website or were in the job posting. It looks really unprofessional if you ask about something that was clearly explained in the job description/job ad.
5. Always ask how soon you would start working. You would be surprised how many employers start interviewing for positions that aren't even open yet/companies that aren't open yet. If the job won't be available for 6 months, that's something you want to know upfront.
6. Don't leave the interview with no idea of what the next step will be. Always inquire about this, because you would be surprised how many employers skip this step. You should know when to expect to hear from someone, and how quickly they are looking to make a decision.
7. Always ask when you can speak to a clinical staff person. Nowadays the 1st phase of the interview may be with a recruiter or administrative staff, and they really will not be able to answer your most critical questions. 
8. Ask about typical caseload/ how many clients you will manage at once.
9. Ask to see company handbook, policies, guidelines, parent policies, etc. If they don't have any, REALLY bad sign.
10. If the position was recently opened, ask why the last person didn't work out. Pay close attention to the response :-)
11. Ask about staff suggestions or input, and how receptive the company is to feedback. No one likes a job that completely lacks autonomy, and could be done by a robot. We all like to feel like we are contributing to the company in some way.

**Super Helpful Resources:

- For the contractors, this audio post about what to expect when you dive into those consultation waters is basically a collection of tips I wish someone had shared with me before I started contracting. I truly hope it's helpful!

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Tameika Meadows, BCBA, Blog Author

If just reading "toilet 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 often a difficult process. Now toss into that situation an Autism diagnosis, and the process can definitely get extra challenging.

Autistic children may have challenges in the areas of communication, sensory processing, social skills/social thinking, and behavior control that need to be taken into consideration when formulating a toileting program. Other issues such as motor planning, sensory needs (feeling a full bladder or a wet diaper), and preference for predictability and routine may make things more difficult. 

It is hard to predict which kids will struggle with toilet  training and which will not. For some clients, this is a skill we can implement and teach in a few weeks. With other clients, it has taken much, much longer.  The amount of time needed to teach this skill to a point of independence will vary, so the best approach is to be prepared and informed before you ever begin.

First, it’s important to redefine the toilet training process. You may have other children you have successfully toilet trained, nieces or nephews where you helped out, or maybe you have friends who have told you exactly what to expect. Throw all of those expectations out the window. 
Realize that the process could be quite different for an Autistic child, and the techniques that worked previously may, or may not, work this time around. 

A few  tips:

• There could be less interest in the toilet, less concern/awareness of being wet or soiled, and a lack of "readiness" signs that typically developing children usually exhibit 
• There could be significant fears or phobias about the toilet, the bathroom, or the smells/sounds/sights involved in the process 
• Use of visual supports could be highly beneficial to teach the toileting steps/routine 
• It may be necessary to separately teach staying dry at night, or bowel training, even if the child can fully use a toilet to urinate (sometimes these skills must be targeted individually) 
• Requesting a toilet/telling someone "I need to use the bathroom" may need to be separately taught
• There may be an aversion to unfamiliar toilets (like at school, or in a public place). This is common, and also happens with typically developing children  
• 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 fully in control of their bowels, and any punishment or consequences will not be helpful. Signs of underlying medical issues could include loose, watery stools, crying/distress during BM's, a child who does not defecate often (defecates 1-2 times per week), or a child with a hard, distended belly. This is why seeking a medical evaluation is so critical, because there could be multiple medical explanations for toileting difficulties.

This post is not going to be a step-by-step guide to toilet training Autistic children.  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 ensure that toileting is motivating and not aversive,  and to focus on reinforcement.

The most important things you can do before you begin potty training is decide on the approach you want to use and stick to it. And of course, reach out for help (through a therapy provider) as needed.

Toileting research:

• Azrin N., Foxx R. Toilet training in less than a day. New York: Simon and Schuster; 1974.
• 
  
• 
  
• 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, Blog Author

"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, Blog Author

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, Blog Author