The Child as a Whole:

Why Behavioral and Biomedical

Interventions are both Critical to
Growth and Recovery

Doreen Granpeesheh, Ph.D.

B.C.B.A-D

Center for Autism and Related Disorders, Inc

Today’s Presentations
What is Autism: A whole body condition
The Synergistic Effects of ABA and
Biomedical Interventions working together
 Sudden and dramatic changes in behavior when
medical interventions are put in place
• Case Studies
What is ABA (Applied Behavior Analysis)
 What is good ABA?
• How can you gain access to it?
What is Autism?
 Pervasive Developmental Disorders
 Impairments in two or more areas of development
• Autism
 Impaired Social Interaction,
 Impaired Communication
 Restricted, Repetitive Behaviors
 6 or more symptoms
• Asperger’s Disorder
 Impaired Social Interaction
 No Language delay
 No Cognitive delay
• PDDNOS
 Delays in all three areas (Social, Communication and
Stereotypy)
 Fewer than 6 symptoms
What is Autism?
Communication:
 My child is delayed in language
 My child has no eye contact
Social Behavior:
 My child doesn’t interact with anyone
 My child doesn’t play with others
Stereotypy:
 My child does repetitive behaviors (lining up objects,
opening closing door, turning on and off the lights)
 My child is inflexible and needs routines
Anything else?
Challenging Behaviors?
Sensory Sensitivities?
Medical Illnesses?
 AUTISM
Metals
Minimize Exposure Pesticides
Genetic Predisposition
To Toxins
Antibiotics

Treat the Physical Conditions

Underlying Oxidative Stress Decreased Methylation
Medical Disorders Immune Dysfunction GI Inflammation

Brain Disorders
Teach New Learning Hypoperfusion
Patterns Hypo and Hyper sensitivity to stimuli
Different Learning Patterns

Behavioral Symptoms
Reduce/Eliminate Delayed Language
Symptoms Delayed Social Skills
Stereotypy
Minimize Exposure to Toxins
Make sure your physician only uses
antibiotics when necessary
Avoid pesticides (go organic)
Spread out vaccinations to reduce stress on
immune system
Check for metal toxicity to determine need
for chelation (toxic metal assay, porphyrins)
Treat Underlying Medical Illness
Immune Markers
 Check for cell mediated immune activation
(neopterin/biopterin)
 Check for Strep Titers
• ASO: Antistreptolysin O
• anti-DNase B: Anti-Deoxyribonuclease B
 Immunoglobulin Subsets (Antibodies that respond to
bacteria, viruses, fungus, etc)
 Vaccine Titers
Discuss Possible Treatments with your physician:
IVIG, Spironolactone
Treat Underlying Medical Illness
Oxidative Stress Markers (reduced
glutathione: found in every cell…helps
neutralize free radicals)
 To identify need for Anti Oxidants
Decreased Methylation/transulfation
(fasting plasma cysteine or methionine)
 To identify possible benefit of methyl B12
Treat Underlying Medical Illness
Evaluate and Treat GI Disorders
 Nutrition
 Diet
 Medication (anti-inflammatory, steroids,
anti-fungals)
Reduce Hypoperfusion
 HBOT?
Teach New Learning Patterns
Evaluate need for modified sensory input
 Visual
 Auditory
 Tactual
ABA: Applied Behavior Analysis
 “30 years of research demonstrated the efficacy of
Applied Behavioral methods in reducing inappropriate
behavior and in increasing communication, learning
and appropriate social behavior”
Surgeon General, 1999
 ABA and Biomed working together

Medical Treatment ABA

Eliminate Triggers Increase Skills

Stabilize condition Decrease Challenging
Achieve Health Behaviors
Generalize to
Daily Living

Because a healthy child sleeps better, feels better and can learn better!
Why would a behaviorist care
about biomedical interventions?
1990: Andrew was diagnosed with Celiac…
we placed him on a diet and he recovered
within a year!
1992: I began to notice a pattern of children
with extremely high use of antibiotics! This
must be leading to some abnormal flora!
1993: Emily had fungus on her nails…
treated with antifungals, her behavior
changed drastically!
Preliminary Outcome Study:1996

79 children
63 boys 16 girls
Average age at intake: 39.1 months

Average IQ at intake: 76.8 (borderline)

Length of time in treatment: 3 years

Preliminary Outcome Study:1996

High Intensity Low Intensity

More than 25 hours/week Less than 25 hours/week

44 children 35 children

Matched on age, IQ,

language, adaptive behavior
Results: Outcome 1996
Mean Client IQ Pre- and Post-Treatment
100

IQ Standard Score
95 High Intensity

90

85

80

75 Low Intensity

70
1 2
Pre-Treatment Post Treatment

Mean Adaptive Functioning Pre- and

Post-Treatment
100
95
Vineland Standard Score

High Intensity
90
85
80
75
70
Low Intensity
65
60
1 2
Pre-Treatment Post Treatment
 Normal Cognitive Functioning
WPPSI: Pre- & Post-ABA Early Intervention
130
Pre-Test
120
Post-Test
110
100
90
80
Intelligence Quotient

70
60
50
40
30
20
10
0
20 22 27 29 29 30 30 31 31 31 32 34 38
Average Therapy Hours Per Week
Why didn’t we publish this?
1996 Outcome Study Confounding Variable:
• A higher percentage of children in the
high intensity group were receiving
biomedical interventions!
• Was the improvement in IQ and
adaptive skills due to ABA or due to
the medical interventions or a
combination???
THE KEY IS TO IDENTIFY WHAT IS
CAUSING AUTISM IN YOUR CHILD!
TREAT THE UNDERLYING CAUSE…
AND THEN USE ABA TO TEACH
YOUR CHILD ALL THE SKILLS HE
DIDN’T LEARN WHEN HE WAS MOST
AFFECTED!
ALL CHILDREN NEED AND BENEFIT
FROM ABA!
 1987: Behavioral Treatment and Normal
Educational and Intellectual Functioning in
Young Autistic Children
Experimental Group: N=19

47%
40 hours/wk
Recovered!
3 yrs

10 hours/wk 10 hours/wk
3 2% UCLA/NPI
yrs Recovered
3 yrs
Control Group 1: N=20 Control Group 2: N=20
Children with Autism DO Recover!
There is NO magic pill
It is hard work and can take a long time

Let’s look at some case studies of children

who improved significantly with a
combination of medical and behavioral
treatment
Mathew R
Diagnosis: Autism
Intake:
 Age: 3.5
 Deficits: no eye contact, speech consisted of 5 one word requests,
tantrums by throwing self on floor and screaming, no interest in
peers, not toilet trained, visual and ritual ssb occurred 90% of time
Treatment:
 1 year 7 months with CARD
 Average intensity of 40 hours/week
 GFCF and probiotics
 Anti-Fungal medications (Diflucan, Nistatin)
Current:
 Age: 5.1
 In typical preschool with aide only for social interactions
 Maintains conversation, asking for information, mand, tact and
answer why/because questions, plays with peers up to 5 minutes
interactively, very advanced in academic skills, few visual ssb, no
tantrums anymore.
 Mathew: challenging Behaviors

GFCF

350 Diflucan +
Nystatin +
300 Probiotics
250
Frequency

200

150

100

50

0
Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb

Months
Tantrums Non-Compliance Screaming

Visual SSB Verbal SSB Ritual SSB Mathew

D.R.
Diagnosis: Autism
Intake:
 Age: 2.11
 Deficits: receptive vocabulary of 10 words, 3 expressive words used for
needs (juice, open, ball), no eye contact, severe tantrums, crying,
aggression and elopement, ssb included gazing, mouthing objects and toe
walking.
Treatment:
 1 year 10 months with CARD to date
 Average intensity of 30 hours/week
 Specific Carbohydrate Diet
Current:
 Age: 4.9
 In typical preschool with aide
 175 mastered receptive labels, mands and tacts with all items using full
sentences, maintains eye contact up to 8 seconds, responds to name by
making eye contact and saying “yes” or ‘what”, answers 23 social
identification questions, interacts with adults average of 10 minutes/peers
2 minutes. Ssb reduced but still exist, aggression and noncompliance
have extinguished.
 D.R.: New Skills per month

ABA + IgG ABA + Specific Carbohydrate Diet

Allergy
Elimination
Diet +
Feingold Diet
+
250 Rotation diet
New Skills per Month

200

150

100

50

0
Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04
Months
DR
 D.R.: Cumulative Skills

ABA + IgG ABA + Specific Carbohydrate Diet

Allergy
Elimination
Diet +
1400
Feingold Diet
+
Cumulative Skills per Month
1200
Rotation diet

1000

800

600

400

200

0
Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04
Months
DR
 D.R.: Stereotypy per month

ABA + IgG ABA + Specific Carbohydrate Diet

Allergy
Elimination
Diet +
Frequency of Stereotypy per Month Feingold
800
Diet +
700
Rotation
600
diet
500

400

300

200

100

0
Nov Dec Jan Feb Mar April May June

M onths
DR

Visual SSB Verbal SSB Oral Motor SSB Tactile SSB

 D.R.: Aggression per month

ABA + IgG ABA + Specific Carbohydrate Diet

Allergy
Elimination
Frequency of Aggression per

Diet +
100 Feingold Diet
90 +
80
Rotation diet
70
60
50
40
30
Month

20
10
0
Nov Dec Jan Feb Mar April May June

Months
DR
Emma
Diagnosis: Asperger’s Syndrome
Intake:
 Age: 3.4
 Deficits: poor eye contact, extensive vocabulary but did not use
language with peers, self-isolated at school, severe tantrums, non
compliance and aggression with family, visual self-stimulatory
behaviors, severe ritualistic behavior, no Theory of Mind
Treatment:
 10 months with CARD
 Average intensity of 10 hours/week
 Lexapro
 Pro DHA and CorOmega
Exit:
 Age: 4.2
 In typical kindergarten with no aide
 Initiated conversations with peers, many friends, no tantrums or
aggression, very advanced in academic skills and very popular in
school
Emma: Challenging Behaviors per month

ABA ABA + ABA +

Lexapro ProDHA +
7 Coromega
6
Frequency per Session

0
April May June July Aug Sept Oct Nov Dec
Months
Tantrums Non-Compliance Ritual SSB
Emma
 Emma: New Skills per month

ABA ABA + ABA + ProDHA

Lexapro + Coromega

120
New Skills per Month

100

80

60

40

20

0
Mar 04 April 04 May 04 June 04 July 04 Aug 04 Sept 04 Oct 04 Nov 04 Dec 04

Months Emma
A. D.
Diagnosis: Autism
Intake:
 Age: 2.11
 Deficits: had 3-4 word utterances but no spontaneous language, self-
isolated around peers, no safety awareness, toe walking, licking hands,
had difficulty inhibiting responses and would often touch people’s hair or
clothing.
Treatment:
 3 year with CARD
 Average intensity of 25 hours/week
 Anti-fungals
 Chelation
Exit:
 Age: 5.11
 In typical kindergarten without aide
 Initiates, joins, transitions conversations with peers, has many friends,
good understanding of others perspectives, no challenging or self-
stimulatory behaviors present. Normal range on all exit testing (IQ,
language, TOM, EF)
A.D.: Challenging Behaviors per month

ABA +
ABA
Antifungal +
14 Chelation
Frequency per Hour
12

10

0
June

Jan

June
Oct

Feb

March
May

July

Nov

Dec

May
Sept

April
Aug

M onth AD
Elopement Fidgeting Leaning
Running Grabbing Screaming
 A.D.: New Skills per month

ABA +
ABA
Antifungal +
New Skills per Month 250 Chelation

200

150

100

50

0
June

Feb

March

June
Oct

Jan

May
Dec
Nov
Sept

April
Aug
July

M onth AD
111-TEM
- 2 year old male
- Completed 80 dives in 14 weeks
- Mother reported tremendous gains in
language and socialization; significant
changes were also noted by examiner
during post-testing.
- Supervisor reported that participant
acquired many skills since starting the
study.
ADOS
Lower scores are better
ADOS

14

12

10

8 Pretest
Total Score

Post-test
Autism Spectrum Cutoff
6 Autism Cutoff

4
Significant improvement on score Commication and
Socialization score on the ADOS; both in autism spectrum
range
2

0
ADOS Com ADOS Soc ADOS Tot
ADOS Area
ABC
Lower is better
Aberrant Behavior Checklist

120

100

80
Irritability/Agitation
Lethargic/Withdrawal
Score by Area

Significant decrease in total score near end of study Stereotypic Beh

60
Hyperactivity
Inappropriate Speech
Total Score
40

20

0
1

k1

k2

k3

k4

k5

k6

k7

k8

k9

n
k1

k1

k1

k1

k1
BL

BL

io
ee

ee

ee

ee

ee

ee

ee

ee

ee

et
ee

ee

ee

ee

ee
W

pl
W

m
Co
Week
What do we learn from these
Case Studies?
A variety of medical interventions worked
for these children
Each child benefited from a different type
of intervention
Autism is a “Spectrum Disorder”…children
with Autism are very different from each
other!
Will these interventions work for your
child?
 We simply don’t know!
Next Steps in the Medical
Treatment of Autism
We need to do studies that show changes
across groups of children
 Exp: all children exposed to MB12 improved
 This is difficult (if not impossible) because the
children are all different from each other!
Therefore, we need to find PHENOTYPES
of Autism
 What type of child does well with MB12?
 Which children benefit from chelation?
 Who needs a course of HBOT?
What you can do as a parent
Look for biomarkers that indicate what
medical treatment your child needs
Understand the lab results your physician
orders
Try one intervention at a time
Measure the change in behavior with each
intervention
Stick with a plan!
DO ABA! IT WORKS FOR ALL KIDS
What is Applied Behavior Analysis
ABA is based on the principles of

Operant Conditioning Theory:

“Human Behavior is affected by events

that precede it (antecedents) and events that
follow it (consequences)”

Change these events…change Behavior!

What does that mean?
In ABA, we manipulate reinforcers in order
to increase functional and adaptive
behaviors, and decrease challenging
behaviors.
We give reinforcers when a good (adaptive)
behavior occurs
We remove reinforcers when a bad
(challenging) behavior occurs
Reinforcers make the world go round!

If a child wants a toy and he cant say “I

want that toy”, what do you think he will do
to get the toy?
He will grab, hit, or do what ever it takes to
get the toy!
When he hits and gets the toy, he just
gained access to a reinforcer for hitting…he
got the toy!
From now on, he will learn to hit in order to
get toys!
 Replacing Challenging Behavior
with Appropriate Behavior

Johnny wants a Johnny

Johnny gets
gets the
Johnny hits theand
toylearns
and
Johnny
toy! sees a
He doesn’t Johnny asks for toy
his sibling learns that
Toy how
know he wants
to andThe toy
grabs that asking is
ask nicely! hitting is
the toy Effective!
effective!

What if Johnny does NOT get the toy when he hits

And
We teach him to ask nicely when he wants a toy?
Everything we do is to
Get good stuff or Avoid bad stuff!
Give Remove

Good Stuff + ReinforcementResponse Cost

Extinction
Behavior Behavior
Bad Stuff Punishment - Reinforcement

Behavior Behavior
What behavior do we want to change?

Deficits Excesses
 Language  Self Stimulatory Behs
 Play  Maladaptive Behs
 Social Skills • Tantrums
 • Aggression
Theory of Mind
• Noncompliance
 Executive Functions

Skill Repertoire Instruction Behavior Management

The Secret to successful ABA
The key is to teach appropriate skills!
If a child has appropriate skills, and they are
easy to do, he will not engage in
challenging behaviors!
We cannot simply “extinguish” challenging
behaviors without replacing them first, with
appropriate skills!
 THE CARD MODEL
Applied Behavior
Analysis or The
CARD Program

Skill Repertoire Building Behavior Management

Curriculum Defining Problem Behavior

Assessment
Functions of Behavior
Teaching
Paradigm
Functional Behavioral
Assesment
Fluency-
DTT NET
Based
Indirect Descriptive Experimental

Teaching
Procedures Function-Based Emergency
Treatment Interventions

Prompting/ Discrimination Replacement Antecedent Consequence

Shaping Chaining
Fading Training Behavior Modifications Manipulations

Evaluation of Tx
Effectiveness
(Data Collection & Analysis)

Generalization &
Maintenance
 Shaping Knowledge
Through Individualized Life
Learning Systems
(SKILLS)
What is SKILLS?
E-Learning
 Trains “how to” do ABA (the techniques)
SKILLS Index
 Every child is different…what do I teach my
child?
 Assesses child’s known and unknown skills
through questions directly tied to CARD I
Curricula
CARD I Curricula
 Provides “what to” teach
Skill Repertoire Instruction
Discrete Trial Training
Prompting
Shaping
Chaining
Reinforcement
Errorless Learning
Natural Environment Training
Fluency Based Instruction

This is HOW we teach skills…This is the

CARD E-Learning Modules
What skills does my child need?
 Skills Assessment
• What skills does my child have?
• Standardized global assessments
 IQ
 Language
 Adaptive
• CARD Assessments
 Language Social Skills
 Play Social Cognition
 Executive Fxns Self-Help
 Gross Motor Fine Motor
 Adaptive Skills Academic Skills
• Curriculum designed to meet child’s needs
 The CARD Curriculum

School
Skills

Executive Social
Cognition
Functions Skills

Motor
Language Play Adaptive
Skills
The CARD Curriculum Language

By Emerging Age and Verbal Operant:

0-11 mos. Choices Listen to/Tell a
Body Parts Fast Mapping Story Statement-
Following Functions Locations Statement
Instructions Objects Negation 4:0-4:11 yrs.
Gestures Opposites Plurals Describe by
Making Recalling Events Category/Feature/
Prepositions
Requests Sound Speed & Function
Pronouns
People Duration Phonic Same/
2:0-2:11 yrs. Different
Sound Syllable
Discrimination Adverbs Segmentation Statement-
Verbal Attribute- Wh- Question
Imitation Object Discrimination What Goes With
Yes/No Conditionality3:0-3:11 yrs. 5:0-5:11 yrs.
1:0 – 1:11 yrs. Deliver a Minimal Pairs Observational
Message Learning
Actions Same/Different
Features Syntax
Asking for Gender Sequences
Information Sound Changes
Categories I Have/ISee
 The CARD Curriculum
Play
Features of a Comprehensive Play Skills Program

 Modeled after the development of play skills in

typically developing children
Breaks down each type of play into its own
systematic and comprehensive program
Sequential format
Programs may be used individually, concurrently,
or cumulatively
Play Curriculum
Play
Domains
Sensorimotor Play
Task Completion
Beginning PlayPlay
Initiating and Sustaining Play

Block Imitation Early Social Games

Constructive
Structure Building Read-to-Me Books & Nursery Rhym
Sand and Water Constructions Interactive
Play Music and Movement
Clay Constructions Play
Treasure Hunt
Arts and Crafts Card and Board Games
Locomotor Play
Peer Play

Audio and Video Play

Electronic
Computer Play
Play Pretend
Functional Pretend Play
Play
Video Games
Symbolic Play
Imaginary Play
Sociodramatic Play
 Adaptive
Personal
Curriculum
Feeding
Adaptive
Domestic
Pet Care
Toileting
Setting & Clearing Table
Undressing
Telephone Skills
Unfastening
Tidying
Dressing
Meal Preparation
Preventing Spread of Germs
Cleaning
Bathing
Gardening
Fastening
Laundry
Teeth Care
School Backpack Prep
Hair Care
Making a Bed
Nail Care
Health Care

Safety
Safety Awareness
Community Safety Equipment
Shopping
Restaurant Readiness
 Motor Curriculum
Motor

Oral
Oral Motor

Visual Ocular Motility

Binocular Vision Skills
Visual Perception

Fine Hand Skills Coloring

Pre-Handwriting Drawing
Cutting with Scissors

Sitting Crawling / Creeping Riding Foot-Propelled Vehicles

Standing Rolling Over Rolling / Throwing / Dribbling
Gross
Walking Stairs and Climbing Riding a Tricycle / Bicycle
Running Balance Beam Swinging a Bat / Racquet / Paddle
Jumping Kicking Physical Education Readiness
Hopping Catching
 Visual Form Constancy
Match the picture on top with one of the four choices. Motor
1.

2.

3.

4.
 Visual Form Constancy
What is added to the first picture to make the second picture?
Motor
1. First Picture Second Picture

to

2. First Picture Second Picture

to

3. First Picture Second Picture

to
 Visual Figure-Ground
Discrimination Motor
1.

How many times is the number 8 in the above picture?

10 times 7 times 8 times 5 times
2.

How many times is the number 6 in the above picture?

10 times 4 times 5 times 1 time
3.

How many times is the number 9 in the above picture?

9 times 3 times 15 times 2 times
 Visual Closure
Draw the missing parts of the picture on the right. Color the picture on the left.
Motor
27. Left Right

28. Left Right

The CARD Curriculum School
Skills
Math
Number ConceptsLanguage Arts 1
Rote Counting
Reading Numerals Reading Language Arts 2
Manuscript
Visual Discrimination
Numeral Comprehension of Symbols Writing
Ordinal Science
Position Reciting Alphabet
Printing Symbols
Physical Education
Numerals in SequenceUppercase Letters Personal Data
Addition Lowercase Letters
Lowercase Letters
Subtraction History
Word Recognition
Uppercase Letters
Advanced Counting ReadingSocialOrally
Letters in Sequence
Studies
Money Reading Comprehension
Letters Dictated
Time Book TopographySimple Sentences
NonAcademic
Story Comprehension
Quality of Printing
Story Summarizing Skills
Text Comprehension
The CARD Curriculum Cognition
Cognition:
 Meta-cognition: Identifying your own …
 Social Cognition: Inferring others’…
Emotions
Thoughts
Knowledge
Desires
Beliefs
Intentions
Classic Test of Social Cognition
“Sally-Anne” or False-Belief Task Cognition

Where will Sally look for her

ball?
Where does she think her ball
“Typical” Meta and Social Cognition
Cognitive Development
First few months: Sense of Self
9 months: Joint Attention / Social Referencing
15 months: Pretence
18 months: Desire / Intention
2 years: Emotion
3 years: Knowing / Thinking
4 years: Belief / False-Belief
5 years: Intention – Accident vs. Purpose
Cognition Curriculum
Cognition
13 Lessons Physical
Detecting SarcasmStates Emotions
Cause &
Intentions
Effect

Deception Senses

Sensory
Beliefs Perspectiv
e Taking
Thinking Desires
Preference
Knowing
s
 Social
Social Skills Curriculum Skills
Social Language
Greetings and Salutations
Non-Vocal Social Behavior
Eye Contact Social ID Questions
Non-Vocal
Non-Vocal Imitation Prosody
Body Language
Absurdities Social& Facial Regulating Others
Expressions
Behavior
FiguresGestures
of Speech Conversational Audience
to Regulate Social Interaction
Social Social Interaction
HumorAbsurdities
and Jokes Physical Context
Language
of Conversation
Apologizing
Listening to Conversation
What’s Wrong?
Assertiveness
Initiating Conversation
Compliments
Joining Conversation
Group Cooperation
Maintaining & Negotiation
Conversation
Group Related Skills Social
Gaining Attention
RespondingRelated
in Unison Social Skills Repairing Conversation
Introductions
Group Discussion Interaction
Transitioning Topics of Conversation
Skills Levels of Friendship
Ending Conversation
Sharing & Turn Taking
Social Rules SelfLending
Esteem & Borrowing
Compliance Dealing with Conflict
Social
Following Rules Self Esteem
Positive Self-Statements
Rules
Community Rules Social Context Winning & Losing
Politeness & Manners Social
Responding to SocialConstructive
Cues Criticism
LearningContext
Through Observation
The CARD Curriculum Executive
What is Executive Function? Functions
 Process that underlies goal
directed behavior
Goal Directed Behavior Involves…
Visualizing situation
Identifying desired objective
Determining plan to meet
objective
Monitoring progress to goal
Inhibiting distractions
 Executive Functions
Curriculum Executive
Inhibition Flexibility/
Functions
Waiting, Set-Shifting
Physical / Motor,
Non-Social,
Vocal,
Inhibition Social,
Flexibility
Planning Pencil / Paper
Social –Cognitive, Attention
Task / Social Situational Social Orienting,
Goal Setting, Previewing, Joint Attention,
Task Initiation, Sustained, Divided, &
Monitoring Progress, Alternating Attention,
Time Management,
Planning
Organizing Materials, EF Determining Saliency,
Attention
Depth of Processing,
Using a Planner, Paraphrasing,
Self-Organization Task Persistence
Meta-Cognition
Meta-
Meta-cognitive Planning,
Cognitive Memory
Self-Evaluation, Meta-memory, Problem
Problem
Planning Memory
Associative,
Self-Monitoring of Attention, Solving Visual, Spatial,
Emotions, Reinforcement Control, Solving
Non-Social, Auditory, Episodic,
Study Skills, & Flexibility Social Working
Children’s Color Trail Test
Stroop Activities
Summary
A good ABA program requires good
assessment to determine exactly what your
child needs to learn!
A good ABA program needs a lot of hours!
Don’t do 5 hours of ABA when 40 hours
are recommended! This is like taking 5 mgs
of a drug that has shown to be effective at
40 mgs! It wont work!
A 4 year progression
Year 1:
 Child entering at age 2-3
 25 hours per week building to 40 hours
Allocation of Hours
 Emphasis on
• Building a relationship with child 40
• Replacing challenging behaviors with 30
functional communication 20
 Mands (Requests) 10
 Tacts (labels) 0
Year Year Year Year
• Receptive identification (objects, 1 2 3 4
actions, body parts, colors, shapes) Home-based School-based
• Receptive instructions
• Verbal and Non-verbal Imitation
• Identical Matching
• Play Skills (toy play)
• Adaptive Skills (toilet training)
• Fine and Gross Motor
• Dietary restrictions/medical compliance
A 4 year progression
Year 2:
 Child age 3-4
 40 hours (in home with partial transition to school)
 Emphasis on
• Building Expressive Language
 Objects, Actions, Attributes, Prepositions, Pronouns Allocation of Hours
 Categories, Functions, Occupations, Locations
• Beginning Conversation 40
 Intraverbals 30
 Reciprocal Statements 20
 Asking Questions 10
• Developing Observational Learning 0
 I See Year Year Year Year
 Sequences 1 2 3 4
 Tell me about/Describe Home-based School-based
• Emotion Recognition
• Inferring others desires
• Play Skills (functional pretend, symbolic, imaginary)
• Adaptive Skills (dressing, grooming, feeding)
• Fine and Gross Motor
• Sharing and Turn taking
• Attention (dual and divided)
A 4 year progression
Year 3:
 Child age 4-5
 40 hours (20 hours at home; 20 hours at school)
 Sample Programs
• Advanced Language Concepts
 Pragmatic Language
 Maintaining Conversation (topic initiation, repair,
maintenance) Allocation of Hours
• Meta and Social Cognition
 Identifying and Managing own emotions 40
 Understanding other’s Perspectives, Knowledge 30
and Beliefs 20
 Inferences 10
• Executive Function 0
 Year Year Year Year
Attention Saliency
1 2 3 4
 Flexibility with Routines
Home-based School-based
 Inhibition and Self Monitoring
 Planning
• Social Skills
 Levels of Friendship
 Recognizing Social Cues
• Problem Solving
• Play Skills (peer play dates)
• Adaptive Skills
• Fine and Gross Motor
A 4 year progression
Year 4:
 Child age 5-6
 40 hours (10 hours at home; 30
hours in school and fading
services) Allocation of Hours
 Emphasis on
40
• Teacher and Parent training 30
• School Skills 20
 Listening and Reading 10
comprehension
0
 Math and Problem Solving Year Year Year Year
• Advanced Social Skills 1 2 3 4
 Detecting Sarcasm Home-based School-based
 Understanding Deception
 Group Skills
• Continued Self Regulation
 Self Esteem and Confidence
 Task and Social Planning