Presentation on theme: "Using the Verbal Behavior Approach to Teach Children with Autism"— Presentation transcript:
1 Using the Verbal Behavior Approach to Teach Children with Autism Mary Lynch Barbera, RN, MSN, BCBAMay 2009Autism One Conference
2 My Autism JourneyJuly 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 autism19 received 40 hours/wk 1:1 ABA for 2 years20 received 10 hours/wk20 received standard special education classrooms/OT/speech47% 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.
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 termsExamines the functional relationship between behavior and its controlling variablesAnalyzes socially significant behavior in need of improvementAnalyzes behavior through a three term contingencyNeed 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 lifeFor 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--ConsequencesA—B—CAlso Described AsDiscriminative Stimulus--Response--ConsequenceMO/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 behaviorBehavior - an observable and measurable act of an individualConsequence - any stimulus that happens after a behavior
10 Three (Really Four) Term Contingency Antecedent--Behavior--ConsequencesMotivation is now seen as playing a significant role in this model (Michael)CABMotivationBe 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 withdrawnAlso: 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 behaviorsLanguage, self care skills, academic skills.Decrease negative behaviorsTantrums, 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 EventAspects of a person’s environment or daily routine that do not necessarily occur immediately before the behavior.Medication adjustmentMedical problems (pink eye, diaper rash)Sleep problemsEating routines/dietNumber of people in roomDaily schedule (how predictable/how much choice)
16 Immediate Antecedents What triggered the behaviorWhat happened immediately before problem behavior started:Computer was turned offTold child to hang up coatChild 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.PunishmentA consequence that results in decreasing the future rate of behavior it follows.
19 ConsequencesAny behavior that occurs repeatedly is serving some useful function and producing some type of reinforcement.
20 ConsequencesAfter 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/manding8 positives to every negativeReconfigure class layout or ratioGive more or less time at a centerGet more sleep at night or napEat breakfast or serve snack earlierProvide 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 MandPlanned IgnoringTime OutWork 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 behaviorYour demands might be too high and/or reinforcement might be too lowThe environment might need to be changed
31 Three things that matter no matter what the age or functioning level!! Problem behaviors at or near 0Ability to request wants and needs to an unfamiliar adultIndependent 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 behaviorDiscuss 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 AnalysisDirect InstructionVerbal BehaviorDiscrete TrialTeachingIntensive behavioral InterventionLovaasTherapyIncidental TeachingPrecision TeachingFluency Based Instruction
38 LOVAAS (UCLA) Plus MICHAEL (WMU) Plus Dual Path of Applied Behavior Analysis ResearchLOVAAS (UCLA)ABA ResearchPlusDiscrete Trial Training(structure)MICHAEL (WMU)ABA ResearchPlusDiscrete Trial TrainingSkinner’s Analysis ofVerbal Behavior(function)
39 Common terms for the Verbal Operants Mand = requestTact = labelIntraverbal = conversation, answering a question, responding when someone else talksEchoic = repeating what someone else saysReceptive 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)TactSensory Stimuli(sees or smells cookie)Non-specific reinforcement(gets praised, for instance)IntraverbalVerbal stimulus(someone says:”What do you eat?”EchoicVerbal Stimulus(someone says “cookie”)Verbal behavior: repeats all or part of antecedentReceptive (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 grapeSaying “grape”Hearing a hornSaying “truck”Someone saying “what says moo?”Saying “cow”Wanting a push on the swingSaying “push”Being told to “stand up”Standing upSomeone “winnie the”Saying “pooh”Someone says “potty”Saying “potty”Seeing a strangerSaying “what’s your name?”Seeing a treeSaying “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.)
46 Why Teaching Mands is Important It helps children avoid frustration in communicating their needs and wantsIt is relatively easy to do because you are using the child’s own motivation as a toolIt is a natural first step in teaching communicationBabies 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 attentionBe 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, 1988Children 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 juiceIf 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 childGiving 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 batteriesBriefly 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 behaviorsCount and MandChild 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 skillsGradually fade in more difficult tasksAvoid escape oriented behaviors: effort and demands should always be outweighed by easy respondingMake demands low at first: deliver reinforcement much more often than you ask the child to performIt 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 ABLLSABLLS 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 ABLLSShow the three books as you briefly explain what they are
57 Recommendations for Mason 1/5/05 Matching Identical Objects/Pictures (F/3)Increase Verbal Imitation using MandWork on Fill-ins with songsBaseline LabelsSet up Mand Sessions (2) 10-minute sessions/dayKeep 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 exemplarsPrompt him to request actions and missing itemsBaseline labels (buy flash cards)Mix 80% easy to 20% hard w/VR 3Continue teaching songsPlay doh and coloringRFFC to TFFC to IFFC with item as answerCount and Mand for access to tangibles
63 Recommendations for Lucas Intensive teaching and NET sessionsVR 15 (with 80% easy/20% hard)Teach prepositions/pronounsTeach manding for attention/informationEdmark reading programTeach coin and time identificationLeisure 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 PositiveBe Positive! Use 8 positives for every negative. Don’t overuse the child’s name especially when saying “no” or placing a demand
66 #2 Pairing2. “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 languageMake sure you are close enough and loud enough for him to hear.Get down to child’s level to get child’s attentionOnly give directions you can make the child doGive 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 Reinforcement4.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 TrainingTeach 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 MatchingTeach 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 Skills8. 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 tospeak, do not use “say______” ifthe child cannot speak or if this isa hard skill. (Say “cookie, cookie,cookie” as you deliver a smallpiece of cookie)
74 # 10 Teach Fill-ins to Songs 10. Use music and familiar nurseryrhymes…leave the last word ofeach line blank to see if childfills 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 negativebehaviors.For problem behavior related to access toattention/tangibles:Walk away, Ignore, or use the Count and Mand procedureFor 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 saysWhat 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 andthen “what is it?”Child: “apple”
78 Some Take Home Points for Use With All Children (and Adults) PairingMandingOnce the child can mand for items, ease in demands graduallyPrevent and Correct Errors throughout the dayDon’t reinforce problem behaviors