1. Using the Verbal Behavior Approach to Teach Children with Autism
Mary Lynch Barbera, RN, MSN, BCBA
May 2009
Autism One Conference

2. My Autism Journey
July 2, 1999 – Lucas was diagnosed with moderate to severe autism one day before his third birthday.
September 1999 – Started 40 hours/wk ABA program with Lovaas consultant coming monthly.
June 2000 – Founding President of Autism Society of Berks.
December 2003 – Became a Board Certified Behavior Analyst and Lead Behavior Analyst for the PA Verbal Behavior Project.
May 2005 – Published the results of a single subject multiple baseline study that I designed in The Analysis of Verbal Behavior.
May 2007 –Publication of my book: The Verbal Behavior Approach: How to Teach Children with Autism and Related Disorders.

3. Lovaas Study Published in 1987
59 children (3 years age or under) diagnosed with autism
19 received 40 hours/wk 1:1 ABA for 2 years
20 received 10 hours/wk
20 received standard special education classrooms/OT/speech
47% of those receiving 40 hours/wk of treatment became “indistinguishable from their peers by first grade”

4. ABA as the treatment of choice
Applied Behavior Analysis (ABA) is the only scientifically validated treatment for autism and is recommended by the U.S. Surgeon General.
ABA treatment became popular in the mid-1990’s when Catherine Maurice, a parent of two children with autism who both “recovered” from autism using this approach, published two books detailing Lovaas type ABA therapy.

5. An Overview of ABA

6. Applied Behavior Analysis (ABA)
Definition
“Applied behavior analysis is the science in which procedures derived from the principles of behavior are systematically applied to improve socially significant behavior.”
(Cooper, Heron, and Heward)

7. Basic Principles of ABA
Behavior is defined in objective and measurable terms
Examines the functional relationship between behavior and its controlling variables
Analyzes socially significant behavior in need of improvement
Analyzes behavior through a three term contingency
Need to explicitly define the topography of a behavior. What it looks like and sounds like. “Stranger Test”
Remind people again about the importance of child-environment relations.
What influences the likelihood a behavior will reoccur or be extinguished.
The outcome of the analysis has practical application for the improvement of life
For every behavior there is a contingency that occurs, A-B-C. Each of these components plays a part in effectiveness of a behavior and whether that behavior will reoccur.

8. Three Term Contingency
Antecedent--Behavior--Consequences
A—B—C
Also Described As
Discriminative Stimulus--Response--Consequence
MO/SD—R—Reinf. or Punish.
Be sure to define reinforcement here: stimulus change (something happens) following a behavior that increases the future probability of that behavior under similar circumstances.

9. Basic Behavioral Principles
Antecedent - any stimulus that happens before a behavior
Behavior - an observable and measurable act of an individual
Consequence - any stimulus that happens after a behavior

10. Three (Really Four) Term Contingency
Antecedent--Behavior--Consequences
Motivation is now seen as playing a significant role in this model (Michael) C A B
Motivation
Be sure to define reinforcement here: stimulus change (something happens) following a behavior that increases the future probability of that behavior under similar circumstances.

11. Examples of Three Term Contingency
“Touch nose” – Child touches nose – receives piece of cookie
“Do Puzzle” – Child falls to floor – Demand withdrawn
Also: other examples:
Green light-press accelerator-get down the road (positive reinf.)
Red light-press brake- avoid ticket, accident or reduce anxiety about getting a ticket or wreck (neg. ref.)

12. You use the principles of ABA all day long!
ABA is used to:
Increase positive behaviors
Language, self care skills, academic skills.
Decrease negative behaviors
Tantrums, biting, kicking, crying

13. $1000 Activity Think of a child you know with challenging behaviors:
If I gave you $1000 for that child to have a “good day” with little to no problem behavior, what would you do?

14. Pick one or two target behaviors
Select the target behavior to be reduced by examining…
The seriousness of the behavior…if could injure self or others…target these before behaviors such as hand flapping or poor attention.
The frequency of the behavior

15. Define Setting Event
Aspects of a person’s environment or daily routine that do not necessarily occur immediately before the behavior.
Medication adjustment
Medical problems (pink eye, diaper rash)
Sleep problems
Eating routines/diet
Number of people in room
Daily schedule (how predictable/how much choice)

16. Immediate Antecedents
What triggered the behavior
What happened immediately before problem behavior started:
Computer was turned off
Told child to hang up coat
Child saw candy and wanted it

17. Using the principles of ABA to reduce problem behavior
Define Behavior----Be Specific!!
Kicking his feet against the chair, throwing books, biting his own fingers, hitting his head with his fist.
NOT: Having a tough time, frustrated, irritable

18. Consequences Reinforcement Punishment
A consequence that results in increasing or maintaining the future rate of behavior it follows.
Punishment
A consequence that results in decreasing the future rate of behavior it follows.

19. Consequences
Any behavior that occurs repeatedly is serving some useful function and producing some type of reinforcement.

20. Consequences
After a behavior has occurred the environment can change in several ways:
1. A neutral event can happen: if nothing happens that is relevant, the consequence will likely have no effect on the behavior.
2. Things can get better: if things get better, the behavior will likely occur again under similar conditions. This is called reinforcement.
3. Things can get worse: if things get worse, the behavior will likely not occur again under similar conditions. This is called punishment.

21. Things Get Better: Reinforcement
Reinforcement is a change in the environment following a behavior that increases the future probability of that behavior under similar circumstances.

22. Things Get Worse: Punishment
When things get worse following a behavior, the behavior is less likely to occur in the future under similar circumstances. This is punishment.
Punishment decreases the likelihood of behavior; Reinforcement (including negative reinforcement) increases behavior.

23. Is Time Out a Reinforcement or a Punishment?
Need to look whether time out is increasing or decreasing the frequency of the target behavior.
Most people think Time Out is a punisher but it functions as a reinforcement for many children.

24. Take Data To Identify the A, B, and C
Without taking baseline date and identifying the antecedent, behavior, and consequence, it is not wise to implement a behavior reduction strategy

25. Functions of Problem Behavior
To obtain something desirable (Attention, Tangibles, Sensory Stimulation).
To avoid or escape something undesirable (Task avoidance).

26. Antecedent Interventions
Changing the environment before the behavior occurs to prevent the behavior.
Focus on pairing/manding
8 positives to every negative
Reconfigure class layout or ratio
Give more or less time at a center
Get more sleep at night or nap
Eat breakfast or serve snack earlier
Provide transition warnings

27. Reactive Interventions
Interventions implemented after problem behavior occurs.
Some examples:
Count and Mand (use for attention only)
Planned Ignoring (use for attention only)
Time Out (use for attention only)
Work through Demand (use for escape only)

28. Count and Mand Explained in Chapter 2 of my book
Used for access to tangibles/attention only!
Can also use count and give choice, count and R+, or count and give attention.
Steps:
Stop the problem behavior (hands down, be quiet, no kicking)
Silent count to 3, 5, or 10—if problem behavior resumes, return to # 1.
Prompt the mand “cookie”—child echoes “cookie” Right…how do you ask?…child responds “cookie”….deliver R+.

29. Combined Approach Spend 95% of your time preventing problem behavior
When negative behaviors do occur, use reactive intervention consequences at the moment.
Count and Mand
Planned Ignoring
Time Out
Work Through Demand

30. If you find yourself using reactive interventions frequently
You need to continue to take data or re-start data taking to determine setting events, antecedents and functions of target behavior
Your demands might be too high and/or reinforcement might be too low
The environment might need to be changed

31. Three things that matter no matter what the age or functioning level!!
Problem behaviors at or near 0
Ability to request wants and needs to an unfamiliar adult
Independent toileting
****2-minute activity****

32. Case Studies Case Study # 1
Amy’s mother reports that Amy is a poor sleeper. Each Monday morning she arrives to daycare and begins to play. When she is called to circle, Amy cries and throws herself to the ground. The staff tries to find something less aversive to Amy and usually tries bouncing Amy on the ball to get her calm. Amy does usually quiet down on the ball.

33. Case Study Questions What might be a setting event?
What is the immediate antecedent?
What is the behavior?
What is the consequence?
Does the consequence serve as a Reinforcer or Punishment?

34. Case Study #1 (cont.) Will the behaviors likely go up or down?
What is the most likely the function of Amy’s behavior?
What are some interventions you would recommend to help reduce Amy’s negative behavior

35. Using ABA and Verbal Behavior (VB) to Increase Positive Behaviors
Increasing language and learning skills using the principles of ABA and B.F. Skinner’s Analysis of Verbal Behavior

36. What is Verbal Behavior?
Behavior that is reinforced through the mediation of another person’s behavior
Discuss here that language = behavior. Behavior = movements of an organism in its environment.
For vocal speech the movements involve lungs, larynx, tongue, lips, jaw, etc.
Such movements change the social environment: “I wouldn’t be talking if every body got up and left”
Also: be sure to mention that language is what people do; its not something that they “have” (VB requires a functional definition; not a structural definition of language)

37. Intensive behavioral Intervention Fluency Based Instruction
Applied Behavior Analysis
Direct Instruction
Verbal Behavior
Discrete Trial
Teaching
Intensive behavioral Intervention
Lovaas
Therapy
Incidental Teaching
Precision Teaching
Fluency Based Instruction

38. LOVAAS (UCLA) Plus MICHAEL (WMU) Plus
Dual Path of Applied Behavior Analysis Research
LOVAAS (UCLA)
ABA Research
Plus
Discrete Trial Training
(structure)
MICHAEL (WMU)
ABA Research
Plus
Discrete Trial Training
Skinner’s Analysis of
Verbal Behavior
(function)

39. Common terms for the Verbal Operants
Mand = request
Tact = label
Intraverbal = conversation, answering a question, responding when someone else talks
Echoic = repeating what someone else says
Receptive or Listener Responding = following directions

40. What is “Coffee”??????? Is it a… MAND? TACT? INTRAVERBAL?
Still another opportunity to review basic verbal operants. Maybe ask for audience participation with this one.

41. Use a review with previous slide:
VIDEO CLIP: Use this clip of intensive teaching to point out the various operants taught. Paula hits echoics, receptive, intraverbal, tacts and mands with Benjy.

42. Verbal Operants Verbal Operant Antecedent Behavior Consequence Mand
Motivative Operation (wants cookie)
Verbal behavior
(says “cookie”)
Direct reinforcement
(gets cookie)
Tact
Sensory Stimuli
(sees or smells cookie)
Non-specific reinforcement
(gets praised, for instance)
Intraverbal
Verbal stimulus
(someone says:”What do you eat?”
Echoic
Verbal Stimulus
(someone says “cookie”)
Verbal behavior: repeats all or part of antecedent
Receptive (actually not a verbal operant)
Verbal stimulus (someone says “touch cooke”)*
Non-verbal behavior
(child touches cookie)
Be sure that you point out that echoics and Intraverbals both have verbal antecedents.

43. Verbal Behavior Activity
As a result of:
One has a tendency to:
This is a:
Seeing a grape
Saying “grape”
Hearing a horn
Saying “truck”
Someone saying “what says moo?”
Saying “cow”
Wanting a push on the swing
Saying “push”
Being told to “stand up”
Standing up
Someone “winnie the”
Saying “pooh”
Someone says “potty”
Saying “potty”
Seeing a stranger
Saying “what’s your name?”
Seeing a tree
Saying “tree”
Say this pager as choral responding

44. Two other related skills:
Imitation: Given another person’s motor action in the antecedent condition, the child performs the same action.
Match to Sample: matching activities involving either identical or non-identical items. (This is a very simplistic definition for a very critical skill area also referred to as conditional discriminations.)

45. Teaching the Mand

46. Why Teaching Mands is Important
It helps children avoid frustration in communicating their needs and wants
It is relatively easy to do because you are using the child’s own motivation as a tool
It is a natural first step in teaching communication
Babies first verbal behaviors are usually mands: I.e the differentiated cry as a mand for diaper change, hunger, to be laid down, to demand social attention
Be sure to also mention how the opportunity to mand serves as the reinforcement in a chain of responses during intensive teaching.
For most children, we are concerned with too much manding (Michael, 1988).
For children with developmental disabilities the mand has been too often neglected (Michael, 1988
Children with autism often fail to develop effective mand repertoires: manding requires social interaction. Many children with autism present “defective mand repertoires”: they engage in problem behavior (tantrums, aggression) to make requests.

47. The Mand (Requesting)
All mands have one thing in common: in the antecedent condition, there is a Motivative Operation (or motivation) in place.
A= thirst (MO)
B= “I want juice”
C= student gets juice
If a child does not want the item, you cannot teach them to mand for it.

48. Examples of contriving an MO
Holding up an M&M within eyesight of the child
Giving the child a bottle with a tight lid. In the bottle is his favorite toy.
Giving the child a bowl of cereal with no spoon.
Giving the child a toy that requires batteries but withholding the batteries
Briefly turning on his or her favorite video.
Giving a bit of his or her favorite snack to another child.

49. When Negative Behaviors Occur During Mand Training
Do not reinforce whining/crying or other negative behaviors
Count and Mand
Child has to learn that crying will not get them anything….appropriate manding will!
Video of crying…count and mand

50. Keep Number and Effort of Demands Low at First
Carefully assess skills
Gradually fade in more difficult tasks
Avoid escape oriented behaviors: effort and demands should always be outweighed by easy responding
Make demands low at first: deliver reinforcement much more often than you ask the child to perform
It is important to keep the child/student with you and responding. Often for many kids “work” has been paired with aversive conditions and provides motivation to escape.
VIDEO CLIP: Mike only requires simple responses before providing Austin with access to preferred items.

51. The Assessment Of Basic Language and Learning Skills
The ABLLS
ABLLS is a VB Curriculum. Credit the authors: Jim Partington and Mark Sundberg, 1998: behavior Analysts, Inc.
The ABLLs was originally developed in the 1970’s and underwent a number of informal revisions prior to its formal publication in 1998: it is not technically “new”

52. Structure Of ABLLS
Show the three books as you briefly explain what they are

53. Daniel’s ABLLS A-H

54. Daniel’s ABLLS I-R

55. Daniel’s ABLLS S-Z

56. Mason’s ABLLS

57. Recommendations for Mason 1/5/05
Matching Identical Objects/Pictures (F/3)
Increase Verbal Imitation using Mand
Work on Fill-ins with songs
Baseline Labels
Set up Mand Sessions (2) 10-minute sessions/day
Keep demands low (VR 3 or 4)

58. Recommendations for Mason 2/25/05
Puzzles/easy toys (shape sorter)
Matching—start categories –make sure he knows tacts of exemplars
Prompt him to request actions and missing items
Baseline labels (buy flash cards)
Mix 80% easy to 20% hard w/VR 3
Continue teaching songs
Play doh and coloring
RFFC to TFFC to IFFC with item as answer
Count and Mand for access to tangibles

59. Lilly’s ABLLS

60. ABLLS--Lucas

61. VB MAPP--Lucas

62. Language Barriers--Lucas

63. Recommendations for Lucas
Intensive teaching and NET sessions
VR 15 (with 80% easy/20% hard)
Teach prepositions/pronouns
Teach manding for attention/information
Edmark reading program
Teach coin and time identification
Leisure and self care skills

64. Thirteen Intervention Tips
Thirteen tips based on the science of ABA and BF Skinner’s analysis of Verbal Behavior that you can start using immediately with all children and adults with language delays and disorders

65. # 1 – Be Positive
Be Positive! Use 8 positives for every negative. Don’t overuse the child’s name especially when saying “no” or placing a demand

66. #2 Pairing
2. “Pair” yourself and the environment with reinforcement by giving the child lots of reinforcement with no effort required .

67. # 3 Giving Directions 3. When giving a child a direction
Simplify the language
Make sure you are close enough and loud enough for him to hear.
Get down to child’s level to get child’s attention
Only give directions you can make the child do
Give the instruction only once and, if no response, prompt the child to complete the task.
Don’t give the child a direction you’re not willing to follow through with

68. #4 Reinforcement
4.Look for things that reinforce the child. Set up high interest activities: bubbles, water play, balls, wind up toys to see if any of these are motivators. Put these things out of reach so the child needs you to get them.

69. #5 Mand Training
Teach the child to communicate his needs and wants…first by pulling, reaching…then by using sign language, pictures, or words. Teach 3-5 signs at a time.

70. #6 Matching
Teach the child to match items and pictures. Label the item instead of using the command “match” or “put with same.”

71. # 7 Imitation With objects/toys.
7. Teach imitation skills.
With objects/toys.
Gross motor….Pick 2 or 3 movements to target at the same time. Provide as much prompting as needed to ensure the child is successful.

72. # 8 Receptive Skills
8.    Teach receptive skills.
Touch body parts, items or pictures…pick 2 or 3 receptive skills… provide as much prompting as needed to ensure the child is successful.

73. #9 Give Directions You Can Prompt
9. Since you can’t force a child to
speak, do not use “say______” if
the child cannot speak or if this is
a hard skill. (Say “cookie, cookie,
cookie” as you deliver a small
piece of cookie)

74. # 10 Teach Fill-ins to Songs
10.   Use music and familiar nursery
rhymes…leave the last word of
each line blank to see if child
fills it in.

75. # 11 Sabotage Daily Life Sabotage daily life to see if child
notices/indicates/or requests:
Give cup without juice.
Cereal without spoon.
Coming upstairs, do not turn off music.
Spill milk…don’t clean it up immediately.
Go a different route in the mall.

76. # 12 Do Not Reinforce Problem Behavior
12. Do not respond whining, kicking,
screaming and other negative
behaviors.
For problem behavior related to access to
attention/tangibles:
Walk away, Ignore, or use the Count and Mand procedure
For escape related problem behavior:
Ignore problem behavior and continue demand

77. # 13 Prevent and Correct Errors throughout the day!
Instructor: Points to an apple and says
What is it?
Child: “bird.”
Instructor: “What is it—apple”
Child: echoes “apple”
Instructor: Right, what is it?
Child: “apple”
Instructor: Presents 2-3 easy demands and
then “what is it?”
Child: “apple”

78. Some Take Home Points for Use With All Children (and Adults)
Pairing
Manding
Once the child can mand for items, ease in demands gradually
Prevent and Correct Errors throughout the day
Don’t reinforce problem behaviors

80. Questions?
Thank You!