Introduction

Applied behavior analysis is a scientific approach to improving socially significant behavior. “Improving socially significant behavior” means changing an actual behavior that is meaningful, and does not mean changing any behavior just because we can. In the 1970s, applied behavior analysis used negative behavior change procedures such as electrically shocking the patients. However, the practices have changed significantly over the past 40 years. Nowadays, positive reinforcement and none punishment procedures are used to create behavior changes in a meaningful way. Procedures derived from the principles of behavior are systematically applied to improve socially significant behavior. Understanding what is being reinforced for the individual and how to use the information is very important. It is very important to be able to demonstrate experimentally that the procedures were responsible for the improvement in behavior instead of individual and unknown variables, so that the procedures can be used repeatedly and create consistent behavior outcome.

1. The basis of behavioral intervention

It is essential to understand the concept of competing reinforcers. Individuals with autism spectrum disorders often do not naturally pay attention to the most relevant stimuli. They are more easily distracted by others such as a piece of lent on the carpet or flicking of a light than the words spoken to them. Autism Behaviors are characterized by behavior excesses and behavior deficits that indicate we want less of some behaviors and more of others. Behavior researches linked between environment factors and behaviors gave us understanding of the competing reinforcers.

2. Influencing Behavior

There are many factors influencing behavior. The key factor is motivations: We all have 9 natural motivations in life (hunger, thirst, fatigue, discomfort, etc.), which do not require any previous training or learning experiences and are naturally reinforcing. It is important to use these motivating factors whenever possible. For example, if you want to introduce a child to a new food, it is best to do it when the child is hungry or has not eaten for hours, using natural motivation of hunger. The sequence is very important as well. When you are offering a child a less desired food, it is best to also provide a highly preferred food right after so that the child can access something quickly that they will enjoy. For example, if a child really likes mashed potato but not peas, you can say: “If you have a bite of the peas you will have mashed potato.” And make the mashed potato present. As soon as the child gets a bite of the peas the child will be able to enjoy the preferred food. This method can also apply to neuro typical children when teaching them to say “please” and “thank you”. They usually spontaneously say “please” before they learn to say “thank you”. The motivation is quite less after they have received the item!

Transitioning inside after playing outside can be a difficult transition time for ASD children. Thus, it is one of the most challenging tasks for many parents. They can play very well in the park for long time but as soon as it is time to leave, they will throw huge temper tantrum. We can attempt to capture the natural state of thirst, hunger, temperature (if a natural deprivation occurred while playing outside). Purposely not bring any food or drink to the park. When it is time to go to the car, simply say, “Let’s go to the car and have some water.” Then, to transition from the car to the house, you need to have some preferable food at home, and say, “Let’s go inside and have some snack.”

3. Learning history

It is helpful to understand previous learning history and how that impacts behavior (antecedents and consequences). Antecedents are things in environment before behavior occurs including varieties of stimuli. Consequences are what happen after behavior: the kid gets the preferred item or not.

One frequently heard complain from parents is: The items or activities that my child were highly motivated to work for lost reinforcing properties over time. It is because when parents are too excited seeing their child engaging in things they enjoy, and then allow the child to have unlimited access to the items or activities without any depravation stage it will loose its reinforcing properties. To help the child motivated by the stimuli, the access to the reinforcing items need to be limited and controlled by the parents and other support providers. Limit access to reinforcers. If there is a history of engaging in an activity or task that is not liked by the child, then we want to use highly preferred reward for engaging in the task.

4. Reinforcement Procedures

There are different procedures we can do to influence behavior: Reinforcement and Punishment. Reinforcement increases the occurrence of a behavior by either positive reinforcement or negative reinforcement. Punishment decreases the occurrence of a behavior by either positive punishment or negative punishment. The terminologies can be quite misleading and confusing. In ABA, “positive” does not mean pleasant and “negative” does not mean unpleasant, they have very different meanings.

Positive reinforcement means that stimulus is added to increase likelihood of future behavior. When behaviors or items such as high fives, pad on back, verbal praise, food, candy result in helping a child to do more of something, we call them positive reinforcements.

Negative reinforcement is the most misused and misunderstood term, even by professionals. However, as a parent herself, Tracy believes that it is important for parents to be equipped with the knowledge and apply it to their daily practice at home. Negative reinforcement means that removing stimulus from the environment results in increased behavior. For example, if crying results in eliminating or delaying a child’s homework, then the behavior of crying will be reinforced by eliminating or delaying the homework. Another example of negative reinforcement for an ASD child is that when a certain social situation is aversive to the child, then the situation is removed when the child engages in certain behavior, such as stimming (rocking, hand flipping, making certain noises over and over again). It is very common to see an ASD child making very loud noises when in noisy and or uncomfortable environment. In this example, noise making is being negatively reinforced when the child does not have to listen to annoying social stimulus. Another example is taking a medication to relieve pain. Because taking Tylenol will remove the pain, thus removing the pain will negatively reinforce the likelihood of taking that medication.

http://media.psychology.tools/worksheets/english_us/operant_conditioning_en-us.pdf

https://wikispaces.psu.edu/display/PSYCH484/3.+Reinforcement+Theory

http://psychology.jrank.org/human-behavior/pages/cmxyrryar7/social-child-parent-aversive.html

Positive Punishment means that stimulus is added to decrease the behavior. Scolding and or spanking a child are common examples of positive punishment. We need to avoid punishment procedures at all cost because they can have a lot of unexpected side effects.

Negative Punishment means that stimulus is removed to decrease the behavior. Timeout is a common example of negative punishment.

If we want to decrease aggression, can we just implement a punishment strategy to decrease aggression? No, and it’s not the treatment of choice anyway!

Side effects of punishment include:

1. Resentment over being punished commonly by being scolded, spanked, excessive timeout etc.

2. Attempts to escape the punishment/avoid the punisher: when trying to avoid timeout, a child may aggressively attempt to escape.

3. Expression of pain and negative emotions associated with punishment due to spanking.

4. Recognition by the punished individual between the punishment and the person delivering it—The person mostly likely a parent delivering the punishment becomes paired (respondent conditioning) with an aversive/punishing experience. When the person (punishment condition) is not present (available) the child will more likely to act up (increase undesirable behavior). Thus, in the end, punishment procedure does not teach the child what we want them to do. On the opposite, positive reinforcement and negative reinforcement procedures give the child clear signals what we want more of their behaviors. Both positive punishment and negative punishment procedures must be implemented by board-certified behavior analysts or at least licensed professionals who were adequately trained in behavior change technics. The extreme harmful self injure behaviors, which may need punishment procedures to decrease, are very rare and definitely need licensed professionals to monitor.

5. Functions of Behaviors

There are only four functions of behaviors that individuals can demonstrate. Before we target a behavior for change, we have to identify the function of the behavior. The four functions are access attention, escape/avoidance, access items and automatic reinforcement. Attention does not have to positive. Negative attention is still attention. After all the chaos (temper tantrum) settles down, did the individual access an item? It is also important to understand: Escape/removal of attention; Escape/removal of items; Positive automatic reinforcement; Negative automatic reinforcement.

Parents and even teachers regard scolding as punishment. But it is actually a function of access negative attention which reinforcing the behavior. Accessing attention can be both positive and negative attention.

To escape from something that they don’t want to do, or to avoid something they don’t like is a motivation for ASD children to change their behaviors.

If after the tantrum the child gets the item he/she wants the behavior is reinforced. For example: A child was crying in a store for a toy. Even after the parent scolded the child and said no, the child would not stop the tantrum until the parent gave in. Then crying serves the function of access the toy. Next time when the child wants something, it is very likely he/she will cry until he/she gets it.

Automatic reinforcement means that the behavior reinforces itself. Stimming behaviors such as hand flapping, rocking are typical automatic reinforcement behaviors. However, when an unwanted task is present, they can have a different function (escape). Thus, same behavior can have different functions.

It will be very challenging for parents to understand and grasp the concept of all the 4 functions of behaviors at once. However, trying to think like a behavior analyst will help parents to analyze your children’s behaviors and aware what functions their behaviors serve. Behavior analysts often use different types of assessment tools to understand what may reinforce a behavior and what function a behavior appears to be.

1. Access Attention:

Examples of questions to ask yourself: what functions does this appear to be?

• Does this behavior occur when you are talking to other people in the room?

• Does this behavior occur whenever you stop attending to the child?

• Does the child engage in this behavior to upset or annoy you when you are not paying attention to him or her?

• Does the child seem to do this behavior to get you to spend some time with him or her?
  

If when you were on the phone with a friend your child started crying and pulling your pants, then it is an attention seeking behavior.

If you were playing with the child, as soon as you walked away, the child started crying, then it is another indication of attention seeking behavior.

If a child purposely engage in a behavior (such as knocking on the table) to upset you it is an attention seeking behavior.

If the child has to sit on your lap while engaging in playing a toy or hug you when with him/her, it means he/she wants more time with you.

2. Automatic Reinforcement:

Examples of questions to ask yourself: what functions does this appear to be?

• Would this behavior occur continuously if the child were left alone for long periods of time (for example, one hour)?

• Does this behavior occur repeatedly, over and over, in the same way (for example, rocking back and forth for five minutes)?

• Does it appear to you that the child enjoys performing this behavior and would continue even if no one was around?

• When this behavior is occurring, does the child seem unaware of anything else going on around him or her?

When a child is left in a room for long period of time, he/she engages in stimming (hand flapping, rocking, flipping objects in front of face), and then the function of the behavior is automatic reinforcement. Even when a child is in an automatic reinforcing behavior, we can be creative, and are able to redirect, introduce and engage him/her in other reinforcing behaviors.

3. Escape or Avoidance:

Examples of questions to ask yourself: what functions does this appear to be?

• Does this behavior occur following a command to perform a difficult task?

• Does this behavior occur when any request is made of the child?

• Does the child seem to do this behavior to upset or annoy you when you are trying to get him or her to do what you ask?

• Does this behavior stop occurring shortly after (one to five minutes) you stop working or making demands of him or her?

When children struggle with verbal communication, they are asked to say a word, they may start to cry or throw a tantrum at that point.

When parents ask the child to use sign language or say a word to ask for a preferred item. Parent says, “OK, say train please!” then the child cries or starts to stimming or other behavior other than follow instruction. The behavior is motivated by escape or avoidance—they are trying to get out of the task.

When you were trying to get the child take a bath, he/she threw a tantrum. Then suddenly, you stopped trying to demand him/her to take a bath, he/she stopped crying. It is an indication that the function of crying is avoidance.

It is challenging to change behaviors that are motivated by escape or avoidance. There are two parts involved in the behavior intervention. The first is to block the individual from being able to escape the task. The second is offering reinforcement of engaging in the task or an easier form of the task.

4. Access items:

Examples of questions to ask yourself: what functions does this appear to be?

Does this behavior ever occur to get an object, activity, food, or game that the child has been told he/she can’t have?

Does this behavior occur when you take away a favorite object, activity, or food?

Does this behavior stop occurring shortly after you give the child the object, activity, or food he/she has requested?

Does this behavior seem to occur when the child has been told that he/she can’t do something he or she wanted to do?

When you take away the iPad, the child starts to cry, then the function of crying is to access the iPad. To check the function of the crying behavior is to access items, you can give the iPad back to the child and see if he/she stops crying.

If the function of the behavior is to access an item, the intervention is relatively simple. Sign language, picture selection and approximation (partial sound) of the word can be taught to the child to access the item.

Review of the 4 functions:

When a behavior function is identified as to gain attention, we can teach the child how to get the attention in a socially acceptable way. For a child who is none verbal, walking to a person and tapping to the arm or shoulder, pointing to a picture of mommy or a preferred teacher can be used to obtain the needed attention. Caregivers need to observe any hint of such socially appropriate behavior and reinforce it by providing immediate access to the attention. To reinforce a behavior of an ASD child, it is very important to give him/her immediate attention without a period of waiting. For reinforcers, the more immediate they are the more effective they will be.

It is definitely trickier to intervene with automatic or self-stimulating behaviors. It is important to encourage the child’s stimming behavior for a certain period of time to satisfy the need, then redirect and engage the child into a highly preferred activity. For example, Tracy worked with a child who was constantly focusing on hand flapping and paid no attention to the environment. It was almost impossible to teach him anything in the beginning. Tracy flapped her hands with the child to catch his attention, and laugh together with him to gain his trust. Then she set a timer. As soon as the timer went off she presented him a very desirable food and gave him a lot of verbal praise while eating. After stabilizing the transition from hand flapping to food, Tracy added trampoline jumping as the following activity, and eventually faded away the food. Over time, the hand flapping behavior was reduced to 10 minutes every hour.

For escape or avoidance behavior, it is a two-part process. We need to break tasks down into smaller components. If an escape or avoidance behavior works for the child, he/she will continue the behavior. The challenge for parents is to make the behavior not effective. For example, if a child can escape from his/her math homework whenever he/she cries, he/she will cry whenever asked to do the homework. The first step to stop the behavior is to tell the child that he/she will need to do the homework no matter how long he/she cries—crying will not get him/her out of the homework. Since it is a highly aversive activity for the child, we will need to be creative and use reinforcers to meet the child where he/she is. It is very important to know the learning history of a child including all the difficult tasks such as math time, bath time, etc. We need to use the information to set the child up for success in the future. If we know that math is challenging for the child, we need to adjust our expectations accordingly. For example, instead of forcing the child to do 20 math problems at once, we may ask him/her to come to the tale to do just one math problem, and then immediately reinforce it with highly preferred activity. If a child is unwilling to take a bath, the first step may be just putting a washcloth on the child’s forehead. In the field of behavior analysis, this process is called shaping, which means we break down the task into small steps, and each time we apply lots and lots of reinforcement, and each time we get closer to the end goal of the task.

Q & A

Q: What can be used to as appropriate reinforcement? I think candy is a no while preferred activities are better.

Candy is not good to be used as reinforcement in long term since a lot of ASD children are obese due to food as reinforcer. The categories of reinforcers are primary reinforcers and secondary reinforcers. Food is considered as primary reinforcers. Primary reinforcers are items that do not need learning curve. A food that taste good to an individual does not require learning history to want more of the food. In the beginning stages of behavior analysis, food is incorporated into early practice because most of the time, food is the only reinforcement option available. Food will become a problem if it is

not faded away. In the hand flapping case, the child was able to transition from hand flapping to jumping on a trampoline, which actually engaged him in physical activity. ABA intervention uses “ables”. One of the first tasks that a child is taught to learn is a task of having a reinforcing toy, learning how to play with a toy, and learning how to find that toy is reinforcing. The way is to pair a toy with food or stimming to give the child a range of choices to choose from that are considered reinforcers.

Q: What do you do if kids no longer react to positive reinforcement, but negative ones (warning, punishment)?

We don’t call something reinforcement unless it increases behavior. For example, a parent says “good job” that initially increases a behavior; after a while, it stops working, then we would no longer call it reinforcement because it does not have any effect on behavior. Periodically, we have to go back to the starting point and we have to figure out again what are positive reinforcers for the particular individual. A couple of months into a program, behavior analyst needs to evaluate the reinforcers and frequently change and swap those out. The reality is that people will get used to certain things and don’t find them exciting anymore, which is a good indication that it is time to change to a different reinforcer. The ideas of reinforcers can be easily found online by Google.

Q: What are the effective positive reinforcement techniques for autistic teenagers, i.e., hands flapping in public, pinching mom’s arms, repeating the same questions or sentences all the time, staying up late and refusing to see psychologists?

The “hand flapping in public” can be due to automatically reinforcing and it feels good; or can be due to feeling uncomfortable in public and doing so can help him avoid feeling uncomfortable. There may be certain stimuli in the environment that the individual finds uncomfortable, thus he need to find a way to control that before he goes to public. Knowing the child will pinch mom while walking, then he needs to put his hands in his pockets. “Repeating the same questions or sentences all the time” and “hand flapping in public” are very common automatic reinforcement behaviors in ASD children, which is called Perseveration. Perseveration is very difficult to treat. However, it just requires a lot of redirection and a lot of reinforcement.

Q: How to use reinforcer to help a child be more focused when there is an elevator in sight, and he is obsessed with elevator? Whenever in malls, he just looks for elevators, nothing can gain his attention.

ASD child does not naturally pay attention to the most relevant stimuli in the room because it is not reinforcing. The strategies can be moving his chair to face away from the elevator, blocking his view to the elevator and providing lots of reinforcement when he is focusing on something other than the elevator. In general, visual and auditoria distractors are frequently present in the environment. We need to try to block them as much as possible. When a child is easily distracted by visual distractors, we need to seat the child in a place with minimum visual distractions. When a child is easily distracted by noise while reading, we can provide headphones to block the noise.

Q: Is there an efficient way to look for local ABA/BCBA? How to find out if he/she is a good match to my child at a particular period of time?

The best way to look for a local ABA/BCBA is to go on the board website: http://info.bacb.com/o.php?page=100155

To find out if a behavior analyst is right for your child, it has to go through trial and error. It is very important he/she is a right match for your child. Parents have to be comfortable with the intervention style that the behavior analyst is recommending in order to follow through. Interview and trial processes are very important. If after a period of time a behavior analyst is not right, parents need to fire him/her, and find someone else who is a better fit. All parents are encouraged to do so. However, we need to be careful about the reason that the parents don’t feel right, and ask: is it because the behavior analyst is asking the parents to do something they don’t like to do (for example, to ride out tantrums of a child), or the personality of the behavior analyst is not a good match? The website also provides information regarding RBTs (registered behavior technicians). The person who works with an ASD child has to at least have RBT credential and under supervision of a BCBA.

Q: How do you teach a child about join attention from the beginning step? What will be the next step?

“Join attention” is a difficult area to study, and there are a lot of researches in this area. The child is initially taught how to play with the therapist. It begins with lots and lots of prompting and lots and lots of reinforcement. Then it follows the generalization training. The child should be able to engage in the same play behavior with other people including parents and other children. Teaching an ASD child how to play often requires tons of prompting in the beginning and then the prompts are faded over time.

Q: What do you suggest parents do to prevent vocal stimming (grinding teeth, singing songs, talking nonsense) especially in public?

It is a good and tough question. These behaviors are self-simulative and automatically reinforcing. We want to be thoughtful about them when we think about different interventions. If a child can keep their mouth occupied then the grinding teeth, singing songs, talking nonsense behaviors can be reduced. For example, we can teach a child how to chew gum or even Laffy Taffy (a very chewy candy), which will give him/her sensory stimulation that he/she is looking for. Meanwhile, we can encourage his/her behaviors in a car, but as soon as in public we can ask him/her to stop by saying: “Now it is time to chew this.”

Q: Preschooler started to be scared of sleeping alone at night. Is there any way to handle it since he couldn’t explain what scared him or should I co-sleep?

It is a tough question. It has a lot of culture factors involved. Some families encourage co-sleeping for a number of years, and other families have strong feelings about not having their children in their bed. The expectations and plans need to be consistent every night, which include trying to sooth the child, and then teaching the child how to sooth him/her self so that he/she can fall asleep on his/her own. Tracy has three children. She decided to train her 3

rd child who was frequently waking up at night. Instead of taking the baby to her bed, she would frequently go to the baby’s room, start singing, and in the mean time, rub her back for 5 minutes, lay her back down in crib, rub her back again for 5 minutes, and stand by her crib, then gradually move out of the room. Occasionally, if the baby started crying very loud, she would go back in and rub the baby’s back again. It is not perfect plan but there are three more people sleeping in the house. It is the best she can do. After about one and half months, the baby finally was able to sleep through the night without waking up.

Q: How to deal with inappropriate behaviors seeking attention or negative enforcement in social settings? For example, my son likes touching peer’s hairs or disrupting class music and other inappropriate behaviors, and laughing about repeat comments like “no touching friends hair” or “no opening doors” etc.

It is a very good question and appropriate. First, we need to make sure the child receives as little attention as feasible for the negative attention seeking behaviors. Sometimes it can be very difficult. Some kids learn very quickly how to push the buttons and how to aggregate people in a way to provoke them and get large response. The teacher has to involve the class to selectively give attention to the behaviors that you want more of, and try to give less and less attention to those type of negative behaviors. Responding in a very neutral and calm tone and then providing appropriate and logical consequences for inappropriate social behavior is a really good place to start. Then, we need to make sure the child will have opportunities to gain attentions through positive social skills.

Q: There are many different intervention methods out there, for example, DTT, VB, ESDM, RDI, etc. Does certain method work better with certain functioning level?

There are a ton of intervention methods out there. Tracy has extended experience with DTT and VB. Her friend’s child was involved in RDI. What she can tell you is that as part of ABA, DTT and VB have the largest amount of research that demonstrates their efficacy. Parents can research other methods. However, ABA is the only one that is covered by insurance, which is considered as the gold standard.

Q: How to help kids with delayed echolalia?

Echolalia is a common behavior among ASD children some time in their lives, especially during language acquisition years of childhood. Tracy has no experience with “delayed” echolalia. The strategy she can come up with is to block the behavior through occupying their mouths. It is also very important to have the child thoroughly checked for neuropsychological conditions to see if there are any medical causes such as auditoria processing issues.

Q: My 4 years old will sometimes start talking about books he read or show he watched out of nowhere. What can be done to reduce that behavior?

It depends on how it interferes with social situations. If it is not interfering with learning or functioning, it is best to be left alone. If it is interfering, you need to find competing reinforcer. During normal language development, it is common that while a child is falling asleep, he/she can tell a complete story about their day, which sounds not

very sensible, but it is a normal part of language development. Thus, we need to be thoughtful and careful about the behavior, and make sure it is a socially significant problem.

Some links:

http://www.specialconnections.ku.edu/?q=behavior_plans/functional_behavior_assessment/teacher_tools/antecedent_behavior_consequence_chart

http://www.specialconnections.ku.edu/~specconn/page/behavior/fba/pdf/completedabcchart.pdf

http://www.specialconnections.ku.edu/~specconn/page/behavior/fba/pdf/blankabcchart.pdf

The blog was edited and summarized by Leichun, from a lecture given by Tracy Shepler MA, BCBA. Tracy is Dr.Yishan’s previous co-worker, a board-certified behavior analyst and has worked in the ASD community for over 10 years. She has a son who was diagnosed with ASD. The main topic is to address the importance of understanding the principles of reinforcement and how to apply them when parenting a child with ASD. The “child” includes both young and adult children.

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