Photo source: www.hamermetalart.com, www.393communications.com

What’s “NR” you ask? A common way to collect data after a trial in which the learner not only did not give a correct response, but didn’t respond at all, is to score “no response” (NR).
While motor actions can be prompted if the learner does not do anything, vocal responses cannot. I say to my staff all the time, “we can’t reach into his/her throat and pull out words”. So if you say to your client “What color is the sun? YELLOW” and they just stare at you, then that was a “no response” trial.

Many, many moons ago I worked at an early intervention clinic. We had one client in particular there, let’s call him Sam. Sam was the bane of my existence for a while, because he made me feel like an incompetent idiot.
 See, Sam was a very bright little boy with the most beautiful smile who could sing songs, answer questions, do simple academic tasks, and engage in various play skills. But then, Sam would hit a wall in his responding. He would remove all eye contact, stop smiling, and just stare blankly at…nothing. I haven’t met anyone since who could be looking directly at you, yet not looking at you at the same time. When Sam got like that he would not emit any of his target responses independently. This meant all motor actions were prompted, and good luck trying to do anything that required vocalizing. I just did not know what to do when this would happen, and it made me nervous to work with Sam because I knew it would happen at some point.

Sam is who I think about when I am working with staff who are having a hard time “connecting” with a client in the session. I can absolutely relate to how it feels to bring your A-game, put on your animated face, and get a lot of nothing in return. It’s frustrating, and makes you doubt your skills.

When correct responding disappears from the session, some clients may turn super silly and distractible, or some may have a spike in aggression. Just between you and me, I would much rather deal with one of those scenarios. It’s the completely checked- out individual that I find to be the most difficult…..it is kind of like your clients body remained in the chair, but the rest of them got up, walked out of the building, and is headed somewhere FAR more exciting.

So if you are working with a Sam or two, here are a few things that definitely do not work, are ineffective, and should be avoided:

·         *Waiting the client out – I have seen a few therapists try this one, and usually the client is perfectly content to keep staring into space as you wait them out.
·        * Continue teaching/Keep up the status quo – Think of it like this, if your client has completely stopped any correct responding and you just keep plugging away: Is learning happening?
·       *  Speak louder – Sound silly? I see it a lot, and back in the day I was guilty of this one too.
·       *  “Saaaam…..Sam!....Helloooooo, Sam?” – If your client is not responding to demands to touch, give, open, or talk, odds are they also will not respond to their name being called.


Now that we got all the stuff that does not work out of the way, I really only have one suggestion for what you SHOULD try when those non- responsive blues kick in. It may be just one suggestion, but it can look about 900 different ways depending on the learner. 

Change something about YOU.

What my staff usually say to me (and how I used to look at this back in the day) is: “I tried this, and that, and this, and Sam just won’t attend/listen/respond! I don’t know what else to do to get him to (insert whatever response the therapist is expecting)”.

What I am suggesting, is flip that statement on its head and instead ask yourself: “What can I do differently that will motivate Sam to respond? Am I interesting? Am I reinforcing? Would I want to attend to me? Is this program interesting? Are these materials engaging? When did I last reinforce any of his behavior? Is my frustration/annoyance showing on my face? Does my voice sound irritated? Am I moving through targets too quickly? Too slowly? How can I be more fun?”.

See the difference? Instead of unintentionally blaming Sam for his lack of responding, first blame yourself. Then, look at your options and start trying them out to see what is effective.  I am a big fan of “Let’s try this and see what happens”. Even if you try something and it fails, you just learned 1 thing that does NOT work. Which is still progress.


** Recommended Reading: 


Photo source: www.mymetroparents.com, www.autism.lovetoknow.com

Here is a very, VERY, common experience that I have when meeting with the teachers of a client:

"Oh, he is doing just GREAT this year! We aren't having any problems"
"Nope, we aren't seeing ANY of that at school"
"What social skill deficits??"
"Sometimes I have to tell him to do something over and over, but other than that everything's fine!"

For ABA therapists/BCBA's who see clients at school, OR your client receives non-ABA therapies (such as OT or Speech) sometimes it can feel like we are speaking 2 different languages or talking about 2 completely different children. Have you ever experienced that? I have, and continue to experience it.

I think first of all it is helpful to put yourself in the shoes of the non-ABA professional. They may not share your perspective, methodology, or clinical training. Also, they may not have as much history of your client as you do. Just think about one of your clients and what they are like at home. Now think about that same client at school. If you were the teacher and never saw that child at home, what would you think about their capabilities? See what I mean?

So once you understand that the teacher could have a different experience of your client, next it is important to make sure everyone has similar levels of expectation. I find pretty often that if I am meeting with a client's school team and having one of those "Are we talking about the same kid" moments, its a good idea to back up and address Expectations.
From working closely with my clients and seeing them in a 1:1 therapy setting, I get to know how well they can perform. I know how many words they can say, how many colors they can name, and how quickly they can come out of a tantrum. The school team does not always have the opportunity to get to know your client this intimately, so you have to share what you know! I might be sitting in a meeting thinking that my client can do FAR more than work on tracing letters, but the teacher may be sitting in that same meeting thinking that tracing letters is a perfectly reasonable goal. So a great place to start bridging the gap between the ABA team and the school team is by outlining expectations. What is expected of the child? Are the goals developmentally appropriate? Are the goals challenging enough based on what the child can do in a 1:1 setting? Are non- academic milestones being addressed, like socializing with peers or waiting to access reinforcement?

Here are a few more tips that I have found helpful when working collaboratively with school staff:
  1. Provide a brief snapshot of information to the school team that summarizes what goals are being worked on during home therapy. I have found it can also be helpful to share video clips of therapy sessions, because some teachers I interact with have no idea what happens during an ABA therapy session. The may not know that my client is fully capable of sitting quietly, labeling animals, or manding for reinforcers.
  2. Consider sharing resources on basic ways to maximize teaching, such as how to deliver reinforcement or how to deliver a demand. Now, the last thing you want to do is alienate or offend the school team. A teacher with 25 years experience will not want to be told how to deliver a demand. So use polite, respectful language. For example, "Here is a brief handout that lists some strategies we have found to be very successful when working with Jared at home".
  3. Use specific examples and concrete, simple language (translation: NO jargon) to help the teachers pick up on skill deficits they may be overlooking. A problem I see often is the teacher will state that my client is doing so well that they don't need the ABA therapist in the classroom. I then have to, tactfully, point out that the very reason my client is doing so well is because the ABA therapist is in the classroom. Realize that the teacher may not pick up on everything the ABA therapist is doing to keep the client moving through their school day.
  4. Give the teacher immediate feedback (if possible). To give in the moment feedback you need to be in the classroom on a regular basis. If you aren't allowed in the classroom, you can still ask the teacher specific questions to draw out detailed information and then give them feedback based on that information. If you are able to be in the classroom, then definitely grab opportunities to prompt the teacher and quickly praise, OR to gently alert the teacher when to intervene. For example: "Ms Katie, you told Jared to clean up the blocks and instead he went over to the kitchen center. This would be a great time to use that gestural prompt I showed you". 
  5. Sometimes the teachers really are not having difficulty with your client inside the classroom, but its because demands are avoided and problem behavior is not corrected. Examples - Teachers avoid calling on your client, taking items away from your client, or redirecting perspective behaviors. In order to avoid vocal protest or a tantrum, demands become optional requests.
  6. Data is your friend. Some of the experiences I reflect on where the teachers were super adamant that my client was doing "just fine", required a bit more elbow grease than just some handouts and gentle prompting. In those situations I would observe in the classroom and collect data on a specific behavior, such as prompt instruction following. Its one thing to tell a teacher that they are regularly dropping demands. Its a much more powerful thing to show the teacher on a data sheet that during a 2 hour observation they dropped 15 demands. Again, remember your goal is not to alienate or offend. Once you hit the teacher with the data, follow up with help or support. For example, "When we work with Alice at home we have a specific procedure for gaining prompt compliance. Can I show it to you?"

Hopefully, your take away from this post is that when you have those "Are we talking about the same kid?" moments that you are not alone!
 It's important to remember that professionals from other fields have differing viewpoints about learning and behavior, and even if you think a behavior is very maladaptive they may not see it as a problem.
Its just realistic to expect that non-ABA professionals will not think the way you think, which means they won't share your perspective. The key is approaching people with a motivation of collaboration, not division, and to show the school staff that you are there to help.


Recommended:

Increasing teacher intervention implementation in general education settings through consultation and performance feedback. Noell, George H.; Witt, Joseph C.; Gilbertson, Donna N.; Ranier, Deborah D.; Freeland, Jennifer T. School Psychology Quarterly, Vol 12(1), 1997, 77-88



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