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Updated Part 3 – Teaching Discrimination to Children with Autism and Overcoming Error Patterns

September 22, 2017 Leave a comment

The author is a Board Certified Behavior Analyst working with Behavior Momentum India. The views in this blog are his own. I hope to keep in mind parents and therapists as I write and will try to keep the jargon to a minimum. Do feel free to contact me via smbehavioranalysis@gmail.com

In parts 1 and 2 of this series, we saw the various examples and types of errors children with autism and learning disabilities make.  In the concluding part of this series, we will see some proven strategies to overcoming error patterns while teaching receptive language.

 

Don’t be too sure that the child ‘knows’ – do a counterbalanced assessment with distractors

Firstly it is important not to be satisfied with a confident assertion that the child ‘knows’ and has acquired the targeted discrimination. The first is done by performing a thorough assessment with the target items and distractors counterbalanced across all positions and across the number of times asked for.

For example, if you are testing for discrimination between say a,b and c ( or tiger/ leopard/panther or cup/spoon/ fork for that matter) then a minimum of 18 trial probes will be needed.  a, b and c should appear in each of the three positions in the array equal number of times and the instruction asking the child to select a,b or c should be done an equal number of times for each one in each position. This will help us find out if there is a  position bias in the students responding, a dominant item response or other errors such as win-stay errors.  An example of a counterbalced array is as below for assessments.

Array Position of stimuli Ask For Observer 1 Observer 2
Left Mid Right SD
1 yellow PINK brown   brown
2 PINK yellow brown PINK
3 brown yellow PINK yellow
4 yellow brown PINK yellow
5 brown PINK yellow brown
6 PINK brown yellow yellow
7 brown yellow PINK PINK
8 PINK yellow brown yellow
9 yellow PINK brown yellow
10 yellow brown PINK PINK
11 PINK brown yellow PINK
12 brown yellow PINK brown
13 PINK yellow brown brown
14 brown PINK yellow yellow
15 yellow brown PINK brown
16 brown PINK yellow PINK
17 PINK brown yellow brown
18 yellow PINK brown PINK

I once had a heart-rending situation.  Mom was confident that ‘Of course, my child knows his mom’. With due permissions, I ran a test. when there were 3 ladies, one of them being mom standing at random distances from the child we asked the child to give some item to mom, he would go and give it to the nearest person. The results were not much better when they were equidistant or when we instructed the child to “go to mom”. While the child would engage in play and singing with rhymes and other manners of sharing affection with her, he could not respond based on the instruction, “give this to mom” or ” go and touch mom”

Don’t be too sure that the student ‘knows’ – Are there some inadvertent prompts :

To rule out the possibility of inadvertent prompts a parent or therapist may be giving, it is important to have other people conduct the same set of assessments. If the child succeeds with everyone with a scientific assessment then it is possible to conclude that the discrimination is acquired. If the child is not able to make correct selections at more than chance rate ( only 33% of the times correct when an array of 3 stimuli is used and child is asked to select one randomly) with other people then either there is a failure to generalize, or, more likely the discrimination acquired is faulty.

Re-cap: error patterns exist if:

■Selection is right sometimes – wrong sometimes “ inconsistent”

■Response starts before instruction is given ( the student is basing responses on some ‘rule’ other than listening to you and selecting’)

■Child attends to /looks at a particular stimulus before instruction is given ( Sometimes instructors instruction coincides with child’s pre-selection)

■Responding occurs  without scanning  ( but some do respond well without directly looking)

■Escape behaviors happen  during receptive ID tasks

The first step is to ensure correct level of  discrimination in target selection :It is not a good idea to train fine or nuanced discriminations if grosser discriminations are not in place – Example – subtle shades in colors, words such as meet/ meat , sew/ sue, concept of honest vs dishonest/ b,d,p,q .

Some strategies to overcome error patterns in teaching receptive language/  discrimination tasks:

No one procedure is guaranteed to work. but if you give considerable thought to the various options you have and if you are prepared to be flexible and if you take data on correct responding and errors under different strategies you will soon find what would work. For a full tutorial read Grow and LeBlanc (2013) – they have put it all together in the form of a tutorial. You will still need a guidance from an experienced Behavior Analyst for children with severe discrimination problems

  • get an observing/ attending  to the stimuli   before  the student responds :
    • Prompt to attend to the therapist – ” look at me” / other attention getting tactics before issuing instruction
    • It can be a simple prompt to look at each of the stimuli
    • A prompt to attend to a critical feature – match stripes before asking to select zebra from an array of zebra, horse, and deer.
    • student echoes  the instruction to confirm that he has heard it right ( Instructor says “zebra”, student says “zebra” and then proceeds to select Zebra from an array of 3 animals
    • Non-vocal children can make a sign corresponding to the instruction and proceed to make a selection
    • In fine discrimination exercises, example ‘b’ vs. ‘d’ – answer first whether the semi-circle is to the right of the line or to the left
  • Minimize inadvertent prompts from parent or therapist such as
    • eye gaze prompts – look directly at learners face and avoid looking at stimuli while giving instructions
    • A relaxing of facial features when student hovers over the right selection
    • small movements of therapists hands or eye movements
    • patterns of instruction ( example always ‘cow’ first, ‘horse’ second and ‘zebra’ third; position-wise – Right, middle, left)
  • Introduce multiple targets simultaneously – over teaching one may make it difficult to introduce new targets
  • By rotation, cover each target equal number of times within a session
  • Introducing sequentially is not recommended as teaching in isolation, simple discrimination is not likely to help with acquiring subsequent discriminations ( Grow et al., 2011, Gutierrez et al., 2009)
  • Use at least an array of 3 unless you are targeting opposites- with 2, the student has a 50% chance of being right anyways !
  • Improve Behavior consequence – A strong reinforcer for correct response And a loss of privileges or delay to reward – guided by Fisher, Pawich, Dickes, Paden  & Toussaint (2014).
  • If there is a position or side bias – counteract with more trials with success in other positions or increase array size
  • If there is a long history of errors with certain targets consider starting with a new set of targets  altogether

If the responding demonstrates improved discrimination, you are on the right track. Otherwise be flexible, look at the rate of correct and error responses across sessions and with professional guidance attempt an alternate strategy.

Happy teaching discrimination.

Selected References

 

Fisher, W. W., Pawich, T. L., Dickes, N., Paden, A. R., & Toussaint, K. (2014). Increasing the saliency of behavior–       consequence relations for children with autism who exhibit persistent errors. Journal of applied behavior analysis47(4), 738-748.

Grow, L., & LeBlanc, L. (2013). Teaching Receptive Language Skills. Behavior analysis in practice6(1), 56-75

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Part 3 – The Errors we See- Discrimination challenges in children with autism and Learning Disabilities

September 21, 2017 2 comments

The author is a Board Certified Behavior Analyst working with Behavior Momentum India. The views in this blog are his own. I hope to keep in mind parents and therapists as I write and will try to keep the jargon to a minimum. Do feel free to contact me via smbehavioranalysis@gmail.com

In parts 1 and 2 of this series, we saw the various examples and types of errors children with autism and learning disabilities make.  In the concluding part of this series, we will see some proven strategies to overcoming error patterns while teaching receptive language.

 

Don’t be too sure that the child ‘knows’ – do a counterbalanced assessment with distractors

Firstly it is important not to be satisfied with a confident assertion that the child ‘knows’ and has acquired the targeted discrimination. The first is done by performing a thorough assessment with the target items and distractors counterbalanced across all positions and across the number of times asked for.

For example, if you are testing for discrimination between say a,b and c ( or tiger/ leopard/panther or cup/spoon/ fork for that matter) then a minimum of 18 trial probes will be needed.  a, b and c should appear in each of the three positions in the array equal number of times and the instruction asking the child to select a,b or c should be done an equal number of times for each one in each position. This will help us find out if there is a  position bias in the students responding, a dominant item response or other errors such as win-stay errors.  An example of a counterbalced array is as below for assessments.

Array Position of stimuli Ask For Observer 1 Observer 2
Left Mid Right SD
1 yellow PINK brown   brown
2 PINK yellow brown PINK
3 brown yellow PINK yellow
4 yellow brown PINK yellow
5 brown PINK yellow brown
6 PINK brown yellow yellow
7 brown yellow PINK PINK
8 PINK yellow brown yellow
9 yellow PINK brown yellow
10 yellow brown PINK PINK
11 PINK brown yellow PINK
12 brown yellow PINK brown
13 PINK yellow brown brown
14 brown PINK yellow yellow
15 yellow brown PINK brown
16 brown PINK yellow PINK
17 PINK brown yellow brown
18 yellow PINK brown PINK

I once had a heart-rending situation.  Mom was confident that ‘Of course, my child knows his mom’. With due permissions, I ran a test. when there were 3 ladies, one of them being mom standing at random distances from the child we asked the child to give some item to mom, he would go and give it to the nearest person. The results were not much better when they were equidistant or when we instructed the child to “go to mom”. While the child would engage in play and singing with rhymes and other manners of sharing affection with her, he could not respond based on the instruction, “give this to mom” or ” go and touch mom”

Don’t be too sure that the student ‘knows’ – Are there some inadvertent prompts :

To rule out the possibility of inadvertent prompts a parent or therapist may be giving, it is important to have other people conduct the same set of assessments. If the child succeeds with everyone with a scientific assessment then it is possible to conclude that the discrimination is acquired. If the child is not able to make correct selections at more than chance rate ( only 33% of the times correct when an array of 3 stimuli is used and child is asked to select one randomly) with other people then either there is a failure to generalize, or, more likely the discrimination acquired is faulty.

Re-cap: error patterns exist if:

■Selection is right sometimes – wrong sometimes “ inconsistent”

■Response starts before instruction is given ( the student is basing responses on some ‘rule’ other than listening to you and selecting’)

■Child attends to /looks at a particular stimulus before instruction is given ( Sometimes instructors instruction coincides with child’s pre-selection)

■Responding occurs  without scanning  ( but some do respond well without directly looking)

■Escape behaviors happen  during receptive ID tasks

The first step is to ensure correct level of  discrimination in target selection :It is not a good idea to train fine or nuanced discriminations if grosser discriminations are not in place – Example – subtle shades in colors, words such as meet/ meat , sew/ sue, concept of honest vs dishonest

discrimination applicators-2022599_1280

 

Some strategies to overcome error patterns in teaching receptive language/  discrimination tasks:

No one procedure is guaranteed to work. but if you give considerable thought to the various options you have and if you are prepared to be flexible and if you take data on correct responding and errors under different strategies you will soon find what would work. For a full tutorial read Grow and LeBlanc (2013) – they have put it all together in the form of a tutorial. You will still need a guidance from an experienced Behavior Analyst for children with severe discrimination problems

  • get an observing/ attending  to the stimuli   before  the student responds :
    • Prompt to attend to the therapist – ” look at me” / other attention getting tactics before issuing instruction
    • It can be a simple prompt to look at each of the stimuli
    • A prompt to attend to a critical feature – match stripes before asking to select zebra from an array of zebra, horse, and deer.
    • student echoes  the instruction to confirm that he has heard it right ( Instructor says “zebra”, student says “zebra” and then proceeds to select Zebra from an array of 3 animals
    • Non-vocal children can make a sign corresponding to the instruction and proceed to make a selection
    • In fine discrimination exercises, example ‘b’ vs. ‘d’ – answer first whether the semi-circle is to the right of the line or to the left
  • Minimize inadvertent prompts from parent or therapist such as
    • eye gaze prompts – look directly at learners face and avoid looking at stimuli while giving instructions
    • A relaxing of facial features when student hovers over the right selection
    • small movements of therapists hands or eye movements
    • patterns of instruction ( example always ‘cow’ first, ‘horse’ second and ‘zebra’ third; position-wise – Right, middle, left)
  • Introduce multiple targets simultaneously – over teaching one may make it difficult to introduce new targets
  • By rotation, cover each target equal number of times within a session
  • Introducing sequentially is not recommended as teaching in isolation, simple discrimination is not likely to help with acquiring subsequent discriminations ( Grow et al., 2011, Gutierrez et al., 2009)
  • Use at least an array of 3 unless you are targeting opposites- with 2, the student has a 50% chance of being right anyways !
  • Improve Behavior consequence – A strong reinforcer for correct response And a loss of privileges or delay to reward – guided by Fisher, Pawich, Dickes, Paden  & Toussaint (2014).
  • If there is a position or side bias – counteract with more trials with success in other positions or increase array size
  • If there is a long history of errors with certain targets consider starting with a new set of targets  altogether

If the responding demonstrates improved discrimination, you are on the right track. Otherwise be flexible, look at the rate of correct and error responses across sessions and with professional guidance attempt an alternate strategy.

Happy teaching discrimination.

Selected References

 

Fisher, W. W., Pawich, T. L., Dickes, N., Paden, A. R., & Toussaint, K. (2014). Increasing the saliency of behavior–       consequence relations for children with autism who exhibit persistent errors. Journal of applied behavior analysis47(4), 738-748.

Grow, L., & LeBlanc, L. (2013). Teaching Receptive Language Skills. Behavior analysis in practice6(1), 56-75

The Errors we See- Discrimination challenges in children with autism and Learning Disabilities – Part I

July 22, 2017 1 comment

The author is a Board-Certified Behavior Analyst and works with Behavior Momentum India as a Research Associate, Faculty in teaching Applied Behavior Analysis course sequence and trains therapists who work with children with autism. He attempts to avoid jargon to make topics in Applied Behavior Analysis intelligible to parents of children with autism and learning disabilities, students, and therapists. The views in this blog are his own. This is the first blog and is expected to run into 3 parts because of the vast amount challenges in teaching receptive language to children with autism and recent advances.

David is a 4-year-old boy with developmental disabilities. One day his mom was excited. She was working at training identification of everyday objects from a small array of 3 different objects and he seemed to get it right with 7-8 objects such as a spoon, cup, top and fork wherever they are placed in an array. At the ABA center he went to during the day, his case manager was surprised by mom’s report. At the center, David would only get his identifications right only 25- 30% of the time, around a chance level of success, as if he were selecting randomly. He requisitioned videos of sessions from home and played them a few times over and found that a simplified array of stimuli was being used. There would be the target object, selecting which produced rewards and two other objects such as scissors and crayon that the parent never asked. David had figured that he needs to go for the spoon or the cup whenever they appeared in the array- he did not have to listen to what was asked for and make a discriminated selection. When probed with spoon, cup, and fork in the same array, hi correct selections dropped to chance levels as now the correct response depended on his selection also tallying with what the adult asked for.


Girls who buy nail polish need to know the difference between two shades that are close to each other in appearance- one could be “just her type” and another one not so! Children with autism and learning disabilities often have serious problems mastering discrimination tasks. One of the reasons is making a selection based on one element or feature of an object instead of attending to all the parts. This is called stimulus over selectivity. For instance, a child whose attention is only on wheels may not be able to identify a car if a truck and a van are also present in the array of vehicle pictures. Examples of making a response based on attending to an incorrect part abound. Discrimination training procedures involve the use of rewarding correct responses, prompting and prompt fading procedures and may inadvertently result in responses with errors or prompt dependence.

Let’s look at some more examples of errors. At a simple level, let us say a student is taught to respond to the instruction “touch head” by touching his or her own head. When “touch elbow” is introduced as a next target, the student could proceed to touch his head as soon as he hears the word “touch”. Similar problems exist with training to answer questions such as “what is your name” and  “What is your mother’s name”. The response “David” could be blurted out as soon as “what is” is heard. A child who is taught to answer “air” when asked what does fan give could reply with “air” when asked what does cow give”. It is quite possible that the “what” or “give” part of the question controls the students answer of “air” and not the “fan” or “cow”.

At a certain stage of learning, generalization must stop and discrimination must set in. There could also be a problem of over generalization without discrimination setting in (or being taught). A child taught to request for “hug” from parent’s could request hug from complete strangers. A child who is taught to say “daddy” with her dad’s picture (let’s say dad sports a beard in the picture) starts labeling other pictures of persons with a beard also as “daddy”. Many children on the spectrum who perform discriminative tasks with nouns well, fail when it comes to discriminating even between the basic colors of red, blue, green and yellow. I have come across students who do a perfect job of matching red card to card, blue card to blue card and so on. However, when they are asked to point at the red card or the yellow card or the blue, in an array that has all these cards things start going wrong. There is some other discrimination issue at work here. Discrimination challenges are part of everyday life with all humans. Husbands could buy the wrong gift on the anniversary day, a writer, could place too many, commas in his sentences, or cops could overlook important evidence at the crime site and obsess with non-essentials while the criminal is thriving and on the run. However, with children with autism and other learning disabilities, these problems acquire serious proportions across several areas of their learning and the error patterns could become stronger confounding parents and therapists.
Behavior Analysts use research based methods to identify error patterns, understand why they could occur in discrimination training and use specific strategies to overcome these.I will look forward to examining additional error patterns and the current state of research on how they can be overcome in the next parts of this series on discrimination training.

Your queries will help me reflect further. Do send them to smbehavioranalysis@gmail.com

Inspect before you respect – Is your Behavior Analyst competent and do they follow their ethical guidelines

October 18, 2014 Leave a comment

This note is written specifically for parents of children who receive interventions based on Applied Behavior Analysis (ABA).A special thanks to my colleagues in the field, Dr. Geetika Agarwal, Ms. Gita Srikanth, Ms. Sheela Rajaram and  Ms. Tasneem Hegde for reviewing the draft and for their valuable feedback. I hope I have been able to do justice to their inputs.

First off : ABA is not a therapy! Rather,  it is science based on which a number of  evidence based interventions have been developed to address socially significant behaviors across the entire human spectrum regardless of age, abilities or challenge.

Would you consent to have yourself treated by a person who has learnt medicine by working in a pharmacy? You should ensure that the person has studied medicine formally, keeps up to date with research in his field and conducts himself according to certain ethical guidelines. Unquestioningly and blindly trusting “experts” and “specialists” is not the way to go and this applies especially to people with whom you trust your children with learning challenges or problem behaviors.

So, when you have decided to give your child the benefit of interventions based on the science of Applied Behavior Analyst (ABA), one of the first considerations is to find out if the therapist who is going to work with your child is guided and supervised closely by a BCBA- D /  BCBA or a BCaBA .  The first two are Board Certified  Behavior Analysts ( Former is Doctoral) and the third is a Assistant Behavior Analyst who in turn needs to be supervised by a BCBA or a BCBA-D. The final responsibility, thus  for your childs programming goals , intervention procedures  and supervision of therapists should be with a BCBA-D or a BCBA.  Once you know the name of the professional, even if they are renowned and famous, see if they are listed in the BACB registry – http://www.bacb.com –> find certificants.

For those in a hurry, let me present some  key questions  to ask  :

1. Is my child in good hands – is a credentialled Behavior Analyst designing and supervising the interventions ?

2. Are the interventions designed to ensure my child/ care giver does not come to harm – are  any risks/ risk mitigation discussed well with me and signed off?

3. Does the Behavior Analyst talk to me in plain english shorn of jargon.  Is he/she able to explain choice of teaching strategies/ interventions to my satisfaction?

4. Does the Behavior Analyst talk to me with data and graphed trends to communicate progress of my child?

5. Does the Behavior analyst respect and  maintain confidentiality  ?

6.  Is the Behavior Analyst a ” good citizen” ? For instance, is he/she  on the right side of the law in his or her dealings?

7. Is the Behavior Analyst on a continuous learning mode – does he/ she attend scientific conferences, present technical papers, disseminate knowledge

For those who would like to dwell a little deeper I’ll aim to elaborate on the above. A Behavior Analyst signs up to high standards of ethical conduct – I will list some of them that have a direct bearing for your child and yourself. You’d need to keep following and watching your behavior analysts behavior and convince yourself that he  or she displays behavior in consonance with these.

1. Do no harm , right to most effective treatment and least intrusive interventions : The primary client for the Behavior Analyst (BA) is the child or the vulnerable person receiving services. Parents / Guardians/ carers /teachers/ relatives  ( called significant others) will be secondary clients.  It is the BA’s responsibility to ensure that risks of any potential harm due to interventions are carefully analyzed, discussed with the client or significant others with risk management plans in place. Interventions covering these should be signed off in writing  with significant others to avoid any misunderstanding.

This also means, for example that in the event of your relocation or transition of services, the Behavior Analyst makes appropriate referrals and communicates status assessments to future provider to ensure the child does not suffer. Similar considerations should be seen if for some personal reason the BA is not able to continue providing services – they need to ensure presentation of suitable referrals where possible, a reasonable notice period , exit reports etc. Any information they share with third parties should be with your written consent.

2. Should maintain high standards of integrity in their personal lives and are seen as upstanding citizens . Even if they are clinically brilliant, they need to be operating on the right side of law. If you have any reasons to suspect this, stay away and consider reporting to the Behavior Analyst Certification Board ( http://www.BACB.com ).

2. Keeps up with scientific knowledge : Does the BA attend conferences/ seminars on behavior analysis, is seen making efforts to use the lastest technological advances in the field?

3. Talks to you in plain english : Behavior analysts have an obligation to explain their intervention, assessments etc. in plain English for clients, consumers and professionals from outside the field.  If there is heavy jargon in their talk thats not intelligible to you , watch out! You could be dealing with style provider than substance.

4. Recommends the most effective evidence based interventions : There are a number of effective evidence based procedures such as Antecedent intervention,Joint attention intervention,Precision teaching, modeling, peer training package, schedules, self management etc.  that are based on Applied Behavior Analysis.   The BA, while discussing interventions for your child, should be able to substantiate their choice referring to scientific evidence base (e.g. number of scientific studies published in peer reviewed journals). If you are proposing a non- behavioral intervention, they could use scientific behavioral methods to evaluate its effectiveness.

5. Assesses, measures and communicates with data : Rather than say that they have been very successful, the BA should be able to discuss progress with data and  graphs of progress pre and post intervention. Do you see the BA constantly assessing progress and making changes on the basis of data ?

6. Takes informed consent :  Knowledge derived from interventions  with your child could be useful in  helping others facing similar challenges and add to the scientific knowledge base. In certain contexts the BA will take your permission in writing with a clause that such permission may be withdrawn by you at a later date.   The typical contexts include consent for use of videos data from interventions with your child in scientific conferences/ training programs/ website,  for including your child as a participant in a scientific study ( even if it benefits your child )  which may be published in a scientific journal and for taking up an intervention that involves reduction in socially inappropriate behavior .  It is  important for you to give the informed consent without any feeling of ‘pressure’  such as a fear that your child’s intervention may be compromised if you withold consent.

7. Confidentiality : The ethical Behavior Analyst will share information about your child only with personnel directly involved in designing and providing interventions .  Information Specifically identifying children are  masked ( unless significant others have consented otherwise) when information needs to be shared with peers or the larger community of Behavior Analysts such as in journal articles, technical paper presentations etc.

8. BA’s responsibility to the field of Behavior Analysis : You may ask, how does this concern me as a parent or recipient of services for my child . However, if the BA is seen disseminating knowledge about the field in various fora, seen fighting mis-representation of the field by non-qualified personnel , is seen attending, presenting posters and papers in national and international conferences you are probably seeing a ethical Behavior Analyst.

9. No Dual relationships or conflicts of interest please :  Behavior Analysts relationships with their clients and their significant others is strictly professional in nature and guided by a written contract. Behavior Analysts becoming best friends, joining you in family holidays, accepting gifts etc., would be in violation of their code of conduct as services to the client could be compromised.

These are but a few important points and some yardsticks lay people can evaluate the Behavior Analyst on.  It may be uncomfortable to do such an evaluation as  blind faith is a lot easier. However, with your child’s interests at stake I’d recommend nothing less than a diligent and ongoing evaluation.

Beofre I close, I must say that there are a number of changes you may have to undergo to make the most of your Behavior Analysts services – yes, it is a two way street.  Behavior Analysts prefer to address matters with data and trends and will need your buy in for the interventions with reasonable modifications . They may nor promise or guarantee miracle results but are likely to share information on interventions that have an evidence base and promise on going monitoring with data to demonstrate improvements. They are more likely to concerned with an improvement from here on rather than on an impractical standard thats out there. A Behavior Analyst may not entertain long discussions involving emotional reasons or hypothetical constructs ( invisible reasons that purport to explain the cause of problem but actually do not – see an early blog of mine on mentalism and circular reasoning) but will in a scientific way be able to draw your attention to the real function of problem behavior ( what does the behavior get as a consequence that makes it relevant) and the socially acceptable interventions that should work. This approach would aim to build trust based on objective evaluation of your child’s progress rather than ‘faith’ and this could be a subject matter for another blog!

 

Activity Schedules for children with autism

Efficacy of Activity Schedules as Intervention for Children with Autism

 Children with autism have difficulty with the concept of time, experience anxiety relating to what events come next and have difficulty in independently planning and engaging in appropriate activities. Activity schedules visually represent a set of tasks or activities. Pictures are used for visual learners and words are used for children who have reading abilities. Sometimes it is seen that children with autism, even while competently doing their activities keep looking at an adult for a prompt to move to next or continue to stay on task. Visual schedules can help reduce dependence on adults or other people.

Activity schedules can be for a simple three or four step activity ( Dressing – wear underpants, wear vest, wear shirt, wear trouser)  they could cover a series of activities the child need to perform ( make a toast, play with iphone, finish a worksheet), it could cover events throughout the day ( breakfast,  get dressed, go to school, return by bus from school, evening meal, TV time, play at park, homework, supper, sleep) and with children that have advanced at learning schedules  even events during a month can be visually presented (  Grandma visit, long weekend stay at beach , going to a marriage…).

In my practice I come across several children who  would start their next activity which could be fixing a puzzle or going and playing on the swing only after an adult gestures or prompts.  They could move from one activity to another in a span of 3- 4 minutes but would be dependent on parent or trainer to stop an activity or start the next activity. Even in seemingly simple functional routines where they are  fluent in all the steps they could need prompts such as open the tap, rinse mouth, take toothbrush, squeeze paste on to the brush etc.,  Further, there are children who can complete the parts of the chain but will look at adult for some kind of a prompt to move on. In the context of helping such children  become atleast partly independent,  I started looking at a combination of visual schedule which can prompt the next activity to move to and and a  timer which can tell them when to stop ( in case the activity is a open ended activity like playing with ipad as opposed a closed ended activity like completing a 25 piece jigwas puzzle). I had to start with research on work that has already happened and felt I’ll share what I learnt while studying literature-  I’ll try to lighten the technical heaviness of what I am going to write but do bear with me if I am not entirely successful as I am trying to look at technical research..

According to Schopler, Mesibov (1995),  activity schedules reduce the need for adult prompts, help children transition between activities and provide a structured teaching environment. Further, the use of visual schedules also  help given the auditory deficits  of children with autism Schopler, Mesibov, and Hearsey (1995) .

Thus activity schedules are expected to transfer  control from verbal or imitative or gestural prompts  given by adults to pictures, symbols or photographs thus reducing the child’s dependence on adult prompts. Further, if correctly designed and implemented, activity schedules visually let children know their rate of progress, estimate time remaining to complete allotted activities and thus can reduce frustration.

One of the early studies by Applied Behavior Anlaysts examined teaching children with autism to be independent in emitting complex  response chains (Macduff, Krantz, & Mcclannahan, 1993).

The authors selected four youth whose interventions involved staff giving verbal instructions and physical prompts. The instructions rate were as high as 2 per minute ( Look at the level of dependence on adults and possible aversion to voice that may arise?) . The authors further reported that most of the responses had to be prompted and there was  no spontaneous emission of previously taught chains of activities. The study, after a baseline measurement went on to use photographic activity schedule depicting 6 leisure and homework activities.  The teachers stood behind and used  graduated guidance ( a procedure where initially trainers provide prompt to the extent required and reduce or fade as the child begins to gain independence)  from behind the participants to teach them to follow a schedule and be on task ( i.e., they had to teach the use of visual schedules using prompting and prompt fading procedures so that the actual performance of chain of activities may be dependent only on the photo schedules).

In terms of results, all the participants , after the training phase ( 13- 27 sessions) were found to be independent , i.e., not reliant on any teacher prompts , were on task and on schedule. They also generalized schedule following to novel chains. Anecdotally, the authors record a reduction in aberrant behavior from the participants. The effectiveness of photographic schedule training with graduated guidance was evidenced by the fact that the participants were able to independently engage in complex leisure and daily living activity chains for one full hour ( Quite a dramatic achievement is’nt it , considering the children needed 2 adult prompts per minute at baseline ).

Referring to the above study and replicating  it  Bryan & Gast (2000) taught four children with autism in a public elementary school program to  use visual activity schedules using a Graduated Guidance procedure. They measured on-task and on-schedule behaviors of the children after teaching them the mechanics of using activity schedule. The children carried the activity schedule in a book. The students not only learnt how  to use an activity schedule (with graduated guidance support from experimenters) but also maintained high levels of independent on-task and on-schedule behaviors with just the support of picture books . This had an automatic effect on reducing non-scheduled behaviors.

A contra indicator is the study by Waters, Lerman, & Hovanetz ( 2009). Transitioning from a one task to another, often from a high preference task to a low preference task can be accompanied by emotional reactions and inappropriate behaviors. A treatment package consisting of extinction plus differential reinforcement of other Behavior (DRO) was tried with and without visual schedules. In this study the authors found that problem behaviors reduced with extinction plus DRO regardless of whether a visual scheduled was used or not.

This study calls into question the usefulness of activity schedules in facilitating transitions especially preferred to non-preferred. However, I would still like to examine the value of removing adult mediation during the transition.

Bryan & Gast (2000) also report a number of prior studies which found the use of activity schedules effective . They are tabulated below:
Betz, Higbee, & Reagon ( 2008) made a first of its kind study when they studied the effect of two children ( a social pair) following the same activity schedule to play  a series of interactive games. The three pairs of children with autism chosen for the study were between 4 and 5 years of age and they were assessed to be able to follow activity schedules independently. Activities or games were chosen for them to engage in that allowed  two people to take turns ( don’t spill the beans, crocodile dentist etc.,)  and the children were taught how to play these games fluently.  While in baseline condition no joint activity schedule was used, in the intervention phase teaching was given for each of the paired children to refer to the joint activity schedule, say brief lines from script and enagage in an activity or game collaboratively.  This study found that for every pair the engagement level ( defined as being on task and taking one’s turn appropriately) that was very low in baseline phase reached to 80% in the teaching phase and was sustained in the maintenance, re-sequencing and generalization phases.  This is a higher order training method and demonstrates the utility of activity schedules in promoting peer engagement in children with autism.Heres another big breakthrough possible with activity schedules: They can be used to teach joint activities, peer play etc., especially where turn taking is involved?

As  elaborated with several examples in this paper, activity schedules have proven to be effective in teaching children to be on task, on schedule, to be independent to a higher degree, in reducing inappropriate behaviors, in facilitating peer play without adult prompts, in teaching vocational skills, home living skills, leisure skills, play skills etc.

From the foregoing discussion it can be discerned that research on activity schedules had started in the 1980s and is continuing till date. It is important to note that though the dozen odd studies referred to in this article have demonstrated effectiveness barring the study by Walters etal., ( 2009), the volume of research and replication in the three decades does not seem to be high. This relatively low volume of research activity is surprisingly at variance with widespread use of activity schedules in one form or other across special schools catering to children with autism and other learning disabilities.

In terms of recommendations, activity schedules along with training to use them should be considered as a treatment of choice to promote independence , reduce dependence on adult prompts and to promote generalization. This is on account of the fact that the studies that have been done have reported success and the treatment will gain more favour with increasing replications and novel variations.

References

Bryan, L. C., & Gast, D. L. (2000). Teaching on-task and on-schedule behaviors to high-functioning children with autism via picture activity schedules. Journal of autism and developmental disorders, 30(6), 553–67.

Betz, A., Higbee, T. S., & Reagon, K. a. (2008). Using Joint Activity Schedules to Promote Peer Engagement in Preschoolers with Autism. (G. Hanley, Ed.)Journal of Applied Behavior Analysis, 41(2), 237–241. doi:10.1901/jaba.2008.41-237

MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. (1993). Teaching children with autism to use photographic activity schedules: Maintenance and generalization of complex response chains. Journal of Applied Behavior Analysis, 26, 89–97.

Miguel, C. F., Yang, H. G., Finn, H. E., & Ahearn, W. H. (2009). Establishing derived textual control in activity schedules with children with autism. Journal of applied behavior analysis, 42(3), 703–9. doi:10.1901/jaba.2009.42-703

Neitzel, J., & Wolery, M. (2009). Steps for implementation: Graduated guidance. Chapel Hill, NC: The National Professional Development Center on Autism Spectrum Disorders, FPG Child Development Institute, The University of North Carolina.

Schopler E, Mesibov G, eds. Learning and Cognition in Autism. New York: Plenum Press, 1995:311–334.

Schopler, E., Mesibov, G., & Hearsey, K. (1995). Structured teaching in the TEACCH system. In E. Schopler & G. Mesibov (Eds.), Learning and Cognition in Autism (pp. 243-268). New York: Plenum Press.

Waters, M. B., Lerman, D. C., & Hovanetz, A. N. (2009). Separate and combined effects of visual schedules and extinction plus differential reinforcement on problem behavior occasioned by transitions. Journal of applied behavior analysis, 42(2), 309–13. doi:10.1901/jaba.2009.42-309

Maimonides on Reinforcement

December 24, 2012 Leave a comment

Maimonides, a Medieval Jewish philosopher ( 12th century ) and a Torah scholar on the workings of positive reinforcement


. Imagine  a small  child  who  has been
brought to his teacher so that he may be taught
the Torah, which is his ultimate good because
it will  bring  him  to  perfection.  However,  be-
cause he is only a child and because his under-
standing is deficient, he does not grasp the true
value of  that good, nor does he understand the
perfection  which he  can  achieve  by  means  of
Torah. Of  necessity, therefore, his teacher, who
has acquired greater  perfection  than the child,
must  bribe him to  study  by  means  of  things
which  the child loves in a childish way. Thus,
the teacher may say, “Read  and I will give you
some  nuts  or  figs;  I  will  give you  a  bit  of
honey.” With this stimulation the child tries to
read.  He  does  not  work  hard  for  the sake  of
reading itself, since he does not understand  its
value. H e  reads in order to obtain the food. ,
As  the  child  grows  and  his  mind  improves,
what was  formerly  important  to  him  loses  its
importance,  while  other  things  become  pre-
cious.  The  teacher will  stimulate  his desire
for whatever  he wants then. The teacher may
say  to  the  child,  “Read  and  I  will  give you
beautiful shoes or nice clothes.” Now the child
will  apply  himself  to reading  for  the sake  of
new  clothes  and  not  for  the  sake of  study  it-
self. . . . As his intelligence improves still more
and  these things, too, become unimportant  to
him, he  will set his desire  upon something of
greater value.  Then  his  teacher  may  say  to
him,  “Learn this  passage  or  this  chapter,  and
I will give you  a denar or two.” Again  he will
try to read in order to receive the money, since
money  is more  important  to  him  than study.
The end which he seeks to achieve through his
study is  to acquire the money which has been
promised  him. When his understanding has so
improved  that  even  this reward  has  ceased  to
be  valuable to him,  he will desire  something
more honorable. His  teacher  may  say  to  him
then, “Study so that you may become the presi-
dent  of  a  court,  a  judge,  so  that  people  will
honor  you  and rise  before  you as  they  honor
So-and-so.” He will  then  try  hard  to  read  in
order to attain his new goal. His final end then
will  be  to  achieve  the honor,  the  exaltation,
and the praise which others might confer upon
him.
Now,  all  this  is  deplorable.  However,  it  is
unavoidable  because of  man’s  limited  insight,
as  a result  of  which  he  makes  the  goal  of
wisdom  something  other  than  wisdom itself,
and  assumes that the  purpose  of  study  is  the
acquisition  of  honor,  which makes  a mockery
of  truth. Our sages called this learning not for
its own sake. . . .”
Reference:

‘Isadore  Twersky (Ed.), A  Maimonides  Reader. New
York: Behrman  House,  1972. Pp. 404-407.


Sridhar Mudhan, Board Certified Behavior analyst, India Mobile : +91 9538001515

Pairing with your child with Autism or other learning disability

November 5, 2012 2 comments

The author is a Board Certified Behavior Analyst, works for Behavior Momentum India (P) limited as a consultant, is the President of Association for Behavior Analysis –India and blogs on topics relating to autism and Applied Behavior Analysis.  The views in this blog are his own and do not represent those of the organisations he works for. He can be contacted on smbehavioranalysis@gmail.com

A note prepared for parents of children with Autism

Pairing with your child with Autism or other  learning disability

What is pairing and why is it important:

Pairing is a process by which a parent or a caregiver associates himeself or herself  with items  and activities that a child prefers and in the process acquires  “positive reinforcement ” properties .

A good level of pairing needs to be achieved before the parent or caregiver can start teaching or expecting compliance from the child. Pairing is not as simple as it seems.   We’ll first talk about what it is not.

What is not pairing :

An excerpt from a earlier blog of mine:

Contrary to what we think,  parent’s often interrupt a child’s preferred activity, do not give what the child wants immediately, unwittingly give tasks which are actually difficult for the child  ,  mistakenly attribute lack of fluency to laziness and try to hurry or hustle, use a raised voice or interact only when the child creates some problem… the cumulative effect of all this is predictable …..

Thus a mother , while playing with a child saying in a sweet an playful voice   “A” , “ B”, “C”…and looking expectantly at the child to say “D” , “E” etc., is actually placing a demand and not pairing herself with a reinforcement. Throwing the ball to the child and asking the child to roll it or throw it back may also look like playing to the parent but could actually be a difficult task for the child.

How can I pair:

Pairing can be done  by associating yourself with as many pleasant and happy situations in the every day life of your child. It involves giving “non- contingent” reinforcement- meaning giving the items , things and enjoyable activities without placing any demand on the child or expecting anything in particular.

This also means you make arrangements so that the child does not get these directly but through you.

Some examples of  pairing

  • Pairing your face – while giving a preferred activity ( say singing to child or handing over the ipad)  wait for child to make eye contact. Whenever the child looks at you break into a nice smile
  • Pairing your voice – In a friendly tone and with appropriate excitement say things like “ that’s very good”, “ That’s Super” , “ You are wonderful” , “ you are doing the puzzle so nicely”, “ Whooooosh”, “ Booooom”, …… you can also sing songs ( be sensitive to whether the child is comfortable with the pitch and tone. With some children these are better said in a soft or gentle voice with variations)
  • Offer reinforcers – liked items like chocolate, juice , favourite toy etc. for free ( not when the child is expecting it or when you want the child to do something)

While pairing:

  • Do not Place demands. Example- “Go and sit on the swing” , “ Come to Mummy”, “wind up the toy” …. Even if you believe the child can do it.
  • Do not abruptly take away an item that the child is enjoying or stop an activity the child is enjoying
  • Avoid giving instructions but make appropriate statements or comments – You can say “ that’s  great coloring”  or  “ nice playing on the toy piano” .  Do not say “ color this spot blue” or “ press these keys in this way”
  • Do not use statements or questions where the child is expected to answer – Example : “ Ahmed, Tell me what is your mummy’s name” or “ What is the color of the pencil”
  • If you need the child to stop doing something ( because it is unsafe or inapprorpriate), ideally avoid using spoken instructions or warnings. Instead walkover and without making any eye contact, in the least intrusive possible way stop the child . This will minimise you being paired with inappropriate items or activities. Thereafter, quickly find something that would interest the child and redirect ( again without using instructions).

The principle behind pairing is that as you ( the person or parent) are present in most of the happy situations, activities and enjoyable moments of the child and are seen as the person through whom the child gains access to these , you acquire the properties of these reinforcers  yourself.

Thereafter, your presence, gestures and  voice can be used to reinforce the child when instructions are given. However that is a later step. The first step is to see if you can be pair yourself with the child in a very positive and fun way.

If you have any questions do write to me on smbehavioranalysis@gmail.com

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