Behavioral Approaches to Early Intervention with Autism

Behavioral Approaches to Behavioral Approaches to Early Intervention with Early Intervention with

AutismAutism

WAYNE W. FISHERWAYNE W. FISHER

Munroe-Meyer Institute at the Munroe-Meyer Institute at the

University of Nebraska Medical CenterUniversity of Nebraska Medical Center

Autism and Childhood Autism and Childhood SchizophreniaSchizophrenia

Once thought to be a form of Once thought to be a form of schizophreniaschizophrenia

Differs from schizophrenia in terms Differs from schizophrenia in terms of symptoms, age of onset, family of symptoms, age of onset, family history, etiology, and response to history, etiology, and response to treatmenttreatment

Definition of AutismDefinition of Autism

markedly abnormal or impairedmarkedly abnormal or impaired

development indevelopment in:: social interactionsocial interaction

communicationcommunication

and markedly restricted repertoire of and markedly restricted repertoire of activities and interests.activities and interests.

Definition of Autism Definition of Autism (continued)(continued)

Definitions are cheap, but explanations are dear, and we must be careful not to confuse them.

–David Palmer, 2004David Palmer, 2004

Autism Spectrum DisordersAutism Spectrum Disorders

Neurological disorders characterized by "severe and Neurological disorders characterized by "severe and pervasive impairment in several areas of pervasive impairment in several areas of developmentdevelopment Autistic DisorderAutistic Disorder Asperger's DisorderAsperger's Disorder Childhood Disintegrative Disorder (CDD)Childhood Disintegrative Disorder (CDD) Rett's Disorder Rett's Disorder PDD-Not Otherwise Specified (PDD-NOS)PDD-Not Otherwise Specified (PDD-NOS)

Prevalence of AutismPrevalence of Autism

Typically diagnosed within first three Typically diagnosed within first three yearsyears

2 to 6 in 1,000 individuals (Centers for 2 to 6 in 1,000 individuals (Centers for Disease Control and Prevention, 2001) Disease Control and Prevention, 2001)

Four times more prevalent in boys than Four times more prevalent in boys than girls girls

NIH Research Dollars Devoted to NIH Research Dollars Devoted to AutismAutism

When compared with other serious When compared with other serious childhood conditions, autism is much childhood conditions, autism is much more common, but fewer dollars per more common, but fewer dollars per case are spent on autism.case are spent on autism.

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Autism Juvenile Diabetes Muscular Dystrophy Leukemia Cystic Fibrosis

Prevalence of Autism and Other Conditions

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Autism Juvenile Diabetes Muscular Dystrophy Leukemia Cystic Fibrosis

NIH Research Dollars for Autism and Other Conditions

(Number of Dollars per Case)

Demographics of AutismDemographics of Autism

Knows no racial, ethnic, or social boundariesKnows no racial, ethnic, or social boundaries Family income, lifestyle, and educational levels do Family income, lifestyle, and educational levels do

not affect the chance of autism's occurrence not affect the chance of autism's occurrence Diagnosis of autism is growing at a rate of Diagnosis of autism is growing at a rate of

10-17% per year (U.S. Department of Education, 10-17% per year (U.S. Department of Education, 2002)2002)

Assessment and Diagnosis of Assessment and Diagnosis of AutismAutism

No medical tests for diagnosing autismNo medical tests for diagnosing autism Accurate diagnosis is based on observation of Accurate diagnosis is based on observation of

the individual's communication, behavior, and the individual's communication, behavior, and developmental levels. developmental levels. Autism Diagnostic Interview-R (ADI-R)Autism Diagnostic Interview-R (ADI-R) Home and/or school observationHome and/or school observation Video analysis of behavioral observationVideo analysis of behavioral observation

Identifying the Genetic Bases of Identifying the Genetic Bases of Autism Spectrum DisordersAutism Spectrum Disorders

Etiologic workups identify specific Etiologic workups identify specific genetic causes for autism in about 20% of genetic causes for autism in about 20% of cases. cases.

At the Munroe-Meyer Institute, Dr. At the Munroe-Meyer Institute, Dr. Schaefer and colleagues (2006) developed Schaefer and colleagues (2006) developed a 3-Tiered Approach that identifies a 3-Tiered Approach that identifies genetic causes in 40% of cases.genetic causes in 40% of cases.

Early Screening for Autism Early Screening for Autism (NICHD)(NICHD)

Does not babble or coo by 12 months Does not babble or coo by 12 months Does not gesture (point, wave, grasp) by 12 Does not gesture (point, wave, grasp) by 12

months months Does not say single words by 16 months Does not say single words by 16 months Does not say two-word phrases on his or her Does not say two-word phrases on his or her

own by 24 months own by 24 months Has any loss of any language or social skill at Has any loss of any language or social skill at

any age any age

Early Screening for Autism Early Screening for Autism (CHAT)(CHAT)

Does not display pretend play (e.g., pretending Does not display pretend play (e.g., pretending to drink from a toy cup) to drink from a toy cup)

Does not point at objects to indicate interest Does not point at objects to indicate interest Does not show interest in other children Does not show interest in other children Does not enjoy peek-a-boo hide-and-seek or Does not enjoy peek-a-boo hide-and-seek or

other social games other social games Does not bring and show objects to parents Does not bring and show objects to parents

Associated DisordersAssociated Disorders

Mental Retardation Mental Retardation 70% 15%70% 15% Seizure Disorder Seizure Disorder 35% 10%35% 10% Self-Injury, Aggression Self-Injury, Aggression 50%50% Tourette DisorderTourette Disorder Bipolar DisorderBipolar Disorder

Autism ASD

Associated Etiologic DiagnosesAssociated Etiologic Diagnoses

Fragile-X syndromeFragile-X syndrome Tuberous SclerosisTuberous Sclerosis Williams syndromeWilliams syndrome Landau-Kleffner syndromeLandau-Kleffner syndrome Congenital RubellaCongenital Rubella Smith-Magenis syndromeSmith-Magenis syndrome Neurofibromatosis Neurofibromatosis

Genetics and Twin StudiesGenetics and Twin Studies

Autism runs in familiesAutism runs in families Heritability for autism is about 90%Heritability for autism is about 90% Monozygotic twin concordance, 60%-100%Monozygotic twin concordance, 60%-100% Dizygotic twin concordance, 10%Dizygotic twin concordance, 10% Associated with abnormalities on Associated with abnormalities on

chromosomes 7q, 2q, and 15qchromosomes 7q, 2q, and 15q

Applied Behavior Analysis (ABA)Applied Behavior Analysis (ABA)

What is ABA?What is ABA? How is it different from other How is it different from other

approaches?approaches? How is it done?How is it done?

Baer, Wolf, & Risley (1968)Baer, Wolf, & Risley (1968)

APPLIEDAPPLIED—strives to produce rapid and clear —strives to produce rapid and clear benefit to problems of social importance;benefit to problems of social importance;

BEHAVIORALBEHAVIORAL——usesuses objective and accurate objective and accurate measurement of the behavior of interest;measurement of the behavior of interest;

ANALYSISANALYSIS—uses controlled (single-case) methods —uses controlled (single-case) methods to understand the environmental variable(s) that to understand the environmental variable(s) that influence an individual’s behavior.influence an individual’s behavior.

Historical Roots of Behavior Historical Roots of Behavior AnalysisAnalysis

1911 Thorndike-L1911 Thorndike-Law of effectaw of effect 1924 Watson-1924 Watson-BehaviorismBehaviorism 1927 Pavlov-1927 Pavlov-Conditioned ReflexesConditioned Reflexes 1938-Skinner 1938-Skinner Behavior of OrganismsBehavior of Organisms 1950’s-B1950’s-Behavioral applications reported in ehavioral applications reported in

scientific journalsscientific journals 1968-1968-Journal of Applied Behavior AnalysisJournal of Applied Behavior Analysis

How Effective is ABA for Autism?How Effective is ABA for Autism?

About 50% of Children with autism About 50% of Children with autism and mild mental retardation who and mild mental retardation who received early intervention with ABA received early intervention with ABA attain normal IQs and are educated in attain normal IQs and are educated in regular classrooms with minimal regular classrooms with minimal assistance. assistance.

Outcomes of ABA for Autism

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How Effective is ABA for Autism?How Effective is ABA for Autism?

Early Intervention of Autism using ABA has Early Intervention of Autism using ABA has been recommended by: been recommended by:

New York State Dept. of HealthNew York State Dept. of Health

U.S. Surgeon GeneralU.S. Surgeon General

National Research CouncilNational Research Council

Association for Science in Autism Association for Science in Autism TreatmentTreatment

Why is ABA Effective?Why is ABA Effective?

ABA developed from and remains closely ABA developed from and remains closely linked to basic research on the principles of linked to basic research on the principles of learning and behavior.learning and behavior.

A central principle of ABA is called “A central principle of ABA is called “Selection Selection by Consequences.by Consequences.””

In a given environment, behaviors that In a given environment, behaviors that produce produce favorable outcomes are selected (or favorable outcomes are selected (or continue to continue to occur) and those that produce occur) and those that produce unfavorable unfavorable consequences are extinguished. consequences are extinguished.

Why is ABA Effective? Why is ABA Effective? (continued)(continued)

ABA has developed a wide variety of ABA has developed a wide variety of procedures for identifying the antecedents and procedures for identifying the antecedents and consequences that influence behavior.consequences that influence behavior.

We rearrange the antecedents and We rearrange the antecedents and consequences in the environment so that consequences in the environment so that appropriate behavior is selected (or re-occurs) appropriate behavior is selected (or re-occurs) and problem behavior is extinguished.and problem behavior is extinguished.

Why is ABA Effective? Why is ABA Effective? (continued)(continued)

Specific procedures includeSpecific procedures include

ShapingShaping ChainingChaining PromptingPrompting FadingFading ExtinctionExtinction ReinforcementReinforcement Generalization strategies, etc.Generalization strategies, etc.

Why is ABA Effective with Why is ABA Effective with Autism?Autism?

ComprehensiveComprehensive: Teaches all skills (e.g., sitting, : Teaches all skills (e.g., sitting, attending, imitating, direction following, attending, imitating, direction following, language, social skills, self-help skills). language, social skills, self-help skills).

Goal and Data DrivenGoal and Data Driven: The focus on objective : The focus on objective measurement and analysis of behavior measurement and analysis of behavior provides ongoing feedback on progress and provides ongoing feedback on progress and setbacks.setbacks.

Example of Individual Goals for BillyExample of Individual Goals for Billy Decease self-injurious behaviorDecease self-injurious behavior Increase eye contactIncrease eye contact Increase spontaneous requestingIncrease spontaneous requesting Increase labeling skillsIncrease labeling skills Increase use of yes and noIncrease use of yes and no Increase imitation skillsIncrease imitation skills Increase matching skillsIncrease matching skills Increase letter identificationIncrease letter identification Increase self-feeding skillsIncrease self-feeding skills

Teaching Imitation Using Teaching Imitation Using Discrete TrialsDiscrete Trials

Starts with simple responses (e.g., clapping). Starts with simple responses (e.g., clapping).

Sessions consisting of 10 trials; each trial starts with Sessions consisting of 10 trials; each trial starts with the therapist saying “Do this” and then modeling the the therapist saying “Do this” and then modeling the target response.target response.

Any approximation of clapping, results in delivery of a Any approximation of clapping, results in delivery of a preferred reinforcer (e.g., toy).preferred reinforcer (e.g., toy).

Otherwise, the therapist guides the child’s hands to Otherwise, the therapist guides the child’s hands to complete the response and then begins the next trial. complete the response and then begins the next trial.

Teaching Imitation Using Teaching Imitation Using Discrete Trials Discrete Trials (continued)(continued)

Once the first response is mastered, the same Once the first response is mastered, the same procedure would be used to teach a second response procedure would be used to teach a second response (e.g., waving). (e.g., waving).

After two responses are mastered in individual After two responses are mastered in individual sessions, they would alternately be presented in the sessions, they would alternately be presented in the same session (e.g., “Do this” [clapping]; “Do this” same session (e.g., “Do this” [clapping]; “Do this” [waving]). [waving]).

Over time, additional responses are added until the Over time, additional responses are added until the child immediately imitates any new action the child immediately imitates any new action the therapist does following the prompt, “Do this.” therapist does following the prompt, “Do this.”

Generalization of SkillsGeneralization of Skills

Skills taught during discrete trials are then Skills taught during discrete trials are then generalized to natural settings.generalized to natural settings.

e.g., Clapping when another child answers e.g., Clapping when another child answers correctly during group instruction or at a correctly during group instruction or at a

recital or school assembly.recital or school assembly.

e.g., Waving to another person when e.g., Waving to another person when entering or entering or leaving a room.leaving a room.

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Billy: Imitating a Model

Why is ABA Effective with Why is ABA Effective with Autism? Autism? (continued)(continued)

Empirical EmphasisEmpirical Emphasis: : Treatments are Treatments are based on principles and procedures based on principles and procedures supported by research.supported by research.

Intensity LevelIntensity Level: : 25 to 40 hours per week 25 to 40 hours per week for 3 years.for 3 years.

Early Behavioral Intervention Early Behavioral Intervention for Autismfor Autism

Lovaas, 1987; McEachin et al., 1993; Lovaas, 1987; McEachin et al., 1993; Smith et al., 2000Smith et al., 2000

Year 1--reduce aberrant behavior, teach Year 1--reduce aberrant behavior, teach attending, imitation, instruction attending, imitation, instruction following, speaking in short phrases, following, speaking in short phrases, play skills, and self-help skillsplay skills, and self-help skills

Early Behavioral Intervention Early Behavioral Intervention for Autism for Autism (continued)(continued)

Year 2--extend expressive vocabulary, Year 2--extend expressive vocabulary, more abstract concepts, extend treatment more abstract concepts, extend treatment to group and community settings to group and community settings

Year 3--pre-academic and academic Year 3--pre-academic and academic skills, appropriate emotional expression, skills, appropriate emotional expression, observational learning, and interactions observational learning, and interactions and friendships with normally developing and friendships with normally developing peerspeers

Cost-Benefit Analysis of Early, Cost-Benefit Analysis of Early, Intensive ABA for AutismIntensive ABA for Autism

Average lifetime cost for a person with autism is over $4 million

Average cost of Early, Intensive ABA is $150,000 over about 3 years

Average lifetime savings from ABA Treatment is between $1.6 and $2.7 million

Assessing Children with Assessing Children with AutismAutism

Periodic assessment for diagnosis and Periodic assessment for diagnosis and managementmanagement

Ongoing assessment for interventionOngoing assessment for intervention

Periodic Assessment for Periodic Assessment for Diagnosis and ManagementDiagnosis and Management

Identify the child’s overall strengths Identify the child’s overall strengths and limitationsand limitations

Determine the appropriate diagnosis Determine the appropriate diagnosis or diagnosesor diagnoses

Set the global goals for treatmentSet the global goals for treatment

Components of a Components of a Diagnostic AssessmentDiagnostic Assessment

Genetic/Etiologic workupGenetic/Etiologic workup Assessment of behavior/symptomsAssessment of behavior/symptoms Formal audiologic evaluationFormal audiologic evaluation Cognitive testingCognitive testing Assessment of adaptive behaviorAssessment of adaptive behavior Speech/Language evaluationSpeech/Language evaluation

Ongoing Assessment for Ongoing Assessment for InterventionIntervention

Identify the specific behaviors to be Identify the specific behaviors to be increasedincreased

Identify the specific behaviors to be Identify the specific behaviors to be decreaseddecreased

Identify effective reinforcersIdentify effective reinforcers

Assessment of Skills to Assessment of Skills to IncreaseIncrease

Attending SkillsAttending Skills ComplianceCompliance Following Simple InstructionsFollowing Simple Instructions Motor ImitationMotor Imitation Vocal ImitationVocal Imitation MatchingMatching Play SkillsPlay Skills Social SkillsSocial Skills Self-Help SkillsSelf-Help Skills

Skill Assessment AreasSkill Assessment Areas

Imitating Behavioral ChainsImitating Behavioral Chains Following Multi-Step InstructionsFollowing Multi-Step Instructions CategorizationCategorization Verbal Behavior-Listener SkillsVerbal Behavior-Listener Skills Verbal Behavior-Speaker SkillsVerbal Behavior-Speaker Skills Pre-academic and Academic SkillsPre-academic and Academic Skills

Matching Skills ProgressionMatching Skills Progression

Identity matching with objectsIdentity matching with objects Identity matching with picturesIdentity matching with pictures Matching pictures to objectsMatching pictures to objects Matching objects to picturesMatching objects to pictures Matching shapes, colors, letters, numbersMatching shapes, colors, letters, numbers Matching on 2 dimensions (color-shape)Matching on 2 dimensions (color-shape) Matching by categories (e.g., animals, vehicles)Matching by categories (e.g., animals, vehicles) Matching objects with their spoken namesMatching objects with their spoken names Matching pictures with their spoken namesMatching pictures with their spoken names

Social Skills ProgressionSocial Skills Progression Shaking handsShaking hands Making eye contact during greetingsMaking eye contact during greetings Imitating a smileImitating a smile Smiling reciprocallySmiling reciprocally Appropriately getting someone’s attentionAppropriately getting someone’s attention Appropriately exchanging toys with a peerAppropriately exchanging toys with a peer Playing a simple interactive game (roll ball)Playing a simple interactive game (roll ball) Showing appropriate affection (e.g., hugs)Showing appropriate affection (e.g., hugs) Taking turns during a simple gameTaking turns during a simple game Making polite statements (e.g., “Bless you. “Your Making polite statements (e.g., “Bless you. “Your

welcome.”)welcome.”) Initiating a conversation (e.g., “Did you watch the Huskers Initiating a conversation (e.g., “Did you watch the Huskers

game?”)game?”)

Preference AssessmentsPreference Assessments

• Children with developmental disabilities Children with developmental disabilities sometimes are not able to tell you what things sometimes are not able to tell you what things they like or tell you when they want one thing they like or tell you when they want one thing instead of another.instead of another.

• Researchers have developed Researchers have developed preference preference assessmentsassessments to identify what things people with to identify what things people with disabilities like.disabilities like.

Steps of Preference AssessmentsSteps of Preference Assessments

Step 1Step 1: Interview the parent with the RAISD to list : Interview the parent with the RAISD to list the kinds of things that the child likesthe kinds of things that the child likes

Step 2Step 2: Get the actual items the parent nominated as : Get the actual items the parent nominated as highly preferredhighly preferred

Step 3Step 3: Allow the child to select items from the : Allow the child to select items from the groupgroup

Step 4Step 4: Rank the items from high to low based on : Rank the items from high to low based on what the child chosewhat the child chose

Types of Preference AssessmentsTypes of Preference Assessments

• Single-item typeSingle-item type – Present each item from the – Present each item from the group one at a timegroup one at a time

• Choice typeChoice type – Present all items 2 at a time and – Present all items 2 at a time and let the child choose between the 2.let the child choose between the 2.

• Group typeGroup type – Present all items together and let – Present all items together and let the child select items from the groupthe child select items from the group

Single-item Preference Single-item Preference AssessmentsAssessments

Developed by Pace et al. (1985)Developed by Pace et al. (1985)• 16 stimuli16 stimuli• Each stimulus presented individually 10 Each stimulus presented individually 10

times for 5 seconds eachtimes for 5 seconds each– The SI method identified highly preferred stimuli The SI method identified highly preferred stimuli

for all participants in the studyfor all participants in the study

– However, subsequent research has shown that However, subsequent research has shown that the SI method may also yield a high number of the SI method may also yield a high number of false positivesfalse positives

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Paired-Choice Preference Paired-Choice Preference AssessmentAssessment

Developed by Fisher et al. (1992, 1996)Developed by Fisher et al. (1992, 1996)• Take 5-10 top stimuli from the RAISDTake 5-10 top stimuli from the RAISD• Each stimulus paired once with every other Each stimulus paired once with every other

stimulusstimulus• Two stimuli presented concurrently; the Two stimuli presented concurrently; the

participant was prompted to choose oneparticipant was prompted to choose one– The participants had to emit a choiceThe participants had to emit a choice

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Group Preference Assessment- Group Preference Assessment- MSWOMSWO

Multiple Stimulus without replacement Multiple Stimulus without replacement (MSWO) developed by DeLeon and (MSWO) developed by DeLeon and Iwata (1996)Iwata (1996)• Compared three different preference Compared three different preference

assessments (PC method, MSWR, & assessments (PC method, MSWR, & MSWO)MSWO)

• Results obtained from MSWO were Results obtained from MSWO were comparable to that obtained by the PC comparable to that obtained by the PC methodmethod

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Preference Assessment OutcomePreference Assessment Outcome

Items that the child chooses are usually the Items that the child chooses are usually the most effective positive reinforcer.most effective positive reinforcer.

Ongoing Preference AssessmentsOngoing Preference Assessments

Paired-choice assessment conducted once Paired-choice assessment conducted once every 4-6 monthsevery 4-6 months

Mini-MSWO assessments conducted daily or Mini-MSWO assessments conducted daily or more frequentlymore frequently

Compliance and Cooperation Compliance and Cooperation TrainingTraining

Individuals on the autism spectrum often Individuals on the autism spectrum often display problem behaviors in a variety of display problem behaviors in a variety of contexts including:contexts including:• when instructional requests are presented when instructional requests are presented • when asked to surrender an unusual object when asked to surrender an unusual object

(e.g., piece of dirt) they are holding during (e.g., piece of dirt) they are holding during instructionsinstructions

Compliance and Cooperation Compliance and Cooperation TrainingTraining (continued)(continued)

Teaching a child to accept removal of a Teaching a child to accept removal of a preferred object using delay fading.preferred object using delay fading.

Teaching compliance using least-to-most Teaching compliance using least-to-most prompts.prompts.

Teaching Tolerance for Teaching Tolerance for Instructional TaskInstructional Task The traditional approach to treating these The traditional approach to treating these

problems involves extinctionproblems involves extinction Extinction often produces deprivation from Extinction often produces deprivation from

reinforcement, which in turn, may evoke reinforcement, which in turn, may evoke bursts of problem behaviorbursts of problem behavior

Teaching Tolerance for Teaching Tolerance for Instructional TaskInstructional Task (continued)(continued)

Bouxsein and Fisher (in press) evaluated an Bouxsein and Fisher (in press) evaluated an alternative to extinction.alternative to extinction.

The alternative involved the provision of a The alternative involved the provision of a choice between surrendering the preferred choice between surrendering the preferred object or completing the instructional tasks object or completing the instructional tasks while retaining the object.while retaining the object.

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Compliance TrainingCompliance Training This case illustrates a simple and This case illustrates a simple and

effective way to increase compliance effective way to increase compliance while decreasing problem behavior while decreasing problem behavior associated with presentation of associated with presentation of instructionsinstructions

This may be a result of decreasing the This may be a result of decreasing the aversiveness of the instruction by aversiveness of the instruction by allowing the child to choose whether to allowing the child to choose whether to surrender a object or complete an surrender a object or complete an alternative demandalternative demand

Improving Vocabulary Skills in Improving Vocabulary Skills in Children with AutismChildren with Autism

Recent behavior analytic work in autism Recent behavior analytic work in autism has focused on teaching critical skills, has focused on teaching critical skills, ones that facilitate the acquisition of ones that facilitate the acquisition of many subsequent skills (e.g., pivotal many subsequent skills (e.g., pivotal responses, behavioral cusps).responses, behavioral cusps).

Vocabulary as a Critical SkillVocabulary as a Critical Skill

Children in advantaged homes are exposed to, Children in advantaged homes are exposed to, and learn two to three times as many words as and learn two to three times as many words as those in disadvantaged homes (Hart and Risley, those in disadvantaged homes (Hart and Risley, 1995).1995).

Correlation of .78 between parents use of “non-Correlation of .78 between parents use of “non-business” words with their kids and later IQbusiness” words with their kids and later IQ

This discrepancy between advantaged and This discrepancy between advantaged and disadvantaged children is not ameliorated disadvantaged children is not ameliorated through schooling.through schooling.

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Vocabulary as a Critical SkillVocabulary as a Critical Skill (continued)(continued)

Vocabulary in the early school years is the Vocabulary in the early school years is the single, best predictor of SAT scores and single, best predictor of SAT scores and adult literacy.adult literacy.

This is why Andy Biemiller has called This is why Andy Biemiller has called vocabulary the vocabulary the Missing LinkMissing Link between between reading mechanics and reading reading mechanics and reading comprehension or literacy.comprehension or literacy.

Vocabulary and ReadingVocabulary and Reading

Read the following word and raise your Read the following word and raise your hand when you know what it is:hand when you know what it is:

• supercalifragilisticexpialidocioussupercalifragilisticexpialidocious

Individualized Vocabulary Lists Individualized Vocabulary Lists with Normative Relevancewith Normative Relevance

Normative word lists provide information Normative word lists provide information on words that most children knowon words that most children know

Individualized word lists contain words Individualized word lists contain words that a child contacts on a routine basisthat a child contacts on a routine basis

Identifying words common to both types Identifying words common to both types of lists may produce the larger increases of lists may produce the larger increases in the child’s working vocabularyin the child’s working vocabulary

Developing an Individualized Developing an Individualized Vocabulary ListVocabulary List

Begin with a word list with a Begin with a word list with a developmental progressiondevelopmental progression Living Word VocabularyLiving Word Vocabulary; (; (Dale & O'Rourke, 1981) http://www.sci.sdsu.edu/lexical/select.phphttp://www.sci.sdsu.edu/lexical/select.php; (Dale & ; (Dale &

Fenson, 1996)Fenson, 1996)

Developing an Individualized Developing an Individualized Vocabulary List Vocabulary List (continued)(continued)

Identify words that the child is likely to Identify words that the child is likely to contact on a daily basiscontact on a daily basis Morning RoutineMorning Routine

Places, people, activities, itemsPlaces, people, activities, items MealtimeMealtime

Foods, utensils, kitchen and dining room itemsFoods, utensils, kitchen and dining room items PlaytimePlaytime

Toys, activities, peopleToys, activities, people

Developing an Individualized Developing an Individualized Vocabulary ListVocabulary List (continued)(continued)

Daycare or schoolDaycare or school People, actions, objectsPeople, actions, objects

Places like church, stores, restaurantsPlaces like church, stores, restaurants What is done there, What they sell, What What is done there, What they sell, What

you buyyou buy

Household chores and activitiesHousehold chores and activities What they are called, Who does themWhat they are called, Who does them

Developing an Individualized Developing an Individualized Vocabulary ListVocabulary List (continued)(continued)

Special eventsSpecial events Birthdays, holidays, vacationsBirthdays, holidays, vacations

Sports and hobbiesSports and hobbies Materials used, players, positions, What Materials used, players, positions, What

they dothey do Things in the yard and neighborhoodThings in the yard and neighborhood

Animals, trees, vehicles, names of Animals, trees, vehicles, names of neighborsneighbors

Developing an Individualized Developing an Individualized Vocabulary ListVocabulary List (continued)(continued)

Keep a 3-day diary and write down Keep a 3-day diary and write down the names of people, objects, the names of people, objects, activities, and actions and add any activities, and actions and add any new words to your listnew words to your list

Developing an Individualized Developing an Individualized Vocabulary ListVocabulary List (continued)(continued)

Enter the individualized list into a Enter the individualized list into a spreadsheet next to the normative word listspreadsheet next to the normative word list

Sort both lists alphabeticallySort both lists alphabetically Identify words common to both listsIdentify words common to both lists Re-sort the lists developmentallyRe-sort the lists developmentally Begin teaching common words ordered Begin teaching common words ordered

developmentallydevelopmentally

Jack's List Normative Words Dev Lev in Months

a a 26.5

a lot a lot 29.5

about after 29

ache all 18

air all gone 17

airplane alligator 25

all am 28

all gone an  

alone and 26

and animal 24

animal ankle 30

ant another 29

apple ant 24

are any 29

arm apple 14

Jack's List Normative Words Dev Lev in Months

belt ball 9

block bath 9

  book 10

bat baby 11

bib balloon 12

bicycle banana 12

book bathtub 12

  bye 12

banana baa baa 12.5

brush bed 13

button belly button 13

  breakfast 13

arm apple 14

boat bathroom 14

  block 14

Behavior Analytic Approaches Behavior Analytic Approaches to Vocabulary Developmentto Vocabulary Development

From a behavior analytic perspective, From a behavior analytic perspective, teaching vocabulary involves the teaching vocabulary involves the establishment of specific types of establishment of specific types of conditional discriminations, ones involving conditional discriminations, ones involving a spoken or written word as component of a spoken or written word as component of the four-term contingency.the four-term contingency.

Conditional Discriminations Conditional Discriminations Involving Deictic WordsInvolving Deictic Words

Children with autism have particular Children with autism have particular difficulty learning deictic words because they difficulty learning deictic words because they require conditional discriminations (or have require conditional discriminations (or have shifting referents).shifting referents).

Examples: I, you, me; first, last; this, that; Examples: I, you, me; first, last; this, that; here, there.here, there.

Conditional Discriminations Conditional Discriminations Involving Social SkillsInvolving Social Skills

Social approaches to other individuals are Social approaches to other individuals are likely to produce reinforcement under certain likely to produce reinforcement under certain conditions and not others (e.g., requests to conditions and not others (e.g., requests to play when a parent is busy or not).play when a parent is busy or not).

Interactive play and joint attention require Interactive play and joint attention require the child to simultaneously attend to objects the child to simultaneously attend to objects and people. and people.

Three- and Four-Term Three- and Four-Term ContingenciesContingencies

Stimulus – Response – ReinforcerStimulus – Response – Reinforcer

Conditional Stimulus – Stimulus – Response – ReinforcerConditional Stimulus – Stimulus – Response – Reinforcer

With spoken-word-to-picture discriminations, a spoken word With spoken-word-to-picture discriminations, a spoken word is the conditional stimulus that specifies which of the is the conditional stimulus that specifies which of the comparison stimuli the individual should respond to produce comparison stimuli the individual should respond to produce reinforcement. reinforcement.

Spoken-Word-to-Picture Spoken-Word-to-Picture DiscriminationsDiscriminations

““Point to Dog” Point to Dog”

Building Working VocabulariesBuilding Working Vocabularies

Spoken-word-to-picture discriminations Spoken-word-to-picture discriminations are critical to the development of are critical to the development of vocabulary skills.vocabulary skills.

Functional Approaches to Teaching Functional Approaches to Teaching Conditional Discriminations in AutismConditional Discriminations in Autism

Unmotivated learnersUnmotivated learners Learners requiring extra-stimulus Learners requiring extra-stimulus

promptsprompts Inattentive learnersInattentive learners Severely limited learnersSeverely limited learners

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Prompted correct

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Teaching Conditional Discriminations Teaching Conditional Discriminations to Inattentive Learnersto Inattentive Learners

Extend prior work on differential Extend prior work on differential observing responses (DORs) by observing responses (DORs) by embedding an identity-matching task embedding an identity-matching task into a graduated-prompting procedure to into a graduated-prompting procedure to teach spoken-word-to-picture relations to teach spoken-word-to-picture relations to children with autism.children with autism.

Treatment and Control Treatment and Control ConditionsConditions

ControlControl• Verbal prompt to point to test stimulusVerbal prompt to point to test stimulus• No feedback for correct or incorrect responsesNo feedback for correct or incorrect responses

Graduated promptingGraduated prompting• Sequential verbal, modeled, and physical promptsSequential verbal, modeled, and physical prompts• Praise and edible delivered for correct response Praise and edible delivered for correct response

following the verbal promptfollowing the verbal prompt Identity-matching Identity-matching

• Identical to graduated-prompting except the Identical to graduated-prompting except the modeledmodeled prompt was replaced with an identity-prompt was replaced with an identity-matching taskmatching task

• ID prompt: Therapist held up a picture identical to the ID prompt: Therapist held up a picture identical to the test stimulus and said, “This is Alex. Point to Alex”test stimulus and said, “This is Alex. Point to Alex”

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Teaching Vocabulary in AutismTeaching Vocabulary in Autism

These cases illustrate how identifying the These cases illustrate how identifying the functional deficit responsible for a child’s poor functional deficit responsible for a child’s poor performance on spoken-word-to-picture relations performance on spoken-word-to-picture relations can be used to develop an effective intervention can be used to develop an effective intervention to improve the child’s working vocabulary.to improve the child’s working vocabulary.

Vocal Mand Assessment and Vocal Mand Assessment and Training (Bourret et al., 2004)Training (Bourret et al., 2004)

Conducted a preference assessment to Conducted a preference assessment to identify a high preference itemidentify a high preference item

Conducted mand assessment to identify Conducted mand assessment to identify the appropriate training procedurethe appropriate training procedure

Conducted mand training using the Conducted mand training using the identified procedureidentified procedure

Behavioral Approaches to Behavioral Approaches to Verbal BehaviorVerbal Behavior

In traditional approaches to speech and In traditional approaches to speech and language, the focus is on the topography of language, the focus is on the topography of verbal behavior or what it looks like (e.g., verbal behavior or what it looks like (e.g., receptive, expressive, phonemes, words, receptive, expressive, phonemes, words, phrases, sentences).phrases, sentences).

Behavioral approaches focus on the Behavioral approaches focus on the functional aspects of verbal behavior (e.g., functional aspects of verbal behavior (e.g., echoic, mands, tacts, intraverbal, autoclitic).echoic, mands, tacts, intraverbal, autoclitic).

Behavioral Approaches to Behavioral Approaches to Verbal BehaviorVerbal Behavior (continued)(continued)

Verbal behaviors are learned responses Verbal behaviors are learned responses that are defined in terms of the antecedents that are defined in terms of the antecedents and consequences of which the behavior is and consequences of which the behavior is a function:a function:

Antecedent Behavior ConsequenceAntecedent Behavior Consequence

Echoic Responses, Mands, Echoic Responses, Mands, Tacts, IntraverbalsTacts, Intraverbals

Antecedent Behavior ConsequenceAntecedent Behavior Consequence

“ “Ball” “Ball” “Good job”Ball” “Ball” “Good job”

Ball on shelf “Ball” Ball givenBall on shelf “Ball” Ball given

Ball shown “Ball” “That’s right”Ball shown “Ball” “That’s right”

““What is round “Ball” “That’s right”What is round “Ball” “That’s right”and bounces?”and bounces?”

Vocal Mand AssessmentVocal Mand Assessment

Each session involved 10 1-minute trialsEach session involved 10 1-minute trials 0 s: No Prompt0 s: No Prompt

Hold the high preference item in front of the childHold the high preference item in front of the child

10 s: Nonspecific Prompt: 10 s: Nonspecific Prompt:

““If you want this, ask me for it.”If you want this, ask me for it.”

20 s: Modeled Prompt: 20 s: Modeled Prompt:

““If you want this, say chip.”If you want this, say chip.”

30 s: Phoneme Prompt: 30 s: Phoneme Prompt:

““If you want this, say “ch.”If you want this, say “ch.”

Give the high preference item for the remainder of the Give the high preference item for the remainder of the trial following a correct response.trial following a correct response.

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Social Skills TrainingSocial Skills Training

Identify one or more peers who are willing to Identify one or more peers who are willing to help promote social behaviorhelp promote social behavior

Identify activities that both your child and the Identify activities that both your child and the peer enjoypeer enjoy

Possible activities include: rolling a ball, Possible activities include: rolling a ball, Lego blocks, basketball and hoop, puzzles, musical instruments, crayons, play dough, dressing up in costumes, duck-duck-goose, ring-around the rosy, trucks and cars

Social Skills TrainingSocial Skills Training (continued)(continued)

Practice the activity with your child and Practice the activity with your child and note any prompts, reinforcers, or note any prompts, reinforcers, or assistance you provide.assistance you provide.

Before the activity starts, teach the peer Before the activity starts, teach the peer to deliver the same prompts, reinforcers, to deliver the same prompts, reinforcers, and assistance as you did when you and assistance as you did when you practiced with your child.practiced with your child.

Social Skills TrainingSocial Skills Training (continued)(continued)

Supervise the initial session closely and Supervise the initial session closely and deliver praise and preferred items for deliver praise and preferred items for appropriate social behaviors like,appropriate social behaviors like, SmilingSmiling Initiations, spoken or gestured (“Look”, Initiations, spoken or gestured (“Look”,

“Watch me”, “Your turn”, “My turn”)“Watch me”, “Your turn”, “My turn”) Turn-taking and sharingTurn-taking and sharing

Initial Toilet TrainingInitial Toilet Training

Prompt the child to go into the bathroom and pull Prompt the child to go into the bathroom and pull down their pants.down their pants.

If the child is wet or soiled, clean and change them If the child is wet or soiled, clean and change them with minimal attention (don’t talk to the child) and with minimal attention (don’t talk to the child) and then leave the bathroom.then leave the bathroom.

If the child is dry, have them feel their underwear If the child is dry, have them feel their underwear and praise (“Good job! Your pants are dry.”) and praise (“Good job! Your pants are dry.”)

Have the child sit on the toilet and immediately Have the child sit on the toilet and immediately deliver their most preferred reinforcer and then deliver their most preferred reinforcer and then allow the child to get off the toilet and leave the allow the child to get off the toilet and leave the bathroom. bathroom.

Initial Toilet TrainingInitial Toilet Training (continued)(continued)

Keep a log and record whether the child was wet, soiled, or Keep a log and record whether the child was wet, soiled, or dry, and whether they voided in the toilet.dry, and whether they voided in the toilet.

Repeat 9 more times (or trials), once every ½ hr.Repeat 9 more times (or trials), once every ½ hr. For the next 10 trials, set a kitchen timer and have the For the next 10 trials, set a kitchen timer and have the

child sit on the toilet until the timer goes off and then child sit on the toilet until the timer goes off and then deliver the reinforcer.deliver the reinforcer.

Mix up the lengths of the toileting sits (e.g., starting with 5, Mix up the lengths of the toileting sits (e.g., starting with 5, 8, 6, 10, 7, 9, 6, 9, 5, 10, 8, and 7 seconds).8, 6, 10, 7, 9, 6, 9, 5, 10, 8, and 7 seconds).

If at any point, the child voids in the toilet, immediately If at any point, the child voids in the toilet, immediately praise, deliver the reinforcer and allow them to get off the praise, deliver the reinforcer and allow them to get off the toilet and leave the bathroom.toilet and leave the bathroom.

Initial Toilet TrainingInitial Toilet Training (continued)(continued)

Get the child used to the toilet (cont.).Get the child used to the toilet (cont.). For the next 10 trials, double the lengths of the toileting For the next 10 trials, double the lengths of the toileting

sits (e.g., 12, 14, 10, 18, 16, 20, 12, 18, 10, 16, 20, and 14 sits (e.g., 12, 14, 10, 18, 16, 20, 12, 18, 10, 16, 20, and 14 seconds).seconds).

Continue doubling the lengths of the sits until the child Continue doubling the lengths of the sits until the child is sitting on the toilet for 5 minutes once every ½ hr.is sitting on the toilet for 5 minutes once every ½ hr.

When ½ of the child’s voids are in the toilet, stop When ½ of the child’s voids are in the toilet, stop providing reinforcement for completing 5-minute providing reinforcement for completing 5-minute toileting sits without voiding (i.e., only voiding in the toileting sits without voiding (i.e., only voiding in the toilet produces reinforcement).toilet produces reinforcement).

This presentation can be located at:

www.unmc.edu/mmi (select the link Departments then

Center for Autism Spectrum Disorders)