Our Cases

Skill Acquisition

Karen, a five year old girl, was referred to ABA Psychological Services to devise and implement a program that would increase her skills and decrease her challenging behavior. Karen had been receiving in-home ABA services for the past year by a paraprofessional under the supervision of a Board Certified Behavior Analyst (BCBA).

The Assessment

Using the Verbal Behavior Milestones and Placement Program (VB-MAPP), an initial assessment was administered to identify and evaluate Karen’s strengths and weaknesses in language, learning, and social skills. The VB-MAPP also identified various factors and maladaptive behaviors that would interfere with the acquisition of language and other functional skills. Based upon the results, various goals and programs were established to teach Karen new skills and decrease her challenging behavior using ABA therapy.

Goals and Solutions

Several of Karen’s goals as well as her progress toward reaching those goals, are stated below:

Decreasing Tantrums:
Karen would engage in tantrums in which she would cry, scream, throw herself on the floor, and hit herself if she could not find a missing piece of a toy (e.g., puzzle piece, or missing piece to Mr. Potato Head), dropped something, and/or if she was not given a preferred item. After collecting baseline data, a program was implemented to teach Karen the language skills necessary to request preferred items or missing pieces. This goal was accomplished systematically and explicitly by creating various situations in which Karen was presented with an item that had at least one missing component, or was not able to access a preferred item. A verbal prompt of “Where’s the (item)?” or “May I have the (item)?” would be provided. Karen received the item immediately once she correctly repeated the phrase. As Karen progressed, the prompts were systematically faded, resulting in Karen independently requesting missing pieces and access to preferred items. Karen has successfully generalized this skill and no longer engages in tantrums.

Independent Play:
Upon the initial evaluation, Karen would play with a few toys, but would not sustain play with these toys for more than 3 minutes at a time and would frequently play with the toys in a repetitive manner (e.g., lining the toys up). Therefore, one of the goals of ABA therapy was to teach Karen to independently play with toys for a longer period of time. In order to accomplish this goal, an activity schedule consisting of four pictures depicting different activities was created, and Karen was systematically taught how to use this schedule. The schedule required Karen to follow a list to complete four different activities and then tell the person administering the schedule, “I’m done,” upon completion. The steps were as follows: get a toy, independently play with the toy correctly, put the toy away, look at the schedule and get the next toy to play with, and tell the instructor, “I’m done.” This goal was achieved through the use of prompts and fading those prompts as Karen successfully completed each procedural step. Currently, she is able to play independently and appropriately with toys for 20 to 30 minutes at a time.

Spontaneously Labeling Objects and Sounds:
Prior to starting ABA therapy, Karen would not make comments or label things within her environment. A program was established to teach Karen to comment on novel objects, pictures, and sounds within the environment. Karen has accomplished this goal, and is able to say, “I hear a ______ (e.g., dog, cat)” when she hears a novel sound. In addition, Karen is also able to label novel objects or pictures around the house, saying, “I see a _____ (e.g., ball, piano).”

Responding to Questions About Objects:
Karen was able to answer questions such as, “what is it?," “what color?,” “what number?,” or “what letter?,” when presented with an object or picture with one characteristic (e.g., a color card or a number). However, we noticed that she experienced difficulty with answering questions when the object being presented had two characteristics, such as a purple ball or a red letter T. For example, if the instructor would ask, “what is it?” Karen would respond correctly with “ball;” however, if she were then asked, “what color?” Karen would respond incorrectly by saying, “ball.” Additionally, if she was presented with a blue letter R and asked, “What color?” Karen would respond by saying, “R.” She was not accustomed to being asked multiple questions regarding a particular object. Therefore, a program was created to teach Karen how to discriminate the questions. Although Karen exhibited some frustration in the beginning, she is now able to respond correctly to multiple questions regarding a particular object or item.

Engaging in Appropriate Play with Siblings:
Karen rarely engaged in appropriate play with her brother prior to receiving ABA services. She would never initiate play and would often hit him or scream when he attempted to play with her. After several months of ABA therapy, in which she was taught how to play constructively, Karen is able to not only initiate play with her brother, but also requests it several times throughout the day, providing her with much enjoyment.

The goals stated above reflect a few of the many programs currently in progress for Karen. She is a fast and determined learner who has acquired various skills in a short period of time through ABA therapy. Due to her success in acquiring more advanced language skills, Karen is able to communicate and interact with members of her family. In addition, she is not only capable, but enjoys playing independently and with her family members for a sustained period of time. Karen’s parents and teachers have indicated that she is more likely to verbalize her needs than engage in tantrums as noted in the past.

Challenging Behavior

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Alexandra, a young woman diagnosed with autism, was referred to ABA Psychological Services for the assessment and treatment of challenging behavior. Her behavior consisted of vocal perseverations (e.g., repeating statements made to her, or repeating phrases several times) and motor tics (short-lasting sudden repetitive movements). Some motor tics consisted of nodding her head repeatedly, while others consist of violently moving her entire body repeatedly. Before treatment was introduced, Alexandra would engage in vocal perseverations between 3 to 10 times per minute. When she engaged in vocal perseverations, she would continue to repeat the same statement or question until she received the response that she wanted from a family member. Additionally, before treatment was introduced, she would engage in motor tics that lasted several seconds to several minutes. These occurred approximately one time every minute to one time every ten minutes, depending on the day. Both of these behaviors persisted throughout the day. These behaviors significantly interfered with her ability to function at home, school, and in the community. In fact, she had stopped engaging in many extracurricular activities outside of school because of the severity of the behavior.

ABA Program Goals and Solutions
A procedure called Differential Reinforcement of Other Behavior (DRO) was used to decrease vocal perseverations and motor tics. Alexandra was taught to set a vibrating, resetting timer for a pre-specified interval. If she did not engage in motor tics or vocal perseverations during the interval, she would give herself a token. Once she received five tokens, she would receive access to a preferred item. If she did engage in behavior, she would stop the timer, reset it, and restart it. Alexandra was able to learn to start and reset her timer when needed, give herself a token, and get her own reinforcement.

Before treatment was introduced, Alexandra engaged in vocal perseverations between 3 to 10 times per minute. However, after four weeks of treatment, when the procedure was used, she typically did not engage in vocal perseverations, and when she did, it was usually less than three times in one hour. Before treatment was introduced, Alexandra engaged in motor tics approximately 1 time every 1 to 10 minutes. Once treatment was introduced, motor tics decreased dramatically. Currently, when the treatment is used, she rarely engages in motor tics, and when tics occur, it is usually less than one in an hour. Therefore, there was a dramatic reduction in motor tics and vocal stereotypy when treatment was implemented. In addition, Alexandra has demonstrated a decrease in motor tics and vocal perseverations when the treatment was not used. During the last six sessions, when the treatment was not being used, Alexandra did not engage in any vocal perseverations or motor tics for four of the six sessions. Alexandra’s parents have indicated that she is engaging in motor tics and vocal stereotypy much less frequently than prior to starting the treatment plan, even when the treatment plan is not in place. Overall, Alexandra is doing well and is able to resume the activities that she was engaged in prior to the increase in motor tics and perseverations.