5 ABA principles that Speech and Language Therapists Use

This guest post is from Trisha Pranjivan at The Children’s Place. You can check out The Children’s Place hereTCP have clinic’s in Clapham and Marylebone that offer speech and language therapy and occupational therapy. I have a good working relationship with the guys at the clinic, and it’s wonderful to work together. Over to Trisha….

 

Since meeting James, and attending the trainings that he provides at our clinic, I’ve learned so much more about ABA than I knew before and my perspective on ABA therapy has changed dramatically and positively. In the last year, thanks to the wonderful trainings that James has provided our clinic, I’ve come to the realisation that everyone uses ABA principles in one form or another. Speech and Language Therapists are no exception! We use certain principles of ABA in our sessions in order to help children reach their speech and language targets. Below is a description of ABA principles as it relates to speech and language therapy. 

 

ABA principles in Speech and Language Therapy

 

                                                                             Pairing

PairingThis is a principle that I never had a label for before learning more about ABA. Pairing is the process of building and maintaining rapport with a child so that they want to play with you. This is so important because the more paired you are with a child, the more willing the child is to do what you ask of them. In Speech and Language Therapy sessions, we often have to do a lot of repetitive practice of speech sounds or language concepts. It can be very difficult to engage a child in these sorts of adult-led, tasks if not properly paired. If the child isn’t interested in playing with the therapist, they will definitely not be interested in practicing their speech sounds. However, if properly paired, the child will be excited to see the therapist and play with them, and will therefore will be more willing to fulfil the demands that are placed on them.   

 

Positive Reinforcement

Positive reinforcement is most definitely the most commonly used ABA principle used in Speech and Language Therapy. Whenever a child engages in a behaviour that we want them to engage in, we provide the behaviour with some form of positive reinforcement. Pos Sr+The behaviours that we might be working on include, correctly producing a certain speech sound, using a certain word structure (e.g. a preposition) or engaging in a targeted social skill such as making eye contact when requesting. Depending on the child and/or the demand, the type of reinforcement that we use will differ. We may provide verbal praise (e.g. “Wow! Well done making your ‘s’ sound!”), provide them with high-fives or tickles, or give them an item that they want. By doing this, they will be more likely to engage in the same behaviour again in the future. If every time a child makes eye contact they are given a toy that they really like, they will be more likely to use eye contact again in the future. The same can be same for all speech and language targets that we work on.

 

Negative Reinforcement

Negative reinforcement is the removal of something that the child doesn’t like. This is the type of reinforcement that we use when teaching children to use language to protest. For example, if the child’s target is to use the phrase “I don’t want it” instead of pushing the toy away or crying, then this is our go-to ABA principle. I might present a child with play-doh knowing that the child hates playing with play-doh. When the child uses the phrase “I don’t want it,” I will remove the play-doh so that he doesn’t have to play with it. If he cries instead, I will keep the play-doh on the table and prompt him to use the phrase before removing the toy.  

 

Negative Punishment and Extinction:

tantrum

Negative punishment sounds like a scary term but it’s not as mean as it seems! What negative punishment means is to remove something that the child likes as a consequence of an unwanted behaviour. In speech therapy, there are a few different reasons why we might use this. The most common way of using negative punishment in our sessions is ignoring unwanted behaviours and removing preferred toys. By removing the attention/a preferred item consistently, we can reduce the unwanted behaviour. Unwanted behaviours might include, refusal to do an activity, throwing, biting, hitting,crying, or throwing a tantrum. While we want to be sensitive to a child’s frustrations, we also don’t want to reward the child by paying attention and reacting to these behaviours. Instead we will remove attention and any other preferred items– we will try not to make eye contact, change our facial expression, or respond verbally. The child will soon learn that crying or hitting is not getting them what they want and in the future the challenging behaviours will be minimised. 

 

Collaboration with ABA Consultants and Teams

collaboratingAlthough we often use basic ABA principles in our sessions, there are still many occasions in which we are unsure of how to deal with certain behaviours and/or a child’s challenging behaviours are impacting upon the child’s success in speech and language therapy. In these instances, it is important to refer the child to a behavioural consultant so that the child can receive tailored support to their needs. Whenever a child has an ABA consultant or ABA team, we will work closely with them to ensure that we are all on the same page. Consistency and collaboration is key to ensuring success in both speech and language therapy and in ABA therapy. While there is overlap between the two fields, we are each experts in our own fields and by working together we can provide the best therapy possible!

Advertisements

Manding for Information – Teaching WH Requests

Manding for information is an important skill. I ask questions all day.

Manding for information refers to the process in which information becomes a conditioned reinforcer as it leads to an already established reinforcer. So basically, ask a question, and use the information to do/get something useful.

featured-content-ipad-icon_2xHere’s an example;


Learner: ‘where’s the iPad?’ (this is the ultimate reinforcer)


Adult/peer: ‘in the kitchen’ (the useful information leading to the ultimate reinforcer)

Learner goes to the kitchen to get the iPad

Here’s some practical tips on how you can teach this skill. When you start out, you need to identify some strong reinforcers; these can be used as the items/activities that motivate/reinforce the learner to ask the ‘wh’ questions. The reason you should start out with highly motivating items is because nobody asks a question if they don’t care about the answer (for example, I am very unlikely to ask ‘where’s the cauliflower’ and much more likely to ask ‘where’s the chocolate’).

You should teach at least 2 WH questions at the same time to help with discrimination hex_pat(so the learner doesn’t just ask ‘what’ questions all of the time).

It doesn’t always have to be a really creative process when teaching this skill, there are plenty of everyday situations in which you ask different ‘wh’ questions (it can be really creative as well if you want).

Remember it’s the information which is valuable, if you’re learner says ‘where’s the iPad?’ don’t just deliver the iPad, tell them the location, then they have to use the information to go and get it. The information is the reinforcer.

Manding for information lesson plans are a good way to prompt you when to use different ‘wh’ questions. It is good to not do 20 what questions in a row, and then 20 where questions, mix it up a bit, intersperse the WH questions. Lesson plans are also a good way to plan out;

1) the contrived situation

2) what information becomes reinforcing

3) what the ultimate reinforcer is

It breaks down the process that the learner goes through. It’s also good to teach during naturally occurring situations throughout the day even if you haven’t planned to do so (so when in a shop, the learner might spontaneously request a magazine, but they don’t know where it is, prompt ‘where is the magazine?’).

Generalise the way you can ask WH questions, for example, ‘what is it?’, ‘what are you watching?’, ‘what are you doing?’, ‘where’s the IPad?’, ‘where are we going?’ etc. This will encourage the learner to emit novel responses, which is the ultimate goal. Don’t just teach ‘where is it?’ and ‘what is it?’.

IMG_0355.PNG

Manding for info data sheet (adapted from Carbone Clinic data Sheet)

Now, I’d never say no to data, it’s always a good 
way to track if what you’re doing is effective
. You can even just tally prompted versus spontaneous use of the targeted WH uestions

As always, differentially reinforce responses (give more social praise/reinforcement for more spontaneous responses).

So if you want to work on this in a spare 15 minute period, firstly give some thought to what the ultimate reinforcer will be (what is the learner getting out of it), think about which WH questions you are targeting (might be 2 for intensity, or more than 2, depends on the learner), and get ready to create situations for the learner to ask. When you have identified that the learner has motivation for the information, the teaching procedure would be as follows,

  • Contrive situation (adult says – ‘lets play with the iPad’)
  • Prompt response (adult models what to say -‘where is the iPad?’ and waits for the learner to repeat it back (this is an echoic prompt))
  • Fade your prompt (independent response if possible ‘where’s the iPad?’)
  • Give the information and differentially reinforce (dependent on how independent the learner’s responses were)

If manding for information is totally new to your learner, it may be worth running a few trials using steps 1, 2, and 4 (contrive, prompt, give information), and you can fade your prompts over each trial, again, it depends on the learner.

The awesome Busy Analytical Bee has also just posted about this – you should check it out for some good ideas how to teach each WH mand – https://busyanalyticalbee.com/2017/02/22/teaching-mands-for-information/.

So there you have it, a brief snippet on how to teach a real important part of your learners’ mand repertoire.

Challenging Behaviour – Part 2

When working on reducing problem behaviour you need to be sure to deny any reinforcement related to the antecedent when problem behaviour occurs.

 

Here are some common reasons challenging behaviour may occur, with typical consequences we should deliver in brackets;

  • Lack of effective communication (requests) (the ‘count and mand’ procedure could be used for this)
  • Avoidance/escape of demands (follow through with reasonable demands)
  • Sensory reinforcement is valuable (block and re-direct)
  • Wanting attention (ignore)
  • Having to wait (continue to wait until the learner has waited appropriately)
  • Being told no (continue to deny access to what the learner wanted)
  • Being interrupted from a preferred activity/having to transition (continue to interrupt /transition)

praising-your-children

It’s also important to reinforce appropriate alternative behaviours where we can. This,
coupled with ensuring the appropriate consequence is delivered if problem behaviour does occur, will most likely reduce problem behaviours faster.

 

Here are some of the best ways to do this;

  • Lack of effective communication (requests) – teach mands, the more spontaneous mands a learner has in their repertoire, the less likely they are to engage in other, less desirable, challenging behaviours.
  • Avoidance/escape demands – implement an appropriate schedule of reinforcement that competes with the motivation to avoid/escape. Chances are, if there is a lot of problem behaviour when demands are placed, your reinforcement needs to be better.
  • Sensory reinforcement is valuable – teach an appropriate behaviour to achieve sensory reinforcement (e.g. if your learner swipes things off of a table to see them fall, teach them to build blocks and knock them down instead).
  • Wanting attention – teach to request attention appropriately (tap on arm, saying someone’s name).
  • Having to wait – initially provide reinforcement during periods the learner is expected to wait (as long as there is no problem behaviour), and fade reinforcement gradually over time (as long as the learner is waiting successfully).
  • Being told no – provide alternatives as long as there is no problem behaviour (you can’t have chocolate, but you can have some raisins).
  • Being interrupted from a preferred activity/having to transition – use promise reinforcers (provide something the learner wants, initiate the interruption and immediately deliver reinforcer in the absence of problem behaviour).

 

This is a very brief snippet of what could be done, and there are comprehensive protocols for working on a range of problem behaviours, that should be overseen by a BCBA/BCaBA, with thorough data being taken.

Challenging Behaviour – Part 1

This will be part 1 of 3 on challenging behaviour. There’s a lot that could be covered, so I thought I would spread them across 3 posts to not overwhelm readers!

 

First, the following point should be noted. I’ve heard people say something like, ‘little Jonny had a behaviour in the last session’; well I should hope so, as behaviour is anything a living organism does. Referring to an incident  as a challenging behaviour, or problem behaviour is clearer.

 

images
Challenging behaviour is a reality for many of those on the spectrum. Challenging behaviour can present in many different ways, but it’s important to look at why something is happening – the antecedent.

 

For each incident of challenging behaviour, we should strive to look at the ABC (antecedent, behaviour, consequence).

 

A – Antecedent – the ‘trigger’, why did it happen, the function

B – Behaviour – what the learner did, the challenging behaviour

C – Consequence – what consequence was achieved

 

Rather than adopting a blanket consequence for a challenging behaviour, we should use the consequence appropriate to the antecedent. For example, a child may hit regularly, but each incident may occur for a different reason. What we do should be dictated on why the problem behaviour occurred.

 

There’s no such thing as ‘out of the blue’. It may seem that way as the antecedent isn’t clear, but there is always a reason. When it’s difficult to see the antecedent, it may be worth taking some video, and if you catch any challenging behaviour, watch it back and see if you notice anything. Try looking at what happened immediately before the onset of the incident.

                                                                                       

IMG_1713

Here is a 0-50 graph used to plot data

Taking constant accurate data is vital. It’s the data, and graphing the data that informs us whether we are making good decisions, and whether the improvement is because of our interventions. It’s a good idea to take data on the following; total frequency of problem behaviour, total duration of problem behaviour, and frequency of problem behaviour for each antecedent (I’ll discuss common antecedents in Part 2).

 

3 and a ½ Top Assessments – My Favourite Assessments


Assessment days are manic. You never really know how it’s going to go. I arrive, boxes of resources, ready to work my socks off. It can certainly be a struggle fitting a whole assessment in in one day, but it depends on different factors; how much problem behaviour (if any) the learner engages in, and the skill level of your learner.

 

Your consultant should do some form of baseline when they start the programme. I’ve always been trained to design a learners individualised curriculum based on the assessments, using assessment goals to design the programme. This seems like common sense to me, it’s a great way to track goals/progress. I like to update the assessments around every 6 months. I also update them if there will be a change in provision, or sooner than 6 months if there’s been a big jump/regression in the learners’ skills.

 

VB MAPP

VB MAPPI love the VB MAPP. This is my most commonly used assessment. It’s a great assessment to get a good baseline of the learners’ skills and barriers to learning. VB MAPP stands for ‘Verbal Behaviour Milestones Assessment and Placement Program’ (VB-MAPP, Sundberg, 2008), which was largely influenced by B.F. Skinner’s (1957) ‘Analysis of Verbal Behaviour’ (find out more about verbal behaviour here). The VB-MAPP can make it easier to compare the current abilities of a learner to those of a ‘typically’ developing child as it highlights a students’ strengths and weaknesses of a variety of critical skills. The assessment breaks down skills in to small achievable goals, and is split across 3 levels, covering 16 different skill areas. These skill areas comprise of areas such as;

  • Mand – (request)
  • Tact – (label)
  • Motor Imitation
  • Listener responding (following instructions)
  • Intraverbal (fill in statements, answering questions)
  • Social skills
  • Play skills
  • Visual skills
  • Group responding
  • Classroom skills
  • Echoic (vocal imitation)
  • Spontaneous vocal output
  • Listener responding by feature, function, and class
  • Reading 
  • Writing
  • Math

The VB MAPP is awesome

 

ABLLS-R

The ABLLS-R (Assessment of basic language and learning skills- Revised) is another excellent assessment. It is used to assess current levels that the learners are working at, and helps structure the programmes we run with the learners.ABLLS-R

It provides a comprehensive review of skills from 25 skill areas that most typically developing children acquire up to the age of 4 years of age. The goals in the ABLLS-R are usually ‘chunkier’ (larger criteria for mastery), and aren’t as developmentally sequenced as the VB MAPP goals. The ABLLS-R covers some skill areas that the VB MAPP doesn’t, such as self care skills.  When designing individualized curriculum, I like to use goals from the ABLLS-R and VB MAPP together.

 

AFLS

AFLSThe AFLS (Assessment of Functional Living Skills) comes in 6 different books;

  • Basic Living Skills
  • School Skills
  • Home Skills
  • Community Participation
  • Independent Living Skills
  • Vocational Skills

 

The authors define functional skills as ‘commonly age appropriate skills that are used everyday for typical activities and routines and are essential for independence’. Basically, what skills does someone that age need to live as independently as possible.

 

The AFLS was developed over several years analysing which skills are required for daily functioning in various settings and independent life within the community. The assessment was designed to further refine and teach additional skills of independence, social interactions, work participation, and other independent living skills.

 

There is a certain point in a learner’s life when conceptual learning, like sorting shapes and colours, needs to be replaced with specific practical skills required to improve learner’s independence (Partington and Mueller, 2012).

 

This assessment is good to use for learners who are secondary school age, particularly from 16 years old.

 

Essentials for Living

My homework is to look in to this assessment more. A few colleagues talk highly of this, and from what I do know, it’s a good assessment for teenage + learners who have more severe developmental difficulties.efl

 

I’d be interested to hear if anybody recommends any other cool assessments! You can buy these assessments here at Treezy, which is a lovely website for resources!

 

 

References

  • Partington, J and Mueller, M (2012). The Assessment of Functional Living Skills. Pleasant Hill, CA: Behaviour Analysts, Inc; Stimulus Publications
  • Skinner, B. F. (1957). Verbal Behaviour.  New York: Appleton-Century-Crofts
  • Sundberg, M. L. (2008). The Verbal Behaviour Milestones Assessment and Placement Program: The VB-MAPP. Concord, CA: AVB Press.

What is VB?

So, another abbreviation – VB, what is that? Is it still ABA? How is it different?

VB (also known as VBA, AVB, ABA/VB) stands for verbal behaviour, and it refers to B.F. Skinners analysis of verbal behaviour. It’s all I’ve ever done, so I’m a big fan. Like my previous post, this is a big topic to cover, but hopefully this will give you a brief idea of what it entails.

You don’t do ABA or VB, it’s an additional analysis, so you would use all of the concepts and principles that ABA encompasses, and in addition to that you would use the analysis of verbal behaviour.

bf-skinner-sm

 

B.F Skinner is a top man in the field of ABA, he bought operant conditioning to the table and dedicated a lot of work to defining the process. B.F Skinner took over 20 years to write his book ‘Verbal Behaviour’. If you want to have a little read about his work, click here.

 

 

Consultants that use the analysis of verbal behaviour prioritise the function of language, rather than the structure. So what does that mean? Well, the function of language would be why someone is doing/saying something, and the structure would refer to how it is presented (sentence structure).

Verbal behaviour is probably the most socially significant of all behaviour (remember the
ultimate aim of ABA‘to increase socially significant behaviours’). Typically, a programme which uses the analysis of verbal behaviour will prioritise manding (requesting), as teaching learners to be able to request their favourite things, and access their environment is very important.

Verbal behaviour isn’t just speaking. I would refer to Drinkspeaking as vocal behaviour. Verbal behaviour can be what people say, gesture, sign, or write. For example, saying ‘drink’, writing ‘drink’, signing ‘drink’, or pointing to a drink, are all forms of verbal behaviour. All verbal behaviour must be socially mediated (someone else must be there). For this reason, getting up and getting a drink when you’re by yourself would not be regarded as verbal behaviour.

 

An ABA programme that uses the analysis of verbal behaviour will break down language in to operants. These are the units of language that Skinner defined in his book, Verbal Behaviour (1957). We (followers of the analysis of verbal behaviour) don’t assume that just because a learner can say ‘dog’when they see a dog, it means they can answer a question such as ‘tell me an animal that barks’.VerbalBehavior

The verbal operants are independent of each other, and each have an independent process of learning. We’ll try to make sure that when a target is being taught, such as ‘dog’, that we target it across each verbal operant, so that the learner can label a dog, find a dog, match a picture of a dog, answer questions about dogs etc, to ensure they are fluent across all areas, and understand what they are saying (for the professionals reading this, I’m aware that Skinner didn’t define visual and receptive as verbal operants).

 

The primary verbal operants are:

  • Mand
  • Tact
  • Intraverbal
  • Duplic (imitation, echoic)
  • Textual (reading, dictation)

I’ll post a more in depth explanation of the verbal operants somewhere down the line.

Logistics of a programme that uses the analysis of VB – they will often involve the following effective teaching procedures,

  • Identifying competing reinforcers
  • Pairing
  • Fading in demands
  • Errorless teaching
  • Task variation
  • Fast pace of instruction
  • Intersperse easy and hard instructions

Programmes are often split between natural environment teaching – NET (through play etc) and DTI (discrete trial instruction, or ‘table work’, ITT (intensive table teaching)). NET will focus on generalising skills to everyday situations; there’s no point in teaching
a learner that a picture of a car is a car, if they can’t tell you a toy car is a car during play.

shutterstock_137699987

DTI is intense teaching, which focuses on teaching a few new targets several times, whilst maintaining previously mastered skills. I’ll upload a video at some point. Programmes are at most 50:50 (NET:DTI), but with earlier learners, the majority of time should be spent on NET. Typically, I would recommend changing activity every 15 minutes; this helps keep it fresh, and also gives you plenty of opportunity to work on transitioning. 

There’s so much to say, but nobody wants to read pages and pages of a blog, so if anyone wants any more info, please get in touch. I’ll likely expand on some of what I’ve said in later posts.

For me, ABA and VB is the way forward.  

What is ABA?

As a parent, by the time you hear of ABA, you’re probably fed up of abbreviations. ABA stands for applied behaviour analysis.

I’ll try and translate some of the things you may read, some of the textbook definitions, and help paint a picture of how it may look. Dr Patrick Friman (author of the book Good Night Sweet Dreams I Love You: Now Get into Bed and Go to Sleep – How Tired Parents Can Solve Their Children’s Bedtime Problem) talks about how, as a field, we aren’t that great at marketing what we do, and I think he’s right.

ABA blocksIn a nutshell, ABA is a science dedicated to helping teach learners the skills they need to live a more independent life. These skills will cover domains such as functional communication (vocal, sign, PECS, (which I’m not a huge fan of for the most part, but that’s another post), or augmented communication devices), social skills, conversation skills,
play skills, group skills, self help skills, imitation, labelling, and many more. An ABA programme is typically made up of skills from several of the areas listed above, and tailored to the skill deficits of the learner. It will teach skills that ‘typically developing’ children often pick up without intensive teaching.  

These skills should be taught in fun and creative ways to help the learners access as much of their environment as possible. Sessions should involve identifying and following the learner’s motivation and reinforcing desirable behaviours. Some people talk about ’40 hours a week’, which was discussed in the Lovass 1987 paper, but I have overseen programmes that are 10 hours per week, and seen good progress; it depends on the learner.

Learners should learn because they want to, not because they have to

A main goal of ABA is to teach socially significant behaviours. It is a science devoted to the understanding and improvement of human behaviour. This means that targets of the programme should identify behaviours of importance to the learner and their family to increase (within reason). A programme should also, where appropriate, decrease undesirable behaviours by analysing why the problem behaviour is happening (the function).

Data

ABA programmes are data led and aim to demonstrate reliable relationships between their interventions and the behavioural improvements; which has led to a ‘mature body of scientific knowledge, established standards for evidence-based practice, distinct methods of service, recognised experience and educational requirements for practice, and identified sources of requisite education in universities.’ (bacb.com). This means that the ABA tutor that’s working 1-1 with the learner will be taking a range of data, such as ABC data (data on problem behaviour), and probe data (data on targets being taught), and at the end of the session they’ll spend some time plotting the data.

What about the logistics? Each ABA programme should have a BCaBA (board certified assistant behaviour analyst), or BCBA (board certified behaviour analyst) consultant overseeing it. Some are more involved than others, some have supervisors (who are usually studying towards board certification). The consultants will generally be responsible for designing the individualised programme, analysing data, training tutors and parents, updating goals, and maintaining good levels of communication between the team. You can search for consultants in your area here. The ABA tutors would act as the 1-1, and implement the programme that’s been designed. Some consultants will provide tutors, or take responsibility of recruitment, and some won’t. There are different places you can look to recruit tutors, such as the ABA UK Yahoo Group, VB Community, ABA Tutorfinder, and different ABA groups on Facebook. Dshutterstock_226205743.jpgepending on the competency of the tutors, and needs of the learner will dictate how often, and how long for, the consultant will visit. ABA sessions may occur at home, in the nursery (if the provision is OK with it), or at school (again if the provision allow it). Personally, I think if you can be around other children, then you should be. I’m not a big fan of teaching in heavily neutral, quiet, non-stimulating environments, as that isn’t real life. Once you’ve recruited some tutors (you should probably look to get at least 2 to aid generalisation of skills), and a consultant, an assessment will be carried out. This will guide the design of the programme. After this the consultant will normally hold an initial training day (may be 2 or 3 days depending on the experience of the tutors). From this point, the consultant will make monthly visits*.

How long will I need an ABA programme? It really depends on the learner and the team around him. The goal of ABA will be to equip the individual with the skills needed to be an independent learner as soon as is appropriate. This can be frustrating to hear as it’s not time specific, but it’s very difficult to predict the future that far ahead.

From asking parents I work with how they found out about ABA, most report it was self searched, not easy to come across, and usually one of the last ports of call. Why aren’t other professionals (paediatricians etc) forth coming with this? How many schools know about this super effective way of teaching? Maybe they do, but I just don’t know about it? As I mentioned in my first blog post, ABA feels like the best kept secret.

ABA is huge in the USA, with 44 states having insurance cover ABA. Why so far behind here then? Is it simply the cost under the guise of ‘not enough research’? That would certainly seem odd seeing as ABA is a field founded on research

I’m going to follow up with a post about the analysis of verbal behaviour, and ‘what is VB?’ as this is likely to be a term you hear, and an analysis I make use of.

There is of course, so much to mention in this section, and I hope I’ve covered enough to give you a little more info about ABA. If anybody would like more information on this, please don’t hesitate to get in touch. All I want to do is spread the ABA love.

*This is what I observe to be the average structure, but it may vary.

(Info used from Cooper, Heron, Heward, 2014)