Customizing Behavior Therapy
Applied Behavior Analysis, or ABA, has come to be one of the most popular and research-based therapies for children with autism. ABA is a system of breaking down skills into small, manageable pieces, teaching each minute skill with positive reinforcement, building upon already learned skills, and teaching the child to then use those skills as a typical child would—in the real world.
B.F. Skinner (1998) is perhaps the grandfather of today’s behavior therapy. His work studied operant conditioning in which the consequence of behavior controls the future occurrence of the behavior. In simple terms, a behavior occurs and a reinforcer is given that will increase the likelihood of that behavior occurring again. It comes down to shaping behavior and rewiring the brain.
If Skinner is the grandfather, then Ivar Lovaas is the father of today’s ABA (Lovaas 1987; Lovaas and Smith 2003). In the 1960s and 1970s, Lovaas began working on a curriculum of behavioral programs to help children with autism improve their language, behavior, and social skills. His program was intense, but nearly 50 percent of the children involved showed remarkable progress. This was the first application of the science of behavior analysis used to teach individuals with autism.
An ABA program can have a variety of components such as social skills training, self-help skills training, language therapy, and so forth. An ABA program should be overseen by a professional consultant who can help train you or anyone you have tutoring your child.
The purpose of this chapter is not to detail ABA nor how to get a program running. There is plenty of literature available to fulfill that need. Instead, this chapter might give you ideas about how to modify some common ABA programs in working with a child with hyperlexia. This is not a full curriculum, but it will, it is hoped, get you going on a path towards better customizing your child’s current therapies to make full benefit of his particular abilities.
Pro-active responses
It is important to remember that positive reinforcement and pro-active responses will help your child progress.
Behavior specific praise
Your child should frequently receive behavior specific praise for appropriate behavior. Behavior specific means instead of saying, “Good job” you say, “Good sitting in your seat” or “Thank you for standing in line patiently.” This should be delivered as soon as possible after the correct behavior occurs. There can never be too much positive praise! A good rule of thumb is to praise your child three times for every correction. As he gets older and in a natural setting, try not to “hover” over him. If you are unable to deliver praise immediately, remember to address it at a later time when it’s more appropriate.
Reinforcement system
Use whatever is most motivating for your child. ABA managers and tutors often use edible treats in the early stages as rewards. That may not be motivating to your child. Letters might! Instead of using treats, you can give letter stickers or write the numbers for him. As he gets older, you’ll find other things that motivate him. Make him work for what he wants most. He will be motivated to learn valuable skills this way. We have gone through a variety of reinforcement systems including token economies (working for a predetermined number of tokens in order to gain desired object or activity), charts (letter sticker for every correct targeted behavior), coupons (earning minutes on the computer for each correct targeted behavior), and a variety of other systems. Find what your child responds to and use it in a reinforcement system for him.
General prompting
Use written or verbal prompts to help your child learn appropriate behavior. Prompts should be direct or indirect. Once he responds appropriately to a direct prompt, an indirect prompt can be used. An example of a direct prompt is: “Remember to look at your friend when you are talking to him;” and of an indirect prompt is: “Don’t forget what to do when you talk to your friends.”
Verbal “prep”
If you know your child will be entering a situation that could cause inflexibility, provide a clear written or verbal warning or rule indicating what might happen and how he should behave. If he is about to enter a situation requiring complex or multiple step task completion, provide a simple explanation indicating the steps that he will be required to take. If possible, have him repeat the steps back to you before he begins the task.
Rule cards
If necessary, create rule cards (simple rules) listed on index cards that can be used as visuals to remind your child of what is expected during specific situations. These should be shown to him just prior to entering the situation.
Prompt fading
It’s important to fade any prompts that you use as soon as possible. This will help avoid prompt-dependence (not doing a task that he can do without your prompt). Go from direct to indirect prompting, and then fade your proximity to him. Be creative in coming up with ways to fade out prompts completely. For example, “You need to ask your friends three questions while you are in the cafeteria today. Then, I’ll give you a point;” to “Remember, three for a point;” to holding up three fingers for him to see before going in; to no reminders.
If your child is showing signs of frustration, attempt to redirect him as soon as possible by making a short comment and drawing his attention away from the trigger. Many problems can be avoided by this method.
Use obsessions
Know what your child responds to most and use that in your teaching. We have made Isaak work for letter stickers, Pokemon cards, and a chance to do math. We have been known to make Who Wants To Be a Millionaire and Jeopardy! games for targeted skills. Some people have children who love to chew on straws or twirl their hair or jump on the trampoline obsessively. Research has shown that working for such obsessions should not increase the obsession, and it should allow for better results during the task (Charlop-Christy and Haymes 1998).
Foundation skills
It might seem obvious, but in order for your child to learn, he has to be “prepared to learn.” A child jumping out of his chair, yelling, and looking out the window is probably not a child that is going to respond well to direct teaching. A child sitting in his chair, looking at you, and anticipating learning because he knows it will be fun and motivating is going to go far! This is instructional control, and with it, your child will make progress. In the beginning, his obsession with letters and the written word may be what most helps him learn to attend to instruction and respond. Once he can do that, you can then use those visual abilities to actually teach him important skills.
Attending skills
Sitting
Purpose: To come to the table when called and sit in preparation for instruction.
Prepare some of your child’s favorite interests and have them at the table. We used letter stickers, letter stamps, foam letters, and letter cookies in those early months. The letters were most effective at the time because Isaak was interested in them and wanted them to be produced one after the other, so he was able to work for longer periods of time with letters than with any other reinforcer. Once you have something that will motivate your child, call his name and say, “Come sit.” Wait five seconds. If he does not begin to respond, walk over to him and say again, “Come sit” and help him stand up and walk over to his chair and sit down. Ignore any protestations. Once he is sitting, say, “Good sitting!” and give him the reinforcement. Continue this program until he independently comes when called.
Hands down
Purpose: To put hands in lap when requested.
When your child is sitting in the chair but his hands are not in his lap, say, “Hands down.” If he does not respond within five seconds, say it again, and then hand-over-hand put his hands in his lap. Say, “Good putting hands down” and give the reinforcement. This should first be done at a time when he’s not in trouble for having his hands all over the place so as to teach him the expectation with a good feeling. Once he knows what’s expected, you can use this instruction any time you need him to be still and attending to you. This can be modified for any other distracting mannerism.
Pointing
Purpose: To point to something when requested.
Use something motivating like a sheet with randomized alphabet letters or numbers or a favorite book with a variety of pictures on a page. Tell your child to “Point to ‘L,’” for example. If he does not respond within five seconds, say it again, and hand-over-hand help him point to the correct response and give the reinforcement saying, “Good pointing!” Continue until he will point independently when asked. Once he can point to a book or something on paper, teach him to point to things in space. You can place his favorite letters on a shelf and have him “Point to ‘L’” there.
Purpose: To imitate upon command.
You can modify any standard imitation program (with objects, gross motor, fine motor, oral motor) to be more adaptable to your child’s interests. Choosing objects of interest, such as letters, to work with can be more effective. Make sure he is attending to you, then say, “Do this,” and then put the letter in the box or clap your hands or open your mouth wide. If he doesn’t respond within five seconds, say it again, and hand-over-hand prompt him to do it, then give the reinforcement. If he is able to read at this point, it may help to give him the written cue along with the verbal request.
Making a choice
Purpose: To learn to make a choice between at least two options.
Once your child can make a choice, he will be more able to handle transitions and changes and will be more compliant. You can turn almost anything into a choice so that he has some control in his life. Prepare index cards with pictures and/or words with your child’s favorite things. Have a few cards for food items, a few for toys, a few for videos, etc. Before you give him one of the items, present him with the appropriate card and have him read it. Say, “Good choosing apple,” for example, and give him the chosen item. Once he regularly reads the card, present him with a choice between the preferred item and a non-preferred item—an apple card and a spoon card. Once he can choose between those consistently, present him with a choice between two preferred items. Continue making it more complex, and use fewer and fewer written cues and more verbal requests for making a choice.
Social skills
Social eye contact—learning when to “check in”
Purpose: To learn when to look at another person when engaged in a shared activity.
Prior to engaging in the activity, your child’s eye contact should be primed. Create social scripts or rule sheets so that specific joint attention statements are paired with looking at your communicative partner. The script could say, “When you say, ‘What do you think?’ or ‘I see __________ too,’ or ‘Look at __________,’ you need to look at me.” Read over this story before you begin the activity.
You should engage in a shared activity such as looking at a book, playing a game, or completing an art project. During the activity, be sure to make the same target statements presented to your child as you wrote in the story, and also be sure that you make eye contact with your child when you make those statements. When your child makes the target statements paired with eye contact, use behavior-specific praise to reinforce his eye contact. “Wow! You looked at me when you said, ‘I’ve drawn a truck.’” If he does not pair eye contact with a target phrase, you should draw his attention to the rules sheet and ask him to practice. Be sure to change the target phrases to match the joint activity at hand.
Emotions
Purpose: To increase ability to understand and show appropriate emotions.
Create a worksheet with two columns. Title one column “Situation/Cause” and the other, “Emotion.” Think of some simple situations such as “I lost my doll” and “I got a new bike.” Write those down on the left-hand side. On the right-hand side, randomly draw a face with an emotion (happy, sad, angry). Present the worksheet to your child. Read over the situations and prompt him to draw a line to the appropriate emotion face. Create new situations each time. This program can be made as simple (happy, sad, angry) or as complex (confused, embarrassed) as your child needs to learn.
Interactive games
Purpose: To learn to play a variety of interactive games.
Provide your child with a list of basic rules for an interactive game such as soccer or tag. Once he can independently state the rules, set up a game in which the rules will need to be applied, and begin playing. If at any time your child does not follow the rules, review the rules with him. Give him an opportunity to follow the rule independently. If he needs it, provide him with a small “cheat sheet” of the rules of the game to keep in his pocket. He may not need to refer to it during the game, but just knowing it is there may help him remember to follow the rules.
Pretend play
Purpose: To engage in multiple imaginative play activities and pretend to be a variety of characters.
Introduce an imaginative play activity such as cowboys, pirates, or firefighters. Say, “It’s time to play ____________. Pretend you’re a __________.” If he does not begin to respond, model appropriate play, and he should imitate your actions. Books or videos can be used as models to illustrate how particular characters behave, materials they use or wear, and places where they live or visit. Give him written cues if necessary.
Observational learning
Purpose: To engage in activities by observing peers in the environment.
Set up a situation where two peers are engaged in a play activity. Your child should be told to watch his friends play. After a specific amount of time elapses, approach him and ask him how to play the observed game. If he does not know, instruct him to observe his peers again. Provide verbal prompts, walking him through the rules of the game as he observes. When he can tell you how to play the game, he should be told to join. If at any time he does not follow the rules of the game, he should be taken aside and asked to state the rules again. This program can be made as simple (pushing a car back and forth, throwing a ball in a basket) or as complex (freeze tag, kickball) as your child needs to learn.
Phone conversation
Purpose: To learn appropriate phone conversation behavior.
Set up a role playing game where you and your child engage in a conversation over the phone. He should be learning that the voice on the other end of the phone is coming from an actual person, so begin by having both of you in the same room. Next, you step out of the room but continue talking on the phone. The distance between you and your child should gradually increase. If at any time he does not engage in a conversation appropriately, provide verbal or textual prompting. Some target phone behaviors should be answering questions, waiting for the other person to finish speaking before he begins talking, and responding to comments.
Asking others about their activity or product
Purpose: During a structured activity, to request information about what peers are doing while engaged with them.
This program should be done after your child can already share what he has made or what he is doing with adults and peers in his environment. The purpose of this program is to help him request information about what his peers are doing. When you see your child making eye contact with another person during play, model for him an appropriate query such as, “What are you drawing?” Use textual prompts as needed, but be discreet so as not to interrupt social interaction. Be sure to reinforce his commenting in these situations so that he will continue to make comments and seek attention for his own actions and objects.
Social interaction
Purpose: To improve social interaction skills.
Present your child with rules for one of the targeted social behaviors. For example, state, “When you want to talk to someone, you must first get that person’s attention. What do you do first?” Once he can independently state these rules, set up role playing activities in which the rules will need to be applied. Role playing activities can be set up using puppets, figures, or actual people. Multiple scenarios should be provided so that your child is able to practice behaving appropriately in a variety of situations. If at any time he does not use appropriate social behaviors, stop the activity and have him review the rules. After the rule has been reviewed, give your child the opportunity to apply the rules to the scenario again.
Role-playing appropriate behavior
Purpose: To improve social situational behavior through role playing and practice.
Present your child with a written set of rules for a targeted social behavior. He should then be asked questions pertaining to the rules such as, “What should you do if someone calls you a name?” Once he can correctly answer the questions, present role playing activities with puppets or figures in which the rules will need to be applied. Provide opportunity to practice using the targeted behavior in a variety of novel situations. Some examples: What would you do if someone cut in line? What would you do if someone pushed you out on the playground? What would you do if you wanted to play with something someone else had? What would you do if you wanted to join in someone’s game?
Real life situations
Purpose: To identify a real life problem and state what is needed to resolve the problem.
Create obvious problem situations for your child to identify, e.g., state that it is time to go for a bike ride and, when your child gets to the bike, the tires will be flat. When presented with the problem situation, your child should identify what is wrong with the item/situation and state why it is a problem and what could be done to fix the problem.
If your child makes a mistake or fails to respond, provide him with visual cues such as photographs or symbols from which he could choose. In the above example, if he does not tell you that the tires need air or that they need a pump, you could provide him with several visual options from which to choose, such as a picture of full tires with the textual cue “tires need air” and several other distractors.
Academic skills
Although your child may not need academic help in the beginning, you can use his academic prowess to teach him other skills. As already introduced, he may be more motivated to learn to point by pointing to letters, he may be better equipped to handle transitions if he can tell the time, and he may be more inclined to do artwork if you have letter stamps. Be creative and use his skills to your advantage.
Because your child is talented in academic ways, it may be that he will deal with boredom at school. Prevent this occurrence as much as possible by finding a good school placement for him. However, there will be times, for whatever reason, when he will need to sit and attend to instruction that is well below his ability level. We all have to sit through that boring meeting from time to time. Teaching him appropriate behavior in such a situation can be important as he gets older.
As your child gets older, it’s possible that he may struggle with handwriting, story writing, or reading comprehension. Many children with hyperlexia do. Here are some ideas.
Maintaining attention
Purpose: To attend to a peer or an adult for a non-preferred activity while in the presence of distracting items or activities.
Your child should be placed in a situation where he is required to attend to an adult or a peer (e.g., begin a conversation with him, listening to instructions or a story). A distracting item or activity should be placed in close proximity to where he is sitting (such as a calendar, a calculator, a computerized device). Before the adult or peer begins to speak, tell your child that he will earn points for keeping his attention on the speaker. These points should be given for keeping his hands off of the item, keeping his eyes on the person talking, asking questions about the person’s topic, and making contingent statements about the person’s topic. If he attends to the speaker for the duration of time determined, he should receive a point. If at any time he becomes distracted, he should be redirected and told that he will not receive a point at that time. Once the time has elapsed, the distracting item or activity should be removed from the situation. If he maintains attention for the entire trial, he should receive access to an additional reinforcer.
Purpose: To improve handwriting skills.
Prepare a list of written rules for good handwriting skills and have the rules posted somewhere obvious.
This program should be taught in a highly motivating manner. For example, have him choose an activity in which he would like to participate. Have him pick a simple sentence to write pertaining to the activity such as “I like to play video games.” A timer should then be set for a specific amount of time. He should spend the entire duration of time writing the specific sentence. The letters should be written on the provided line slowly and neatly. After the timer sounds, he should receive a point for each letter written appropriately. Points can then be traded in for a certain amount of time with the desired activity (i.e., one point = one minute). This program can be made as simple (short sentence provided) or as complex (full paragraph) as your child needs to learn.
Handwriting Rules
1.Keep my letters on the line.
2.Write small so I can fit all my words on my paper.
3.Remember a space between each word.
4.Write slowly and neatly.
Academic writing
Purpose: To improve academic writing skills.
A variety of writing activities should be printed up and cut apart. Introduce each activity before your child is asked to write about it independently. Put the activities in a bag from which your child can pick. Use a timer, and have him write for that time. A reward should be given for good writing. Remember, this is a writing assignment, not a handwriting assignment. Although neat handwriting is important, teaching him good writing skills is the primary focus of his program. Some examples of writing activities are:
•writing a personal page
•writing a poem
•writing a short story
•drawing a story
•writing an essay
•doing a vocabulary page
•writing a letter
•writing a report
•copying dictation
•writing a dialogue
•making a sentence diagram
•typing.
Story writing
Purpose: To improve creative writing abilities.
Help your child write imaginative stories. The curriculum in Teach Me Language (Freeman, Dake, and Tamir 1997) is good for this purpose. If your child struggles to generate ideas, help him by providing him with a word bank or scripted choices. This should not be about a past experience or previously read book, but it should be an imaginative and logically sequenced original story.
Summarizing
Purpose: To summarize a story in the effort to improve reading comprehension.
You or your child should read a short story. After the story is completed, your child should be instructed to summarize the story using a specific number of sentences. For example, state, “What was the story about? Use two sentences to tell me.” If he does not respond correctly, provide him with choices of appropriate ways to summarize. Begin with one sentence, and then increase the length and number and complexity as he improves. Teach him to summarize content in his own words. Start by teaching him to note the important words in the passage. He should be able to do this when someone reads to him and when he reads to himself.