By Mary Barbera, PhD, RN, BCBA-D
Quite a lot of us have negative connotations to the word “work,” and a child with autism is no different! The word “work” often creates a feeling of doom so it’s no surprise that kids with autism often have an aversion to the word, as do many adults!
Many teachers say things like, “do your work and then you can have a break,” so “work” becomes the unpleasant thing to get through before a child can get away from his teacher to take a break. Because children with autism usually have very poor play skills, their breaks can often be unproductive and filled with stereotypical behaviors.
Using an ABA/VB approach, the goal is that our children or students run to the learning table and stay with us as we pair the table and materials with high levels of reinforcement and present content that is mostly easy. Once the child is at the table and responding nicely to easy tasks, we “slip” in demands gradually while we use prompting procedures so it doesn’t feel too difficult and too much like “work.”
Also, using a Verbal Behavior Approach, instead of giving the child “breaks” to get away from us, the materials and the table, we want to try to engage the child during natural environment teaching sessions in between tabletop activities. We want our children to stay engaged with us as much as possible during sessions so they get the most out of their therapy time. Saying, “first work then break” is counterproductive to this approach.
Instead of saying, “come and do your work,” why not try using “learning time” or “come and play with Mommy/Miss Jones” or “table time.” In addition to avoiding the word “work,” I’d also recommend reducing or eliminating “breaks” so your child or client remains engaged with you throughout your sessions.
By Mary Barbera, PhD, RN, BCBA-D
I often hear parents say, “When we call Johnny’s name, he doesn’t respond but when he hears his favorite TV show, he comes running!” One of the hallmark symptoms of autism is the child’s failure to respond to his or her own name.
Parents and professionals often overuse a child’s name both in and outside of autism therapy which can cause more problems. It sounds crazy not to use a child’s name, but so often children’s names are paired with “don’t,” “stop” or “no.”
Think about it, if all you heard was, “No, Sally. Stop it. Sally, don’t do that,” you wouldn’t feel a positive connotation to your name, would you? The same is true, if not truer, for children with autism. If a child’s name is constantly said and paired with demands and “no,” they will respond to it negatively, if at all.
Secondly, adding the child’s name can often add unnecessary information to a request or instruction. If you’re looking at the child and already have their attention, you don’t need to say, “Sally, sit down” when “sit down” will perfectly suffice and avoids the pairing the name with a demand.
My recommendation is to avoid saying a child’s name when placing a demand or saying “no.” Instead, try saving the child’s name for more fun and positive things that they enjoy, in order to create a more positive connection to their name.
For many children, you need to actually teach a child to respond to his name by systematically fading prompts and reinforcement. But, teaching a child to respond to his name can be tricky! Download this worksheet to learn the steps to teach this important skill.
By Mary Barbera, PhD, RN, BCBA-D
I teach children mostly at the table, even very young children. Many Early Intervention providers such as Occupational and Speech Pathologists and even other Behavior Analysts recommend teaching young children on the floor and using more Natural Environment Teaching.
While many people advocate for teaching in the natural environment, ie, on the floor, in my clinical work I have seen significant gains with children with autism using ABA techniques at the intensive teaching table.
During instructional time with me and/or the behavior technician, and here’s why:
Having the child sit at a table with you begins to build instructional control. The child soon realizes that you (the teacher/parent/therapist) are the giver of all the good things. When your child or client is sitting, attending, and eventually requesting, he will receive preferred items and activities.
With most families, I usually only provide ABA oversight for 2-3 hours a week or every other week. With limited time, I’ve got to get in there and assess and plan carefully. Then I need to train one or both parents and other professionals to carry out the program. I need to modify the environment so it is most conducive to learning. If I have a 2-year-old client, for example, who is flitting around the house, then every room has to be sanitized (free of reinforcers and distractions) and there isn’t time for that. My clients are usually severely delayed and the more time I spend following the child’s lead, the more behind they get!
But, when the table and table materials come out, the child knows it’s time to learn, so much more can be accomplished! Sure it may take time to pair the table and the materials and to gain instructional control but once that is done, we tend to see much more progress. Also, it’s a lot easier to train parents or others with less experience to teach at the table. I find that instructional control comes so much easier at the table than in the natural environment, especially for young children with significant impairments.
Do you want to know more about implementing an ABA program at the table? Watch my 3-part video series, including Video 1 (Two Tips to Teach at the Table).
By Mary Barbera, PhD, RN, BCBA-D (Autism Mom, BCBA-D & Best-Selling Author)
Is your child or client with autism addicted to a pacifier?
Many children, especially those with behavioral issues frequently use pacifiers well past infancy. Their parents struggle with what to do about it so to keep them quiet and happy, they usually give in and “plug the child up” with a pacifier.
Older children can also be addicted in the same way to a bottle. Both bottles and pacifiers are both really bad for toddlers and older children because they hamper talking, increase problem behaviors for items, and can be detrimental to normal teeth development (both baby and adult teeth).
These steps should help with weaning your child from a pacifier or bottle if you are not willing or able to go the “cold turkey” route.
- Assess (rate of use, times of day when your child most needs it and when you most need it–ie nighttime, car rides, church, etc.)
- Make a plan with boundaries to wean based on your assessment (I will only feed via a bottle 4 times/day, she will only have a pacifier at nap/nighttime in the car and at church, I will only give one bottle at night when I’m at home sitting in a certain rocking chair).
- If your child likes/has more than one bottle/pacifier, hide or dispose of all others (so they can’t stash them or accidentally find one during non-pacifier times). If you want to keep one pacifier in bedroom and one in the glove compartment of the car, that is fine….you just need to have one or two and maintain control of them.
- If you are going to wean to just using the pacifier at nap/nighttime for instance, create a “Binky Box” to be stored on the high shelf in the closet that the child puts it in the morning or naptime after waking. Don’t take the pacifier and hide it or make it disappear. Instead, have the child put it in the “Binky Box” or “Paci Box.”
- Give a strongly preferred edible or toy for giving up the pacifier and putting it into the box.
- For bottles give the least preferred drink in the bottle and the most preferred drink in a cup. Also pair cup with highly reinforcing videos during non-bottle times.
While your child or client probably will not understand your complex plan, even infants will respond to reinforcement and other behavioral procedures.
If your child is ever crying while trying to access these items, do not give it to them.
Also if they are crying or having problem behaviors while accessing any reinforcement (including blankets, pacifier or bottles) take the item away for at least a few seconds to show her/him that crying will not work!
At the very minimum, children should not have access to pacifiers, blankets, or bottles on demand at any time of the day or night. They need you to help them with boundaries!
Assessing, planning and taking action may be emotionally taxing to you and your child so it’s OK to pick a less stressful time to implement all of this such as after the holidays, when the other siblings go back to school, after a vacation is over, etc. The important thing to remember is that with these 6 steps you can tackle the pacifier problem and help your child.
For children who do not yet speak, I usually recommend teaching 3-5 signs at a time and to teach these signs as mands first. Many of these signed mands will need hundreds of practice trials before a child will be able to request an item using a sign without assistance. Careful prompting and prompt fading across many trials per day is usually needed.
To teach a child to mand using sign language, hold out a preferred item and make sure the child wants the item by giving a “freebie” and/or looking for a reach, eye gaze, or smile. If the child does not want the item, you should not proceed. If the child wants the item and has some ability to imitate, I would then recommend you model the sign.
If the child cannot yet imitate, check for the motivation (MO) and then take the child’s hands and help him or her perform the sign. After the child performs the correct sign (with an imitative or physical prompt), deliver the reinforcer. Each time you or the child signs the word and when you deliver the reinforcer, it is important to say the item name.
I would also focus on trying to increase vocalizations by using simple inset puzzles or two sets of identical first word flash cards you can buy at the Dollar Store. As you hand the child a pig puzzle piece or a picture of a pig to match with the pig picture on the table, say the word “pig” three times (pig, pig, pig) as you hand the child the pig and as the child puts the pig in the puzzle or matches the picture. If the child says the word as he is matching, give lots of extra reinforcement but don’t worry if no words are heard during the activity. Bombarding your child with many single words a day is key so continue these activities daily.
My book (The Verbal Behavior Approach) especially chapter six should be particularly helpful in learning more about teaching non-vocal and minimally vocal children.
I have series of YouTube clips that may make getting started with the Verbal Behavior Approach a little easier for both parents and professionals! There are three short (6-8 minute) YouTube clips on the assessment and beginning ABA/VB intervention for Mia, a 2 year old girl I diagnosed with PDD-NOS.
I have permission from Mia’s parents to post these clips on YouTube so that others may benefit from my work with Mia. Hopefully these clips will be the first three in a series of videos that I will post as Mia makes progress!
Clip #1 shows Mia’s problem behaviors and poor instructional control at baseline. Clip #2 demonstrates for parents and professionals what to do to help Mia and Clip #3 shows me reviewing Mia’s VB-MAPP and Barriers with her mother. All three clips were filmed during a 3-hour initial assessment in June 2010.
Clip #4 was filmed in July 2010 and shows progress in 3 weeks.
Here are the links:
Clip #1/Mia’s Baseline Problem Behavior: http://www.youtube.com/watch?v=FCbBLhLjoXA
Clip #2/ABA/VB Interventions to Start Immediately: http://www.youtube.com/watch?v=rPUII8DWlCo
Clip #3/VB-MAPP: http://www.youtube.com/watch?v=8zgn3Tqy8nM
Clip #4/Progress after 3 weeks: http://www.youtube.com/watch?v=665jj4i29Ag
I’m looking forward to watching Mia progress on her journey with ABA/VB!