Using the Verbal Behavior Approach to Teach Children with Autism Mary Lynch Barbera, RN, MSN, BCBA www.vbapproach.com May 2009 Autism One Conference
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.
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”
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.
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)
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
Three Term Contingency • Antecedent--Behavior--Consequences A—B—C Also Described As Discriminative Stimulus--Response--Consequence MO/SD—R—Reinf. or Punish.
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
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
Examples of Three Term Contingency • “Touch nose” – Child touches nose – receives piece of cookie • “Do Puzzle” – Child falls to floor – Demand withdrawn
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
$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?
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
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)
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
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
Consequences • Reinforcement • 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.
Consequences • Any behavior that occurs repeatedly is serving some useful function and producing some type of reinforcement.
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.
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.
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.
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.
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
Functions of Problem Behavior • To obtain something desirable (Attention, Tangibles, Sensory Stimulation). • To avoid or escape something undesirable (Task avoidance).
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
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)
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+.
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
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
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****
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.
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?
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
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
What is Verbal Behavior? Behavior that is reinforced through the mediation of another person’s behavior
Applied Behavior Analysis Direct Instruction Verbal Behavior Discrete Trial Teaching Intensive behavioral Intervention Lovaas Therapy Incidental Teaching Precision Teaching Fluency Based Instruction
Dual Path of Applied Behavior Analysis Research LOVAAS (UCLA) ABA Research Plus Discrete Trial Training (structure) MICHAEL (WMU) ABA Research Plus Discrete Trial Training Plus Skinner’s Analysis of Verbal Behavior (function)
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
What is “Coffee”??????? Is it a… • MAND? • TACT? • INTRAVERBAL?
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.)
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
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.
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.
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!
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