CT FEAT: Families Helping Children Achieve Their Full Potential
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GOOD SCHOOL-BASED ABA PROGRAMS: What Every Child with Autism Deserves
By Sue Frost

Typically-developing children spend virtually every waking hour, including weekends and holidays, learning from their environment; they remain engaged with their surroundings in a way that children with autism cannot. Therefore, a good ABA program tries to keep children with autism learning during most of their waking hours.

It is critical that teaching be carried out everywhere: at home, at school, for as many hours a day as possible. Everybody has to teach, and everybody has to teach in a consistent manner, at least in the beginning.

Parents are therefore a critical component in their children’s educational programs. They teach their children how to use new skills in everyday family life. They teach the children to interact with other people & in other places, such as stores & restaurants. They also continue the learning experiences during weekends and vacations. In the long run, it is informed and knowledgeable parents who are able to maintain and expand upon treatment gains as the children grow up.

Before the Child Turns 3 Years Old
The Individual Education Plan (IEP) team meets with the parents & the early intervention team. A board certified behavior analyst (BCBA) or board certified associate behavior analyst (BCABA) uses an assessment tool, such as the Verbal Behavior Milestones Assessment & Placement Program (VB-MAPP) or the Assessment of Basic Language & Learning Skills (ABLLS) to figure out the child’s current skill levels, and determines which skills to teach next.

These skills form the child’s initial IEP objectives. The BCBA and the teacher prepare appropriate curriculum & materials, and train any additional aides needed, so that everything is ready the day the child turns 3.

If school space and aides are available on the first day of school, and the child will turn 3 during the coming school year, the child may begin the school-based ABA program before the age of 3. The school may be able to make an arrangement with the early intervention team. Federal law does not require schools to begin intervention until the child turns 3. However, children who start ABA treatment at younger ages are more likely to be in regular education classes by the time they finish preschool.

What skills the child works on during each year of school depends on what the child already knows, and how quickly the school can teach the child new skills. Every child also learns at a different pace. However, a general guideline follows.

When the Child is 3 (Year One of School)
Create an environment that is as close to a normal environment as possible, but that works for the child. Provide 1:1 intervention for the first 6-12 months.

During the first few weeks of treatment, have the child spend about half the time working with the teacher or aides, and half the time engaging in free time activities with the adults, alternating every few minutes. After several weeks, have the child spend about 75% of the time with the teacher & aides, and 25% of the time in free play.

During the first month, focus on establishing a positive relationship between the child and the teacher & aides. Identify reinforcers (rewards that the child likes), and provide them freely on a non-contingent basis. Gradually, begin discrete trials. Then steadily increase the discrete trial time, with a highly structured use of contingent reinforcers, until it is the primary method of therapy.

Begin with 20-25 hours/week. Gradually extend the hours so that, within a few weeks, the child is receiving 35-40 hours/week, for up to 241 school days per year. (If child is under age 3, continue the reduced hours and 50:50 ratio of work to play until the child turns 3.)

The teaching needs to be intensive. Present the children with 50-100 learning opportunities per hour, via discrete trial, incidental teaching, and other behavior analytic procedures.

After each hour of treatment, give the child a longer break of 5-10 minutes outside the room, to play with an aide in other rooms, the playground, or to take a walk.

Encourage the parents to teach, in a more informal way, the child to use the skills learned during the 1:1 time to other environments, throughout the student’s remaining waking hours.

The curriculum the first year focuses on: building compliance (sitting still & paying attention to the teacher), remaining on-task, understanding cause & effect, learning imitation, learning appropriate play skills, reducing self stimulatory and aggressive behaviors, & promoting generalization of all these skills to other environments outside the classroom.

If the child needs ancillary services, such as speech, the school Speech & Language Pathologist (SLP) can be a part of the child’s team and ABA program—working directly with the child in the classroom, and showing the teacher & aides how to continue the intervention during their shifts.
When the Child is 4 (Year Two of School)
Teach as many socially appropriate behaviors as possible. The curriculum focus is on: expressive language & communication skills, early abstract language, self-help skills, social skills, & interactive play with peers.

Gradually, as the child is ready, he or she should spend more time with typical children in natural settings. The child should have pretty good language and communication skills, be able to sit in a chair or in a circle when an adult says to, and have gotten over any tantrums.

Begin first by having the child play with just one typical child at a time for one hour. Rotate the peers, so that the child learns to play with several different children. Aim to be spending at least 6 hours a week in supervised peer play by the time the child is age 4½. When those interactions are going smoothly, introduce play with a 2-3 typical children at a time. Then introduce the child to a preschool classroom.

Arrange for the child to attend the preschool classroom for just a short period of time, so that the child is successful there: 30 minutes in the morning for 1-2 days/week.

A “shadow” (a highly trained aide) initially accompanies the child to preschool, to prompt the child pay attention to the teacher’s instructions and join other children on the playground. The shadow also notes any social errors to be addressed later during the 1:1 sessions.

Gradually extend the time in preschool classroom, usually up to just 1-2 half-days (2.5 hours each) per week. And gradually fade the shadow’s prompts.

Encourage the parents to invite a typical preschool friend (& the child’s mother, if she wants) to come over to the house to play 2-3 afternoons a week.

If the preschool teacher & peers are able to take over shadow’s functions, then child is on his or her way!

When the Child is 5 (Year Three of School)
Spend as much time with typical peers as possible, using the remaining 1:1 time to continue remedying language deficits.

The curriculum focus now is on: subtle social skills, higher level play skills, advanced cognitive and communication skills, appropriate and varied expressions of emotions, pre-academic tasks (the Three Rs), observational learning, & integration of skills to everyday environments (including typical school classrooms).

Encourage the parents to continue holding lots of play dates after school. Also, if the child is ready to benefit from being around larger groups of typical children, look for after-school programs or activities to enroll the child in.

When the Child is 6 and Older
The team of a BCBA, BCABA, aides, classroom teacher, and parents continue to meet for an hour every month, providing whatever level of support the child still needs. If a resource room teacher also works with the child, he or she also attends. Transitions to new classrooms or schools are carefully planned by working closely with the receiving teacher & ensuring that the child has the necessary skills to succeed in the new setting.

At this age, some children may be completely mainstreamed; some may be mainstreamed with an aide, some may be mainstreamed with an aide but need pull-out tutoring in a resource room, some may do most of their learning in a resource room but join their peers for certain subjects & activities.

Older childen usually work in small groups, and focus on learning different skills than younger children do.

Progress Reviews
Progress reviews for each child are held for 1 hour every week for the first 6 months, then for 1 hour every other week for the next 6 months, then for 1 hour every month during the following years.

These reviews are attended by the team assigned to the child: the BCBA, the teacher, the aides, the parents, and the child. The teacher, aides, & parents take turns working with the child. The BCBA observes the child’s performance, demonstrates techniques with the child, and recommends appropriate changes in the child’s program.

Board-Certified Behavior Analyst (BCBA)
One full-time BCBA is assigned for every 14 students with autism under the age of 8. BCBAs overseeing the programs of children age 8 and older may have higher case loads, depending on the level of support the children need.

BCBAs must have at least a master’s degree, and have completed 5 courses in Applied Behavior Analysis (ABA), have many hours of supervised practice, and passed a national examination from the Behavior Analyst Certification Board (BACB).

In addition, those BCBAs supervising school-based ABA programs must have worked directly with many children with autism in ABA programs and trained new aides for 1500 hours, all under the direct supervision of another BCBA. They must have a sophisticated understanding of the procedures used to decrease disruptive behavior, a detailed understanding of autism, and a well-developed teaching curriculum. They must have mastered teaching advanced programs such as verbal imitation, conversational speech, time concepts, and interactive play.

BCBAs need to maintain their certification through the BACB, and stay in touch with other colleagues, who can help them brainstorm about how to handle unusual situations that may occur.

The BCBAs teach basic behavior analytic strategies to the parents, teachers & aides. They demonstrate how to work with each child, and how to take direct, observational data on the child’s progress. The BCBAs review this data several times per week and make modifications as necessary, such as reinforcers, instructions, prompts, & pacing of instruction.

The BCBAs are available to answer parents’ questions about their child’s program. During the first three years, they provide at least weekly reports on the child’s progress on each skill being taught. They encourage the parents to come into the school and observe the teacher and aides working with their children.

They also visit the parents & the child at home as needed to help with sleep issues, toileting, and behavior problems.

Teacher (BCABA)
Each teacher is responsible for no more than 9 students with autism. Teachers work under the direct supervision of a BCBA.

The BCBA can spend less time training the teachers & oversee more children when the teachers are board-certified associate behavior analysts (BCABAs). BCABAs have at least a 4-year college degree. They have worked with children with autism for at least 1000 hours at a BACB-approved university experience program under the direct supervision of a BCBA.

The teacher spends at least 4 hours each week on each child under the age of 8, providing case management, supervision of the aides, parent training, and working directly with the child. Under the BCBA’s supervision, the teacher does assessments, selects & organizes curriculum, collects needed materials, helps train the aides, and makes data-based decisions about when to move the child onto the next step.

Aides work under the direct supervision of the teacher. More experienced aides may assist the teacher with the case management of up to 4 students.

Each classroom has enough aides so that, including the teacher, the adult-to-child ratio is 1:1. These aides rotate, so that each child works with at least 2 different aides each day, and with a total of at least 5 different aides & one teacher each week.

The aides are at least 18 years old and have completed a minimum of 1 year of college. They have received 30 hours of initial training from the BCBA and the teacher, including a minimum of 10 hours of 1:1 training and feedback while working with one child. They also receive ongoing training and supervision from the BCBA.

During their first 3 months on the job, aides assist another aide who has already been trained. They do not work 1:1 with a child until they have completed their training under the BCBA.

Only the most highly trained and skilled aides accompany children as “shadows” into settings with typical children. They have strong social skills themselves. They know when to fade themselves into the background, and when to intervene. They are also able to take data without the typical children noticing.

It is much more demanding to work as an ABA aide than as a regular paraprofessional. Many school districts have found that they can retain their ABA aides by providing a separate pay track for them, so that they are paid at a higher rate.

Preschool teachers and Kindergarten Teachers
The preschool teachers have classrooms of typical 3 and 4-year-olds, up to a total of 10 students per classroom. The typical children have been screened and accepted into the program only if they have strong social skills and can act as peer models. They may be charged tuition to attend.

The preschool and kindergarten teachers work closely with the BCBA and other team members, to make sure that each child’s IEP objectives for that setting are being addressed.

The teachers who have children with autism in their classrooms should want to challenge all their students to learn new things. They should also want to talk to parents and encourage them to visit the classroom.

The teachers should prefer structure. Children with autism don’t use their free time as well as others, so they need a clear definition of what is expected of them.

Ideally, there should be no more than one student with autism in each classroom at a time. This eliminates the potential for the child to pick up inappropriate behaviors that he or she might observe from other children who also have autism.

Developmentally disabled children, placed among other children with the same or worse status, tend to imitate or model their peculiar and bizarre behaviors. A child with autism, who has learned some basic social skills and been placed among more normal children, will improve simply because there are more opportunities to imitate more appropriate behavior.

It’s important, therefore, to place the child in a class with typical children who are functioning at a similar level. Younger typical children are more likely to play with the child, and thereby encourage the child to interact appropriately because their mental ages are about the same.

The idea is to hook up the child with autism with other children early on, so that the other children provide treatment. The adults can then “fade out” as the peers “fade in.”

Resource Room Teacher (for children age 6 and up)
The resource room teacher who works with children with autism is supervised by the BCBA. The BCBA will have to spend less time training the resource room teacher if he or she is a BCABA. The resource room teacher provides direct instruction to the children, and provides instructions and the materials for the
resource room aides to use with the children. The teacher & aides keep accurate data to track the students’ progress and to determine when to move on to the next level.

Setting up and running a school-based ABA program is demanding. It requires energetic and involved parents, supportive administrators, and highly qualified staff who are dedicated to improving the futures of children with autism. This team effort may also be the most rewarding work they ever do.

Copyright © 2007 CT FEAT, Inc. Connecticut Families for Effective Autism Treatment

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