Autism 24/7

A Family Guide to Learning at

Home and in the Community
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 About the Authors

Andy Bondy, Ph.D., has over 35 years experience working with

children and adults with autism and related developmental disabilities.
For more than a dozen years he served as the Director of the Statewide
Delaware Autistic Program. He and his wife, Lori Frost, pioneered the
development of the Picture Exchange Communication System (PECS).
Based upon principles described in B.F. Skinner’s Verbal Behavior, the
system gradually moves from relatively simple yet spontaneous mand-
ing to tacting with multiple attributes. He designed the Pyramid Ap-
proach to Education as a comprehensive combination of broad-spectrum
behavior analysis and functional communication strategies. He is the
co-founder of Pyramid Educational Consultants, Inc., an internationally
based team of specialists from many fields who annually train and act
as consultants for thousands of people around the world.

Lori A. Frost, M.S., CCC/SLP, is a speech/language pathologist

certified by the American Speech-Language-Hearing Association. She
has over 25 years experience working with children with limited com-
munication and severely challenging behavior. She is co-developer
of the Picture Exchange Communication System and coauthor of the
PECS Training Manual, 2nd edition. Ms. Frost is cofounder of Pyramid
Educational Consultants, Inc. She has led regional, national, and
international conferences and workshops. She consults to numer-
ous schools and programs worldwide regarding the development of
functional communication skills for children and adults with autism
and related disabilities.
 To the many children, families, and professionals
for the many lessons they’ve taught us.

In particular, Lori wishes to thank Tom Layton, Ph.D.,

and Andy wishes to thank Marilyn Erickson, Ph.D.,
for their many years of guidance during
our years of graduate training.
 Table of Contents

Introduction .......................................................ix

Chapter 1 Setting Goals at Home .............................................

Chapter 2 Using Motivational Strategies to Build

Successful Change ................................................. 

Chapter 3 Important Communication Goals in and

around the Home ..................................................

Chapter 4 Creating Natural Opportunities for Learning ........ 

Chapter 5 Teaching Strategies for the Home

and Community ....................................................

Chapter 6 Dealing with Common Errors ................................

Chapter 7 Dealing with Difficult Behaviors............................

Chapter 8 Evaluating What You Are Doing ..........................


Chapter 9 Putting It Together in the Neighborhood .............

Forms & Checklists .........................................


Bibliography....................................................


Index .................................................................

 Introduction

When Becky was a year and a half old, she was not interacting with
her parents or her brother as expected and she had yet to say a word. Soon,
she was formally diagnosed with autism. Now Becky is almost 5 and has
been attending an excellent educational program designed to help children
with similar educational and developmental needs. The school program is
based upon the principles of learning developed within the field of applied
behavior analysis. It places a strong emphasis upon developing communi-
cation and learning skills typically seen in preschoolers. Becky’s parents,
George and Myra Engler, are proud that she has made excellent progress
at school and pleased with the lessons her teachers have taught her.
George and Myra have studied the teaching strategies recommended
by their daughter’s school program. They spend many hours each week
arranging for Becky to practice the skills taught at school. Despite their
daughter’s progress, however, including Becky within the normal routines
of family life is problematic. Up until now, they have tried to meet Becky’s
everyday needs directly—often anticipating what she wants, avoiding
situations that are stressful to her, and trying to use the materials they’ve
observed the teachers using at school. But weekends are becoming too
difficult for the family. Becky does not enjoy noisy, public places such as
supermarkets or the mall. She doesn’t enjoy watching her older brother
play soccer or skateboard. She runs to her room whenever visitors, includ-
ing relatives, come to the house. Sometimes Myra and George wonder if
they are supposed to convert their home into a school so that all routines
are familiar and comfortable for Becky.
Z  Introduction

Myra and George have decided that Becky needs to learn to be a full
participating family member and are looking for ways to accomplish this
goal. This book is dedicated to families like the Englers who are seeking
to help their children with autism and related disabilities fully integrate
into the routines of a family within and around the home.

During the past few decades, effective strategies have been devel-
oped to help children with autism learn many crucial skills. (See, for
example, Right from the Start by Sandra Harris and Mary Jane Weiss.)
For many young children with autism, learning to communicate with
their parents, peers, and teachers is a daunting challenge. Important
strides have been made to help these children learn to speak or to use
other modalities to communicate. Children with autism often have
difficulty in imitating the actions of their parents and siblings. Here,
too, great progress has been made in developing strategies to teach
imitation, and then to use this new skill to acquire other skills.
Still, Becky has difficulties with communication and imitation
skills. She also has problems in acquiring skills everyone thinks of as
“natural” for toddlers and preschoolers—playing with toys, engaging in
imaginative play with friends, acting as “mommy’s little helper” when
she is doing common household chores, and learning to have fun out
in the community. Going into her neighborhood— whether to shop,
visit doctors and other specialists, or play in the park—has become
a stressful event for her and everyone in the family. Most children
seem to enjoy “free time,” but Becky spends it in ways that often lead
to serious behavior problems or “shutting down” in a manner that is
difficult to get her out of. Sometimes, moving from room to room or
activity to activity, or simply changing who is currently taking care of
her causes Becky to loudly protest.
If your child is like Becky, your family may be experiencing some
or all of the same frustrations related to integrating your child into
your family life. If your child is older, you may have other difficulties,
perhaps related to delays in acquiring self-help skills. You may worry
that, unless your child masters these skills, she will continue to need
intensive parental involvement, thus limiting the extent to which she
will be able to enjoy her adult years.
This book is designed to help all families of children with autism
spectrum disorders overcome the challenges that keep their family life
from running as smoothly as they would like. In the next chapters, we
 Autism 24/7

ZK

will provide examples of how George and Myra, and the families of
other children with autism and related disabilities, can:
■ effectively teach their children to participate in impor-

tant as well as routine family activities at home and in the

neighborhood;
■ select appropriate skills associated with the routines of

home life as well as communication and social skills;

■ learn how best to use a variety of strategies, including

many that are visually based, to help children communi-

cate and to better understand our efforts to communicate
with them;
■ learn how we can help motivate children to learn often

complex lessons while participating in home- and com-

munity-based routines;
■ alter and expand goals over time so that the children can

continue to demonstrate new skills. To accomplish these

goals, we will describe teaching strategies that parents
and other family members can successfully use with their
children;
■ minimize errors over time, since all learners occasionally

make mistakes.
Our hope is that we can show that it not necessary for parents
to convert their homes into a school. We are confident that children
with autism spectrum disorders can effectively learn in all parts of
the home as well as in the most common and important aspects of
their neighborhoods—from stores to playgrounds. We will use many
real-life examples to help make our suggestions as real and practical
as possible.

The Pyramid Approach to Education

As the statewide director of a public school program for students
with autism, the first author needed a strategy to organize the factors
that teachers, specialists, and parents required to develop effective
educational environments both in and out of school. The strategy
developed to meet this need—the Pyramid Approach to Educa-
tion—has been successfully applied within numerous classrooms
on an international scale. (See The Pyramid Approach to Education
ZKK  Introduction

in Autism by A. Bondy and B. Sulzer-Azaroff, 2002, for a detailed

description.) One indication of its success is the recognition received
by the Sussex Consortium, which is part of the statewide Delaware
Autism Program. With its complete implementation of the Pyramid
model, this program received the 2002 Wendy F. Miller Autism Pro-
gram of the Year Award in recognition of its excellence by the Autism
Society of America (ASA).
The Pyramid Approach integrates broad-spectrum behavior anal-
ysis with a heavy emphasis upon functional communication. It provides
a problem-solving strategy that school staff and parents can follow, both
to achieve effective learning and to address common problems related
to either challenging behaviors or slow acquisition of skills.
The shape of a pyramid is used to help address particular issues
in an organized fashion. As with the construction of a real pyramid,
we begin with certain issues at the base of the pyramid and gradually
build our way up to form a well-balanced, solid model. The foundation
of the Pyramid relates to the principles of learning first espoused by
psychologist B.F. Skinner and demonstrated within the field of applied
behavior analysis. Skinner stressed that the most important aspect of
behavior is how it is functionally related to the environment. He studied
how events that happen before (antecedents) and after (consequences)
a behavior can influence the likelihood that the behavior will occur
again or change in some way.
Next, the four base struts of the Pyramid deal with issues associ-
ated with “What to teach.” These topics include:
a. a focus on functional skills and objectives in many dif-
ferent environments,
b. motivational factors, with a stress on using powerful
reinforcement systems,
c. functional communication skills and critical social skills,
and
d. challenging behaviors, which we refer to as “contextu-
ally inappropriate behaviors.”
Once these core issues are in place, then we turn our attention to
issues related to “How to teach.” These factors are organized around
four key areas:
a. generalization, which includes systematically planning
to assure that the student can apply various skills in a
broad and sustainable fashion,
 Autism 24/7

ZKKK

b. designing effective lessons that may differ in terms of

their simplicity or sequence or in terms of whether they
are teacher- vs. student-led,
c. teaching strategies that may involve the use of prompts
and how to eliminate them, as well as how to use feed-
back alone (“shaping”) to achieve learning, and
d. planning to minimize errors and knowing how to react
when the student makes errors.
Finally, we evaluate the effectiveness of our efforts and thus must
address issues related to data collection and analysis.
It is important to understand that when this model is taught,
everyone—regardless of their personal, educational, or teaching his-
tory—learns its elements and how to implement them in the same
sequence. That is, staff and parents essentially undergo the same
training, although the professional training of many staff will permit
a deeper analysis of certain issues. The goal is to permit school person-
nel and parents to communicate with each other in a manner that will
yield the most effective teaching environments for the children with
whom we are all concerned.

How This Book Is Organized

We have organized the topics in this book to follow the basic
sequence of questions posed by the Pyramid Approach. We will try to
avoid overwhelming readers with highly technical terms or jargon,
although we will use specific language to help clarify certain points.
This book will not cover the contents of the Pyramid Approach in
depth—for that goal, please refer to the book previously cited by
Bondy & Sulzer-Azaroff. You may also wish to refer to the study guide
that accompanies that book (Study Questions, Laboratory, and Field
Activities to Accompany the Pyramid Approach to Education in Autism,
Sulzer-Azaroff, Fleming & Mashikian, 2003).
This book will explore issues that parents like the Englers can
take advantage of to successfully teach their children skills that are
important at home and in their neighborhood. We will point out that
while teachers and parents may use similar teaching strategies, there
are aspects of home and community that are unique and that offer
special opportunities when working on important skills. These skills
ZKX  Introduction

will include many functional ones that children need to become com-
petent and independent while living at home, as well as skills needed
to successfully navigate in the outside world.
We will first consider factors that will help parents choose goals
that are reasonable and attainable, both in and around the home. We
then will describe ways to help motivate your child to learn skills that
you have found to be important. Some children with autism spectrum
disorders may be able to actively help choose what is important for them
to learn, but there will be times when you will need to help convince
your child that a skill you pick is truly important! We will then focus
on communication and social skills that will have lifelong influences
regarding how your child interacts with people within your family and
the community at large. Next, we will look at the many opportunities
available within your home to help create effective lessons that will
last throughout your child’s life. We will continue with a discussion
of teaching strategies that can be used by parents and other family
members, and then focus on ways to react when our children make
mistakes or simply don’t do what we expect them to do. Since no one
can guarantee that a particular teaching strategy will work, we will
review ways that parents can collect information that will help them
evaluate the effectiveness of their lessons. Finally, we will take an
extensive look at how your child can best achieve the skills necessary
to integrate into the neighborhood and community.
It is our firm belief, backed by our experience and considerable
research performed by scores of people over many years, that children
with autism spectrum disorders live most successfully and happily at
home and in the community when they are engaged in functional ac-
tivities, have a clear system of reinforcement in place, and have support
for their communication skills, both expressive and receptive. When
these three critical factors are in place, significant behavior manage-
ment problems are greatly reduced and children learn new skills in
ways that are efficient, practical, and enduring.
 1 Setting Goals at Home

Kris was a school psychologist at a renowned public school program

for children with autism. He was very sensitive to the stress levels of
parents and felt confident that if he could reduce stress, then the children
were more likely to show the skills they had acquired at school in all set-
tings. Kris was comfortable with the goals that teachers and specialists
typically recommended for the very young, incoming students—orienting
to the teachers and their instructions, improving their communication
skills, and reducing the inappropriate behaviors they often had when
they entered the school program.
Kris typically interviewed parents about the impact their child
had on their home life. While interviewing Amy and Mark Baskel about
their typical grocery shopping patterns, he was surprised to learn of
a style he had never dreamt of. They calmly told him that one of them
would usually shop at one o’clock in the morning. Kris asked if this had
anything to do with special sales at that hour. The parents said that
they picked that hour because one of them could shop while the other
stayed home, most confident that their three-year old son, Billy, would
be asleep! Kris then asked if they had considered taking their son to the
grocery store with them. They looked at each other, and then simply
laughed. A few weeks later, Kris asked the classroom staff to take Billy
to the supermarket. Upon their return, they told Kris about Billy’s loud
tantrums throughout their trip to the store and exclaimed that they now
understood why the Baskels had laughed—and that they now knew a
critical skill for Billy to learn.
  Setting Goals at Home

How Do We Choose What to Focus On?

How do we help parents determine what’s important to teach
to their children at home and in their neighborhood? As we can see
from the above example, teaching Billy to accompany his parents to
the supermarket would permit them to shop at a more normal hour,
and also greatly reduce their stress levels. So, one important way to
determine what we should teach is to identify what typical family
patterns are most disrupted and thus lead to substantial stress for all
members of the family.
The other major way to pinpoint what we should teach is to de-
termine what skills are most important for a child to learn so he can
become less dependent
on adults. When chil-
dren are very young,
parents and ot her
caregivers expect to
do many things and
provide great support
for these family mem-
bers. But as children
grow, we increasingly
expect them to partici-
pate more fully in many
routines at home and
in the neighborhood. If
this change does not occur, parents’ levels of involvement remain very
high. So, you will want to consider the various ways that your child’s
lack of skills leads to additional stress relative to what you would expect
of other children at the same age. For example, if your teenage son
cannot help in any of the laundry routine, then you will be spending
many extra hours every week doing his laundry, just as you did when
he was two years old.
On the other hand, you may experience stress because of the
disruptive behavior your child displays either at home or in neigh-
borhood settings. In our example above, while Billy’s parents would
not expect a great deal of independence from any three-year-old in
a supermarket, they were concerned with the tantrums they had to
 Autism 24/7



deal with when they took their son shopping with them. As we shall
discuss in Chapter 7 on “Dealing with Difficult Behaviors,” sometimes
a problematic behavior is related to your child’s lack of skill in some
area, but other times your child may well have a skill but not use it in
certain situations.
Your first step, therefore, in figuring out how to improve your
family life is to consider critical areas in which your child either has:
a. limited skills, or
b. significant problem behaviors that you feel cause ongo-
ing stress within your family.
For issues that involve skills related to communication, please refer
to Chapter 3 for more details about functional communication goals.
We’ve provided the form below (Table 1-1) for you to fill in with
other members of your family. We suggest you limit your answer to
three or four items in each category so that you will be able to create a
workable list of goals. Right now, we are only concerned with finding
areas that are causing stress within the family. Later, we will describe
how you may best work on teaching certain skills (Chapter 5) and
handle behavior management problems (Chapter 7).

Table 1-1  Skill Deficits and Problem Behaviors

Location Skill Deficit Problem Behavior

At home Example: Cannot tie Example: Screams for
shoes help
1. 1.
2. 2.
3. 3.
Neighborhood Example: Cannot cross Example: Opens other
streets people’s mailboxes
1. 1.
2. 2.
3. 3.
Community Example: Cannot buy Example: Runs through
Settings snacks independently the mall
1. 1.
2. 2.
3. 3.
  Setting Goals at Home

Other Methods for Determining What to Teach

Focusing on the most stressful situations may seem like a natural
way to prioritize what to teach at home. However, your child may not
have many problem behaviors or you may feel that his skill deficits
interfere with home life more than the presence of problem behaviors.
So, in addition to reviewing critical behaviors, you should also look
more broadly at important skills to teach. There are two other sys-
tematic approaches that will help you discover what you should teach
at home. One system relates to the time of day when problems occur,
while the other focuses on the area of the house (or the location in the
community) where your child experiences difficulties.

The Time-Based Approach

When we follow the time-based approach to identifying skills
to teach, we ask parents to describe common sequences of events in
the course of the day and then cluster activities by when they occur.
For example, what are the routines for school-day mornings? Often,
parents will describe a sequence similar to that shown in Table 1-2—

Table 1-2  Sample Schedule

7:00 AM Wake Billy

7:03 Take Billy to the bathroom and use toilet
7:07 Go back to bedroom and help Billy take off his pajamas
7:11 Help Billy put on his school clothes and sneakers
7:20 Go to the kitchen and turn on TV with favorite video
running
7:23 Eat cereal (without milk!), drink juice, eat 5 grapes while
watching TV
7:40 Go to bathroom, wash hands and face, brush teeth
7:50 Go to living room and watch TV (cartoons)
8:05 Get coat and backpack
8:10 Leave house and get on bus
 Autism 24/7



starting with when they wake up their child to the time when he gets
on the school bus.
We would continue to ask for a description of other time-chunks,
such as:
1. The block of time in the afternoon after the child comes
home from school;
2. Times associated with preparing, eating, and cleaning
up after dinner;
3. Early evening recreational activities;
4. Preparing for and taking a bath;
5. Getting ready for and going to bed.
Of course, on weekends and holidays, families typically identify
other significant blocks of time (see Table 1-3 for examples of common
weekend family-based activities). When you make this type of timetable,
be certain to indicate whether it relates to everyday or special routines.
Notice that these examples focus on routines at home. It will be
helpful to start with a full description of your life at home, but you will
eventually want to write down routines for community activities and
events. It is possible that your family has a routine or frequent commu-

Table 1-3  Detailed Schedule for Saturday Mornings

(Make time adjustments for Billy’s actual wake-up time.)

7:00 AM Wake Billy

7:03 Take Billy to the bathroom and use toilet
7:07 Put in Billy’s favorite videotape or DVD while he plays in
his room in his pajamas
7:45 Help Billy put on his play clothes and sneakers
8:00 Go to the kitchen and turn on TV in kitchen with favorite
video running
8:10 Eat cereal (without milk!), drink juice, eat 5 grapes
8:30 Take Billy to bathroom, wash hands and face, brush teeth
8:45 Go to living room and watch TV (cartoons)
9:30 Let Billy wake up Dad and jump on his bed!
9:40 Get Billy to help Mom bring laundry to basement
  Setting Goals at Home

nity outing on many school nights. These could include visits by tutors or
other specialists (e.g., the piano teacher), trips to a dance class, or Scout
meetings. For such events, be sure to note the people your child interacts
with as well as the activities in which he is expected to participate.

The Area-Based Approach

Another way to identify important skills to teach is to review
all areas in and around your home. When we follow the area-based
approach, we talk to parents about common activities and routines in
particular areas of the house. In addition to asking questions about
common expectations for the child, we would ask questions about
particular areas of the house that currently cause significant stress.
Sometimes these areas are places in the home in which some fam-
ily members like or need to engage in particular activities that your
child does not participate in. For example, if you need to spend time
in the kitchen preparing dinner, what will your three-year-old do at
the same time?
Table 1-4 includes a list of common areas in a home or apartment
and activities that families often do within those areas. Using the
blank form provided on page 148, please list the typical activities that
members of your family engage in. You may want to make a special
note if you expect your child to do something other than what other
people are doing. For example, you may be cutting vegetables for
dinner but you’d like your child to use a coloring book while sitting
at the kitchen table.
Consider what you expect of your child while in the kitchen, the
living room, his own bedroom, the basement work-area, and so on.
Be sure to consider what you expect your child to do while you are
watching TV. Parents may hope that their child will also watch TV, but
ask yourself if you should reasonably expect your child to watch the
same shows as you do. That is, if Mom likes to watch the 6 o’clock local
news, what will she expect her son to do in the living room at that time?
Are there toys that he can play with, or are there other recreational
materials on hand? At times, we all have vague expectations for our
children—“I’d just like him to leave me alone for 15 minutes and not
to get into trouble!” However, most young children with autism and
related disabilities have significant limitations in how well they can
occupy themselves in a manner that we would find acceptable.
 Autism 24/7



Table 1-4  Areas of the Home and Common Activities

Area of home/
Common activities
apartment
Kitchen Preparing food, setting table, eating, cleaning
up after a meal, washing dishes, putting dishes
away, putting groceries away, sweeping the
floor, getting food items from the refrigerator or
cupboards, talking on the phone, listening to the
radio, watering plants, feeding pets
Living room Reading books or magazines, sitting and talking
to other adults, vacuuming
Dining room Setting the table, eating meals, cleaning up,
dusting or waxing furniture, cleaning floors
Bedroom Making bed, selecting clothing, sorting clothing,
vacuum room, dusting room, reading books,
listening to music, feeding fish, watering plant
Bathroom Filling bathtub, starting shower, bathing, using
toilet, brushing teeth, applying deodorant, shav-
ing, cleaning mirror, washing sink and bathtub,
cleaning toilet
Rec/TV room Watching TV, playing DVD, playing music, play-
ing card/board games, dusting and vacuuming,
sorting and putting away books, videos, DVDs
and CDs
Laundry area Sorting laundry, loading and running washing
machine and dryer, folding laundry, ironing
Garage Sorting tools, sorting outdoor toys, putting toys
away, cleaning car, working on building projects

Kitchen Activities
Let’s think about activities in the kitchen. Parents prepare,
serve, eat, and clean up meals. Another common adult activity in
the kitchen is talking on the telephone. We want to think about how
a child can help us with activities as well as consider what the child
can do while we are engaged in some important activity and do not
want to be interrupted.
  Setting Goals at Home

What can we expect a five-year-old to do in the kitchen? Many

people would simply wait for the child to get older—quite frankly,
we don’t really expect much of typically developing five-year-olds
in helping prepare for dinner! However, we know that children with
significant learning needs require more time to learn many different
skills. So, if we want the child to be able to help us like a typically de-
veloping ten-year-old when he is ten, then we must start far earlier than
age ten to teach him to help out. We encourage very young children
to start participating in household routines in order to provide ample
opportunities for them to learn the required skills.
To help set the table, we can reasonably expect a five-year-old to
put out the napkins—at first, maybe simply on the plates; over time,
next to the plates; still later, folded and under the fork. Instead of asking
the child to handle glassware, we could have him put out small paper
cups. In teaching him to place the silverware on the table, we could
start with the spoons and use plastic knives if we think that is safer.

Bedroom Activities
Using this area-based approach, let’s review what we can expect
a child to do in his own bedroom. Usually, we expect children to get
undressed and dressed, put away and retrieve clothes, make the bed,
play with toys and clean up afterwards, possibly use a computer or au-
dio/video equipment, and go to bed. Here, too, we believe that children
with autism should be encouraged to participate in these routines as
early as possible, using age appropriate goals.
In general, we advise that you anticipate what you are likely to
expect of your child when he is three, five, or even ten years older. Be as
specific as you can with particular skills. (See Chapter 5 for examples of
how to write a task-analysis for complex skills.) Next, try to determine
how much of that skill set your child can currently do. Can he do any
of the steps by himself? What type of help does he now need for these
skills? Next, think of how you can simplify the task so that it is more
age appropriate for your child. For example, you may want to involve
fewer steps now than he’ll need in three years. You may want to modify
the materials involved so that they are more durable, lightweight, or
safer to handle, or make similar alterations. It is important to consider
the types of communications issues that can arise within each activity
as well, and we will take a more detailed look at some of these goals
within Chapter 3.
 Autism 24/7



For example, while we may not expect a five-year-old to pick

out his clothes and put each item on independently, we would want
to teach him to participate as fully as possible in getting and putting
on his clothes. Choosing clothes can involve having him follow your
instructions regarding what item to wear (e.g., “Pick up your pants”
vs. “Pick up your shoes”); details about the item (e.g., “Take the blue
shirt” vs. “Take the red shirt”); where to find the clothes (e.g., “Open
your dresser” vs. “Open the closet”); and so on.
If your child has difficulties understanding language, you can
arrange to teach him the same skills without giving verbal instructions
like those we just described. For example, you can set out on his bed
his father’s biggest sweatshirt, a shirt from a Barbie doll, and his own
shirt. There is no need to say, “Take your shirt.” You merely need to
encourage him with gestures to take a shirt. If he chooses the wrong
shirt, simply encourage him to put it on. When that fails, immediately
encourage him to pick up his own shirt. It is not necessary to have him
immediately take his shirt off and try to choose again. Instead, the
next time he needs to choose—most likely the next morning—repeat
the choice, and if he chooses correctly, praise him for his cleverness
while helping him put on his shirt. At other times, you can offer him
choices between huge sneakers, baby doll shoes, and his own sneakers
or other similar comparisons.

Prioritizing Goal Setting

Once you have identified a number of skills and behavior prob-
lems that you want to address, you will need to prioritize your goals.
Clearly, you will not be able to devote concentrated time and effort
to everything. You could pick the most difficult problem behaviors to
start, but it is likely that these are behaviors that have a long history
and may involve many steps to change. We advise focusing first on the
skills that would have the most dramatic effect upon your family life if
your child acquired them. Teaching your child skills also will involve
the use of powerful reinforcers and this will help keep a positive spot-
light within your family. (See Chapter 2.) You may want to give added
weight to skills that will affect several family members, thus assuring
that everyone in the family will have a chance to help promote new
skills at home. For example, teaching your child to play quietly with
  Setting Goals at Home

toys or other materials will benefit everyone in your home because then
your child can always have something fun to do when others need to
do something that does not directly involve him.

How Can We Write Reasonable Goals?

Once you have selected some goals, you will want to write them
down so that they are clear to everyone else at home. Try to keep the
descriptions relatively simple and straightforward, but at the same time,
descriptive of an action. For example, your first impulse may be to write,
“Joey will be happy playing” but there will be many different meanings
of “happy” within your home. Instead, you could write, “Joey will play
with his cars for 10 minutes without help.” This type of description is
something that everyone can readily agree upon and directly measure.
In fact, your aim is to write a description of the goal in such a way that
everyone can count or measure the action in the same way.
Here are pairs of potential goals within your home. Please look
at each pair and see if you can tell which ones lead to direct measure-
ment and which ones are too vague or indirect:
a. Zach will dress himself quickly.
b. Zach will put on his underwear, socks, pants, shirt,
shoes, and belt within 10 minutes of being told to get
dressed in the morning.

a. Maria will hit with her fist no more than 2 times per
week.
b. Maria will be less aggressive.

a. Phillip will wash his clothes.

b. Phillip will take his laundry basket to the basement, put
his clothes in the washing machine, add soap, set the
dial correctly, and start the machine within 10 minutes
after seeing “laundry time” on his written schedule.

As you can readily see, in each pair, one description is too vague
to lead to a direct way to measure or count the action, while the other
one is narrow enough to permit two (or more) people to easily agree if
the action occurred. Yes, it takes a bit more time to write goals in this
 Autism 24/7



detailed fashion, but you will end up avoiding many arguments as to

whether or not something important happened.

How Many Lessons at Once?

We think it is a good idea for parents to remember to focus on
only one lesson at a time. For example, your goal might be to teach
your child to pick out his clothes by listening to your instructions. If
so, after he picks his clothes, you should help him quickly put them on
rather than starting another lesson on how to put on a shirt. When you
want to teach him how to put on a shirt, simply give him the shirt you
want him to wear rather than adding another layer (such as choosing
the shirt) to the lesson. As your child’s skills improve, you can combine
tasks, such as having him listen to your instructions as well as putting
it on by himself.
We do not mean that children cannot do more than one thing at
a time. For example, we can encourage a child to talk about what he is
putting on while getting dressed, but it will be most effective to decide
ahead of time whether you are focusing your attention on what he is
saying or how he is getting dressed. If you are trying to give feedback
on both skills, you are likely to confuse your child.

Should We All Do the Same Thing at the

Same Time?
Many families enjoy spending time together while in the family
room or living room; often, this time is centered around the TV. While
some children with autism and related disabilities like to watch particu-
lar cartoons or favorite videotapes, they may want to watch the same
show too often for everyone else in the family to enjoy. What can they
do while their family is watching other shows or videos? Although you
may hope that your child will enjoy what you watch, achieving that
goal in the near future is probably unlikely. Therefore, you should plan
for your child to do something else when other family members are
watching a TV program he does not enjoy. If your child needs to learn
a new skill in order to do something else, then this is yet another thing
to add to your list of skills to teach your child.
  Setting Goals at Home

One family knew that their daughter enjoyed the sound and music
on her favorite movie video, so they bought the CD of the music from
the movie and taught her to listen with headphones. They then taught
her to sit in the family room listening to her music while everyone else
watched TV. At first, this worked for only 5 minutes at a stretch, but over
time, they were able to increase that time to about 30 minutes. Another
family noticed that their son liked to build complex designs with his
Lego® set. They reserved his Lego playtime for when they wanted to
watch TV. Then, they would put the blocks out on a table in the room
so that they could generally watch what he was doing without having
to pay attention to him moment by moment.
To find something your child can do while the family is otherwise
occupied, observe what he likes to do independently or start to teach
him some quiet but independent activities. Remember, teaching a child
to engage in appropriate activities independently for significant periods
of time will be a gradual process, requiring great patience from your
family. It may take a full year to progress from 2 to 3 minutes of quiet
time to 20 to 30 minutes—and your end goal should be tempered by the
age of your child. Rarely do 4-year-olds play alone and constructively
for 30 minutes or more.
In addition to thinking about how to occupy your child when
everyone is gathered in the living room or family room, consider the
other areas of your home where you spend significant amounts of time
or that you use on a consistent and frequent basis. For example, you may
not spend a great deal of time in the laundry area, but doing the wash is
something that occurs over and over. Here, too, you can choose between
teaching your child to participate with you in some manner or you may
want to teach him something to do when you need to spend time here.

How Is a Home Different from a School?

If your child receives special education, a team has worked
with you to develop an Individualized Education Program (IEP). In
general, these plans are constructed after a specialist has reviewed
the skill deficits and strengths your child displayed on some standard-
ized assessment(s). From this list, team members most likely selected
certain areas that needed to be addressed and noted them in general
terms. For example, a teacher may have suggested that your child needs
 Autism 24/7



to work on “attending skills” and on “knowing colors and shapes”;

a speech/language pathologist may have proposed goals related to
learning receptive and expressive communication skills; another spe-
cialist may have suggested that your child needs to improve his sense
of balance. From these general descriptions of skills your child needs
to learn came more specific descriptions of lesson plans detailing how
the staff would teach specific skills. But how can parents best address
their child’s skill deficits in the home?
Rather than trying to convert your home into a school, we suggest
that you examine your home for opportunities to work on the same set
of skills that staff are trying to address at school. The routines you’ve
already identified earlier in this chapter will become a great source of
teaching opportunities. Below are some examples of how you can look
at common routines to find teachable opportunities throughout your
home and across the day.
By examining the routines in the laundry area you can find op-
portunities to work on many of the basic skills your child is taught at
school. For example, you can teach your child to sort or match clothes
by: a) type (shirt vs. pants), b) size (large, medium, small), c) color
tone (lights vs. darks), d) specific colors (red vs. blue), e) specific
people (the child’s vs. Dad’s or Mom’s items), or even f) clean versus
dirty. When sorting, you begin with a large pile of clothes (possibly in
a laundry basket) and teach your child to go through the items, plac-
ing the t-shirts in the washing machine but the socks and pants into
another basket. When matching, you can place some light clothes in
one basket and some dark items in another and guide your child to
place the remaining items in the proper baskets. You can add various
communication goals within these activities (e.g., instruction follow-
ing, naming items or attributes, asking for items, etc.), but that is not
mandatory. In fact, learning the steps of the routine should be taught
before working on these communication goals. (See Chapter 3 for
guidance on communication goals.)
It may be difficult for young children to take wet clothes out of the
washing machine and put them into the dryer but you can teach an in-
termediate step, such as having them help place some small items from
a basket into the dryer. After the clothes are dry, you can again work
on sorting or matching, or you can work on learning how to handle the
clean clothes—folding them, putting them into baskets, taking them
to the bedroom, and putting them neatly into dressers. You can adjust
  Setting Goals at Home

the degree of assistance at each step (we will describe specific teaching
strategies in Chapter 6) according to your child’s current skill level.
For example, you may complete some of the folding while leaving the
last step for your child to complete. Or, you can put two socks next to
each other and simply have your child place one atop the other; later,
you can add the goal of having your child find the matching sock that
you pull out of the pile.
Look at Table 1-5 to compare lessons that may be taught at school
but also could be taught at home. As you can see, some of the materials
you might use for teaching at home are the same as materials used at
school, and some are different.

Table 1-5  Comparing Lessons at School and Home

School Lesson Home Activity Home Materials

Expressive Name common Pets, toys, clothes, cutlery,
Labeling areas, items, activities TV, bed, table, foods
Receptive Get or point to com- Pets, toys, clothes, cutlery,
Identification mon items; put object TV, bed, table, foods
with common items
Direction “put on ” Hug a toy or pet; shake
Following hands or kiss people;
“Give it to ” push or put away a toy
car; scribble with or pick
up a crayon
Sorting Separating items into Cans on one shelf/bottles
groups on another; dolls in one
box/toy cars in another;
socks in one drawer/
shirts in another; pots in
one cabinet/paper bags
in another
Matching to Putting similar items Laundry: put clothes in
Sample together piles by family member,
size, color, type, etc.
Kitchen: put like utensils,
dishes, cups, pots, etc.
together
 Autism 24/7



Review
The first element of the Pyramid Approach involves issues re-
lated to the functional activities we want our children to develop over
time. Functional activities include skills that will serve the individual
throughout his lifetime and lead to greater independence in different
settings. In order to help your child develop skills that will last a life-
time both in and around a home, you will need to create lessons that
are practical and that function in these settings.
To determine what is important to teach, consider your child’s
skill deficits as well as the problematic behaviors that lead to stress
within the family. Review your routines both by the time of day and
the location within your home where activities occur. Be prepared
to spend several years to help your child acquire skills that will lead
to greater independence. In part, this goal can be accomplished by
considering how your child can participate in many activities and
routines throughout the day and within all areas of your home. We
will continue moving through the elements of the Pyramid Approach
in the following chapters. We next focus our attention on how to mo-
tivate your child to learn these new skills before we address how to
teach them step-by-step.
 Using Motivational
2 Strategies to Build
Successful Change

Donna Martin loves to ride in the family car. She likes to go to

fast-food restaurants but she does not like going to the mall. Her parents
usually first take Donna to get a quick meal before going to the mall. Still,
every time they park the car in the mall, Donna launches into a routine
litany of complaints about how much she dislikes the mall and her behav-
ior escalates until her parents take her out of the mall. Donna’s parents
have set a goal for their daughter to tolerate trips to the mall. However,
they feel at a loss as to how to motivate Donna to enjoy going with them
to the mall and other places in the community.

Like many parents, the Martins have tried many ways to motivate
their child to do things she isn’t eager to do. Most of their attempts have
been fruitless. One unsuccessful strategy that parents frequently try is
appeasing the child by buying anything she wants. Of course, on the
next visit to that same store, the child will expect to receive whatever
treat was purchased the last time. Another common approach is to
temporarily remove the child from the store, wait for her to calm down,
and then reenter the store. But here, the child learns that a tantrum
may lead to leaving or momentarily escaping from the store, which
may be precisely what she wants. And when she reenters the store,
there often are treats to help persuade her to stay calm.
Clearly, it’s one thing for parents to set a goal for their child to
achieve, and another thing to help the child achieve that goal without
inadvertently teaching her something unintended. When children are
  Using Motivational Strategies to Build Successful Change

very young, we are used to helping them perform many tasks that we
hope they will complete independently as they grow older. However,
for some children the problem of motivation remains acute for some
time. For example, if a child’s parents have always tied her shoes, when
they now expect her to do so on her own, she may be thinking, “Why
should I do this myself? You’ve always done such a fine job of tying my
shoes!” The key to getting your child to learn your lesson is to ensure
that she is motivated to achieve that goal.

Reinforcers
How do we best motivate children to learn new skills? Everyone
has observed coaches cajoling their players to “try harder” or urging
them on by shouts and yells. However, the most important leader in
the field of behavior analysis, B.F. Skinner, pointed out that learning
is best achieved by the thoughtful use of certain consequences for
particular skills. We call those outcomes reinforcers—and they are a
teacher’s best friends!
Formally, reinforcers are consequences that result in an increased
likelihood of the same behavior occurring in similar situations. We
often think of reinforcers as rewards, but we need to keep in mind that
reinforcers are highly personalized. What works as a reinforcer for one
child’s behavior may not be effective for another’s behavior.
There are two types of changes that might result in a reinforc-
ing outcome:
1. positive reinforcers,
2. negative reinforcers.
Positive Reinforcers. Positive reinforcers are things or events
that we introduce or add (and hence are considered “positive”) into a
situation. For example, you might praise your child for cleaning up the
table and find she is more likely to do it again. Or you might give your
child time to watch a TV show, read a story, or go outside to fly a kite
together with you, or give her a cookie after she demonstrates a skill
you are teaching her. Each of these might lead to improved learning.

Negative Reinforcers. Other reinforcers are effective because

they take something out of the situation. We call these negative (as in
“take away”) reinforcers. For example, your child might put on a headset
 Autism 24/7



to cope with a noisy mall—reducing the level of noise acts as a reinforcer

for wearing the headset. Or your daughter might scream when you tell
her to clean her room and you then decide to back off and “not push the
issue”—then, after you stop nagging, she completes the task.

Keep It Positive. We advise that you work hard to create as

many positive reinforcers as possible and use them frequently when
teaching your child skills in and around the house. The frequent use of
negative reinforcers is often associated with nagging and threatening.
We prefer for you to aim for the development of new skills through
positive approaches.
You may have observed your child working on a formal lesson at
school (or within an in-home ABA program) and noticed that teach-
ers provided some type of reinforcer following virtually every correct
action by your child. At home and in the community, your aim will be
to design reinforcement systems that permit you to take advantage
of the more natural environment available. We will describe several
ways of using powerful reinforcement systems within your home and
while you are in your neighborhood. For more information about using
reinforcement strategies, including how to figure out which reinforcers
are most effective for your child, please read Incentives for Change, by
Lara Delmolino and Sandra Harris (Woodbine House, 2005).

Taking Advantage of Natural Rewards

Whenever you are considering beginning a lesson, you should
first try to identify reinforcers that are natural to the situation. Natural
reinforcers are those that are commonly associated with successfully
completing some activity. For example, a natural reinforcer to putting
on sneakers is being able to run around outside; putting a CD into the
CD player leads to the opportunity to listen to music; setting the table
leads to eating a meal. In each of these cases, the reward for the task
comes immediately upon completion.
Let’s consider a number of common activities in and around the
home and think about their potential for being associated with natu-
rally occurring rewards. See what rewards you can think about for
the end of the list and then try to add some activities and their natural
rewards for your child and situation.
  Using Motivational Strategies to Build Successful Change

Table 2-1  Areas, Activities, and Related Rewards

Area Activity Natural Reward

Kitchen Cook Eat
Family Room Turn on TV Watch show/videos
Bathroom Take a bath Warm (not cold or hot
water)
Library Take out a book Read on a bench
outside
Playground Climb the slide Slide down
Grandma’s house Give Grandma a kiss Smiles and hugs
The Mall Walking calmly to store Your thought?

What Do We Do When We Can’t Find a

Natural Reinforcer?
While we believe that natural rewards are best to use, they are not
always motivating for children. For example, the primary benefits for
brushing teeth are associated with long-term improvements in dental
health and a lower risk
for dental problems.
The benefit of putting
the open milk carton
in the refrigerator is
associated with less
spoilage (better taste)
over time. These con-
sequences only occur
far in the future and
thus may be ineffective
in motivating young
children to brush their
teeth or put food away.
Toothpaste producers
are aware of this prob-
lem and try to make
 Autism 24/7



their products taste as pleasing as possible. We also may try to make a

special arrangement to bolster the immediate consequences, as when
we say, “When you’re done brushing your teeth, I’ll read your favorite
book to you!”
So, whenever possible, try to arrange for natural outcomes, but
if you think these are too removed in time from the activity, then be
certain to arrange for something rewarding to immediately follow
your child’s completion of the activity. In either case, we will describe
a “reinforcer first” strategy to help your child focus on the natural or
arbitrary reward that she can earn by completing the task at hand.
Here is a list of some activities for which “natural” reinforcers
may be difficult to identify or difficult to bring to bear immediately.
Once again, we hope you’ll fill in the blanks and also add some others
pertinent to your child:

Table 2-2  Area, Activity, and Arbitrary Rewards

Area Activity Arbitrary Reward

Kitchen Put silverware away Watch TV
Family room Shut off the VCR Dad reads a book
aloud
Bathroom Use a towel to dry Play alone in bathroom
hands
Library Walk and look quietly Points toward earning a
book to take out
Playground Takes turns on the Praise and another
slide chance on the slide
Grandma’s house Sit at the table Your thought?

How and When Do We Make Our Child Aware of the

Reinforcer?
As we noted, reinforcers are consequences for certain actions, so
perhaps you think you should wait until you observe your child doing
that behavior before you introduce the reinforcer. It also may seem
natural to start lessons with your instructions or demands. However,
we ask you to think about what happened when you went to interview
  Using Motivational Strategies to Build Successful Change

for a new job. Did you agree to start the job without knowing what your
salary and benefits would be? In all likelihood, you knew exactly what
your reinforcer would be—your salary—for doing the job well before
you started to work. We believe we should interact with our children
in the same manner that we expect to be treated. We refer to knowing
your potential reinforcer before you start the lesson (or job!) as the
“reinforcer first strategy.”
For example, let’s say that Phil hates going to the grocery store
and whines persistently whenever his parents make him go. Let’s
further say that Phil’s parents know that he likes to eat bananas. They
take him to the supermarket, and tell him (or show him) that they are
going to get a banana. They take him directly to the bananas and pick
one out. They then go to the checkout line (hopefully it is empty), buy
the banana, and allow Phil to immediately eat the banana. Then they
go home! This trip was not intended to complete the family’s shopping
needs. It was only done to help teach Phil that he can go to a store and
get something that he likes. Sometime soon, the parents return to the
supermarket, again letting Phil know (via their spoken words or with
visual cues) that they will buy a banana. This time, while they are
walking to the bananas, Mom picks up a box of pasta before picking
out the banana. They take both items to checkout, and allow Phil to
eat the banana just after they leave the store.

Table 2-3  Gradually Increasing Skills and Goals in

the Community

Visit# What to buy Other skills to teach

1 Banana Walk with Mom and Dad
2 Pasta, banana Walk with Mom and Dad
3 Pasta, milk, Walk with Mom and Dad
banana Stand at checkout line
4 Pasta, milk, Walk with Mom and Dad
cereal, banana Choose cereal
Stand at checkout line
5 Pasta, milk, Walk with Mom and Dad
cereal, cheese, Choose cereal
banana Put cereal and cheese on checkout belt
Stand at checkout line
 Autism 24/7



Over the next several trips, Phil’s family gradually adds more
items to the cart before heading to pick up the banana. They also en-
courage Phil to select other items that he likes to buy. Furthermore,
they prompt him to help with some of the items—putting them into
the shopping cart, putting items onto the checkout counter, giving the
salesperson some money, etc. Notice that each trip starts by reminding
Phil about what he will get when he completes the shopping, consistent
with our reinforcer first strategy.
At home, it is helpful to avoid beginning interactions with a de-
mand. For example, do not say to your child, “Go clean up your room
and then we’ll play a game” or “Put the ball away and let’s go inside and
then we’ll look for a movie that we can put into the video machine.” By
starting with the task, you alert the child to the work to be done. You
also may be signaling the end of whatever enjoyable activity the child
is currently doing. If you try starting this way, you may not even get
to finish your sentence! The demand may immediately lead your child
to protest what she has lost or is about to give up. Rather, start with,
“Hey, let’s play a game! Oh, by the way, we need to clean up first,” or,
“Want to watch a video? Great! Let’s put the ball away and go inside,”
or, “Let’s get a book! Remember, we have to walk quietly to the shelf.”
In each case, we began by telling the child what the point, or goal, of
the activity will be and then said how to get that goal.
If your child does not understand what you are saying, you can
show her (via the object or a picture, depending on her level of under-
standing) what she can earn before you visually indicate what task
she will need to complete.

Let’s Make a Deal

There may be times when you feel hard pressed to come up with
the right deal at the very instant you want your child to do something.
In these situations, you may want to remember why you go to work,
even at times when you simply aren’t thrilled with the idea of working!
That’s right—we tell ourselves that if we do our work, we will earn a
paycheck and then we can use the money for something we want later.
That is, we use money in situations where we can’t or simply don’t want
to specify exactly what we are trying to achieve by completing the job.
When we earn money, we can choose what we want when we have a
  Using Motivational Strategies to Build Successful Change

chance to spend the money. For some children, earning money—via

household chores and other responsibilities—is commonplace. But it
only works when the child understands the value of money. If your child
does not yet understand money, it won’t help to simply give her some
when she does a job well. First, children have to learn to appreciate
money by learning why it is useful—to buy things. So, before you use
money to help motivate your child, you must arrange for her to want
to have money.
If you are uncomfortable with using real money at home or in the
community, you may want to use some type of point or token system.
However, just as with money, you must first teach your child the value
of the points or tokens before you try to use them to motivate her.

Teaching the Value of Tokens

To teach the value of the point or token (or real money), start
with a simple activity—one that your child can already accomplish.
At this stage, the goal is to teach your child that you are trustworthy.
When you make a deal, you will hold up your end of the bargain. Let’s
assume your child can sort the forks from the spoons. Have several of
each with you. Before showing them to your child, find out—either by
asking or having your child choose directly—what she would like at the
moment. It may help to offer her a limited range of choices rather than
risk her requesting something you do not have available at the moment
or something that is currently impractical. Whether you present these
choices verbally or visually will depend upon your child’s skill level.
You may want to use a simple visual aid such as the one in Figure
1 or one of your own design. The key elements will include information
about what is to be earned, how much work needs to be done or how
long the job will last, and some way of monitoring progress toward
the goal. You can use pieces of a puzzle (as in Figure 2) or, for some
children, simply have them earn a letter toward spelling out the name
of what they want to earn.
Once the child selects what she wants (remember, reinforcer
first!) put some type of visual symbol representing her chosen reward
on the “work” card that has one open circle on it (or one place for the
puzzle piece, etc.). Then have her do something very simple and very
quick, such as put one fork in one container and one spoon in another.
Immediately give her a token while you praise her hard work. Have her
 Autism 24/7



Figure 1: Token-type reinforcement system

put the token on the open circle.

Since there is only one open cir-
cle, she has now completed the
deal! Have her cash out by giv-
ing you the token that’s on the
card and immediately give her
whatever she was working for.
She does not have to ask for that
item again because she already
indicated what she wanted (but
don’t stop her if she does ask on
her own). Practice earning and
redeeming tokens with this and Figure 2: Puzzle-type reinforcement system
other simple tasks until she independently gives you the token when it
is placed on the card. You also can add a small amount of work required
to earn that single token. At that point, your child will have shown you
that she understands that the token leads to the reward.
You then can stretch the deal by placing two open circles on the
card. You can stretch this two-circle deal by having her do somewhat
  Using Motivational Strategies to Build Successful Change

more work for the first t oken b ut s lightly l ess w ork f or t he s econd.
When she seems to catch on to the fact that she can cash out when
both circles are full, then you can gradually add a third, fourth, and
fifth circle (see Figure 3 for an example). We often stop when we have
reached five circles and continue to stretch how much work the child
needs to do for each token rather than keep on adding circles, although
for some children, adding circles will work just fine. For example, if you
are using the system to help your child clean up her toys, at first you
may want to give her a token after each toy is put away. However, by
the time you are using several tokens, you can wait until she puts two
or three toys away before giving her the next token. While you want
to gradually increase how much “work” she will do for each token, do
not make the demand so high per token that she quits!
In general, we do not recommend taking a child’s tokens away
once she has earned them. When managing some behaviors, however,
it may be useful to start out with a number of tokens and then gradually
remove them. See the section on “Fines” in Chapter 7 for information
on this strategy.

Figure 3: Partially completed token card

 Autism 24/7



Remember, we are not saying that you should use money or tokens
all the time. In fact, you may only need to use them infrequently at
home or in the neighborhood because there should be an abundance
of natural rewards available. But if you teach your child to use tokens
properly, they can provide powerful and consistent systems to motivate
her in situations where it may be difficult or impractical to find an im-
mediate reward. You can take work cards and tokens with you when
you go out of the house in case you need to set up some quick deals
while visiting neighbors, playing in the park, or shopping. Also, these
systems can act as a type of clock for the child who cannot tell time.
For example, rather than telling her she will be able to watch TV in
10 minutes, you may be able to set up a deal in which she can turn on
the TV after she has earned 5 tokens. Then, all you do is arrange for
a simple activity for her and pace handing out the tokens so that you
give her the last one after about 10 minutes.

Catch ’Em Being Good!

Everyone agrees that it is a good idea to catch our children being
good— the hard part is doing it often enough! Several factors make
this good advice tough to follow. For one thing, who decides what’s
“enough?” Well, we should gauge this on our children, since it is their
needs that we are trying to meet. And what does “being good” mean?
Sometimes, it is simply a matter of not getting into trouble! Think
about times when you’ve been busy with something— balancing your
checkbook, cooking a meal, or just sitting and relaxing a bit. While
you’re doing that, your child is quietly playing or doing something
nondestructive and nondemanding. Most of us would sit there as long
as we can, enjoying the quiet opportunity to do what we want to do. If
you think about it, you’ll realize that eventually your child is likely to
do something that forces you to pay attention. She may scream, knock
something over, break something, etc. At that point you are forced to
pay attention and stop what you are doing. In the long run, it would
have been more helpful to pay attention to your child while she was
doing something positive or at least nondemanding.
Sometimes we adults may need some help to remember to do
things that will benefit our children in the long run while involving
some effort in the here and now. What are some options to help us
remember to reinforce our children for good behavior?
  Using Motivational Strategies to Build Successful Change

In school situations, we have advised teachers to use tape record-

ings (or CDs, if that’s the technology you use) that play a nonirritating
tone on a planned basis. We call these Audio Reinforcement Reminder
Tones. For example, a tape may be set to play a tone, on average, every
one to five minutes. W hen the teachers hear the tone, their job is to
catch some student doing something positive as quickly as possible. We
have found that rates of praise rise dramatically while these tones are in
use and are sustained over long periods of time. Furthermore, without
any direct suggestions, the number of negative or corrective comments
from these same teachers noticeably drops. Some families who have
observed this positive classroom atmosphere like it so much that they
use a similar system during their most chaotic times at home—those
times when it is easy to forget about their quiet child. Other parents
have found this strategy somewhat out of place within their home.
An alternative to using reminder tones at home is to use a token
system and set a goal of handing out a set number of tokens for posi-
tive behavior every hour. For example, put 10 tokens in your pocket
with the goal of having none left in an hour’s time. Carrying around
the tokens helps to remind you to give them out.
You may have some other way to cue yourself, but we promise it’s
not easy to remember when you are very busy with your own activities
unless you plan to give yourself a helpful reminder. For instance, you
might cut up a picture of your child’s favorite fast food meal and hand
out pieces of the puzzle throughout the afternoon, ending up at the res-
taurant when the completed puzzle is exchanged for the real deal!

Better Work—Better Pay!

Sometimes, parents ask us what to do when their child tries some-
thing but doesn’t do it very well. Perhaps your child has cleaned up her
room but has left several toys on the floor. Perhaps she set the dinner
table for four instead of five. Perhaps your child asked for something
but you expected a polite “please” that was omitted. Or, perhaps you
know you have to help your child while she is still learning a skill but
she certainly has tried hard to perform the task. How can you encourage
your child to continue trying while letting her know that improvement
is still warranted?
When people compete during a track meet (or some other related
competition), the top three racers may all win ribbons, though only
 Autism 24/7



one wins the race. In some sense, we can look at the different ways
that a child performs a task as several actions competing with each
other. Some attempts should earn ribbons even if they aren’t the best,
while others may not earn anything distinct other than, “good try.” For
example, if your child sets the table for all five family members, she
will certainly earn high praise and some time to watch a favorite TV
show. However, if she sets the table for four, rather than five, you could
praise her, then follow up with some assistance to help her complete
the job, and then give her access to either some less-preferred activity
or a shorter time to watch TV. In contrast, if your child just puts one
spoon on the table, you might make a short, positive comment about
starting the task, then provide lots of assistance to complete the task,
and finally give her some modest reward. In other words, if putting one
spoon earned the same outcome as completing setting the table for five,
why would anyone work harder to complete the job independently?
Our general rule is to reinforce all appropriate behaviors but to
reserve our big rewards for the best performances. If we need to help
our children, then their reward should not be as powerful as when they
complete the task independently. The procedure of rewarding different
levels of independence with different size rewards is described as us-
ing differential reinforcement. This strategy will encourage persistence
while also promoting greater independence in your child.

Is Everything a Lesson?
In this book, we describe many ways that parents, other family
members, and professionals can teach various skills to children with
autism and related disabilities within their own homes and neigh-
borhoods. While reading this book, you may feel that we want you
to spend every waking moment creating and implementing lessons!
That’s not our goal! First, we hope that you will encourage your child
to participate in independent recreational or leisure activities—ones
that you will not have to closely supervise or participate in.
Furthermore, there are many activities in and around the
home that do not involve lessons. For example, your child must take
a certain medicine at a set time. While you would like your child to
cooperate, your parental responsibilities demand that you assure that
the medicine is taken at the prescribed time. Or, you hear one of the
  Using Motivational Strategies to Build Successful Change

house fire-alarms blasting and it may well signal a real fire. No one
would expect your child to follow a 22-step task-analysis and put on
her coat independently—your sole goal is to get the child out of the
house safely! In this situation, there is no lesson to be taught regarding
putting on a coat.
How do we distinguish between times we teach as opposed to
times we take care of our children? In part, this depends on how much
active participation we expect from the child and whether the degree
of participation will alter the outcome. In the examples from the last
paragraph, parents assure the outcome—taking the medicine and get-
ting safely out of the house—regardless of how much or how little the
child participated. On the other hand, you may be teaching your child
a skill, such as making toast. While you’d like her to learn to do it on
her own, for now, even if she simply takes the bread you hand her and
allows you to guide her to put the bread into the toaster, you will still
give her the toast when it’s ready. As her skills improve, you may decide
that she needs to complete more of the task independently. So, unless
she helps push down the toaster-arm, you let her eat cold bread rather
than warm toast. That is, you decide to use differential reinforcement
to encourage greater independence. This strategy implies that you are
teaching a lesson and not just feeding your child.
Whenever you decide that you are teaching rather than taking
care of your child, then you must consider your child’s motivation to
complete the chore that you believe she should complete. As we noted
earlier, we support the general strategy of making deals in such situ-
ations. That is, make sure your child knows ahead of time what she
will earn or receive for completing the lesson.

What Is the Ultimate Goal for Using

Reinforcers?
As we have noted, it is important to gradually reduce how often
you reinforce your child’s appropriate actions so that you see more
and more action for fewer and fewer reinforcers over time. But will we
ever totally eliminate reinforcers? This question can lead to interesting
philosophical debates! But at a practical level it may be best to expect
that reinforcement will most likely continue at some level, although
it may become quite rare.
 Autism 24/7



Think for a moment about how you learned to read. When you
were very young, your teacher most likely reinforced very small ac-
tions—naming letters and saying their sounds. Then, the teacher
changed the deal so that you needed to read individual words before
she reinforced you, and then you needed to read short phrases. Gradu-
ally, you needed to read longer and longer sentences, then paragraphs
and chapters, and finally entire books. Over time, the number of times
that you received direct reinforcement for reading books greatly di-
minished. But has reinforcement disappeared entirely? Most likely, you
still read books and occasionally you talk about enjoying (or hating!)
a particular book—the conversation you have about the book is a type
of reinforcer for reading the book. In addition, you sometimes read
something that provides information that helps you solve a problem
or provides insight that helps you address an important issue more
effectively—each of these outcomes is likely a reinforcer for reading.
Although a teacher is no longer dispensing reinforcers for your read-
ing, the natural community provides for this arrangement. So too,
many of the skills you teach your child will eventually be reinforced
by society at large and you will no longer have to make explicit plans
to reinforce all skills.

Review
In this chapter, we have reviewed the next element of the Pyramid
Approach by focusing on motivational factors. Properly motivating your
child to learn important skills in the home and community is crucial
if she is going to achieve independence. We have emphasized the use
of powerful reinforcement systems that accentuate the use of positive
reinforcers. Our first choice within any lesson is to try to use reinforc-
ers that seem natural to the circumstances. However, that may not
always be practical. In these situations, we need to develop systematic
reinforcement systems that help remind our children about the rein-
forcers available for doing many different skills. Gradually reducing
the frequency of reinforcement is another important goal that parents
can achieve both within and around the home. The next area of the
Pyramid Approach involves social and communication skills, areas that
are crucial for children to fully participate in our society.
 Important Communication
3 Goals in and around
the Home

Shelby’s parents are reading in the family room. Shelby comes in

and walks up to the bookcase. She reaches for a book on the top shelf
and when she can’t quite reach it, she drags a chair over to the shelves,
climbs on the chair, and gets the book. Her parents certainly know
what she wants.
Did Shelby communicate?

Josh is playing in the sandbox while his father is sitting on a nearby

park bench. Josh leaves the sandbox, walks over to his father, looks at his
father’s eyes while he pulls him to the seesaw, sits his father on one end,
and runs to sit on the other end. His father immediately pushes him up
and down and Josh laughs out loud.
Did Josh communicate?

Hunter is playing in the family room in front of a big window.

Suddenly the trash truck pulls up in front of his house. It is very big
and very noisy. Hunter, who is about 15 months old, stops, gasps, and
looks at his mother. As she turns to him, he looks back at the truck,
points to it, and looks back at Mom. He continues looking back and
forth between his mother and the truck until she, too, sees the truck
and reacts: “Wow! That’s a loud truck!” Hunter has not yet developed
any whole words to say, but his mother certainly understands that he
wants her to react.
Did Hunter communicate?
  Important Communication Goals in and around the Home

What Is Communication?
Let’s consider the first scenario. Shelby directed her behavior
to the shelf, chair, and then the book. Actions that are directed to the
environment and that lead to rewarding outcomes are not communi-
cative! Even though her parents were sitting nearby, Shelby did not
interact with them in any way, so we conclude that she did not com-
municate. In fact, her behavior would have been exactly the same had
they not been in the room. Shelby’s parents, by watching her, could
have interpreted that she wanted the book, but that interpretation does
not mean that Shelby communicated with them. Their presence had
no impact upon her actions.
In each of the next two scenarios, the children did something di-
rected to their parents, who responded in some way. Josh’s dad pushed
him on the seesaw, while Hunter’s mom reacted to the truck he was
pointing out. Even though these children did not say words, everyone
recognizes that they did communicate with their parents.
So, communication involves at least two people. One person
(we will call this person “the speaker,” even when no speech is in-
volved) directs a behavior of some sort to another person (we will
call this person “the listener,” even when speech is not involved). The
listener then reacts to the speaker in a manner that is rewarding to
the speaker. In the last scenario above, Hunter looks at his mother
and then back to the truck. He does this again and again until his
mother notices the truck and makes some comment about it. He
definitely communicated! The message he delivered did not involve
spoken words; he gasped and directed his mother’s eyes to the truck
by looking from her to the truck. Likewise, while Josh did not say
anything, his actions involving his father lead his father to begin
playing with him on the seesaw!
Understanding the basics of communication will help parents
better cope with situations in which communication has broken down.
The root of many behavior management problems lies in either the lack
of communication or miscommunication. While it is beyond the scope
of this book to review many effective strategies to teach functional
communication, it will be helpful to review some of the fundamental
issues associated with communication.
 Autism 24/7



Why Children Communicate

Before we make plans to teach communication in the home
and community, it is helpful to look at the conditions that might
affect a child’s communication. Sometimes children are chatty
and simply want to spend time interacting with others. Sometimes
children need or want a specific item from someone. Some children
are great at starting interactions and other children tend to wait for
someone else to start a conversation. Therefore, we need to look at
why children communicate, and under what circumstances, or when
children communicate.
In 1957, B.F. Skinner published a highly influential book, Verbal
Behavior, in which he offered an analysis of language from a behav-
ior analytic perspective. His book has led to many studies that have
supported many of his interpretations as well as to the development
of particular intervention strategies. For example, the PECS (Picture
Exchange Communication System) protocol was developed based
upon the principles laid out by Skinner. In his book, Skinner proposed
a number of terms to help clarify specific types of communicative acts,
and we encourage readers to learn more about his ideas. Within this
chapter we will use colloquial terms but attempt to highlight the func-
tion connected with different types of language use.
Let’s look at the situation in which Josh directed his actions
toward his father until his father pushed him on the seesaw. The out-
come—playing on the seesaw—was specifically what Josh wanted. We
call this type of communication a request (in Skinner’s analysis, this
is a “mand”). The direct outcome for Josh was something material or
concrete that he wanted.
There is another type of outcome or reward for communication.
Think about Hunter and the interaction with his mother. Hunter no-
ticed the big truck and got his mother to notice it too. He didn’t expect
or want his mother to get the truck for him. He wanted his mother’s
attention and for her to see what he saw. He wanted something social
from his mother—her attention, her praise, her apparent enjoyment
of her conversation with him. He did not get anything material from
his communication, such as playing on the seesaw as Josh received.
Instead, he commented to his mother, who provided him with a social
reaction (a “tact” in Skinner’s terminology).
  Important Communication Goals in and around the Home

We can divide the main purposes (or functions) of communica-

tion into requests and comments. When we want to teach communica-
tion, our first job will be to consider what purpose a communicative
act will serve for the child. Furthermore, what we know about the
child may influence our lesson goals. For example, we know that social
rewards for very young children with autism and related disabilities
tend not to be very effective. Therefore, it may be difficult to start
communication lessons with very young children with autism by
targeting communication skills that primarily serve a commenting
function, such as simply naming common objects. It is likely to be
more useful to the child to begin teaching him how to request their
most important reinforcers.

When Children Communicate

In addition to looking at the “why” or the consequences of com-
municating, we also must look at the conditions that exist prior to
communication. These conditions, known as antecedents, will affect
how we plan our communication lessons. For example, Will, Julie, and
Mike can say the word “swing.” Today when Will’s dad takes him to the
neighborhood park, as soon as Will sees the swing, he grabs his dad’s
arm, says, “Swing!” and pulls Dad toward the swings. When Julie and
her dad arrive at the park, Julie stands at the edge of the playground.
Her dad waits for Julie to let him know what she wants to do first, but
Julie doesn’t say anything. Dad asks, “What do you want to do?” and
Julie then says, “Swing.” When Mike arrives with his mom, she too
waits to see if he will tell her what he wants to do. When he doesn’t,
she says, “What do you want to do?” When Mike still doesn’t respond,
she says, “Can you say ‘Swing’?” Mikes says “Swing.” Soon all three
children are happily being pushed on the swing.
Although all three children said “swing,” and all three children
got to go on the swing, each child actually did something different.
Will saw the swing and initiated a request for the swing. Julia did not
initiate, but she responded to her dad’s question about what she wanted
to do. Mike did not initiate or respond to his mom’s direct questions,
but he did imitate her by saying, “swing.” Thus, although each child
said “swing,” one child initiated, one child responded to a prompt or
cue, and one child imitated a model—three distinct behaviors.
 Autism 24/7



It would be fantastic if children could automatically interchange

these behaviors with each other. That is, if we teach one form, the
child can immediately use the other two. Unfortunately, our knowl-
edge of typical language development and the general principles of
learning have taught us that such is not the case. Each of these types of
communication skills initially develops independently. At some point
in their development (usually when their communication repertoire
grows to a reasonable size) children eventually can generalize (or
transfer) new vocabulary across each type of communication skill.
However, when we begin to teach children with communication
deficits, we will have to teach each of these communication skills
independently. So, we must decide which skill to teach first. We
recommend teaching initiation first, as this enables children to be
independent communicators.

Children as “Listeners”
We said that communication involves two people, a speaker
and a listener. So far we have discussed teaching children to be the
speaker. In addition to learning to use communication, children also
must learn to understand communication directed to them. Children
learn to be the speaker because of the social or tangible outcomes as-
sociated with interacting with someone else. Children learn to be the
listener for the same two outcomes. Some directions that we give our
children involve natural outcomes that they enjoy. For example, if Dad
says, “Go get your ball,” the outcome for his daughter doing what he
said is getting to play ball with Dad.
Sometimes we give directions because they help us in some way.
Mom may be thirsty and say to her son, “Please bring me a Coke.” Mom
can only get her drink if her son understands what she said. But what
does her son get out of the interaction? Hopefully, Mom will politely
thank him for getting her drink. Remember that not all children with
disabilities find polite praise highly motivating. For these children,
teaching them to follow directions that are personally useful is more
likely to be successful than teaching them to follow directions that
primarily benefit other people.
There will also be times when you will need to give instructions
to your child for his own safety or “just because I said so!” In essence,
  Important Communication Goals in and around the Home

these types of demands should result in compliance. As children get

older, they may find themselves in such situations more frequently, such
as when they need to listen to what the boss tells them at work simply
because she is the boss. In our perspective, compliance is something
that we build in over time and is rarely the first type of instructional
situation we want to design. That is, we suggest working on:
1. instructions that initially lead to natural and powerful
rewards that directly benefit the child, and then on
2. instructions for which the social rewards are clear, and,
hopefully, effective as well.
3. Finally, we will need to work on instructions for which
immediate reinforcement may be lacking.
For example, if your child has never listened to what you say, you
would obviously not start teaching him to listen on a busy street corner
and try to get your child to obey when you say, “stop!” Instead, you
would develop good listening skills in safe situations before carefully
applying them in potentially more dangerous settings.

Summary of the Reasons Children

Communicate
Think of all the “whys” and “whens” associated with the word
“video.” In the role of the speaker, your son might imitate the word,
answer a question (e.g., “What do you want? or “What’s that?”) with the
word, or initiate with the word. In all three conditions he could either get
a video (requesting) or he might receive some social praise (comment-
ing). In the role of the listener, he might follow a direction involving the
word “video” that results in getting to watch a video or a warm “thank
you!” from you. Look at the flowchart on the next page and you’ll note
eight different skills associated with communicating the word, “video!”

Are There Many Ways to Communicate?

Are there times when we speak but do not communicate? Remem-
ber, communicative acts must be directed toward another person. Does
your daughter ever sing a song or recite dialogue from a video when
she is alone? Do you ever sing in the shower or while driving alone?
 Autism 24/7



Flowchart 3-1  Communication Associations with Single Words

Such talking and singing would not meet our definition of communi-
cation because the speaker or singer is not directing his or her words
or song to a “listener” or communicative partner. In fact, many of us
quit singing when we are joined by another person!
Some children with autism and related disabilities repeat words,
phrases, jingles from TV or the radio, or entire dialogs from movies
without understanding what they are saying. They are not constructing
the sentences from words they know how to use but, rather, are repeat-
ing the sounds for reasons not related to communication. Therefore,
when we assess a child’s ability to communicate, we must go beyond
a simple description of what words the child can say.
Is speaking the only way we communicate? Of course not! We
also use gestures or “body language.” Some people use sign language
with others who understand sign language. Sometimes we write notes
to ourselves or to others. You might jot down a “to do” list for yourself
or leave your kids a note to read. Sometimes we use or respond to
pictures. For example, you might save a picture of a particular object
you’ve been wanting and show it to your partner a few weeks before
your birthday!
Each of these examples involves a different type of communica-
tion modality—using our hands and other parts of our body, using print
or pictures, etc. Each type of communication—including speech—has
its advantages and disadvantages. Competent communication is pos-
sible through several different types of modalities. Even when we can
  Important Communication Goals in and around the Home

speak, we often combine several modalities when communicating.

Some of us use expansive hand and arm movements and exaggerated
facial expressions to emphasize certain points.
If your child does not yet speak or doesn’t speak in a manner
others understand, he might be using some form of augmentative or
alternative communication (AAC). He could use an electronic device
with a synthesized or recorded voice. He might use pictures within
the Picture Exchange Communication System (PECS). He might
use sign language or type and print messages for others to read. If a
professional such as a teacher or speech-language pathologist has rec-
ommended that your child use some form of AAC, this doesn’t mean
that the teacher or SLP are “giving up” on speech. What it means is
that the goal is to provide your child with a means to effectively com-
municate right now, while speech production and development are
being addressed. Will these alternative modalities “inhibit” speech
development? We know from many years of research that the answer
is “NO!!” Use of AAC systems will not inhibit or prevent the develop-
ment of speech. In fact, many researchers report that these systems
actually enhance speech development (Glennen, 1997; Mirenda,
2002). To learn more about these visual modes of communication,
a good introduction is A Picture’s Worth: PECS and Other Visual
 Autism 24/7



Communication Strategies in Autism, by Andy Bondy and Lori Frost

(Woodbine House, 2002).

Modalities for “Listening”

Just as there are several modalities our children can use to com-
municate with us, there also are different modalities we may use that
they will need to understand. For example, you may be on the other
side of the playground from your child and he may be unlikely to hear
what you are saying. In this case, you might wave your arms to gesture
for him to come over to you. Will he understand what your arm motions
mean? Similarly, there will be times when you point to critical things
or places in your home or community and you will want your child to
be able to understand your gestures.
There are many types of visual signals in our society. Some
of these involve printed words. That is one reason we put so much
emphasis in school on teaching children to read. But even if a child
cannot read, he still will benefit from understanding different vi-
sual cues in the environment. For example, while some bathrooms
in your community are labeled with the words “men” or “women,”
think of how many different pictures/drawings are on the doors! We
once counted over 25 different ways of indicating gender for bath-
rooms within a 10-mile radius of a school in Delaware. Many of us
understand a stop sign by its shape and color long before we can see
the word printed in the middle. Therefore, it is important to teach
children to respond to visual cues because they are so common out
in your neighborhood.

Setting Goals for Critical Communication

To meet our goal for children to grow up to live and work as
independently as possible, they must learn certain communication
skills. These skills are critical because, if your child cannot calmly
and effectively engage in each skill, then he or she will most likely try
other means to obtain the same outcome. Typically, we are not thrilled
with these other “means”—crying, fussing, shouting, hitting, etc. We
have identified nine such skills, some of which are skills to be used as
a speaker and some to be used as a listener. See Table 3-1.
  Important Communication Goals in and around the Home

Table 3-1  Speaker and Listener Skills

Speaker Skills Listener Skills

1. Asking for reinforcers 6. Responding to “Wait/No”
2. Asking for “help” 7. Responding to transitional
3. Asking for a “break” cues (going from one activity
4. Answering “no” to “Do you to another)
want this?” 8. Following functioning direc-
5. Answering “yes” to “Do you tions (obeying oral or visual
want this?” instructions)
9. Following a schedule

Assessing Critical Communication Skills

It will be helpful for you to assess each of these critical skills for
your child. We suggest that you complete a checklist involving all of
these skills no matter what other measures have been done to assess
your child’s language skills. That is, knowing that your child has a
language age-equivalent of a nine-year-old will not necessarily tell
you whether he can accomplish each skill independently. At the end
of this chapter is a checklist regarding the nine critical skills that you
can complete for your child.
For each skill, it will be helpful to think about how your child
currently handles a particular situation. For example, when your child
sees a toy or something else he wants, what does he do? Is his response
appropriate or problematic? If a two-year-old pointed to a book on a
shelf that he wanted to look at, that might be considered appropriate
for his skill and age level. On the other hand, if he stood and stomped
his feet and screamed until someone gave him the book, that would
be something you would want to work on.
After you’ve gone through all nine skills, look at each of the prob-
lem areas and rate how difficult each problem is. That is, prioritize the
severity of the problems to help determine which ones you’ll want to
work on first. For example, if your child requests help by handing you
items that do not work, but you’d like him to say the word “help,” that
would not be as important as working on his screaming when he can’t
get toys that are out of reach.
 Autism 24/7



Critical Communication Skills: Problems and

Potential Solutions
When you are analyzing routines and activities that are prob-
lematic for your child, as will be discussed in Chapter 7, be sure to
consider what role expressive or receptive communication plays in
the problem. For children with autism spectrum disorders, lack of
appropriate communication skills are often among the biggest im-
pediments to smooth family functioning. When your child is having
difficulties with a family activity or routine, ask yourself whether a
problem with one or more of these specific communication skills is
contributing to the problem.
After you have used the critical communication skills checklist
to pinpoint what areas of communication are posing the biggest prob-
lem for your child and family, the next step is to figure out what your
child can learn to do instead of what he is doing now. The following
sections therefore give many examples of potential problems with
communication that children with autism have, together with some
potential solutions. Once you have identified a skill you would like
your child to learn in place of a current problematic communicative
behavior, add it to the list of teaching goals you developed while
reading Chapter 1. You also will want to review your priorities, in
terms of which skills should get the most attention at first. In the
next two chapters you will learn strategies to begin teaching these
skills to your child.

Requesting Reinforcers
Asking for a desired item is perhaps the most fundamental
communication skill. Requesting allows us to get access to items and
activities that are essential for day-to-day living or that allow us to
enjoy ourselves and our interactions with others. Refer back to Chapter
2 for guidance on choosing and using reinforcers that your child will
be motivated to obtain.
Problem: Three-year-old Derek wants to watch his favorite
video, but his dad has put it on the top shelf above the televi-
sion where Derek can’t reach it. He tries to climb on top of the
television but can’t quite make it. He begins whimpering and
  Important Communication Goals in and around the Home

jumping up and down. When Mom comes into the room, not
knowing that Dad put the video out of reach, she cannot figure
out what he wants.
Potential Solution: Teach Derek to use his PECS sys-
tem to ask for the video.

Problem: Eight-year-old Sam wants some juice and the juice

carton is empty. He goes to his mother and says, “Sam, say you
want some juice.”
Potential Solution: Teach Sam to say, “I want some juice.”

Problem: Twelve-year-old Curt likes Marsha, who is new to

the class. He walks over and says, “Hi, can I kiss you?”
Potential Solution: Teach Curt to say, “Hi, I’m Curt.
Can we talk for a minute?”

Problem: Fourteen-year-old Darlene is about to do some

homework. She looks at her sister who is on the computer and
says, “Get off now!”
Potential Solution: Teach Darlene to say to her sister,
“I have homework to do. Can I use the computer soon?”

Requesting Assistance
Asking for help is universally important because everyone at
some time will be in a situation where the solution to a problem must
come from someone else.

Problem: Joey is playing with his favorite electronic train

set. He has learned to set the track up on his own; connect the
train engine, cars, and caboose; and put the train on the track
and start the train. Today when the train rounds the first
corner, it falls off the track. Joey tries several times to restart
the train but doesn’t notice that the track is not properly con-
nected at the first corner. After several attempts to get the train
going, each time ending with a derailed train, Joey screams
and throws the train across the room.
Potential solution: Teach Joey to bring the train to his
sister and gesture for help.
 Autism 24/7



Problem: Amanda is working on her math homework at the

kitchen table along with her brother. She carefully adds the
numbers for each problem, reciting the problem aloud as she
works. (“Seven plus eight equals fifteen.”) When her pencil
lead breaks, she grabs her brother’s pencil.
Potential solution: Teach Amanda to point to her
brother’s pencil and say, “Can I use that for now?”

In teaching your child to request help, you will want to identify

many activities and times in your child’s day when it will be natural
for him to ask for help. Table 3-2 lists some common opportunities for
teaching children about asking for assistance.

Table 3-2  “Help” Opportunities

1. Blow bubbles
2. Blow up balloon
3. Put coins in vending machine
4. Cut food
5. Cut paper
6. Insert CD/DVD/ music tape/video
7. Open curtains
8. Open bottle
9. Open doors
10. Open food packets
11. Open milk or juice carton
12. Pour from pitcher/carton
13. Put on shoe/socks
14. Snap clothes/coat
15. Take cap off marker
16. Tie jacket strings/shoelaces
17. Turn on/off lights
18. Turn on/off water
19. Reach towel to dry hands
20. Turn on/off music player/television
21. Unwrap plastic utensils/straw
22. Unzip backpack/coat/pencil pouch
23. Zip backpack/coat/pencil pouch
24. Wind up toy
25. Install batteries
  Important Communication Goals in and around the Home

Requesting a Break
We all have been in situations where the demand is too high
or fatigue has set in due to the length of the task at hand. In these
cases, we ask for a break—some time to recuperate. We periodically
need to avoid or escape from certain events and have learned to do
so in a number of socially acceptable ways. While parents may be
able to “read” when their child needs a break, children also need a
calm way to ask for a break on their own. As with learning to ask for
help, the key will be for the child to be able to ask for a break before
he has a tantrum.

Problem: Maria’s aunt, uncle, and cousins are visiting from

out of town. The entire family has congregated in the family
room and Maria is sitting in her dad’s lap. As all the family
members talk at once, trying to catch each other up on their
lives, Maria tries to slide out of Dad’s lap. When he holds on
tight, boosting her back up into his lap, she cries loudly, arches
her body backwards, and hits her head into Dad’s head.
Potential solution: Teach Maria to use a break card
when she is overwhelmed by a situation. In the future, Ma-
ria can hand her father a card that says, “Break” and walk to
the break-area.

Problem: Reggie’s parents are having a party and want Reg-

gie to meet their guests. Reggie has learned to greet people by
saying, “Hi, nice to meet you.” Several guests arrive at once
and as Reggie’s father and mother introduce him to each guest,
he greets them appropriately. As the tenth and eleventh guests
arrive, Reggie is reluctant to go to them with his parents, but
when his dad firmly guides him, he approaches the new guests
and greets them. As the next several guests arrive at the door,
Reggie begins to breathe heavily. He greets the first, and then
tries to back away. When his dad nudges him forward, Reggie
shouts, “Hi, nice to meet you,” and pulls away from his father.
When Reggie’s mother says, “Reggie, say hello to Mr. and Mrs.
Wells,” Reggie yells, “Hi to meet you!” and runs from the room.
Potential solution: Teach Reggie to say, “I need to find
a quiet place for a moment” when he feels like yelling.
 Autism 24/7



Rejecting
Rejecting offers from other people allows us to participate in
interactions with communicative partners who are determining what,
specifically, we might want. When we cannot politely or calmly reject
something that we don’t like, trouble usually ensues.

Problem: Jacqui, nineteen, is having dinner at her grand-

parents’ house with her parents. She has learned to sit with
her family at mealtime, but meals at her house involve Mom
or Dad handing her a plate of her favorite foods. Tonight
Jacqui’s grandmother tries to pass Jacqui the bowl of broccoli.
Jacqui won’t take it from her and when her grandmother tries
to spoon some broccoli onto Jacqui’s plate, Jacqui forcefully
pushes the bowl away, knocking over her water glass.
Potential solution: Teach Jacqui to shake her head
“no” when offered foods she does not like.

Problem: Jamie wants to watch a video. Her sister tries to

help and puts in the Barney video because it is nearby. Jamie
screams “Sesame Street! Sesame Street! Sesame Street!”
Potential solution: Jamie learns to say, “No thanks”
and give her sister a picture of the video she wants to watch.

Accepting
We all can remember times when we’ve played “Twenty Ques-
tions” with our children in order to figure out what they want. If we
are holding out a preferred item and asking, “Do you want this?” most
often our children will simply take it. We won’t always be able to hold
an item (“Do you want to go to the swimming pool?”), so our children
need to be able to indicate “yes!”

Problem: Eight-year-old Sierra is in the kitchen with her older

brother, Sam. Sam is trying to help his sister get a snack and
is pulling one food after another out of the snack cupboard,
asking, “Is this what you want?” He thinks it is the blue corn
chips she wants, but he hasn’t been able to reach them yet. So,
without showing them to her he asks, “Do you want the blue
  Important Communication Goals in and around the Home

corn chips?” Sierra doesn’t answer. Finally, he reaches them

in the back of the cupboard and when he holds them out to
Sierra, she takes them from him.
Potential solution: When Sam asks, “Is this what you
want?” Sierra nods her head.

Problem: Fourteen-year-old Alexis is helping her mother make

cookies. When it is time to stir the dough, her mother asks, “Do
you want the big spoon?” Alexis answers, “Big spoon.”
Potential solution: When asked whether she wants
something, Alexis learns to say, “Yes!”

Responding to “Wait” or “No”

What are we trying to communicate to someone when we say,
“Wait?” The message is actually complex: “I know what you want and
you are going to get it but after some more time.” Our children must
understand that they are not being denied access to the item—they are
eventually going to get it. Because learning to wait is such a crucial skill
for everyone, we will provide some more details on the issues that need
to be addressed. For a more complete description of effective strategies
to promote waiting, please refer to A Picture’s Worth.

There are three key elements to teaching someone

to wait:
First, you must be able to fully control access to whatever it is that
person is waiting for. That is, if you can’t provide it when you want to, then
the lesson will be very difficult to learn. Therefore, start with something
you know your child wants but you can give it to him at any time.
Second, you must control how long your child should wait. Start
with a time interval that is so short—one or two seconds!—that it virtu-
ally guarantees that there will be no failure. Then, begin to gradually
increase the time interval. If you add too much time and run into a
problem, simply readjust your next interval to something shorter. You
may want to highlight that it is time to practice waiting with a visual
cue, such as a large, brightly colored card that has ‘wait’ written on it.
Third, as the wait intervals become one minute or longer, you
will want to help your child select something easy to do while wait-
ing. The point is, do not expect someone to simply wait while doing
 Autism 24/7



nothing—that remains very hard for all of us! Instead, pick some easy
activities such as looking at a picture book or listening to music (as long
as he is not waiting to listen to music).
Here are some more common situations that all families face and
suggested solutions:

Problem: Mom is on the telephone trying to schedule an ap-

pointment. Mark comes up to her and begins tugging on her,
trying to get her to move with him. Mom resists and whispers
to Mark, “Just a minute. I’m almost done.” Mark falls to the
floor and begins screaming.
Potential solution: Mom teaches Mark to use a Wait
card. For example, Mom hands Mark a card that says,
“Wait” and Mark calmly stands next to her for one minute.
Mom then pays attention to Mark. (Note: Even if Mark can’t
yet read, he can learn to associate this visually unique card
with waiting.)

Problem: Sue’s family is planning an outing to a favorite

restaurant for dinner. During the early afternoon, Sue begins
asking her parents when they’re leaving and they answer, “Not
for several hours,” “Later,” or “at 6:00.” Sue does not know
how to tell time and continues to ask every 15 or 20 minutes,
which begins to annoy her parents. By the time the family
finally leaves for the restaurant, everyone is frustrated.
Potential solution: Her parents place a picture of the
restaurant on Sue’s picture schedule, which she quietly
checks several times during the afternoon.

Problem: Marshall has finished his homework and a bowl

of ice cream that he had earned. He asks his dad if he can
have another bowl of ice cream. His father says, “No, one is
enough.” Marshall ignores his dad and heads for the freezer
for more ice cream. His father blocks his path and they start to
yell and shout at each other.
Potential solution: Marshall’s parents teach him “the
no game.” They tell Marshall that sometimes they will say
“no” to him, but if he responds calmly they will provide
other types of rewards—special time with them when he
  Important Communication Goals in and around the Home

can pick which game to play. They give Marshall an index

card with five open circles and tell him that he will earn a
token for each time he calmly responds when they say, “no.”
When all five circles are filled, he can pick a game to play. At
first, Marshall’s parents arrange to say “no” at times when it
does not seem highly important to Marshall. For instance,
he is about to sit on one chair at the dinner table and they
say, “No, please sit on that chair.” When he follows through,
he earns a token. After several weeks of this type of prac-
tice, Marshall asks once again for more ice cream. When his
father says, “no,” he calmly walks out of the kitchen and his
father praises him while giving him a token.

Following Directions
Responding to directions is viewed as a critical communication
skill because of the potential risks associated with failing to understand
a message. For example, when Mom shouts to her son, “Don’t walk in
front of the swings!” failure to respond could result in injury. As we
discussed earlier, we need to first teach our children to respond to
directions that will produce meaningful and desired outcomes from
our children’s points of view.

Problem: Mom and Dad report that Angela sometimes looks

toward them when they call her name. If she’s engaged in a
favorite activity, however, she doesn’t respond when they say,
“Come here.” She seems to understand directions some of the
time but not always. For example, yesterday when Dad told
her to put her shoes away, she didn’t do so. But this morning
as Dad was getting on his coat so they could go to the park, he
told her to get her shoes, and she ran right to them.
Potential solution: Angela’s parents can teach her to
listen for her name paired with “come here” by rewarding her
with favorite items (e.g., toys, snacks, etc.) for coming over.

Following a Schedule
We adults keep track of all the important things we need to do
today, this week, or this month by using some type of written calendar
 Autism 24/7



system. Children also like to know what is expected of them and when
activities will occur. Therefore, we should teach them how to use systems
that contain information about their future schedule of activities.
Schedules can come in many shapes and forms. If your child can
read, then using words may be helpful, but virtually all children with
autism can understand and use pictures or other three-dimensional
items to keep track of their schedules. When you use pictures within
a schedule, it is a good idea to first teach your child what the pictures
mean (i.e., what to do when he sees a picture) and only then teach him
how to use the schedule itself. We like to teach one lesson at a time
and avoid mixing them together. The pictures you use should refer to
important objects, activities, or areas of your home or neighborhood.
Your child should be able to respond to the picture without someone
telling him what the picture means—otherwise, why use the pictures?
For example, when shown a picture of a spoon, your child should know
that he should get the spoon and go to the area or start the activity
shown without someone saying, “Right! Get the spoon!”
We tend to arrange the pictures in a top-down fashion to show
the sequence of events as shown in Figure 1 on the next page, but you
can also use notebooks that show a single activity for each page or use
some other systematic presentation style. Figure 1 is an example of a
vertical schedule that includes different approaches to offering choices
to students. Figure 2 is an example of a pocket schedule that a child
can take with him into the community or use at home.
For more details on how to teach the use of schedule, you can
read either A Picture’s Worth: PECS and Other Visual Communication
Strategies in Autism by Andy Bondy and Lori Frost (Woodbine House,
2002) or Activity Schedules for Children with Autism by Lynn E. McClan-
nahan and Patricia Krantz (Woodbine House, 1999). The first book
also describes how to introduce important elements such as choice
and surprise into these systems.

Problem: On weekdays, Mom and Dad maintain a very

predictable routine in the household. David seems content to
follow along with the family activities. On weekends, though,
when the schedule is more unpredictable or loosely structured,
David has frequent tantrums. On days when any kind of “sur-
prise” occurs (an anticipated trip to the park is cancelled when
it storms), David is inconsolable.
  Important Communication Goals in and around the Home

Figure 1: Vertical Schedule with Choices

 Autism 24/7



Figure 2: Pocket Schedule

Potential solution: David’s parents introduce a “sur-

prise” card on his schedule during weekdays. Initially, they
make sure the surprise is something that David enjoys, such
as time on the computer. Later, these good surprises are
intermixed with surprise activities that David feels neutral
about. Finally, his parents intersperse some surprises con-
cerning things that David does not enjoy. Then his parents
begin to use a visual schedule for weekends as well.

Dealing with Transitions

Everyone must deal with transitions—between locations, ac-
tivities, and from person to person. Use of a schedule can help a child
understand what is going to happen at different times of the day. How-
ever, some children respond to transitions as if their lives were being
turned upside down! While you may think that improving information
about the upcoming event will reduce the magnitude of the ensuing
tantrum, in our experience providing more information (even visually
based) is not always sufficient.
Some transitions involve changes from activities that are highly
rewarding to those that are less rewarding—and no one looks forward
to leaving pleasant activities. Some children become upset even when
they are asked to change from a less rewarding activity to one that is
more rewarding! We think this may be because the transition involves
leaving something behind as well as changing to a new activity. For
children with autism spectrum disorders, having information about
the next reward may be more important than having information about
the next activity. When the next activity is not inherently rewarding,
then adding a separate reinforcer may be necessary.

Problem: MaryJane has just finished her breakfast and is

coloring on a piece of paper in the kitchen. Her mother tells her
  Important Communication Goals in and around the Home

that it is time to play in the family room. MaryJane throws the

crayons on the floor, and screams while her mother physically
guides her to the family room. Within a few minutes, she is
calm once more and contentedly playing with her toys. Then,
her mother tells her that it is time to water the plants—some-
thing that MaryJane usually enjoys. She screams and throws
the toys around while her mother coaxes her to get the water-
ing can. This pattern cycles many times each day.
Potential solution: MaryJane’s mother lets MaryJane
know what her reward will be for making a transition
before asking her to change activities. For example, while
MaryJane is coloring, her mother brings her one of her
favorite toys from the family room. She shows the toy to her
daughter, who immediately reaches for it. Then she says,
“Let’s play with the toys in the family room . . . but first we
need to put away the crayons.” MaryJane puts away the
crayons and runs to play with the toy. Later, while MaryJane
is still playing with the toy, her mother shows her a picture
of the watering can. While she is looking at the picture,
her mother says, “Let’s go water the plants . . . but first we
need to clean up the toys.” Throughout the day, MaryJane’s
mother shows her the next available reward before indicat-
ing that she needs to stop what she is currently doing.

Review
This section of the Pyramid Approach has dealt with communica-
tion skills. It is extremely important to teach children to use functional
communication skills at home and in the community. We’ve noted
several key communication skills and strategies to promote them.
When these critical skills are weak or missing, we often see severe
behavior problems in their place. Since all families are unique and
not all families go into the same community settings, it is crucial that
you assess your child’s abilities to communicate in the many different
settings where your child is expected to participate and then map
out a plan to help improve each of the critical skills described in this
chapter. Remember that communication is something that you should
work on during all activities—we don’t suggest having a special time
 Autism 24/7
 

to practice communication. Instead, look for opportunities to work

on these skills throughout the day and across all environments. The
next chapter will help you learn to build lessons involving functional
activities or communication skills into your daily routine.
 CRITICAL FUNCTIONAL COMMUNICATION SKILLS CHECKLIST©

Name: Date:

Skill Example Appropriate?

1. Request reinforcers
edibles
toys
activities
2. Request help/assistance
3. Request break
4. Reject
5. Affirm/Accept
6. Respond to “Wait”
7. Transition between activities
  Important Communication Goals in and around the Home

8. Respond to directions
Visual Directions
Orient to name being signaled
“Come here”
 “Stop”
“Sit down”
“Give it to me”
“Go get…” (familiar item)
“Go to…” (familiar location)
“Put it back/down”
“Let’s go/ Come with me.”
Oral Directions
Orient to name being shown
“Come here”
“Stop”
“Sit down”
“Give it to me”
“Go get…” (familiar item)
“Go to…” (familiar location)
“Put it back/down”
“Let’s go/ Come with me.”
9. Follow visual schedule
©Copyright, 2003-2005, by Pyramid Educational Products, Inc. May be reproduced.
Autism 24/7


 Creating Natural
4 Opportunities
for Learning

Kimberly has been thinking about her son, Daniel, and what she
can teach him to help him be more independent in and around the home.
She wants him to learn some skills that are relatively simple, such as us-
ing the buttons to turn on his TV or computer, pointing to a drink in the
refrigerator and saying, “Apple juice,” putting his dirty cup in the sink, etc.
She also would like him to learn more complex skills—putting toothpaste
on his toothbrush and brushing all his teeth reasonably well; setting the
table for the entire family at dinner time; looking at a picture-array of
items to buy in the supermarket and putting them all in the cart. Kimberly
expects Daniel to respond to her requests to start certain activities but
she also wants him to initiate some of these activities so that she doesn’t
feel as if she is running his life. How can she begin to plan to use everyday
activities to create learning opportunities for Daniel?

We advocate using many common activities around the home and

neighborhood to create natural opportunities for learning. While chil-
dren learn many important skills at school, there are some skills that
are unique to the home and neighborhood that are virtually impossible
to replicate at school. And, many of the skills learned at school need to
be used at home. Schools are a time-limited resource, while children
will live in a home-like setting for the rest of their lives. Parents can be
excellent teachers without making their homes into a school. In this
chapter, we will look at how to find many opportunities to teach your
child within your home and your particular community. Your child will
  Creating Natural Opportunities for Learning

need to learn different types of activities and skills and thus you will
need to design different types of lessons. We will describe some of the
most common issues related to designing effective lessons and provide
examples of how they can be incorporated into everyday routines.

Discrete Lessons
Some activities are relatively short and sweet. That is, they begin
with a simple instruction or request, and are followed by reasonably
straightforward tasks. For example, you could ask your daughter to come
to you, bring you a fork, wipe her nose with a tissue, or tell you the name of
a toy that you’re holding. Each time your child succeeds, she receives praise
and possibly some other simple reward. Notice that the form or type of
response is not at issue—the correct response can involve doing something
or communicating about something. We call these direct, straightforward
types of lesson discrete trials. In this case, discrete means distinct, separate,
or isolated, while trial is synonymous with opportunity.
You will recognize that schools are filled with discrete trial types
of lessons—rote learning about math facts, names of country or state
capitals, and names of objects or their attributes are all examples of this
type of lesson. The age of the student does not determine whether or not
a lesson involves a discrete trial; high schools students and preschoolers
alike learn many discrete trial lessons. In fact, higher levels of educa-
tion often involve greater amounts of rote learning—for instance, all
the elements on the periodic table, all the states and their capitals, all
the presidents, etc. So, when you read our discussion of discrete trials,
please do not think that this involves a special kind of lesson for children
with autism or other learning difficulties. Everyone needs to learn many
different discrete trial lessons at school, home, and in the community.
Consider some of the most common discrete trial types of lessons
for children to learn at home, as listed in Table 4-1 on the next page.
Also consider examples of discrete lessons our children need to learn
in the community, as listed in Table 4-2.

The Role of Repetition in Teaching Discrete Skills

When you have identified discrete skills for your child to learn at
home, you also need to identify many opportunities for your child to
 Autism 24/7



Table 4-1  Discrete Activities at Home

Area Discrete Trial Activity

Kitchen Respond to “Give me the spoon”
Bedroom Kiss Dad goodnight
Living Room Point to picture in book Mom is reading
Dining Room Ask for drink
Bathroom Choose toothbrush
Backyard Kick a ball

Table 4-2  Discrete Activities in the Community

Area Discrete Trial Activity

Mall Throw a coin in fountain
Grocery Store Point to desired cereal
Playground Ask for swing
Neighbor’s house Greet adults and children
Library Choose from three books offered by Mom
Haircut Take lollipop from bowl
Dentist’s office Respond to “Open up!”

practice those skills. But you have to make sure that in repeating a skill
you are not actually reducing the likelihood that your child will learn
it. This may happen if you remove your child’s motivation to perform
the skill or ask her to over-practice it. You also want to arrange for the
skill to be repeated in a natural way that makes sense to your child.

Does Repetition Fit the Situation?

In general, we all know that repetition is often beneficial to learn-
ing. If I want to learn to be good at shooting foul-shots in basketball,
shooting the ball one time per week will not lead to much improvement.
But, while we know that practice may help, it is not always easy to know
how much repetition we should plan for at any one time.
  Creating Natural Opportunities for Learning

In fact, sometimes repetition may be counterproductive to the

goal of enhancing the likelihood of learning. Imagine an interaction
with your daughter, who, for the first time in her life, says, “Slide” while
standing by the backdoor and pointing to the slide that she obviously
wants to play on. Would you say, “Great! Go outside,” but when she
took one step out the door, pull her back inside and immediately say,
“Now say it again!” We think everyone will recognize that such a tactic
would be effective if we want the child to have a tantrum but this type
of repetition will not help her learn to ask to go outside. Instead, she
should immediately go to play on the slide as a powerful reward for
using functional communication indicating what she wants. Although
we will want to plan for other similar occasions to encourage and sup-
port her efforts to speak, asking her to immediately repeat her request
will not be beneficial.

How Many Repetitions Should You Do?

In situations where repetition would be helpful, how many oppor-
tunities should we create right now? As we noted earlier, you may have
observed teachers at school taking data on each trial and arranging
for a block of 10 trials. Why 10? It would be nice if research supported
that this number is the best number of repetitions to promote learn-
ing, but unfortunately, there is no such data. In fact, people tend to
use 10 trials so that they can quickly determine the percent correct per
block of trials—after all, it’s easy to see that 7 out of 10 is 70 percent.
However, most of us are not equally adept at immediately seeing that
8 out of 11 trials is about 73 percent. To avoid the more difficult math
issue, many people arrange for a block of 10 trials. While this may make
some aspects of a teacher’s life easier, it is not being done to make the
lesson more effective. The prime difficulty for teachers and parents
alike is that there is no magic number of repetitions to be used for all
lessons involving discrete trials.
Furthermore, at some point in a lesson, continued repetitions may
lead to students changing their correct answers. Why would someone
stop giving the correct answer? It may have to do with the child’s per-
spective, which may be different than our own. Let me share an obser-
vation that we made in a classroom for children with autism. It was 10
o’clock in the morning. On the teacher’s list of one-step directions (a type
of discrete trial lesson) was the instruction, “Go get your lunchbox.” So,
the teacher said this to George, who immediately ran across the room,
 Autism 24/7



put his hand on his lunchbox, and turned to smile at the teacher. She
smiled back and said, “Good! Come sit down.” It is very likely that the
teacher thought that her praise was a good reward for George (and in
many other situations, it was). When he sat down, the teacher said, “Go
get your lunchbox.” Again, George zoomed across the room, and smiled
while placing his hand on his lunchbox. The teacher smiled and said,
“Good. Come here and sit down!” Faithfully, George did as he was told.
Once seated, the teacher said, “Go get your lunchbox.” This time, George
sauntered across the room, put his hand on his lunchbox, and looked
at the teacher without smiling. She did smile and said, “Good! Sit over
here!” He sat down. You guessed it—she said, “Go get your lunchbox.”
And George once again slowly walked to his lunchbox.
Although you do not know this teacher, I’m sure you have a good
idea of how many times she intended to ask George to get his lunch-
box. Right! Her data form had ten boxes and she was planning to run
that number of trials. Around trial number seven, when she issued
her instruction, George walked across the room and put his hand on
a flowerpot sitting on the window sill and looked back at the teacher
with a rather inquisitive look. Although we don’t profess to be able to
read minds, we’re sure he was thinking something along the lines of,
“Maybe today, this is the lunchbox because that can’t be the lunchbox
or she wouldn’t keep asking me to get it!”
In other words, George may have focused on getting to eat lunch
as the natural reward for getting his lunchbox. Since that did not hap-
pen, even though the teacher smiled and praised him, he most likely
thought he was not being successful. One strategy that many of us
use when learning new skills is called “lose-shift”—if something isn’t
working, try something else! In this situation, the teacher’s repetition
was convincing George that something was wrong; his answers were
not leading to getting to eat lunch. Therefore, when we want to use
repetition to help build up “learning muscles,” we want to make sure
that the number of repetitions fits the situation.
For example, you may want your daughter to put a napkin next to
each plate at dinnertime. Clearly, putting 10 napkins by each plate won’t
help, nor would setting the table for 10 (unless that’s your family size!).
On the other hand, you may want your 5-year-old child to sort her socks
from those of her 6-foot 5-inch dad’s socks. In this case, the number of
socks to sort will be related to how many socks you’ve washed—maybe
Dad has 6 pairs and your child has 7 pairs. (When you start this lesson,
  Creating Natural Opportunities for Learning

you may want to be sure there are only a few socks and only add more
as your child becomes more acquainted with the task.)
In short, you need to decide before you start a lesson whether
repetition will fit into the situation, and if so, how many meaningful
opportunities you want to provide during each occasion. You may need
to make adjustments over time—your child may really enjoy the task
and you then may want to extend how long it takes to complete the job.
On the other hand, your child may not enjoy the task or may become
readily bored. If providing additional motivation to complete the task
does not seem to be very effective, then you may want to reduce the
number of repetitions you are requiring for that job.
How do we ensure enough repetitions for activities that don’t
naturally seem “repeatable?” For George in the example above, the
teacher could use naturally occurring opportunities for repetition by
spreading the “Get your lunchbox” direction across the day. The first
opportunity occurs just before lunch. The next opportunity could be
just after lunch when George needs to retrieve his lunchbox before leav-
ing the cafeteria. Finally, at the end of the day, George’s teacher might
give the direction once more while George is gathering his belongings
to take home. At home, you can create multiple “natural” opportunities
for putting napkins on the table by having your son or daughter put out
one or two napkins for breakfast, afternoon snack, and dinner.

Sequential Lessons
While there are virtually innumerable discrete trial opportuni-
ties, not all lessons in life involve simple, brief actions. Some of what we
must learn involves actions that require many steps to be performed in
a particular order. For example, you may think of “getting dressed” as
a single action, but in fact, getting dressed involves many steps where
the order of the steps is important. Not only do children need different
actions to put on their socks versus shoes, but they also need to learn to
put on their socks before they put on their shoes. We will describe les-
sons that require many ordered steps as sequential to remind ourselves
that we are dealing with a sequence of actions to be learned.
There are many sequential lessons in and around the home, and
many more to learn in the neighborhood. We also should point out that
sequential tasks may change over time—that is, as a child gets older
 Autism 24/7



and acquires more skills, we

often make adjustments to what
we expect a child (or adult) to
do. So, grocery shopping for a
5-year-old will often involve
fewer skills than what we would
expect of a 15-year-old.
Let’s review some common
sequential lessons around the
home as noted in Table 4-3. You
also should consider addressing
some of the sequential lessons
noted in Table 4-4 that occur in
common community locales.

Table 4-3  Sequential Lessons at Home

Area Sequential Lesson Activity

Kitchen Sort silverware while unloading dishwasher
Bedroom Get dressed
Living Room Choose, load, and play a video
Dining Room Set the table
Bathroom Wash hands
Backyard Plant seeds

Table 4-4  Sequential Lessons in the Community

Area Sequential Lesson Activity

Mall Order a meal
Grocery Store Empty shopping cart onto checkout belt
Playground Build in the sandbox
Neighbor’s house Make a snack
Library Check out a book
Haircut Sing the “Haircut” song
Dentist’s office Brush teeth
  Creating Natural Opportunities for Learning

How Do Communication Goals Relate to the

Type of Lesson?
As with any skill, communication goals can either be discrete or
sequential. For expressive communication skills (whether involving
speech, sign, PECS, or other modalities), examples of discrete lessons
would include answering simple questions, such as, “What’s your
dog’s name?”; “What do you want for dinner?”; or “Who is playing in
the den?” For receptive communication skills (whether responding to
spoken or visually based instructions), examples of discrete lessons
would include appropriately responding to “Bring me the hammer,”
“You can turn on the TV now,” and “Give this to your dad.”
Examples of sequential lessons involving expressive communi-
cation would include responding to “Tell me how to set the table” or
“Tell me about your class schedule.” Furthermore, getting children to
respond in sentences as opposed to single words (via speech, pictures,
signs, or otherwise) also involves using chains of responses and are thus
sequential lessons. Examples of sequential lessons involving receptive
skills include, “Bring me two spoons, and put two plates on the table.”
“Hang up your coat and then you can go watch TV.”
In the next chapter, we will discuss how and when to use prompts
when teaching a lesson. All of these considerations apply to communi-
cations lessons, just as they do with any other type of lesson. It may be
difficult to think about avoiding verbal prompts during communica-
tions lessons, especially subtle ones (such as, “Use a whole sentence…”)
because they do not involve much effort on our part, but they still need
to be removed to prevent prompt-dependency from creeping into the
situation. (See Chapter 5.)

Designing a Task Analysis

A sequential lesson involves teaching many steps in a set order.
Therefore, it is important to note the specific steps and the order in
which you expect them to occur. Formally, we would call this a task
analysis (TA), but it is exactly the same process as writing down the
recipe for something we plan to make for dinner. Although I don’t
always follow a recipe for everything I cook, if I want to make cheese-
 Autism 24/7



cake exactly the way my mother used to make it, then I should follow
a specific and detailed recipe. When we want someone to learn to
perform a complex, sequential task independently, then we will need
to be consistent with the steps and their order.
How can parents design a good task analysis (TA)? When you
realize that the skill you want to teach involves a sequence of steps,
then you will need to plan out each of those steps. As we’ve noted be-
fore, there are no perfect lessons, so there are no perfect task analyses.
There are many effective ways to make a bed (despite what your mother
told you!), or to get dressed, or even to open a hard-boiled egg (read
Gulliver’s Travels for more on that!). We suggest you use the following
guidelines when you want to design your own TA:
1. Form a little group within your family and talk about
how you each perform whatever task you are aiming to
teach. Most likely, you will find some variations on how
to do any task. Try and come to a reasonable compromise
on how best for your child to perform the task. You can
think of this as a type of armchair exercise because most
of this step will be done by just talking about the activity.
2. Watch how someone performs the task and see how well
it matches your written description. Rewrite as neces-
sary to best describe what you see rather than what
someone tells you he or she is doing. It may be helpful to
watch more than one person perform the task.
3. Talk to your school team (or other families) and see if
anyone has written a version of a TA for this activity. You
do not have to accept what someone else wrote without
considering modifications to fit your child and situation.
4. Consider how your child’s skills and age may affect your
expectations. For example, you would expect more from a
teenager cleaning her room than you would a 4-year-old,
so the TAs would be different for each child. If your child
can read instructions, then a TA may involve steps that
would not be the same as for a child who cannot read.
5. Test out your TA! First, test it on someone other than
your child—a friend, perhaps, or a sibling. See if they
can read your TA and follow it in the manner you expect.
6. Then try it with your child. That is, watch carefully as
you use the TA to teach your child and be prepared to
  Creating Natural Opportunities for Learning

make modifications. Your child can teach you a lot about

how she learns best, so take advantage of her advice!

The steps in your TA are put together much like a chain—each

step is like a loop linked to the step before and the step after. In the next
chapter we will describe how to use prompts to best teach sequential
lessons, and even consider which end of the chain you will want to
start teaching.
Now let’s consider some common sequential lessons at home and
in the neighborhood. At home, the task analysis for washing hands
might look like this:
1. Turn on water
2. Adjust temperature
3. Wet hands
4. Dispense soap onto hands
5. Rub hands
6. Rinse hands
7. Turn water off
8. Dry hands

In the community, the task analysis for checking a book out from
the library could look like this:
1. Choose book
2. Walk to checkout counter
3. Wait in line
4. Put book on counter
5. Give librarian library card
6. Take book back from librarian
7. Leave checkout line

Before you set out to teach your child the steps you have identified
in a task analysis, you will need to decide which step to teach first. This
is covered in the next chapter, on Teaching Strategies.

Who Goes First?

When our children are young, we are accustomed to asking—or
simply telling—them what to do. We are the ones in charge and set up
 Autism 24/7



situations such as when to set the table, when the TV can be on, when
it’s time to take a bath, and so on. We often ask many questions, such as
“What do you want to drink?”; “Which video do you want to watch?”;
“Did you have fun at school today?” or even, “Look at me (so I can wash
your dirty face!).” As parents, we are used to taking the lead for our
children. But as they get older and more competent, we like to see our
children become increasingly independent. When our daughter is 3,
we’ll happily make her favorite cheese sandwich, but when she’s 15, we
expect her to be able to make her own sandwich (even if we still have to
clean up after her!). Furthermore, even when children are quite young,
there are times we would like to see them be spontaneous rather than
having to play “20 Questions” to find out what they want.
In other words, we need to strike a balance between teaching
our children to follow our directions some of the time and yet be in-
dependent at other times. In the next chapter we will describe how
we might go about teaching these different styles but for now we want
to focus on finding situations in which the different styles are easily
identified. When choosing between teaching a lesson that will result
in a child being responsive as opposed to spontaneous, it will not
matter whether the lesson involves discrete or sequential activities. It
also will not matter whether the lesson will involve communication as
opposed to physical routines. Each of these can be either responsive
or self-initiated.
For example, we could teach a child to set the table (a sequential
task) only when we say, “Go set the table.” On the other hand, we could
aim for the child to learn to set the table at 6:00 P.M., independent of
what we’ve said. Likewise, we could teach a child to turn the TV on
(a discrete action) only when we say, “It’s time for television” or we
could teach her how to turn the TV on whenever she wants to watch
a show or video.
When teaching social or communication skills, we need to make
similar choices. We can teach a child to say, “Hello” only when we say
hello first, or we can teach the child to initiate the social greeting when
entering a room. Our point is that you must decide before you start the
lesson what you want the child to do:
1. respond to something you’ve said or done, or
2. initiate the act following something going on inside of
her (e.g., she’s hungry) or something around her (e.g.,
she sees a friend she wants to play with).
  Creating Natural Opportunities for Learning

It would be nice for us as teachers and parents to be able to teach

children to respond to us now and to become more spontaneous on
their own later on. Unfortunately, this rarely happens—children with
autism tend to become more independent and spontaneous only when
we teach (and thus support) them for doing so. Therefore, when you are
initially planning a lesson, it is wise to think ahead about not only how
you will teach your child to do the skill on your instruction, but also
how you will later get her to do it more independently. Many of these
issues relate to how to use and phase out prompts, which is discussed
in the next chapter.

Building and Taking Advantage of Routines

If you want to learn to teach your child needed skills during the
course of everyday life, you will naturally need to learn how to embed
teaching in your daily routines. If you need to do a routine anyway, and
if one of the steps of the routine involves your child, then whenever
you do the routine you will automatically be teaching your child. We
can teach any kind of skill in the course of performing a routine, but
we will illustrate how to do this with communication skills because
all children with autism have needs in this area.
Parents typically understand the advantages of helping their
children expand their communication repertoires—both in terms of
the total number of words in their vocabulary and in the complexity
of their sentence constructions. Parents often observe teachers and
speech-language pathologists teaching lessons at school where they
try to increase a student’s vocabulary by introducing novel items ei-
ther directly or via pictures. During some of these lessons, a teacher
may show the student many common objects, including items that
are familiar to the child as well as a few new items around which
the lesson is built. For example, we could place a fork, knife, and
a spoon before the student and ask her to name each one. Then we
could show her a can opener and teach her the name of that item.
In this way, the new item is embedded within a relatively easy task.
Hopefully, when the child next sees a can opener at home, she will
be able to recall the name learned at school. Sometimes, this lesson
is arranged using pictures or photographs of both the familiar as
well as the novel items.
 Autism 24/7



Keeping with our theme that parents can arrange for successful
lessons at home without changing their home into a classroom, let
us consider some strategies that we can use at home to help children
increase their vocabularies. Our key suggestion involves designing
activities and routines to help the child understand the functional
value of increasing her vocabulary.
Let’s consider this goal with the can opener. Although it is possible
to teach a child the name of something and then later learn the use of
that object, it is often more effective to first teach the functional use of
the item before designing a communication lesson associated with that
item. So, at home, we would first create an activity during which a can
opener will be helpful. Let’s assume that your daughter likes soup and
that there are some canned soups that she enjoys. Rather than simply
preparing the soup for her—that is, serving hot soup in a bowl—we
will first teach her the routine associated with opening the can before
preparing the soup. Even children who are too young to manipulate
the can opener themselves can learn this routine.
To design an effective routine, we first need to think about the
steps that make up the routine. Look at the list below for an example
of a task analysis for preparing canned hot soup:
1. Get a bowl
2. Get a spoon
3. Get the can of soup
4. Get the can opener
5. Open the can of soup with the can opener
6. Pour the soup into the bowl
7. Place the lid into the empty can and throw in garbage
8. Put bowl in microwave
9. Turn on microwave for 1 minute
10. Take out bowl and put on table
11. Eat soup with spoon
12. When finished with soup, put bowl and spoon in sink

We hope you can see that this is only one way to prepare canned
soup! For our example, it is important to note where the can opener will
be used—in step 5. When we first begin this lesson, we should not expect
the child to actively participate in any single part of the routine. That
is, we expect to guide the child throughout the routine. For this kind of
activity, which involves many physical actions, we suggest using direct
  Creating Natural Opportunities for Learning

physical assistance. We will eventually have to remove our guidance

(see the discussion about getting rid of teaching prompts in Chapter 5).
Therefore, we do not want to use many different types of prompts at
this point. So, once we announce the general activity (“OK, let’s make
soup!”) in some manner, we would help the child get each of the items
we need for the routine. When we have all the items, then we would
guide the child to pick up the can opener and place it on the soup can.
Again, whether our aim is to teach the child to independently
open the can will be a function of the child’s age and skill level. How-
ever, our immediate goal is to teach the child to pick up the can opener
to begin Step 5. Over several opportunities to make soup, we try to
gradually remove our help until the child is automatically picking up
the can opener when it is time to use it. Of course, we hope that you
will remember to heap great praise upon your child when you see her
acquiring that skill! After a few successful opportunities with this step
in place, we are ready to create our communication lesson.
During the next soup-making opportunity, you put the can opener
somewhere that your child cannot reach it by herself. Essentially, you
place yourself between the child and the completion of the next step.
That intervention creates the need for your child to communicate with
you in order to complete the routine that she has previously learned.
If you tried this arrangement on the very first day of this lesson, she
would have no reason to ask for the can opener since she has no idea
why she should want it. And, it is not enough to just teach the name of
something—we must create the need for communication.
One way to help identify functional vocabulary is to fill out a
form like the one shown in Table 4-5.
Note from the table above that you can teach a variety of vocabulary
words by varying which item is missing when your child wants to make
soup. On some days the can opener is missing and on some days the bowl
is missing. In order to balance your child’s opportunities for being indepen-
dent at making soup with her opportunities to learn to communicate while
making soup, remember that on some days, no items should be missing.

Review
This chapter introduced the Pyramid Approach to designing ef-
fective lessons in various environments. Not all lessons are alike. Some
 Autism 24/7



Table 4-5  Vocabulary within Routines Form

Routine: Making canned soup

Steps Vocabulary for Requesting

1. Get a bowl 1. bowl
2. Get a spoon 2. spoon
3. Get the can of soup 3. soup
4. Get the can opener 4. can opener
5. Open the can of soup with the can
opener
6. Pour the soup into the bowl
7. Place the lid into the empty can 7. garbage can
and throw can in garbage
8. Put bowl in microwave
9. Turn on microwave for 1 minute 9. help
10. Take out bowl and put on table
11. Eat soup with spoon
12. When finished, put bowl and
spoon in sink

Reinforcement for completing routine: Getting to eat soup!

are relatively simple and require a single action—these lessons can be

described as discrete. Other lessons involve many steps in a particular
order—these are sequential lessons. For lessons involving many steps,
it will be helpful to write out the task analysis you think will be effec-
tive for your child. For either type of lesson, you must consider how
to incorporate repetition to promote success but not undermine the
power of naturally occurring rewards. Furthermore, you must also
consider whether you want the lesson to begin with your action or be
initiated by your child. Each decision you make regarding the type of
lesson you want your child to learn will affect how you will go about
teaching that lesson—the topic of our next chapter.
 Teaching Strategies
5 for the Home
and Community

Lisa and Charles are watching their son Albert as he struggles to

put together his train set. They have set a goal of teaching him to do this
independently so that he can play while they attend to chores around the
house. They know that they need to teach a sequential lesson, since there
are several steps involved in connecting the trains. They’re not sure, how-
ever, how best to help him. Should they point to where the trains connect
or just tell him what to do? Is there a way to teach him without having to
physically guide him through the right actions? Should they show him
a completed set or have him watch them while they put it together? Lisa
and Charles wonder whether helping Albert this time will mean that he
will come to rely upon them in the future rather than figuring it out for
himself. How should they reduce how much help they are giving him? They
also aren’t sure how to reward him—they know Albert likes to play with
the trains, but should they praise him as well? Will that distract him?

Lisa and Charles are struggling with issues that face everyone
trying to teach a new skill, whether at home or at school. In addition,
they have heard that it is important for children with autism to experi-
ence few, if any errors, when learning. Is there a way to teach that will
minimize errors and yet not result in the child becoming dependent
upon his parents’ help? Like most people, they have heard about trial-
and-error learning but wonder whether this would be a good strategy
for their son—wouldn’t this lead to many errors? (In fact, one promi-
nent behavior analyst, Dr. Beth Sulzer-Azaroff, reminds us to practice
  Teaching Strategies for the Home and Community

“trial and success” rather than trial-and-error. Careful attention to how

we design lessons will result in few errors and effective learning.)
Like Lisa and Charles, you may think that teaching children with
autism is hard, or may not know where to begin. The whole idea of
keeping your child from making any errors also may seem very intimi-
dating. We believe, however, that parents and other family members
are very capable of teaching their children new skills at home and in
the community. This chapter will tell you how to begin.

What Is Teaching All About?

Before we focus on what teaching is all about, let’s review what it
means to learn. If you’ve taught a successful lesson to your child, then
your child can do something when the lesson is completed that he or
she could not independently accomplish earlier. That is, as teachers, we
only know if our children have learned a lesson if we see them doing
something different after the lesson than they could do before—they
then can “show us what they know.”
When we start a lesson, the child cannot perform the lesson
goal. In the example above, Albert cannot put his trains together. Let’s
consider how Albert’s parents can teach him to put his trains together.
What will Lisa need to do on the first day that she attempts to teach him
this skill? If she simply watches him, he will stand there and not ac-
complish the task. Lisa will have to help her son put the trains together
on this day, although her goal is to teach him to play independently,
even if she is not in the room. Therefore, one way to think about this
(and most) lessons is that the teacher (Lisa) must help the child (Albert)
at the start of the lesson but then must stop helping while the child
continues to perform the target skill. When the child is independent,
he will be responding to natural cues in the surroundings—such as the
train itself, the tracks for the trains, etc.

Prompts
How can Lisa help Albert on the first day? We immediately
recognize that there are many potential ways of helping. Each strat-
egy of help is called a prompt. A prompt is simply something that a
 Autism 24/7



teacher uses within a lesson to help

the child perform the target skill.
For example:
■ Lisa could tell her son to

pick up the train. That

would be a type of vocal
or verbal prompt. Lisa
knows, however, that
Albert has a very limited
receptive vocabulary, so
she isn’t sure that he will
understand what she is
saying. Her words would
probably not be an effective
prompt because it would
not be helpful to Albert.
■ Lisa could try to point to the train—thus, trying a type

of gestural prompt. In this case, Lisa knows that Albert

rarely looks at what she is pointing to and thus does not
choose to try this strategy.
■ Lisa could show Albert what to do—thus, trying to model

certain actions that he can then imitate. But Lisa knows

that Albert’s schoolteachers are still trying to teach him
to imitate so she doubts her modeling will be effective
right now.
■ Lisa could hold up a picture of the train—thus, trying a

type of visual prompt. Here, too, Lisa realizes that her

son does not yet seem to always associate pictures that
are shown to him with objects around him.
■ Finally, Lisa realizes that she can physically guide Albert’s

hands to put the train together—thus, trying a type of

physical prompt. She knows that this will be effective
because her son has accepted her assistance when she has
physically helped him with other simple tasks.

Eliminating Prompts
Once Lisa has selected the prompt she will use—in this case,
physical assistance—she now needs a strategy to get rid of the prompt.
  Teaching Strategies for the Home and Community

That is, she must plan to reduce how much physical help she provides
so that over time Albert will not need any physical or other prompts
to complete putting his trains together.
There are many effective ways to get rid of a prompt. First, Lisa
could reduce how much physical help she provides over successive op-
portunities. For example, for each new car that Albert is trying to add
to the train, she could provide slightly less assistance. We would call
this “fading” a physical prompt, or using graduated guidance. There
are several ways that prompts can be faded. For physical prompts, such
as guiding a child’s hand movements, you can gradually decrease how
much physical pressure you apply over successive opportunities. You
also can alter where you touch the child—you can start with hand-
over-hand and then gradually adjust your point of contact to the child’s
hand, wrist, arm, and then shoulder. The key is to continue to gradually
reduce the assistance and thus move the child toward independence.
Lisa also could slightly increase the amount of time she waits be-
tween handing Albert a train car and providing physical assistance. We
call this strategy “delayed prompting.” This strategy is often a good choice
when you are sure that your prompt will work because on every oppor-
tunity, the child succeeds—either on his own or with the prompt.
There are many strategies to eliminate and reduce prompts—far
too many for us to review them all here. Each is designed to help a
child learn to respond to natural cues rather than teacher prompts.
For more information about these strategies we encourage you to
read The Pyramid Approach to Education (Bondy and Sulzer-Azaroff,
2002—especially Chapter 9).

Are Some Prompts Better Than Others?

By definition, a prompt is something you do or modify within a
lesson that successfully helps your child perform the particular skill you
are focusing on. Some people prefer using vocal prompts; they like to
talk to the child almost continuously. Other people prefer using picture
and other visual prompts; they put pictures and signs on everything,
everywhere in the home. It is not possible to determine which prompt
is “better” than another prompt. If it works, great!
A bigger challenge than finding a prompt that works is selecting a
strategy that will remove the prompt. I may find using verbal prompts
so easy to use that I forget to plan to remove them. Or, I may put so
 Autism 24/7



many pictures around the house that I forget that they won’t be in other
homes or locations. If I use a series of pictures to prompt a child to get
dressed when I am first teaching him that skill, it is my responsibility
to recognize that these pictures will later need to be faded. I need to
remember that it is possible for my child to learn to get dressed without
the pictures (or some other prompt) and I need to plan a strategy to
reach that independent goal.

What Do We Do If a Prompt Is Not Effective?

Once you have decided what type of lesson you want to teach—
discrete vs. sequential, for example—you then select the type of prompt
to use: vocal, physical, gestural, etc. Then you choose a strategy to
eliminate the prompt. It is important to remember that not all plans
will work and that no one can guarantee that the selected strategy will
be effective. At best, we are making educated guesses! Prompts are
things we introduce into a lesson that help the child perform the task.
If the strategy is not helpful, then it is not really a prompt.
If you point to a picture to help your child pick it up but he does
not pick up the picture, then what you did was not really a prompt. In
this case, you would need to find another way to help your child—some-
thing that will act as a prompt. Likewise, it is possible that when you
try to use physical guidance to help your child, he resists and pulls
his arm away. In this case, your physical guidance was not a prompt.
Perhaps shining a light on the object will draw your child’s attention to
the object, leading him to pick it up. In this case, the light is a prompt.
Essentially, you will not know whether something is a prompt until
you try it out and see if it helps your child. So, be willing to be flexible
and try out different types of prompts for different lessons.

Should We Combine Prompts?

While Lisa is choosing which prompt to use with her son, she
wonders whether it would be better to use several prompts at the same
time. That is, should she show him what to do (perhaps using photo-
graphs) while she simultaneously tells him what to do as she guides
him in what to do? After all, it seems logical that the more help she
provides, the more likely Albert is to complete the task. However, she
realizes that the goal of her lesson is to eliminate all prompts so that
  Teaching Strategies for the Home and Community

Albert can play with his trains independently. She knows that if she
uses three or four prompts at the same time, she will then need to plan
to get rid of all of these prompts. It will be hard enough to eliminate
one prompt! More is not always better. So, she wisely plans to use the
physical prompts that she knows will be effective and designs a plan
to eliminate that single type of prompt.
Charles understands the need to get rid of helpful prompts, but
he is concerned that if they do not talk to Albert while he is learning
to put his train together, he will not learn any language associated
with the task. He wonders if they will need to remain totally silent
throughout the lesson. Lisa points out that prompts are actions teach-
ers use before the child tries an action, and while she does not want
to combine prompts, she too wants Albert to hear their words in hopes
that he will learn to associate them with the activity. So, she rightly
advises that they can talk to Albert while he is doing a prompted step
(or just after) rather than talk during the prompt itself. Lisa will guide
Albert to connect two trains and then immediately say something along
the lines of, “Yes! You put the trains together!” or “Wow! Look at the
trains! They are together now!” Charles now understands that it is not
about whether to speak or not; it is more about the timing of what he
will say while teaching his son.

Can We Use Prompts When Addressing Challenging

Behavior?
In Chapter 8, we discuss the importance of teaching alternative
behaviors to replace challenging behaviors you are targeting in your
teaching efforts. Part of that overall strategy may involve prompting
your child to engage in the alternative behavior, and we will now
discuss some issues related to this use of prompts.
One important issue concerns when to prompt your child to
do the alternative behavior. We do not think it is a good idea to try
to teach any skill when a child is in the midst of a tantrum. During a
tantrum, the goal is to calm things down and avoid injuries or serious
property damage. However, you should be attentive to what may have
triggered the reaction.
Ideally, you would read your child’s cues and prompt him before
he has a tantrum. For example, let’s say your child is still in the process
of learning to give you items that are not working correctly rather than
 Autism 24/7



getting down on the floor and screaming until you help him. To help
your son learn the new skill, you need to create situations that lead
to him needing help—for example, you can give him a bottle that is
closed too tightly for him to open. After you’ve handed him the bottle
but before he screams (possibly within a second or two of struggling
with the bottle top), you would arrange for his sister to prompt him
(with physical guidance) to hand the bottle to you. You would then say,
“Oh, you need help!” and immediately open the bottle. Notice that the
prompt from his sister came before any meltdown and not in the middle
of screaming. Over opportunities, you would get his sister to gradually
reduce the amount of physical assistance she provides.
If you prompt your child once he starts screaming, that is likely to
reward him for both screaming and handing you the bottle. Thus, he’s
likely to repeat the scream the next time a similar situation arises.

Where Should We Start Sequential Lessons?

Whether we are teaching a discrete type of lesson or one that
involves many steps, our overall strategy typically involves finding an
effective prompt and then eliminating it. In Chapter 4 we discussed
the importance of writing down a task analysis for sequential les-
sons. Once this is completed you still need to decide which end of the
sequence you want to teach first. When we start by trying to teach the
first step, we describe this as forward chaining. For example, you put
a puzzle form before your child and you then teach him to put in the
first piece, and then another, and another . . . until all the pieces are
correctly placed. Another way to teach a sequence is to first teach the
last steps—a process described as backward chaining.
At first, backward chaining may sound counterintuitive, but there
are many examples in our lives when we naturally use this strategy.
Think about teaching your daughter to ride a bicycle. Most likely, you
helped her get on the bike, supported her while she put her feet on
the pedals, helped her start to move the bike, and finally—when she
seemed to have balance and a steady speed—you let go! In this case,
the first thing she learned was the very last step—keeping the bike
moving ahead. The last thing she learned was how to get on the bicycle
without help and start to pedal.
Backward chaining is a strategy that we often suggest when
teaching the steps of a task analysis. In our puzzle example, if we were
  Teaching Strategies for the Home and Community

using backward chaining, we would put in all of the pieces except the
last one and then help the child put that piece in. Once he has learned
to put in that piece, then we put in all the pieces except the last two.
Once he’s put in the second to the last piece, he can complete the puzzle
since he’s already learned about the last piece. In general, it is the last
piece that is nearest in time to completion of the puzzle and thus may
be the most rewarding piece of all.
We can use backward chaining in many routines around the
house, such as the one in Table 5-1.

Table 5-1  The Last Step of Sequential Activities

Area Activity Last step

Bedroom Folding clothes Top half of T-shirt over
bottom half
Bedroom Tying sneaker laces Pull both loops tight
Kitchen Making PB&J sandwich Put bread slices together
Laundry Putting wet clothes in dyer Taking last item in washer
room and placing in dyer
Family room Operating (and loading) Pushing the “Play” button
a DVD player
Garden Fill and use watering can Pour water on plants

Can We Teach without Prompting?

A major concern about using prompts to help children learn skills
is that they will learn to rely upon the prompt, or become prompt de-
pendent. Some people assume that prompt dependency is a common
feature of children with autism. However, we think that since it is
the teacher who selects and uses the prompt, then it is the teacher’s
responsibility to remove that prompt. In part, that is why we suggest
using only one prompt at a time—if you pile them up, then you will
have a great deal of work to do to eliminate them all! Whenever we
teach using prompts, then we will have to eliminate those prompts.
Fortunately, there are several effective teaching strategies that
do not involve prompts and we will discuss these in the next section.
 Autism 24/7



Shaping
The best-known teaching strategy that does not involve using
prompts focuses instead on the power of rewards to teach new skills.
One of the founders of behavior analysis, B. F. Skinner, described this
strategy as shaping. In this strategy, the teacher gradually changes the
standards for reward, thus encouraging very small adjustments in per-
formance—which, over time, can result in a large behavioral change.
For example, Rayna wants to teach her daughter, Doris, to go from dot to
dot on a piece of paper using a pencil. She could use physical prompts to
guide Doris’s actions. Instead, she puts two dots very close together—so
close that almost any drawing motion will connect the two.
As soon as Doris draws from one dot to the other, Rayna claps
her hands and praises her daughter. Now, Rayna starts gradually to
increase the distance between the dots, in increments that are so slight
that Doris does not notice the change from opportunity to opportunity.
Fairly soon, the dots are inches apart and Doris thinks it’s a great game
to see where her mother will place the next dot. Notice that Rayna did
not use any type of prompt and therefore she did not have to remove
any prompts. She did have to very carefully watch her daughter so that
she could reward her correct efforts immediately. On any occasion
when Doris did not connect the dots, Rayna simply provided another
opportunity— sometimes reducing the distance between the dots to
improve the likelihood of success.
Shaping is an excellent strategy for teaching children to respond
to simple directions such as coming when their names are called or to
improve various sports skills (such as throwing a ball, jumping, running,
etc.). For example, if your child does not seem to react when his name
is called, you first would find a small reward that he enjoys, one that he
immediately tries to take when he sees it. In this situation, while you are
standing about 10 feet from your child, you can call out his name, and,
even if he does not react in any manner, you would slowly approach him
while holding his special toy in your open hand. At some point while
you are approaching him, he is likely to see the toy and reach for it.
Sometime later (when you have the toy again), you repeat this process
and continue to gradually walk toward him. After a few opportunities
like this, he is likely to notice you while you are walking toward him.
At that point, slow down so that he will start walking to you.
  Teaching Strategies for the Home and Community

Continue this process of calling and approaching, and you are

likely to find that upon calling your child’s name, he looks toward you
and starts to approach. At this point, after you call his name, gradu-
ally begin to hide the toy so that he sees you but not the toy. Once he
reaches you, praise him and of course give him the toy. Over time, when
he approaches you after you call his name, you can use other reinforc-
ers, especially praise and hugs. Eventually, you may introduce some
simple tasks for him to do before providing praise. In this manner, he
has learned to come to you when you call his name. Sometimes he gets
a material reward, sometimes simple social rewards, and sometimes a
small task to perform. Notice you did not prompt him during any part
of this lesson. Yes, shaping behavior requires great patience on your
part but the outcome is well worth it!
In teaching athletic skills, such as throwing a ball, shaping will be
far more effective than trying to find an effective prompt. For example,
if your child can toss a ball while you stand 2 feet away, you can then
try standing 2½ to 3 feet away and praise all successful throws. Gradu-
ally move further away and praise all good throws. If you find that you
reach a point where you’ve stepped too far away—several errors have
occurred in a row—then move a bit closer to the point where your child
succeeds again. When you have successfully “stretched” the length of
your child’s throws on one day, you may want to try shortening that
distance a bit at the start of the next day while aiming to exceed the
previous day’s limit by the end of the new day. Many coaches apply this
strategy in their training, even if they don’t describe it as shaping!
Shaping has been successfully used to teach all types of skills.
It can be used to help children articulate more clearly, improve their
penmanship, be more creative in terms of artwork and writing, and
almost anything you can think of! The keys to using shaping are:
1. to know what your child can currently do,
2. to have precise information on what you want your child
to do, and
3. to develop a clear plan to identify tiny steps between
those two behaviors.
Shaping takes patience and a keen eye (or ear!). You will be
tempted to add prompts in an effort to make the learning process go
more quickly, but you must remember that you will have to remove
every prompt you add into a lesson. With shaping, there are no
prompts to remove!
 Autism 24/7



For more information about how to use the power of shap-

ing in your home (for everyone!), you may want to check out Karen
Pryor’s website on clicker-training ([Link]) or the
TAGTeach International website, for information on teaching various
sporting skills ([Link]). Clicker-training is the term used
to describe how teachers can use a simple clicker to provide timely
feedback for successful performance. The advantage of a clicker is
that we can use it immediately and it always sounds the same—unlike
our voice, which often varies in tone, quality, strength or some other
feature. Clicker-training has even been used successfully to help train
high-level gymnastics students.

Video Learning
Video learning (video modeling) is a relatively new teaching
method in which peers, siblings, or adults are videotaped performing
a skill correctly and then the video is shown repeatedly to a child who
needs to learn that skill. A number of recent studies have shown that
many children with and without autism can effectively learn skills and
routines if they first watch videotaped examples and are then quickly
given an opportunity to practice the modeled skills. This strategy has
been shown to be effective for teaching both communication and motor
skills. Some of the skills taught via video modeling have included play
skills such as having a tea party, going shopping, and baking. More ad-
vanced social skills, such as perspective-taking, can also be improved
via video modeling (Charlop-Christy and Daneshvar, 2003).
Some researchers have shown that having children watch videos
of themselves—video self-modeling—can help them learn to more
consistently use skills that they only occasionally use. For example, two
researchers (Wert and Neisworth, 2003) demonstrated that children
learned to be more spontaneous with their spoken requests after watch-
ing videos of themselves making requests in guided situations.

Review
In this chapter, we’ve reviewed some general guidelines that
should help you create effective lessons at home and in your commu-
  Teaching Strategies for the Home and Community

nity. In teaching most lessons, you will need to help your child perform
a task—typically, by using a variety of prompts. Whenever you use a
prompt, however, you also need a plan to eliminate that prompt so that
your child will be able to perform the task without your assistance, in
response to cues that are part of the natural environment, including
the social surroundings. There are many strategies for eliminating
prompts and none will work in every situation all of the time. Therefore,
you should try to vary the types of prompts you use and the types of
strategies you use to get rid of those prompts.
It is possible to teach without the use of prompts by using shap-
ing. This strategy relies upon reinforcing small changes in behavior
that add up over time to dramatic changes in performance. Although
shaping requires patience and attention to detail, it has the advantage
of not requiring a strategy to eliminate prompts.
In the next chapter, we will look at strategies used in the Pyra-
mid Approach to minimize the chances that a child will make errors
when learning, as well as ways to thoughtfully respond to errors
when they do occur.
 Dealing with
6 Common Errors

Keiko is washing dishes when her son, Yoshi, walks into the room
from the bathroom. Keiko hears the faucet still running so she says,
“Please go turn off the water.” Yoshi does as she asks. The next day, Keiko
again hears that Yoshi has not turned the faucet off after he has been to
the bathroom. She again reminds him about what he needs to do. After
five days in a row of this pattern, Keiko is getting exasperated, wonder-
ing why her son cannot learn this simple rule about when to turn off the
water. Her husband comments, “But Keiko, he does know when to turn
the water off—he does it when you tell him to!”

As we suggested, our preference is to try to teach in ways that limit

the likelihood of errors—“trial and success” is a good motto to follow!
Still, no matter how tiny may be the steps we design, all children will
make mistakes at some point. Sometimes, we’ll see the mistake within
a formal lesson that we’ve created, while at other times, we’ll notice
an error during a time when we’re not even conscious of an ongoing
lesson taking place. The key to long-term effective learning often is
how well we respond to these errors.
On the one hand, adults often feel that it is a good idea just to
repeat things if a child makes an error—maybe the child would do
better with another chance. However, you might want to follow the
advice of a brilliant man who is not often thought of as a teacher.
Albert Einstein once said that it is insane to “do the same thing over
and over but expect a different outcome.” How does this relate to
  Dealing with Common Errors

teaching? Well, think of how many times you’ve repeated yourself

(or watched others repeat themselves): “Michelle, come here…. Come
here, Michelle . . . come here! Come on, now, come here . . . you can do
it . . . come here now . . . COME HERE!” If we ask the child a question
or use some type of prompt and the child does not respond correctly,
should we repeat the prompt that we just determined was ineffective?
Why should we expect a different outcome if we repeat what already
hasn’t worked? It seems that Einstein would suggest doing something
differently after an error, and we would agree. If a prompt doesn’t
work, try a different way to help.
How should we help? That is easier to figure out if you know
the kind of lesson being taught. As Chapter 4 explains, some lessons
involve discrete trials and others involve sequences of steps. Because
these are two very different types of lessons, we should use two very
different types of strategies to handle errors.

Handling Errors During Discrete Trials

Let’s say you asked your daughter, Emily, to bring you a cup, but
instead she brought you a sock that was lying on the floor. Since she
did not seem to understand the spoken word, “cup,” repeating it is
more likely to result in another error than the correct response. You
know that Emily does a good job of getting things when you point to
an item. So, rather than repeat your request, you point to the cup. She
now brings you the cup. However, you now may well wonder whether
Emily is learning the lesson you are trying to teach. After all, this was
not a lesson about “bring you things you point to”; rather, it started as
a “listen to my instruction” lesson.
We would like to see if Emily really can understand our spoken
words. So, we put the cup back, and ask Emily again to bring the cup.
This time she does so correctly. But are we done with the lesson? Some
of you may have a queasy feeling because you notice that Emily brought
you the cup twice in a row. Does she really understand what you are
saying or is she just repeating the last successful thing she did (a very
good learner-strategy, by the way). So, we provide a little praise and
we put the cup back. Now, to make sure that Emily is listening to us
(rather than getting locked into her own pattern of repeating the last
correct action) we ask her to get something that she already knows how
 Autism 24/7



to do—get a ball. Immediately after she brings us the ball (because

she always does this task well), we ask for the cup. Now, if she brings
the cup, we can feel more confident that she has indeed listened to our
request, so we also provide some enthusiastic praise (and fill the cup
with something she likes to drink).
These steps may seem complicated and take a little time to adjust
to but they will help speed up the learning process and help reduce the
chances that the child will get stuck on the type of help you provide
(some people call this “prompt dependency”). Notice that this was a
discrete trial type of lesson—simple question, simple response. Once
the error occurred:
1. We helped in a manner that showed, modeled, or dem-
onstrated the correct answer.
2. We then used the original cue to encourage the child
to repeat in a practice fashion—that is, we give some
praise, but not a lavish amount, for a correct response.
3. We next switched or changed the task to something that
the child is already good at doing (this varies from child
to child, and from occasion to occasion). We also used
this third step to help assure that the child was really at-
tending to us.
4. Finally, we repeated our original request and provided a
nice reward for successful completion of the task.
Not surprisingly, we call this the 4-step Error Correction Proce-
dure to help us remember each of the four steps that leads to improved
learning. Refer to Table 6-1 on the next page for a description of this
error correction strategy for one lesson.
You may find opportunities for this type of error-correction strat-
egy even when you are not conducting a formal lesson. For example,
your daughter is helping you load the washing machine and you have
a pile of clothes that has both dark and light pieces. Your aim is to load
only the “whites” for this load. As you load the laundry, your daughter
reaches for an item that is “dark.” You can gently block this error and
immediately point to a light item (model) and gesture (practice) for
your child to put that one in the machine without providing much
praise. Then you could ask her for a clothespin (something that she
knows very well)—this would be your “switch” step. Next you would
gesture (repeat) to the pile (without pointing to any one piece) and
when she takes out a light piece, praise her generously! This 4-step
  Dealing with Common Errors

Table 6-1  Using the 4-Step Error Correction Sequence

Step name Teacher action Child action

“Give me the apple” Gives an orange
1. Model Points to and taps on apple Gives the apple
Replaces apple
2 . Practice “Give me the apple” Gives the apple
Quietly says, “Good”
3. Switch/change “Where’s Mickey?” Points to Mickey
Mouse doll
Quietly says, “That’s right”
4. Repeat “Give me the apple” Gives the apple
“That’s great!” and hands
over a cut piece to eat

error correction can be used whenever a task involves discrete trials,

whether or not you are setting up a true lesson or just reacting within
a naturally occurring opportunity.
There may be times when your child repeats the error at the
last step of your correction sequence. In this case you may repeat the
entire four steps. However, too many repetitions of the error will likely
lead to an emotional outburst and little learning, so we advise running
through the 4-step sequence two or three times at most before ending
the situation (on a positive note if possible—after a successful switch,
for example). At that point, you should move on to something else while
you think about what went wrong. Perhaps your child is too tired or
bored or simply not motivated to learn your lesson at that point.

Handling Errors during Sequential Lessons

Backstepping
Remember, not all lessons involve discrete trials. Many lessons
involve sequential tasks. What should you do when your child makes
errors in this type of lesson—either errors of omission—she pauses or
 Autism 24/7



simply doesn’t do a step, or errors of commission—she does the wrong

thing at a certain step?
Let’s suppose you’re baking a batch of pre-mix cookies. Part of the
sequence calls for the child to turn on the oven, set the temperature,
put the dough on the tray, open the oven, insert the tray of cookies,
close the oven door, and set the timer. As you watch your daughter,
you see that she has put the tray in the oven but did not start the oven
or set the temperature. You know that if you now point to the correct
buttons, she will start the oven and also set the temperature. This
approach will fix the immediate problem but will it lead to improved
learning? That is, what do you think she will do the next time she bakes
cookies? Right—she will put the tray in and wait for you to remind her
to push the correct buttons.
How should we handle this type of error within a sequence? We
think it is important to understand that each step should act as the
signal for the next step. Putting in the tray should only follow starting
the oven and setting the temperature and putting the dough on the
tray. If we help outside of the proper sequence, we will maintain that
inappropriate sequence. Therefore, we need to recreate the correct
sequence. In this case, we would calmly tell the child to try it again
and take the tray out of the oven and put it back on the kitchen counter
(because putting the dough on the tray was the last successful step).
Then we would prompt her to start the oven and to set the temperature
before getting her to put the tray in the oven. This strategy seeks to
link setting the temperature to finishing putting the dough on the tray.
Thus, we have stepped back into the sequence just before the error
took place. We call this type of error correction backstepping. You can
review the use of backstepping in Table 6-2 on the next page.
Now, we realize that it is far simpler to just point to the tem-
perature button on the oven and thus fix the problem. But fixing the
problem now may not lead to avoiding the problem in the future. Only
if the child learns the proper sequence will she be able to perform the
steps in their proper order the next time. So, it will be worthwhile to
spend a little extra time on this occasion in order to save a lot of time
down the road when you would keep having to remind your child to
set the temperature.
Let’s look at another example of using backstepping. What would
you do if your child slammed the door too hard upon entering your
car? You might be tempted to tell your child not to do that again or to
  Dealing with Common Errors

Table 6-2  Using Backstep Error Correction with

Hand-washing Routine

Correct sequence Actual sequence Teacher Backstep actions

1. Pick up soap Picks up soap
2. Turn on water Turns on water
3. Wet hands/soap Wets hands/soap
4. Put soap down Puts soap down
5. Rub hands Rubs hands
6. Rinse hands Rinses hands
7. Turn water off
8. Dry hands Dries hands
9. Leave bathroom Leaves bathroom 1. Take child back into
bathroom (no scolding!)
2. Help child get hands wet
and soapy
3. When child rinses hands,
prompt to turn off water
4. Allow to dry hands
5. Praise and reward for
completing routine!

tell her to open and close the door gently while she is sitting in the car.
However, using the backstep error correction strategy, you would ask
your child to get out of the car and reenter it while guiding her to gently
close the door. This way you help her associate entering the car with
proper handling of the door, not merely following your instructions.
If your child refuses to go back within the sequence, you should
check on a couple of things. First, make sure that your tone of voice
is not harsh or punitive. It should be matter-of-fact and supportive,
as in, “Let’s try that again!” You should also check and determine
whether your child is motivated to complete the activity. If she is not
motivated to complete the task, then you will need to address this is-
sue before modifying your teaching strategy. Finally, if the situation
itself is difficult to replicate, you may consider the strategy described
in the next section.
 Autism 24/7



Anticipatory Prompts
There will be occasions when you will find it hard to arrange for
an immediate backstep. Some tasks at home and in the community
will not permit any type of restart. For example, think about helping
your child to put the right amount of liquid soap into the dishwasher
dispenser. If she makes a mistake and pours in a quarter-cup too much,
would you want to back-step then, have her put in the correct amount,
and then turn on the machine? Only if you are prepared to work on
mopping up the extra suds!
Or, perhaps you are at a movie theater, and, after standing in a
long line for a popular movie, your son has walked past the ticket col-
lector without giving him the ticket. If you wanted to use the backstep
strategy you would need to get back in the line so that your son can
associate approaching the ticket collector with giving the ticket. Of
course, that is very impractical in this situation. We suggest that you
will need to anticipate this error during the next natural opportunity
(or during a mock-movie-ticket rehearsal in some other locale) and
give your son some help before he once again makes the error that
you can anticipate.
This type of anticipatory prompt is helpful when you know that
an error is likely to occur. Thus, as you approach the end of the line, you
could use a direct reminder: “Hold out your ticket for the collector” or a
more indirect prompt, “Remember what to do with your ticket” or “What
will you do with your ticket?” You will know if you have an effective
prompt if your child hands over the ticket at the right time! Likewise,
when it comes to measuring out soap for the dishwasher, you would need
to provide an effective prompt—perhaps a bright red line on the cup at
the correct level—prior to the next opportunity to load the dishes.
Sometimes you may realize that your child has made an error
but you have no time to run through an error correction sequence.
For example, your sixteen-year-old needs to leave the house in the
next two minutes to catch the school bus and you realize she has not
put on her deodorant. In this type of situation, we would suggest that
you simply take care of the immediate problem (fix it!) and save your
error-correction for the next occasion. If we don’t have time to teach,
then we still should take care of our children. That is, immediately
help your child apply deodorant on this occasion but be sure to use an
anticipatory prompt tomorrow!
  Dealing with Common Errors

Review
Our first goal as teachers is to promote learning with as few errors
as possible. In this manner we try to assure that learning is a positive
experience for our children. When errors do occur, we should under-
stand the type of lesson we are teaching before deciding how to respond
to the error. We can view errors as an opportunity to practice the cor-
rect response. Errors made within discrete types of lessons can lead to
the use of a 4-step error correction sequence as a way to help the child
perform without an immediate prompt. Within sequential lessons, we
should focus on linking each step in the correct order. Consequently, we
may need to backstep to assure that the chain is being constructed in
the correct manner. When going back to an earlier part of a sequence
is not possible or practical, then we can anticipate that the error will
take place similarly on the next opportunity and provide some type of
prompt to prevent the repetition of that particular error. Remember,
don’t simply fix the problem—teach a skill via error correction!
In the next chapter, we will take a look at another issue that
may be problematic within your family—what to do when your child
doesn’t act his or her best!
 Dealing with
7 Difficult Behaviors

After a long day at the office, Mary comes home and asks Bob how
the day went with their son, Vince. Bob immediately tells her that Vince
pinched his arm several times and points to the new dent in the wall
that Vince made when he threw a chair. He asks Mary if she knows what
they can do to get Vince to stop these outbursts. She asks Bob if he knows
why Vince is doing these things and he admits that he’s not sure. Mary
and Bob realize that it will be hard to plan for a change without better
understanding their son’s actions.

Context and Magnitude

All children, including those with autism spectrum disorders,
at least occasionally engage in actions that we adults are not happy to
witness. In general, there are a host of behaviors that we wish would
either disappear, or, at a minimum, would decrease in severity or
frequency. Part of the difficulty parents face in determining which
problem behaviors to address is deciding which behaviors are truly
problematic. We may feel that certain behaviors are always inappro-
priate, but a more careful review of this issue reveals that the setting
for an action may influence how we view that action.
For example, we observe a young boy shouting loudly. If he were
screaming in his home kitchen, then we might feel confident that this
behavior is not appropriate. However, if the boy is at a baseball game
  Dealing with Difficult Behaviors

and is rooting for his brother’s team, then shouting support may be
perfectly acceptable—and even encouraged. Similarly, slapping my
own face may be inappropriate—unless I am trying to stop a mosquito
from biting me. In other words, the setting—or context— will influence
how we view a behavior. To remind us of this issue, we will refer to
contextually inappropriate behaviors (CIBs) when we are dealing with
actions that we hope to reduce or eliminate.
Just as we consider context of a behavior, we must also consider
issues associated with the frequency or intensity of an action. Asking
people how they are feeling is an appropriate skill, but asking the ques-
tion every minute for an entire hour is not appropriate. Knocking on a
door to see if someone is home is fine, but punching your fist through
the windowpane is not reasonable.
We must also consider the severity of the problematic behavior. If
you simply watch someone else over a length of time, it is highly likely
that you will notice some little actions that you wouldn’t do or that even
bother you to watch. For example, why does she play with her hair?
Why does he tap on the tabletop? Why does she have to double knot her
shoelaces? While these actions may be irritating, they really do not rise
to the level of concern that you must work hard to eliminate them.
Behaviors that we want to eliminate include:
■ actions that are harmful to the child (i.e., self-injury),

to other people (i.e., aggression), or to the environment

(tantrums, property destruction, etc.);
■ actions that significantly interfere with routine activities

(e.g., self-stimulation, disruptive noise, etc.), either for

the child or for others; or
■ actions that may bring social sanctions against the child

or caretakers (e.g., disrobing in public, speaking in a

weird or bizarre manner, certain lengthy rituals, etc.).
It is important to note that the mere presence of self-stimulatory
actions is not a sufficient justification to seek to eliminate that behavior.
Self-stimulatory behaviors may include odd actions such as flicking
fingers and hopping on toes but they also include rather common ac-
tions such as twirling hair and chewing gum. In fact, everyone engages
in self-stimulatory behaviors, and it is likely impossible to eliminate
all of them. Instead, we should focus on the impact that such actions
have on other important behavior. That is, if Hank rocks his foot under
the table but pays complete attention to everything happening around
 Autism 24/7



him, then his foot rocking does not need to be addressed. On the other
hand, if he flicks his fingers before his eyes and does not pay attention
when his name is called or other important things are said to him, then
finger play poses a serious problem and should be addressed.

Why Did He Do That?

Once your family has decided that something your child does
needs to be addressed, several key factors must be considered. Now that
you have your focal point—your “target behavior”—you will need to
act as a news reporter and determine: Why is this happening? What can
we do about it? How can we make a change? Do we have the resources
to make this change? And finally, was this a good change?
Let’s consider Rosalie’s situation. Her daughter, Natalie, often
screams while they are shopping in the local mall. First, Rosalie must
consider why this may be happening. To simplify the possibilities, we
will consider three main factors. One, Natalie may be screaming in
order to gain something—possibly her mother’s attention or something
material. Perhaps in the past, when Natalie screamed, Rosalie bought
her some candy to calm her down. In this case, Natalie has learned
that the best way to get candy is to scream. Another broad possibility is
that Natalie is trying to avoid or escape something. For example, maybe
Rosalie leaves the mall whenever Natalie screams and that is precisely
what Natalie wants—to get out of the noisy, crowded situation. The
final general possibility we will consider is that Natalie’s screams are
elicited in a manner similar to reflexes. These actions are somewhat
different than actions that reliably lead to a predictable outcome and
are often thought of as “emotionally driven.” Think about not only
how you feel but also the often useless behaviors you engage in while
waiting for an elevator to arrive or when you’ve just been told that
the baseball or football game you’ve been waiting to watch has been
cancelled due to rain. You might even scream at the TV, knowing full
well that this will not help the situation. Similarly, Natalie may scream
because she is frustrated over waiting to get to her favorite store, or
because her shoes are too tight and hurt.
Why is it important to figure out what is leading to the contextually
inappropriate behavior (CIB)? Let’s assume that Natalie is screaming
because she wants candy. Now, suppose that we magically eliminate her
  Dealing with Difficult Behaviors

screaming. What does she still want? Right, she still wants candy and
may not have calm communication skills that would help her get candy
when she wants it. So, even if we could magically get rid of her scream-
ing, she now will have to figure out some other way to get candy while at
the mall. And it is not likely that her next solution to this problem will be
more pleasant. Furthermore, her mother doesn’t think that having candy
is a bad thing for Natalie—it is the screaming that she doesn’t like.
Similarly, if Natalie were screaming to leave the mall, even if we
could magically get her to stop screaming, she would still want to leave
and may not have another calm way of indicating that to her mother.
Finally, if she is screaming because she is frustrated about how long it
is taking to get to her favorite store, then her mother must either rear-
range her shopping schedule or teach Natalie to improve her ability to
wait for things she likes.
In each scenario, Rosalie must first determine what is leading
Natalie to scream in order to determine the best course of action.
To summarize, functions of behavior are often categorized as:
1. to obtain a desired object or activity, including social
outcomes;
2. to escape or avoid someone or something;
3. elicited by the properties of the situation.

We cannot go into great detail here about how you determine

what function is controlling your child’s behavior. Briefly, you need to
not only monitor the behavior itself but also important factors that oc-
cur both before (e.g., location, time, activity, people present, and other
types of relevant stimuli) and after the behavior (e.g., consequences
introduced or removed, both social and materials). It may be helpful to
try to guess at which of the three key functions the behavior seems to
be serving for your child on each occasion it occurs and see if there is a
pattern over time. For more information on determining the purpose
of your child’s behavior, you may want to read Functional Behavior
Assessment for People with Autism by Beth Glasberg.

Choosing a Replacement Behavior

The best course of action will not focus just on eliminating the
problematic behavior, because that leaves the root cause in place. We
must also focus on teaching the child a more appropriate way to meet
 Autism 24/7



his or her goal. For example,

Natalie’s mother will have to
help Natalie learn a more ap-
propriate way to achieve her
own goal—whether it is to get
something she likes, such as
candy; to get away from some-
thing she doesn’t like, such as
the noise level; or to improve
her ability to wait for things
she likes, and thus improve
her emotional responding.
Unless Natalie learns these
replacement skills, when the
old needs arise, she will likely revert to her old ways or try something
else that her mother will not be pleased to witness.
Notice that the potential replacement behaviors for Natalie in-
volve those critical functional communication skills that we stressed
teaching and supporting earlier in this book. In general, we advocate
teaching functional communication skills as early and as strongly as
possible. This way, when CIBs do arise, their potential alternatives are
skills that the child has already acquired. If your child has not learned
the replacement skill for a particular CIB, then you will have to spend
time on developing that skill, as opposed to more simply making sure
your child uses the skill.
Another important point—although some replacement skills
involve expressive communication, such as asking for a favorite item,
a break, or help, other replacement skills involve receptive skills, such
as learning to wait. Simply being able to express needs, such as, “I want
to go to the music store now!” or even pointing out the problem, such
as, “I’m getting upset that it’s taking so long to get to the music store!”
may not solve the problem. That is, no matter what your child is able
to express, getting to the music store will take some time.
There are several things you’ll want to consider when selecting re-
placement behaviors. For example, it is easier to pick a replacement that
your child can already do as opposed to needing to teach a new skill.
The replacement should be relatively easy and efficient to perform so
that there is no natural preference for the original behavior. Of course,
the replacement also should be one that is socially acceptable.
  Dealing with Difficult Behaviors

If waiting is the issue, then remember to plan for something that

your child can do while waiting for the main goal. Rosalie needs to
consider what Natalie can do while waiting to get to the music store.
She should not expect her daughter to simply not get upset. That would
be a hard goal for anyone. Depending on Natalie’s skill level, Rosalie
might ask her to try to find five people with red hair, or find the letter
“Q” in five store signs, or simply talk to her about what happened at
school that day. What Natalie is asked to do while waiting should be
relatively easy—not a new or difficult skill—just something to help
pass the time.
It is also important to support replacement skills that truly meet
the child’s needs, rather than being something that you want to see
instead. For example, while Mandy is watching TV at home, her son,
Frank, frequently runs around the room, often knocking things over
and making a mess. Mandy would prefer that he sit in a chair while
she watches her TV show. She knows that he likes licorice so she tries
to make a deal—if he sits, she’ll give him some licorice.
Although this type of arrangement may work for a short time,
Mandy has not determined why her son was running around in the
first place. It is very unlikely that Frank has been running around to
get licorice. It is more likely that other factors are at play. He may run
around to get her attention. And even though he likes licorice, when he
really wants her attention, he will run once more. He may be running
because he does not like her show and he is trying to get her to turn it
off. He may be running because he is bored and frustrated that, from
his point of view, nothing worthwhile will happen until after the TV
show. Therefore, Mandy cannot just pick a replacement behavior for
her son and an arbitrary reward for that behavior, but must figure out
why Frank is running around before she tries to intervene and help
him to change his ways.
Determining the function of the CIB and the best possible re-
placement that will meet the same needs may require the assistance
of a specialist— especially if the behavior is particularly dangerous.
The field o f a pplied b ehavior a nalysis (ABA) p rovides t raining a nd
support to help families and schools make this type of determination
in complex cases. The Association for Behavior Analysis International
([Link]) has a Special Interest Group (SIG) for
autism and this group can help families find competent specialists to
help in this endeavor.
 Autism 24/7



Whether or not you consult with a specialist in behavior analysis

in selecting a replacement behavior, your family should involve your
child’s school (or other program). You and the school staff need to
coordinate what you are doing since it can be confusing to children to
have to cope with different rules in different situations.
Once you have selected a replacement behavior, you also will need
to implement a plan to assure that this replacement meets with success.
That is, you must plan to reward your child when he use the replace-
ment behavior, and even encourage him to practice the particular skill
when the CIB is not occurring, to be certain that it is well developed and
readily used. In Chapter 2, we described several ways of “catching them
being good.” Use these strategies whenever you are trying to improve
the likelihood that your child will use the replacement skill instead of
the CIB. Remember, if you do not adequately reward your child for the
replacement skill, then he will use whatever CIB has been effective.
In general, the key to long-term successful intervention with
contextually inappropriate behaviors rests with:
1. identifying the function of the behavior, and
2. systematically replacing it with a socially appropriate
and functionally comparable alternative.
If a child screams to get attention, he can be taught to commu-
nicate via words, pictures, or signs that he wants someone to interact
with him. If a child is hitting his head because he sees a toy that is out
of reach, he can be taught to communicate to request the toy directly
or to ask for help to get to the toy. If a child slaps his face when the toy
he is playing with stops working, he can be taught to communicate to
ask for help. If a child is putting his head down on the dining room table
midway through setting the table, he can be taught to ask for a brief
break. And if a child is punching the wall when he is told he cannot go
outside to play right now, he can be taught how to wait for gradually
longer and longer periods of time. In each of these examples, the solu-
tion—including choosing the replacement behavior—depends upon
understanding why the target behavior is occurring.

Altering the Environment vs. Teaching Replacement

Behaviors
Many people try to avoid situations that provoke the problem
behavior. For example, if the child with autism does not like noisy
  Dealing with Difficult Behaviors

or visually stimulating environments, then they avoid going into

such settings. Some families and schools have their children work
long hours alone in cubicles that visually block the typical stimula-
tion of classrooms or rooms within the house. While these types of
strategies will lead to fewer behavior problems, they will not teach
the child how to cope with noisy or stimulating environments when
they are unavoidable.
Sometimes a better strategy to help the child pay attention to
critical parts of the environment is to increase the motivation (posi-
tive outcomes) for paying attention. Let’s examine a fairly common
experience for adults before we think of applying this strategy for our
children. Imagine that you are at a noisy party talking to someone
who is rather boring. Most likely, you are having problems hearing
that person talk because of the surrounding (and distracting) noise.
Suddenly, the person you’ve been waiting to talk to comes over and
starts a conversation—the very thing you’ve been hoping for! Do you
now have any trouble hearing what is being said to you? Of course not.
And not because the room really became quieter but because it is now
much more rewarding to hear what is being said to you. In the same
manner, rather than always trying to turn down the noise of the room
for your child, you may want to design a system that strongly rewards
him for paying attention and doing whatever it is that you are aiming
for. These aims can include substituting replacement behaviors for
those unwanted CIBs.
For example, your child may be able to set the table when only
the two of you are in the room but you want to improve his ability to
complete the task in the face of distractions. We’ll also assume that
you’ve successfully used a token system to reward your child when he
has successfully set the table. Once your child begins to set the table,
ask someone else in your home to come into the room and begin talking
to you. As long as your child continues to set the table, give him tokens.
If he stops setting the table, remind him about what he is working
for—the reward you’ve set up. Once he is able to set the table in this
circumstance, gradually add other distractions—other people coming
into the kitchen, turning on the radio or TV, turning on noisy appli-
ances like the dishwasher or a blender, and other similarly distracting
but natural events. Notice that you should not introduce all of these at
once but rather teach your child to pay attention by gradually increasing
distractions while continuing to use the powerful reward system.
 Autism 24/7



We are not saying that you should never try to reduce annoying
circumstances. For example, many people use noise-attenuating head-
phones on airplanes and in other noisy environments, and those with
autism can well adopt these same strategies. Our main point is to try
to prepare the child for situations in which the headset doesn’t work,
or when being in a noisy, visually distracting situation is unavoidable,
without the child having to resort to a CIB.

Should We Use Punishment?

As noted, the most important aspect of any behavior intervention
package is identifying why the contextually inappropriate behavior is
occurring and then implementing a plan to assure the child will use a
better replacement behavior. Preventive and ameliorative strategies
also will be helpful. Still, even with the best of prevention and replace-
ment strategies, we should recognize that if a child has frequently spat
at people for the past several years, it is highly likely that another spit-
ting episode will occur before significant progress is seen.

Ignoring Behavior
What, then, should parents and others do when the contextually
inappropriate behavior does take place? Many people automatically
think, “Ignore it!” This strategy may be helpful if the CIB is motivated
by some type of reward that you can eliminate. However, if the CIB is
related to your child’s desire for escape or avoidance, ignoring him may
be precisely what he wants! So, we first must understand that how we
react should be related to why the behavior is taking place.
If the CIB is related to getting attention, then ignoring the
child should be helpful. Of course, ignoring screams or tantrums
is not easy! Rather than simply trying not to respond, you may do
better if you plan something specific that results in the equivalent
of not attending to your child. For example, one parent took out a
specific notebook and began to write her thoughts (including angry
ones!) while her child was screaming at her. Because she was intent
on her writing, she did not pay attention to the screaming. Another
parent put on a headset and listened to classical music whenever
her son took all the pots and pans out from the cabinet. Again, she
  Dealing with Difficult Behaviors

engaged in something that helped her not attend to the noise of the
crashing pots and pans.
If you decide to try to use ignoring (more formally called extinc-
tion), you must be certain that you can follow through on your plan.
To make this happen, you must be able to assure that your child will
only receive the reward connected to the CIB with your permission.
For example, if you are trying to withhold attention for screaming
but you know that your other children will likely provide some at-
tention, then your strategy of ignoring the behavior will not truly be
implemented. If you cannot completely control the reward for your
child’s CIB, then you risk rewarding the CIB after your child has es-
calated his efforts, essentially making the reduction or elimination of
the CIB more difficult. If the potential reward—social attention, for
example—can be provided by more than one person—every adult in
the home, in this case—then everyone must use the strategy or it will
not be effective for anyone.

Time Out
Another commonly used strategy is time out (TO). This strategy
works best when the CIB is associated with receiving some type of
reward and may be helpful in situations involving elicited actions. For
example, if your child starts to scream because he wants you to take
him outside or because he simply wants you to play with him, time out
can be part of an effective strategy. It is not as likely to be effective for
escape- or avoidance-related behaviors. If your child is smiling on the
way to the TO area, then you are not using the right intervention!
To implement time out in your home, you will most likely want
to designate a specific location that is boring (not the child’s room),
but not scary (not a small, closed closet). When you observe your child
engaging in the CIB, calmly and matter-of-factly tell him to go to time
out. Most likely, you will have to firmly guide your child to the area,
where you may have placed a chair. Have a kitchen-timer (or similar
device) by the chair and set it for one to two minutes. Setting the timer
for longer periods of time has not been shown to be more effective and
reduces the child’s opportunities to learn appropriate alternatives.
While your child is in the TO area, try not to interact in any man-
ner—no eye contact or facial reactions to anything your child does
(short of seriously hurting himself). If he attempts to leave, firmly and
 Autism 24/7



physically guide him to stay in the chair but try to do this without talk-
ing or explaining what you are doing. When the timer rings, announce
the end of TO and immediately point out what reward your child can
earn for some appropriate action—the same rewards you had made
available before you started the activity. This last step is crucial: time-
out works only if time-in is rewarding. From your child’s point of view,
if there are no benefits to being out of TO, then why bother to leave?
You can use TO in the community, although implementing it
away from your home can be a little trickier. If you routinely go to a
park, then pick a spot that will serve as the TO area—somewhere that
you can reasonably assure the other children will not play with your
child. If you visit someone else’s home, pick a location as soon as you
arrive—even the bottom of a staircase may serve the purpose. If you
are in a community setting such as a store or the mall, then you may
want to use a ribbon or light necklace to signal time out. That is, if
your child engages in a problem behavior, place the ribbon or necklace
around your child’s neck and set a timer.
During the timed period, try to ignore everything your child does.
Your child may well escalate his inappropriate behavior, but as long as
it is not dangerous to him or others or particularly destructive, it is best
to continue to ignore his attempts to force interactions with you. Once
the timer rings, signal the end of TO by reminding your child about the
potential rewards for appropriate actions—for example, going to his
favorite store for calmly walking with you, picking out a piece of candy
for holding onto the box of cereal while in the supermarket, etc. Remind
others with you about the rule associated with wearing the ribbon.

Verbal Reprimands
When your child is engaging in a problem behavior, you also
may want to say, “No” or “Stop,” or use some other type of quick verbal
reprimand. Your child is very likely to hear these words at school or
in the community, so it is a good idea to teach him what they mean.
There are a few simple rules for using verbal reprimands:
1. Use a matter-of-fact tone of voice and speak loudly
enough that you are sure that you’ve been heard.
Screaming, yelling, or shouting will not make the mes-
sage more effective and may generate reactions that will
be counterproductive.
  Dealing with Difficult Behaviors

2. Avoid using a singsong manner: “no, no, no!!” This style

will diminish the serious intent of the message.
You may want to teach your child what “no” and “stop” mean
in situations when everyone is calm and the likelihood of any CIB is
remote. For example, you may set up a game in which your child is
searching through various closed boxes for a treat or favorite toy. You
calmly say, “no” as your child approaches an empty box and immedi-
ately encourage him to try another box. In this manner, “no” comes
to provide useful information to your child as well as informing him
not to proceed with an action.
Similarly, you may set up a game of tag, or some equivalent game
involving chasing. It is important to try this game in a safe situation—a
hallway or room where the exits are already secured. When you say,
“run,” you will chase your child when he runs and make the chase
exciting. When you say, “stop,” the rule is that if your child stops, you
will walk over and then restart the game. However, if your child does
not stop, then you end the game (possibly by just walking away). This
type of game teaches your child the value of responding to “stop” in a
safe setting before you need to try it in a more difficult situation.

Fines
If you are using a type of token or other visual reward system
(e.g., collecting puzzle pieces or letters that spell out the name of the
reward) you will be tempted to use fines if your child behaves inap-
propriately. We advise that you not take away tokens that your child
has already earned by good learning or other positive actions. Instead,
you may want to create a separate system that builds in a type of
countdown strategy. For example, your daughter may enjoy playing
on the computer but she also has a rude habit of yelling to get your
attention. You give her a card that has five pictures of the computer
game she likes to play. You also remind her to use her “inside voice”
when she begins to speak to you. Of course, you will reward her with
attention whenever she uses an appropriate tone. But when she does
yell, you remind her of what she should do (speak quietly) and remove
one of the pictures.
After an hour (or whatever your goal is), if she has at least one
computer picture remaining, then give her access to her favorite
game for some time. This way, you can have a deal in place for good
 Autism 24/7



“work”(your token system related to the learning goals you have

established for her) and a separate deal for good “behavior” (your
count-down system connected with the computer).

Don’t Forget to Evaluate What You’re Doing!

Let’s be realistic. Although you probably know it is important
to evaluate the strategies you are using, it is not easy to do so while
you are dealing with an inappropriate behavior. However, we want to
stress the importance of this type of evaluation. We should never scold,
reprimand, ignore, or use time out if it is not producing the outcome we
are hoping for—reducing or eliminating a contextually inappropriate
behavior. Therefore, if you are willing to put in the time and effort to
use some type of intervention, then you also must be willing to put
in time and effort to collect information to assure its success. How
you collect information may depend upon what it is you are trying to
modify. In Chapter 8, we will describe ways that you can collect this
type of information at home and in the community.
We know that data collection and evaluation can seem like a
daunting task, but we also are sure that significantly reducing your
child’s inappropriate behavior is important to you and your family.
You may want to set up some type of reward for yourself and the
entire family for your successes—that is, remember to treat yourself
(and anyone who has been helpful) well! Changing CIBs requires a
lot of planning and dedication, so take time to celebrate when things
are going well.

Review
Within this area of the Pyramid Approach, we’ve talked about
many aspects of dealing with contextually inappropriate behaviors.
First, you must determine why the behavior is taking place. Next, you
must identify a replacement behavior that is directly related to what
you’ve figured out in the first step. Then, you need a system to assure
that the replacement will be effective in getting your child what he
wants and that he will be rewarded for using the new behavior. Next,
you need to measure changes in the CIB and the potential replace-
  Dealing with Difficult Behaviors

ment behavior, and then decide whether the change is appropriate

or whether you need to modify your strategy. Finally, if things have
improved, enjoy the fruits of your labor!
The next critical area of the Pyramid Approach addresses how to
best evaluate whether our teaching and behavior intervention plans
are truly effective.
 Evaluating What
8 You Are Doing

Amanda comes home and watches her husband, Scott, setting the
table with their daughter, Amy. She asks Scott how things are going. He
says, “Well, sometimes I think she’s got it and other times it seems that
she’s never seen a fork in her life!” They both have been working with Amy
on this task for several months and wonder whether they should just give
up and set the table themselves.

Peter and Beth have been trying to help their son, Tony, decrease
the amount of time he spends humming very loudly. They’ve put time into
determining why Tony seems to do this, and they think they’ve developed a
good intervention plan. And yet, some days Tony seems content to quietly
listen to music but on other days he hums as long and as loudly as ever.
They don’t see an easy pattern so they are not sure what to do next.

We all hope that the skills our children learn will make a big differ-
ence in our lives. Many of us also think that these changes will be readily
noticed—for example, my daughter couldn’t talk but now she does; my
son couldn’t tie his shoes, but now he can; we used to have to cut up his
steak but now he uses a knife and fork with ease. Unfortunately, these
positive changes usually do not show up suddenly in a type of “ah-ha!”
phenomenon. Instead, most skills are learned gradually and via the
accumulation of small improvements over time. We have watched teach-
ers who were actually making progress with their students but didn’t
realize that they were and were therefore ready to make changes to an
  Evaluating What You Are Doing

effective strategy. On the other hand, we have also observed teachers

fail to make changes within ineffective lessons because they did not
realize that their students were not making any progress.
We encourage parents to put in time and energy to figure out
whether their teaching efforts are worthwhile. If you do not assess what
you are doing, then you could be wasting not only your own time but
also your child’s. How can parents collect information that will help
them make good decisions about how to proceed with a lesson or a
behavior intervention strategy?

Why Bother to Collect Data?

One of the most important reasons
to collect information about your child’s
performance is to help you answer the
question, “Is this a good lesson?” If
the answer is “yes,” then you should
continue to use your strategy. If the an-
swer is “no,” and you’ve given yourself
adequate time to make that judgment,
then you’ll need to change your teaching
strategy. The same rationale holds true
for intervention plans for contextually
inappropriate behavior (CIB).
Another reason to take data is that
the changes in your child’s skills may
be subtle. If you don’t look carefully for the change, you may miss the
improving trend. Not only can you miss the improvement in your child,
you may then miss the opportunity to congratulate yourself on a job well
done as a teacher! Furthermore, gathering systematic information that
shows slow but steady progress can help motivate you to continue with
all the hard work it takes to design and implement an effective lesson.

What Type of Information Should We Collect?

Just as there are different skills to learn, different reward systems
to use, and different teaching strategies to try, so too are there differ-
 Autism 24/7



ent targets to gather information about. At times, you may be satisfied

with a very general question such as “Are things getting better?” Your
medical doctor often starts with this type of question—are you feeling
better? If you say “yes,” the conversation may well end there. It is when
you say “no” that more questions will be asked.
You likely have seen questionnaires that try to set general guide-
lines about your feelings or sense of what’s happening. For example, you
might be asked to indicate how much you enjoyed watching a particular
movie on a five-point scale—with a one meaning “hated it” and a five
meaning “loved it.” You may construct a similar type of questionnaire
about the skill you are working on with your child, to be completed by
each family member once a month (or as often as you think appropri-
ate). For example, if you are trying to improve your child’s expressive
language skills, the questions may include:
How often did Hannah initiate communicative exchanges
this week?
a. 0 to 10 times
b. 11-20 times
c. 20-50 times
d. more than 50 times

How relaxed did Hannah appear while she was talking with her
siblings?
a. very anxious
b. somewhat anxious
c. no reaction
d. somewhat happy
e. very happy

How satisfied are you with Hannah’s communication skills?

a. very dissatisfied
b. a little disappointed
c. no reaction
d. somewhat happy
e. elated

Notice that you can include a range of specific numbers or you

can use a range of general ratings. Furthermore, you can address more
advanced or complex skill sets. For example, you can ask:
  Evaluating What You Are Doing

How independent is Alex in completing the yard work?

a. Needs many spoken reminders (such as “check the
mower gas level”)
b. Needs some spoken reminders
c. Needs written checklist
d. Sometimes checks written list
e. Does everything independently

What Can/Should You Measure?

As you read these examples, you may feel that there is a very large
degree of subjective evaluation included in the process. Your ratings may
change because you weren’t feeling well that week, or perhaps something
especially good happened to you and this helped put a rosy sheen on
everything. That is why it may be more effective to develop assessment
strategies that can provide precise and unbiased information.
What can you directly measure? Recall that we noted in the
Introduction that a learner must “show what she knows.” There are
many ways that someone can “show” you what she knows, as discussed
in the sections below.

Keeping Track of Frequency

You can count how many times something happens—such as
how often a child asks for help, or how many times she screamed to-
day. Counting occurrences is called taking a frequency count. To take a
frequency count, you choose the length of time during which you will
count a behavior. This will enable you to determine the rate, which is the
frequency divided by the amount of time you use. For example, you may
want to track how often your child asks for help during the morning. If
you count 5 occurrences between 9:00 and 11:30, the rate is 2 per hour.
You may want to compare that rate with what happens at another time of
the day, such as in the evening. If the rate is very different then—perhaps
only 0.5 per hour—then you would want to determine why your child
appears more independent in the evening than the morning.
Figuring out the rate is very important in situations in which the
time intervals are not equal. For example, you should not compare how
often your child asked for help during the week with how often she asked
 Autism 24/7



for help on the weekend since the time intervals are not the same. You
can, however, compare the rates during the two different time periods.

Keeping Track of Intensity

You may be concerned about some feature or characteristic of
an action, such as its intensity. Perhaps your daughter asks for help
but most of the time she says it in a whisper so that it is very hard for
anyone to understand her. Counting how often she asks for help will
not provide the right information if your goal is to increase how loudly
she speaks when asking for help. Or, perhaps your child can say, “No
thank you” but screams it at the top of her lungs! The issue is not what
she is saying but how she is saying it. In this case, you can measure
intensity by devising a rating system in which 1 equals “inaudible,” 2
stands for “barely audible,” up to a 5 for “much too loud.”

Measuring Duration
You may be concerned about how long a particular behavior
lasts—its duration. For example, you may realize that all three-year-
olds have tantrums now and then but you are concerned that your
child’s tantrums last for 45 minutes or more. A reasonable goal may
involve reducing how long the tantrum lasts once it is started. In this
case, you are not aiming to immediately eliminate all tantrums, be-
cause that is unrealistic. It is reasonable, however, to see if you can help
your child decrease the length of her tantrums to five or so minutes.
It also makes sense to measure duration if you are teaching your
child to complete a task more quickly. Perhaps Stephanie is teaching
her son, Adam, to clean his room. He has learned to put away all of
his toys accurately but Stephanie would like him to finish cleaning
his room within 15 minutes of when she leaves his room. Currently, it
takes him from one-half to a full hour to finish this task.
In this situation, it will be helpful for Stephanie to be very accurate
about the duration it takes Adam to clean up. She may set a timer and
also let Adam know that if he finishes before the timer rings, then he
can play his favorite video game on the large screen TV. At first, she sets
an easy goal—50 minutes— because she knows that he usually finishes
within this limit. When he is successful at that level for several days, she
resets the timer for five fewer minutes. This strategy will only work if
  Evaluating What You Are Doing

Stephanie accurately records how long it takes to clean the room. There
are other specific goals that Stephanie can set, such as how many toys
he is able to put back where they belong. In other words, Stephanie’s
goal will help define what she wants to count.

Measuring Accuracy
Perhaps your child makes a valiant attempt to clean up the play-
room but she places the toys almost randomly around the room. That
is, there is very little accuracy connected with where she puts the toys.
You would like to see the balls go in the ball-bin, the stuffed animals in
another box, and the train set on its own special shelf. In this case, you
don’t need to measure how quickly your child cleans up but rather how
many things are properly put away. Similarly, perhaps your teenaged
son enjoys helping in your workroom but frequently puts the tools in the
wrong location, thus making it harder for you to find things when you
need them. It’s great that he’s willing to help but because his accuracy
of placement is so poor, it is not really saving you any time.

Writing Goals That Let You Measure the

Progress You Are Looking For
As we noted in Chapter 2, you will know you have written a good
definition of a goal if two or more people can agree that they are observ-
ing the same action, and if your definition makes it clear how you can
directly measure whether the goal has been accomplished. However, as
explained above, there are different ways to measure progress. When
you are writing your goals, you need to be sure to address the aspects of
a behavior where you want to see progress. At times, how often some-
thing happens—its frequency—can be very important. For example,
how many times did your son initiate a request for help? At other times,
you may want to measure the rate of an action—as when you determine
how many plates your child can put away within 10 minutes after dinner
is completed. Sometimes, you will focus on the accuracy of a skill—as
when you monitor whether your child puts the plates with the plates and
the bowls with the bowls. In some cases, you will be most interested in
the duration of an action—as when you time how long your child can
play independently while you are doing some housework.
 Autism 24/7



There is no one best way to measure all behaviors. You will need
to consider what is most important about an action each time you
decide to teach a skill. See Table 8-1 for examples of different types of
data to collect.

Skill Your Goal Type of Data

Sorting Correctly sorts spoons, knives, Accuracy
silverware forks
Empties dishwasher utensil tray Rate
in a reasonable amount of time
Interactions with Asks sisters for toy Frequency
older sisters Spends more time with sisters Duration
Improved quality of interaction Rating question-
naire for sisters
Play skills More time engaged in indepen- Duration
dent play
Uses a wider variety of toys Number
Fold towels Folds neatly Accuracy
Folds many towels Number
Folds towels more quickly Rate
Greetings Appropriately waves when Dad Prompt level
arrives
More variety to greetings Number of types
Making cookies Cracks eggs Accuracy
with Mom Completely presses cookie Intensity
cutter through dough
Temper tantrums Reduce number of incidents Frequency
Shorter time for each tantrum Duration
Aggression to Hits less often Frequency
sibling
Does not hit so hard Intensity
Your own target? ? ?
  Evaluating What You Are Doing

Measuring Things Done by Others

Up until now, we’ve focused on measuring actions taken by your
child. However, you may find it valuable to measure changes involving
other people, including yourself. For example, you may want your son
with autism to agree to play a game suggested by your daughter. How
well this skill develops depends in part upon how often your daughter
initiates playing the game, and possibly how rewarding your daughter
is to your son after playing the game. Similarly, how often your son asks
for help will depend upon how many “needy” situations you create. If
you simply wait for these situations to occur naturally, your son may
not have sufficient opportunities to practice the new skill. Therefore,
in addition to measuring how your son responds to your daughter’s
invitations to play and how often he asks for help, you should also
measure how often your daughter asks your son to play and how many
situations you create where your son could ask for help.
Here are some other examples where it would be useful to mea-
sure other people’s actions:
 You decide to use a token system to encourage your child

to use more complete sentence structure. How quickly your

child acquires this new skill will depend upon how often
you use the token system. Therefore, you may want to
count how many tokens you’ve handed out in the morning.
 You want everyone in the family to ignore the latest swear

word that your child has just picked up from school. In

this situation, you may want to count how often each
member of your family follows through by ignoring the
new word. You could make a game out of this, rewarding
the family member who ignores the best across the week!
Many lessons involve changing the intensity or even the type
of prompt that you will use. In this case, it is the level of support that
you use that you will be measuring, not whether your child actually
engages in the behavior. For example, Harry is working on teaching
his son, Theo, to cross the street when the light turns green. Should
Harry count how often Theo successfully crosses the street? Of course
not, since Harry will make certain that Theo always crosses the street
in a safe manner. Instead, Harry can measure what kind of prompt
he uses to assure a safe crossing, or how long before they reach the
 Autism 24/7



street he needs to use a particular prompt (e.g., “What will you do if

the light is red? What will you do if the light is green?”). In each of
these examples, we need to measure what teachers and other people
are doing who interact with our children.

How Much Information Should Be Collected?

In school, you may observe teachers or specialists taking data
on every opportunity or trial that they set up. Early in a lesson, when
minor alterations can result in important problems in skill acquisition,
collecting a lot of information can be very important. But consider
this situation: you’ve developed a task analysis for tooth brushing that
involves sixteen steps. Your child has been working on this task for
almost two years and has nearly mastered this skill. In fact, she only
occasionally makes a mistake on two of the steps. Should you stand
there and record her performance on all sixteen steps each time she
brushes her teeth? We don’t think this represents a good investment of
your time and effort. Recording your child’s performance on the two
steps in question is the only “new” information you need.
Collecting, and then studying, information about performance
always involves a degree of effort and expenditure of time. As your
child acquires a skill, you will most likely need far less information
to assure that progress continues. Take measurements only in so
far as they help you answer your primary question—is this a good
lesson or should I make a change? In fact, it is possible to gather too
much information. That is, you can collect information that does not
help you improve the lesson. In these cases, you end up wasting your
limited resources.
There are two situations where it is important to record every
occurrence of a behavior:
1. If the behavior is especially dangerous (e.g., you are
working on decreasing how often your child lights
matches in the house), or
2. If the behavior is a critical new skill (e.g., you are in the
first two weeks of teaching your child to ask for a break).
On the other hand, if your child currently runs around the house
150 times each day, it may be impractical to try to record them all;
furthermore, it is unlikely that recording each instance will add helpful
  Evaluating What You Are Doing

information to you. We advise you and your family to look over all of the
lessons that you are planning to teach and consider these questions:
1. Which lessons are relatively new and which ones are
nearly mastered?
2. Do any involve critical new skills?
3. Do any lessons target behaviors that are dangerous to
your child or others?
4. Who is in the best position to record the information you
deem important?
Only after you have considered these questions are you in a posi-
tion to discuss how often information should be collected.

Sampling Behavior
When you decide that you do not want or need to record each oc-
currence of an action, you may want to use a sampling strategy instead.
This strategy is the same used by quality assurance managers in many
situations. For example, a company cannot practically test every pen
nib on every pen they produce. Instead, they sample in a systematic
fashion some of the pens and measure the quality of that sample. So
too can you choose to sample some of your child’s specific behaviors.
One sampling strategy takes advantage of units of time—called
an interval sampling strategy. For example, rather than count each
time Sonja runs around the house, Lily simply chooses to note
whether any running occurred within each block of 30 minutes.
If Sonja gets home from school at 4:00 PM and goes to bed at 9:00
PM, then there are 10 intervals for Lily to record. The length of the
interval will depend on how often the action typically occurs. Pick
a length of time during which some intervals include the target
action but others do not. By comparing the number of no-running
intervals to the number of intervals with running, you will be able
to measure progress—more intervals without Sonja running around
means things are improving in this case.
Another way to sample high rate actions is to use spot checks—se-
lect specific times when you will observe whether the action is occur-
ring or not. Set a timer and when it rings, immediately observe whether
the behavior being measured is taking place. For example, Raymond
is teaching his son Charlie to play quietly in the family room while he
is not in the room. He lets Charlie know that if he does a “good job”
 Autism 24/7



of playing like a big boy then he will get to watch his favorite cartoon
video. Raymond leaves Charlie in the family room and sets a timer
for five minutes. When it rings, he peeks into the room and notes that
Charlie is still playing. He continues to spot check every five or so
minutes for about 30 minutes. If Charlie has stayed in the room for 80
percent of the spot checks, he gets to watch the video. In this manner,
Raymond does not have to observe everything his son is doing but can
still accurately track Charlie’s progress.

Product or Outcome Reviews

Another way to monitor performance without directly observ-
ing your child is to measure the outcome or product of a task. For
example, when Lucy tells Shelby
to clean her bedroom, she does not
have to watch what Shelby is doing.
Instead, at a set time later, she can
come into the room and determine
how clean the room is. If the bed
is neatly made, the clothes are put
away in the proper place, the toys
are stored correctly, and the floor
is swept, then Lucy can decide that
Shelby did a good job of cleaning.
Similarly, if Lucy tells Shelby to get
dressed, she does not have to watch Shelby getting dressed. Instead,
she can set standards that are associated with proper dressing—zippers
and buttons are closed, shirt is tucked neatly into pants, etc. Likewise,
once Shelby has learned the basic steps of setting the table, Lucy will
not need to watch her doing this. Instead, she can check whether all
the plates and dinnerware have been properly set. You can readily
see that using this type of strategy will help reduce time you spend
measuring performance.

Charting and Summarizing

Taking measurements regarding your child’s actions is only ben-
eficial if it reveals information that helps you decide what to do about
  Evaluating What You Are Doing

your lesson strategy. If the information indicates that steady progress

has been made, then you will not want to change your strategy. If your
information shows that little or no progress has been made, then you
will need to consider revamping your lesson strategy. Therefore, the
information collected needs to be summarized in a manner that helps
you see the basic direction or trend of your child’s performance. Con-
verting raw numbers into a visual model—a chart, graph, or table—is
one way to help you find trends.
A chart or graph can be made by creating a grid noting your
measurement information on one axis (the Y-axis, or the vertical axis)
and noting time on the other axis (the X-axis, or horizontal axis). A
line graph is made by using a single point to represent each piece of
information (data), while a bar graph is made by filling in the space
below a specific level. If you do not want to create the graph by hand,
there are many user-friendly software programs (including Microsoft
Excel®) that can help you create graphs and determine a trend line. If
you do not use a program to find the trend line, then you may want to
use some relatively simple strategies to note trends.
For example, Sidney is focusing on helping Sara increase the
number of spontaneous requests she makes at home. He notes her
progress by charting the number of spontaneous requests per day for
ten days. Then he estimates the mid-point of the first three points and
places an X at that point and does the same for the last three points. He
then connects these lines to create a trend-line. He extends that line
 Autism 24/7



on the chart and then looks to make sure that subsequent points are
at or above that line. He knows that if the points start to consistently
fall below that line, then Sara’s progress would not be maintained. In
the example shown in Graph 8-1, you can see that the points after the
second X largely remain above that line. If you are trying to reduce
a CIB, then you would be checking to see whether your points are
remaining below your trend line. While there are more stringent and
statistically powerful ways to find a trend line, this strategy typically
is useful enough for family purposes.
Another strategy to chart progress is shown in Graph 8-2, which
uses a bar graph approach. In this case, Sam is monitoring the number
of pictures that John-Paul uses within his PECS communication book.
Although there are some ups and downs from day to day, the overall
pattern is clearly one that shows nice progress.
When you design a task analysis, you can place an area to graph
your results on the same page where you list the sequence of steps in
your task. Your graph can indicate the number of steps that your child
performed without any help or prompting. For example, if your task
analysis has 14 steps and your child performs 7 of these independently,
then you would note 50 percent for that day. Since different tasks are
associated with a different number of steps, using percent independent
will allow you to compare progress across vastly different types of
  Evaluating What You Are Doing

goals. If you see that your child performs at 90 percent on a task, you
may want to reduce how often you record her performance on that
task. On the other hand, if your child’s performance is hovering at 25
percent for several weeks, then you will want to reconsider how you
are teaching that particular task.
You can also use a graph or similar visual aid to help you deter-
mine the level of expectation you want to maintain for a particular
skill or CIB. For example, James is aiming for his son Carl to spon-
taneously ask for things around the house at least 10 times per day.
James puts a chart on the kitchen wall that includes 10 open circles.
Each time Carl asks anyone in the family for something without any
prompting from them, they fill i n o ne o f t he c ircles. W hen a ll 10
circles are filled in, then the family does not need to record any fur-
ther information about Carl’s requests. On a separate log, James can
note how many days Carl has met the target. If the target is met for
8 out of 10 days, then James slightly raises the level of expectations
for requests and tracks this increased level by adding more circles to
the chart on the kitchen wall.
This strategy can be used to note your child’s progress on behav-
ioral goals when the goal is to achieve a level below a certain number.
For example, Char knows that Jack frequently turns on the kitchen
faucet to play with the water; he does this at least 20 times each day.
While Char would like him to stop completely, she realizes it will take
some time to achieve such a dramatic change. She also knows that if
Jack turned the water on only 15 times, that would be a better day.
She places 16 tokens on the refrigerator and tells Jack that if there
is at least one token remaining by 8:30 PM (30 minutes before he
starts his bedtime routines), then he will be able to have a favorite ice
cream treat. Each time Jack turns on the faucet, Char removes one
of the tokens and reminds him how he can earn the ice cream. If all
the tokens have been removed by 8:30, Char does not allow him this
treat. She records how many days he is successful at earning his treat.
When he reaches four days in a row, she lowers the target level by one
token. This way, she does not have to record each time she removes
a token. She only needs to note how often the overall strategy is suc-
cessful on a day-to-day basis. And her chart about successful days lets
her quickly see when she should change the requirement for Jack’s
treat. This strategy is obviously similar to the token/point systems we
described in Chapter 2.
 Autism 24/7



Review
The evaluation strategies discussed in this chapter are truly the
core of the Pyramid Approach. If we don’t evaluate what we are doing,
we can waste our own time and that of our children. Teaching your
child new skills and reducing or eliminating problematic behaviors
involves a great deal of time and effort on your part. To help assure
that you are best using your resources, you must evaluate what you are
doing. When we design a lesson or an intervention for a contextually
inappropriate behavior, we can only guess what will be effective—we
cannot guarantee the outcome. Therefore, plan to collect information
in a manner that will help you decide whether you should continue
with your current plan or modify it.
Once you’ve collected your information, you will need a system
to help you analyze that information so that you will make sound deci-
sions about your strategies.
The steps we should take to help evaluate skill development les-
son plans are:
1. Pick a way to measure the target skill.
2. Try out your measurement system (does it make sense
and appear reliable?).
3. Choose a level of success—X level by Y date—remember-
ing that success can be measured by changes in rate,
intensity, accuracy, duration, number, amount of
prompting needed (e.g., “This is working!”).
4. Choose a level of failure—Z level by Y date (e.g., “This is
not working.”).
5. Implement your teaching strategy.
6. Use your measurement system.
7. Evaluate your outcome and compare it to your expectation.
8. If you are successful, keep going.
9. If you are not successful, what will you change? Review
your goal for your child, the reinforcers you are using,
the types of prompts, and the other elements of lessons
discussed in earlier chapters.
The final chapter of this book offers suggestions on how you can
integrate the full Pyramid Approach into all the activities associated
with living at home and in the community.
 Pulling It Together
9 in the Neighborhood

Teresa has worked hard to make her home a place where Zena and
Crystal, her two teenage children with autism, can learn and still have
a lot of fun. She dreads going out into the community, however, because
her children find many places too novel and unpredictable. Crystal, who
uses speech to communicate, seems readily frightened; Zena, who uses
PECS to communicate in short sentences, seems oblivious to danger.
Teresa wonders how she will be able to take her children safely into the
community while also teaching them the many skills they will need to
make a good adjustment into the adult world.

We’ve discussed several strategies to promote many skills in a

variety of situations in and around the home. We will now focus on
how you can use these same strategies away from home, when you are
visiting your favorite locales in the neighborhood. We will consider
recreational activities, shopping and other service-oriented settings,
family visits (including during special occasions such as holidays), and
some options while on vacation (both at home and while away). We also
will review mealtime issues, both at home and out in the community.

Recreational Settings
For your child to fit into recreational settings in the community,
he needs to know:
  Pulling It Together in the Neighborhood

1. how to use community equipment and facilities appro-

priately;
2. how to play with other children in a way that they per-
ceive as appropriate and friendly.

It may be difficult to combine the two skills immediately, because

if a child does not know how to play with something such as a swing or
slide, other children may not be interested in playing with him.
Let’s look at how you might begin to teach these skills at a com-
munity playground. As with teaching other skills, we strongly suggest
that when you arrange to teach your child to use the play equipment,
you have no other obligations at the time (such as monitoring your
other children or wanting to work on interactive play skills). You may
even want to arrange to visit the playground when it is deserted to help
you and your child focus on the equipment. We also encourage you to
use something to motivate your child and permit him to request breaks
or help during play time. Remember, although we hope that children
will learn to have fun, some may be less than thrilled with their initial
lessons at the playground.
To use most types of playground equipment, children need to
do many steps in a particular order—such as climb up the ladder, sit
down on the top of the slide, let go of the bars, slide down, and land
on their feet. As with many other sequential lessons, you may want to
start by helping your child fully with the first steps and expecting him
to learn to be independent with the last steps. In the case of the slide,
you would first remind your child about the potential reward— either
how much fun sliding is or perhaps something he will receive when he
gets to the bottom. Then, help your child climb up the ladder and get
into position on the slide, and finally encourage him to let go. Hope-
fully, you (or somebody else) will be at the bottom to enthusiastically
meet your sliding child! Over time, you will gradually reduce your help
in climbing and letting go.

Turn Taking
Once your child has learned all the steps involved in sliding and
can do them independently, it is time to teach about turn taking. Your
child may have already learned about turn taking while playing at
home. For some children, however, the community may be the first
 Autism 24/7



place they need to use this skill. Ask another child (a sibling or rela-
tive, perhaps) to play, but be sure to make it clear that your child is just
learning to take turns and may appear to be “rude” at first. Be sure to
praise both children for taking turns. You may want to encourage each
child to communicate to the other child, “Your turn” (regardless of the
mode of communication).
For this lesson to be most effective, choose equipment that in-
volves activities that have a clear start and stop point. Using a slide
involves climbing the stairs and then sliding down and thus has natural
break points. In contrast, if a child can swing by himself, then he can
sustain that activity for a long time. You would have to interfere with
his swinging to get him off the swings, and that may not be easy to
accomplish at first. For the slide, while your child is sliding down, the
other child could move to the bottom of the stairs. When your child
gets to the stair bottom to climb up again, you can encourage him to
communicate that it is the other child’s turn, and learn to take his turn
after the other child completes his slide down.
During this time, if you have been using any arbitrary rewards
for sliding, be sure to try to minimize their use in order to promote the
social consequences associated with playing with friends. If your child
has learned to use and enjoy other equipment, you may want to build
in opportunities for the children to alternate selecting which piece of
equipment will next be used.
In general, add only one new piece of equipment on each day of
training. Once your child has learned to play on one or two pieces, you
can start the playtime with using whatever he likes best before trying
to introduce a new play routine. That is, let him use his favorite routine
first, then teach him to use some other equipment before letting him
return to the one he most likes. In fact, access to a favorite piece of
equipment will probably serve as a good reward for learning how to
use a new piece of equipment.
Remember that if your child especially likes the playground, at
some point you will want to leave! So, do not surprise your child with
an announcement that it is time to go home. Set that up at the very
start of playtime. You can set a timer or use activity-cards/pictures to
indicate when you will leave. For children who like several activities,
you may want to use “tickets”—3 tickets for the slides means three
rides, 2 tickets on the jungle gym means 2 times climbing all the way
around, etc. If your child understands time, then be sure to set the time
  Pulling It Together in the Neighborhood

before you start to play—otherwise, leaving will seem like a “surprise”

to your child and he may not like that. You may want to use a type of
transitional object or other visual cue associated with a reward for
doing (or starting) the next activity. For example, perhaps your child
picked out a favorite audiotape or CD before you left your car to go onto
the playground. When it is time to go home, you can take out the tape
and give it to your child while he is still on the playground. He’s likely
to take you back to the car so that he can listen to his favorite tape!
If you go to a new playground, you may want to determine first
which equipment your child knows and likes to use. You also want to
assure yourself that the equipment is as safe as what you use in your
neighborhood. Some slides are made of plastic derivatives and do not
get very hot even in the direct sun, while other slides are made of metal
and can become scorching hot. You should also check if there is room
around the equipment. Can your child safely walk past other kids who
are swinging? Remember, your child is not likely to be as aware of safety
issues as you are, so be his eyes when first appraising a new location.
The playground is a natural place to work on communication
skills. For example, your child may have difficulty u sing a p iece o f
equipment or may need a boost to get started. These are great times
to work on having him ask for “help.” Of course, if your child is playing
with other children, you will want to encourage him to ask for help from
his friends. Don’t forget to work on receptive communication skills such
as following simple instructions from both adults and children—for
example, “Let’s play in the sandbox” or “Hey, give me the shovel!”
While you want your child to enjoy playing with other children,
this goal may represent a challenge from his perspective. In this case,
asking for a quiet break would be appropriate. You may want to bring
a timer to help set limits on alone-play time.
You may want to plan how and where you will deal with inappro-
priate behavior on the playground. If you use time out at home, then
you will want to plan to use a specific location for your TO area in the
park—possibly a bench or a spot near a fence where your child can sit
quietly for a moment. It is important to plan for problems rather than be
surprised if you see actions out in the community that you sometimes see
at home. This is also why it is most important to be sure that you have
arranged for some powerful reinforcers to be available for your child’s
appropriate behaviors as well as support for any communication system
that your child uses. For example, if your child uses PECS, then you must
 Autism 24/7



be sure that his communication book and the necessary vocabulary

pictures are available at all times while out in the community.

Attending Quiet Events

Teaching children to go to the movies or attend events at places
of worship can be tricky because other people usually have high stan-
dards regarding proper decorum. First, it is important to separate
times when you feel that you must go versus times you are attending
to teach something to your child. In the second situation, you should
be willing to leave if your child cannot handle the entire event, but in
the first case, you will feel very stressed if you leave (or possibly very
embarrassed if you stay!).
Here is one strategy that we have found effective when we take
children with autism spectrum disorders into the community in order
to teach a skill. Rather than start the activity the same time everyone
else does, do something else with your child at the start (including
practicing things that might come up at the end of the activity) and
then join the group near the end. This way, your child will only have
to successfully participate in some of the event but can enjoy finishing
with everyone else. Over time, try to bring your child into the event
earlier and earlier.
Before beginning the activity, remember to have your child select
something that he would like upon finishing the activity—hopefully,
something that can be shared with others, but, if necessary, something
that is unique for your child. You may need a visual system to remind
your child how long the activity will last. If he can’t use a watch or clock
to tell time, try a type of token-system using the tokens as markers for
the passage of time.
For example, if your child has never been to a movie theater and
you are not sure he can sit and watch a 90-minute movie, then be sure
to bring some highly motivating items, since you cannot be certain that
the movie alone will be motivating. Furthermore, rather than bringing
your child into the start of the movie and seeing how long he can last,
you may want to bring him in just 15 minutes before the end and then
reward him richly for “staying until the end.” If he likes popcorn, then
you can slowly distribute the popcorn throughout the time that he is
watching the movie. The next time you go to the movies, you can try to
  Pulling It Together in the Neighborhood

have him see the last 30 minutes, then 45, etc. Of course, this is not a
natural way to watch a movie, but the point is not to see this particular
movie but to teach your child how to successfully “go to the movies.”
When he learns this skill, there will be plenty of movies that you can
watch together from beginning to end!
Since you are going to the movie specifically to learn that skill,
if your child acts inappropriately, you can choose to take him out and
end that opportunity. Of course, if your child was trying to get out of
the theater, then it would be better to teach him to ask for a break. This
would allow him to get out for a moment or so, but then return and try
to earn the reward you’ve set up.
There are other places in the community that often require chil-
dren to be quiet for some or all of the time. Many religious services
have noisy periods (e.g., singing) as well as quiet times (e.g., silent
devotions). Before attending a quiet event, be sure to consider what
type of reinforcing activity your child can engage in while everyone
else is being quiet. Food may not be permitted, so you may need to
choose other types of rewards, such as coloring or sticker books, or
even tokens. It will be helpful to involve the community elders/leaders
so they can see that you are trying to establish routines that should
ultimately benefit the entire community.

Service-Oriented Settings
Parents frequently must take their children to locations in the
community that provide special services—places such as the barber,
clothing or shoe store, the library, and various medical providers.
Families visit some of these places on a routine basis—such as for a
monthly haircut—but others only on an as-needed basis—such as to
see the doctor. For these service-oriented settings, it is helpful to plan
time to teach your child the routines of the location on a day when you
do not really need the services.

Stores
In previous chapters, we discussed strategies for teaching your
child about going to the grocery store. Food shopping is something
most families do fairly often, so children need to learn how to toler-
 Autism 24/7



ate grocery stores pretty early on. But your child will also eventually
need to learn how to behave and what to do at stores that your family
patronizes less often—such as clothing or shoe stores.
You may want to take your child to a clothing or shoe store when
you do not need to buy something. Just as when you are teaching your
child about the playground, you will probably want to arrange to come
to the store at a time when not many other people are around. Before
entering the store, have your child pick out a reward that he would like.
Then choose a very easy goal—perhaps to sit in a chair and simply hold
a pair of shoes without even trying them on. Reward your child for a job
well done and quickly leave. On the next visit, extend what you expect of
your child—perhaps to have one foot measured, for example. Be sure that
what you provide as a reward is more important to him than the shoe—if
he thinks he gets every shoe he tries on, shopping will be difficult!
Over time, you may want your child to help you determine
whether things fit. To begin this type of lesson, you might start with
exaggerated errors. For example, have your child try on a shoe that is
far too small or one that is far too big; a shirt that is too small to even
so large that the arms are almost hanging to the floor. Praise your
child for rejecting the things that do not fit and for selecting ones that
do fit. Of course, if your child has distinct preferences for colors or
styles, incorporate choosing things in his favorite color or style into
the activity. You may be able to practice some of the activities at home
before trying them in the store. For example, perhaps the shoe store
manager would lend you a measuring tool. Still, you must remember
to use your rewards when you change from practicing activities at
home to actually doing them at the store, even if you think your child
is comfortable with the routine.

Healthcare Settings
If you are going to the dentist’s office—something that you will
do many times over the years!—arrange with your dentist for a prac-
tice run. One friendly dentist that we know allows the child to simply
sit in the chair for the first visit before receiving some type of reward.
On the next visit, he tries to get the child to open his mouth and allow
him to simply tap—not poke or prod—on each tooth with a pick. He
might introduce the child to his equipment. Our friendly dentist uses
“Mr. Thirsty” and “Mr. Tickler” as names for the suction device and
  Pulling It Together in the Neighborhood

the tooth polisher. Over the next several visits, he gradually does more
“real” work, but allows the child to stop him by asking for a break.
Yes, this process takes some time but most dentists view their contact
with a family as something to be cultivated over time and will gladly
cooperate if you talk about this strategy. Because you may need several
“trial runs,” talk to the office about why this is important in the long
run so that they won’t charge you for each visit!
If your child is comforted at home by “deep pressure”—he likes
to wrap himself tightly in a blanket, etc.—have the dentist put the lead
apron used during x-rays over your child during the visit.
You may also want to put time into practice trips to the doctor’s
office— going there, sitting in the waiting area, and leaving without
even seeing the doctor. If the visit involves use of something novel, such
as a tongue depressor or pressure cuff, try to arrange for an opportunity
to use it at home with your child before the doctor or nurse must use
it with him. If your child can use a schedule at home, you can bring a
mini-schedule to the doctor’s office, noting sequences such as:
1. Wait in the outer room
2. Sit in the examination room
3. Greet doctor/nurse
4. Step on scale
5. Have nurse take blood pressure/measure heart rate
6. Doctor looks in ears
7. Doctor looks in mouth and down throat
8. Add as necessary

Note: visits to the barber (or hair stylist!) can likewise begin
with short visits aimed at helping your child become acquainted with
the setting, the chairs, the combs, brushes, scissors, dryers, and other
common equipment before having his hair cut.
Another tricky aspect of many healthcare locales is dealing with
the dreaded waiting room. You have a 2 o’clock appointment but you
know you will not be seeing the doctor at that precise time. In fact, your
doctor is fairly certain of the same fact and has arranged for a separate
waiting area—and has placed relatively boring magazines for you to
read there if, by chance, you did not bring yourself something to do.
So, since you can anticipate that you must wait, you must antici-
pate the same for your child. It is not likely that the magazines will
be enticing to your child. Many pediatricians have toys in the waiting
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room, but these, too, may not be appealing to your child. Therefore,
you must bring along something that your child enjoys doing and can
engage in while not be highly disruptive to the other people waiting.
In Chapter 3, we talked about the importance of the “wait” lesson, and
here is where its fruits will be the sweetest! But remember, this is not
the location to start the wait lesson since you do not control how long
the wait will last and such control is the key to creating a successful
lesson. Be sure to have your child select a potential reward before you
enter the doctor’s or dentist’s office area, and make sure it is something
you can provide quickly once you leave.

Libraries
Libraries can be interesting community settings for children with
autism. Some children like these settings because the expectation is
for relatively little communication via talking—being quiet is a virtue
here! Of course, for other children, this requirement is a problem, as
they enjoy being noisy. If this is the case for your child, then you may
want to practice visiting the library when there are few other patrons
on hand—perhaps just upon opening.
You may want to work on the initial goals for learning how to use
a library just as we described for going shopping. That is, on your first
trip, quickly locate and check out one book that you know your child
will enjoy and read it as soon as possible. On subsequent trips, gradually
spend more time looking for books (including ones that you want) before
getting the book that he wants. You can also choose to spend some time
using other library resources such as copy machines or computers.
One clever mom hid a McDonald’s coupon in a library book and
taught her child to quietly search through the pages to find the coupon.
Over time, she would give her child more books to look through and
occasionally hid other items that were fun for the child but not associ-
ated with going out for a snack.

Visiting Family and Friends

Taking your children to visit relatives and other acquaintances
can be richly rewarding—or highly stressful! Fundamentally, children
will do best when they feel secure and believe that they can trust their
  Pulling It Together in the Neighborhood

surroundings, including other people. Over time, almost all children

can learn that the rules at Grandma’s home are different than those at
home, but that they are consistent and can be followed. How to reach
that point of comfort may involve many steps.
As we’ve tried to note, children do well at home (and in the
community and at school) when they: 1) are engaged in functional
activities, 2) have a clear system of reinforcement in place, and 3) have
support for their communication skills, both expressive and receptive.
If your child has learned to follow a visual schedule at school and at
home, then take the schedule with you when you visit other people,
indicating what activities will take place, including when you will go
back home. (See, for example, Figure 3-2 on page 53.)
If you use a token system for rewards (or a puzzle or point system),
be sure to take that with you as well. And if your child uses a visually
based communication system (such as PECS or an electronic device)
be sure that system is available whenever you leave the house. If your
child uses sign language, be sure that you’ve taught your relatives how
to respond to the most important signs. If your child’s reinforcement
and communication system
are available in the new
setting, this support will
minimize the novel—and
thus potentially frighten-
ing—aspects of going away
from home.
Remember that de-
spite your efforts to calm
your child, he might be-
come upset in the new situ-
ation. Therefore, plan how
(and where) you will give
your child an opportunity
to take a break (or simply
get away) from either specific activities or specific people. That is, if
the routines for dinner are new (and possibly slower) than at home, you
should allow your child the chance to request a break and be permit-
ted to leave the dining room for a short time. If your child feels there
is no escape, then you will see a dramatic escalation of problematic
behaviors. For example, if you go to a relative’s home for Thanksgiv-
 Autism 24/7



ing dinner, plan for an area where your child can take a quiet break,
especially if he is likely to react to the hustle and bustle associated with
so many new people around him. You should take care that the food
served will not be too novel or that you’ve brought along some favorites
that might help coax your child to sample some new fare.
When we think of visiting our grandmother’s, we usually smile
in anticipation of all the nice things she will give us, even when we
really don’t deserve them! You may want to help your child learn how
rewarding it can be to visit other people. That is, have the people you
visit immediately provide some reinforcers for your child even before
putting any demands upon him. If you’re not sure they will have things
that your child likes, bring rewarding items with you but let them hand
the rewards out. In time, you (and those you are visiting) can gradu-
ally increase your expectations for your child’s participation in various
activities and routines, or for simply being polite.
Be sure to bring “filler” activities—things your child has learned
to do relatively independently, and, hopefully, with enjoyment. Then,
when everyone else is helping to set the table with the heirloom china
that no five-year-old should handle, you will have something else your
child can do. If you merely hope your child will “stay out of trouble,”
that expectation is doomed to fail, given enough time!
When visiting someone’s home for the first time, be sure to check
whether there are any pets that may frighten your child or cause al-
lergic reactions, or that your child may aggravate! If other children
will be present, you may want to arrange for some time to talk about
your child and any of his unique characteristics. Openness and candor
should be the rule, along with high expectations all around.

Routine Visits
If you are visiting relatives or friends and you anticipate that
such visits will become routine, then it is important to develop some
routines for that location. You may want to consider activities that
your child can engage in that require minimum supervision so that
you will have time to spend with whomever you are visiting. If these
activities require materials not likely to be where you are going, then
be sure to take them along.
Let your child know if there are any areas that are “off limits” to
him—either for safety or privacy reasons. If you use portable locks to
  Pulling It Together in the Neighborhood

secure certain areas of your home, you may want to bring some and ask
your friends or relatives if you can use them in such special places.
Asking for Breaks. You may also want to designate a special
“quiet” area—somewhere that your child can calmly escape to if
circumstances become overwhelming (e.g., many unfamiliar guests
continue to show up and they’re all trying to talk to your child).
One creative mother we knew taught her son Josh to ask for a
break at home. He became quite independent at quietly asking for a
break when events in the home became stressful for him. His mother
created a special “break chair” for him in a quiet part of the house. When
his mother took him out in the community, though, Josh didn’t seem to
generalize this skill to novel environments. Josh’s mom thought that this
could be because she couldn’t take Josh’s break chair with her. So, she
began putting a bright yellow cloth napkin on the break chair at home,
and Josh continued taking breaks at home. Then, when she went into
the community, she took the yellow napkin with her, and she made sure
that Josh saw her take it from his chair when they left the house. Josh
quickly learned to ask for a break in the community, and when he did so,
his mother put the yellow napkin down in whatever quiet area she could
quickly find, and Josh happily sat on it while he “cooled down.”
Video Modeling. To teach your child social skills that would
be useful at a specific friend’s or relative’s house, consider using video
modeling, as described in Chapter 5. For example, when Phil went to
visit his grandparents, he immediately ran to the video game room. Al-
though his grandparents had set this area up for Phil, they were always
disappointed that he did not greet them when he came into their home.
His parents decided to videotape a scene in which his brother (playing
the role of Phil) greeted their next-door neighbor (playing the role of
his grandparents) as he entered the neighbor’s house. Next, they taught
Phil a three-turn social greeting script, as modeled by his brother in the
video, and had him practice this at home. They also sent the script to
his grandparents. On Phil’s next visit there, his grandparents met him
at the door while holding his favorite video game and then proceeded
through the script. Phil took his turn appropriately in the script, greeting
his grandparents and answering their question about how he was doing.
After this “proper” greeting, Phil ran down to play his game.
Scripts. There are a variety of social scripts that may be helpful
to your child—in a variety of situations, not just when visiting friends
and relatives. A script is like learning the lines within a play. And just
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as actors first rehearse their lines before trying them out before the
audience, so too would children learn their lines within a role-play-
ing situation before using them in real life situations. How the script
is presented will have a great deal to do with your child’s skills. Some
children can be taught their “part” simply by observing a model and
then imitating and repeating what the model did. Other children are
able to read, so following a written script can be helpful for them. It also
is important to teach children several scripts or different ways to effec-
tively handle a situation so that the outcome does not appear to be too
artificial. For example, if you want your child to learn how to respond
to questions about seeing a movie, be sure that your child eventually
learns to talk about different movies with different people.
Visitors in Your Home. Many parents wonder how they can
tell visitors to their home about their child’s special needs or traits.
Borrowing from a strategy observed at her son’s school, Denyse posted
a few key reminders under the “Welcome to my Home” sign by her
front door. The first asked visitors to look directly at her son when
talking to him. The second note asked them not to look at her son if he
was throwing a tantrum. You may want to similarly post any special
instructions you’d like visitors to your home to follow.

Mealtimes
Most of us look forward to a quiet, relaxing meal with the other
members of our family. It is a time to share good food and to talk about
things that are important within the family or simply just fun to discuss.
Unfortunately, mealtimes also can be stressful times for everyone.
Some people may feel rushed and ready to move to the next activity,
while others may be upset about things that happened that day (or will
soon happen) and thus not want to talk to anyone. And some children
with autism may not enjoy family discussions or may be distracted
by the foods, smells, or routines associated with the meal. What can
parents do to minimize stress and promote a relaxed atmosphere?

Learning about Mealtime Routines

Let’s first consider routine meals and then we’ll consider com-
mon exceptions. At breakfast time, everyone is often running around
  Pulling It Together in the Neighborhood

getting ready for the day and spending little time as a group. Sitting
alone and eating a bowl of cereal is a fairly common routine in many
families. If this scenario is true for your family, then you may not need
to require a great deal of social interaction during the meal. You will
want to determine how much of the routine you’d like your child to
directly participate in, remembering that the more he gets involved
in the routine, the fewer opportunities he will have to engage in in-
appropriate actions. Depending upon your child’s age and skill level,
you should expect some participation in some of the routines—for
example, taking a plastic bowl from the counter to the table and
getting a spoon from the drawer and a napkin from the holder. You
may want to speed up certain aspects to help avoid problems—for
example, you may want to pour milk from the gallon container into
a cup for your child to pour into his cereal bowl or put some cereal
into a large bowl for transfer to his bowl (instead of expecting him
to handle the large cereal box).
You should consider what else your child can do while eating
his breakfast. Will you have time to review his day with him, either
by simply talking about what will occur or by reviewing a visual
schedule? If you don’t have much interaction time, can he look at a
book (picture or otherwise) or something else without this interfering
dramatically with finishing eating? Remember, it is likely that you do
other things while eating your breakfast, such as reading the news-
paper or watching the sports review on TV. Thus, it will be important
to gradually teach your child about appropriate activities he can do
while having breakfast.
Be sure to have your child participate in some manner in cleaning
up, even if only to put his spoon in the basket in the dishwasher. If your
child has trouble finishing his breakfast within a reasonable time, you
can use a timer, clock, or some other visual aid to help him note the
progress of time. Of course, when he does finish on time, he should
receive some prearranged reward—even if just your joyful praise!
Dinners may be more complex because there may be more social
demands associated with having more family members present at this
meal. As with all meals, plan which parts of the dinner routine you’d
like your child to participate in—from setting up to cleaning up. To
prevent your child from developing rituals, you may want to make a
visual (or written) chart with many jobs related to dinnertime and
rotate through the possible activities throughout the week.
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Communicating during Meals

You should expect communication to be part of dinner, with your
child expressing himself (using whichever modality) and also listening
to others. Everyone needs to learn to ask for and share various common
items, from specific foods to utensils and other materials. Remember
to encourage your child to initiate communication, not just to respond
to or imitate others. Dinnertime is also a great time to encourage
communication between siblings, so try to avoid having the parents
(or other adults) control all of the interactions. If there are topics you
routinely discuss—from what happened at school that day to what the
family will be doing on the weekend—then it may help to rehearse
these issues/topics before the meal with your child.
Having a visual script (either written or pictorial) may help your
child when it is his turn to communicate. For example, the script can
contain information about topics that your child can talk about or
areas of interest of other people in the group. Perhaps a word or pic-
ture will help your child remember that Uncle Bob likes to talk about
baseball or that Aunt Sue just took a trip to Australia. The script can
also help your child recall interesting things or events that he has
recently participated in.
If your child can communicate quite well but isn’t sure what to
talk about, or if he talks about issues that are inappropriate or just too
ritualistic, then you may want to prepare a simple list of topics to discuss
during dinner. With such a list, you can also encourage your child to
cross out or erase topics that have been covered in order to promote
variation both within and across meals. You can also introduce top-
ics that you want to include—upcoming visits to relatives, important
events at school such as parties or tests, changes in routines involving
visitors to your home, etc. If these types of changes stress your child,
you may want to introduce them before the meal so that when they are
brought up at dinner time, they are not novel items for him to adjust
to while everyone is present.
If your child is stressed by aspects of the dinner—either the social
or activity routines—then set up a system to reward him for participat-
ing in portions of the meal in such a way that he can tell when the meal
will be finished. Be sure to permit him to use some of the critical skills
noted in Chapter 3, such as asking for a break or help.
  Pulling It Together in the Neighborhood

Dinner Guests
Whenever possible, plan for changes in your normal family meal-
time routines, whether you have a single guest coming over for one meal
or are confronting wholesale changes, such as during holiday dinners.
Not only should you work with your child to cope with your dinner
guest, but you may want to offer advice to your guest prior to the start
of the meal. Bearing in mind what your child likes to talk about, you
can offer suggestions on topics that will promote interaction between
the guest and your child. You may want to offer advice on whether
the style of your guest will fit the style of your child. For example, you
can warn Uncle Dave, who likes to slap people on the back as a sign of
friendship, that your child tends to react to such contact as aggressive
or frightening. You also can find out from your guest some topics she
enjoys talking about—what she likes to eat, where she has traveled
recently—and prepare your child to talk about these issues.

Eating Out
Going out for a meal can be very stressful for children with au-
tism. From your child’s perspective, there may be nothing fast about
“fast-food” restaurants, especially at peak times. These locales involve
many strangers, from those working at the site to other customers,
many of whom will expect some communicative interaction with your
child. If your child is very young or appears quite stressed at such places,
you should consider going to them only when there are the shortest
lines possible. You also should plan what your child will order before
getting in line and consider something quick and easy. For example,
rather than buying a full meal, just buy some French fries and eat them
quickly. Review the routines of different restaurants with your child
so he knows what to expect. For example, will your child be handed a
drink or will he be given an empty cup to fill? Over time, order fuller
meals and visit the restaurant when more people are around.
As noted before, consider the first trips as teaching time, not eat-
ing time. If a serious problem arises, end the trip and offer your child
something to eat that is less appealing than the fast-food option. Con-
sider what went wrong and then plan accordingly to modify the next
outing. For example, if the line was too long, consider reviewing the
“wait” lesson. If your child screamed because someone was sitting too
 Autism 24/7



close, either choose a spot further away from crowds on the next trip
or offer your child more rewards for tolerating people being close by.
Sit-down restaurants offer different challenges than fast-food
places do. For example, rather than ordering at a counter, your child will
probably need to communicate with a server and select from a menu.
You may want to rehearse
these routines at home.
Most restaurants will lend
you a menu so your child
can have an opportunity
to review what’s on it and
how to use it before you
enter the restaurant. Plan
for what to do during the
time between ordering and
food being served. What
relatively quiet activities
can your child do at the table? What will you do if your child eats more
quickly than you do? Are there rewards you can offer to your child for
staying quietly with you until everyone has finished their meal?
In general, remember that mealtime is not simply food-time.
There are many expectations for social interaction during meals and
these issues may involve considerable stress for your child, even if
he enjoys the food that is offered within the meal. When out in the
community, will your child’s manner of communication be readily
understood by everyone else? Do you have a back-up plan if his com-
munication attempts initially fail? Finally, what rewards will you be
able to give your child during the meal and for completing the meal,
both at home and out in the community? For some children, simply
eating the food will not be sufficiently rewarding to motivate them to
use the many skills that will be expected of them.

Going on Vacation
Going on vacation should involve fun and excitement for ev-
eryone, and possibly some calm moments as well. Unfortunately, we
know of many families who virtually dread holidays and vacations. In
our previous examples, we suggested doing “test runs” whenever pos-
  Pulling It Together in the Neighborhood

sible—arranging for opportunities for your child to learn skills without

expecting him to complete everything all at once. The problem with
vacations is that there may be no opportunity to practice going to Dis-
ney World or a mountain resort. In such situations, it is still important
to bring strategies into the novel situations that promote stability and
routine—for example, reward systems, schedule systems, other types
of communication systems if they are used, and possibly reminders
about behaviors you are working on changing (and alternatives).
Whenever possible, try to obtain promotional materials related
to where you will be traveling. Review the materials with your child
by using visual aids (pictures, videos, etc.), written materials where
appropriate, and general discussions. Before the trip, review what
special vocabulary you may need—items to request (including novel
foods, toys, or activities such as rides), novel things to talk about, in-
cluding special places (mountains, snow, canyons, etc.), or other novel
things your child will experience. Many amusement parks and other
well-organized attractions promote special conditions for those with
disabilities, especially if you contact them ahead of time. These may
include passes to circumvent long lines, or even a special guide to help
everyone enjoy the events.
Whenever you go to new locations, be sure to plan for the unex-
pected. That is, talk to everyone in the family about what to do in case of
emergencies such as injuries, someone getting lost, or your child having
a temper tantrum. In the midst of a chaotic and scary situation it will be
difficult to calmly think of a plan. Be sure to secure identifying informa-
tion with your child, something that someone else (including the police)
would quickly find if your child is not able to fully communicate about
the situation. Whether such information is on a card inside a wallet or
on a bracelet or necklace would depend on what you know about your
child’s tendency to remove such items. To counter these tendencies, give
your child frequent praise and rewards for having the ID on at all times
in the community. And remember that your child may not be able to
produce his best skills if the situation is stressful; thus, always have a
backup plan. This information should include a way to contact you as
quickly as possible (as via a cell phone, for example).
We recommend teaching children to remain still if they get lost.
After all, it will not be helpful if your child is trying to find you while
you are trying to find him. You also will have to make decisions about
what you want your child to do if he becomes lost and someone else
 Autism 24/7



approaches him—should he talk or should he continue to wait for some-

one he recognizes? As with any skill, you should arrange to practice
what to do if your child gets lost while you are in a safe environment.
For example, when you have several people with you to assure safety,
abruptly walk away from your child in a supermarket (with both ends
of the aisle monitored) and reward your child for standing still until you
return. If he tries to walk out of the aisle, try again but with a shorter
interval of time for him to wait for your return. If you think your child
will understand a story about dealing with being lost, you may want
to read it with him to help him learn how to handle the situation.

Dealing with Holidays

Dealing with holidays can be stressful, even if your family is
staying at home. Routines change, people come and go—including
people your child may rarely see—strange food, costumes, customs,
and other alterations become the rule rather than the exception! The
key to helping your child cope with these novelties is to take advantage
of calm times to teach better tolerance for change. If you put all your
effort into maintaining a fixed routine virtually all the time, when
change comes—and it must!—your child will not have the skills to
manage it in a calm fashion.
Many of the communication skills described in Chapter 3 will
hold the key regarding how well everyone will deal with holidays. For
example, in the section on teaching children to follow schedules, we
noted the importance of teaching the concept of “surprise.” If you’ve
spent time teaching this as part of your everyday routine, you’ll find
many opportunities to inform your child of surprises throughout any
holiday. Likewise, being able to ask for a break will be important when
your child is overwhelmed by sudden changes or the introduction of
new foods, activities, or people.
Giving and receiving gifts is a part of many holidays, and you
can anticipate that your child may not like everything he receives. You
should not expect to teach your child how to deal with being disappoint-
ed by a gift in a room filled with your relatives. Instead, you can help
prepare your child for this possibility by offering him surprise “gifts”
within your normal home routines, being sure to include some duds!
In this way, not only can your child be taught how to say, “Thanks!” for
  Pulling It Together in the Neighborhood

well-appreciated gifts but he can also practice how to politely (though

less enthusiastically!) say, “Thank you!” for any gift.
Many holidays involve wearing special clothes, whether it is a
Halloween costume or a shirt, jacket, and tie or a fancy dress. Have
your child wear these unique items at times prior to the required time
and you will have a better chance at rewarding him or her for tolerat-
ing the new attire.
We should also recognize that during holidays parents have many
responsibilities—from preparing and setting out food, to talking to
relatives and friends, to helping older relatives who need more atten-
tion. All of these factors will tend to decrease the amount of time and
attention you will be able to devote to your child. How will he react to
this change? To help your child cope when you cannot devote a lot of
time to him, plan to provide him with access to a variety of reinforcing
activities and materials that he can use independently.
You also should be sure that your child can tell you directly if he
really needs more attention from you. This type of communication is
important for all children, though the message may vary according to
the child’s overall communication level. For example, a young child
might say (or use an equivalent picture to say), “Come play with me!”
If you are concerned that your child may ask too often, then you can
limit the number of requests by using a count-down visual system. For
example, you may give him five “play with me” cards to use for a holiday
party. Children with more sophisticated communication skills can be
taught to say, “I know you’re busy but can we do something together
soon? I’m getting a bit anxious!”

Review
In this chapter, we have used examples of routines that your
family may use at home, in your neighborhood, and in the general
community. All of the ideas that we have introduced via the Pyramid
Approach now become integrated to best help your child with autism
effectively cope with many different situations. To successfully teach
your child in these varied settings, you must focus on functional ac-
tivities using powerful rewards (as natural as possible) while assuring
that your child has a set of critical functional communication skills
(regardless of the modality he uses to communicate). In addition, you
 Autism 24/7



must handle any problematic behaviors by first addressing their cause

and then identifying appropriate replacement skills.

Conclusion
After reading the preceding chapters, you should understand
how to decide upon the type of lesson involved within any activity. You
should be able to choose a teaching strategy to match that lesson and
later promote its expansion into other settings. You should also under-
stand the importance of responding to your child’s errors in a planned
and consistent manner. Finally, you should now know how to collect
information that will help you decide whether your teaching plans have
been successful or whether you need to make some adjustments.
At this point, you should have the knowledge you need to teach
your child with autism in many settings and circumstances. When you
encounter problems and challenges, you can return to the elements
of the Pyramid Approach to find a potential solution in a systematic
fashion. We know that you will feel great pride as you watch the growth
of your child in and around your home!
 Forms & Checklists

Areas of the Home and Common Activities ................................. 142

Communication Programming across the Day (Example)........... 144

Communication Programming across the Day (Home Use) ........ 146

Routines and Communication in the Home Worksheet

Morning Example ....................................................................... 148

Routines and Communication in the Home Worksheet

Afternoon Example .................................................................... 150

Routines and Communication in the Home Worksheet

Evening Example ....................................................................... 152

Routines and Communication in the Home Worksheet

Morning .................................................................................... 154

Routines and Communication in the Home Worksheet

Afternoon .................................................................................. 156

Routines and Communication in the Home Worksheet

Evening ..................................................................................... 158

Routines and Communication in the Home

Steps within Routines (Example) ............................................... 160

Routines and Communication in the Home

Steps within Routines ................................................................ 162
 AREAS OF THE HOME AND COMMON ACTIVITIES

Area of home/apartment Common activities

Kitchen
  Forms & Checklists

Living room

Dining room

Child’s bedroom

Parent’s bedroom
Rec/TV room

Laundry area

Garage

Basement

Other
Autism 24/7


 COMMUNICATION PROGRAMMING ACROSS THE DAY© (for Home Use)

Child: _______________________________________________________________________ Date: _______________________

Time Activity Location Functional Goals Expressive Skills Direction Following

  Forms & Checklists

2:45 Arrival Doorway Unload book bags Request help/toy Follow simple directions:
Free time Bathroom Toileting Answer “Do you want?” “Go to bathroom”
Free play “Give it to me”

3:00 Snack Kitchen Eat properly/ Request: snacks/drink/ utensils Respond to directions:
set-clean table Request items to complete “Get…”(spoon, cup, plate,
Social interaction setting table snack items, drink, straw)
Communication Answer “What do you see?” “Put in/on…” (sink, garbage,
Direction-following Answer “Do you want?” table, counter)

3:30 Play Backyard or Transition to play area Request desired toy/area Respond to “kick” vs. “throw”
basement Gross motor: Request help Respond to “run” vs. “jump”
 kick/throw ball Comment on environment Respond to “select block by
 run/jump color, size OR shape”
 build with blocks
4:15 Wash, Bathroom Transition to bathroom Request desired item “Throw away”
Laundry Laundry area then laundry Ask for help “Give me the [type of clothes]”
Wash hands/face Answer “Do you need?” “Put color/size/type here”
Put wash in Comment on type, color, and “Push start button”
Take out of dryer size of clothes

4:45 Watch Den Turn on TV, DVD, put Request DVD “Please turn the volume
TV/Video in disc Request “help” up/down”
Comment about movie Signal “all done” “What is she doing?”
Comment on actions of “What is her name?”
characters
Politely say “no thanks” to
“Let’s watch X”

©Copyright, 1997 Pyramid Educational Consultants, Inc. May be reproduced for instructional use.
Autism 24/7


 COMMUNICATION PROGRAMMING ACROSS THE DAY© (for Home Use)

Child: _______________________________________________________________________ Date: _______________________

Time Activity Location Functional Goals Expressive Skills Direction Following

  Forms & Checklists
 Autism 24/7



©Copyright, 1997 Pyramid Educational Consultants, Inc. May be reproduced for instructional use.
 ROUTINES AND COMMUNICATION IN THE HOME WORKSHEET©
Summary of Routines

Time of Day: MORNING

Routine Reinforcement (routine itself or Area of House/Class Materials
finishing routine)
  Forms & Checklists

get dressed finishing—gets 5 minutes of video bedroom underwear, pants, shirt, socks,
shoes

wash hands finishing—gets breakfast bathroom water, soap, towel

eat breakfast routine is reinforcing kitchen cereal, bowl, milk, spoon

brush teeth finishing—gets 5 minutes of free bathroom water, toothbrush, toothpaste,

play towel
get ready for bus finishing—likes to ride school bus family room shoes, coat, backpack

©Copyright 2002 Pyramid Educational Products, Inc. Reprinted with Permission. May be reproduced.
Autism 24/7


 ROUTINES AND COMMUNICATION IN THE HOME WORKSHEET©
Summary of Routines

Time of Day: AFTERNOON

Routine Reinforcement (routine itself or Area of House/Class Materials
finishing routine)
  Forms & Checklists

arriving—take coat finishing—gets snack family room hanger/hook

off, hang coat, unload
book bag, shoes off

snack routine—likes to eat snack kitchen favorite foods, plate, cup,

coat/shoes on finishing—gets to go outside family room coat, shoes

outdoor play routine—likes to play outside back yard swings, ball

coming in—coat off, finishing—gets to watch video family room hanger/hook
shoes off

video routine—likes videos family room television, video, favorite chair/

mat, etc.

wash hands finishing—dinner is next bathroom water, soap, towel

dinner routine—eats favorite foods kitchen plate, cup, bowl, utensils, food

©Copyright 2002 Pyramid Educational Products, Inc. Reprinted with Permission. May be reproduced.
Autism 24/7


 ROUTINES AND COMMUNICATION IN THE HOME WORKSHEET©
Summary of Routines

Time of Day: EVENING

Routine Reinforcement (routine itself or Area of House/Class Materials
finishing routine)
  Forms & Checklists

help with dishes finishing—gets to take bath next kitchen refrigerator, dishwasher

bath time routine—loves bubble baths bathroom water, bubbles, washcloth, toys,
towel

pajamas on finishing—gets to watch video bedroom pajamas

video routine family room television, video, favorite chair

brush teeth finishing—gets to play before bathroom water, toothbrush, toothpaste,
bed towel

bed time routine—likes to look at books bedroom books, bed, lamp

in bed

©Copyright 2002 Pyramid Educational Products, Inc. Reprinted with Permission. May be reproduced.
Autism 24/7


 ROUTINES AND COMMUNICATION IN THE HOME WORKSHEET©
Summary of Routines

Time of Day: MORNING

Routine Reinforcement (routine itself or Area of House/Class Materials
finishing routine)
  Forms & Checklists
©Copyright 2002 Pyramid Educational Products, Inc. Reprinted with Permission. May be reproduced.
Autism 24/7


 ROUTINES AND COMMUNICATION IN THE HOME WORKSHEET©
Summary of Routines

Time of Day: AFTERNOON

Routine Reinforcement (routine itself or Area of House/Class Materials
finishing routine)
  Forms & Checklists
©Copyright 2002 Pyramid Educational Products, Inc. Reprinted with Permission. May be reproduced.
Autism 24/7


 ROUTINES AND COMMUNICATION IN THE HOME WORKSHEET©
Summary of Routines

Time of Day: EVENING

Routine Reinforcement (routine itself or Area of House/Class Materials
finishing routine)
  Forms & Checklists
©Copyright 2002 Pyramid Educational Products, Inc. Reprinted with Permission. May be reproduced.
Autism 24/7


 ROUTINES AND COMMUNICATION IN THE HOME WORKSHEET©
Steps within Routines

Routine Steps Vocabulary for Requesting

eating snack—cookies and milk on 1. go to kitchen 1. ___________

table
  Forms & Checklists

2. get cup 2. cup

3. get plate 3. plate
4. put on table 4. ___________
5. sit down 5. ___________
6. open bag of cookies 6. cookies
Sabotage strategy once routine 7. put two cookies on plate 7. ___________
is mastered:
8. open milk 8. milk
vary: have no cup available; have no
plates available; no cookies or wrong 9. pour milk 9. help
cookies on table; no milk available; 10. eat cookies 10. ___________
milk carton sealed 11. drink milk 11. ___________
12. clean up 12. ___________

Reinforcement: access to cookies and milk

 The routine was intact—no The routine was intact—no
requesting was necessary. requesting was necessary.

Date 11/6 11/7 11/8 11/9 11/10 11/13 11/14 11/15 11/16 11/17

Item Cup Plate Cup none none absent Milk Milk Cookie none

Response + + + - + + - - -

Staff lf lf lf sr sr lf lf lf jr jr

©Copyright 2002 Pyramid Educational Products, Inc. Reprinted with Permission. May be reproduced.
Autism 24/7


 ROUTINES AND COMMUNICATION IN THE HOME WORKSHEET©
Steps within Routines

Routine Steps Vocabulary for Requesting

1. ____________________________________ 1. _______________________
  Forms & Checklists

2. ____________________________________ 2. _______________________

3. ____________________________________ 3. _______________________

4. ____________________________________ 4. _______________________

5. ____________________________________ 5. _______________________

6. ____________________________________ 6. _______________________

7. ____________________________________ 7. _______________________
 8. ____________________________________ 8. _______________________

9. ____________________________________ 9. _______________________

10. ____________________________________ 10. _______________________

Sabotage strategy once routine 11. ____________________________________ 11. _______________________

is mastered:

12. ____________________________________ 12. _______________________

Reinforcement:

Date

Item

Response

Staff
Autism 24/7



©Copyright 2002 Pyramid Educational Products, Inc. Reprinted with Permission. May be reproduced.
 Bibliography

Anderson, S. et al. (2007). Self-Help Skills for People with Autism: A

Systematic Teaching Approach. Bethesda, MD: Woodbine House.

Bondy, A. & Frost, L. (2002). A Picture’s Worth: PECS and Other Visual Com-
munication Strategies in Autism. Bethesda, MD: Woodbine House, Inc.

Bondy, A. & Sulzer-Azaroff, B. (2002). The Pyramid Approach to Educa-

tion in Autism, 2nd Edition. Newark, DE: Pyramid Products, Inc.

Cafiero, J. (2005). Meaningful Exchanges for People with Autism: An

Introduction to Augmentative & Alternative Communication. Bethesda,
MD: Woodbine House.

Charlop-Christy, M. H., & Daneshvar, S. (2003). Using video modeling

to teach perspective taking to children with autism. Journal of Positive
Behavior Interventions, 5 12-21.

Delmolino, L. & Harris, S. (2005). Incentives for Change: Motivating

People with Autism Spectrum Disorders to Learn and Gain Independence.
Bethesda, MD: Woodbine House.

Glasberg, B. (2006). Functional Behavior Assessment for People with

Autism: Making Sense of Seemingly Senseless Behavior. Bethesda, MD:
Woodbine House.
  Bibliography

Glennen, S.L. & DeCoste, D. (1997). The Handbook of Augmentative and

Alternative Communication. San Diego: Singular Publishing Group.

Harris, S. & Weiss, M. (2007). Right from the Start: Behavioral In-
tervention for Young Children with Autism. 2nd ed. Bethesda, MD:
Woodbine House.

Mirenda, P. (2002). Augmentative and alternative communications

systems. In A. Bondy & L. Frost, A Picture’s Worth: PECS and Other
Visual Communication Strategies in Autism (pp. 43-66). Bethesda,
MD: Woodbine House.

Mirenda, P. (2003). Toward functional augmentative and alternative

communication for students with autism: Manual signs, graphic sym-
bols, and voice output communication aids. Language, Speech, and
Hearing Services in Schools, 34, 203-216.

Skinner, B. F. (1957). Verbal Behavior. Englewood Cliffs, NJ: Pren-

tice-Hall.

Sulzer-Azaroff, B., Fleming, R. & Mashikian, S., (2003). Study Ques-

tions, Laboratory, and Field Activities to Accompany the Pyramid Ap-
proach to Education in Autism. Newark, DE: Pyramid Products, Inc.

Weiss, M. & Harris, S. (2001). Reaching Out, Joining In: Teaching

Social Skills to Young Children with Autism. Bethesda, MD: Wood-
bine House.

Wert, B. Y., & Neisworth, J. T. (2003). Effects of video self-modeling

on spontaneous requesting in children with autism. Journal of Positive
Behavior Interventions, 5, 30-34.
 Index

AAC,  Backstepping, -

Accepting, - Backward chaining, 

Accuracy,  Baking, 
Activity Schedules for Children Ball, throwing, 

with Autism, 
Bedroom activities, -

Antecedents,  Behavior, appropriate
Anticipatory prompts, -
prompting, -
Assessment, of communication rewarding, -

skills,  Behavior, problematic
Assistance, teaching child to altering environment to
request, -, avoid, -

Association for Behavior context of, -
Analysis International, 
ignoring, -
Attention, reducing need for in community, -
parental. See Entertaining keys to reducing, 

self measuring, -
Attention seeking, , 
reasons for, , -, 

Audio Reinforcement Reminder replacement behavior for,
Tones,  -
Augmentative or Alternative sampling, -
Communication, 
time out and, -
types
Autism, children with of, to eliminate, 
verbal
common delays of, x reprimands for, -
critical factors for, xiv Behavior analysis, xii, , 
  Index

Bondy, Andy, ,  charting, -
importance

Break, requesting, , , , of collecting, ,
-,  -
Chaining, 
types to collect, -

Clicker-training, 
Delmolino, Lara, 

Clothes. See Dressing
Demands, after informing child
Communication about reinforcer, 

antecedents of, -
Dentists, -
assessing,  Directions, following, -,
critical skills for, -, -
, -
during meals, 
Discrete lessons, -, -

expressive,  Discrete trials, , 

forms for planning, -
Distractions, tolerating, -

functional vocabulary for, Dressing, , 
,  Duration, 
goals for teaching, 
Eating. See Mealtimes
Einstein,
imitating,  Albert, 

initiating, ,  Entertaining self, -
Errors
listening to, -, 

nature of, - four-step procedure for
nonverbal, - correcting, 

PECS, and, ,  handling during discrete
reasons for, -
receptive, trials, -
 handling during sequential
repeating,  lessons, -

responding to,  minimizing, -, 

scripts and, -, 
Extinction, 
working on at playground, Fines, -

yelling,  Forward chaining, 
Consequences, reinforcers as, Four-step Error Correction
,  Procedure, 
Contextually inappropriate Frequency counts, -

behavior (CIB), . See also Friends, visiting, -
Frost,
Behavior, problematic
Critical Lori, , 
Functional Communica- Functional Behavior Assessment
tion Skills Checklist, -
Cues, for People with Autism, 

visual. See Visual cues
Data Generalization, xii
Glasberg, Beth, 
amount to collect, - Goals. See Teaching, goals for
 Autism 24/7



Graduated guidance, 
Listening, -, 

Graphs, - Lose-shift, 
Guests. See Visitors Lost, getting, -
Mands,
Hair cuts,  
Harris, Sandra, x, 
McClannahan, Lynn, 

Healthcare settings, -
Mealtimes, -
Help. See Assistance
Miller (Wendy F.) Autism
Holidays, - Program of the Year, xii

Home Mistakes. See Errors

and coordinating lessons with Modeling, 
school,- Money, -
areas of, , - Motivating child.
visiting unfamiliar, -
See Reinforcers
Movies,
IEP, - -
Ignoring behavior, -. See Name, responding to, -

also Behavior, problematic
No, saying, -. See also
Improvement, encouraging, Rejecting
- Outcome review, 
PECS,
Incentives for Change, 
, 
Independence, promoting A Picture’s Worth, , 

child’s, , , -. Pictures, for schedules, 

See also Prompts, fading Playground skills, -

Instructions, following. Pointing, 
See Directions, following
Product review, 
Prompts
Intensity, 
Kitchen activities, -, , . anticipatory, -

See also Mealtimes
combining, -

Krantz, Patricia, 
Laundry, dependence on, , 

-, 
Learning. See also fading, -
ineffective,
Teaching 
measuring use of,
definition of, 
natural -
to engage in
opportunities for, alternate
-,  behavior, -
Lessons. See also Teaching types of, -
determining when not to Pryor, Karen, 
teach, - Punishment, -
evaluating effectiveness of,  Puzzle-type reinforcers, , 

timing of, 
Pyramid Approach to Education
Libraries, ,  functional activities and, 
  Index

history of, xi Right from the Start, x

motivational factors and, 
Routines
overview of, xii-xiii embedding teaching in, -

Pyramid Approach to Education opportunities to work on
(Bondy and Sulzer-Azaroff), skills during, -


 Sampling, -
Quiet events, - Schedules, -, , 

Rate,  Scripts, -, 
Reading,  Self-stimulatory behavior, -

Recreational settings, skills for, Sequential lessons, -,
- -, -, 
Shaping,
Reinforcers -
arbitrary,  Shopping
beginning with, 
anecdotes about, , , -,
definition of, 
differential, 
-, 
having others reinforcers and, -, 
provide, 
informing child time out during, 

about, -
money as, Sign language, 

- Skills to teach
natural, -, , 
area-based approach to
negative, - identifying, -

positive, ,  time-based approach to
puzzles as, , 
reducing, identifying, -
-
requesting, - Skinner, B.F., xii, , , 

social, , ,  Soup, preparing, 
tokens as, -
transitions Speech. See Communication;
and, - PECS
Sports, , 
Rejecting,  Spot checks, 
Relatives, visiting, -
Stimulation, avoiding, -

Religious services, 
“Stop,” teaching meaning of, 

Repetition Stress, sources of, , , , 

deciding how much to use, Sulzer-Azaroff, Beth, 

- Surprises, , , 
deciding whether to use, -
Sussex Consortium, xii
Reprimands, -
Requests, Tacts, 
,  TAG-Teach, 
Restaurants, - Tantrums. See Behavior,
Rewards, . See also Reinforcers problematic
 Autism 24/7



Task analysis, -, , 
Turn taking, -

Teaching. See also Lessons; Unfamilar homes, visiting,
Prompts; Shaping; Video -
learning Vacations, -
discrete lessons and, - Verbal Behavior, 
embedding in
routines,- Verbal reprimands, -


evaluating, 
Video learning/modeling, ,
responsiveness vs. 
self-initiation, 
Visiting family and friends,
sequential lessons and, -
-, -, -,  Visitors, , 
vs. taking care of child, -
Visual cues, , 
Teaching, goals for Waiting, -, , , -

choosing, - Washing hands, 
focusing on one at a time, 
Weiss, Mary Jane, x
gradually increasing, -
Yelling, 
prioritizing, - Yes, saying. See Accepting
routines and, -

writing, -
Television watching, , , 

Time, marking passage of, ,
-
Time Out, -
Timer, , 
Tokens. See also Reinforcers
increasing amount of work
for, 
taking away, , , 

teaching child value of,
-

using as “clock,” , -

using in community, 
Tones, reminder, 

Transitions, -, 

Traveling. See Vacations

Trends, 
“Trial and success,” , 

Trials
discrete, , 

number of, -