ABA Training

DISCLAIMER: This is a summary of what I learned/observed from this training. It is obviously very biased and is not meant to be objective. Please do not mistake this for an academic effort; I am sharing what I noticed so that those of us advocating against the use of ABA can understand how people are currently being trained on it. These notes are also not comprehensive; I took notes on most things, but not everything, because much of it was redundant.

Day 1 Session 1: Overview of Autism and ABA

  • Presenter asked everyone to answer the following in the chat: “what comes to mind when you think of Autism?” . Almost all the responses were negative-- “poor social skills”, “communication deficits”, etc
  • History of Autism-- conveniently left out Hans Asperger’s history as a Nazi sympathizer
  • Did not mention the gender gap in Autism diagnosis (“it’s more prevalent in boys than girls”) until I brought up the fact that many studies have only been done on AMAB people and thus the diagnostic criteria is based on AMAB people
  • Presenter used the phrase “epidemic of Autism” to describe increases in Autism diagnosis over the years
  • Presenter consistently used the phrase “mental retardation”
  • Cites Autism Speaks as a credible source
  • ABA partially rooted in Pavlovian conditioning, also work of BF Skinner-- consequence increases or decreases likelihood of behavior occurring in the future
  • Elan and Michael’s 1959 paper considered the start of ABA
  • Using rewards system:
  • Primary reinforcer-- a prize (i.e., the cookie)
  • Secondary reinforcer-- not rewarding in themselves, but collecting them leads to getting a primary reinforcer (i.e., when you get five tokens you can have the cookie)
  • Really driving home that ABA is scientifically backed and proven-- but it seems to be based in flawed science!
  • ABA components:
  • Clearly identified behaviors to increase and decrease
  • Direct observation methods
  • Data collection
  • Treatment based on function
  • Assessment prior to treatment
  • Ongoing monitoring during treatment
  • Evaluation following treatment
  • Stated goal of ABA is to decrease the amount of support needed over time (get people out of receiving services)
  • Learning Challenges in ASD
  • Not motivated by social interaction
  • Trouble with problem solving/ complex concepts
  • Need frequent practice, can have trouble translating skills from one context to another (“generalizing skills”) (i.e. sending an email on a laptop vs a smartphone)
  • May not focus on the important info-- ex: focusing on the colors of a ppt slide rather than the text or the presenter
  • “Errorless learning”-- using supports until you don’t need them anymore
  • All of the above are framed as things to “overcome”-- goal is to assimilate with neurotypical students
  • Modifying content, methodology, and performance criteria
  • I feel like so much of ABA is rooted in distancing Autistic people from humanity-- treats them like test subjects. True across lots of 20th century psych research.
  • Systematic instruction
  • Skills broken down into smaller parts
  • Highly structured teaching environment
  • Many opportunities to practice a skill as its being learned
  • Very focused on how teachers will support the student-- detailed plans for this, including plans on how they will fade out over time
  • Presenter noted how another teacher called her out for giving a student a small piece of candy for standing in line “the right way”-- the teacher told her it looked like she was training a dog. That’s kind of how all of this feels.

Day 1 Session 2: Classroom Roles

  • Intensive Instructional Model
  • Individualized for each student
  • Inclusion-- opportunities for skill generalization
  • Proactive adult support-- planning for the phaseout of supports
  • Lead Teacher Role
  • Day-to-day classroom ops
  • Coordinates IEP development and implementation
  • Oversees tutors/paras
  • Communicates with parents/caretakers
  • Supports “challenging behavior reduction”
  • Clinical Supervisor Role
  • Supports the lead teacher-- comes on site once per week and meets with teacher about the student
  • Supports tutors/paras
  • Attends IEP and similar meetings
  • Collaborates with school administration
  • Tutor/Para Role
  • 1:1 support for students in the classroom and inclusion settings (i.e. recess)
  • Usually responsible for one “primary student”-- this is the student whose case they manage
  • Training org provides curriculum and some staff. District provides paras, admin support, other normal things you’d find in a public school
  • Off-topic-- they keep saying “edibles” when they refer to giving students food, and it’s very funny to me. “I gave a student edibles”... hope not!
  • Behavior-stimulus pairing
  • Stimulus is a “reinforcer” if it increases/strengthens a behavior
  • Studying a history of reinforcement for a behavior-- what is causing the behavior to be repeated?
  • Presenter asked people to list desired behaviors. Someone said “compliance”. So clinical!
  • Also asked for undesirable behaviors. Someone said “OCD tendencies”, another said “crying”. ??????
  • “Stereotypy” is the word being used for stimming now. Framed as a negative thing.
  • Reinforcing through attention
  • Provide attention for good behaviors, ignore the student for bad behaviors (ugh!)
  • Positive reinforcement= adding something after a behavior (positive equals add, not “good”)
  • Negative reinforcement= taking something away after a behavior (negative equals take away, not “bad”)
  • Sometimes reinforcements are misunderstood-- requires trial and error
  • Reinforcers must be:
  • Immediate
  • No gap between the behavior and the reinforcer
  • Clear
  • Simple message
  • Be sure the student knows you’re focusing the reinforcer on them
  • Enthusiastic (if a student responds well to that)
  • Different tone from instructional tone (i.e., “I’m talking to a child” voice)
  • Varied and genuine praise
  • Contingent
  • Only give the reinforcer if the target behavior is exhibited (no ‘freebies’)
  • Individualized
  • Every student has different preferences that can change over time
  • Trainer said“If they have the ability to make choices”-- EVERY student must have the ability to make choices, wtf???
  • Token economy
  • Tokens earned for good behavior, then exchanged for a desired (primary) reinforcer
  • Lessens the number of times you give the primary reinforcer because the student might get tired of it
  • “Thinning the reinforcement schedule”-- number of tokens required to earn primary reinforcer increases over time
  • Question: how do we transition students out of using a token economy if they do it their entire school lives???? Obviously money is a reward for work in the “real” world but this rewards system is not nearly as consistent in the average workplace. More negative than positive reinforcement in workplaces.

  • Text on a slide reads: “No matter how extreme or extraordinary the behavior is that you witness, there is a SIMPLE explanation for why it is occurring. The ONLY way to increase a behavior is to reinforce the act”. This seems wrong on so many levels, not least of all because we justify the behavior of neurotypical students by saying “you never know what’s going on at home” or similar, but Autistic students are reduced to single-input creatures of habit. I hate this.

Day 1 Session 3: Data Collection

  • IEP goals are always measurable, data is used to provide those measurements
  • Document small steps of student progress
  • Take data on:
  • Age-appropriate skills
  • Pre-requisite skills
  • Challenging behaviors
  • Adaptive responses
  • Operational definitions
  • Define exactly what a behavior looks like for the specific student
  • Ex: “Out of seat” means “standing more than three feet away from their desk without adult permission”
  • Baseline data collection
  • Collecting info before introducing an intervention
  • Reinforce correct responses, ignore incorrect responses (this seems confusing)
  • Frequency recording         
  • How many times a behavior/response happens
  • Flapping is explicitly stated as a negative behavior

Day 2 Session 1

  • Identify skills, develop reinforcement, plan new prompts for response, determine when to fade prompts, determine how to measure success
  • How do you know when a skill is acquired?
  • Discrete trial instruction
  • Generalization: children with autism do not learn readily from “typical environments” and are easily distracted. Can’t handle complex stimuli and instructions. Need more practice opportunities.
  • Discrete trial instruction steps
  • Selecting skills to teach-- based on the environment. Gen ed or Sped class?
  • Is it useful/developmentally appropriate?
  • Does it provide a functional alternative to problem behaviors?
  • Is it socially acceptable? (don’t want to reinforce “unacceptable behaviors”. Example used is high schooler playing with HotWheelz)
  • If a student really isn’t picking up a skill, try to teach a similar but different skill (i.e., kid can’t write by hand, teach voice to text or typing)
  • More about functionality than learning exact skill-- many means to the same end
  • Need basic skills before advanced skills
  • Selecting stimuli
  • Don’t pick materials that will be distracting-- if a student focuses too much on the color or size or texture, they won’t learn what you actually want them to learn
  • Control for distractions. Ex: if you want to teach color, present three identical objects in different colors. Can’t focus on other aspects.
  • Teaching
  • Trial
  • Each presentation of the instruction, student response and consequence
  • Session
  • Predetermined number of trials presented-- multiple trials in a session
  • Multiple teaching targets
  • Embedding other skills-- ex: teaching same letter in multiple fonts
  • Interspersed trials
  • Mix in old skills with new skills for both maintenance and teaching
  • “Delayed gratification” is an advanced skill-- waiting ten tokens for a prize vs needing a prize after two stokens
  • Anecdote-- private K teacher said NH State cited class for having reward chart up that noted when a student did not achieve desired behavior
  • Baseline
  • Test student’s skill ability before teaching
  • Few trials
  • If less than 80% correct, need to teach the skill
  • Stop after three incorrect trials
  • Assessment only-- no help, no instruction. Reinforcement is debated-- should we reinforce in baseline? Trainer says yes-- student should get “credit” for getting something right regardless of context.
  • Don’t correct wrong answers, but praise right answers
  • Instruction
  • Teacher behavior
  • Student behavior
  • Teacher response
  • Prompt: any instruction that guides the student toward the correct response
  • Fading: gradual removal of prompts until the task can be done correctly independently
  • Prompting and errorless learning
  • Giving/prompting correct answers
  • Going off the assumption that Autistic kids do not learn from mistakes, only from direct reinforcement (can’t generalize knowledge)
  • Types of prompts: modeling (gesturing, showing what to do), Physical (touching the student), verbal (giving the answer)
  • Fading a prompt
  • Skill is acquired when student responds before the prompt
  • Delay the prompt more and more until the student doesn’t need it anymore
  • If a student becomes “prompt dependent” (cannot do task without the prompt)
  • Video example: teacher grabs students hands when she stims. Trainer points this out and encourages it.
  • As soon as they get to 80% correct, you don’t need to continue fading.
  • Criteria
  • Increase or decrease prompt step
  • Get help
  • Mastery
  • How to handle an error
  • Remove stimuli
  • Do trial again with most intrusive prompt
  • Provide moderate reinforcement for prompted response
  • Fade out reinforcement-- say “good job” every fourth correct answer, for example
  • Response generalization-- reinforcing equivalent responses
  • I.e. reinforce ‘Hey how are you’ and ‘Hi what’s up’
  • Use every opportunity to teach a skill with existing stimuli in the environment

Day 2 Session 2: Task Analysis

  • Breaking bigger skills into smaller skills
  • Learning each part
  • Learning how to put different parts together
  • Chain of events leads to terminal goal
  • Add reinforcement to skills that are not self reinforcing (don’t have intrinsic value for the student)
  • Constructing a task analysis
  • Determine the steps and write them in order
  • Be very specific about what you are looking for
  • Practice the skill yourself to construct the steps, then modify to meet needs of individual student
  • Baseline for task analysis
  • See what the student already knows
  • Must prompt in TA to get from one step to the next
  • Teach using prompting and reinforcement
  • Forward chain-- if students have the beginning skills but not the rest. Also default if not sure what else to do. Start training at the first step the student fails.
  • Start with most restrictive prompt (ex: hand over hand), then delay prompt, then independence
  • Limit verbal cues-- physically show them
  • Thought: 2 sec delay is not a lot of time when learning a new skill. It’s ok to do things slowly!
  • Completing the chain
  • Teacher completes chain
  • Teacher prompts students to complete chain
  • Stop chain and run another trial
  • Total task chain
  • Least to most prompt instead of most to least
  • Assume they know what to do then intervene as necessary (this seems way more intuitive to me!)

Day 2 Session 3: Incidental Teaching

  • Ex: Student says “help”, we use opportunity to teach “help please”
  • Plan environment so student feels comfortable initiating
  • What will motivate them to initiate an action?
  • Example used: getting in a student’s personal space to make them initiate asking for space. Ugh.
  • Steps
  • Student initiates
  • Avoid using verbal prompts-- wait for the student to initiate!
  • Teacher prompts next level of response
  • Pause between prompts
  • Reinforce response
  • Reinforcer is access to the preferred thing that initiated the incidental teaching
  • Thought: They use tickling as an example a lot and I hate it!
  • Thought: Leaving out conversational verbal cues on purpose seems like you are priming students to respond to commands but not have meaningful conversations
  • Thought: It is NOT ok to violate a student’s boundary until they ask you to stop doing something “the right way”.
  • Possible student responses:
  • Independent response with no cue
  • Prompted response
  • No opportunity
  • Student does not respond to the motivation you set out; i.e., they don’t care about your silly games

Day 3: CALM De-escalation (CW FOR RESTRAINT USE)

  • Crisis prevention and management
  • Regulations around physical restraint
  • Calm Approach tenets
  • Objective
  • Behavioral
  • Proactive
  • Safe (emphasized)
  • Decreasing “problem behavior” so you don’t need to use “protective measures” (restraint)
  • Core concepts
  • Modulation of force-- level of intervention should match intensity of aggression
  • Minimum effect-- use “least restrictive but still EFFECTIVE procedure”
  • Pliancy-- physically relaxed rather than rigid
  • Threat perception-- “accurately gauge threats”
  • Observation: trainer consistently uses he/him pronouns when referring to aggressive students
  • Terminology note: using phrase “protective movements” rather than “restraint”
  • “Challenging behavior” is defined beyond physical aggression-- stimming and being distracted are used as examples
  • Functions of challenging behaviors (why do students do them?)
  • Seeking attention
  • Escaping or avoiding activities or people
  • To gain items/activities
  • Automatic reinforcement (feels intrinsically good for the student-- stimming)
  • Trainer pointed out that everyone “engages in some form of stereotypy” -- no follow up on that
  • Understanding challenging behavior
  • ABC data
  • A for Antecedents-- what happened before the aggression
  • B for Behavior-- the aggression
  • C for Consequences-- what was the consequence
  • Use data to teach new skills and reinforce good behavior
  • What is a crisis?
  • “A situation that poses a threat to the safety and security of yourself or others”
  • Thought: “proactive’ approach encourages people to get into slippery slope mindset-- “this kid is stimming, so he’s going to hurt someone”.
  • Crisis CALM
  • C- Changes
  • Increase or decrease from baseline behaviors
  • A- Acceleration
  • Behavior escalates in intensity-- can happen slowly or quickly
  • L- Leveling off
  • Behavior stops acceleration-- either before or after behavior becomes dangerous
  • M- Moderation and decrease
  • Student gradually returns to baseline
  • Emphasizes that you have fewer choices in the middle of a crisis-- feel like this could be used to justify inappropriate use of restraint
  • Proactive strategies
  • Replacing problem behaviors and reinforcing alternatives
  • Establish rapport outside of crisis-- students more likely to respond to de-escalation if they trust you
  • Monitor:
  • Yourself (verbal and nonverbal comms with the student)
  • Environment
  • Other people in the environment
  • Verbal instructions
  • Focus on what you want the student to do, not what you don’t want them to do
  • Structured choices
  • Instead of open ended “what do you want to do”, give choices “would you like to sit in your chair or go to the break area”
  • Moderation and decrease time
  • Get yourself under control
  • Plan to re-engage the student in a functional activity
  • “Offer students opportunity to comment on protective hold (if applicable)”-- what are you expecting them to say????
  • Regulations (BASED ON MASSACHUSETTS LAWS)
  • Physical restraint: “direct physical contact that prevents or significantly restricts a student’s freedom of movement”
  • Things that are not physical restraint
  • Brief physical contact to “promote student safety”
  • Providing physical guidance or prompting when teaching a skill
  • Redirecting attention
  • Physical escort as defined by DESE (guiding by the shoulders without applying pressure)
  • Medication restraint
  • “Administration of a medication for the purpose of temporarily controlling behavior” (we do not do this in schools 99% of the time, and if we do it is calling paramedics)
  • Prone restraint
  • “A physical restraint in which a student is placed face down on the floor or another surface, and physical pressure is applied to the student’s body to keep the student in the face down position” (Trainer says we only do this as a last resort. Other participants seemed surprised and said they use them often.)
  • Prone restraint is illegal in MA
  • Mechanical restraint
  • Can only be used if it is implemented by trained personnel, must be prescribed by a medical/related professional
  • Trainer: may be “tempting” to strap a kid to a chair, but you can’t
  • Seclusion
  • Confining a student to a room by themselves (illegal in MA)
  • Vs “time out”-- not leaving the child unattended, time away from activities but still in the classroom
  • Vs “exclusionary time out”-- bring child into separate room, continuously observed by a staff member but could be through a peephole
  • Physical restraint is prohibited “except as an emergency procedure of last resort”. Prohibited unless:
  • Other non-physical interventions have failed or “are judged to be inadequate to the circumstances” AND
  • A student’s behavior poses a threat of “imminent, serious, physical harm to self and/or others”
  • Law enforcement/school security are not prohibited from using their “best judgement” with physical detainment

CALM Physical Summary

I was not able to attend the CALM Physical training. Prior to the training starting, the trainers said that we needed to be able to complete a list of holds/movements without additional assistance or any modifications. Many of these involved bearing the weight or partial weight of a student while transitioning from a kneeling to standing position. I am unable to do these without additional support due to a birth defect in my right hip. I explained that I could not do the movements, and they dismissed me for the remainder of this portion of the training.

Day 5 Session 1: Classroom and School Support Strategies (Inclusion)

  • Inclusion: Time a special education student spends in a general education setting with their non-disabled peers (from MA Dpt of Elementary and Secondary Ed)
  • Learning challenges and strategies
  • Motivation
  • Need individualized reinforcement systems-- autistic students not motivated by same things as gen ed students
  • Complex concepts
  • Break tasks into smaller units
  • Frequent practice
  • Need multiple exposures to concepts in order to absorb them
  • Attending
  • Gen ed classrooms can be distracting, need to minimize distractions
  • Learning style
  • Most to least prompting
  • Generalization
  • Might have difficulty applying concepts learned at school, at home and vice versa
  • Long Term Goal of Inclusion
  • Overall goal is “student is able to learn and be successful in inclusion with fewer supports”
  • Build in supports and fade them out over time
  • Prerequisite skills for inclusion
  • Basic language, social, and behavioral skills
  • Inclusion strategies apply both in and out (lunch, recess, specials, etc) of the gen ed classroom
  • Reverse integration/inclusion
  • Bringing gen ed students into substantially separate classrooms
  • Structuring a mixed environment-- ex: pulling a gen ed student to come play a game with a special ed student
  • Requires collaboration with the gen ed teacher
  • Inclusion models-- two ends of the spectrum
  • Supported inclusion
  • Student requires specialized instruction and ongoing adult support to access curriculum and social opportunities
  • 1:1 with staff
  • Significant curriculum modifications
  • More prompting
  • Support across the whole day, in and out of the classroom
  • Faded supports
  • Student accesses general education curriculum and social opportunities with minimal support
  • 2:1 or more student to staff ratio
  • Staff support supplements existing general ed instruction and curricula
  • Additional monitoring for academic and social independence
  • Social skills learned through rehearsal/review
  • Benefits of inclusion for students
  • Provides peer role models
  • Generalizes skills to other settings
  • Less restrictive environments
  • Grade level curriculum
  • Teaches social skills/builds friendships
  • Builds tolerance/acceptance/diversity (for gen ed students)
  • Provides natural opportunities for turn taking, waiting, and cooperation
  • For gen ed teachers
  • Develop a better understanding of “severe disabilities”
  • Learn to modify curriculum to meet needs of all learners
  • Gain experience working with a broader spectrum of students
  • Share approaches, workload, and resources
  • For the family
  • Interact with more people in the community
  • Skills at school can generalize to skills at home
  • Meet new friends in the community
  • Planning for inclusion
  • Inclusion goals determined by current skills, IEP goals, team priorities, and district philosophy
  • Some districts love inclusion, some limit it more
  • Classroom characteristics of gen ed class
  • Peer group
  • Teaching style
  • Environment
  • Resources in classroom
  • Schedule of activities
  • Pace of curriculum
  • Use combination of mastered and unknown skills in an inclusion setting
  • Use mastered skills to help teach unknown skills
  • Wait before prompting known skills
  • Thought: Presenter said that “we never know what students are thinking”-- probably because you ask things in a way that isn’t accessible to them or they don’t have the skills to respond in the way you think is “right”
  • Don’t do or say things for the student-- prompting and doing are different

Day 5 Session 2: Communicating with Families

  • Not gonna lie, my brain is not working well right now and I am not grasping much of this
  • Home-School communication logs are important
  • Communicate major issues by phone/email, not on the log, and do it as fast as possible

Day 5 Session 3: Summing It All Up

  • Trainer: people with autism “definitely have communication deficits and social deficits”
  • Thought: Is it a deficit, or do you just not like it?
  • Self-injury is listed as a common trait-- how common is it actually?
  • The rest of this was literally a repeat of Day 1. Not including these notes.