by: Kerry Peterson, MA, CCC-SLP, BCBA
Speech pathologists, occupational therapists and physical therapists often work together when treating children with autism spectrum disorders and other developmental delays.  As a speech therapist treating young children age birth to six, I often worked with an occupational or physical therapist in a co-treatment model.  We were able to target sensory processing, communication, and fine and gross motor skills through shared activities. We shared a basic understanding of each other’s area of expertise and we valued each other’s input.
It is less common to find a behavior analyst (BCBA) working directly and collaboratively with speech pathologists, occupational therapists and physical therapists toward unified goals.  However, there are many ways in which a behavior analyst can help all therapists get better outcomes from children during treatment sessions.  Understanding and using the principles of applied behavior analysis (ABA) can improve the effectiveness of other treatment methods and reduce interfering behaviors that often slow a child’s progress.  The effectiveness of my own treatment sessions as a speech therapist improved significantly when I gained an understanding of the basic principles of effective teaching, which are rooted in ABA.  I found myself responding to challenging behaviors far more confidently and implementing strategies to reduce the likelihood that those behaviors occurred at all.
Understanding and implementing effective teaching procedures can help a clinician structure sessions to get the best outcomes.  The following scenarios may indicate that important aspects of effective teaching may be lacking or missing in a treatment setting:

• Child does not want to come for therapy and cries on arrival
• Challenging behavior during treatment tasks
• Child seems to gain a skill but cannot demonstrate it the next week
• Lack of fluency and poor generalization of skills when out of the therapy setting

Effective Teaching Procedures:
In ABA we refer to establishing a willing and cooperative learner. For any therapy to be effective and result in measurable gains, we must have a child who is cooperative and responsive to their therapist. The following is a basic overview of several principles of ABA with regard to effective teaching and learning.  When used consistently, these principles can result in highly effective teaching and learning.

1. Pairing the environment with reinforcement:  Before placing any demands on a child it is important to spend time pairing the environment and the teacher/therapist with preferred activities and items.  By doing so, the environment and the therapist take on reinforcing properties of the child’s favorite toys, things, activities, etc.   Too often, we forget to take time to “pair” with a child or we feel a sense of urgency to show what we can get a child to do.   Pairing is a first, critical step in any relationship where we will be placing demands on a child to perform tasks that might be difficult for them.
2. Errorless teaching/learning:  Errorless teaching refers to the procedure of not allowing a child to make frequent mistakes during the learning process.  It is more effective to use prompts that will evoke a correct response and then systematically fade those prompts so the child gains practice being correct.  Nothing is more frustrating than being unsuccessful. The less a learner is wrong the more motivated they will remain and the less likely they are to engage in challenging behaviors to try to avoid the tasks. Determine what prompts a child needs to be successful, provide those prompts and then fade those prompts over time. Do not “explain” why one answer is incorrect (“no, a giraffe has spots, just like some dogs have spots and you have spots on your shirt, but a zebra has stripes.”)
3. Reinforcement – start steady and  keep it variable:  Be sure your tasks include opportunities for tangible reinforcement in the form of preferred items or activities.  By definition, reinforcement means that the presence of something increases the likelihood of a behavior that preceded it.  If you blow bubbles for a child to pop after they do a great job stringing a bead and they subsequently string more beads, you can say blowing bubbles had a reinforcing effect on bead stringing.   Take the time to do a preference assessment (systematic analysis of what a child prefers most) and be sure to have many of those items available to the child when they provide a good response.  Do not allow the child to have access to those items freely but rather keep them visible so they know they are available.  Each child is different and will need to be reinforced on a different schedule.  In general, skills that are being newly taught need to be frequently reinforced initially and as soon as skills are established reinforcement should be delivered intermittently and on a variable schedule.  The child should not know exactly when you are going to provide reinforcement.  Slot machines are a great example of variable reinforcement.   People sit for hours responding because they have no idea when the payoff will come!
4. Interspersing easy and hard  tasks:  Momentum is important in teaching. Therefore, beginning with easy tasks where a child is successful without prompts is a great way to begin a teaching or therapy session.  Eventually fade in harder tasks, being sure to keep mixing easy tasks throughout the session, so you are able to provide frequent verbal praise and reinforcement.
5. Short intervals between trials/teach to fluency:  As therapists we don’t often refer to our activities in therapy as “trials.”  The idea here is to keep the pace fast to keep the child responding.  As a general rule, present the direction or task, such as, “Point to the shoe,” or “Make a T,” count to two or three and then provide some level of prompt.  Do not let several seconds go by waiting for the child to respond and never repeat the direction many times.  In doing so, you risk teaching the child to ignore directions the first time and to be slow and imprecise in their responding.  We want children to develop skills that are fast and fluent so they can be generalized easily when they leave the therapy setting.
6. Reinforce quickly. Be sure the reinforcement matches the response:  In order to be tied to a certain response, reinforcement needs to be provided immediately!  Do not wait until the end of the session to reinforce a young child for performing a task  ten minutes earlier.  Be sure really great responses (e.g., stringing beads for the first time independently) gets better reinforcement than a task that has been done many times before.
7. Use extinction for problem behavior if needed:  If the child engages in off-task responses to avoid tasks, be sure to keep the task demands at the same level of difficulty until you get them responding.  Give consideration to the overall expectations and be sure all other effective teaching procedures are being used (are tasks too difficult, is reinforcement available, are you prompting to help child be successful? etc.).
8. Use clear prompts:  Be sure the prompt you provide increases the likelihood the child will get an item correct or perform a task successfully.  Avoid vague  prompts such as waving your finger across a bunch of items for the child to scan or saying “look at all the pictures.”  Instead, provide a clear prompt or even a full prompt and then fade that prompt systematically and quickly.

To learn more about effective teaching procedures contact a board certified behavior analyst in your area.  You can find a BCBA by visiting
www.bacb.com.  The following resources are also available for related professionals:
A Work in Progress: Behavior Management Strategies and A Curriculum for Intensive Behavioral Treatment of Autism edited by Drs. Ron Leaf and John McEachin.
Understanding Applied Behavior Analysis: An Introduction to ABA for Parents, Teachers, and Other Professionals. Psychologist Albert Kearney explains ABA to teachers and parents alike using everyday language and examples.
Teaching Language to Children with Autism or Other Developmental Disabilities by behavior analysts Mark L. Sundberg Ph.D. and James W. Partington Ph.D.
Featured PediaStaff Columnist:  Kerry Peterson, MA, CCC-SLP, BCBA
Kerry Peterson, MA, CCC-SLP, BCBA, is the director of TrainIn, the applied verbal behavior program at the Kaufman Children’s Center for Speech, Language, Sensory-Motor & Social Connections, Inc.. She came to the KCC from Ann Arbor Public Schools and has also worked with children at Dexter Community Schools. Kerry earned her bachelor’s degree in psychology and speech and hearing from the University of Michigan and her master’s in speech-language pathology from Michigan State. Kerry is also a board certified behavior analyst. Kerry and her husband Rich have two children. She enjoys gardening, reading and watching movies.