Elena Burch, M.Ed, BCBA
I’m a BCBA with extensive experience in early autism, and was a director for a center-based ABA program in Vermont, as well as a consultant for in-home therapy. Currently, I’m a consultant for DrOmnibus, and offered the ABA DrOmnibus App to a previous client to test its efficacy.
I first met Jane and her daughter, Julia, when she was four-years old. She was diagnosed with severe autism at 18 months, and was placed on a long wait list. After two and half years, Julia finally received approved services, and I started home ABA therapy with her.
Julia was a very active child, who loved to run, swing, jump on trampolines, and dance to music. The biggest challenge was a major safety issue. Julia was constantly running off, even darting towards cars and other potentially life threatening situations. She was not able to listen to simple directions, wouldn’t sit in a chair, and could not receive any direct instructions. Teaching was limited to what she could learn in her natural environment. And, she regularly tantrummed – cried, flailed on the floor and had self injurious behavior – when asked to do simple tasks that were already in her repertoire.
Assessment & Behavior Plan
After I observed Julia and made formal assessments, my first goal was to pick two or three behaviors to decrease, and then find appropriate replacement behaviors to increase for her ABA behavior plan. I started with the most serious issues: darting away from her parents and reducing the severe tantrums. The aim would be to have Julia walk calmly next to her parents, and increase her vocabulary so she could ask for things, which often reduces tantrumming in autistic children.
In order to begin the ABA therapy and implement the plan, I needed to gain stimulus control so that Julia could learn to follow my instructions, increase her vocabulary, and learn to walk by my side. Paramount in my efforts was to find things that Julia really liked that I could use as a reward (or reinforcer). I wanted things that could be varied depending on the day and Julia’s satiation level of that specific treat. Coconut chips, small bits of sugarless candy, crackers, time swinging, jumping on the trampoline, and listening to music worked the best. In the beginning, I asked Julia’s family to withhold the coconut chips and swinging so that she only had access to them during our therapy time.
I started with increasing her vocabulary by holding up a piece of coconut to gain her attention, and said the word “coco” (an easier sound to repeat than coconut), and then immediately put the coconut chip in her mouth. Julia tried to grab the bag and fussed when I didn’t give her more. I waited for her to calm down, and then repeated this step. After several attempts, Julia realized she would receive the chip only when she wasn’t fussing and could listen to my cue.
I repeated a similar process with the swing. While Julia was seated on the swing, I held the swing up to a push off position, said “swing,” and immediately let go. After several trials, I hesitated after my verbal cue of “swing” to see if she would make an approximation of the word. It took about 15 tries, and then she made the “ing” sound! I was so excited with her progress. We went back inside and after a few more tries with the coconut chips, Julia was able to sit quietly and ask for the coconut chip by saying “coco.” These are the moments that make my job so much fun!
This type of work can take just a few tries as in the case with Julia, who fortunately has the capability to produce vocal words, or the ABA therapy may require days or weeks of consistent repetition. I have seen tremendous gains in expressive language by using this ABA methodology even with the most severe ASD cases.
Simultaneously, I worked on the issue of Julia darting away when walking with her parents. I used tiny bits of crackers and the cue, “Walk with me.” I kept Julia in very close proximity to me so I could block her from darting off. Then we took just a few steps together, and I placed the cracker in her mouth. We took a few more steps, I said “Stop,” and placed another small bit in her mouth. Within a couple weeks of doing this five times a week for two sessions of ten minutes each, Julia was able to walk a whole ten minutes without leaving my side. After the first two days, I included mom and dad in the sessions so that Julia was able to generalize her new skill with other people.
I recorded the data, implemented the plan, and kept track of her progress to make sure Julia was achieving the goals. Soon we expanded the behavior plan to include table work so that I could assess her knowledge of colors, numbers and other basic learning skills. At this stage, Julia was not able to sit at a table and attend to my cues.
The goal was to teach Julia to sit with calm feet and hands, and to look me in the eye. Within one day, she was able to sit and look at me for five seconds, which was a huge improvement over flopping in her chair as soon as she sat down. After eight months of intensive therapy, Julia’s vocabulary reached over fifty words, and she could sit at a desk and use a tablet for educational purposes.
Using the ABA DrOmnibus App
Last September, Julia was accepted at an all day center-based program, and her mother, Jane, was looking for ways to increase learning opportunities at home. I suggested the ABA DrOmnibus App. Jane downloaded the App on her daughter’s iPad, but was concerned that Julia would be unable to use the App without supervision. Julia began the first session which had her identify several colors. Julia quickly learned what to do with very little prompting from her mother, and moved through the initial testing phase built into the App without her mother’s help.
The ABA DrOmnibus App identifies the user’s ability to correctly pick the color of the balloons asked for and move at the pace of the child. I also was able to review Julia’s progress through the assessment feature, which gave me a baseline for ongoing educational purposes that could be used at her school.
Jane said, “Once she is on the App, she does NOT want to get off it.” Now during Julia’s free time she was learning valuable lessons that further expanded her vocabulary and comprehension.
After two weeks of using the App, Julia reached the fourth level and could identify many colors, shapes, fruits and vegetables. Jane told me she plays at home after school, and is excited and motivated to play for an hour or two a day. “She is mostly independent on the App, but still needs supervision sometimes to keep her focus, otherwise she would stim,” her mother said. “She likes the reward part the most, and chooses the balloons for cash almost every single time.”
Jane was now offering the App not only during Julia’s free time, but as a reward for good behavior. Her mother saw this aspect of the App as a major benefit. She started replacing coconut chips and swinging with time on the App.
Jane wanted to introduce the ABA DrOmnibus App to Julia’s school as a better reward option, for enhancing her cognitive skills, and to reinforce the learning at home. Her school was interested in including this App in her behavior plan. In the next article I’ll share the results of implementing the ABA DrOmnibus App at Julia’s center-based program.
*Paid content by DrOmnibus.