Using the Verbal Behavior Approach to Teach Children with Autism

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Using the Verbal Behavior Approach to Teach
Children with Autism

• Mary Lynch Barbera, RN, MSN, BCBA
• www.vbapproach.com
• May 2009
• Autism One Conference

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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.

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Lovaas Study

• Published in 1987
• 59 children (3 years age or under) diagnosed with
  autism
• 19 received 40 hours/wk 11 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

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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-1990s
  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.

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An Overview of ABA
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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)

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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

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Three Term Contingency

• Antecedent--Behavior--Consequences
• ABC
• Also Described As
• Discriminative Stimulus--Response--Consequence
• MO/SDRReinf. or Punish.

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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
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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
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Examples of Three Term Contingency

• Touch nose Child touches nose receives
  piece of cookie
• Do Puzzle Child falls to floor Demand
  withdrawn

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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

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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?

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Pick one or two target behaviors

• Select the target behavior to be reduced by
  examining
• The seriousness of the behaviorif could injure
  self or otherstarget these before behaviors such
  as hand flapping or poor attention.
• The frequency of the behavior

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Define Setting Event

• Aspects of a persons 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)

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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

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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

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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.

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Consequences

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

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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.

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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.

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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.

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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.

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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

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Functions of Problem Behavior

• To obtain something desirable (Attention,
  Tangibles, Sensory Stimulation).
• To avoid or escape something undesirable (Task
  avoidance).

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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

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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)

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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 10if problem behavior
  resumes, return to 1.
• Prompt the mand cookiechild echoes cookie
  Righthow do you ask?child responds
  cookie.deliver R.

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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

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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

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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

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Case Studies

• Case Study 1 
• Amys 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.

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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?
•  

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Case Study 1 (cont.)

• Will the behaviors likely go up or down?
• What is the most likely the function of Amys
  behavior?
• What are some interventions you would recommend
  to help reduce Amys negative behavior

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Using ABA and Verbal Behavior (VB) to Increase
Positive Behaviors

• Increasing language and learning skills using the
  principles of ABA and B.F. Skinners Analysis of
  Verbal Behavior

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What is Verbal Behavior?

• Behavior that is reinforced through the mediation
  of another persons behavior

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Applied Behavior Analysis
Direct Instruction
Verbal Behavior
Discrete Trial Teaching
Intensive behavioral Intervention
Lovaas Therapy
Incidental Teaching
Precision Teaching Fluency Based Instruction
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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 Skinners Analysis of Verbal
Behavior (function)
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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

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What is Coffee???????

• Is it a
• MAND?
• TACT?
• INTRAVERBAL?

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Verbal Operants
Verbal Operant Antecedent Behavior Consequence
Mand Motivative Operation (wants cookie) Verbal behavior (says cookie) Direct reinforcement (gets cookie)
Tact Sensory Stimuli (sees or smells cookie) Verbal behavior (says cookie) Non-specific reinforcement (gets praised, for instance)
Intraverbal Verbal stimulus (someone saysWhat do you eat? Verbal behavior (says cookie) Non-specific reinforcement (gets praised, for instance)
Echoic Verbal Stimulus (someone says cookie) Verbal behavior repeats all or part of antecedent (says cookie) Non-specific reinforcement (gets praised, for instance)
Receptive (actually not a verbal operant) Verbal stimulus (someone says touch cooke) Non-verbal behavior (child touches cookie) Non-specific reinforcement (gets praised, for instance)

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Verbal Behavior Activity
As a result of One has a tendency to This is a
Seeing a grape Saying grape
Hearing a horn Saying truck
Someone saying what says moo? Saying cow
Wanting a push on the swing Saying push
Being told to stand up Standing up
Someone winnie the Saying pooh
Someone says potty Saying potty
Seeing a stranger Saying whats your name?
Seeing a tree Saying tree
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Two other related skills

• Imitation Given another persons 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.)

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Teaching the Mand

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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 childs own motivation as a tool
• It is a natural first step in teaching
  communication

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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.

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Examples of contriving an MO

• Holding up an MM 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.

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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!

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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

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The Assessment Of Basic Language and Learning
Skills

• The ABLLS

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Structure Of ABLLS
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Daniels ABLLS A-H
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Daniels ABLLS I-R
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Daniels ABLLS S-Z
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Masons ABLLS
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Recommendations for Mason 1/5/05

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

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Recommendations for Mason2/25/05

• Puzzles/easy toys (shape sorter)
• Matchingstart categories make sure he knows
  tacts of exemplars
• Prompt him to request actions and missing items
• Baseline labels (buy flash cards)
• Mix 80 easy to 20 hard w/VR 3
• Continue teaching songs
• Play doh and coloring
• RFFC to TFFC to IFFC with item as answer
• Count and Mand for access to tangibles

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Lillys ABLLS
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ABLLS--Lucas
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VB MAPP--Lucas
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Language Barriers--Lucas
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Recommendations for Lucas

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

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Thirteen Intervention Tips

• Thirteen tips based on the science of ABA and BF
  Skinners analysis of Verbal Behavior that you
  can start using immediately with all children and
  adults with language delays and disorders

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1 Be Positive

1. Be Positive! Use 8 positives for every negative.
   Dont overuse the childs name especially when
   saying no or placing a demand

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2 Pairing

• 2. Pair yourself and the environment with
  reinforcement by giving the child lots of
  reinforcement with no effort required .

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3 Giving Directions

• 3.    When giving a child a direction
• Simplify the language
• Make sure you are close enough and loud enough
  for him to hear.
• Get down to childs level to get childs
  attention
• Only give directions you can make the child do
• Give the instruction only once and, if no
  response, prompt the child to complete the task.
• Dont give the child a direction youre not
  willing to follow through with

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4 Reinforcement

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

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5 Mand Training

• Teach the child to communicate his needs and
  wantsfirst by pulling, reachingthen by using
  sign language, pictures, or words. Teach 3-5
  signs at a time.

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6 Matching

• Teach the child to match items and pictures.
  Label the item instead of using the command
  match or put with same.

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7 Imitation

• 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.

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8 Receptive Skills

• 8.    Teach receptive skills.
• Touch body parts, items or picturespick 2 or 3
  receptive skills provide as much prompting as
  needed to ensure the child is successful.

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9 Give Directions You Can Prompt

• 9. Since you cant force a child to
• speak, do not use say______ if
• the child cannot speak or if this is
• a hard skill. (Say cookie, cookie,
• cookie as you deliver a small
• piece of cookie)

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10 Teach Fill-ins to Songs

• 10.   Use music and familiar nursery
• rhymesleave the last word of
• each line blank to see if child
• fills it in.

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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 milkdont clean it up immediately.
• Go a different route in the mall.

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12 Do Not Reinforce Problem Behavior

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

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13 Prevent and Correct Errors throughout the
day!

• Instructor Points to an apple and says
• What is it?
• Child bird.
• Instructor What is itapple
• Child echoes apple
• Instructor Right, what is it?
• Child apple
• Instructor Presents 2-3 easy demands and
• then what is it?
• Child apple

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Some Take Home Pointsfor Use With All Children
(and Adults)

• Pairing
• Manding
• Once the child can mand for items, ease in
  demands gradually
• Prevent and Correct Errors throughout the day
• Dont reinforce problem behaviors

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Questions?

• www.vbapproach.com
• Mary_at_vbapproach.com
• Thank You!