Pointing is a Dramatically Undervalued Skill

Many children with autism and other developmental disabilities struggle to learn communication skills. Today, I’m making a simple argument that often, teaching pointing is a simple thing that can be done relatively easily with most learners that has a huge potential to make a big difference in his or her life. Unfortunately, in my experience, teams rarely pursue this as one of the skills they choose to teach.

There are a variety of ways to teach children who need help learning to communicate how to indicate their wants and needs. Some children can make excellent progress using their voices right from the start of therapy. Others can benefit from a wide variety of effective procedures. A few examples include:

  • Teaching children sign language.
  • Teaching children to communicate using pictures (Picture Exchange Communication System-PECS).
  • Teaching children to communicate with speech generating devices (iPad with an app like proloquo2go).

All of these systems have advantages and disadvantages, and a particular system might be more or less appropriate for a child based on his or her individual needs. Often, I think there is a reasonable argument to be made for a child to have multiple systems. There are many articles debating fine points like you can’t take the PECS book with you in the pool, the cashier won’t understand sign language, or what happens when the iPad isn’t charged.  I don’t intend to get into that here.

Today, I’m just making the simple point (ha!) that teaching pointing in addition to whichever other communication system(s) you use can make an enormous difference. Although this skill is known to be useful in the ABA world, rarely do teams pursue this. I suspect that part of the reason might be that as far as I’m aware, this skill has not been researched thoroughly. Some of the advantages to teaching pointing include:

  • Many learners, even those with the most severe impairments, can learn to point for things they want in a relatively short period of time. It does require a good teacher who is skilled at shaping. But unless there are severe physical limitations, most learners can acquire this skill.
  • Often, after a few days of teaching, learners will generalize this skill and be able to use it in a wide variety of contexts to ask for many items. With any of the other systems described above, it will typically take much longer to acquire a large number of items. This makes it possible to reduce frustration much faster with many children.
  • Children with autism often want things that aren’t easy to communicate with sign language, PECS, or even speech generating devices. This includes things like getting a specific piece of Play-Doh, rubber band, something lined up, a piece of string, or a person to play in a particular way. All children, but especially children with autism, want idiosyncratic things that aren’t simple to communicate. Often, this becomes possible through pointing. Children can often learn to show us what they want this way, which wouldn’t be possible with any of the other systems. Again, it gives the child a way to communicate relatively quickly.
  • Later, when the child has a strong pointing repertoire (often just a few days of teaching), this skill can be used to teach other skills. When the child communicates what they want through pointing, you now know what they want in that moment, which is the perfect opportunity to try to teach sign language or vocalizations.

Of course, teaching pointing does not eliminate the need for other more comprehensive communication systems. But it can be a quick win that can make a huge difference.

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.

Why Goals are Sometimes Harmful

I have frequently written on this blog about practical problems that occur when Organizational Behavior Management is implemented poorly in ABA organizations. Today’s focus is the subtle ways goals can lead to learners not doing as well as they should.

In many situations, goals can be extremely helpful. Goals can help us focus our time and attention on what is really important. But when goals are used as a way to evaluate our progress, things often go wrong. The problem is that in most organizations, it is virtually impossible to prevent contingencies being attached to these evaluations, which leads to huge negative effects for our learners.

There are at least three problems that occur frequently when using goals to evaluate progress:

  1. When everyone knows that they are being evaluated on goals, they now have a huge incentive to set the goal as low as possible.

If I set the goal at 20 and achieve 23, things look great and everyone can see the child is doing well. But, if I set the goal at 25 and achieve 23, I have to report the student did not meet the goal, and possibly come up with an improvement plan. Either way, the child achieved 23. The student’s results are the same. Evaluating staff on whether or not their students meets a goal sets up the situation where staff is rewarded for meeting the objective, not the child making as much progress as possible.

  1. Teams will want to see regular updates on those goals.

Teams will want to see updates on goals in every area of development (e.g., language, social skills, self-help, reading, math, motor skills, behavior reduction, etc). Although this might seem completely reasonable, sometimes just a few areas are critical for a particular student at a particular time. But if goals are the focus, and you have to report at the monthly team meeting, people focus on too much at once, which will often reduce overall progress. Usually, I can’t show up to a meeting and say we are taking a couple of months off math to focus on critical skills that will make a huge difference in his life – and really, who cares about long division anyway?

  1. It looks very impressive to have a lot of goals.

When you have a lot of goals, that leads to big, fat program books or long reports with fancy graphs. Everyone is very impressed when a lot of goals are being mastered. Frequently, insurance companies, school districts, advocates, and lawyers will argue for long lists of goals. Goals that are really important, but difficult, are more likely to get ignored. Instead, we end up with long lists of easy to master goals, regardless of their level of importance.

I think the long-term solution is having strong standards. Unfortunately, that will probably take years of research, and I’m not confident that I’ll see that day in my lifetime.

In the meantime, there is a lot that we can do to ease the negative effects of these types of contingencies:

  • If you work with individuals with autism and other developmental disabilities, it is almost certain that your organization has this problem. Be honest about the problem. Realize that virtually all funding sources will require goals, so making sure parents, BCBAs, and staff aware that this is a common problem is very helpful.
  • Development of goals and objectives is an extremely important task. Don’t take that job lightly. This will focus the time and attention of BCBA’s, RBT’s, teachers, and others for months to come. Do everything possible to ensure that the goals that go into the treatment plan or IEP are things that will really make a difference in the learner’s life.
  • Managers should emphasize that they do not evaluate staff on whether or not goals are achieved. Focus on the staff behavior of interest and whether behavior change is occurring. Not whether arbitrary criteria set six months to a year ago are being met.
  • Celebrate behavior changes and achieving results with learners. Do everything possible to downplay whether the arbitrary criteria are being met.
  • Dramatically exceed goals when appropriate. If, when you started three months ago, 10 seemed impossible so you set the goal at 7, and now the learner can do 139, don’t fret about that. Make the best decision for the learner based on the most recent information.

As long as funding sources require evaluations based on goals, I think this problem will continue to creep up from time to time in virtually any organization. But with smart management, we can mitigate the negative effects.

If you think that you have solved this problem, I’d say look a bit more closely. Are you sure? If you have suggestions on how to reduce or eliminate this problem, I’d love to hear from you. Please contact me.

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.

“Show Me the Data”

For many years, behavior analysts who were responding to other professionals about non-science-based treatments had a standard line, almost a catch phrase; “show me the data.”  Perhaps a bit obnoxious, but many were frustrated that despite overwhelming evidence of its effectiveness, there was minimal acceptance of applied behavior analysis (ABA).

Now that ABA enjoys much wider acceptance, I hear this much less often. In addition, it has been years since I’ve heard a special education teacher, speech pathologist, or other professional complain about the need to collect data. It is just an accepted part of practice of most professionals working with children with special needs. I still hear people say, “show me the data,” but now it is in the context of clinical decision making.

On this blog, I’ve frequently discussed how data collected by ABA professionals can be misleading in a wide variety of ways. But when data are collected by people who don’t have the expertise in the design of data collection systems, things are even more likely to be extremely misleading, as there are often fundamental flaws in those systems.

In some professions, it is possible to get a tremendous amount of information simply by looking at the data. That’s because there are standardized ways of collecting the measurements, and it is easy for any professional to compare those measurements. Some examples include investors evaluating company profits and loss statements, doctors diagnosing cancer, or construction workers using an architect’s blueprints.

We need that level of precision in ABA, too. It would be a wonderful thing if any BCBA could pick any other BCBA’s data and have a clear picture of what’s happening. Unfortunately, we aren’t there yet. So, what to do until the real thing comes along? Instead of saying, “show me the data,” say, “show me the video.” Often, in five minutes of video (or live observation), it is possible to get more information than hundreds of pages of data and reports.  There is no substitute to actually seeing what’s happening.

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.

Dancing Between the Raindrops

Anthony Freemont was a 6-year-old boy who would engage in serious problem behaviors if he did not get what he wanted. In fact, he could have destroyed much of the world. That was an episode of The Twilight Zone called “It’s a Good Life,” which aired 1961. Anthony had virtually unlimited power; just by thinking about it, he could turn people into different things, read minds, and change the weather. The show focuses on the complete fear in the adults willing to do anything to prevent Anthony from getting angry.

The story is familiar to me, as over the years I have frequently seen parents and school teams go to completely unreasonable lengths to prevent a child with severe problem behaviors from getting angry. A store is out of his favorite brand of mac and cheese, and the nearest store that carries it is 100 miles away? No problem. I can drive four hours to get it and be back in time for dinner. He doesn’t like anyone to wear green clothes? Everyone in the household gets rid of any green clothing. She wants to assign seats for everyone in the 3rd grade classroom? The teacher is happy to allow it.

I call this type of behavior from the adults “dancing between the raindrops.” The well-meaning adults in this type of situation are doing something very important. They are maintaining safety. If challenging any of these situations would cause dangerous behaviors like self-injurious behavior or aggression, “dancing between the raindrops” might be a completely reasonable temporary solution. Sometimes, I’ve seen “dancing between the raindrops” from adults even when the behavior isn’t very dangerous. Many people are just afraid of a tantrum. In the short term, this might prevent problems. But in the long-term, it is disastrous and will seriously limit the child’s options in life.

If you find yourself “dancing between the raindrops,” here are a few suggestions. First, understand that this is, at best, a temporary solution. Most likely, the behavior problem will require treatment, and is unlikely to improve on its own. Second, be sure not to be fooled by the data. The data might show low levels of problem behavior. But if it is based on “dancing between the rain drops” behavior, it will clearly be unsustainable and unlikely to maintain. Third, sometimes the adults might not even be aware of everything they are doing to prevent problem behaviors, and it will take some work to show them how important it is to address.

When counseling parents or school teams in this type of situation, I strongly encourage them to provide treatment for this behavior, as if it’s left untreated, it will very likely become worse over time. Sometimes, people are so afraid of the behavior, they decide against treatment, and are just happy that they have a system in place that is preventing problems. In my view, that is a serious mistake for the long-term best interest of the child.

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.

 

Call the Plumber

Previously, I’ve discussed how there are large reinforcers for staff to make sure children make excellent progress, and punishers when children don’t make progress. The quality of the program is directly related to staff satisfaction. Although I don’t have the data to prove it, I believe children not making good progress is one of the main causes of staff burnout, turnover, and general dissatisfaction. I know, I know- staff complain about a lot of things; salary, benefits, commute times, nasty managers, difficult parents, and uncomfortable chairs. Do everything you can to fix the other problems, but if you miss on the program quality measure, you have no chance of keeping strong staff around.

Now, even the highest quality program will have children who don’t do well from time to time. That should be a major concern for managers. We should realize that even though no one planned it, working with a child who is making very little progress is likely to be highly punishing for staff. It does not matter if you “provide support,” “spend time with them,” or “try something different.” It doesn’t matter that you are reassuring them that it is not their fault and praising their attempts at teaching or implementing a behavior plan. Either the problem is fixed or the problem is not fixed. The staff person and the parents are the people who will be with the child for long periods of time each day.  If a staff person is coming to work frustrated that the child, they are working with is not progressing day in and day out, it is only a matter of time before they start looking for another job, or even getting out of the field altogether. This happens everywhere from time to time. What to do? Call the Plumber.

Plumbers are problem solvers. When your toilet is overflowing, you don’t want to hear that they can come see your problem a week from Tuesday. You want someone who can come fix the problem now.

Every organization needs some high-level plumbers who can walk the walk. When things inevitably go wrong from time to time, do the staff have someone they can call? When they call that person, does the person get to see them quickly? When the person sees them, do they actually help fix the problem and get the child on the road to strong progress again?

We should try to not act like plumbers most of the time. If you are always plumbing, there is a fundamental problem in the system. Most of the time, we should be doing thoughtful analytic work. But the toilet overflows everywhere from time to time. Make sure that there is someone to call who can help quickly, or those staff and parents are likely to be extremely dissatisfied.

Behavior analytic services should only be delivered in the context of a professional relationship. Nothing written in this blog should be considered advice for any specific individual. The purpose of the blog is to share my experience, not to provide treatment. Please get advice from a professional before making changes to behavior analytic services being delivered. Nothing in this blog including comments or correspondence should be considered an agreement for Dr. Barry D. Morgenstern to provide services or establish a professional relationship outside of a formal agreement to do so. I attempt to write this blog in “plain English” and avoid technical jargon whenever possible. But all statements are meant to be consistent with behavior analytic literature, practice, and the professional code of ethics. If, for whatever reason, you think I’ve failed in the endeavor, let me know and I’ll consider your comments and make revisions, if appropriate. Feedback is always appreciated as I’m always trying to Poogi.
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