Functional Communication Training for Children with Autism Spectrum Disorders

Children with autism struggle with communication issues.  While these children often evidence social skills deficits and repetitive/stereotypical behaviors, many of these problem areas can be remediated if the child is taught how to use language functionally.

A functional use of language is something that is difficult to teach in the classroom, but it can be managed through appropriate procedures and strategies. We often “measure” language by asking parents and staff to identify how many words a particular child may speak; programs are then developed to increase the number of words which children on the spectrum speak.

However, this measure of assessing language in children on the spectrum (i.e., a total amount of vocabulary) gives an incomplete picture of the nature of the child’s strengths and weaknesses – it is a good start to teach vocabulary, but we need to go beyond that.

Our studies of evolutionary psychology indicate that humans are a species that uses tools; it is this tool use that sets us apart from other mammals and other species.  Language is another tool that we use to obtain what we want from the environment.

While some children speak too little and others too much, what all these children on the spectrum share is the inability to use language effectively as a tool to actualize their goals.  Some children do not have enough words to express themselves – these students need to be taught more words and when these words should be used.  Others have so many words that they do not know which ones to choose to express themselves – these students need assistance in choosing their words and using them at appropriate times.

In the absence of efficient methods of communication, many children on the spectrum resort to other means to actualize their goals.  These means are often interpreted by many of us in the schools to be destructive, rude or disrespectful.  But, using words as tools to actualize their goals is a concept that is difficult for them to understand.  So, they often perform other actions to obtain their goals.  In the most severe cases, they will injure themselves in horrific ways.  In other cases, they may yell, scream, throw things or perform any other set of actions that would be considered a “meltdown” or “tantrum”.

Fortunately there are many guides out there that are easily written and can help the practicing school psychologist.  Mark Durand’s Severe Behavior Problems: A Functional Communication Training Approach is an excellent book that has helped me tremendously when implementing Functional communication training (FCT).

FCT is a set of procedures that teach communication skills to the child as a replacement to the inappropriate actions with which he is engaging.  Central to FCT is the idea that child perform challenging responses to the environment when they: 1) lack the communication skills to convey their intent or 2) do not know which specific communication patterns should be used to convey their intent.

For example, one of the children with which our team is currently working had a goal of using the word “no” to stop activities which he did not enjoy.  While this goal may appear to be counter-intuitive, we wanted the word “no” to replace what his current response at the time was: biting staff members until their skin broke.  Conceptually, it was important for us to understand that while his reaction was extreme, his biting was the tool he used to stop activities .  Our goal was to teach him how to use another tool, which would actualize the same goal (stopping activities) better and more efficiently.

Typically, when this student was presented with a task that he usually avoided (i.e., math), he often bit staff.  What we had done initially is as he would lean in to bite, we gave him the command “Say no”.
At first any sound was rewarded with a cessation of the activity and a loud proclamation from the staff member indicating “OK, all done!”.  We walked away quickly and gave him a break for 2 – 3 minutes.  After he learned to just make a sound and not bite, we required that he approximate the sound “n”.  Soon after we ratcheted up the demands and required he say “no”, which lead to “no more” and then “no more, please”.

Our next step was to identify what aspects of the activity (math, in this instance) was so aversive, and we worked to teach him the component skills that he lacked so that he may perform the activity in the future.

Visual strategies can be used in addition to FCT or instead of FCT.  For example,  with another child, our team has developed a visual strip of common phrases that one particular child can use (e.g., “No thank you”, “Yes, please”, etc.).  When the targeted child is asked a question, he is pointed to the particular menu of phrases that he can use.  The student then can scan the phrases and can select the one he can use.  Our team does require that he use the words; failure to do so would have him too dependent on the strip.  Two very useful resources for these sets of procedures are A Picture's Worth: PECS and Other Visual Communication Strategies in Autism by Andy Bondy and Lori Frost and Visual Strategies for Improving Communication: Practical Supports for School & Home by Linda A. Hodgdon.

Overall, teaching children with autism better alternatives for communication can greatly enhance their social skills, advocacy and overall life satisfaction.

School Psychologist

"What is a school psychologist?" people often ask me  - this great piece is a nice succinct description of what school psychologists do!  Check it out!

The development of mands

Over the last few weeks, I have been thinking about the development of the mand reptetoire in all children.  Typically we discuss how the mand develops in children on the spectrum, but it appears that we need to look at other issues as well.

For example, how does the mand develop in response to motor development - for example, does the development of the ambulation repetoire affect the mand repetoire in any discernable manner?  If I can walk, and experience more of the environment, will I not want more of it?  And will I not ask for more?  So if the motor skills of a child are impaired, then these children will not necessarily see as much of the world and by consequence, not mand for it.

Just some Sunday evening thoughts...

Overt and covert behavior

The term "behavior" has been misrepresented and misinterpreted by many in the school psychology field, including proponents as well as opponents of behavior analysis. Proponents have used the term too loosely, while opponents have used a bit of a warped definition to attack the field.

Furthermore, school psychologists as well as behavior analysts have also taken a very narrow view of the definition of behavior.

According to Cooper, Heron, and Heward (2007), in order for a phenomenon to be considered a behavior, we need to have several conditions:

1. there must be a part of the organism which is moving.
2. there must be a change in the environment as a result of this movement.

With this, it is easy to see that throwing a desk or completion of homework are behaviors. However, some individuals in the field develop behavior plans based on the lack of a behavior, such as "not doing homework" and "not throwing a desk as targets or goals of behavior plans.

That is not going to work.

You need to target behaviors constantly. You may want to reduce certain behaviors or increase other ones, but you want to target behaviors or to set behaviors as goals - not non-behaviors.

Let's look at reading, something that is often not considered to be a behavior. While reading, there is movement of the lips, tongue, and vocal chords. After the behavior is done, there is a transformation of the sound waves in the environment, which informs us that we have had a behavior occur.

Ahh, someone would say - that only counts if the person is reading out loud. What if the person is reading silently.

Yes, it is sticky, but not unmanageable. If one is reading silently, thinking, feeling mad, or examining a beautiful painting, there are neurotransmitters which are being released and activating neurons. After the neurosynaptic reaction the brain is different than what it was prior to starting the behavior. Therefore, these activities qualify as a behavior.

Overt behaviors are those that anyone can observe, while covert behaviors are those that only the organism can examine.

More on this after a bit....

B.F. Skinner quotes

I came across a few quotes here and there from BF Skinner:

• The real question is not whether machines think but whether men do. The mystery which surrounds a thinking machine already surrounds a thinking man.

• I did not direct my life. I didn’t design it. I never made decisions. Things always came up and made them for me. That’s what life is.

• Physics does not change the nature of the world it studies, and no science of behavior can change the essential nature of man, even though both sciences yield technologies with a vast power to manipulate the subject matters.

Eating disorder education programs are really harmful

A new article in the International Journal of Eating Disorders suggests that teaching teenagers about eating disorders can make them more knowledgeable about the problem, but it may also make them more likely to engage in eating disorders behaviors.

Yale University researchers found that when they presented female high school students with videos on eating disorders, it met the intended goal of boosting their knowledge about anorexia and bulimia.

However, the team saw that the students didn't necessarily find the results of eating disorders unappealing. Teens who watched a video featuring a woman recovering from an eating disorder became more likely to view girls with eating disorders as "very pretty," and some thought it would be "nice to look like" the woman in the video.

The findings suggest that more research should go into the unintended effects of eating disorder education before such programs are widely used, the researchers conclude in their article in the International Journal of Eating Disorders.

Marlene B. Schwartz (the principal investigator) suggested that having an attractive, articulate woman talk about her eating disorder could inadvertently "glamorize" the condition.

• 376 female high school students viewed one of two videos on eating disorders.
• Both videos were the same, except for the "presenter." In one video, the presenter was a young woman identified as a doctor, who told the story of a typical eating disorder patient; in the other, the woman was a "recovered eating disorder patient" who described her personal experience.
• The students completed questionnaires before and after the video.
• Overall, the study found, both videos increased the girls' knowledge about anorexia and bulimia.
• Regardless of which video they saw, the girls were more likely to say afterward that "it's not that hard" to recover from an eating disorder. They were also more likely to believe girls with eating disorders have "strong" personalities.
• Girls who viewed the video featuring the eating disorder patient were particularly likely to see women with anorexia or bulimia in a positive light.
  

Some of the discussions of the article suggested that instead of targeting "anti-eating disorders" programs, schools should address eating disorders by promoting healthy eating, exercise and positive body image, and discouraging "weight bias" and teasing based on physical appearance.

In general, I think that this is a correct view to espouse. In essence, by developing eating disorders prevention videos, we are focusing on the elimination of behaviors (or future behaviors) without teaching new behaviors.

Criticism of Piaget

I've often been surprised at how much people in education(and laypersons as well) take for granted that Jean Piaget's work may be false. Although we question many aspects of our lives, such as religion, politics, even the decision to vaccinate children against viruses and cancers, we often do not question "big names" in psychology.

Well, we should.

I'm not going to go into the intricacies of Piaget's theory. If you are interested, you should reference the Wikipedia article on his life and work. However, in general, Piaget's theory indicates that children progress intellectually through four stages of development: Sensorimotor, Preoperational, Concrete Operations and Formal Operations. At each one of these levels, Piaget posited, there were different challenges that the child needed to deal with. He also indicated that unless the child mastered the tasks in the one stage, he or she could not master the tasks in other stages.

There are problems that are inherent in all theories which posit "stages" of development. Development does not occur in discrete stages - it occurs whenever the environment places increased demands and/or provides less support to the individual. In our society, it simply appears that we all tend to place these demands on children at around the same time - this makes it appear that we are witnessing "stages" of development.

Zimmerman conducted a series of various studies beginning around the 1960's and up until today demonstrating that if the environment placed certain demands, then children would surpass what was expected of them.

Here are some other studies:

Baillargeon et al. (1985). Infants could identify, to a reasonable degree, events which violated the laws of physics, even though, Piaget noted that infants at the "sensorimotor" stage could not do so.

Das Gupta & Bryant (1988). Children were able to follow simple transformations, even though, Piaget noted that children at the "pre-operational" stage could not do so.

Hughes (1978). Children were able to take the perspective of multiple people even though, Piaget noted that children at the "pre-operational" stage could not do so.

Light, Buckingham & Robbins (1979). When children were taught to pay attention to the concrete properties of an event (e.g., pouring liquids into different sized beakers), then they were able to do so, even though, Piaget noted that children at the "pre-operational" stage could not do so.

McCarrigle (1978). When given discrete instruction about the super-ordinate and sub-ordinate categories, children were able to classify information effectively.

Piaget was instrumental in getting people to think about children as individuals who are developing. However, children develop in radically different ways. Assessments of intelligence (WISC-IV) appreciate this as these children tend to go through items as much as possible. There is no cap on how much a child can or cannot do on a particular set of items.

Pizza Hut reading program - no way man.

Since 1985, that's been the gist of Pizza Hut's Book It, an incentive program used by 50,000 schools nationwide to reward young readers with free pizzas. The program is now under attack by child-development experts who say it promotes bad eating habits and turns teachers into corporate promoters.

Book It, which reaches about 22 million children a year, "epitomizes everything that's wrong with corporate-sponsored programs in school," said Susan Linn, a Harvard psychologist and co-founder of the Campaign for a Commercial-Free Childhood.

This week, Linn's organization called on parents to end their schools' participation in the long-standing program.

Though some activists have previously questioned Book It, Linn said Friday that only after the recent upsurge of concern over child obesity and junk food did her group feel it could make headway with a formal protest campaign. She said many schools are trying to reduce students' access to soda, and contended that Book It should face similar scrutiny.

But the program -- which has given away more than 200 million pizzas -- has deep roots and many admirers at the highest levels of politics and education. It won a citation in 1988 from President Reagan, and its advisory board includes representatives of prominent education groups, including teachers unions and the American Library Association.

Dallas-based Pizza Hut says Book It is the nation's largest reading motivation program -- conducted annually in about 925,000 elementary school classrooms from October 1 through March 31. A two-month program is offered for preschoolers.

Participating teachers set a monthly reading goal for each student; those who meet the goal get a certificate they can redeem at Pizza Hut for a free Personal Pan Pizza. Families often accompany the winners, turning the event into a celebration that can boost business for the restaurant.

At Strafford Elementary School in Strafford, Missouri, the roughly 500 students collectively read 30,000 books a year with Book It's help, said principal Lucille Cogdill.

I remember reading something about this in the book Fast Food Nation - there the author described the fact that many children were induced towards pairing their love for fast food and reading.

Theoretically, this should work. In essence, Book It! is a token economy, in which a person receives tokens (tickets, money, etc.) which may be exchanged for items later on. Many people have raised concerns that using this techniwque is analogous to bribery.

That's so wrong, it is not funny. Bribery is the attempt to get someone to do something that is wrong or illegal. Here we are pairing something that the child finds enjoyable with reading. We do it when children first learn to read with praise. Pizza Hut is just doing it with disgusting fast food which kids love.

I think that that is the problem - the choice of rewards is limited and not appropriate. In essence, the fast food chain is using the behavioral technology uniethically - there should be a choice of healthier awards that children should be able to choose from.

For more information see: http://www.nowpublic.com/pizza_hut_reading_program_gets_a_thumbs_down_from_critics_0

Review of "Strange Son" by Portia Iverson

Mr. and Mrs. Iverson have set up a foundation to deal with autism in their and many other individuals' chidlren. Mrs. Iverson wrote this book about her experiences with Soma Mukhopadhyay from Bangalore, India. Soma had managed to teach her severely autistic son, Tito to communicate, write poetry on a laptop, and articulate his thoughts and feelings.

Mrs. Iverson persuaded her foundation to bring Soma and 14-year-old Tito to Southern California for what proved to be an exhausting and exhaustive monthslong effort by a network of neuroscientists and well-wishers to anatomize the miracle that was Tito. But few miracles withstand minute dissection, and this one was no exception.

For one thing, the young poet was still an immensely dysfunctional adolescent who could not remain still for most neurological testing, who was besieged by erratic impulses (like trying to jump out of a minivan speeding down a California freeway) and who became unhinged whenever he was separated from his mother.

His mother was a loner and a bit of an oddball, whose method of cajoling intelligent communication from Tito depended on an alphabet board and a frenetic combination of shouts, gestures and taps on the knee.

But, when Soma finally sat down with Mrs. Iversen’s Dov and begins to prod and cajole him just as she does Tito, their frighteningly inaccessible and uncontrollable child began to use an alphabet board to tap out logical human thoughts.

He wanted a Barbie doll and a blue blazer. He identified that he had known how to read English for three years. His favorite color is red. He thinks his little brother is spoiled rotten. After a few weeks he drops Barbie like a shot when he learns that dolls are for girls.

We learn that Soma’s method works better for some autistic children than others, and is nowhere near being a panacea.

I havent read the book, but it may be interesting. Those of you who have, please drop me a line

Why do we persist in our bad habits?

Although this article mentions many interesting reasons why (http://www.sciencedaily.com/releases/2006/11/061106144757.htm), I think that the main reason has to do with the delivery, quanity and quality of reinforcement.

Take alcohol or drug use (or hey, even scouring sites like myspace and youtube excessively): These activities give people immediate reinforcement. Oftentimes it is very difficult to eliminate a behavior which delivers immediate reinforcement (e.g., overeating) with a behavior that delivers delayed reinforcement (excercise --> better physique).

This could be looked at as a societal response as well - it is easier for societies to pollute in order to receive immediate reinforcement (getting rid of waste and participating in the burning of fossil fuels) vs. having them participate in activities designed to recycle and reuse waste in order to reap benefits in the future (Al Gore - eat your heart out!)

These examples highlight how important the immediacy of reinforcement is.

What is a school psychologist?

Sorry all for my departure - I was quite sick for some time and I had some problems installing Windows Vista on one of my computers.

I wanted to start to begin to answer the question in my title - what is a school psychologist. It is a particularly difficult profession to define - even its members are currently engaged in a debate as to what a school psychologist is.

Historically, the first school psychologists were teachers who were re-trained in psychology. These school psychologists were to consult with teachers regarding difficult learning and behavioral issues.

As the testing craze hit its phase, school psychologists because primarily evaluators.

Currently, this is how I would define the term. A school psychologist is:

1. An applied educational psychologist
2. A professional who is versed in child pathology so that s/he may prevent problems in the school setting.
3. A consultant to teachers, administrators and professionals for learning and behavior problems.

One of the things which strikes me is how professionals may not be willing to consult with school psychologists as they assume that they do not know the current research on evidence based practice in educational settings. Hopefully this will change.

For more information please consult the NASP Website page: Who are School Psychologists?

Parenting as a Form of Therapy

In a comprehensive review, the American Psychological Association urged in August that for childhood mental disorders, “in most cases,” nondrug treatment “be considered first,” including techniques that focus on parents’ skills, as well as enlisting teachers’ help.

Some researchers and doctors are looking again at how inconsistent, overly permissive or uncertain child-rearing styles might worsen children’s problems, and how certain therapies might help resolve those problems, in combination with drug therapy or without drugs.

It has almost become standard practice for all adults to turn to medications before attempting some type of behavioral interventions for students or children. We need to look at some of these interventions first.

Behavioral techniques uses to influence children's eating habits

Researchers in London have developed a program to influence children's eating habits using behavioral application techniques. The program was funded by the Irish government, the European Union Commission, and Unilever.

• They created an educational video program called "Food Dudes" that relies on peer pressure, peer modeling, and a reward system to persuade kids to eat more fruit and vegetables and shun fatty foods.
• The Food Dudes video stars a quartet of preadolescent kids who get superpowers from eating fruits and vegetables. The dudes battle General Junk, who steals healthy food, thereby robbing the world of its life force.
• The Food Dudes are slightly older than the kids targeted in the program, making them believable role models. Prizes like small toys, pencils and pens are also an enticement.
• "In some respects, we use the same techniques as multinationals selling junk food" said Dr. Fergus Lowe, a University of Wales psychologist who was part of the team that devised the program.
• A pilot program at 150 schools in Ireland, targeting children aged 2 to 11, doubled intake of fruit and vegetables and in some cases boosted consumption of such foods by 10 to 14 times, the organizers say.
• In one primary school, the fruit consumption of children aged five and six more than doubled. The kids were originally only eating 28 percent of their fruit; six months later they were eating nearly 60 percent. Vegetable consumption jumped from eight percent to 32 percent.
• In a control school, where the program was not used, no change in fruit or vegetable consumption was noted.
• Scotland has introduced a modified version of the program in 210 schools in Glasgow, and England is experimenting with the Food Dudes in schools in London and Plymouth. The World Health Organization recently honored Food Dudes with a best practices award.
  "People had assumed that it would be very difficult to make fruits and vegetables appealing to children, but Food Dudes has proven that that's not true," said Dr. Francesco Branca, WHO's European adviser for nutrition and food security, who is not involved in the Food Dudes program.
• In 2005, the government announced it would ban school cafeterias from serving poor-quality hamburgers and hot dogs. From this September, vending machines selling soft drinks, chocolate bars and potato chips to students will be outlawed. The poor quality of school food first rose to the national consciousness thanks to Oliver's TV series "Jamie's School Dinners," which shocked Britons by showing them exactly what kids were eating at school.
• Changing food habits isn't easy. Humans are genetically predisposed to prefer sugary and fatty foods - an evolutionary twist that made sense in prehistoric times but not anymore.
  "Back when we lived in caves and children were crawling in forests, anything that tasted sweet was generally safe to eat," said Paul Sacher, a dietitian at London's Great Ormond Street Hospital for Children. High-fat foods were also desirable because they were good sources of energy. "Today, evolutionary tendencies are actually our worst enemy," said Sacher. "We're beyond the stage where we have to be that careful, yet we still have this natural desire for sweet things."

Common Sense

The other day, I was discussing someone and the description of them came up - they have no common sense.

But what is common sense?

Well, it reflects a lot of things. I've made a bit of a list, but it is by no means exhaustive.

1. Attention to the saliency of stimuli - A person with common sense will be able to observe something or someone and recognize which aspects of the stimulus are important and s/he should attend to. This is important because people will focus discretely on these tasks and they will be able to learn from these tasks.

2. The use of modeling as a technique to learn new skills. A person with common sense will learn by observing models in his/her environment. A person with common sense will also pay attention to all models - not just the ones that have a skill that they need to learn immediately, but those that have skills which they believe will be needed in the future.

3. A wait-and-task-analyze approach - A person with common sense will be able to delay resopnding to a particular situation, and analyze steps that will need to be accomplished. This can also be described as planning your actions. As part of this technique, a person with common sense will not only task analyse how to solve immediate problems, but also how to solve future problems and problems that are not even distally present (for instance, a person with common sense may have task analysed, in a rudimentary sense, what to do in case of a natural disaster)

4. A theory-of-mind. A person with common sense will be able to project in the future how s/he will feel, how others will feel and how others will perceive them as feeling and being (for instance, a person with common sense will be able to determine how the model is feeling, how she or he feels towards the model and how others may perceive him if he performs the activities the model just completed.