Independence is typically an easily identified goal for children with autism; however, writing treatment goals for independence is very difficult. Most functional goals for children with autism to become independent are identified by families of children with autism, and then treatment goals can be written to help children complete tasks of daily living without adult assistance. However, developing programs to bring about durable and generalized change, i.e. Change that occurs in the absence of prompts, is the real work of applied behavior analysis.
These ten targets that nobody practices at home produce graphs, not independence. Thus it is best to choose a few of the above-mentioned functional goals for the child’s independence which the family will also practice at home.
Turning daily routines into measurable targets
Ten targets that nobody practices at home produce graphs, not independence. So, select the functional goals for the child’s independence that are also going to be practiced at home by the family. When families identify goals for their children with autism, they are often easily identified, such as completing tasks of daily living, completing school work, ordering food in restaurants, etc. However, developing programs to bring about durable and generalized change, i.e. Change that occurs in the absence of prompts, is the real work of applied behavior analysis. In many cases much of this work can occur prior to the first session with the child and their family.
Choosing which routines to program first
There are many programs that can be worked on in the family’s home. First, determine the child’s daily routines that require the adult’s assistance. Then choose some of the routines that are currently being supported by family members and are done on a daily basis. For example, instead of teaching a child with autism to play with a novel toy for 10 minutes a day, teach the child to complete parts of the morning routine on a prompt-free basis. There are 10-20 routines in which a child can be supported by family members outside of session hours. Choose a few of the routines to work on in the child’s home to teach the child to complete the routines on a prompt-free basis within each of the routines.
Prompt fading is where independence is won or lost
Of the various problems that a child can have completing a number of steps, such as to get dressed for school, to complete tasks in the home, to participate in activities with peers, the problem of completing each step of a number of steps without being given a prompt to complete each step of a number of steps is a very hard problem to solve.
Structuring the fade
- Start with the most intrusive prompt likely to produce a correct response, then reduce it systematically rather than waiting for errors to force the issue.
- Fade physical guidance to gestural, gestural to visual, and visual to naturally occurring cues such as the sight of a toothbrush or an empty plate.
- Retire verbal prompts early. They are the hardest to fade and the least likely to exist in the natural setting.
- Use transfer trials after any prompted response so the child performs the step at a lower prompt level within the same teaching opportunity.
- Set a mastery criterion that requires unprompted performance across at least two people and two settings.
Matching the service setting to the skill
Children and their families are most influenced by programs that are delivered in the children’s and families’ natural environments (e.g., the child’s home, school, community). However, as with any new skill that a child is trying to acquire, the child needs to practice new ways of responding in new situations with the help of a behavior analyst for the child to begin to generalize new skills to new, naturally occurring situations. Such sessions can be delivered in a variety of locations (e.g., clinic, child’s home, child’s school, community locations), and the intensity and location of sessions can be clinical decisions. Families weighing these options are well served by a provider that offers ABA therapy in Needham, MA across more than one setting, so the same goal can be taught in the clinic and then practiced where the child actually uses it.
| Setting | Best suited to | Main trade-off |
| In-home | Self-care, chores, sibling interaction, routines tied to a specific place and time | Fewer peers, and progress can stall if the home schedule is unstable |
| Center-based | Early acquisition, dense practice, structured peer groups, toileting programs needing quick access | Skills may not transfer without a deliberate generalization plan |
| Community sessions | Ordering, paying, waiting, safety awareness, transitions in unpredictable environments | Low trial density and limited control over what happens |
| School-based consultation | Classroom participation, following group instructions, work initiation | Requires teacher buy-in and coordinated data collection |
Reading an intensity recommendation
The number of hours of treatment that is required for children to learn new ways of responding is generally decreasing as children are learning new skills and using those skills in natural settings. In addition, children require fewer hours of treatment to maintain the new skills that they have learned. In fact, children typically require the same amount of treatment to maintain their newly acquired skills as was required to learn those skills in the first place.
Evaluating clinicians and providers
When looking for a practice that offers ABA therapy in Needham, MA, examine the operational practices of the agency as well as their philosophical practices. Although having the appropriate credentials to practice ABA is the minimum, fit and follow-through (i.e. Following through on what you say you are going to do) are the true measures of quality when working with families and their children with autism and other developmental disorders.
- How often does the supervising analyst observe sessions directly, and what is the ratio of supervision hours to technician hours?
- What is technician turnover, and how is a new technician trained on an existing client’s protocols?
- Can the team show graphed data for a similar functional goal, including how prompts were faded?
- How are caregiver training hours scheduled, and are they billed separately?
- What triggers a change to a program that is not working, and how quickly?
Caregiver coaching and planning the exit
That the caregivers can use the procedures that the BCaBA has not received coaching on; that the children will generalize the newly acquired skills to new situations that were not directly targeted in the sessions with the child; that newly acquired skills will be maintained across time following cessation of active teaching of those skills. The fact that all of these indicators of progress are occurring means that hours of treatment can be decreased as needed. Remember that a well-run ABA program is able to work itself out of the family’s calendar; therefore the ABA provider should initiate the discharge conversation with the family long before the family brings up the topic of discharge.
Signs the plan is transferring
So in summary, hours of treatment can be decreased by several indicators. These indicators are, (a) caregivers are using procedures without having received coaching by the BCaBA on those procedures, (b) children are generalizing newly acquired skills to new situations where those skills were not directly targeted, and (c) maintenance of newly acquired skills across time following cessation of active teaching of those skills (i.e., probes continue to indicate that skills are being maintained). In summary, a child’s ABA program is working itself out of the family’s calendar. The discharge conversation should be initiated by the ABA provider long before the family even begins to bring up the topic of discharge from services.
