I get emails pretty frequently from people who are new to the field of ABA. If you are making the switch to being an ABA Therapist then its pretty normal to have lots of questions about what to expect and how to approach the job. Especially if you work directly for a family, you probably wont get much information about the first day and what you should/shouldn't do. Many families believe that the ABA professional will show up on day 1 knowing exactly what to do. However, the truth may be that you're nervous or a bit confused about what you should be doing.

There are SO many settings an ABA therapist can work in, from the classroom, to an agency, to directly for a family. I will try to be all-inclusive, but some of this information may not apply to certain settings. For example, if you start a new job with an ABA agency then typically your first day will be some type of training or orientation, and it can be anywhere from a few days to a couple of weeks before you actually start working directly with clients.
I will mainly talk about new ABA therapists who are going to work with a client in the home setting.

Below is a general list of tips. This is information that I wish someone would have shared with me when I first entered the field of ABA. I hope its helpful!

  • Do Your Research- If at all possible, observe the client during 2-5 therapy sessions (across multiple staff) before you start working with the client by yourself. This is sometimes called Shadowing, and its when you are paired up with another therapist and follow them around as they go into the field to work. Despite what some agencies/companies may think, Shadowing is not the same as Training. Simply shadowing someone for a few days does not mean you will necessarily be ready to work with the client by yourself. During your first few days, ask TONS of questions, review the program binder and Treatment Plan, and pay attention to how the client interacts with current therapists. As the new kid on the block you can pretty much expect to have all sorts of testing behaviors thrown at you, so its always helpful to know what the client looks like on a good day. You also want to observe transitions and down times during the therapy session. If the current therapist starts every session by playing a DVD and giving the client grapes, there's a good chance the client will expect you to do that too. The current therapist is a valuable source of information to you, as they already know the client very well. Its one thing to sit and observe a session, but when you are responsible for running an entire ABA therapy session all of a sudden ABA doesn't look quite so easy. Be patient with yourself, and understand that there is a learning curve.
  • Establish rapport- Pairing is taking the time to establish rapport with the client, and to approach them with the items/objects they find highly enjoyable. This process should occur prior to formal instruction. I typically tell new therapists to spend their initial sessions pairing, and running mastered programs. You want to build a positive relationship with the client and take time to learn their personality and strengths. Pairing is essential because it makes the child want to be around you, and it makes escaping from you less desirable. Ask caregivers or current therapists what the client LOVES to do, and then do those things with the client. One of my very first clients used to love to go to a neighborhood park. He rarely got to go because all the other therapists came at night. Well, as the only mid-morning therapist I took that child to the park every single day. Over time this child associated me arriving to his house with his favorite activity, and we had a great paired relationship. You can use activities, tangibles, or edibles to pair with the client. You could also use people, such as playing with the child while he sits on Mom's lap. Be careful when using people though, because it can be hard to separate the client away from Mom when its time to start working. 
  • Meet The Parents/Caregivers- When you initially start working with a new family, use that time to familiarize yourself with the household routine, rules, and get clear answers about the family's expectations of you. Ask the simple questions (Where does the family want you to park? Where are reinforcers stored? Does the family have pets?) as well as the bigger questions (What other therapies does the client get? Is the client aggressive at all?). On day 1, its a good idea to ask for a tour of the home. It is helpful to know where the closest bathroom is located, where the child's bedroom is, where favorite goodies are stored, etc. Familiarize yourself with the therapy materials, and ask the parents how they want things organized. I have had families ask me not to park in their driveway, to remove my shoes in certain rooms, or inform me about a loose back door the client may try to bolt out of. All good information to have!

There are MANY different ways to apply the science of ABA, such as Natural Environment Teaching, Verbal Behavior, and DTT: Discrete Trial Teaching. Many people think DTT is all ABA is; that all ABA therapists do is sit at a table with flashcards and small pieces of candy. That is a common misconception, but ABA is broad and multifaceted. Applied Behavior Analysis is a science that can be applied in a variety of ways to teach new behaviors, and DTT is just one branch on the ABA tree.

The 1987 Lovaas study (which is THE research study in the field of ABA) utilized Discrete Trial Teaching in order to teach many complex skills to a group of children with Autism. Before this study was published, it was considered a widely accepted fact that children with Autism could not learn. Parents of children with Autism were told to institutionalize their child and try to move on with their lives. It cant be emphasized enough what the Loovas study did to demonstrate that kids with Autism CAN learn when the teaching is modified.

DTT is widely used today and probably the best known type of ABA. If your child receives ABA services at a clinic/Autism school, or from an agency, they are probably using DTT techniques for the sessions. It is common that lower functioning or younger children start with a more structured and rote DTT style, and eventually over time or as the child develops they transition to a more naturalistic learning style, such as NET or Incidental Teaching. I LOVE DTT as a teaching methodology because it gives me the ability to remove all the frills and boil my teaching down to exactly what my learner needs to be successful.

When people make complaints or negative statements against ABA, they usually critique ABA for being too robotic, focusing on repetitive drills, giving kids bites of candy all day, etc. Although distorted and inaccurate, there is some truth to these complaints. The DTT method does focus on breaking down skills, repetition, and reinforcement. However when done properly by qualified staff, DTT can bring about amazing and significant gains in language, imitation, attending, self-help, motor, and play skills in children with Autism.  The research is extensive and conclusive: DTT works.

Let’s take a closer look at the DTT method--

  • Teaching Trial: For the DTT method, the following teaching trial is used: Present materials, give SD, prompt incorrect response or reinforce correct response, clear materials. That entire process is called a teaching trial, and it is repeated over and over in a therapy session. It should move at a brisk pace, and the therapist should be collecting trial by trial data after each trial has ended. Each trial is a learning opportunity, and the goal of a DTT session is to give the child hundreds of learning opportunities in order to teach specific skills. Younger children usually do 10 trials of each skill, while older children might do 5 trials of each skill.
  • Breaking down tasks- DTT breaks down complex skills into small, separate tasks to teach. So what is considered a complex skill? Well, pretty much everything. For a child with Autism, learning to write their name could be a 5-10 step process. For example, if the child’s name is “Adam”, first they learn to individually trace “A”, then “d”, and so on. After tracing, they learn to write each letter individually. Finally, the child is given paper and pencil and told “Write your name”, as the therapist provides letter prompting (therapist says as child writes “A…d…a…m”). Over time the therapist would remove her assistance until the child can independently write his name. Sound complicated? It’s really not. The goal when using a DTT approach is to break down the skill as much as is necessary for the child. It might not take that many steps for your client to learn to write his name. Or, your client may need even more steps. Let the child’s progress determine how far to break down the skill. If you have been stuck on a particular skill for weeks, it probably needs to be broken down further to help the child understand.
  • Mass Trial vs. Mixed Trials- Depending on the ability and functioning level of the child, you would teach using “mass” or “mixed” trials. A mass trial simply means you are asking the target multiple times in a repetitive manner. That would look like this: “Trial 1: Touch dog…Trial 2: Touch dog…..Trial 3: Touch dog”. Mass trialing is typically used to teach very young children, children new to ABA, or lower functioning children. Some programs add in generalization at this step by changing the stimuli for each trial. So the 1st trial the child touches a photo of a brown dog, the 2nd trial the child touches a photo of a white dog, and so on. Mixed trialing, also called random rotation, is when you teach targets in a random order and do not use repetition. That would look like this: “Trial 1: Touch dog…Trial 2: Give me red…Trial 3: How old are you?”. Typically you want to transition from mass trialing to mixed trials; although with some children they may need the repetition of a mass trial in order to learn.
  • SD---> Response- The SD is simply the instruction or demand you present to the child. Examples of SD’s include: “Touch your nose/Stand up/What number? /Touch apples”. With DTT, the SD leads to a specific desired response. If I say to a child “Touch your nose” there is a specific response I want the child to do. If the child does the response correctly, I provide reinforcement. If the child doesn’t respond correctly, I provide prompting. The SD must be consistent across time, therapists, and settings. If the morning therapist says “Touch your nose” and the afternoon therapist is saying “Show me your nose” that could be confusing to the child, and could slow down learning. The SD tells the child what you want them to do, and their correct response is how they contact reinforcement. It is the reinforcement that increases the likelihood that the child will respond correctly in the future.
  • Reinforcement- Reinforcement is a critical part of any ABA program, but particularly so with DTT. This is because DTT has so many learning opportunities in a session. Depending on the schedule of reinforcement being given, the child may be reinforced hundreds of time in a therapy session. With a continuous or dense reinforcement schedule, every correct answer contacts reinforcement. With an intermittent or thin reinforcement schedule, only some correct answers contact reinforcement. The schedule of reinforcement you use will depend on the child. Reinforcement must be easily accessible and ready (a bag of unopened chips is a poor choice. The chips should be opened and placed into a bowl or on a plate for easy access), yet out of reach of the child. Reinforcement should be varied, rotated often, and given in small amounts. If the reinforcer is tickles, then don’t tickle the child for 5 minutes after one correct answer. Tickle the child for maybe 4 seconds, and then continue teaching. Many people ask me if DTT sessions have to use food treats. The answer is no, they do not. The reason why so many DTT sessions use food reinforcers is because very young children or children new to ABA often don’t find social interaction, adult attention, or toys/games reinforcing. For those children, the therapists have to use things like candy, chips, or ice cream because that’s all the child likes. However the goal is always to transition the child away from food treats as soon as possible.
  • Data Collection- Data collection for a DTT trial is done after each trial. As the child is contacting their reinforcement, the therapist is writing down how the child performed at the task. The type of data sheet used can range from very simple to complex. It can be checkmarks, a plus/minus system, graphing, etc. The method of data collection isn’t as important as making sure data is collected. It will be difficult to impossible to determine progress and make programming decisions without solid, accurate data. If you don’t like data collection or want to avoid taking so much data, I’d suggest collecting first trial data or doing a weekly Cold Probe.
  • Generalization- DTT gets a pretty bad rap when it comes to generalization. Many people think that DTT is the most robotic and boring type of ABA out there, and that it teaches skills in a vacuum (the child can answer “pig” when asked “What says oink-oink?”, but says nothing when asked “What does a pig say?”). I have stated this before on my blog, and I’ll say it again: Poor quality ABA providers perform poor quality therapy. The only reason why DTT would be lacking a plan for generalization is if the DTT program was being done improperly.  I already mentioned one way that DTT can plan for generalization (vary the materials). Another method is something called “Maintenance”. This is when known skills are reviewed days, weeks, or even months after the child was taught the skill. So if my client learned to say her phone number last week, I will ask the skill again next month. The purpose of maintenance is to make sure the child retained the skill, which can be an issue for children with Autism. Failing to incorporate generalization techniques into a DTT program will only lead to problems in the long run.

**Quick Tip: For more information about Discrete Trial Teaching, check out the information below:

DTT Research Articles:

Gresham, FM & MacMillar, DL. (1998). Early intervention project: Can its claims be substantiated and its effects replicated? Journal of Autism and Developmental Disorders,28(1): 5-13

Sallows GO, Graupner TD (November 2005). "Intensive behavioral treatment for children with autism: four-year outcome and predictors". Am J Ment Retard 110 (6): 417–38.

McEachin JJ, Smith T, Lovaas OI (January 1993). "Long-term outcome for children with autism who received early intensive behavioral treatment". Am J Ment Retard 97 (4): 359–72; discussion 373–91

Suzannah Ferraioli, Carrie Hughes and Tristram Smith (2005) : A Model for Problem Solving in Discrete Trial Training for Children With Autism. JEIBI 2 (4), Pg.224- 229

DTT Books:

 Individualized Autism Intervention for Young Children: Blending Discrete Trial and Naturalistic Strategies, Travis Thompson

A Work in Progress: Behavior Management Strategies and a Curriculum for Intensive Behavioral Treatment of Autism, Ron Leaf

Teaching Individuals With Developmental Delays: Basic Intervention Techniques, O. Ivar Lovaas

This is a continuation of my post about staffing your in-home ABA program, How to Hire ABA Therapists: The Interview. That post was for families who aren't using a company or the school system to get ABA services, and instead are hiring staff directly to work inside their home.

This post is intended to be helpful to families who are working with an agency/company that sends therapists out to your home. It can be difficult to know how to evaluate the quality of an ABA agency, what services they should provide, and what expectations to have.
There are some families who approach agencies demanding the absolute best, and this can be a set-up for disappointment. On the other hand there are families who place all of their trust with an agency and ask no questions, and that can lead to poor quality of services.

Similar to selecting and interviewing your own ABA therapists, parents have the right to be thorough and selective when choosing an ABA agency. Depending on the area you live in and the funding sources available, there can be a variety of agencies to choose from or only a few agencies available. 

Parents here is a tip: the parts of the country with the best funding sources tend to have the most agencies available. Places like CA, NY, CO, and FL are flooded with ABA agencies. Cities and states without insurance funding or other ABA resources tend to have only a few agencies to choose from. So if you only know of 1 or 2 agencies in your local area, it’s probably because there are limited funding sources. The good news is many ABA agencies provide long distance services, so don't feel hopeless if there are no quality agencies in your area.

Here are some tips for what to expect when starting services with an agency:

What To Expect-

  • Intake Process: The intake process is basically where the agency is gathering information about you (the parents) and your child. This can include a telephone interview, a home visit, and likely lots and lots of paperwork. The agency may also request various documents from you, such as medical reports, or the most recent IEP. During this time the agency may also explain any policies and rules they may have, and have you sign a contract.
  • Assessment/Observation: The goal of the assessment is to determine your child’s current level of functioning and learn about your child's motivation, interests, and problem behaviors. The assessor may obtain this information via observation, record review, parent interview, testing your child, or a combination of all of these methods.
  • Program Development aka “The Plan”: “The Plan” refers to the plan of action created for your child, based on the results of assessment. This plan of action can include instructional goals (e.g. language) as well as behavioral goals (e.g. reduce tantrumming). An agency representative, usually a Lead Therapist or Supervisor, will create multiple goals for your child and should explain all of the goals to you in a manner that is easily understandable to you. What I mean by that is the supervisor should not just hand you a program book and tell you to read it. The supervisor should answer any specific questions you may have in simple, plain language.
  • “The A- Team”:……And here comes the team. This is the point where you would typically meet your child’s new therapist(s). The supervisor will fade into the background somewhat, and the ABA therapists will be the ones who come to your home 2-5 times a week to work directly with your child. Usually agencies put 1-3 therapists on a case, and each person works 3-5 hours per week with your child. You should be given a schedule so you can know who will work on what day, at what time, and for how long. Do not feel that you have to just accept the people the agency sends to your home, because you don’t. However, it’s important to be realistic. If you keep rejecting the therapists the agency sends to your home, one of two things is happening: you are being too picky and the agency will soon be unable to find staff for your case, or the agency has very low quality staff members who leave much to be desired.
  • Parent Training: This is where that supervisor you met in the very beginning stages will begin coming around again. The supervisor was still involved the whole time, but sometimes they aren’t as visible as the ABA therapists. Supervisors have many behind the scenes duties such as writing programs and analyzing data. In addition to these duties, the supervisor should also incorporate parent training on a regular basis. Parent involvement is a critical key to the success of any ABA program, so if you have no idea what your child is learning in their ABA sessions, that is definitely a problem.
  • Meetings, Meetings, and Meetings: There should be some system in place for accountability and tracking progress. This usually happens with face to face meetings where the team (including you) may meet in or outside of the home to discuss in detail your child’s progress. If face to face meetings do not occur, then there should be a system of communication between you, the therapists, and the supervisor, such as emails, phone calls, written notes, etc. At a minimum, the ABA therapists should be taking time at the end of each session to update you on your child’s progress, any new behaviors, etc. The therapist should not just finish a therapy session and leave your home.

What To Look For-
  • Professionalism: It is a sad reality that there are agencies out there who care nothing about the science of ABA or helping people, and are simply looking to make $$. As a parent you might not be able to question an agency about complicated behavior analytic techniques, but you can look for evidence that you are dealing with professionals. If you give a developmental evaluation report to the agency in August, are you still waiting for them to give it back to you when October rolls around? If you call the supervisor assigned to your case and leave a voice-mail, does it take her 2 weeks to return your call? Do the ABA therapists consistently arrive to your home to do a therapy session wearing revealing, low cut clothing, or are they on their cell phone constantly during the therapy session? These are all indicators that you may be dealing with an unprofessional and likely unethical agency.
  • Respect: Do you feel valued and respected by the agency and its staff? Are your opinions and ideas about the goals and behavior plan listened to and viewed as valued input? Or does the staff make you feel as if they are the experts, you are the parent, and you should keep quiet?
  • Says “No” To You: Okay, let me explain this one. It is important that the agency and its staff sets boundaries, and boundaries mean that sometimes they will need to say no to you. I once worked for an agency that had a policy that they “never turned a client away”. That sounds very nice in theory, but in practice what it meant was that the staff was severely overworked and stressed because they were given far too much to do. Overworked staff will produce sloppy work, and stressed staff will quit. Instead, the agency should set clear boundaries and politely maintain those boundaries. If the company is always bending over backwards to please you, and setting rules and then allowing you to break them, you may be dealing with an unethical company that is more focused on profit than quality services. That kind of agency will do or say anything to keep you as a client, and to keep your money.
  • HAPPY Staff: It usually isn’t hard to tell when an agency mistreats its staff. The ABA therapists always seem to be irritated, tired, or stressed out when they arrive for therapy sessions. The owner or management doesn’t seem to care when staff leave or quit, and is very vague about the interview/selection process of new staff (that means there probably isn't a process).  Do the ABA therapists complain to you about a lack of training? Are they always making comments about how they "don’t get paid enough" to put up with your child? These are all signs of unhappy staff, and if several staff members are acting this way that’s a really bad sign.

**Quick Tips: 

-A handy checklist for parents giving tips on how to select a quality ABA provider. 

-Here is a wonderful blog post written by a parent that gives specific tips on how to select an ABA provider.

To be strong in statistics, it’s important to understand basic math skills. To be a skilled driver, it’s important to understand basic safety rules of the road. To become a 5 star chef, it’s pretty important to know how to boil water and peel a potato.

Similarly, to be a knowledgeable and qualified ABA professional it’s important to understand the basics of Applied Behavior Analysis: Operant Conditioning.

It's quite possible to work in this field and have a minimal understanding of the science of ABA. Expertly written behavior plans and programs can be implemented by almost anyone. However, if you are serious about this field then a solid understanding of operant conditioning is a must. The difference between being good or great at ABA is often a strong understanding of the science of ABA.

If you have ever taken an Intro to Psychology college course, then you likely remember learning about Pavlov and Skinner. Pavlov is associated with Classical Conditioning, which is the pairing of stimulus to produce an unintentional effect (remember the salivating dogs?). Skinner is associated with Operant Conditioning. Operant conditioning is using reinforcement or rewards to strengthen behaviors, and removing that reinforcement to weaken behaviors.

The field of ABA stands on the amazing work of B.F. Skinner and his theories, which is why ABA is such an impressive treatment method. ABA has decades of research behind it, in literally thousands of settings, with all kinds of behaviors. 
ABA therapy as a treatment method is based on Operant Conditioning, extensive research studies, and the science of behavior. If an ABA program is done ethically and correctly, then amazing progress is possible. 

The Basics: Operant Conditioning

  1. The best way to understand an organism is by its behavior: ABA focuses on behavior and not feelings or thoughts, because behavior is observable. Behavior can be quantified, which helps with data collection. Other than medications, there aren’t many ways to change someone’s thoughts or moods (and what happens when the child won’t take the pill anymore?). However to change someone’s behavior, you can use reinforcement, punishment, shaping, environment modifications, prompting, and so much more.
  2. Behavior that is reinforced is strengthened, and behavior that isn’t reinforced tends to die out: Why do you answer your phone when it rings? Why do you check your mailbox?  Why do you lower your voice when entering a library? It is the response you receive to a behavior that determines if you will continue to engage in the behavior or not. With consistent punishment, you could be taught to stop answering your phone. With consistent reinforcement, you could be taught to shout inside a library. It’s simply a matter of the consequence your behavior receives.
  3. The environment is the key to understanding behavior: This is why that student in your class starts screaming and climbing on top of desks when his mom shows up at the end of the day. The environment influences the way we behave, and the environment includes the setting, people, temperature, objects/stimuli, and time of day. If you significantly modify the environment, you will see a significant change in behavior.
  4. Behaviors are learned: Behaviors do not “just happen”. Behaviors serve a purpose, and behavior that isn’t reinforced is quickly extinguished. If you sit on a bench in a shopping mall and find a $100 bill stuck to the bench, you are more likely to sit down at that bench again in the future, in the hopes that you will find more money. If you sit down on a bench in a shopping mall and a light fixture falls from the ceiling and hits you on the head, how likely are you to sit on that bench again? All behavior is strengthened or weakened depending on the consequence it receives.
  5. Desired reinforcement and internal motivation vary and change over time: If your boss dumps a bunch of extra work on you and then says a very heartfelt “Thanks so much!” afterward, that would probably be very reinforcing the first time. If your boss continued dumping extra work on you, after a while that “Thanks so much!” will stop being reinforcing. That’s because you became satiated, or full, on that type and level of reinforcement. The work output expected of you kept increasing while the reinforcement given to you stayed the same.
  6. Behaviors that are low effort and contact consistent reinforcement will be more persistent than behaviors that are high effort and contact inconsistent reinforcement: Sound complicated? Its really not. Lets say you have a 5 year old who has learned to scream when anyone attempts to take a toy from him. The screaming doesn’t require much effort and he gets consistent reinforcement because other children leave him alone when he screams. How can this problem behavior be extinguished? What most people would do is just tell the other children to let the screaming child keep the toy. With a solid understanding of Operant Conditioning, its easy to start a chain of events that will extinguish this problem behavior:
-          The child is given a toy to play with for a few moments, and then the  adult takes the toy back. The child begins to scream. The adult ignores the screaming. The child begins to wail, drops to the floor, and kicks his legs. The adult holds up an index card that says “My Turn” and prompts the child to touch the card. As soon as the child touches the card, the adult gives the toy back.

      Did you see what happened there? The adult changed the situation so that tantrumming became a high effort behavior and communicating using a card became a low effort behavior. As long as the adult continues to reinforce appropriate communication, screaming will be extinguished. 

Sometimes ABA might seem like magic to frustrated and stressed out parents or teachers who have been dealing with challenging problem behaviors for years. I can promise you ABA isn’t magic. :-)
 ABA is an ongoing and fluid process of manipulating the environment based on a solid understanding of Operant Conditioning in order to strengthen or weaken behavior. ABA makes specific behaviors seem really rewarding to a child, or really pointless.

**Suggested Reading:

About Behaviorism by B.F. Skinner
Copyright T. Meadows 2011. All original content on this blog is protected by copyright. Powered by Blogger.
Back to Top