Author: Barry Morgenstern

I did an evaluation where the child had an ABLLS (The Assessment of Basic Language and Learning Skills) completed. I noticed all the sections on answering questions were all checked off as mastered (i.e., who, what, when, where, which, why, and how). But when I met the student, and I started to ask him some questions, the student seemed incapable of communicating anything that I could understand. I thought he might be nervous or feeling uncomfortable, but he sure didn’t look nervous or uncomfortable. He was laughing, seemed to want to socially engage, and generally seemed to be having a good time. 

The parent was present and so I took her outside to ask if I was doing something wrong. Why doesn’t he seem to be able to respond to anything I’m asking? The ABLLS seemed to suggest that he has these types of language skills. The parent reported that I was asking questions that aren’t mastered. She then pulled out lists of all the mastered questions. Sure, enough, if you asked him questions from the “mastered list,” he was very successful at answering them. 

The ABLLS has items on it like, Answers “Where” questions, which is evaluated on a scale of 1-4. You score a 1 if the child answers 5 questions, a two for 10 questions, a 3 for 25 questions, and a 4 for 50 or more questions. The parent took out a list of 50 questions that were completely “mastered.” The student had completed hundreds, maybe thousands of hours of therapy to learn all of this, yet clearly, a lot of it was not very useful. 

I’ve sometimes used this story as an example of how easy it is to completely waste therapy time and still have the data look good. This program had pages and pages of graphs of many, many behaviors that had been taught. So, the evaluation using the ABLLS looked good, as many of the boxes were filled in at the highest level of mastery. 

The typical response that I’ve heard is that this isn’t a generic problem, simply an example of bad programming from someone not very well trained. Sure, this particular example is extreme. But I’ve seen similar problems come up over and over again. Are you focused on things that will look good temporarily or things that will make a real difference for the client?  

I once visited a program where I had previously worked but hadn’t returned in over five years. One student I worked with frequently was about 12 years old when I had left and was about 17 when I visited. When he saw me, he said, “Hi, Barry,” and continued with his work as if he saw me every day. The staff thought it was hilarious.  

Apparently, I had made enough of an impression that he remembered my name after five years, but not so much that he was interested in talking to me after so much time had passed. Running into people you haven’t seen in a very long time is an unusual event. It doesn’t come up very often, so the opportunity to practice appropriate social skills for that event are rare. This is not a particularly important event, but some others might be. 

For example, many people with developmental disabilities have been victims of abuse. There are many programs designed to teach individuals the appropriate skills to prevent themselves from becoming victims of abuse. Parents of teenagers with developmental disabilities are often extremely interested in programs to address this issue. These skills can be quite challenging to teach. Sure, you might get acquisition, but teaching and assessing whether these skills are generalized to the point where they would be successful under real-world conditions is an extremely challenging task. Most of the time, when I’ve seen people attempt to teach these skills, they do not even attempt to get the generalization data to know if it is likely effective. It is just so hard to collect. Plus, there is little or no opportunity to practice these skills regularly. Even if you were extremely successful teaching these skills, what are the chances that the student would use those skills well if there was an occasion to use them in say, three years? Most skills will deteriorate without practice. Should we have a constant maintenance schedule for a skill we hope the person never has to use? 

In my view, there is a place for teaching these types of skills for the right type of learner, for the right time in their development. Is this one of the most critical items for this learner now? If so, definitely teach these skills. Just don’t do it to check off a box on someone’s agenda. If you are going to teach abuse prevention skills, understand it is a major challenge that will require significant time and attention. Spend the time to do it right. If you don’t have the time or resources to do the generalization and maintenance, it’s probably better to not waste everyone’s time. 

When working with children with autism, often a major constraint is the amount of time we have available to work with the learner. There are so many possible behaviors where our procedures may help, but we only have x number of hours to work with them. Everyone also has limited attention; even if you could work with the student more, there’s only so long they can work without needing a break. Using your limited time with a student wisely requires making careful decisions. If you don’t plan well, you are sure to waste it. 

Something that I have found useful is the concept of the TILE (Time in Learning Environment). Probably, the main goal for any behavior analysis program serving children with autism should be something like making sure the TILE is optimized. How can we make sure that we are maximizing the use of the TILE and not wasting it?

When people learn about the TILE, often their first idea is to make sure that we have “extra” things to work on so that if we end up with extra TILE on a particular day, we can always keep the learner busy and not waste the TILE. Of course, our goal isn’t to keep the learner busy, but to make a socially significant difference in the life of the learner. It is easy to get distracted by measuring whether the learners are on-task, acquiring new skills, or reducing problem behaviors. Sure, those things may be important. But maybe not as much as you think if you are focused on the long-term view of what matters. 

I think the key is to not to try to make sure every minute of the TILE is focused on some learning activity. That’s almost guaranteed to add unproductive and distracting tasks that won’t make a long-term, significant difference. The key is to think, “If we mastered this behavior change, would it make a significant difference in the life of the learner?” Then, optimize your time on those behavior changes. In most cases, the time available will be shorter than what we’d like. But focusing on the most important things in the TILE will make a big difference. 

Sometimes, even just asking the question is helpful. Is this the best use of the TILE? How can I prevent wasting the TILE? What’s the best use of the TILE–a social skills group, time in the general education classroom, or 1-1 therapy? Well, let’s think, what are the behavior changes, if made, that will make a major difference in his life outside of therapy? 

People who do well as a BCBA (Board Certified Behavior Analyst) or an RBT (Registered Behavior Technician) are people who truly enjoy seeing children learn, grow, and make progress.  These people did not go into the field to become rich, and it is impossible to do well in the long run if this is just a job you are doing for money alone. Of course, we all need to make money, but there must be other reinforcers to sustain high levels of performance over time.

That sounds good, but there is a downside to this characteristic of effective professionals. When things are going great, the job is fun–we can hardly wait to get to work to see what’s next. On the other hand, no matter how good you are, there will be times when things don’t go well.

I’ve argued before that this is a time when professionals are at a high risk for burnout, and ideally, you can call a plumber to help fix the problem. But, unfortunately, that is not always the case. Sometimes, you have to show up for work without assistance, and many of the most potent reinforcers you expect from work are likely not going to be present.  That can lead to depression and stress. Even worse, people are often angry in this situation, and emotions can be high, leading to seemingly endless conflicts. I know what this is like.

I survived all those long lonely days When it seemed I did not have a friend.

 The one thing that I think has helped me personally is the attitude of “Humble Arrogance.”

Usually, when I work with a child, I am not the first professional to have seen the child. In all likelihood the parents or school team have seen quite a few professionals before they have reached someone like me. So, I try to remind myself there is ample reason to be humble. In all likelihood, the problem will not be easy to solve. Many smart people have already tried to help this child and not succeeded. This is likely to be a significant challenge. Too often, we think that all the other people that worked with the child before just didn’t have the proper training or experience, and this will be an easy fix. Often, that isn’t the case. It is easy to become overconfident when you have had a lot of success (as most BCBAs do). I try not to expect that everything will go smoothly. If I expect bumps in the road, then I am prepared for the times when things go wrong.

On the other hand, being in this situation requires some arrogance too. Despite the fact that all these other smart people have attempted to help this child and were not succeeded, I’ll be able to do it. Try to think like a scientist with humble arrogance.  If something doesn’t work, our response is not frustration or depression, but to think “that’s interesting.” Why didn’t it work? Figure that out, and be on a Poogi. Be humble that the first thing you try may not be successful, but arrogant enough that despite the fact that other smart people haven’t been able to do it, you will be successful.

I believe that a major component of effective organizations is to have a mission that is meaningful, motivational, and measurable. After some work on this issue, I crafted the mission: “Teach more, better, faster; now as well as in the future.”

This mission generally had great social validity among staff, parents, and other BCBA’s where I tried it out. We could easily measure how many new skills children were acquiring and increase that over time. We could use the best available research data to design treatment checklists and measure whether our instruction was getting better and better. We could look at rates of acquisition to determine if those were improving. Finally, we could look at whether our procedures were continuing to be used over time. We were on a Poogi!

I was pretty happy with this for quite a while. But one day, I realized that I was focusing on the wrong things. There are a lot of ways that we might be performing well on those measure and still not doing what is in the long-term best interest of the child. It is great that he is learning new words faster, but would he have learned them naturally through play if he wasn’t in therapy? It is wonderful that he is reducing problem behaviors and increasing appropriate social skills, but does he use them outside of therapy?

It doesn’t really matter how well a child is doing while they are still in your care. In most situations, that care is not going to last forever. What matters is what happens after the person leaves your care. Did the person go on to have a better life without your assistance?

Measuring things like how many skills are acquired, how fast those skills are acquired, and if the staff are implementing procedures accurately are all relatively easy to measure. They seem like the common-sense things that, of course, we should be doing. Maybe that’s true. My argument is not that these things are bad, just that they can be a distraction from what’s really important, which is making a socially significant difference in the lives of the children we serve. That could involve teaching, more, better, faster. But maybe not.  For some children, it may be that more is not better. It may be that teaching just a few things really well is what they need. The ultimate goal is not success during therapy, but success when the child is no longer in therapy.