Today's QOTD is an amazing & fun discussion that I had the privilege to join, with the dope people over at: "ABA Inside Track".

"Special interests" are what we used to refer to as "obsessive interests/ritualized play/info dumping" or restrictive, repetitive interests or conversation topics.

If you are an ABA peep, or a caregiver of an Autistic, then you know exactly what I'm referring to. For non-Autistics, it can be hard to understand the intense interest (often to the exclusion of other important tasks and activities) in Toy Story, or Thomas the Tank Engine, or obscure 1970 bands, or construction sites, or objects that spin, or Mickey Mouse Clubhouse.

A unique special interest is an item, show, song, toy, etc., that sparks a very intense, and very elaborate fascination. If there is a toy or figurine, then ALL the figurines must be purchased. If there is a DVD or TV show, then the ENTIRE show must be watched, with 0 interruptions. If the interest is a place or location (such as a special interest of watching garbage trucks), then we MUST go watch the thing, at the place, right now.

There is an urgency to special interests that makes it difficult for teachers, therapists, caregivers, to transition the individual to other activities, or away from the special interest.

So how do we deal with this?

Well, the old way is to try to remove or lessen the fascination. To try to block or put away the interest, particularly if it isn't "age appropriate". To say "no, not right now", or "we're done with that", or "stop talking about that".

But is that the way we should approach this? Is that helpful or healthy, long term? And what does that say to the person with the special interest? Who may not cognitively understand why we CANNOT watch elevator videos on YouTube all day, every day.

Instead, let's talk about ways to include, embed, and incorporate special, unique interests into everyday life. Into instruction, into therapy, into school, into intervention. Think it can't be done?

Well, research would disagree with you. ;-)

Take a listen! This is good stuff.

ABA Inside Track Podcast, Episode 160

*Recommended Reading:

Autistic 'Obsessions' and Why We Really Need Them

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Tameika Meadows, BCBA, Blog Author

I don't work with adult clients often, but I do regularly work on life skills/building independence, and pre-vocational training stuff with children and adolescents.

The thing about adulting is that trying to shove a bunch of information and life lessons into your grown child is a bit too late. Especially if we're talking about Autistic adult children who may or may not ever live independently, may or may not hold down steady jobs/have a career, and may or may not attend college or technical school.

Wayyyy before you think you need to start teaching this stuff, is when I recommend teaching this stuff. :-)

For any parent, its a hard thing to look at your 10 -year- old and start thinking about teaching them to do laundry, independently grocery shop, change a flat tire, or shop online. But, if you expect your child to do all these things one day as an adult, then yes, absolutely start teaching it early.

Your teen or adult child can start learning today, to do things like:

1. Personal care/Hygiene/Grooming
2. Shopping & Money Management
3. Electronic Use & Internet Safety
4. Vocational Training (*which should be a natural extension of interests, hobbies, or strengths)
5. Driving or Navigating Public Transportation
6. Time Telling/Time Organizational skills
7. Employment Seeking (resumes, interviews, etc.)
8. Self-Advocacy/Assertiveness ---- probably my #1 Adulting 101 skill to teach

For children with disabilities (not just Autism), it may take more time, more repetition, and more real-world practice for these skills to be taught. Which means starting sooner rather than later is the way to go. Think about your own adulting for a second-- when you first left home, did you know how to scramble eggs without burning them? Or manage a credit card responsibly? Or negotiate with a pushy salesman when buying a used car? If you answered "yes" to these questions, then you were far superior to most of us! 

The reality is that whether your child will ever be able to live separately from you or not, as a parent I'm sure you want to help them be as independent as possible, and be able to make decisions about their life/have a say in their own life. Teaching some common 'Adulting 101' type of skills can be the way to do this, and be sure to combine that instruction with actual real world practice. Despite what we may like to think, school will not teach our children everything they could possibly ever need to know by graduation day. Nope.

What do I mean by real world practice? Well, I've worked with high school age clients before who received vocational/life skills training at school, or through a special program that helped them get part-time jobs. The problem was, these skills didn't generalize outside of those settings. If Charles learned to cook chicken breasts at school with Ms. Larson, that did not automatically mean he could cook chicken breasts at home, with Mom and Dad. If Kacey helped out in a local daycare classroom every Tuesday afternoon, that didn't not mean she could successfully baby-sit her younger brother at home.

Like any other skill, life skills need explicit, intensive instruction, as well as multiple generalization opportunities in real world situations. Multiple generalization opportunities means that the instructor/supervisor needs to differ. The setting needs to differ. The materials/items used need to differ.

Don't just teach your child to wash/load the dishes at home. Let them practice at the neighbor's home, at Grandma's house, etc. The steps of the skill will vary a bit as it is generalized across opportunities, and that's a good thing! There are very few adulting tasks that are done the exact same way, every time. We also know that many Autistics lean towards rigidity and sameness of routine, which can be a good thing or can be highly detrimental to learning if it gets in the way of doing something differently. For example, if the sink, dishwashing liquid brand, or the equipment used (e.g. type of dishwasher) change, can your child still wash the dishes?

It is hard to look at your children when they are young and know with certainty what their future holds. That has nothing to do with Autism, I think any parent would agree with that. Since we don't know what the future will bring, it makes sense to start preparing our children for an uncertain future now.

You may be wondering, "How young is too young to focus on this?". It may surprise you to learn that I start teaching life skills (Adulting 101) with clients as young as 2 or 3. Yup, its true. 

A toddler can learn to clean up their toys. A toddler can learn to put their empty cereal bowl in the sink. A toddler can learn to pour their own juice. A toddler can learn to put dirty clothes in a washer, or pull clean clothes from a dryer. Why not?? If your children are young and you don't know where/how to start with this, just start with teeny-tiny baby steps:

• Let your child help as you complete household chores.
• Slow down before leaving the house, and let your child put their own shoes on, or put their own coat on, or grab their own bookbag.
• Cooking is a life skill. As early as you can, introduce no-heat recipes such as making a sandwich or fruit salad.
• When in public settings, help your child pay for their own meal, or hand the cashier money for purchases. Let your child place items on the conveyer belt at the grocery store, or teach them to shop by giving them a visual grocery list.
• Allow older children to have some responsibility for younger children. Let your 6 -year-old help you care for the 1-year-old.

There are SO many resources out there for teaching life skills and increasing adaptive functioning. This doesn't need to be hard or overwhelming! 

Ask your child's therapists for help and ideas, or talk to their school and see if there are any specialized trainings, classes, or programs available for students on the Spectrum. Most school districts have far more programs and community connections than most parents know about.

You got this!

RESOURCES- 

Functional Skill Training

ASD Life Skills

Essential for Living  Assessment Tool

TACA Life Skills

Total Spectrum Life Skills

Teaching Everyday Life Skills

Spectrum News: Severity predicts autistic children’s ability to learn life skills

Organization for Autism Research: Transition to Adulthood

The Assessment of Functional Living Skills

The Life Skills Lady

Transition to Adulthood Research Findings

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Tameika Meadows, BCBA, Blog Author

Related Posts: NET, Program: Toy Play


A great program for teaching or increasing appropriate play skills would be: Play Stations.

I usually teach this during NET portions of the session, and the specific way it is implemented will vary according to client age, current play ability, and the setting. So what follows should really be considered a template that will need to be individualized to your specific client(s).

Teaching play stations would be ideal for a client with play deficits, to teach independence/leisure activities, or for pre-school age clients struggling in that setting.
Many of my young clients spend their time at pre-school/daycare wandering aimlessly around the room, or engaging in problem behavior. In that type of setting there's often less of a strict schedule of activities, and more "free play" time with multiple choices around the room. So the client would be at a disadvantage if they are unable/unwilling to interact with the play choices.

A play station is just an all-contained area for play with a related group of toys. For example: clay/Play Dough area, play kitchen area, water play area (I like to include sensory play as well), blocks/Lego area, etc. Think of a typical pre-school classroom. The room usually will have specific play areas sectioned off, in what teachers often call "centers". Toys stay in the specific designated area, and there are many choices available for the children to rotate through.
A play station could also include one themed toy, such as a carwash toy, a marble maze toy, or a railroad set. The options are endless.

I like to label the play areas, this can be done textually or visually, and also include teaching prompts for both the therapist team and the parents/caregivers. A huge benefit of this program for me, is that it's often so easy to generalize to the parents/outside of therapy sessions.

Teaching prompts for the therapist team could include current targets that can be embedded into the play. For example, at an art play station the therapist could embed color ID, tracing/writing, imitation, one step instruction, sharing or turntaking, and multiple fine motor targets ("open the ______","pick up the _______, "use the scissors to cut", etc.).  Mastered targets could also be embedded as a maintenance skill or to target generalization across stimuli.

Teaching prompts for the parents or family could include suggested ways to interact/engage the child with the play, as well as a handful of teaching examples (that have been modeled for the parent during therapy sessions). For example, at a water play station the parent could start an imitation game of pouring out water, implement manding trials to have the child request, or redirect the child to a play station activity when the parent needs to take a phone call, do laundry, etc.

For older clients or as appropriate, play scripts could also be used to teach this skill. For example, a play station with dress up clothing could be made with the following script used as a prompt:

Characters: Civilian (C), Firefighter (F)
Props: Firefighter's hat, empty spray bottle, crayon drawings of fire

1. C: "Oh no! There's a fire."
2. F: "Don't worry, I'm on the way to help."
   (Make fire engine sounds and drive a pretend fire truck over to client)
3. C: "Help, there's a fire"
   (points to crayon drawing of fire)
4. F: "I'll save you!"
   (squirts crayon drawing with empty squirt bottle)
5. C: "Help, there's another fire!"
   (points to another crayon drawing)
6. F: "I'll save you again"
   (squirts second crayon drawing)
   --Continue until all fires are out--
7. C: "Thank you Mr./Ms. Firefighter."
8. F: "You're welcome!"

Over time this script prompt can be faded, the acting roles can be alternated, and the language used can vary for spontaneity.  For example, the firefighter can pretend to be unable to put the fire out to see how the civilian will respond.

Keep in mind that this program is aimed at teaching play skills, meaning it should be FUN!
If the client isn't enjoying interacting with the play stations then reinforcement needs to be examined, perhaps the time interval is too high, perhaps the adult isn't all that fun to play with, or maybe the play choices available just aren't that interesting.
Does the client love straws? Iron Man? Beads? My Little Pony? Insert their interests/likes into the play stations, and remember to bring along lots of creativity when designing their play choices.

Below are some examples of varied play stations. All images found on www.pinterest.com:

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Tameika Meadows, BCBA, Blog Author

And there absolutely is an art to it.

I will include TONS of links at the bottom of this post, because it's important to understand this post won't be a paint-by-numbers kind of thing. Teaching a new skill or behavior is not as simple as "Do this-Do this-Do that-Done".

If you took 3 BCBA's and asked them to teach a child to ride a bike, you could end up with 3 different ways to teach that skill. And that's okay.
The expertise, related experiences, and unique professional identity of each BCBA will impact how they design treatment, and how they teach skills. As long as the end result is the child independently riding their bike, then the skill acquisition was a success. The exact path to the finish line is allowed to vary.


Parents and ABA professionals reach out to me fairly frequently to ask "How do I teach my child/client to (fill in any behavior here)". My answer is usually some form of "I'm not going to be able to answer that for you in a brief email". Teaching skills, aka programming, aka skill acquisition, requires thinking/intentional planning by someone with knowledge of the learners individual skillset, deficits, and strengths (professionals refer to this as "assessment").
If you want shortcuts and don't want to think, or you want to rush over planning, or you don't know the learner very well, then you have no business designing treatment for them.

If you are a parent reading this and you work with an ABA team, ask for training in skill acquisition. If you are a parent who does NOT have the help of an ABA team, my first piece of advice is to get that help if you can. Even if you consult remotely with a BCBA for a few hours a month, that would be far more helpful than trying to implement skill acquisition on your own.
Trust me, the BCBA had to learn this skill via graduate level coursework, supervised work experience, and hands-on training with multiple learners. Translation being: skill acquisition is not as simple as it looks.


So to wrap up, if you are a parent needing help teaching your child a new behavior (making a bed, putting shoes on, completing a puzzle, putting toys away, etc.):

1. Get as much professional assistance as you can afford. Emphasize your need for parent training to that professional
2. Expect to put time into learning about skill acquisition. One meeting with a BCBA will likely  not be enough
3. Have a solid understanding of the following: what is the terminal goal (how do you define the skill as being "learned"), how far away is your child from the terminal goal (baseline data), what steps will your child need to have in order to learn the skill (pre-requisite skills), and what concepts do YOU need to know in order to teach the skill (do you know how to prompt? do you know how to reinforce? do you understand motivation?)

Free Parent Handout: The Art of Skill Acquisition

*Links: (some great resources here!)

Heflin, J., & Alaimo, D. F. (2007). Students with autism spectrum disorders: Effective instructional practices. Upper Saddle River, NJ: Pearson/Merrill Prentice Hall.

Crockett, J. L., Fleming, R. K., Doepke, K. J., & Stevens, J. S. (2007). Parent training: Acquisition and generalization of discrete trials teaching skills with parents of children with autism. Research in developmental disabilities, 28(1), 23-36.

Designing Instructional Programs for Skill Acquisition

Why Discrete Trial teaching works

https://www.iidc.indiana.edu/pages/a-brief-explanation-of-discrete-trial-training

Leaf, J. B., Oppenheim-Leaf, M. L., Call, N. A., Sheldon, J. B., Sherman, J. A., Taubman, M., … Leaf, R. (2012). COMPARING THE TEACHING INTERACTION PROCEDURE TO SOCIAL STORIES FOR PEOPLE WITH AUTISM. Journal of Applied Behavior Analysis, 45(2), 281–298. http://doi.org/10.1901/jaba.2012.45-281

https://www.aare.edu.au/publications-database.php/1200/Teaching-functional-skills-to-autistic-children-in-natural-settings:-Skill-acquisition,-maintenance-and-generalisation

Using a Task Analysis for Instruction

•  Luiselli, J. K. (2008). Effective practices for children with autism: Educational and behavioral support interventions that work. New York: Oxford University Press.

Teaching Tips for Children and Adults with Autism

https://www.letstalksls.com/resource-library/autism/dos-and-donts-teaching-children-autism

Secan KE, Egel AL, Tilley CS. Acquisition, generalization, and maintenance of question-answering skills in autistic children. Journal of Applied Behavior Analysis. 1989;22(2):181-196. doi:10.1901/jaba.1989.22-181.


Anderson, S. R., Taras, M., & O'Malley Cannon, B. (1996). Teaching new skills to young children with autism. In C. Maurice, G. Green, & S. C. Luce (Eds.), Behavioral intervention for young children with autism: A manual for parents and professionals (pp. 181-194). Austin, TX: Pro-ed.

Sundberg, M. L., & Partington, J.W. (1998). Teaching language to  children with autism or other developmental disabilities.  Danville, CA: Behavior Analysts, Inc. 

Writing ABA Programs

Skill Acquisition: Programming Sequence

Everything You Ever Wanted to Know About ABA

Read more »

Tameika Meadows, BCBA, Blog Author

If you're an ABA professional then you're likely already familiar with BST (Behavior Skills Training). 

The 4 basic steps of BST are as follows: Instruction, Modeling, Rehearsal, & Feedback.
Lather, rinse, and repeat as needed.

I LOVE utilizing BST with supervisees and direct staff, but also when intensively targeting parent training. Such as with a case that has low hours, so instead of traditional therapy we utilize more of a parent coaching model.
BST is super effective, and makes you look like a genius who can teach anything to anyone. If it sounds like I'm overselling, shut up. No I'm not. BST really is that amazing.

If your parent training strategies could use some help, or aren't always super effective (particularly in producing long lasting change) then keep reading for some rock star parent training tips!

Here is each BST step explained in a bit more detail:

Instruction – You are most likely already doing this. Put simply, this is telling the parent what to do. The problem is, many professionals start and end at this step. As in, "Well I told the parent what to do like 8 times already, but they still aren't doing it!". Effective teaching should include more than just telling. 

Modeling – Put simply, this is SHOWING the parent what to do. I need to go beyond just putting up a visual, or walking the parent through a transition, as much as possible I need to show the parent what to do with their actual child, in the actual target situation. Meaning, if I am teaching the parent how to reduce meltdowns at Publix, then we need to go to Publix. 

Rehearsal – How often do we (I'm including myself here) forget about this step? This is one I have to remind myself to do, because my tendency is to jump in and model, but then I neglect to allow the other person to practice while I watch. If you're like me, you have already learned that skipping this step is no bueno. We all like to practice new behaviors to ensure mastery, especially complex behavior chains. And most of the things you teach to parents will meet the criteria of a complex behavior chain. 

Feedback – This last step also can be overlooked, or forgotten. I find that most of my supervisees struggle with giving immediate feedback. Meaning, tell the person what to correct while they can still change it. Don't wait until the parent has completed the entire toileting procedure with their child to tell them they did the 1st step wrong. That's extremely frustrating! It also makes it more unlikely that the parent will perform the behavior correctly when you are not around, because you just let them practice errors. Just like we do with our clients, be sure to provide both positive praise statements and corrective feedback. 

Here are a few examples of BST in action:

Behavior: Transitioning child to therapy table

Instruction: Explain to the parent exactly what they need to do. Be sure to ask for questions, and answer them fully

Modeling: Show the parent exactly how you want them to transition the child

Rehearsal: Say to the parent "Your Turn". Observe closely

Feedback: Both in the moment and once they are done, give the parent specific information about what went great and what needs improvement. Skip the jargon, or define any terms used. Also be sure to ask the parent where they need more help, or if any part is confusing

Behavior: Implementing a Manding Trial with the child

Instruction: Explain to the parent exactly what they need to do. Identify needed materials. Be sure to ask for questions, and answer them fully

Modeling: Show the parent exactly how to run a Manding Trial

Rehearsal: Say to the parent "Your Turn". Observe closely

Feedback: Both in the moment and once they are done, give the parent specific information about what went great and what needs improvement. Skip the jargon, or define any terms used. Also be sure to ask the parent where they need more help, or if any part is confusing

If BST makes parent training ridiculously easy, then its always effective all the time, right? Wrong. Here are some common parent training pitfalls I see all the time, that can hinder the effectiveness of your BST procedures - 

Common Parent Training Errors

1. Not enough training examples: The child regularly has meltdowns at grocery stores, so you spend 2 hours inside a Publix with the parent. Whew....they should never have that problem again. Ummm, no. What about when the child has problem behaviors at Kroger, or Sams Club, or Whole Foods? Each store is different and may have differing maintaining variables, so the parent will likely need practice in each store. If this is not possible then at least during the instructions phase talk the parent through how to address the behavior across different settings.
2. Not enough practice: Very closely related to the previous point, is letting the parent briefly jump in for rehearsal and then immediately you take over the session again. When I see this with my staff, I usually say to them: "YOU are not the one who needs to learn this. You already did that". Remember who the student is in parent training (the parent). They need lots and lots of practice under the watchful eyes of the team, on an ongoing basis. 
3. Letting the parent practice errors: Would you let your client practice errors? No, right? Well then why would you sit back and let the parent practice errors? Errors impede learning. Sometimes staff allow this because they feel too awkward or hesitant to correct the parent. Again, would you correct your client? Then what is the difference? You are teaching the parent a new behavior, and in order to learn effectively they need error correction procedures.
4. Failure to teach concept of Reinforcement: This is a big one. Many times when I follow up with a parent about their parent training I hear, "He/she just won't do (target behavior) when you guys aren't around!". Further digging usually reveals what the actual problem is....their child expects to contact (gasp!) some reinforcement for their behavior. Many parents do not understand this, and so they approach the child outside of therapy sessions with a complex and difficult demand, that can earn...nothing. Not surprisingly, the child immediately kicks off problem behaviors. Take the time to make sure the parent understands reinforcement is the glue that makes behaviors stick. It needs to be immediate, differential, and valuable to be most effective.
5. Failure to select socially valid parent training goals: Yes, parent training should have goals like any other intervention. This is the #1 error I see, so I'll discuss it last. As the BCBA/supervisor do you tell the parents what their parent goals are? I hope not. Social validity basically means that the individuals/stakeholders requesting the treatment agree that the treatment is important and helpful to them. In order to do that, I have to work together with the parents to create parent training goals. This also provides opportunity to identify unrealistic goals ("I want her to always be happy"), or to help parents understand how concretely a skill needs to be broken down to intervene on it. If the parent you are working with has no input on parent goals, or refuses to participate in the goal selection process, then unfortunately, you have a bigger problem on your hands.

Bottom line: If the parents cannot produce the same, or at least similar, behavior change results as the ABA team when they are alone with their child then parent training needs to be modified. It needs to be revised, increased, or a common pitfall has not been addressed yet. The same way you wouldn't blame the learner for not learning, you shouldn't blame the parent for ineffective parent training. Review the BST guidelines, and come up with a new plan that works for the parent.

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Tameika Meadows, BCBA, Blog Author

Photo source : www.thirtyhandmadedays.com, www.journeyofmylifendestiny.blogspot.com 

*Recommended post-- Writing ABA Programs


My last post on programming was really for professionals, but this one should help parents/caregivers understand the "why" and "how" of teaching new skills.

Typically with ABA treatment, intake/assessment is followed by treatment planning, which is followed by creating individualized programs, which is followed by teaching those selected programs. What's a program you ask? Basically, a program is what is being taught to the learner. If your child is receiving ABA services, they probably work on multiple programs every single therapy session.

I find that most parents/caregivers have a very vague understanding of what their child is working on and why, and how skills connect to each other. Due to this lack of understanding, some common problems that can arise include:

• Expecting the ABA team to teach your child everything, all at the same time
• Expecting skills to be taught in a matter of days
• Parent gives little to no input on treatment planning/can't think of anything they want to work on
• Confusing a "Program" with a "Target"

These are the main problems I see, although there are many more that can pop up when parents don't understand how the teaching part of ABA therapy works (yes, ABA is far more than behavior reduction!).

I always recommend to parents to ask questions, observe therapy sessions, utilize the BCBA, and review/look at the data regularly. These components are like the blueprint of the building, or anatomy of the cells of your child's treatment. If you are confused about the services your child receives, I would ask: how regularly are you viewing that blueprint? How involved are you with the anatomy of it? It took the staff and BCBA on the case extensive training, years of experience, and college coursework to have a solid understanding of what they are doing. How much harder do you think it will be for YOU to understand what they are doing?

I love to remove confusion (just call me Confusion Off) so let's address each of the common problems I see, one at a time:

• Expecting the ABA team to teach your child everything, all at the same time - Definitely the biggest misconception I see. Intake/assessment is usually the point where the BCBA discusses goals for treatment with you. From the assessment results and this conversation, the BCBA will prioritize goals based on a variety of factors such as: goals that can replace current problem behavior, goals that are needed for daily functioning, goals that address the most pervasive developmental delays, etc. What this means in plain English is we cannot teach everything, all at the same time. It's just not possible. Plus your child would hate that. The reality is other non- clinical factors must be considered too, such as how available is the child for therapy, how many hours of therapy a week can the family afford, how many hours of therapy a week can the ABA therapist provide, etc.. When you add up all these factors and weigh the highest priority goals, this does mean that some skills may not be targeted right away. Your suggestions to keep adding new goals are not being ignored, it's likely that the things you want to add are not priority, the child already has the maximum number of goals for the moment, or new goals won't be added until performance improves.
• Expecting skills to be taught in a matter of days - When you start climbing a ladder, do you put your foot on the 5th rung? No, right? Teaching is very similar to that. When teaching a new skill, there is this thing called a "pre-requisite skill". This means there is something the child needs to be able to do before they can move on to more complex or advanced skills. For example, many play skills require the ability to imitate. Why? Well, if I am trying to teach a young child to play with a Barbie doll I am going to do this by sitting down with them.....and playing with a Barbie doll. I know, this is complicated stuff :-) But what happens if while I am enthusiastically playing, the child just stares up at the ceiling and drops their doll? The child needs to be able to watch my play and imitate it, in order for me to teach them to play on their own. So before I can tackle play skills, I first need to work on teaching imitation. Much of ABA treatment involves these kind of careful ladder steps. We have to work our way up that ladder, which depending on the learner can take days, weeks, or even months. But its super unrealistic to assume the learner will just fly through learning new skills. Expect it to take time.
• Parent gives little to no input on treatment planning/can't think of anything they want to work on - This may sound like it would never happen, but it absolutely does. A parent initiates ABA services, and during the intake makes statements like "I just want him to be normal", "I'm fine with whatever you think we should focus on", or "I just want her to be happy". Unfortunately, I don't have any curriculum for teaching "normal" or "happy". So in these kinds of situations what can happen is the ABA team puts together a treatment plan that is not functional for the learner. For example, the BCBA may decide the child should work on manners to improve their social skills. However the family isn't big on manners, and this is not an important goal to them. So when the ABA team is not around, who is practicing manners with the child and reinforcing this skill? Likely nobody. Which means the skill won't progress, and it probably won't  generalize. Think of the ABA team like a group of painters showing up to your home. We have our coveralls on, our paint, and our paintbrushes. But...what exactly do you want us to paint??
• Confusing a "Program" with a "Target" - "I told you I wanted him to learn his body parts, why is he just playing with a Mr Potato Head toy?". If I did not have the knowledge I have, I would find much of what the ABA team does highly confusing.  It looks like we teach random flashcards, meaningless games, and senseless activities over and over again, that have nothing to do with the reasons parents initiated therapy. This could not be more inaccurate. Every "program" is like a menu at a restaurant. You open the menu because you want something to eat or drink. But you can't tell the waitress "I want to eat". You need to be more specific. So you read over the menu and see the hamburger section. But you can't tell the waitress "I want a hamburger". You need to be more specific. So you choose the exact hamburger, and the exact toppings and tell the waitress "I want a hamburger-well done- with no onions and extra cheese". Make sense? Bringing it back to ABA treatment: menu= overall objective, hamburger= program, specific hamburger= target. When a parent says to me "I want him to play with his brother". What I hear is "I want him to improve his social skills", which means breaking that down to improving and reducing behaviors, which means breaking that down to first learning to play with me, then learning to play with me and a peer, then learning to play with just a peer. Whew. Designing treatment is not quick, or simple. Rest assured, the issues you initially discussed with the BCBA are being worked toward, but we have to break the skill apart in order to teach it.

With any child, there will be skills that come easy and skills they struggle to learn. There will be things they should be able to do but cannot, and other things they do super early or super easily. Thats just part of being a human. It will drive you crazy if you look at your child with Autism as a collection of deficits and "not there yet's", and it will also cause you to overlook all the progress they are making right now.
Take time to appreciate those baby steps, sometimes baby steps are all we have.

*Free Resource: This simple handout helps explains common program names many BCBA's use (what the program is supposed to teach).

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Tameika Meadows, BCBA, Blog Author

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.

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 clinical skills.

When correct responding disappears from the session, some clients may turn super silly and distracted, 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 non-responsive individual that I find to be the most challenging…..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.

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. And lets be real, your session is only so long. The client is quite aware that you will tire of this game before they do :-)

·        * 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.

·       *  “Saaaam…..Sam!....Helloooooo, Sam?” – If your client is not responding to task demands or any of your instructions, 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 NR 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: 

ICEL

ABA is FUN!

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Tameika Meadows, BCBA, Blog Author

Photo source: www.ciam.edu, www.shootthecenterfold.com

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

Disclaimer Time :-)

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.

We already reviewed the challenges of designing intervention for early learners/individuals who are new to therapy. Now let's talk about the challenges of designing intervention for the advanced learners, or those who are only mildly impacted by their diagnosis.

To make sure we're are all on the same page, what do I mean when I say an advanced learner?

• Typically older, or if younger this is an individual who is only mildly impacted by their diagnosis (Autism is a SPECTRUM)
• Typically in a regular education classroom with some supports. If this type of child IS in a self- contained room, it is usually only because of problem behavior
• Deficits are NOT pervasive; the individual may be on grade level academically, but struggles with self-help skills. Or the individual may have appropriate use of language/be conversational, but has meltdowns on a daily basis
• Typically this individual has problems with communication only when escalated. The ability to communicate, yet the likelihood to aggress when upset, can be highly frustrating to parents/teachers
• Interest in peers, age appropriate toys, or social interaction can often be quite typical. Sadly there can be a strong desire/interest to be social but significant social deficits that prevent this
• Problem behavior rate and severity can range from mild to high. This type of individual may be described as "moody". When they are calm and cooperative, they are a joy to work with/hang out with. However when they escalate, they can escalate quickly and take a long time to de-escalate  

For those of you who will be designing intervention, this type of child is way past Matching, Gross Motor Imitation, and Stacking Blocks..

When I first meet an advanced learner, what usually strikes me is my initial thought of "Wow, why in the world are we working with this kid???". This is the type of client who will greet you, strike up a conversation, excitedly show you their room and their toys, and proudly tell you they just got an A on a science report. But then.......you start to notice some things. Like the child is 9, and the parents report he wears Pull Ups at night. Or the child is 13, and her best friend is the 4 -year old girl across the street. Or the individual is 22, and very much wants a job but cannot keep a job (always gets fired).



It is critical not to lower your expectations of early learners, or to have ridiculously high expectations of advanced learners. People are people, and despite appearances they can need more or less support than you might think.

It frustrates me, but I come across people all the time who don't expect much out of my early learner clients. Or the exact opposite: people who think just because my client can talk and be sociable, that they have NO other problems. Both are unfair, inaccurate, and completely ignore the unique strengths and deficits of the individual. 


There are so many areas of programming you explore with a advanced learners (cooking, vocational skills, shopping/making purchases, science projects/arts & crafts, manners/respecting others). 


Below is a sample of the intervention package for one of my previous advanced learner clients, including typical (see disclaimer) program goals.

Keep in mind that these recommendations are not setting specific. In other words, advanced learners will likely need these structures in place whether intervention takes place at home, at an ABA clinic, in a classroom, or at a work site. Changing the setting does not change what these individuals need to be successful.

Sample Intervention Package 

Teacher to Student Staffing Ratio:	Group Instruction (if aggressive, a 1:1 aide may be necessary)
Teaching Format:	Mostly Natural Environment Teaching, Incidental Learning, and Community Based Instruction
Recommended Intensity:	8-12 hours per week
Reinforcement Schedule:	Variable or fixed interval schedule, for example 25:1 (one break every 25 minutes)
Types of Reinforcement:	Naturally occurring reinforcement (bake a cake, then eat it) should be provided on a thin schedule, as well as Token Economy systems if helpful
Intervention Goals:	Community Outings, Intraverbal Associations, Socio-Dramatic Play, Hygiene, Sight Words, Reading Comprehension, Math Fluency Drills, Sportsmanship, Accepting Change, Resolving Conflict, Social Stories, Chores, Preparing Meals
Watch Out For These:	Over prompting/promoting rote responding (this is why DTT with this individual is not recommended), client curiosity about therapy progress, "splinter skills" learning profile, teaching should include adult, peer, and self-provided reinforcement, don't forget to teach self-management of behavior/self-evaluation of goals, for older clients physical management training for staff becomes vital

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Tameika Meadows, BCBA, Blog Author

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

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

I have 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". For example, having an IEP goal of sitting in Circle Time for 10 minutes, yet the child currently lays on their back, making noises, and kicking the children closest to them. Sitting perfectly still and quiet for 10 minutes is a pretty unrealistic goal if this is the starting point.

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. 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, or being consistently stuck in one or more areas.
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 or disruptive behaviors, or completely checked out from what is happening.

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:	Mostly Discrete Trial Teaching, be sure to include some Natural Environment Teaching
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)

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Tameika Meadows, BCBA, Blog Author