The Aurora model for Child Success! (free from the use of edible and electronic reinforcers)

I’ve written about the need to unconditionally discontinue the need for edible reinforcement in autism services – that edibles create far more problems than they serve. That parents/caregivers often have no idea how much junk food and sugar their children are receiving during the day by a notable percentage of ABA Centers and, for that matter, in some schools, too. I’ve also been asked by a number of folks to further explain how this can be done most effectively.

Identifying Alternative Reinforcers

This blog is dedicated to that question… But, first, I think it’s important to share how to better identify a wider range of individual reinforcers (which are not edibles or electronics!) and more effective ways to integrate them into BIPs/instructional programs for the children we serve.

As I’ve shared before (and will again!), edible reinforcement is – never – used at any time at Aurora Behavior Services. Food never needs to be ‘earned.’ Food is also never lost as ‘punishment’ or withheld to be used later as a ‘reinforcer.’ Sadly, these are not exactly uncommon practices across a number of ABA agencies.

If your child comes home from his/her center time and immediately starts to demand and/or rifle cabinets looking for junk food, suspect there may be a problem with and a connection to those services. No, not always – but be aware and ask questions.

The Myth of Food as the ‘Only Motivator’

I also can’t tell you how many times I’ve heard the excuse that food is the ‘only thing which can be used to motivate’ a particular child. I’ve also been told that young children with autism, in particular, ‘only respond to food.’ Both statements are patently incorrect. A BCBA who believes this, among other potential concerns, is also doing inadequate Preference and Reinforcer assessments. I’ve also heard many times how a given child’s ‘reinforcers are always changing’ given as an excuse to use edible (or electronic) reinforcement. This is also very misleading.

Yes, of course, it’s true that we all periodically find new activities, items and interests and may lose interest in those to which we were previously drawn. But individual preferences are not constantly changing and certainly are not a routine occurrence. When it does occur, we should be able to identify it based on data being collected towards making proper changes.

Preference vs. Reinforcer Assessments

Preference Assessments are distinct from Reinforcer Assessments. And there are a wide range of different ways, both more formally and less so, to effectively identify preferred items and activities to include those more idiosyncratic to a particular child. In fact, effective use of idiosyncratic reinforcers can be uniquely positive while allowing time to identify, build in, and condition others.

More formally structured Preference Assessment methods are largely decontextualized, not child centered and, often, not particularly child friendly. More often, ‘reinforcers’ are presumed and selected by adults for lack of effective Preference and Reinforcer assessments. At Aurora, we use our own unique Preference and Activity Assessment followed by an interview with parents/primary caregivers. And what will become reinforcers don't always start that way but may need to be more naturally paired and conditioned.

With this, the default to edible reinforcers is more often a cop out and admission of the lack of an effective assessment process. Of not taking the time to truly get to know a child rather than making presumptions. At Aurora, we never ‘presume’ but are guided by each child. And shaping new interests and activities is a practice common to a great many families of young children.

The Problems with Edible Reinforcement

While Preference Assessments are used to create a list of items or activities in which the child has identified interest, the Reinforcer Assessment requires multiple presentations of identified Preferences to see which ones most effectively increases the targeted skill/instructional objectives. To identify which ones help lead to Success!

I've been a clinical provider for a freaking long time specializing in both significant, persistent behavioral concerns along with folks on the more severe ('profound') end of the autism, ID, and MH spectrums. Again, children should never earn or lose access to food. Doing so only teaches significant misrules which can be very hard to reteach and change. It's been my extended anecdotal experience that the use of edibles can play a direct and contributing factor when feeding, and especially, severe feeding issues exist. It can also significantly interfere with success and independence.

I have found more than just a few times that previous edible misuse is directly connected to more substantial and higher risk behavioral needs in a percentage of children (adults, too) with whom I’ve worked. Edible use also ignores the compassionate and thoughtful individualization of services and is, too often, correctly among the negative accusations and concerns surrounding 'ABA' services.

Effective Alternatives

The BIP may be poor but wave around a cookie, promise an iPad and put the child on a high frequency ‘reinforcer’ schedule using either and all becomes good. The child may have limited to no success, but it sure is a heck of a lot easier towards BIP planning and daily implementation. At Aurora, we take the time needed to effectively assess, get to know and understand each child whom we support

So, what are alternatives to food AND uber high preference items to notably include electronics? A key is the purposeful integration of effective instructional methods and best clinical practices taken from both Applied Behavior Analysis and education. Both the owner of Aurora Behavior Services, Amber Furby, BCBA, and myself have previously had many years of experience as licensed teachers.

The Aurora Model

The model for Aurora Success! means combining natural environmental teaching (NET), behavioral learning constructs such as the Natural Language Paradigm which helps increase motivation for functional communication training (FCT) where needed, Incidental Teaching and Pivotal Response Training (PRT), both of which are forms of NET.

Incidental Teaching looks for (and creates) natural and in context teaching opportunities during the day. PRT fundamentally prioritizes placing different individualized items/activities of interest for each child in the immediate area. We then let the child select to which he or she is most interested, allow some free play then use that child selected activity for related program goals and increase and better motivated opportunities for functional communication. PRT can also be used towards natural and active instruction in a variety of different ways.

A strong initial and ongoing assessment process includes a comprehensive, ecological functional behavior Assessment (FBA), Our next blog will talk more about the unique ecological assessment process we use at Aurora.

We look to keep instruction interesting and engaging rather than the constant stops and starts of ‘earned’ reinforcement periods. This older model is not normative and isn’t used in schools, homes or in the community but in Autism Centers – but never, as part of Aurora Behavior Services. It also means ending the 40+ year-old intrusive DTT model which far too many Centers and school 'ABA' programs still employ. It also means ending table time as a primary instructional marker of 'success.'

The Aurora model is Activity-Based just as occurs in many preschools, kindergarten and primary elementary classrooms. Small children need to move; they need to be engaged and fully participatory rather than just responding to adults. Young children must have reinforcers and motivation built directly into the instructional/therapeutic day rather than constantly going back and forth to often include excessive ‘table time.’

To note, at Aurora we certainly provide instruction to children at tables and desks. One reason is that it allows for opportunities for much more concentrated 1:1 instruction when that is needed. Another reason is that the reality is that to be successful in school (home and other settings, too), children must be able to sit in a room of kids, focus on and learn from the teacher.

In this way, 1:1 at a table can be its own therapeutic goal. But at Aurora, supervisors carefully monitor table/desk time to ensure that this time is limited and able to effectively shaped over time. Our Registered Behavior Technicians (RBT) are also sensitive to this dynamic and are well trained towards keeping kids moving and engaged.

Our always child centered Activity-Based model of using instructional ‘centers’ is individualized, or differentiated, for each child. As one straightforward example, consider a station focused on learning and recognizing colors. Using largely the same materials, we will break it up using the model of ‘Some,’ ‘Most,’ and ‘All.’

‘All’ kids can learn to point to colors as requested. For children with less spoken language, we use ‘informational PECS’ to give them a way to respond to questions. ‘Most’ children should be able to recognize a specific color across different stimuli (i.e., a toy car v. a crayon) and point to the correct word for the color. ‘Some’ kids will be able to recognize and write out different colors on worksheets and select out specific colors from larger mixed groups. We’ll also add other resources such as using markers on an easel which we find many children enjoy.

We do not believe in demarcating children between ‘high’ and ‘low functioning’ since, for one, calling a child ‘low functioning’ may automatically and about always incorrectly infer the child’s ability to learn thereby limiting what may even be identified and attempted. Instead, our reference is to the spectrum of ‘early’ to ‘advanced learner.’ And an early or advanced learner can be aged 3 or 43.

With this, our goal is to identify and build upon the strengths and interests of each child with the intent to move them further along that learning spectrum. Autism can also be considered a ‘Crisis of Instruction.’ That is, kids who may initially present as earlier learners may be so more related to previously inadequate assessments, learning and behavior instructional strategies. At Aurora, nothing is assumed and no pre-existing limits exist.