“Touch Your Head” or “Make Your Bed”? Staying true to the Applied dimension of ABA when creating program goals for students with profound cognitive impairment

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By Katherine DeCotiis Wiedemann, M.A., BCBA

bSci21 Contributing Writer

Nearly six months had gone by since we began Lily’s home-based ABA program, and she had not mastered a single target of a single program. Not one. I stared blankly at my own furrowed reflection through the graph on my computer screen. What was I doing wrong? Why couldn’t I get her to learn? Why was ABA failing me?

Prior to taking on Lily’s case, I had worked almost exclusively with early intervention and preschool children; kids who came to me with limited or nonexistent foundational skills, but who responded to ABA like a dream and whose graphs were magnificent; a baseline of 0% with a quick and steady climb to mastery. Over and over again, like behavioral clockwork. My work with early intervention kids is what got me hooked on ABA and convinced me that it could work for everything and everyone. “It’s a science!” I once exclaimed over-zealously to the thrilled parents of a toddler who was finally talking after only 30 days of treatment. I had become superbly confident in my niche.

But Lily’s graphs were a nightmare. Like the jagged teeth of an orthodontically-challenged dinosaur, and always below the 50% line. Identifying Body Parts, Matching Identical Pictures, Sorting Objects by Color, Requesting – the quintessential programs that I had come to rely on as instantaneously acquired were just not working. I had tried everything – switching back and forth from errorless teaching, using prompting strategies up the wazoo, working in different environments and at different times of the day; every new approach led to the same low, variable results. She couldn’t label. She couldn’t identify. She couldn’t imitate. She had one self-created sign that she used to universally indicate that she wanted something, but it was up to us to figure out what that something was. Her data book was a nasty, inflamed pimple on the otherwise flawless complexion of my career as a behavior analyst.

I considered talking to my supervisor and requesting that another BCBA take over the case. Someone with more experience, someone who knew more about non-verbal kids, someone who had tricks up their sleeve that I clearly didn’t. Before I made that call, I went back through her file one last time. She was 10-years-old and entirely nonverbal. She was not reliably toilet trained. A recent medical report indicated that her cognitive functioning level was similar to that of a 6-month-old child, and likely always would be. And then it hit me.

She didn’t need my programs. She didn’t need Imitating Actions with Objects. She didn’t need to meet criteria on “Answering ‘Who’ Questions or “Identifying Parts of a Picture.” Sure, those skills would be great to have, but they weren’t her most pressing needs. This child needed to learn to bathe herself. She needed to learn how to make a snack. She needed to brush her teeth and make her bed and use the bathroom independently. These were the skills that might one day mean the difference between a group home and an institution – not whether she could identify 15 exemplars of a school-bus from a larger array. I suddenly felt silly and almost angry at myself that I had spent so many months trying to jam the concept of pronoun-specific body part identification down her throat when there had been such an obvious deficit in actual living. I understood for a moment why we as behavior analysts sometimes get flak from the general population for being hard-headed and data-obsessed.

I scratched her entire program. I bought a copy of the AFLS (Assessment of Functional Living Skills) and started probing that week. Her scores were low, but we had a starting point. We implemented 10 functional programs and began fully prompting backward-chains of each. Her therapists relied on muscle memory and consistency, since she could not comprehend visual cues or task analysis pictures. We worked untiringly after school and on weekends to commit these sequences to memory and reach independence. And 30 data points later, she had mastered her first program: Making a Snack. She could find the cabinet where the cheese puffs were, twist off the top, pour some into a bowl, replace the top, replace the puffs, walk to the table, sit down and eat them. Without a single prompt. When the therapist called me to tell me, I welled up.

In the end, it wasn’t ABA that failed me. It was my own limited application of ABA, and the fact that I lost sight of perhaps the most important dimension of our science –that it’s meant to be applied. After working with Lily, I threw out my grand idea that I held the secret recipe for the “Fix-all Cookie Cutter ABA Program for Children Everywhere.” Now, every time I begin an initial assessment for a new client, I start the recipe from scratch. The first question I ask myself is, “What is the most significant, functional, real-life challenge for them?” instead of asking whether or not they can tell me the functions of 10 community helpers within 60 seconds over 3 consecutive sessions.

If you can relate to Katherine’s experiences as a behavior analyst, share your story in the comments below!  Also, be sure to subscribe to bSci21 via email to receive the latest articles directly to your inbox!

The content of this article is not based on any specific person. Certain incidents, characters, and timelines have been changed for creative purposes and may be composites or entirely fictitious.

Katherine WiedemannKatherine DeCotiis Wiedemann, M.A., BCBA had her very own behavior intervention plan as a kindergartner in 1989. She had to earn five smurf stickers every morning in order to go to recess. Katherine eventually graduated from kindergarten and beyond, and after a false start as a comedic actress (she dropped out of NYU’s Tisch School of the Arts) she found herself very at home in special education and behavior analysis.

After 10 years in the field, she founded Every Child Behavior Solutions, a NJ-based consulting practice that provides behavior-analytic services to school districts, families and anyone else who asks. She loves public speaking, and has done countless school in-service presentations about ABA, as well as for pediatric groups and medical students at the top hospitals in the state.

Although the first chapter of her career focused mostly on children with autism spectrum disorders, she has also spent a good deal of time in general education and specializes in the school-based treatment of ODD, ADHD, OCD and anxiety disorders. One of her short-term goals is to convince the world that ABA is not just a teaching tool for autism (although it does that well), and that behavior analysts are not all condescending blockheads (although some may be). You can contact her at katherine@everychildnj.com.
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22 Comments on "“Touch Your Head” or “Make Your Bed”? Staying true to the Applied dimension of ABA when creating program goals for students with profound cognitive impairment"

  1. Michelle Lawton | March 6, 2016 at 11:45 pm | Reply

    I am gushing with pride….. You have found your niche as I knew you would! Well done Katherine!

  2. Your simple, honest account of our sometimes, narrow minded application helped me to widen my perspective and encouraged refreshed reliance on our firm foundational principles. Thank you.

  3. I’m finding this is a hard sell in the school setting where goals must all be rigorously tied to common core content. Thanks for sharing your post. It was a fun read!

    • Hi Ann, thanks for reading. I’ve consulted in a number of public schools, and you’re right – that is definitely one of the most solid barriers to giving children with special needs a functional education. I am finding, at least in my state, there is more and more leeway being given to classified students in terms of modified goals and testing, etc. Many districts do have a life skills curriculum at the middle and high school levels, but you’re right in that we are limited. Thanks for your comment, and hope to see you back soon!

  4. Cynthia Watzlavik | March 7, 2016 at 1:20 pm | Reply

    Interesting article. As I was reading it, I thought back to my training from Indiana State University in the 80’s. I’m not certain whether the college actually taught me or I just learned through experience, but when you teach a child something that will benefit them as an adult, it’s so much easier to teach–perhaps because it makes sense to teach skills children are actually going to use. Thanks for that reminder!

    • Hi Cynthia, thanks for your comment. I remember moaning and groaning through all the things in middle school that we were “never going to use in real life.” Turns out, I really didn’t use a lot of them! But it is important to always look at the functional side of any skill, or how it could potentially serve a kid later in life. Thanks again for reading!

  5. Lisbeth DeCotiis | March 7, 2016 at 2:18 pm | Reply

    From one educator to another your approach is refreshing and honest. I am so very proud of you. Continue to make a difference one child at a time.

  6. Love how practical this is; also I bet if there’s some way to make the acquisition of these basic skills fun (and somehow to laugh with the children, so maybe kind of zany-style ? ?) it might accelerate the learning. I know that James, our nephew, likes it when we are fun & funny and kooky and always returns to that. I am going to pass this on to some families I know are challenged in working with their children in this same way.

  7. Very interesting article. It opened my mind and made me reconsider some of my older client’s goals

  8. Johna Sommer | March 8, 2016 at 10:07 am | Reply

    As a parent of a child, who learns in very specific ways, I love love this article. I also believe, even vocal learners, and learners who are not as cognitive challenged, can benefit in making sure what they are learning are functional, no matter the level. As important, is to build learning where the learner can always feel competent, no matter how creative you have to be find those steps! Thank you for all that you for these kids and the community of DD!

    • You’re absolutely right, Johna. One-size-fits-all doesn’t really have a place in education. That’s the part of my job I love the most – getting creative and changing it up every single day. Thank you for reading! -Katherine

  9. I will definitely be sharing this article with colleagues; and very brave of you to share this story!

  10. Thank you for the kind words, Matt, and for sharing the article. Remember — fortune favors the bold! Best, Katherine

  11. Shunsuke Izai | March 15, 2016 at 1:00 am | Reply

    I just sent this to my BCBA supervisees! I’ve been stressing programming functional skills to my staff, and this was another great example to provide for them. Thanks for the great read!

  12. This article was amazing! It hit extremely close to home with one of my kiddos. Thank you for sharing.

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