Common Problems in Teaching

Common Problems in Teaching

One is likely to encounter numerous problems when delivering the kind of intervention detailed in this manual because of both the large number of programs involved in comprehensive intervention and the large individual variability among students in their responses to programs as a whole as well as aspects within particular programs. For example, a student may encounter serious difficulties acquiring receptive language but may proceed rather quickly in acquiring expressive language. At the present time, we have no way of predicting such an occurrence. There is also the question of defining what is meant by 'serious difficulties' in learning the skills involved in a particular program or aspect of a program and whether such difficulties are caused by the teacher's mistakes in administrating the treatment or whether they represent unique and idiosyncratic variations of a particular student's nervous system. It would be much less difficult to administer a treatment that was monolithic, as in remedying what some would guess to be a pivotal problem in autism. Unfortunately, no one has been able to identify such a problem, leaving little choice except to address the large range of behavioural excesses and delays shown by individuals with autism and other developmental delays.

Another problem one must face when providing behavioural intervention concerns untrained or poorly trained team members. One must continuously train new persons given that most persons eventually leave one's treatment team, and it is impossible for any one teacher or parent to implement 40 hours of effective one-on-one treatment every week. Seeking adequately trained team members is perhaps the most important factor in facilitating the student's treatment, because persons with good training are able to train others and help identify mistakes early, before treatment mistakes pose significant problems for the student. One may hear of a person who has read a teaching manual, attended one or two workshops on behavioural intervention, gained some background in behavioural literature, and then set out to establish a service that superficially seems to have all the features of integrity, claiming a title of senior aide, case supervisor, and the like. As described in Chapters 3 and 34, there are no data to support that such a person can provide effective treatment.

Identifying and Preventing Common Problems

Because of the likelihood of encountering a variety of difficulties when administering the programs presented in this manual, lists of common problems in a variety of general areas essential to providing effective behavioural treatment are given in this chapter. When problems arise, the teacher may refer to these lists in an attempt to help identify possible teaching mistakes. The areas to monitor closely include (a) how to use instructions, (b) what behaviours to reinforce, (c) how to select and deliver rein-forcers, (d) how to prompt, (e) how to pace trials, (f) how to weaken interfering behaviours, and (g) where and when to teach. The lists are followed by examples of various specific problems one may encounter and how these problems may be overcome.

Instructions

1. Avoid talking casually to an individual with developmental delays as if she understands what is being said to her. Perhaps some teachers do this because they draw upon experiences with typical individuals when approaching a student with developmental delays. If the student does not understand what is said to her, if language is experienced merely as noise, then over time the student will learn to adapt to or otherwise ignore the verbal message (e.g., act as if she is deaf). To facilitate the student's attention to instructions, the presentation of instructions must initially include only the most relevant information; instructions must be succinct and distinctive.

In short, do not be verbose when speaking to a student with developmental delays.

Present stimuli that are maximally different from each other in both auditory and visual modes. As the student progresses, the stimuli may be made gradually more and more similar, requiring finer and finer discriminations.

Once a student can respond correctly to instructions when they are presented alone, be sure to randomly rotate their presentation so as to ensure the student's attention to the instructions, avoiding the adoption of patterns of responding such as a win-stay and lose-shift strategy (see Chapter 16).

Make certain that the time elapsed between the instruction and the student's response is as short as possible (i.e., no longer than 3 seconds). If an instruction is given and the student waits for more than 3 seconds and then engages in the correct behaviour, it is likely that some other stimulus occurring during the time interval will acquire control over the student's behaviour. An exception to this rule is when the student develops echolalia speech and gives evidence of repeating the teacher's verbal instructions. The student's repetition of the instructions (rehearsing, storing, or remembering the instructions) may serve to bridge the interval between the teacher's instructions and the student's response.

Avoid taking time out between instructions to record the student's response (as correct, incorrect, or a non-response). Although spaced trials are important for maintaining treatment gains (see Chapter 31), spaced trials are not likely to provide optimal conditions for acquiring new behaviours. Short inter-trial intervals facilitate the student's attention to the task. Ask someone else to record the responses if you cannot recall what occurred in a sitting immediately after it ends.

Selecting Behaviours

A major consideration in selecting behaviours is picking those that lead to the student's success. Maximizing success and minimizing errors establishes a cooperative relationship between the teacher and the student and builds the student's trust and self-confidence. Given the difficulties that students with developmental delays have in understanding what well-meaning adults attempt to teach them, it is likely that the student will respond to teaching with tantrums over the first month of treatment and then periodically thereafter. Should the student show little reduction in tantrums over several weeks into treatment, examine the teaching situation to assess whether tantrums are inadvertently being reinforced. If they are not, consider the following alternatives.

For the time being, stop teaching a particular task that gives rise to serious tantrums. Introduce easier tasks, and then return to the more difficult task some weeks or months later.

Break down complex behaviours to make them easier for the student to acquire, reinforcing each component and later chaining them together (see Chapter 10).

Do not teach eye contact ('look at me') in the early stages of instruction because eye contact is such a subtle response that the student may not be able to associate it with the instruction and the reinforcer.

Minimize the length of time the student sits in the chair. It is better to have a student sit in the chair for 1 to 2 minutes in a one-on-one teaching situation and then have 1 minute off to play (before the student tantrums) than to have the student sit in the chair for 10 to 20 minutes while tantruming. While tantruming, the student is probably learning very little and the whole teaching situation is likely to acquire aversive properties. To help avoid this situation, short sittings should be performed at the beginning of treatment and gradually lengthened as the student acquires skills conducive to doing so.

Examine the teaching situation to ascertain whether two behaviours are accidentally being taught at the same time. For example, the teacher may present one SD such as 'Look at me' and almost immediately present another SD such as 'Point to the ball.' In such a situation, the student may not be able to discriminate what the teacher wants the student to do and may therefore not respond. It is also possible that the student's behaviour of looking at the teacher is punished in this situation because it is accompanied by a demand (i.e., being asked to point to the ball is the consequence for looking at the teacher). To solve this problem, the student should be reinforced for looking when the teacher requests this, and then be presented with the second SD, 'Point to the ball.' For most tasks, it is not even necessary that the student maintain eye contact with the teacher. Eye contact appears to spontaneously increase for most students as they make progress in treatment.

Do not assume that the student possesses prior knowledge about a particular task being taught. It is better to assume that the student does not possess such knowledge. Do not assume that a healthy and knowledgeable individual resides inside 'an autistic shell' waiting to be let out. The task of teaching-treatment is enormously more complex than that. If the student already knows part or the entire task, this will be evidenced by the speed with which the student acquires the new task.

7. Avoid overwhelming the student. Certain students move along very rapidly, learning difficult concepts such as colour, shape, size, and prepositions within the first 3 to 4 months of treatment. Such a student can be very reinforcing for the teacher who, because of the student's tremendous progress, continues to teach more and more difficult tasks at a rapid rate. To everyone's surprise, this student will most likely suddenly and unexpectedly aggress toward the teacher or withdraw into self-stimulation (e.g., gaze off into the distance). The student will likely become overwhelmed by too many demands and have no way of telling the teacher that the rate of introduction of new tasks is too rapid. If this occurs with your student, we recommend dropping most if not all demands for the next few days, replacing lessons with play, and then going back to the beginning, reinforcing the student (e.g., with food) for just coming to you and then leaving without having to work. Reintroduce teaching in a gradual manner. Re-establishing the teaching situation as one associated with success is likely to bring the student around. Do not be concerned that this type of break in treatment will interfere with the student's progress; a student who learns skills quickly will continue acquiring skills when treatment is done in an optimal manner, minimizing the need to be in a hurry.

Selecting Reinforcing Consequences

Teachers will not make any progress in teaching the student unless the teachers select the kinds of reinforcers the student will value and work for. We know now that teachers have available to them a much larger set of reinforcers than the relatively small group postulated some 20 to 30 years ago. We also know that individual differences in preferences for certain reinforcers are enormous. Perhaps novel and idiosyncratic reinforcers emerge in proportion to the individual differences detected among students. If difficulties arise in teaching, consider the following issues related to reinforcement.

1. Avoid relying on a limited set of reinforcers, such as food reinforcement or social reinforcement (e.g., saying, 'Good'). Although you may be limited to these types of reinforcers during the first hour or two of teaching when you are still exploring the uniqueness of the student, you should soon be able to identify a much larger range of reinforcers to maximize teaching effectiveness. It may become apparent that saying, 'Good,' does not even function as a reinforcer in the early stages of treatment considering that social reinforcement in general takes time to learn. A teacher who has access to 10 to 20 reinforcers is clearly much more likely to be effective than someone who has access to only one or two reinforcers. This idea relates closely to the next problem.

Avoid having the student become satiated on a particular reinforcer. Often a teacher presents the same consequence such as 'Good girl' over and over again. In the early stages of treatment, it is unlikely that the statement 'Good girl' has any reinforcing properties at all for most students with developmental delays. Even typical individuals satiate on a reinforcer if it is repeated too often.

One is also likely to promote satiation if food reinforcement is used when the student is given a meal 1 to 2 hours before the teaching session or a relatively large amount of food is given for each correct response. To help prevent satiation, give small bites of food when providing food reinforcement, provide small sips of liquid, and explore effective reinforcers by following the suggestions presented in Chapter 7. The discovery of new and varied reinforcers motivates the student and allows for a great deal more learning than that which results from limited and monotonous reinforcement.

Effectively use primary and secondary reinforcement combinations. Primary reinforcers include items such as food and beverages, physical activities (based on the student's preferences), sensory reinforcers, and escape from unpleasant situations. These reinforcers are likely to be powerful independent of the student's reinforcement history. In contrast, social approval, such as attention and verbal praise, is a secondary (acquired, learned) reinforcer. This means that, to become effective reinforcers, secondary events must be paired with primary reinforcers. Once such associations are established, occasional pairings with primary reinforcers have to occur for the secondary reinforcers to be maintained. For example, repeatedly consequating correct responses by saying, 'Good' (or something to that effect), will quickly cease being reinforcing unless the verbal praise is paired and becomes associated with primary reinforcers such as food or a short play break.

Consider whether the student likes to be exuberantly reinforced with clapping, laughing, being tossed in the air, and so on. Although many or most students find such enthusiasm reinforcing, a few do not, at least not in the beginning of treatment. Some students are extremely sensitive to sound and may be punished instead of positively reinforced by loud noises. Assess for such sensitivity (e.g., by asking the student's parents) before assuming that ebullience is reinforcing.

Do not delay reinforcement. It is not uncommon to see teacher deliver reinforcement some 4 seconds or longer after the student completes a correct response. By delaying reinforcement, the teacher risks strengthening a behaviour other than the target response. For a reinforcer to be effective, it must be given immediately after a correct response (i.e., within 1 second of the completion of a correct response). Therefore, have reinforcers readily available (e.g., in your hand, under the table) so you do not take undue time retrieving and administering them. The only exception to this rule occurs when a teacher bridges the delay between the response and the desired reinforcer by using some social event, such as smiling and saying, 'Good,' while reaching for and delivering a primary reinforcer (e.g., food). In such a situation, it is likely that the smile and the teacher's saying, 'Good,' will acquire secondary reinforcing properties by being paired with the primary reinforcer.

6. Avoid reinforcing the wrong association. As an example, imagine an adult teaching the student expressive labels. To the SD 'What is it?' while showing the student a shoe, the student responds, 'Ooze.' The teacher says, 'No,' and then prompts the correct response 'Shoe.' The student responds by saying, 'Shoe,' and the teacher reinforces the response. In this interaction, the student is not reinforced for labelling the object 'ooze,' an approximation of the word 'shoe.' Instead, the student is reinforced for imitating the teacher's prompt, the correct enunciation of 'shoe,' rather than responding correctly with 'shoe' to the sight of the shoe and the teacher's question 'What is it?' In this example, the teacher should have provided a consequence for the original response, repeated the SD ('What is it?' while presenting a shoe), prompted the correct response, and then reinforced. As a general rule, do not give several commands at the same time. Rather, follow the guidelines in Chapter 10 that outline discrete trial procedures.

7. Avoid verbally reinforcing a student's behaviours on the assumption that the student understands your comments. This reinforcement is known as behaviour-specific praise. For example, the teacher may state, 'That is good placing the block in the bucket,' after the student places a block in a bucket. Or, while working on verbal imitation, the teacher may reinforce by saying, 'That is good saying 'mama' the right way.' Typical persons who are 4 years old or older may understand such comments. There is little reason to believe that a student with developmental delays understands the meaning of such statements during the first year of treatment. Nor is there any firm data showing that students with developmental delays learn the meaning of the teacher's remarks from the teacher's incidental comments on the student's behaviour. As a general rule, we advise teachers not to talk too much. If the student does not understand what the teacher says, it is likely that the student will learn to tune out the teacher.

Do not inadvertently reinforce the students tantruming by letting the student escape or avoid the teaching situation. In a teaching situation there are two kinds of rewards: positive reinforcement and negative reinforcement. The delivery of something positive, such as food, is considered a positive reinforcer, as is the opportunity to engage in self-stimulatory behaviour. Escaping from stress and pain are considered negative reinforcers; these situations reinforce a behaviour through the removal of something negative. For example, if the student finds the teaching situation stressful and engages in tantrums, letting the student leave the teaching situation contingent on such behaviour (tantruming) negatively reinforces that behaviour by the removal of the unpleasant event. In contrast, letting the student leave a stressful teaching situation contingent on correct or appropriate responding strengthens that behaviour.

9. Avoid reinforcing errors. Data show that once persons receive information that a student has been labelled autistic or mentally retarded, persons tend to provide encouraging comments (e.g., 'Good try') when the student makes mistakes (Eikeseth &. Lovaas, 1992). Although such comments may represent sincere attempts at being helpful, by providing them, one runs the risk of reinforcing and thus strengthening errors.

Prompting

Avoid unintentional prompts. These prompts include visually attending to the object the student is asked to identify, mouthing the correct response without recognizing that it may be a form of prompting, continually asking the student to identify the item appearing in the centre of a display and not recognizing that this could be a position prompt, and so on. If the teacher is unaware of such prompts, they are unlikely to be faded. Thus, it is likely that the student will become prompt dependent by being reinforced for responding to these prompts rather than to the SD. Members of the treatment team should closely monitor each other's teaching to identify inadvertent prompts.

Overlap instructions and prompts. That is, avoid delays between the instructions and the presentation of prompts. Prompts serve to facilitate the student's response to the instructions, and any delay between the two is likely to hinder the student's making the association between the instruction and the response.

Fade all prompts. Prompts can be faded either abruptly or gradually. Fading a prompt abruptly is called probing. If the student responds correctly on a probe trial, teaching is sped up because the entire prompt fading process does not have to occur. If the probe fails, the least intrusive prompt that is effective should be reintroduced and more gradual fading of the prompt should be undertaken. Then, at a later stage, a probe should again be attempted.

In selecting prompts, explore the least intrusive prompts first to assess whether or not they are effective. Should the student fail to respond correctly when a prompt is given, repeat the instruction and the prompt on the next trial? If the student still does not respond correctly, pair a more intrusive prompts with the instruction on the next trial. In fading a prompt, the teacher shifts from one prompt to a less intrusive prompt in gradual steps. For example, if a student is physically prompted to perform a task initially, the teacher should gradually lessen the physical assistance over trials and then shift to a subtler prompt, such as pointing to the correct item.

In fading prompts, make sure that the student does not pay attention to the decreasing intrusiveness of the prompt, which may block attention to the SD. This problem can be reduced in three ways: (1) Minimize reinforcement for responding on prompted trials while maximizing reinforcement for correct unprompted responses, (2) probe unprompted trials, or (3) switch to another type of prompt.

Know how to teach the student to imitate both verbal and nonverbal behaviours. It is easier, more efficient, and more natural to teach most behaviours by modelling them rather than physically prompting them. If the teacher does not know how to teach the student to imitate, it is likely that the student will move slowly in treatment.

Pacing

Pacing refers to the speed with which trials are performed and tasks are intermixed. The following suggestions may be helpful for gaining and maintaining an appropriate pace when teaching.

Keep intertrial intervals (i.e., the period between the consequence of one trial and the SD of the next trial) as short as possible, especially in the early stages of skill acquisition. If the intertrial interval is not kept short, the teacher may lose the student's attention. The teacher who takes time out to record whether the student was correct on a particular trial will inadvertently lengthen the time interval between trials. Assign someone else to that task if, immediately after a sitting ends, you cannot remember what occurred during the sitting.

Intersperse mastered tasks with new tasks. This strategy is important considering that mastered tasks help the student receive reinforcers, which are likely to increase the student's attention and reduce tantrums. When the student is learning a task, do not let the student experience more than three or four failures in a row before interspersing one or two trials of a mastered task.

Prevent the student's attention from drifting when the student is being taught difficult material. Perhaps this drifting is reinforced by the resulting escape from the difficult task. If this wane in attention interferes with the student's learning, introduce attention exercises, in which the teacher presents the student with four or five mastered instructions in quick succession, such as 'Stand up,' 'Sit down,' 'Turn around,' and one or two nonverbal imitation tasks. Quickly reinforce each response and then immediately introduce the difficult material. We call such activities wake-up or attention exercises because they appear to interfere with the student's self-stimulatory behaviour and help focus the student's attention.

When the student is given time to play between teaching sessions, make sure that these breaks do not involve the kinds of self-stimulatory behaviour that lead to the student's being 'unavailable' when she returns to the formal teaching situation. For example, some students become completely absorbed in certain Disney cartoons. Some of these cartoons may cue delayed echolalia and other forms of self-stimulation, which may carry over to the teaching situation. Break times should involve play with appropriate toys such as puzzles and engagement in physical activities.

Weakening Interfering Behaviours

1. To weaken behaviours, identify the reinforcers that maintain the behaviours and then withhold these reinforcers (i.e., place these behaviours on extinction). The best way to discover what reinforces and therefore maintains a behaviour is by examining what happens immediately after the behaviour occurs, and then testing for the relevance of that stimulus by withholding it. For example, a student may appear indifferent to the presence of adults unless she is engaged in self-injurious behaviour. When the student is engaged in such behaviour, one may discover that she visually attends to the teacher's face, observing whether the self-injurious behaviour achieves a glance from the teacher. Even a brief glance from the student's teacher or parent can maintain self-injurious behaviour, although the same glance may not serve as a reinforcer for any other behaviour. Remember that, when extinction is employed, the behaviour for which the reinforcement is being withheld will temporarily increase before it subsides, showing an extinction burst. This occurs because the student works harder (e.g., tantrums more intensely) to gain back the reward she is used to receiving for that behaviour. Once the student learns that the behaviour will not achieve its customary reward no matter how intensely it is performed, the behaviour subsides.

When using time-out (e.g., by placing a student in a corner contingent on a tantrum), make certain that this consequence does not serve as negative reinforcement, allowing the student to escape from the teaching situation. Time-out may also allow the student increased access to self-stimulatory behaviour, a positive reinforcer. This kind of dual reinforcement may serve to strengthen the very behaviour the teacher thinks he or she is weakening.

Remember that the rewards inherent in self-stimulatory rituals are most likely sensory or perceptual in nature. Such reinforcers are controlled by the student and cannot readily be removed by the teacher. For that reason, removing social attention is not effective at reducing this form of behaviour. This is particularly true of lower level forms of self-stimulatory behaviour that involve the body only. The treatment of choice for helping the student overcome lower level forms of self-stimulatory behaviour is building higher level and more appropriate forms of self-stimulatory behaviour which contain reinforcing stimuli that are external.

Where and When To Teach

In the early stages of learning, teach the student in one room and at one table. Once a particular task is mastered, the skill may be transferred to other settings. Avoid abrupt transitions by slowly fading in new environments. For example, generalize mastery first to the doorway connecting the teaching room and the adjoining hallway, then progress to teaching in the hallway, then move slowly into the living room and other parts of the house. If the transfer from the teaching room to other environments is made gradually, the student is likely to make few, if any, errors generalizing skills across environments.

be aware that generalization training occurs when new people join the teaching team. Older and experienced teachers will inevitably leave and have to be replaced by new persons. Make certain that the transition between the old teacher and the new teacher is as gradual as possible so that discontinuity in the student's program is minimized. When a teacher must leave, provide at least a 2-week interval in which the experienced and new teachers work together side by side in an apprenticeship fashion and then take turns teaching. This allows for the new teacher to become familiar with the student and the student's programs and be faded in while the old teacher is slowly faded out.

Do not assume that the student, without extensive preparation, will learn new behaviours by being! Placed in a mainstream class. We are not familiar with any data indicating that merely exposing a student with autism to typical peers helps the student's development. For example, many individuals with autism grow up in the company of typical siblings, and these individuals do not seem to fare better than those without such siblings. We recommend that mainstreaming occur only after the student has mastered most of the programs in this manual.

When placing a student into a mainstream class, use a one-on-one aide experienced in behavioural intervention to help make sure exposure to the typical classroom environment is beneficial to the student. Examine several school programs and select one that has structure and one in which the teacher is willing to be advised about how to handle the student. The teacher should also agree to the presence of an aide from the student's treatment team who is familiar with the student's learning history to help the student participate in the group setting.

Teachers tend to be task-oriented individuals and less likely to be tied up in theoretical systems than other professionals. The great majority of teachers are willing to help. To lessen the burden on the teacher and the student, teach the school activities at home prior to introducing the student to the new classroom environment. Thus, the student initially does not have to learn anything new in school, but rather must transfer learned material from the home to the school environment. Such a practice is not unusual; it is common among typical individuals. A fuller description of how to integrate students into mainstream classes will be provided in an upcoming manual on advanced programs.

be aware that data show that placing a student with mild developmental delays in the company of individuals with severe developmental delays may cause the student to regress (Smith, Lovaas, & Lovaas, in press).

Do not expect the student to make optimal progress with less than 40 hours of one-on-one treatment per week. There are no valid long-term outcome data to support that 20 or even 30 hours per week provide adequate treatment intensity.

6. If the student is taught 6 hours per day on a daily basis, reserve most of the difficult tasks, such as verbal imitation, for the morning sessions because the student will likely learn more in the mornings than in the afternoons. Save some portions of the afternoon sessions for working on play skills, arts and crafts, and self-help skills. Some afternoon time may also be used for maintaining mastered tasks and for generalizing treatment gains across teachers and new environments.

Examples of Specific Problems

The first portion of this chapter lists common problems that arise in treatment and ways to avoid them. In the remainder of this chapter, we provide examples of problems that commonly occur to illustrate how problem solving may be carried out in practice.

The following examples are accompanied by potential solutions proposed by a group of experienced teachers. It is possible that the recommendations suggested will not help to overcome the specific difficulties. Rather, by introducing a recommendation in teaching, the teachers can closely examine how the student responds to certain interventions and then, based on the student's behaviour, work from there. More often than not, effective solutions for a particular student's difficulties are the result of serendipitous discoveries based on observations of the student's behaviours. Searching for possible causes of problems can be extremely interesting, and answers, when found, are as powerful a reinforcer for a teacher as any reinforcer can be. Herein lays one of the rewards of being able to work with individuals with developmental delays.

Problem 1

A student has mastered several words in the Verbal Imitation Program, such as 'bus,' 'shoe,' 'juice,' and 'watch.' The student readily learns words and sound blends if they are maximally different, but he experiences considerable difficulty learning the discrimination between similar sounding words such as 'bee' and 'boo.'

Suggestions

Teach the discrimination between dee and 'boo,' then go back and teach 'bee' and 'boo.'

Maybe the student attends to your facial movements, which blocks the student's response to the auditory input. Cover your face when giving the SD.

Perhaps the student is not attending to your face and is not able to use facial expressions as prompts. To help establish facial expressions as prompts to be faded at a later time, teach the student to imitate facial expressions and then return to verbal imitation training, using one distinct facial expression when presenting 'bee' and a quite different facial expression when teaching 'boo.' Then fade the use of facial expressions as prompts. Using facial expressions as prompts for the student's verbal behaviour may seem inconsistent with earlier warnings of avoiding such stimuli. The difference lies in knowing that prompts are present and using them to facilitate teaching versus inadvertently using prompts and not fading them.

Try a reverse chain; that is, instead of teaching the student to imitate 'bee' versus 'boo,' present her with 'eeb' versus 'oob.' If the student learns the discrimination between these SDs, perhaps it may facilitate acquisition of the discrimination in the reverse order. It is possible that consonant-vowel combinations are more difficult than vowel-consonant combinations for the particular student.

If the unsuccessful sessions of verbal imitation are conducted in the chair, test whether the student responds better in sessions out of the chair. Try to keep the sessions fun and the student's attention high. In addition, limit each session to just 1 to 2 minutes and provide play breaks between each session. At later stages into the program, when the student has a longer positive reinforcement history in the chair, the student may be returned to the chair or kept in the chair for longer periods of time.

6. Place this discrimination on hold for 2 to 4 weeks, reintroducing it after other discriminations have been mastered.

7. Because the student is confronted with a task that is difficult for her, make sure that easy tasks are intermittently presented so that the student is given the opportunity to receive reinforcement and gain self-confidence. No more than 3 or 4 failed trials should pass without the student being presented with 1 or 2 trials of an already mastered task.

Problem 2

A student has difficulty imitating the teacher jumping when this skill is taught with the teacher and student standing beside the table.

Suggestion

Move away from the table and chairs and have the student imitate jumping on a bed. When this is mastered, move the task back to the table in gradual steps. This is only one example of using objects in the student's environment to help her learn new skills. As another example, one can teach a student to imitate waving bye-bye when she is at the door and provide reinforcement by letting her exit contingent on the imitation. The task can later be brought under instructional control in the chair. Likewise, if the student refuses to play with puzzles while sitting at the table, puzzles may be positioned first on the floor and then gradually moved to the table.

Problem 3

A student encounters major difficulties acquiring the instruction 'Touch head.' However, the student has learned to imitate the teacher's use of objects (e.g., placing a block in a bucket, moving a toy car back and forth).

Suggestion

Teach the student to touch his head when requested to do so by first having him imitate placing a beanbag on his head following the instruction 'Do this.' If the student has difficulty with this, the task may be broken down by teaching the student to first imitate placing the beanbag on the table, then on his lap, and then on his shoulder. Next, give the instruction 'Touch head,' prompting the correct response by having the student imitate you placing the beanbag on your own head. Lastly, gradually fade the beanbag and bring the correct response under the control of the SD 'Touch head.' In short, use an object or your modelling (visual cues) to facilitate mastery of receptive instruction (auditory cue).

Problem 4

When does a student's aide (i.e., shadow) fade out of the classroom and leave the student with her teacher and classmates? Sometimes parents or teachers want the aide to stay in the classroom for an excessive amount of time, perhaps in an attempt to ensure the student's adjustment. In contrast, some parents and teachers do not want aides to remain in the classroom for very long, and they suggest their dismissal before you feel comfortable leaving the student by herself. Keep in mind that when some teachers are asked how the student functions in the classroom when the aide is not present, they may report that the student acts appropriately, even if this is not the case. This same teacher may, at the end of the term, announce to the child's parents that the child caused so many difficulties that she needs to be transferred to another class. Remember that the teacher must attend to his or her entire class, there are often many problems and many students, and the teacher may not want to take attention away from the other students or favour your student with a disproportionate amount of time.

Suggestion

First and foremost, be certain that the person chosen as the aide is familiar with the student's treatment and programs; if the aide does not have the knowledge acquired through such familiarity, he or she will not be effective at generalizing treatment gains and may very well sabotage the classroom placement. The aide should not leave the class unless data demonstrate that the student can manage on her own. To gather such data, ask a colleague with whom the student is unfamiliar to visit the classroom and observe the student on days when the aide is present and days when the aide is absent, and then report back. Use an unfamiliar observer because the student may not act typically in the presence of a familiar person. Also, for familiar persons to gather data without affecting the outcome, they would have to hide from the student while observing, which is highly impractical. Note also that if a parent or teacher records the data, the report may be very different from the reports provided by someone not personally involved in the student's program. As an additional precaution, ask the colleague who takes data on the student to also take data on other students in the class (e.g., whether the student you work with interacts with the other students, whether the other students in the class act much like the student you work with, etc.). Such information will tell you a great deal about whether the aide should continue his or her involvement.

Problem 5

A student is very distracted by wallpaper or toys in the room where treatment takes place.

Suggestion

Remove the wallpaper or the student's toys from the room, or move the student's treatment into a barren room. Gradually introduce decorations and toys at a later stage in treatment when the student has learned to become more attentive to the teacher.

Problem 6

A student has mastered the expressive labels of 15 or more objects in a 3-D format. When the same objects are presented in a 2-D format, the student fails to make progress. The student appears not to attend to 2-D stimuli.

Suggestion

Rather than placing the pictures flat on the table in front of the student, give the student the pictures, one at a time, to hold in his hand. Another option is to pin or Velcro the pictures to the wall, thus avoiding the angle created by placing the stimuli on a flat table (for some students, stimuli placed at such an angle is difficult to visually attend to). Slowly fade the pictures from the wall onto the table. You may also try using a 3-D object as a prompt by placing the 2-D picture next to or in front of its corresponding 3-D object, then slowly fading out the 3-D object by covering it with its corresponding 2-D picture.

Problem 7

A student does not cry at home except when she enters the treatment room or the teacher enters the student's house.

Problem 8

In programs requiring verbal responses, a student's enunciation is poor.

Suggestion

Associating visual representations with the student's verbal responses might improve the clarity of the responses. Such associations may be made by introducing a sight reading program, teaching the student to read the words that constitute the correct responses in the verbal programs. These words may be spelled out on flash cards or shown in books.

Problem 9

A student's parents have a newborn baby, and the student handles the baby roughly at times when the parents are out of the baby's room. The parents are concerned that

Suggestion

Crying usually subsides as the student gains success at responding to the teacher's requests or habituates to treatment being a part of her daily routine, provided the student is not somehow reinforced for crying. If you can be certain that crying is not being inadvertently reinforced (e.g., by your delaying the session when the student cries), begin each treatment session with a favourite activity. For example, rather than starting off the session with programs, begin the session by playing with the student. This will not stop the crying right away, but it may do so over time. Another option is to simplify the teaching situation by intermittently calling the student to the table just to receive a favourite reinforcer and allowing the student to leave with no work required. If this suggestion is employed, make sure that such sittings occur randomly throughout the session so the student is not able to anticipate when she will receive free reinforcement. Also, make sure that sittings for free reinforcement do not occur contingent on tantruming or other inappropriate behaviours. The baby might get hurt. This is a potentially dangerous situation for both the baby and the student. Should the baby be seriously hurt, the parents' feelings about the student may become negative.

Modify the prize board system introduced in Chapter 7 by giving the student a red card for approaching the baby. The student's parents should decide what kind of unpleasant consequence should be paired with the red card to help prevent future occurrences. Reinforce the student for leaving the baby alone until the baby is older and better able to fend for himself, and then teach the student how to interact with the baby in a safe manner.

Problem 10

Whenever one of a student's favourite toys is taken from her, she screams.

Suggestion

Remove the favourite toy and then give it back to the student almost immediately, before the student screams, reinforcing the student for not screaming. (If the student screams and then receives the toy, the student's screaming will be reinforced.) Slowly increase the interval of not screaming from 1 to 2 seconds and gradually up to 10 seconds before returning the toy. Call this exercise in frustration tolerance the 'Big Kid Program.'

Problem 11

A student has difficulty learning prepositions.

Suggestion

Prompt by keeping the objects used to teach each particular relationship constant while varying these objects across the general concept. For example, use a box as the base when teaching the relationship 'on top,' use a bucket as the base for teaching 'inside,' and let the placement of 'beside' occur in relation to a book. Once these prepositions are mastered in this format, fade the prompt, replacing the varied objects with a common object.

Problem 12

The student completes the correct action but does so by attending to the teacher's facial expression rather than the auditory instruction. For example, the student is being taught to place a cup on top of a box in contrast to beside the box. The teacher instructs, 'On top,' and the student begins to move the cup slowly toward the top of the box, then pauses and looks at the teacher. As the student moves the cup toward the top of the box (the correct location), the teacher smiles encouragingly.

Suggestion

As the SD is presented, visually fixate on the student's forehead (or some other neutral place) and do not signal to the student in any way that his movement is toward the correct or incorrect location. Withhold smiling and other reinforcers until the student completes the correct response (i.e., the student places the cup on top of the box and then releases the cup).

Problem 13

In workshop-based interventions, there is a considerable amount of turnover; there seems to be an almost continuous outflow of older more experienced staff and influx of new staff who must be trained.

Suggestion

Try to arrange careers for your staff. One way to do this is by joining a local chapter of Families for Early Autism Treatment (FEAT) or a similar parent organization (see Chapter 36). For staff who remain on the job for 9 months or so, consider offering medical insurance or part of a tuition payment needed to complete a bachelor's or master's degree contingent on the person's remaining on the project (per a legal contract between the staff member and the institution or the student's parents). Recruit and train enough student teachers such that the departure of one or two does not seriously jeopardize the student's program.

Problem 14

One often comes across a workshop leader who claims to be qualified to deliver and supervise early and intensive behavioural intervention. This person, however, proposes unreasonable and arbitrary recommendations, such as not beginning expressive labelling prior to the student's mastery of 50 receptive labels. This recommendation is made despite data showing that some children with developmental delays acquire expressive labels before acquiring receptive ones. Rigidity on the part of the service provider may well hide an underlying insecurity about his or her own competence.

Suggestion

Ask for the person's written credentials from outside agencies and for names of parents who have already employed that person, then visit them, phone them, or ask for letters of recommendation. Request the consultant's college or university transcripts. If valid credentials cannot be produced to demonstrate his or her qualifications as a well-trained consultant, replace that person. Remember that attending a 2-day workshop and reading teaching manuals is inadequate preparation. Many parents feel, however, that a little help is better than no help. Although this may be true, parents should be informed that, under the guidance of an inadequately trained consultant, the treatment burden placed on them will likely be larger than if the consultant is well trained. There is also a higher risk of relapse if treatment is terminated.

Problem 15

A student who has mastered the concept of size through the use of blocks then seems to lose the discrimination and begins to perform at chance level (i.e., the student responds correctly approximately half the time).

Suggestion

The student may be bored of using blocks. Change the stimuli, shifting to objects such as large and small cars, cups, animal figurines, and so on.

Problem 16

Rather than appropriately attending to 2-D stimuli, a student uses them to self-stimulate (e.g., eyes them or waves them back and forth).

Suggestion

Velcro the stimuli to the wall, fasten them on cloth, or place them on a slanted surface such as an easel. At the first sign of inappropriate self-stimulatory behaviour during the response interval, immediately consequate the incorrect response and then repeat the SD.

Problem 17

A student makes little or no progress in learning receptive identification of objects, letters, numbers, and the like.

Suggestions

Write the letters and numbers on a dry-erase board and, as reinforcement, let the student erase stimuli he correctly identifies.

To make the program more enjoyable and game-like, remove the stimuli from the table and place them on the floor for the student to retrieve when you name them rather than having the student just point to or touch them.

Suggestion

Have the student aim for brightly coloured disposable items (e.g., Fruit Loops) placed inside the toilet.

Problem 22

Someone other than a student's parents coordinates the treatment, and the student's parents do not make much of an effort to involve themselves in the treatment.

Problem 18

A student tantrums when she receives an informational 'No' as a consequence for incorrect responding.

Suggestion

Replace the informational 'No' with 'Try again.'

Problem 19

A student refuses to urinate in the toilet, urinating only outside on the lawn.

Suggestion

Place a potty chair on the lawn and teach the student to urinate in it. After the student masters this step, gradually move the potty chair into the bathroom, then place it beside the toilet, and then on top of the toilet. Finally, fade the potty chair.

Problem 20

A student refuses to defecate directly into a toilet, but will defecate into a diaper while sitting on a toilet.

Suggestion

Cut a small hole in the rear of the diaper. Gradually increase the size of the hole until only the portion of the diaper around the student's waist remains. Next, replace the diaper with a belt and gradually reduce the width of the belt (e.g., slowly move from a wide belt to a narrow belt, then to a piece of yarn, then string, and so on until no prompt is needed).

Problem 21

A common problem for boys is poor aim when attempting to urinate into a toilet bowl.

Suggestion

Perhaps the coordinator has taken over much of the treatment from the beginning and has not invited the parents to become actively involved. The student's parents should be involved from the very beginning for several reasons, one being that it will be very difficult for the parents to become effective at teaching the student if they step in 3 to 4 weeks into treatment. At that time, the student may be working on complex programs and the parents may feel incompetent and inadequate if asked to participate (just as any novice person would). Inform the parents that, without their learning some of the basic treatment procedures, their child will be less likely to generalize treatment gains from teachers to parents or from the treatment environment to the outside community, such as shopping centres and restaurants, or to weekends and vacations. More important, their child is likely to regress when the present teachers leave unless the student becomes fully integrated and learns from typical peers. In the long run, it is informed and knowledgeable parents who are able to maintain and expand upon treatment gains as the child grows up.

One way to help parents stay involved is to request that they maintain their own log book, describing their day-to-day interactions with the student in concrete detail and then review their entries with the senior aide or workshop consultant on a weekly basis. Parents, however, should not be given an overabundance of responsibility. For example, if the parents do all of the treatment by themselves, chances are they will burn out, as any person would. Further, by performing all the treatment responsibilities alone, parents will not be able to take advantage of the problem-solving capacity often inherent in the collaboration of a group of people (see Chapter 32 for further help).

Problem 23

Many students with developmental delays are clever at making discriminations among (a) persons who provide treatment versus those who do not and (b) the places and times the treatment is administered versus locations and periods that signal free time.

Suggestion

Start treatment in one room to reduce interfering stimuli, then slowly transfer (generalize) mastered skills to other environments (e.g., to other rooms of the house, then to outside of the house) and persons (e.g., neighbors, family members, people at the grocery store). As the student progresses in treatment, new tasks may be taught in less structured and more varied environments.

Problem 24

A parent reports that he or she is very depressed and anxious, feeling as though he or she is failing the child. In discussing this problem with the student's parents, it appears that the student's grandparents and other relatives are spending a great deal of time in the home and giving a variety of suggestions as to how the parent should improve the treatment (about which they know very little). All these suggestions make the parent feel increasingly confused, anxious, depressed, and incompetent.

Suggestion

Recommend that all relatives refrain from visiting the house for the time being. If the parent is to meet with relatives, suggest that this be done without the child, away from the house, and with an agreement not to discuss the student's treatment. such as one or more of the following: speech therapy, holistic medicine, Facilitated Communication, Sensory-Motor Training, Auditory Integration, Play Therapy, and various medical interventions to correct for suspected food allergies and intestinal yeast infections.

Suggestion

Although such eclectic combinations may sound promising, be aware that the effectiveness of most or all of these treatments is not supported by scientific data. If other treatments are involved, make certain to communicate closely with these other providers so that one intervention does not sabotage the work of another (e.g., so that a speech therapist does not inadvertently reinforce tantrums). In the case of medical interventions, make certain that medical diagnoses are confirmed by independent physicians and those side effects of the prescribed medications are thoroughly spelled out. Some medical interventions seem innocuous at first, but may in fact cause serious problems. For example, the medication fenluramine, which was once widely prescribed as a treatment for autism both in the United States and abroad, has since been recalled because it caused heart damage and death for some persons. Be aware that any service provider, even providers with advanced degrees from well-respected institutions, may offer the promise of a miracle treatment.

Problem 27

A teacher gets angry at parents for not following through on treatment recommendations.

Problem 25

A parent becomes depressed and anxious and is referred to a professional who is an expert at dealing with depression. The parent, after four or five meetings, feels that he or she is not experiencing any relief.

Suggestion

Refer the parent to a group of parents with similar issues. It is likely that, through participation in such a group, a great deal of support will be provided to the parent. Depression can have a variety of causes, and a particular professional may not have experience helping parents of children with developmental delays (see Chapter 36).

Problem 26

Concurrent with the present treatment, an authority on the treatment of autism recommends other interventions,

Suggestion

The teacher needs some counselling. It is highly inappropriate to express one's feelings in such a manner in a professional environment; if a teacher is concerned for the student's welfare; there are positive and tactful ways of approaching such an issue.

Problem 28

A professional suggests that behavioural treatment is not appropriate for high-functioning persons with autism, or that 20 hours per week of one-on-one intervention is enough for 'smart kids.'

Suggestion

Although recognized authorities in the field of autism have made such claims, no scientific data support either assertion (see Chapter 40).