Behavior Analysis & Autism - by Paul Coyne PhD

Using Pivotal Response Teaching (PRT) to Teach Language

via vimeo.com

Tina filmed, edited and stars in this nifty little video clip we made on how to use pivotal response teaching to teach language skills. The password is coynemovies .  Paul Coyne and Tina Cavallaro.

Helping autistic children with iOS devices [From the TUAW blog]

Filed under: Education

Helping autistic children with iOS devices

by David Winograd (RSS feed) on Aug 18th 2010 at 2:00PM

Autism is a developmental brain disorder that, in some manner, plagues one out of every 110 children (according to the Centers for Disease Control). It's usually discovered by the time the child is three years old. Varying medical and scientific authorities characterize the condition in different ways, but scientists generally agree that autism spectrum disorders (ASD) manifest themselves in social, communication, and behavioral challenges. The SF Weekly recently wrote about a number of families with autistic children and how the iPad is proving to be quite useful in helping them.

A number of studies have been done on the use of iPhones and iPods as aids for the autistic. One such study was titled iPod Therefore I Can: Enhancing the Learning of Children with Intellectual Disabilities Through Emerging Technologies, and it tracked the progress of 10 autistic children who were using iPod touches in Australia.

The results were quite encouraging. In one case, a child who could not wash his hands was exposed to photos (combined with voice-overs) of a child doing it successfully. Through this method, the correct behavior was reinforced, and in short order, the child was able to wash his hands by himself. About 60 percent of the goals of the study were achieved.

The results of this and other studies have been encouraging, but a major problem for 60 to 80 percent of autistic children is poor motor skills, including poor motor planning, which makes using the small buttons on an iPhone or iPod touch quite difficult. Because of the larger size of an iPad, it can be much more accessible to a larger number of autistic children.

The first major study concerning autism and the iPad (titled Touch Technologies in the Classroom) is currently underway in Toronto. In February, iPads and and iPod touches were installed in six classrooms where they could be used by autistic children. The data is still being analyzed, but the results seem to be positive and indicate that the use of these devices can extend short attention spans, demonstrate understanding, and increase interest (at least in playing with the iPad) when students were previously found to have scant interest in much of anything. One major problem with the use of the iPad is that it is quite fragile, and a good number of autistic children are prone to violent outbursts. One big tantrum could easily result in a shattered iPad.

A large number of apps have been introduced to assist the autistic, and they seem to fall into three categories: those that help with attention span, those that help with communication, and those that help with organization.

Short attention spans are found in the the majority of children with ASD, and this can be a major problem in public if the child gets bored and acts out. One app that seemed to help isiEarnedThat (US$1.99). This app allows parents to use pictures (or take one if they're using an iPhone) for creating jigsaw puzzles with varying numbers of pieces and is compatible with iPhone, iPod touch and iPad. Next, the parent determines a reward. The general idea is that each time a child completes a positive task, they get to put a piece in the puzzle, which when finished, reinforces the behavior, and the child will get the reward. 

One parent of an autistic child used it in a simpler manner, though. In an airport, after finding out that their flight would be delayed, her son started to act out. She used iEarnedThat to create a 30-piece puzzle, which occupied her son for the next half-hour. (He was used to doing 15 piece puzzles.) The reward was cookies. This may not seem like much, but it averted a crisis and taught the parent that her child could be occupied for longer than she ever imagined. 

For children who need to master simple organizational skills in a particular sequence (for example, find toothbrush, find toothpaste, take the cap off, wet toothbrush, brush teeth, etc.), there are a few apps that can help. One is First Then Visual Schedule (US$13.99). This app is also compatible with multiple devices, and it uses pictures and voice recordings to build a lock-step sequence that can be repeated. Another app is Stories2Learn (US$13.99), and it's also not iPad specific. This app is used to create social stories that will show the child how to behave in certain situations. Using an iPhone, photos of the child demonstrating the correct behavior can be sequenced into stories that use text, photos, and recorded sounds. This app has been used to model how to behave at the dinner table, or it could be used to set up sequential tasks in a narrative format. I haven't had a chance to use either of these apps, but they both provide context and motivation, which are critical for success. 

We've covered a few augmentative and alternative communication (AAC) apps, which allow non-communicative children to make their intentions known. Proloquo2Go (US$189.99) is the most extensive of these apps. It's enhanced for the iPad, and it allows the building of phrases through the use of customizable buttons. As is the case with other AAC apps, the price is absurdly low when compared to the non iPad/iPhone competition of standalone devices that can cost anywhere from $3,000-$8,000. A much simpler (and cheaper) app is the AutoVerbal Talking Soundboard(US$8.99). This iPad-enhanced app allows for the customization of one row of buttons. You can choose from hundreds of preset buttons that speak one phrase when touched. Another limited feature app is iConverse (US$9.99), and it's not iPad enhanced. This is geared for low functioning autistic children, and it allows them to use six buttons to display common needs, including bathroom, eat, drink, sick, break, and help. The current version allows voice recording to customize the six graphics. 

These examples are harbingers of more and better apps to come. Compared to something like games, the market is quite small, and the research that drives such apps is slow to filter down to a product development stage. Given that, I would expect to see a slow but constant trickle ofAssistive Technology apps being released. 

Matthew Goodwin, Director of Clinical Research at the MIT Media Lab, is planning to launch a major project that studies what "sexy" technologies (like the iPad) can do for the autistic. He doesn't see the iPad as the perfect device, but he says that "it is currently a very appealing system given its size, rich screen display and processing power." Goodwin believes that the technology can potentially make the lives of the autistic easier. However, if they're successful, they may be able to do something that's just as important: demonstrate to society the hidden potential in children with autism.

via www.tuaw.com

What to Do if You Suspect a Learning Disability: A Critique

Paul Coyne PhD

The New York Times published an article, “What to Do if You Suspect Learning Disability by Lesley Alderman on February 19 2010.  The article provided advice about what to do if a parent suspects his or her child has a learning disability.  She describes how a parent might obtain services for their child with special needs through the local school district.  Ms. Alderman provided some good advice and some incorrect advice.  Since the issues raised are common among parents who have children with autism, I thought I’d comment on her article here. 

Ms. Alderman writes:

    “The first sign may be that your bright child is having trouble reading or organizing school assignments, or concentrating on homework.  Your child may be frustrated with school, and you may find yourself frustrated with what looks like a lack of effort.  And a teacher may also notice that something is amiss.” 

The description suggests that the child does not have the prerequisite skills to complete the academic assignments.  His or her language skills, reading skills or arithmetic skills may be below grade level.  The teaching techniques, the curriculum, the motivational system used, or a combination of all three were not effective teaching the child the skills s/he needs to be successful. 

Ms. Alderman suggests ‘your best recourse is to have the child tested’.  I agree.  An essential key to learning is to assess the child’s skills and place the child in the appropriate place in the curriculum.  However, be careful of labels. If a child is in fourth grade, but his reading level is at the second grade level, labeling the child, that is, identifying the child as having a learning disability does not explain why the child is two grade levels behind. A diagnostic label is not an explanation. As mentioned above, it could be the teaching techniques, the curriculum, some aspect of the environment that is responsible for his rate of learning, not necessarily a neurological problem. 

Nevertheless, an educational assessment and/or a behavioral assessment of your child’s performance at school is recommended.  Ms. Alderman points out that you may request a free assessment from your local school district. The results of the assessment will be discussed at an Individual Educational Program (IEP) meeting. The district will discuss if your child is eligible for special education services.  If your child was determined to be eligible previously, the IEP team will suggest relevant goals and objectives and discuss services your child may require to make progress towards the goals and objectives.   If you are dissatisfied with that assessment you may ask for a second opinion.  The district may offer another professional to provide the second opinion.  However, you may have an independent professional do an assessment.  

Once the independent assessment is completed request a new IEP by writing to the Director of Special Education.  You do not have to wait for your child’s annual review.  You can request an IEP anytime.  Ask the independent examiner (e.g., Behavior Analyst, Psychologist, Speech & Language Pathologist) to come to the IEP meeting to discuss his or her results and to suggest goals and objectives for the IEP.  The assessor may also recommend an intervention program.  S/he may recommend specific changes in the curriculum, or may recommend using particular reinforcers to improve motivation or recommend remedial instruction from a specially trained teacher.   

If goals and objectives to the IEP are added as a result of the independent assessment you can submit the cost of the assessment to the school district for reimbursement. If the school district denies your request, appeal the decision.  If the school district does not agree to the goals and objectives or to the services recommended by the independent examiner, do not request a hearing with the board of education as Ms. Alderman suggests. Instead, file for due process by writing to the Director of Special Education. Try to resolve your disagreement by scheduling a mediation conference.  You may not obtain all the services requested.  However, you may be able to work out an acceptable compromise. If not you can take your case to a fair hearing (sometimes called a due process hearing) where your case will be heard by a judge.  Whether you participate in a mediation conference or in a due process hearing it is wise to bring an attorney or someone knowledgeable about the special education code to represent you. 

How to use a variety of point or token systems.

Download how_to_design_a_point_system_revised.doc

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How To Design A Point System

Paul Coyne Ph.D.

Reinforcement systems can be simple or complex. A simple system is better than a complex one. However, some simple systems are just not effective enough to maintain behavior over time. So, something in between may work best. We will start with a simple type and add elements to make them more effective. Use the simplest system that works.

Simple Designs
1. One simple design: the child follows your instruction. you praise him and provide a pick from the prize basket. The next step is to give him a pick not every time he complies but every 3rd or 4th or 5th time he complies. Vary the schedule for best results.

2. A more formal design is the 5 penny system. On a board draw 5 small circles. Put a piece of Velcro inside each of the circles. Put a corresponding piece of Velcro on each of 5 pennies. When the child complies to an instruction give the child a penny. Have him put the penny in the circle. When all the circles are filled he receives the reinforcer. Sometimes people put a picture of the reinforcer on the 5 penny board so he can see what he is working for. Sometimes that is not a good idea, because somewhere along the line he changes his mind and doesn’t want that reinforcer anymore. So, it may be best to have another board with pictures of several reinforcers. After he earns 5 pennies then he takes a pick from the reinforcer board. A variation of this program is to draw a castle with 5 steps. Have the child place a mark in each step that leads to the castle after some good behavior. When he reaches the castle have him pick from the picture board or the grab bag, or the prize box and so on. Some people use stickers instead of pennies.

3. Another simple design is the numbered dot to dot drawing. Pick a drawing that has about 15 or 10 numbers. You can increase or decrease the amount of numbers depending upon your child. Put a star on every 5th number. Post the drawing on the wall. When the child follows an instruction have him drawn a line from #1 to #2. The next time he follows and instruction have him draw a line from #2 to #3, and so on. When he reaches a star, give him a pick from the picture board. Remember to vary the pictures on the reinforcer picture board so there is always something on the board he will find reinforcing. When he finishes the picture give him a pick plus an extra reinforcer for completing the picture. Notice that in this program the reinforcers build up over time. Drawing the line is reinforcing, plus there is praise. Then he hits a star and gets a reinforcer. As more lines are drawn the picture appears, and at the end he gets an extra reinforcer. Point systems that build up reinforcers over time are effective.

4. Another simple design is the picture puzzle. A favorite photo is cut into X [5?] number of pieces. Each time the does the target behavior (follows your instruction, eats his spinach, plays cooperatively with his sister) he receives a piece of the photo puzzle. The piece is placed on the refrigerator door. When all the pieces are put together and the complete picture is revealed, the child receives his tangible reinforcer. Then a new picture is started. This is one of the most effective token systems. Do not confuse this with the picture schedule described below.

5. The next step in point system design expands this notion of building up reinforcers the longer the child behaves well. Let’s say you have five things you want your child to do each day. Make a list, either a picture schedule or a written list. Let’s take the picture schedule. Each time he does something on the list, he takes the picture off the schedule and gives the picture to you. You then give him a pick from the prize basked or reinforcer menu board. When the 5th picture from the picture schedule is taken off and given to you, he receives a pick from the prize basket and a star for his star chart because he completed all the tasks for the day. When he earns 5 stars, you give him an extra special reinforcer. Adding the star chart will make the whole system more effective. Please note that there is no requirement that the reinforcement ratio be 5. It could be 3 or 8 or 10. Pick the ratio that works with your child. You can start off with a low ratio (3) and work up to a higher ratio (8). Increase the ratio as your child becomes more skilled.

If you wanted to add this component to the picture puzzle system, then give the child a star for his star chart after each photo is completed or simply say that when five completed pictures are on the refrigerator he gets an extra prize. Then take off the pictures and start again.

6. With older children it is best to have a list of behaviors that you want your child to do each day of the week. Determine how much money you want to spend on this program each week. Let’s say it is $7.00. Then you have 700 points to distribute over the week, 100 points each day. If you have 10 tasks for your child to complete then each task could be worth 10 points. Or you could make the less preferred tasks be worth more points than the easy tasks, just so the total still equals 100 maximum points a day. In this system it is always good to have a bonus point category, just in case your child does something good that is not on the list. Then you can give him bonus points. Pick a day of the week when he can trade in his points for money and provide an opportunity for him to make purchases at a favorite store. Once points are earned do not take them away. If your child misbehaves do not give him points, do not take points away. Consequences for misbehavior should be independent of the point system. Once a reinforcer is given do not take it away. [An excellent example of a consequence for misbehavior is the 5 minute work detail, e.g., take out the trash, walk the dog, clean up the dog poop, empty the dishwasher, and so on. When your child misbehaves assign an unpleasant task that takes 5 minutes to complete. ]

7. Sometimes it is effective to give yourself a quota of points you will give your child each day. Remember you are trying to teach your child new skills. You are using these “points” to shape and reinforce behavior. If you wait for him to “earn” the points, you may wait a long time. It is better to say to yourself, I am going to find 10 things each day my child does appropriately and give him “points” for it. It is your job to find examples of good behavior and reinforce them when they occur, especially when your child misbehaves often. Don’t think, “because my child misbehaved X amount today he doesn’t deserve any points.” Don’t wait for him to deserve or earn the reinforcers. Be proactive. Catch him when he is good.

8. Response Cost. Parents often ask whether it is effective to take away points when the child misbehaves. Taking away points contingent upon misbehavior is called “Response Cost”. It is a punishment procedure. There is evidence published in psychology journals that indicate Response Cost procedures can be effective. The risk is if you have a child that frequently misbehaves. If you take away points frequently, the child will rarely come in contact with the reinforcers. It is reinforcement that results in better behavior, not punishment. So, if you have high rates of punishment (you frequently take away points) the aversiveness of the procedure may result in more misbehavior. On the other hand, if your child earns points frequently and only loses a few points here and there, then the combination of earning points and response cost will be more effective than either procedure used alone. One way to mitigate the problems of Response Cost is to have two separate point systems. The regular point system where your child earns points – once earned never taken away. Then have another posted reinforcer for example, TV time. Draw 5 TVs on a piece of paper and tape it to the refrigerator. Each time your child misbehaves mark off (or better yet, have him mark off) one of the TVs. He loses 15 minutes of TV time. If all the TVs are marked off, he loses TV for the day. The next day the paper with the 5 TVs are posted back on the refrigerator – the Response Cost procedure begins again. As you can imagine, there are many variations on this theme.