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.

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...

Autism Caught On Tape -- Computer Scientists Use Technology To Help Children With Autism

ScienceDaily -- Computer scientists have devised two tools to help people interact with autistic children. Videotaping interactions allows teachers or parents to replay situations and evaluate the cause of particularly good or bad behavior. Cataloging actual data, rather relying on memory or interpretation, proves to be a more accurate measure of a situation.

Rehab

There was an interesting article on the CNN website that lamented that Lohan and Spears were making a "mockery" of the entire rehab process.

Did it really take a strung out actress and a singer past her prime to do that?

Not that I feel bad for them, but really - how much of this is the fact that two good-looking girls are going all out and crazy as opposed to two guys?

There is hardly a tree in the New York suburb of Suffolk that has not been crashed into by a car owned by Bily Joel. And hardly a drug that Robert Downing Jr. has not used to excess.

I wonder about rehab. Does it really work? Are there studies out there that allow us to examine the efficacy and effectiveness of the most commonly used procedures in drug and alcohol treatment? Alcoholics Anonymous does not allow for independent research to examine these aspects of their treatment.

Furthermore, any individual who does question AA is often sent for re-training (at least here in New York). These re-training sessions are similar to the re-education camps that Mao Zedong sent those who opposed the Communist party.

At its core, rehab attempts to stop behaviors, and gives very few skills to replace behaviors. I mean, seriously, does playing squash really take the place of a good drink? (see the ads of TV and in our schools: "Do sports, don't drink").

Rehab is in essence a bunch of DRA procedures- a differential reinforcement of alternative behaviors. People are reinforced for playing ping pong as opposed to drinking or smoking pot.

The problem is that you can do both at the same time. Hey - just look at Sunday softball games - they are designed so you can drink and play at the same time. And Keith Hernandez, legendary baseball player of the 80's used to pop into the dugout between innings to down a cold and snort a line or two.

The issue which people in the rehab treatment community don't really get is that there is really nothing out there which is as reinforcing as drugs or alcohol. There is nothing really that can replace it.

Maybe it might be better to help these people change their environment, permanently. Rehab is a place that these people use which (to borrow a word from the field) "enables" these people. It changes their environment temporarily, allows people to feel falsely secure in this new environment, and discourages people from actually making changes.

It does, however, allow these people to talk about the changes that they want to make. But talking isnt doing.

So, when we blame Brittney Spears or Lindsay Lohan for "making a mockery" of rehab, consider that maybe the intervention of rehab is flawed. Where is the evidence?

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.

How is fear learned?

An article in the journal Social Cognitive and Affective Neuroscience indicates that that the neural processes associated with the development of fear are the same whether humans personally experienced an aversive event or only witnessed it.

The study shows that the amygdala, which is known to be critical to the acquisition and expression of fears from personal experience, is also involved during the acquisition and expression of fears obtained indirectly through social observation.

Previous research has shown how people develop fears after first-hand experience of an aversive event—getting stung by a bee or being burned by a hot pan. In acquiring these fears, a process known as fear conditioning, the brain’s amygdala plays a critical role.

However, it’s unclear if fear conditioning can occur indirectly—that is, through social observation with no personal experience. It is also uncertain what neural processes take place in the acquisition of fears stemming from events or circumstances not experienced first-hand.
In this study, subjects witnessed a short video of another individual participating in a fear-conditioning experiment. In the video, subjects saw another person responding with distress when receiving mild electric shocks paired with a colored square.The subjects watching the video were then told they would take part in an experiment similar to the one they just viewed.

Unlike the experiment in the video, these subjects never received shocks.

The results showed that the participants had a robust fear response when they were presented with the colored square that predicted electric shocks in the video, indicating that such a response resulted from merely observing—rather than directly experiencing—an aversive event.

In addition, using brain imaging techniques, the researchers found that the amydgala response was equivalent with both when watching others receive a shock and when presented with the colored square that was previously paired with shock in the video. This finding demonstrates that similar neural systems are engaged when fears are learned through first-hand experience or by merely observing others.

The knowledge of somebody else’s emotional state may evoke empathic responses. However, as our results reveal, when others’ emotions are accompanied with vivid expressions and perceived as potentially relevant to our own future well being, we may engage additional learning mechanisms.

In a way, learning by observing others’ emotional responses is like exploiting their expertise without being directly exposed to the potential risks associated with the direct learning. This seems a very adaptive thing to do for most social animals, which could explain why it is commonly seen across species. However, it remains to be explored in what way uniquely human social abilities contribute to learning fears through social observation.

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.

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.

FBA Podcast Handout Sheet

This is the handout for a podcast that I
developed on Functional Behavioral Assessment. You can find the podcast
at: http://collabra2.liu.edu/weblog/andrewlivanis/FBA/

In our previous class we discussed the l_____________________ (or the t______________-t__________ c_________________________), as well as the f_______________________ of behavior.

Let review some of the definitions necessary for these issues:

Antecedents – ________________________________________________

___________________________________________________________

Behavior - ________________________________________________

_________________________________________________________

Consequence - ________________________________________________

____________________________________________________________

We refer to a full ABC interaction as a __________ _____________ or a _____________

___________________ __________________.

The more learn units you can identify, the _______________________________________________________________





Consider this example:

What do you think will happen on Wednesday in math class? If algebra is what will be done on Wednesday, _________________________________

_______________________________________________________________

This consequence is one ___________________________________.

However, what should be noted is that the environment is

s__________________________________________ this behavior by

__________________________________________________________

If the e______________ (the teacher in this instance) changed the

a_____________________ (by providing some sort of assistance to Johnny or changing the

topic) or the c______________________ (by resisting the urge to kick him out), then it is

possible that the behavior might not occur.

All behavior occurs to o________________ on the environment (i.e.,

“__________________ ______________________________”)

Remember that the environment refers to the external world as well as the individual’s internal

world.

All behavior occurs to force an environment to either _________________

___________________________________________________________. In order

to make our interventions better and more effective, we need to identify _________

behaviors occur. During this “why” assessment (i.e., ___________________ Behavioral

Assessment), we need to look at several things:

Antecedent
Behavior
Consequence

By recording _________________ three term contingencies or learn units, we can start to

look at ________________ in behavior which may help us to determine “why” someone is

performing this behavior.

Example

· Mrs. Johnson is a teacher in a kindergarten
· Johnny and Mary are cursing in the classroom.
· Cursing occurs when they are exposed to situations that are aversive (usually math).
· Current intervention - scolding them – is not effective
· Applies a negative punishment procedure Time Out for both students. (This is called a “_________________________” approach; because you are using one technique without examining individual factors that are impacting the behavior).
o Baseline: only scolding
o Intervention: no speaking – simply take students by the hand and put them into the time out room.

· Baselines are the same.
· Effect of the intervention is different
o Johnny: after the time out intervention was put into place, his cursing behavior increased
o Mary: the time out intervention appeared to decrease her cursing behavior.
o Why this difference?

We can only conclude: _________________________________________

___________________________________________________________

Let’s look at Mary first. Her three term contingencies during baseline are outlined in the table below:

Once Mrs., Johnson stops scolding her and starts using the time out room instead, her behavior decreases. Why? It appears that the punishment procedures worked – Mary was removed from a situation in which she was actually receiving reinforcement.

But hold on a minute! We mentioned before that Mary would curse in situations that were already aversive to her. So how was she obtaining reinforcement?

If we can exclude that no other children were giving her reinforcement, we would need to say that the teacher, by scolding her was giving her p_______ ________________________________________. Remember that the definition of positive reinforcement is the ___________________________ _________________________________________________________________And that is what the stimulus (Mrs. Johnson’s scolding), performed right after the behavior (Mary cursing) is doing in this instance.

In essence, the time out procedure operated almost as a mini-experiment to test this assumption out. Mary cursed, and was placed in time out without the teacher speaking to her. She was not able to access the ____________ ___________________________________, which was acting as a positive reinforcer for her.


Let’s look at Johnny’s baseline three term contingencies:
In essence, this is the exact same chart as Mary’s chart. Once Mrs., Johnson stops scolding him and starts using the time out room instead, his behavior increases. Why? It appears that Johnny is being n______________ _________________________________________ for his cursing behavior, both during baseline and probably more so after the intervention.

In both phases (during baseline and intervention), he is allowed to escape or delay performing his math assignments. For Johnny, the scolding serves as a negative reinforcer – __________________________________________ _________________________________________________________________And that is what the stimulus (Mrs. Johnson’s scolding), performed right after the behavior (Johnny cursing) is doing in this instance.

In essence, the time out procedure operated almost as a mini-experiment to test this assumption out. Johnny cursed, and was placed in time out. While in time-out, although he could not access reinforcement (as was Mary’s gripe), he did not have to do his math assignments. Over time, he learned that if he cursed enough times, he could potentially avoid or escape the entire math period.

We can say that May performed the behavior to obtain __________________ ____________________________. Therefore, the function of her behavior was _______________________ ___________________________________. We can also say that Johnny performed the behavior for _____________________ __________________________________________ – he cursed in order to _____________________________________________________________ _____________________________________________________________. Therefore, the function of his behavior is ________________________ ___________________________________.

This example is important because it highlights some important aspects of functional behavioral assessment and functional behavioral analysis:

1. _________________________________________________________________

________________________________________________________

2. ____________________________________________________________

________________________________________________________

3.________________________________________________________

________________________________________________________

4. ___________________________________________________________

________________________________________________________

5. ________________________________________________________

__________________________________________________________