Writing skills can include a variety of specific tasks such as coloring, scribbling, tracing, writing, and copying. Children with Autism who are school age absolutely need appropriate writing skills to contact success in the classroom. Unfortunately, some ABA programs can focus more on oral communication and forget about written communication. Nowadays with so much focus in the Autism community on electronic assistance such as the Ipad, children can learn to type or touch letters instead of writing them. While I love what the Ipad can bring to an ABA session and how it can seize the attention of almost any child, the skill of holding a pencil to an actual piece of paper is not obsolete; it’s still a necessary skill to teach.

Your child or client may need a writing or pre-writing program if they exhibit difficulties with pencil/pen proper grip (a Fine Motor program may need to be taught first), staying within lines when coloring, coloring at all (child wont even scribble on paper), tracing/copying/writing letters, shapes, lines, or numbers. I've already mentioned fine motor skills as an important pre-requisite to teaching a child to write. It is always a great idea to work with your OT when developing a writing program, to learn specific strategies to help with handwriting. If you do not have access to an OT I recommend reading books or research articles about techniques to help with handwriting and grip control. A great tool I would recommend is Handwriting Without Tears (HWOT). It’s a very hands on, tactile method of learning how to form letters using workbooks, cardboard letter pieces, and graduated guidance that children with Autism really respond to.

If you are dealing with a child who currently isn’t writing at all, you want to write a pre-writing program. If the child has minimal writing skills (such as lines or shapes) then you can start teaching writing letters and numbers. There is a hierarchy to teaching writing skills, and it is:

  • Mark on paper (scribbling)
  • Color between lines or boundaries
  • Trace lines and shapes
  • Trace letters and numbers
  • Copy straight lines
  • Copy curved lines
  • Copy letters and numbers
  • Print letters and numbers
  • Print sentences

Many of the ABA therapists I meet with get tracing, copying, and printing mixed up. Tracing refers to giving the child a broken line outline of a line, shape, letter, or number that they are to trace. Copying refers to giving the child a sample line, shape, letter, or number to create on their own underneath or next to the sample. Printing means writing, and is the hardest skill. There is no model or sample, you simply say to the child “Write the number 8”, and they should correctly write a number 8.
Following the hierarchy of skills, here is an example of how to teach writing skills:

  1. Pre-writing: Coloring- The child is taught to mark on paper, and then to color within gradually shrinking boundaries. The first boundary might be a circle with a 3 inches thick black boundary that the child must stay inside. As learning progresses, shrink the boundary to a thick 2 inches, a thick 1 inch, a thin 1 inch, etc. Learning to stay within boundaries is an important pre-requisite to tracing, and ultimately to writing on lined paper.
  2. Tracing- Remember with tracing to present a model with a broken line for the child to trace. Teach the child to trace a vertical line, horizontal line, diagonal, curved line, and shapes. Once the child can easily trace any shape then move on to teaching letters and numbers one at a time. I typically start with upper case letters and then teach lower case letters.
  3. Copying- Remember to give the child a sample of the actual line, letter, or number that they can copy. Moving from tracing to copying is where many topographical and legibility errors begin to happen. This is why I recommend consulting with an OT. For example many kids will mix up letters like “p” and ‘q”, the child will write letters too big or too small, or the child writes too lightly on the paper (this is really a pen/pencil grip issue).
  4. Printing- The child needs to be able to print letters and numbers on demand (“Write the letter D”) before you can start working on sentences. If you have taught the child both upper case and lower case letters, then at this point you can begin focusing on capitalization. Moving from printing letters to printing sentences is where spacing issues often pop up. The child may write their letters very large so that only 2-3 words are on each line, or they may write their letters so close together that its impossible to read. Consult with your child’s teacher or an OT to get specific tips and instructions about how to clean up sloppy handwriting.


**Quick Tip: Sometimes parents or therapists will ask me if the child should write with a pen or pencil, or when to start teaching cursive writing. I prefer teaching writing skills with a pencil, only because of ease of grip and being comparable to the classroom. However, it will only help the child generalize the writing skill if you sometimes hand them a pencil, crayon, pen, or even chalk to write with. As far as teaching cursive writing, I would defer to the parents’ opinion. I personally think that if my client can print their name, that’s success. I don’t need them to be able to print their name as well as sign their name in cursive. Even for typically developing children, writing in cursive can be a laborious, challenging skill to learn. Unless a parent specifically asks you to teach their child cursive, stick to teaching the child to print.





 

Disclaimer: The information in this post is intended to be a general guide to writing a behavior plan. Behavior plans, like FBA’s, must be an individualized, needs-specific process. As a parent or professional, please avoid “paint -by -number” guides to writing behavior plans. Like most professionals, I do follow somewhat of a template when I create behavior plans. However, it’s just a basic shell for me to individualize depending on the client. Various funding sources (such as different insurance companies) will have different requirements of how they want the behavior plan to look, so again, trying to stick too closely to a formula definitely wont help you. Besides, the creating is the best part!

End of disclaimer.





What is a behavior plan?

A behavior plan is the last step in the FBA process. When dealing with any behavior you want to reduce, a FBA is completed to determine the function of the behavior. Once a function is determined, then a behavior plan is created. ABA professionals also use the terms Intervention, Behavior Reduction Strategies, or Plan of Action. Teachers may use the terms Behavior Intervention Plan, or Positive Behavior Support Plan. We are both describing the same thing: a behavior plan.
* Some agencies or school systems will write behavior plans for appropriate behaviors that need to be increased, such as manding or greeting peers. In my experience, skill acquisition goals, or programs, are used for appropriate behaviors, and behavior plans are used for inappropriate behaviors.


Why do I need one?

The FBA describes why the behavior is happening, and the behavior plan is the strategy for what to do about the behavior. Neither is complete without the other: skipping straight to behavior plan writing is essentially making a guess about what might work. Completing a FBA and then failing to write a behavior plan is a waste of time, resources, and (possibly) money, because you have a function for the problem behavior but no plan of how to reduce it. The FBA and the behavior plan are meant to go together…think of them as peanut butter and jelly.


Who can write one?

That depends on the setting. A parent can create a behavior plan for their child, to implement in the home. A teacher can usually create a behavior plan to use with a student; although various schools have policies on how/when a behavior plan can be written. In some schools, only Behavior Analysts or the School Psychologists can write a behavior plan. At other schools, teachers can complete the entire process. An ABA professional, usually at the BCBA or BCaBA level, can write a behavior plan if there is a demonstrated need for one. The setting and the severity of the problem behavior will determine who can write the behavior plan.


How do I write a behavior plan?

The good news: It’s not as hard as it sounds. The bad news: It can be an intricate and lengthy process, and may take some time to get the hang of it. Experience is the best teacher, and the more behavior plans you write the easier the process becomes.
The standard components of a behavior plan include: demographic/identifying information, client history/background, problem/target behaviors including an operational definition, function of the behavior (this comes from the FBA) including actual data, strategies to decrease the problem behaviors based on the function including replacement or incompatible behaviors, data collection sheets/graphs to monitor the success of the behavior plan.


Can I see a sample?

Sure! Below is a sample behavior plan for “John Doe”, with an explanation of each component. Use this as a basic guide or learning tool. The school or company you work for may have behavior plans that look very different from this sample…that’s normal. Even in the same company, behavior plans can vary depending on the funding source.




SAMPLE BEHAVIOR PLAN

Individual’s Name: John Doe
Date of Birth: August 31, 1981
Diagnosis: Moderate Mental Retardation
Medications: None
Allergies: N/A

(Demographic information should include basic things like: age, name, date of birth, official diagnosis, any secondary diagnoses, current medications, allergies, etc.)

History: John is a 31 year old Cuban-American male who resides in a state licensed community residence in Norcross, GA. He resides in the home with two other male residents, one of whom is a recent addition. John is a friendly and sociable person, who enjoys watching TV and visiting the community pool. John has a history of elopement, emotional outbursts, and anxiety. John sees his psychiatrist every 3 months, and is on a limited sodium diet. John’s challenging behaviors had been latent since March of 2012, and have recently increased in frequency. The most recent behavioral event occurred in August of 2012 when John attacked a staff member during lunch time. Staff members at the residence report that John’s challenging behaviors often occur randomly, and for no apparent reason. Staff states that John will be calm and quiet, and then will suddenly lash out.
This behavior plan was created based on John’s history and current behavioral problems, and to ensure that staff members are aware of the protocols that must be kept in place to support John.

(The history, or background, is usually obtained from record review or parent/staff interview. Include a variety of information to give a snapshot of the individual, what they like, what behaviors are occurring, frequency of behaviors, staff/parent reaction to behaviors, and remember to include any suggested functions of the behavior that the parents or staff mention. In this example, the staff gave the function of “no reason”. As non-helpful as this response is, it’s very common that during the interview the parent or staff will tell you the behavior has no function and “just happens”.)

Problem Behaviors:
1. Physical Aggression- Defined as John attempting to or successfully punching another person with a closed fist, or slapping with an open palm against the body of another person. This behavior typically occurs when John is given a demand.
2. Vocal Threats- Defined as John making inappropriate expressive statements directed towards others, pertaining to causing physical harm. This behavior does not include when John is "scripting" dialogue from a TV show or movie.

(An operational definition is a way of defining a behavior in simple, observable terms. Avoid using definitions that are vague, overly technical, or can’t be observed—like thinking. The reason it’s important to define the problem behavior is so that everyone is intervening on the right behavior. If one person describes a hit as a “punch” and another person thinks a hit is a “slap”, then those two people will be intervening differently, which will cause the behavior plan to be ineffective. Its a good idea to include exclusions of the problem behavior: what the behavior is not)

Function of Behaviors: Based on the results of the FBA (see attached), John is most likely to engage in physical aggression or verbal threats when staff member Kevin is on duty. Frequency of physical aggression or verbal threats increased by 75% when Kevin was present. John is least likely to engage in physical aggression or verbal threats when he is engaged in a preferred activity, or interacting with staff member David, or staff member Bobby. The hypothesized function of both the physical aggression and the verbal threats is attention. Currently, the staff only give direct statements or conversation to John during daily routines, such as telling him to make his bed or turn off the TV. It was observed that in a 5 hour period, no reinforcement or praise was given to John. When John exhibits problem behaviors, staff will speak in a loud tone of voice, sit near John, or talk to John to calm him down. It was also observed during the FBA that the non-targeted staff members will often run into the room when John begins exhibiting problem behaviors, and 2-3 staff members will simultaneously attempt to calm John down.

(The FBA and accompanying data would be attached to this behavior plan. It’s typical to use a color coded line graph. Make data based decisions by using the data to confirm or deny your hypothesized function. Along with the results of the FBA, refer to information obtained during interview or observation to bolster your findings.)

Behavioral Strategies/Intervention: Staff member Kevin will switch shifts with staff member Lonnie, so that Kevin is working at night when John is asleep. Staff member David had the least amount of aggression directed towards him (3%), and he appears to be very reinforcing to John. Staff member David will be the main staff assisting John throughout the day, and will watch a 30 minute TV show with John 3 times per day. For every 10 minutes that John is calm and quiet, he will earn one token. At the end of 30 minutes if John has at least 2 tokens then he can earn extra TV time, or select a staff member to take him to the community pool. When delivering a token provide behavior-specific praise with eye contact, such as “Great job reading quietly, John”. If John exhibits problem behavior, use blocking and a 2 person restraint hold to maintain safety. Avoid direct eye contact with John, and use minimal language with a calm tone of voice. No other staff member should be present except the 2 staff members performing the restraint hold. If John begins making verbal threats, do not respond. Do not engage John in conversation or argue with John. Once John is calm and has stopped making threats, provide eye contact and redirect John to an appropriate activity.

(A good number of recommended strategies is 2-4. Avoid giving just 1 suggestion, because the staff/parents may dislike that option and refuse to carry it out. If the parents or staff do not agree with your behavior plan then you must revise it--you must get the people who will implement the behavior plan on board with following it. Include simple strategies as well as more complex strategies. Since the behavior happened the most with Kevin, the simplest option is to remove Kevin from the environment. The more complex option would be to implement a system of reinforcement, and to give John an appropriate way to gain staff attention. A replacement behavior is what you want the person to do instead of the problem behavior. An incompatible behavior is something that the person cannot do at the same time as the problem behavior. You will not be able to come up with a replacement behavior for every problem behavior, and sometimes you have to settle for an incompatible behavior, or shaping the problem behavior into something more appropriate.)

Data Collection: See attached ABC data collection sheet, in order to monitor the success of the behavior plan. Data should be collected daily for at least 45 minutes, across staff members.

(Continued data collection is critical after creating and implementing a behavior plan. A behavior plan is considered successful only after the data has shown a reduction, or elimination of the problem behavior. It isn’t unusual to go through all of these steps, implement the behavior plan, and the data shows no change in the problem behavior. If that happens, don’t give up-- just roll up your sleeves and review your data to see where the problem lies.)



Suggested Resources:


Functional Assessment to Prevent & Remediate Challenging Behavior in School Settings by Chandler, L., Dahlquist, K.

Functional Behavioral Assessment, Diagnosis, and Treatment: A Complete System for Education and Mental Health Settings, 2nd Edition by Ennio Capini, Keven Schock

Functional Assessment and Program Development for Problem Behavior: A Practical Handbook by Robert O’Neil























"Children are great imitators. So give them something great to imitate."
 by Anonymous





Applied Behavior Analysis is not just a reputable and empirically supported treatment method for managing the symptoms of Autism. It's much larger than that.


ABA is for anyone who wants to improve, manage, or reduce behaviors, and a behavior is any observable and measurable action.
ABA at its core is a way to teach. I'm not a teacher, but much of what I do involves helping individuals learn. If I am working with a 5 year old who bites his fingers to escape a task, it is my job to teach that child other replacement behaviors to request a break from tasks. All great ABA therapists are great teachers. What would really be amazing was if all great teachers were also trained in basic ABA knowledge.

This post is for special education teachers, teachers in Autism classrooms, and general education teachers who are dealing with persistent, challenging behaviors. ABA strategies can be successfully used on any student exhibiting problem behaviors in the classroom. Behaviors such as:


*        Attention seeking behaviors
*        Difficulty transitioning
*        Poor social skills
*        Lack of waiting skills
*        Tantrums
*        Disrespectful to teacher
*        Inattentiveness
*        Elopement (wont stay in classroom)
*        Hyperactivity/Fidgety
*        Aggressive
*        Destructive (throw things, break chairs, etc)

Essentially, teachers who are trained and equipped to “Think Like a Behavior Analyst”  are teachers who will lower job stress, improve teacher student relationships, and maintain control over their classroom.

Recommended Strategies:
1.      Understand that all behavior has a purpose, and learn how to determine the function of behavior- As a teacher you might be familiar with the ABC’s of behavior- Antecedent, Behavior, Consequence. This three term contingency is the backbone of the work that ABA professionals do. We seek to improve or reduce behaviors by determining what is maintaining the behavior. Behaviors don’t just happen and persistent behaviors are being maintained, or strengthened, by something. My job, and maybe 80% of what I do, is to figure out what that “something” is. This takes patience, dedication, and most importantly the belief that the behavior serves a purpose for that child. If I walked into a classroom and came up with a behavioral intervention without first determining the function of the behavior, then what I am actually doing is little more than guessing. The intervention I come up with might work, and it might not. With many behaviors, professionals don't have time for guesswork. If a student is headbanging 7 times a day, it would be unethical and dangerous to "guess" at an intervention and take the risk that the behavior could worsen. Research has shown that when the function of a problem behavior is not determined prior to intervention, the resulting intervention tends to be punishment based. In other words, the goal is just to make the behavior stop. The problem with that approach is the need that the function served is still there - - it hasn’t gone away.
2.      Understand reinforcement and consequences, and how to effectively deliver them- Reinforcement and consequences are facts of life. We all receive a variety of consequences throughout our day as we interact with the environment. Humans (and animals) will go to a great deal of effort to contact pleasurable things, and to avoid unpleasant or painful things. Bring this knowledge into the classroom. Focus on and give your attention to the behaviors you want to strengthen: sitting quietly, waiting appropriately, finishing assignments on time. Ignore, redirect, or provide a consequence for behaviors you don’t want to strengthen: hitting peers, throwing books, yelling “no” at the teacher. It may feel odd to ignore such disrespectful behaviors, but it’s important to realize that attention is a powerful source of reinforcement for most kids. For some students, removal of teacher attention is a strong enough consequence to diminish a behavior.
3.      Modify the environment: Visual supports are your friend- When I go into classrooms to conduct an observation or to meet with a teacher, I usually spend the first few minutes just walking around the room. Many times I see issues in the environment that may be causing or maintaining problem behavior. To name a few: the child who has issues with attending is seated right next to the window, the child with severe Autism sits directly under a fluorescent bulb, and the child who always refuses to clean up is playing in a messy and disorganized play area where nothing is labeled. Many persistent behavioral problems are maintained or made worse by chaotic or poorly organized environments. The classroom lacks structure, rules are not clear to students, transitions happen suddenly and without warning, etc. An ideal classroom to promote appropriate behavior from students will be organized, quiet, divided into clear sections, and follow a schedule that is taught to all the children.
4.      Consistency, consistency, consistency- Say what you mean and mean what you say.  Do not let any demand come out of your mouth that you are not prepared to enforce if you have to. Don’t shout across the room to a child climbing up onto their desk “Get down right now!”, unless you have a course of action ready for if the child completely ignores you. I often say to ABA therapists “Don’t back yourself into a corner with your words”.  If I say to a student at the lunch table “We’re not leaving this table until you eat all that food” then I have backed myself into a corner. What if it takes the child 15 minutes to eat an apple? What if the child chooses to fling their lunch tray across the room? Instead, I would say something like “First you need to eat your hot dog, and then we can go buy an ice cream”. If the child still refuses to eat their food or engages in aggressive behaviors, then I can just decide that lunch is over and take the child back to the classroom without getting any ice cream. I never made eating food a requirement to leave the table; I made eating food a requirement to get a treat.
5.      Understand MO, and how to capture it- MO, or Motivating Operations, is a way of describing motivation. At any time in the day my MO for certain activities will be stronger or weaker. My MO for drinking orange juice will be very low if I just brushed my teeth. My MO for answering my cell phone will be much higher during work hours than it will when I am sleeping. Understand how to assess a child’s MO and then use that to your advantage. MO is very unique to individuals, and it can increase and decrease all day long. Have a system of reinforcement in place that is tailored to each student.
6.      Be open to change and trying new things: If the behavior isn’t improving it isn’t the child’s fault, it’s a faulty behavior plan- Challenging, persistent behaviors require a well thought out and consistent behavior plan. I’d say the #1 reason most properly written behavior plans fail is a lack of consistency. The special education teacher follows the behavior plan, but no one told the Music teacher how to handle the behavior. Or the behavior plan doesn't include strategies for what to do if the behavior escalates. To implement ABA strategies correctly you have to be willing to roll up your sleeves, face a problem behavior head-on, and stick to the behavior plan.  If you can persevere through the child's worst, then you just may get to see them at their best.


      Teachers, have realistic expectations about the behaviors you decide to intervene on. Ask yourself if you can honestly deal with seeing the behavior worsen before progress begins. Decide if you can stick to a behavior plan and be consistent in your follow through. Letting a problem behavior take control of your classroom is just as bad as starting to intervene, then backing down. In both of those situations you are reinforcing the problem behavior and making it stronger.
      Ultimately your actions and behaviors  are what will determine the success of any behavioral intervention you create. 






 “Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do.”  Steve Jobs, February 1955- October 2011

"Choose a job you love, and you will never have to work a day in your life." Confucius, 551-479 BC

Parents often desperately seek out ABA professionals who seem to love what they do. Many parents might not know that is what they are looking for... parents might say they want someone who is energetic, or outgoing, or punctual, or open to feedback, etc. But all of those qualities are really the behaviors of an individual who is passionate about what they do for a living.

 Just like any other profession there are ABA professionals who dislike or even hate their job. Fortunately, the apathy these people have for their career is usually quite apparent. Like a bad teacher, a bad ABA therapist is easy to spot. These people just don't seem to care; they are always irritated or frustrated with something or someone.
Parents often say to me that they wish there was some test to give to verify that a potential therapist will be kind to their child, patient with their child, and ethical. I would say that there is a character trait that leads to all of those behaviors: its Passion. Excellent ABA therapists are full of passion about the field of ABA.

 I can attest that when you do what you love for a living, you really do stop "working".
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