Saturday, February 27, 2016

The Basics: Intervention for Early Learners


Photo source: www.communiquepr.com, www.paperbullets.us

*Note: This post is Part I of a Two Part series.

I have hinted at and made quick reference to Early Learners before on my blog, but this post is all about designing intervention for early learners.

First, another lovely disclaimer :-)

ABA treatments or interventions are not one size fits all, and should never follow a generic formula across individuals. The specific needs and strengths of the individual receiving services will always guide treatment planning and intervention choices. This post is meant to be a helpful guide, not a guaranteed "recipe" to designing intervention.

End of disclaimer.

So if you haven't seen my other posts about early learners, allow me to quickly bring you up to speed:
  • Typically younger, or if older this is an individual who is very impacted by their diagnosis
  • Typically in a self -contained classroom, or attending a school for special needs children
  • Deficits are pervasive; there are significant difficulties with communication, social interaction, repetitive behaviors, toileting, etc.
  • Typically this individual has no means to communicate, other than through problem behavior
  • Interest in peers, age appropriate toys, or social interaction is typically low
  • Problem behavior rate and severity are typically high (if given lots of "free time" this individual would likely fill it with problem behavior)
So now that we all know what I mean when I say "early learner", what are The Basics for intervention?

A problem I see a lot when it comes to non - ABA interventions (special needs schools, the "Autism" classroom at a public school, related therapies) is a lack of starting with The Basics. A BCBA would be able to tell you that when working with an early learner, you won't get very far until you start by helping that individual "learn how to learn". This is often lacking from the various school intervention programs that I visit. For example, having an IEP goal of sitting in Circle Time for 10 minutes, yet the child sits there engaging in sterotypy the entire time. Or, having an IEP goal of reading a short story in Language Arts, yet the child cannot identify letters. I think the main problem is sometimes non-ABA professionals think they are starting at Level 1/Ground Floor, but they really are not.

Regardless of client age, the developmental ability and overall functioning must take priority. I find that specialized programs often overlook this. Just because the child is 9, the best placement may not be the classroom filled with 7-9 year olds. Maybe that child's chronological age is 9, but their developmental age could be 24 months. If that is the case, any goal/target created based on chronological age will be highly inappropriate, and most likely the treatment will be ineffective.

The reinforcement system, communication system, teaching format, and goals selected all need to be particularly modified for early learners. Failure to do this often leads to the child making erratic progress (which to me, is a way of saying "the child learned this, but we don't think it was due to our intervention efforts"), having a "swiss cheese" learning profile, being consistently stuck in one or more areas ("flatline data"), OR a child who is completely checked out of the intervention process.
I recently had the very unfortunate experience of conducting a school observation where my client was physically prompted to complete every single academic task placed before her.....all math tasks, all reading tasks, all matching tasks, all writing tasks, etc.
What is being taught in that scenario? Not much more than prompt dependency.

 I once had a supervisor who used to say early learners are unaccustomed to contacting success in a learning scenario.
Just think for a second about your early learner clients: how often do they come home from school with an "A" grade, a sticker on their behavior chart, or a ribbon they earned for super attending? The answer is probably never, as these individuals are usually the ones in the classroom who are constantly engaged in problem behavior, or completely checked out.

Below is a sample of the intervention package for one of my early learner clients, including typical (see disclaimer) program goals.
Keep in mind that these recommendations are not setting specific. In other words, early learners need these structures in place whether intervention takes place at home, at an ABA clinic, at daycare, or in a classroom. Changing the setting does not change what these children need to be successful.

Sample Intervention Package 



Teacher to Student Staffing Ratio:
1:1 (if highly aggressive, 2:1)
Teaching Format:
Recommended Intensity:
30+ hours per week
Reinforcement Schedule:
Initially 1:1 dense schedule may be necessary, thin this as appropriate
Types of Reinforcement:
Likely tangibles or edibles (cookie, candy, juice, favorite toy car, etc.)
 Intervention Goals:
Parent Training, Manding/Requesting, Toilet Training, Motor Skills, Imitation, Compliance/Cooperation, One Step Directions, Toy Play, Puzzles, Matching, Receptive Identification, Dressing, Tooth Brushing, Waiting
Watch Out For These:
Failure to generalize or retain learned skills, rote responding, school readiness (don’t forget to program for this), high resistance to behavior change, consistency across environments (everyone has to be on same page)







4 comments:

  1. Dear Tameika

    Wow what a blog you have!!! A...mazing!!!!

    My almost 3 year old just got diagnosed. he is so smart, and he speaks in 5 and 6 word sentences (no conversational yet), but his main issue would be he is unpredictable in therapy. When he is in "compliant" mood, everyone is amazed at how many things he can do. For example, he can follow three step commands. But sometimes he just hates the demand, and refuses to go to therapy, and is trying everything possible to slack off. Can ABA teach discipline? Also he is having language burst but along with it, we hear plenty of scripting. Is there a way to reduce that?

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    Replies
    1. Hi there & welcome!

      These are not unusual issues/concerns, particularly if you son is new to intensive therapy.
      There could be multiple reasons why it seems your son runs "hot" for therapy at times and "cold" at other times. Without knowing the specifics, my suggestion would be to discuss your concerns with the case supervisor/the BCBA. He or she will be able to explain how they are addressing these issues, and what strategies will be used to increase compliance/cooperation with treatment.

      ABA can improve or decrease any behavior, so scripting can definitely be addressed as a treatment goal. I would also suggest discussing that with the case supervisor, as that is the person who designs treatment/decides what goals to select.

      Good luck!

      Tameika

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  2. Question: where do you draw your cooperation programs from? ABLLS-R? I'd love to see a post on cooperation programs if there isn't one already. Thanks for sharing your experience in this area!

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    Replies
    1. Thank you for commenting!

      Yes, I pull from Domain A of the ABLLS-R a lot when I am targeting compliance/cooperation. I also have many resources I created that I use for compliance training, based on the literature. Sometimes I use curriculum guides to write programs, and sometimes I just make my own.

      I do have a post on creating cooperative learners, here is a link:
      http://www.iloveaba.com/2015/09/creating-cooperative-learners.html

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