LSHSS

Tutorial

Team Collaboration: The Use of Behavior

Principles for Serving Students With ASD
Amy L. Donaldsona and Aubyn C. Stahmerb,c,d

Purpose: Speech-language pathologists (SLPs) and Method: This tutorial draws from empirical studies of
behavior analysts are key members of school-based ABA-based interventions for children with ASD within school
teams that serve children with autism spectrum disorders settings, as well as discussions in the extant literature about
(ASD). Behavior analysts approach assessment and the use of behavior principles by SLPs and strategies for
intervention through the lens of applied behavior interdisciplinary collaboration.
analysis (ABA). ABA-based interventions have been Conclusion: Given the prevalence of ASD at 1 in 68 children
found effective for targeting skills across multiple (Centers for Disease Control and Prevention, 2014) and the
domains for children with ASD. However, some SLPs high cost of serving these children within schools (an average
may be unfamiliar with the breadth of ABA-based cost of 286% over regular education; Chambers, Shkolnik, &
interventions. The intent of this tutorial is to briefly introduce Perez, 2003), the need for effective, comprehensive service
key ABA principles, provide examples of ABA-based provision and efficiency within interdisciplinary teams is
interventions used within schools, and identify strategies paramount. Communication, mutual understanding, and
for successful collaboration between behavior analysts recognition of common ground between SLPs and behavior
and SLPs. analysts can lead to successful collaboration.

A
utism spectrum disorders (ASD) are characterized Manteuffel, Sgro, & Pinto-Martin, 2005). In a recent study
by impairment in social communication and the of 101 higher functioning children with ASD, 81% of children
presence of repetitive behaviors and restricted in- were receiving special education services (White, Scahill,
terests (American Psychiatric Association, 2013). However, Klin, Koenig, & Volkmar, 2007). According to the U.S.
children with ASD vary greatly in symptom severity, presence Department of Education (2013), over 455,000 students with
of intellectual disability, and language deficits, and there autism received services during the 2011–2012 school year,
are often significant changes in behavioral features within making children with ASD the third most frequently served
individuals over time (Lord, Leventhal, & Cook, 2001). population of children with special education needs that
Additionally, the pervasive nature of the disorder across all year. Additionally, the American Speech-Language-Hearing
areas of development (communication, social, cognitive, Association (ASHA, 2012) reported that 90% of school-
play, motor, adaptive skills) means that multiple disciplines based speech-language pathologists (SLPs) reported serving
are necessarily involved in effective intervention. This can students with ASD in 2012; this reflects an increase of 13%
often create challenges in coordinating and implementing since 2000. Moreover, the number of students with ASD
services for children with ASD. served by school-based SLPs per month has doubled (from
Large-scale research in the United States indicates four per month in 2000 to eight per month in 2012). No other
that children with ASD are likely to receive school-based population of students has grown to this degree during this
services as a primary intervention service (Mandell, Walrath, time period; indeed, several have decreased or remained the
same (ASHA, 2012).
The prevalence of ASD continues to rise (one in
a
Portland State University, OR 68 children and one in 42 boys; Centers for Disease Control
b
Child and Adolescent Services Research Center, San Diego, CA and Prevention [CDC], 2014), and the costs for educating
c
University of California, San Diego children with autism are high. Recent research indicates
d
Autism Discovery Institute, Rady Children’s Hospital, San Diego, CA
that the annual costs associated with educating a child with
Correspondence to Amy L. Donaldson: [email protected] ASD are roughly $6,500 to $10,400 higher than for educat-
Editor: Marilyn Nippold ing a child without special education needs (Lavelle et al.,
Associate Editor: Stephen Camarata 2013). These increased costs may be related to the intensity
Received March 28, 2014
Revision received May 27, 2014
Accepted July 30, 2014 Disclosure: Amy L. Donaldson is a member of the Behavior Analysis Regulatory
DOI: 10.1044/2014_LSHSS-14-0038 Board (BARB) for the State of Oregon.

Language, Speech, and Hearing Services in Schools • Vol. 45 • 261–276 • October 2014 • © American Speech-Language-Hearing Association 261
of service needs in this population. In order to maximize has been widely applied to intervention for individuals with
staffing and the benefit of costly services, school-based special needs from its inception (e.g., Bijou, 1970), many
teams must carefully coordinate care. everyday interactions and explanations for human behavior
Assessment and intervention methods based on princi- are based on these principles (Kearney, 2008; Sidman, 1994).
ples of behavior are used widely within school settings. In- Interventions based on ABA adhere to an operant model,
deed, applied behavior analysis (ABA) is the lens through which holds that learning is the result of consequences that
which behavior analysts and other team members (including follow a behavior, and these consequences determine the
SLPs) target skills for children with ASD. “Applied behavior likelihood of a behavior occurring again in the future (Baer,
analysis is a scientific approach for discovering environmental Wolf, & Risley, 1968). The operant model involves three
variables that reliably influence socially significant behavior” main parts: (a) an antecedent, which is an event or experience
(Cooper, Heron, & Heward, 2007, p. 15); careful examina- that happens before a behavior and occasions or triggers the
tion of these variables, or intervention methods, through data behavior; (b) a behavior or response (or lack of response)
collection and analysis, determine if one continues an effec- from an individual; and (c) a consequence that occurs after
tive intervention or discontinues an ineffective one. the behavior, the value of which can increase, decrease,
Social communication deficits are a core feature of or maintain the behavior in the future. This is called the
ASD (APA, 2013). Certified and licensed SLPs, with their three-part contingency (referred to as “the ABCs of ABA”),
specialized background and expertise in social and commu- and it is the basis for ABA interventions (Skinner, 1968).
nication skills, are particularly well qualified to provide ser- Within an intervention context, the antecedent is most often
vices for these students (ASHA, 2006). The training and the stimulus presented by the clinician with the intent to
knowledge of board-certified behavior analysts (BCBAs) elicit the target behavior, the behavior is the child’s response
also makes them highly qualified to serve children with to the stimulus, and the consequence delivered by the clini-
ASD, particularly for addressing the needs of children with cian can either reinforce (increase), shape (modify), or punish
ASD who present with challenging behaviors. In addition, (decrease) the behavior (Cooper et al., 2007; Kearney,
many children with ASD demonstrate improved outcomes 2008). For a more detailed introduction to the principles of
across multiple domains when taught within a behavioral ABA, see Kearney (2008).
framework (National Autism Center, 2011; Z. Warren et al, Although no one intervention has been identified as
2011). Thus, both team members are vital for providing stu- the most effective for all children with ASD, strategies
dents with ASD comprehensive school-based services. based on the principles of ABA have the most empirical
SLPs and behavior analysts will find that they are of- support for this population at this time (e.g., Maglione,
ten targeting skills within the same developmental domains, Gans, Das, Timbie, & Kasari, 2012; National Autism
even using some of the same strategies, but may be viewing Center, 2009, 2011; Z. Warren et al., 2011). Contrary to
the needs through different lenses. Many SLPs may be popular belief, ABA is not synonymous with one method
employing principles of ABA within their daily clinical or technique (e.g., discrete trial training; Lovaas, 1987).
practice, yet may not recognize them as such (Ogletree & ABA-based interventions range from highly structured pro-
Oren, 2001). Indeed, the discipline of speech-language pa- grams that are conducted in a one-on-one treatment setting
thology has its roots in behavioral principles (e.g., Gray & to more naturalistic inclusion programs that include typi-
Ryan, 1973; Hargrave & Swisher, 1975; Mulac & Tomlinson, cally developing children as models. Some ABA programs
1977). However, current practitioners may have limited are distinguishable by “brand names,” such as discrete
familiarity with the breadth of intervention methods that are trial training (DTT) and pivotal response training (PRT;
based on ABA, from very structured to naturalistic. Thus, R. L. Koegel, Schreibman, Good, Cerniglia, Murphy, &
increased understanding is warranted to promote successful Koegel, 1989), whereas other programs use the principles of
coordination and collaboration. ABA (such as the ABCs) more generally. For a complete
Given these issues, the overarching purpose of this tu- review of current evidence-based practices in schools for
torial is to further acquaint SLPs with core ABA principles children with autism, please see National Autism Center
and ABA-specific practices, to increase understanding and (2011).
communication with behavior analyst colleagues. Specifically, As indicated, principles of ABA can be applied across
we (a) briefly introduce key ABA principles; (b) provide ex- a wide continuum of intervention methods, from structured
amples of both structured and naturalistic evidence-based to naturalistic. DTT is one example of a highly structured
interventions based on ABA principles in use within school ABA approach, whereas PRT is one example of a more
settings; (c) discuss ABA strategies that are often used by naturalistic approach. DTT involves multiple or massed
SLPs; and (d) describe ways in which SLPs and behavior trials of the same skill at one time, with complexity system-
analysts might successfully collaborate on school-based in- atically increased.
tervention teams serving children with ASD.
Discrete Trial Training (DTT)
Introduction to ABA Principles Intervention within a DTT framework most often
proceeds as follows:
Applied behavior analysis is a scientific approach to
examining behavior (Cooper et al., 2007). Although ABA 1. The clinician gains the child’s attention;

262 Language, Speech, and Hearing Services in Schools • Vol. 45 • 261–276 • October 2014
2. the clinician presents the antecedent (referred to as A token economy system of reinforcement can be
a discriminative stimulus or SD) intended to elicit the very useful in a school environment. In this system, tokens
target behavior; (which can be pennies, stickers, or any small item) serve as
3. the child responds to the stimulus (behavior); symbols that may be traded for the chosen/desired rein-
forcer after successful collection of a predetermined number
4. the clinician provides the consequence; and of tokens. Use of a token economy can be advantageous in
5. there is a brief pause before introduction of the next teaching a child to complete a series of trials, while delaying
trial (referred to as an intertrial interval). reinforcement. It may also be helpful when the child’s de-
sired reinforcer is not immediately available, so delayed
Depending upon the accuracy of the behavior, the
access is necessary. Tokens can be earned for any number
consequence either reinforces desired behaviors or shapes
of behaviors, such as a correct trial in the example above,
approximations of desired behaviors using a specific, prede-
periods of time with desired behavior (e.g., a token is placed
termined error-correction procedure, such as saying, “Try
in a jar for every 10 min that the child does not call out in
again,” or modeling the correct behavior (Smith, Mruzek,
class), or for participation (e,g., engaging in a social game).
Wheat, & Hughes, 2006) and repeating the trial. Within
When the child has earned the number of tokens predeter-
DTT, desired behaviors are often reinforced with a conse-
mined with the adult, s/he is given access to the preselected
quence that is not directly related to the behavior, such as
reinforcer (delayed consequence).
an edible or sticker (referred to as an artificial reinforcer).
Once a trial is complete and reinforcement is provided
A preference assessment, which is a formal, systematic
(immediate or a token), data about the trial(s) are docu-
way of gathering information about children’s preferred re-
mented. A core principle of ABA is data analysis to inform
wards, can be used to choose effective reinforcers. Multiple
clinical decision making. Therefore, the clinician carefully
assessment methods can be used, such as (a) providing
documents the child’s performance and the level of support
forced choices—a systematic method of pairing multiple
provided for each trial. This DTT framework may be quite
potential reinforcers in a forced-choice paradigm and rank
familiar to SLPs who use drill-based learning to target
ordering the items according to the child’s choices to deter-
speech sounds and/or specific language behaviors. Indeed,
mine effective reinforcers; (b) using time-based assessment—
such an approach has a rich history within the discipline
the clinician provides an array of potentially reinforcing
of speech-language pathology. See Duchan (2010) for a his-
items and collects data on the amount of time the child spends
torical review of SLP practices within school settings.
with each item in a free access situation; and/or (c) inter-
viewing caregivers—using systematic interview protocol, the
clinician obtains information about child preferences. (See Pivotal Response Training (PRT)
Cooper et al., 2007, Chapter 11, for more detailed description.) In contrast to DTT, PRT (L. K. Koegel, Koegel,
As an example, when targeting expressive vocabulary Harrower, & Carter, 1999; R. L. Koegel et al., 1989) is an
using DTT, the activity may present as follows. The child example of a naturalistic ABA-based intervention. A vari-
or clinician chooses a reward (often an artificial reinforcer). ety of naturalistic behavioral interventions grounded in the
The clinician gains the child’s attention and then presents principles of ABA were developed to address some of the
the child with a picture of a cat and says, “What’s that?” limitations of highly structured approaches such as poor
(antecedent). The child responds, “Cat” (behavior). The generalization of responding to new stimuli, people, and en-
clinician states, “Yes! It’s a cat,” and gives the child the re- vironments, and limited maintenance of some skills over
inforcer (immediate consequence that reinforces the behav- time (Simpson, 2005). PRT is a multicomponent interven-
ior). If the child does not respond or responds in error, a tion shown to be effective for improving communication
consequence intended to shape the behavior is presented. (e.g., R. L. Koegel, Dyer, & Bell, 1987), play (e.g., Stahmer,
For example, if the child does not respond, the clinician 1995), joint attention (e.g., Whalen & Schreibman, 2003),
may give the child an expectant look and point to the pic- social interaction (e.g., R. L. Koegel & Frea, 1993), and
ture. If the child’s response is incorrect (e.g., the child says, speech intelligibility (e.g., R. L. Koegel, Camarata, Koegel,
“Dog”), the clinician may respond with a specific error Ben-Tall, & Smith, 1998). PRT has been established as an
correction procedure intended to reduce the likelihood of evidence-based treatment for children with ASD (National
another error (e.g., holding up the picture and modeling, Autism Center, 2009, 2011; Z. Warren et al., 2011; Wong
“Cat”). The sequence is repeated with a brief pause (inter- et al., 2013). It is based on a series of studies identifying
trial interval) between each trial. A child who is learning important treatment components and demonstrating their
a new skill typically requires use of a continuous reinforce- effect on child behavior.
ment schedule (e.g., production of one target behavior The “pivotal” responses trained in PRT are motivation,
followed directly by the reinforcer; 1:1 reinforcement initiation, and responsivity to multiple cues (i.e., increasing
schedule), as described above. As the child’s performance breadth of attention). Specific elements include gaining the
improves, the clinician may modify the reinforcement sched- child’s attention, presenting clear and appropriate instructions,
ule (e.g., production of two target behaviors followed by interspersing easier tasks (maintenance) with more difficult
the reinforcer; 2:1 reinforcement schedule) and/or use a token ones (acquisition), sharing control (including following
system. the child’s choice and taking turns), requiring the child to

Donaldson & Stahmer: Team Collaboration: The Use of Behavior 263

respond to multiple aspects of the learning environment ABA in the Schools
(e.g., both the color and shape of a puzzle piece), providing
contingent consequences, ensuring a direct relationship be- Although the effects of comprehensive ABA-based in-
tween the child’s response and the reinforcer, and reinforc- terventions have been most widely investigated with young
ing attempts at correct responding (Humphries, 2003; R. L. children in home-based or research settings (e.g., Dawson
Koegel et al., 1989; Verschuur, Didden, Lang, Sigafoos, & et al., 2010; Smith, 1999; Z. Warren et al., 2011), numerous
Huskens, 2013). school-based interventions employ principles of ABA. Some
To provide a direct comparison of naturalistic and specific ABA strategies, such as positive behavioral supports,
highly structured ABA-based methods, the previous exam- have been widely implemented in schools over the past sev-
ple of targeting the expressive vocabulary word cat is pre- eral decades (e.g., Neitzel, 2010). Also, researchers have
sented here. Within PRT, the clinician might teach the started to examine the effectiveness of comprehensive ABA-
word cat in the context of playing with a set of animal figu- based interventions for children with ASD within school
rines or an animal puzzle, offering the child a choice be- settings (e.g., Eikeseth, Smith, Jahr, & Eldevik, 2007;
tween the two activities (child choice). If the child chooses Mandell, Stahmer, Shin, Xie, & Marcus, 2013). Some re-
the puzzle activity, the clinician holds up the cat puzzle searchers have worked to adapt previously established
piece and asks, “What’s this?” (antecedent). If the student ABA-based intervention methods to meet the unique needs
responds, “Cat,” the clinician hands the student the cat puz- of schools.
zle piece to put into the puzzle (consequence), and then the
clinician takes his/her turn by labeling a piece and placing
it in the puzzle (shared control). Note that the consequence Comprehensive Behavioral Approaches
of giving the child the cat puzzle piece directly relates to The following discussion provides examples of com-
the behavior of saying “cat”; this is referred to as a natural prehensive school-based interventions based on principles
or direct reinforcer. If the child makes an attempt at correct of ABA. The discussion is intended to orient readers to sev-
responding, by approximating the production, the clini- eral of the ABA-based interventions that they may en-
cian would model the correct production and then follow counter within schools. It is not intended to be inclusive of
the same steps to reward the child for the attempt, thereby all such interventions, nor an endorsement of any particular
increasing motivation to respond and shaping the target method. Although further research is needed to establish
behavior. If the child responds incorrectly, for example, the efficacy of these interventions as a comprehensive ap-
with “dog,” or does not respond to the antecedent, the clini- proach to education for children with ASD, the components
cian might say, “Cat. It’s a cat,” to model the expected be- within these interventions have been established as evidence-
havior, and then withhold giving the puzzle piece to the based treatments for children with ASD within schools
child. The clinician would then present the antecedent again (National Autism Center, 2011). For further information
and reinforce the child’s imitation of “cat” or an attempt regarding evidence-based practices for children with ASD,
to do so by giving the child the puzzle piece. If the child please refer to the EBP Report (2014) of the National Pro-
seems to be unresponsive due to lack of motivation for fessional Development Center on ASD (http://autismpdc.
the activity the clinician might provide alternative choices fpg.unc.edu/content/evidence-based-practices).
that may be more motivating. Within PRT, the clinician Classroom Pivotal Response Training (CPRT). CPRT
would use several examples of cats, such as different cat (Stahmer, Suhrheinrich, Reed, Schreibman, & Bolduc,
puzzles, books that contain cats, and cat figurines to ensure 2011) is a comprehensive school-based intervention for chil-
the child generalizes the concept of “cat” across different dren ages 3–11 years based on PRT that is used by school
stimuli. teams to target skills across developmental domains. The
Again, this PRT framework is most likely familiar to program was developed in collaboration with teachers after
SLPs; however, they may recognize it under a different research indicated that teachers and other school-based
name—milieu teaching. Like PRT, naturalistic behavioral professionals were not using the research-based model PRT
intervention methods such as enhanced milieu teaching and (L. K. Koegel et al., 1999) as specified in the original training
prelinguistic milieu teaching combine principles of behavior manual (Stahmer, Collings, & Palinkas, 2005; Stahmer,
with a social–pragmatic emphasis on adult responsivity Suhrheinrich, Reed, & Schreibman, 2012; Suhrheinrich,
and reciprocity. Milieu teaching methods have been found Stahmer, & Schreibman, 2007).
to be effective for increasing the language skills of young Because the majority of studies related to PRT have
children with ASD (Franco, Davis, & Davis, 2013; Ingersoll, been completed in home-based or research settings, teacher-
Meyer, Bonter, & Jelinek, 2012; Yoder & Stone, 2006a, recommended adaptations to PRT were tested to ensure the
2006b). Additionally, a combination of DTT and milieu intervention would still be effective when adapted for use
teaching/PRT has been found effective for increasing the in a school environment. A new manual was developed to
joint attention skills of children with ASD (e.g., Kasari, help teachers, SLPs, and other team members use CPRT
Freeman, & Paparella, 2006; Whalen & Schreibman, 2003; in classroom and group settings to address school-related
see Patten & Watson, 2011, for further information regard- goals. Teachers and SLPs wanted these additional materials
ing joint attention interventions and the clinical implications and examples to help them use CPRT within group activi-
for SLPs). ties, address Individualized Education Plan (IEP) goals using

264 Language, Speech, and Hearing Services in Schools • Vol. 45 • 261–276 • October 2014
CPRT, and train paraprofessionals in use of the methods. are specifically trained in task analysis (i.e., identifying task
For instance, team members had difficulty implementing components and breaking complex tasks into discrete steps),
turn-taking strategies within school settings. So the CPRT and the language expertise of SLPs enables them to deter-
manual provides examples of how to assist students in mine the appropriate level of instruction (i.e., use of verbal
modeling turn-taking behavior for each other during group language instructions) and how to best utilize visual supports
activities. In addition, the manual includes a data collection to increase student understanding.
system that ties in with IEP goals and allows for collection The STAR program also uses the behavioral strategy
of data in both group and individual teaching interactions of errorless learning. Errorless learning (sometimes referred
that was developed with the help of an advisory board of to as most-to-least prompting) is an approach to teaching
school-based professionals. that attempts to minimize errors by the child with ASD
Preliminary analysis of student outcomes following (Demchak, 1990; Libby, Weiss, Bancroft, & Ahearn, 2008).
implementation of CPRT indicated progress on observational This is achieved when the clinician controls the prompt to
measures of IEP goal attainment and standardized com- ensure correct production of the behavior and consequent
munication assessments. Rates of student engagement reinforcement (Leaf, Sheldon, & Sherman, 2010). For exam-
(appropriate and on-task behavior) doubled after CPRT ple, when targeting identification of body parts, the clinician
(Stahmer et al., 2012). might say, “Touch your nose,” while providing hand-over-
Although there are no clear data to determine which hand assistance to the child to touch his nose. When the
students will benefit most from methods such as those used child does so (even with full assistance), the clinician says,
in CPRT, early PRT studies suggest that increased toy “Yes! You touched your nose” (consequence). The clinician
exploration and approach behaviors may predict a better repeats this level of prompting several times before slightly
response to a play-based intervention that requires inter- fading the prompt; perhaps, instead of providing full hand-
action with toys and an adult, such as CPRT in preschool- over-hand prompting, the clinician might simply touch
age children. In addition, high levels of nonverbal stereotypy the child’s elbow as a partial physical prompt while saying,
and avoidance may predict a slower response to naturalistic “Touch your nose.” Errorless learning may also be familiar
strategies and suggest a need for more structured interven- to SLPs who serve adults, as it is an oft-used strategy when
tions (Schreibman, Stahmer, Bartlett & Dufek, 2009; Sherer working with individuals with acquired neurogenic commu-
& Schreibman, 2005). More recent data have suggested that nication disorders (ASHA, 2013; Frattali, 2004).
these behaviors may not be predictive of treatment response Arick and colleagues (2003) completed an investiga-
in a younger-aged sample of children (age 24–30 months) tion of the effects of the STAR curriculum with two cohorts
with ASD (Cunningham, 2007). of children with ASD ages 2–6 years who were receiving
Strategies for Teaching Based on Autism Research school-based services within the state of Oregon. Across
(STAR). STAR (Arick et al., 2003) is another school-based children who presented with varied communication, cogni-
program for children with ASD in preschool through early tive, and social skill profiles at baseline, they found over-
elementary school. The STAR program utilizes a number of all increases in language, basic academic skills, social skills,
ABA-based methods, including DTT, PRT, and functional adaptive skills, and cognitive skills for both cohorts fol-
routine (FR) instruction. In this model, DTT is used to teach lowing at least 2 years of intervention. In addition, parents
primarily receptive language and preacademic concepts. reported above-average satisfaction with the quality of in-
PRT is used to teach play skills, social interaction, and spon- tervention services their child received. In a more recent
taneous language concepts, and FR instruction is used to randomized trial of STAR in Philadelphia schools, Mandell
encourage generalization and self-help skills and routines. and colleagues (2013) found that student progress was re-
Functional routines are events that are predictable, lated to fidelity of implementation; however, this varied
follow a chain of behaviors, and are typically associated greatly across classrooms.
with a functional outcome (e.g., using the bathroom, morn- Based on their results, Arick and colleagues (2003)
ing arrival to the classroom, etc.). Functional routines are made several recommendations for school-based services
taught in a step-by-step, systematic manner to children for children with ASD, including the use of one-to-one
with ASD to increase independence for common school DTT, PRT, and group-based FR teaching; consistent prog-
and self-care routines (Arick et al., 2003). An example of a ress measurement through ongoing data collection and
functional routine within a classroom might be washing assessment; and ongoing service provider training. The
hands in preparation for lunchtime. The hand washing se- Mandell et al. (2013) results also highlight the need for on-
quence is broken into specific steps: turn on the water, put going support for teachers implementing complex strategies
hands in the water, put soap on hands, rub hands together, in classrooms. Given the increase of push-in services and
turn off the water, get paper towel, dry hands, put paper the important role of collaboration within response to inter-
towel in the garbage. The clinician might provide the child vention models, SLPs are in an ideal position to support
with visual supports for each step, facilitate completion of such classroom needs.
the task with verbal and nonverbal supports, and reinforce Learning Experiences, an Alternative Program for
completion of the routine with social praise and access to Preschoolers and Their Parents (LEAP). LEAP (Strain &
snack. Teaching of FRs is a great opportunity for collabo- Bovey, 2008) is an inclusion, public school-based pro-
ration between behavior analysts and SLPs, because BCBAs gram that capitalizes on incidental teaching and uses peer

Donaldson & Stahmer: Team Collaboration: The Use of Behavior 265

mediation (described in detail below) to facilitate the social 4. developing a hypothesis about the function of the
and communication competence of children with ASD. It behavior;
incorporates a variety of ABA-based teaching approaches, 5. testing the hypothesis; and
including errorless learning, PRT, picture exchange com-
munication system (also described below; Frost & Bondy, 6. developing a behavior plan (Neitzel & Bogin, 2008).
2002), and positive behavior supports (Strain & Bovey, SLPs often serve as key members of FBA teams
2008). throughout all steps of the process. However, they demon-
Incidental teaching is a naturalistic behavioral inter- strate particular expertise in identifying functional commu-
vention strategy similar to PRT. Incidental teaching was nication behaviors to replace challenging ones, and leading
one of the first naturalistic strategies developed first for use teams in developing and implementing behavior plans to
with children from impoverished environments (B. M. Hart teach the replacement communication skill. That is, after
& Risley, 1982). Incidental teaching involves identifying the function of a challenging behavior in collab-
1. arranging the environment to elicit communication oration with the FBA team, SLPs not only can identify re-
from the child (e.g., placing preferred materials in placement communication behaviors that are within the
sight, but out of reach); speech and language developmental levels of the student,
but also can guide team members in the level of their instruc-
2. waiting for the child to initiate an interaction around tion when teaching the replacement behavior. See Bopp,
an item of interest; Brown, and Mirenda (2004) for further information about
3. the teacher/clinician providing support /cues for more the role of SLPs in PBS and, more specifically, as members
complex communication or language; and of an FBA team.
4. reinforcing the child by providing the item of interest A randomized, controlled trial of LEAP revealed that
(Fenske, Krantz, & McClannahan, 2001; S. F. children in classrooms that received 2 years of training and
Warren & Kaiser, 1986). coaching in the LEAP model achieved greater cognitive,
language, and social gains than children in classrooms that
This is very similar to the procedures described above received LEAP intervention manuals only with no further
for PRT in that the clinician follows the child’s lead; shapes training (Strain & Bovey, 2011). In addition, children in the
a specific response; and uses a natural, direct reward to in- experimental classrooms showed greater improvements in
crease that response. However, often the antecedent is pri- challenging behaviors and autism symptoms, as compared
marily environmental, rather than a specific prompt by the to children in control classrooms. There is currently no evi-
clinician, as is often used in PRT. This is due to increased dence regarding differential effects of LEAP based on child
focus on child initiation in incidental teaching procedures. characteristics; however, perhaps more importantly from a
Positive behavior supports (PBS), or positive behavior service provision perspective, the fidelity with which LEAP
interventions, refer to the use of systematic strategies to sup- was implemented predicted child outcomes. That is, school
port prosocial behaviors and decrease challenging behaviors. teams required extensive training in the LEAP model in
These interventions are often employed on a schoolwide order to implement it with fidelity, and children in class-
basis (not exclusively with children with ASD). They use a rooms where teams demonstrated the highest levels of fidel-
prevention model of providing environmental supports to ity also achieved the best outcomes (Strain & Bovey, 2011).
promote positive behavior, and a data-driven, systematic This reinforces the importance of clear, consistent under-
approach to intervention for challenging behavior (Horner standing and implementation of intervention strategies
et al., 2005). across the entire school intervention team. It also illustrates
Components of PBS that may be effective when serv- the important role of SLPs in helping other team mem-
ing children with ASD include use of clearly and positively bers effectively use social and communication intervention
stated classroom/school expectations and rules (including methods.
use of visual supports for routines and transitions); reinforce-
ment of positive social behaviors; and systematic, data-driven
strategies for responding to challenging behaviors, such as ABA-Based Methods Used in Schools
the functional behavior assessment (FBA; Carr, 1977; Carr & In addition to the more comprehensive behavioral
Durand, 1985). ABA-based tools, such as the FBA, are used approaches described above that are often used in schools,
to assist teams in determining the function of behaviors, there are several other methods that are well suited to the
particularly challenging ones, and developing behavior plans expertise of SLPs. In fact, many SLPs are most likely em-
to support use of alternative behaviors that enable the child ploying these methods, yet some may not recognize them as
to appropriately express his intent. The process of com- ABA-based. In contrast to the comprehensive interventions
pleting an FBA includes several steps: described above, these methods are used most often to target
1. identifying team members; one specific area of need (e.g., communication, social, play,
adaptive, etc.). Again, these examples are intended to cap-
2. identifying the challenging behavior; ture the breadth of ABA methods that are commonly in use
3. collecting data about the behavior; within schools and may be of particular interest to SLPs.

266 Language, Speech, and Hearing Services in Schools • Vol. 45 • 261–276 • October 2014
 Picture Exchange Communication System (PECS). errors, because it requires two intervention team members
PECS (Frost & Bondy, 2002) is an augmentative and alter- in order to capitalize on the child’s own motivation and ini-
native communication system intended to support the func- tiation. For a child learning use of PECS within Phase I,
tional communication of preverbal or minimally verbal the clinician first determines what objects may be reinforc-
individuals with autism and other communication deficits. ing for the child (e.g., highly preferred toy, edible, etc.). The
PECS is widely implemented by SLPs in schools and other clinician then arranges the environment to include a picture
service provision sites. PECS, as used according to the man- of the highly preferred item (placed in front of the child)
ual, is a communication intervention based on the behav- and the item itself; the clinician serves as the communication
ioral principles of B. F. Skinner (1957; Frost & Bondy, 2002). partner, and another team member positioned behind the
The six phases of PECS are intended to help children prog- child serves as the helper/physical prompter. The clinician
ress from requesting (referred to as manding) to independent shows the child the item, but does not say anything. As
and spontaneous commenting through the use of picture the child reaches for the item, the clinician opens his/her
symbols. These phases are as follows: hand, while at the same time the helper guides (hand over
hand) the child from behind to pick up the picture symbol
• Phase I: Learning to Communicate (exchange of
and place it in the communication partner’s hand. When
single pictures for desired items/activities)
the clinician receives the picture, the clinician gives the
• Phase II: Distance and Persistence (continued use of child the object, labeling it, and the sequence is continued.
single pictures with different communication partners Neither the clinician nor the helper verbally prompts the
and across physical distance) child, nor do they give any hand-over-hand prompts before
• Phase III: Picture Discrimination (selection and the child demonstrates initiation of a gesture request (reach-
request of desired object/activity from two or more ing for object). The child’s reach is interpreted as an initia-
pictures) tion to request the object. In this way, PECS capitalizes on
a child’s natural motivation and initiation (Frost & Bondy,
• Phase IV: Sentence Structure (use of “I want” +
2002). The use of a second person to provide prompts also
desired item /activity picture to request—known as a
reduces the likelihood of later dependence on the commu-
sentence strip)
nicative partner for prompting.
• Phase V: Answering Questions (use of sentence strip Another implementation challenge observed when
to respond to “What do you want?”) using PECS is confusion regarding when to begin use of
• Phase IV: Commenting (use of pictures and sentence PECS. As such, SLPs play a fundamental role on the team
strip to comment on environment, feelings, thoughts, by identifying the student’s current level of communication
etc.) skills and thus guiding the team’s decision making about
when to introduce PECS (or use of another communication
See Frost and Bondy (2002) for a full description of method) and when to fade use as the child’s verbal language
PECS and implementation procedures for each phase. increases. Bondy (2011) stated, “Beginning PECS immedi-
PECS has been well researched and has been identified ately [after starting intervention] does not interfere or com-
as an evidence-based intervention for increasing the func- pete with working on vocal production, vocal imitation
tional communication skills of children with ASD (Wong and blending, and other skills that are necessary to produce
et al., 2013). PECS has been found to increase requesting, functional vocal behavior” (p. 795). Because PECS includes
social communication, and speech production, and to de- protocol for using spoken language, research indicates that
crease challenging behaviors (S. L. Hart & Banda, 2010). it does not seem to impede the development of spoken lan-
As Bondy (2011) reported, significant challenges to success- guage in children with ASD when speech is also reinforced
ful use of PECS include misunderstanding about its roots in appropriately (Schreibman & Stahmer, 2013). However,
ABA, and lack of adequate training and consistency in im- many team members may demonstrate confusion about how
plementation. Indeed, Bondy (2011) stated, and when to implement PECS with a nonverbal child.
Fundamentally, ABA is often misunderstood. It is If the child begins to demonstrate use of spoken lan-
therefore not surprising that PECS is often misunder- guage while learning PECS, it is important for SLPs to in-
stood as well. From my perspective, many people struct the team in how to facilitate continued spoken language
view ABA programs as solely relying on a discrete- growth while appropriately reinforcing all methods of the
trial approach, in which the teacher and a student sit child’s communication. A common error in PECS imple-
at a desk and the teacher leads all lessons. (p. 793) mentation occurs when a child’s verbal production is ignored
at the insistence of use of the picture symbol. The team
As indicated above, the view of ABA as synonymous should directly reinforce a child’s verbal request to promote
with only highly structured approaches such as DTT is in- additional productions. However, the opposite can also
correct and outdated (Stahmer, 2014). With regard to train- be observed. Team members must be careful not to ignore
ing and implementation of PECS, clinicians and teachers the child’s appropriate use of PECS by demanding verbal
may stray from the manualized and evidence-based method production in addition to the picture exchange prior to pro-
of introducing PECS and moving a child through the phases. viding the reinforcer. Thus, the SLP plays a leading role in
Phase I can be particularly vulnerable to implementation training teams to high fidelity of implementation to avoid

Donaldson & Stahmer: Team Collaboration: The Use of Behavior 267

such errors, as well as in modeling reliable implementation teaching the child mands for preferred items. The child can
of PECS within all school environments. SLPs can also use a variety of means, including nonverbal (reaching or
ensure that children with ASD have access to their commu- pointing) and verbal communication (vocalization, approxi-
nication books at all times, not simply during specific high- mation, verbalization), to request and achieve access to the
request activities (e.g., snack time) and that the decision desired object. By accepting approximations of commu-
to move to the next phase of PECS is data driven. nication behaviors in the beginning of intervention, the child
In recent studies, authors have compared the use of learns communication as a skill. The intent is to gradually
PECS to naturalistic behavioral strategies for eliciting ver- increase accuracy to correct production of a verbal request.
bal communication. In general, for young children with There is also a systematic progression of moving toward
ASD who are nonverbal or minimally verbal, using PECS more complex tact and intraverbal skills as children master
or a naturalistic verbal approach leads to similar levels of earlier skills (see Sundberg & Michael, 2001). Verbal behav-
spoken language over time (Schreibman & Stahmer, 2013), ior, like other interventions based on ABA, focuses on mo-
as well as an increase in joint attention skills (Yoder & Stone, tivation as an important antecedent and tries to use direct
2006a, 2006b). However, there may be benefits to one or reinforcement (rewards that are directly related to the ac-
the other based on the child’s early joint attention skills. tivity) as a tool to increase children’s use of skills over time
For children who demonstrate joint attention skills prior to and across environments. Careful assessment guides the
intervention, targeting use of verbal communication may teaching of new skills.
result in an increase in initiation of joint attention. For chil- The efficacy of verbal behavior interventions has been
dren with more limited joint attention skills prior to inter- investigated in many small studies. Although these studies
vention, use of PECS may lead to use of more requests and have demonstrated effectiveness in improving communica-
initiation of joint attention (Yoder & Stone, 2006a). In tion skills in children with autism (Sundberg & Michael,
addition, children who began treatment with low object ex- 2001), additional research is needed to confirm efficacy and
ploration benefited more from the verbal communication examine which children will benefit (National Autism Center,
intervention, whereas children who began treatment with 2009).
higher levels of object exploration benefited more from Peer-mediated intervention. Speech-language pathol-
PECS (Yoder & Stone, 2006b). In another similar study, ogists such as Goldstein and colleagues (Goldstein, Kaczmarek,
Cunningham (2007) found that toddlers entering treatment Pennington, & Shafer, 1992; Goldstein, Schneider, & Thieman,
with no words were less likely to develop spoken language 2007; Goldstein & Wickstrom, 1986) have long advocated
than those entering with just a few words; however, 80% use of peer mediation to increase the social communication
of these children did develop augmentative communication skills of children with ASD. Peer mediation typically refers
skills through PECS. Although these findings must be repli- to one of two approaches to training peers with the intent of
cated, they provide some preliminary clues regarding when increasing the social communication skills of children with
to use PECS or a verbal communication approach with young ASD: (a) training peers to increase their initiations and
children who have ASD. However, the two approaches directly teach skills to children with ASD (e.g., Goldstein
need not be mutually exclusive. That is, use of PECS is et al., 1992; Strain & Odom, 1986); or (b) training peers
often combined with other methods within comprehensive strategies to elicit and facilitate the social and communica-
approaches to intervention (e.g., LEAP: Strain & Bovey, tion skills of children with ASD (e.g., Kuhn, Bodkin, Devlin,
2008; Early Start Denver Model: Rogers & Dawson, 2009). & Doggett, 2008).
Verbal behavior. Verbal behavior therapy is based Peer mediation is a key component of the LEAP
on the principles of ABA and, like PECS, is rooted in the program described above and, although it is not in and of
language development theories of B. F. Skinner (1957). itself an ABA method, principles of ABA are well suited
In this model, spoken language is viewed as a learned be- to teaching peers behaviors that facilitate the social and
havior; thus, principles of behavior (antecedent, behavior, communication skills of children with ASD. For example,
consequence; reinforcement; motivation) can be used to within the LEAP program (Strain & Bovey, 2011), peers
teach language. The intervention focuses on teaching chil- are taught to support the communication of children with
dren with autism to use language to communicate effectively, autism using modeling and reinforcement and then, in turn,
rather than teaching only vocabulary, as was the case for the peers are given supports for presenting antecedents to
very early DTT models. children with ASD and reinforcing their behaviors. In an-
Of particular interest to SLPs may be an understand- other example, Pierce and Schreibman (1995, 1997) investi-
ing of the terminology used within verbal behavior interven- gated the use of ABA within peer mediation in a school
tions. They may encounter these terms in their interactions setting. They trained classroom peers in the use of PRT
with other professionals and mutual understanding is key. In strategies to promote the social and communication skills
other words, professionals may be using different words to of children with autism. The peers were trained in 10 PRT
discuss the same communicative concepts. Skinner described strategies:
four word types: (a) mand, a request; (b) tact, a comment
used to gain attention or share an experience; (c) intraverbal, 1. gaining the child with ASD’s attention
a response to a question; and (d) echoic, a word that is sim- 2. providing the child with ASD choices to increase
ply repeated. The verbal behavior intervention begins by motivation

268 Language, Speech, and Hearing Services in Schools • Vol. 45 • 261–276 • October 2014
 3. engaging in a variety of toys/activities skills, severe social impairments, and lower adaptive
4. modeling appropriate social behaviors, using a skills had greater relative cognitive outcomes than higher
variety of play, social, and language examples functioning children (Nahmias, Kase, & Mandell, 2014).
Indeed, use of peer mediation to address core social com-
5. reinforcing all communicative and social attempts by munication deficits requires daily interaction with typical
the child with ASD peers, as well as training of those peers (Strain & Bovey,
6. encouraging conversation by briefly withholding an 2011).
object or activity until the child with ASD initiates Video modeling. Video modeling is another example
7. extending conversation by asking questions and of an intervention that has been examined within a behav-
commenting on object/topics of interest to the child ioral framework to target skills across a variety of areas.
with ASD; This intervention involves the creation of a video of a peer
and/or adult demonstrating a discrete skill/target behavior,
8. taking turns during play showing the video to the child with ASD, and then prac-
9. narrating their own play ticing the skill within the same activity demonstrated on the
10. teaching responsivity to multiple cues by commenting video model. Video modeling has been found effective for
on the properties of object/activities increasing social communication, play, and adaptive skills
in children with ASD (Shukla-Mehta, Miller, & Callahan,
Peers demonstrated high fidelity in use of the strate- 2010; Wang & Spillane, 2009). For school teams, video
gies. Children with autism demonstrated increased language modeling is an intervention method that might be combined
and joint attention behaviors. In addition, teachers reported with other intervention methods to target a range of skills
an increase in positive social behavior and an increase in within a school environment. Indeed, Donaldson et al. (2012)
peer-preferred activities (Pierce & Schreibman, 1997). combined use of video modeling and sibling mediation to
Training peers in use of PRT strategies is a method target the social communication skills of a school-age child
that can readily be used by SLPs in schools and other service with ASD. The child with ASD demonstrated increased re-
provision sites to promote the social and communicative sponsiveness to her sibling, joint engagement, and requests.
growth of children with ASD. In addition, it may be espe- For more information on use of video modeling within
cially important because it is likely that children with ASD, schools for children with ASD, refer to Wilson (2013) and
especially in special education settings, have limited oppor- Whalen, Franke, and Lara-Brady (2011).
tunities to interact in structured ways with typically develop-
ing peers (Stahmer, 2007). Donaldson, Hidde, Mershon,
and Sanford (2012) have trained graduate speech-language Common Ground Between SLPs
pathology student clinicians to teach PRT strategies to sib-
lings of children with ASD (sibling mediation). Graduate and Behavior Analysts
student clinicians have demonstrated high fidelity of im- Speech-language pathologists increase the commu-
plementation, and sibling dyads have demonstrated im- nication and social skills of children with ASD not only
proved social communication behaviors and overall social through their direct intervention services, but also through
engagement. sharing their expertise with behavior analysts and other
Children with ASD who have some awareness of team members. Conversely, SLPs may improve their use of
their peers and are not actively avoidant of peers (e.g., they behavioral strategies and methods, which support their
tolerate parallel games) may be good candidates for peer- treatment with children with ASD, by working alongside
mediated intervention (Ingersoll, Stahmer, & Schreibman, their behavior analyst colleagues.
2001). However, it is important to be cautious of the notion As indicated throughout this tutorial, SLPs are most
that children must achieve some social or communicative likely using some, if not many, ABA principles within their
criteria in order to benefit from facilitated interactions with current clinical practice. Recognition of this commonality
typical peers. There is no evidence to support “inclusion may be an important step in effectively collaborating with
myths” such as (a) a child with ASD must demonstrate behavior analysts and other team members serving children
certain readiness skills prior to interaction/inclusion with with ASD. Key behavioral strategies that are often imple-
typical peers; (b) a child with ASD only learns within indi- mented by SLPs in schools include use of clear instructions,
vidual instruction settings; (c) the challenging behavior of a attention to motivation, and data collection and analysis
child with ASD is tied directly to the level of stimulation representing functional use of skills.
within an inclusive environment (i.e., overstimulation); and An interesting and often useful self-study for clini-
(d) severe problem behaviors can only be targeted within cians (both SLPs and behavior analysts) is to video record
restrictive environments (Strain, McGee, & Kohler, 2001; a portion of an intervention session with a child and then
Strain, Schwartz, & Barton, 2011). In fact, in a recent study review the video to identify their use of the ABCs of ABA
of children in an urban public school program, more se- (antecedent, behavior, consequence) and other behavioral
verely impaired children with ASD demonstrated greater principles (e.g., capitalizing on child motivation, providing
benefit from inclusive preschool placements over disability- contingent responses to child behavior). Many SLPs may
only placements. Children with limited communication find that they are already employing ABA principles, and

Donaldson & Stahmer: Team Collaboration: The Use of Behavior 269

clinicians from all disciplines can learn ways to improve on following a three-part direction, use of an art activity
their skills. In addition, viewing within a team setting offers employing the child’s favorite theme and materials may
an opportunity to discuss common approaches and to share serve as a natural and powerful reinforcer for completion of
effective activities and strategies for targeting social and the three-part task. However, following a three-part direc-
communication behaviors. tion for completion of an undesired activity or a routine
task may require a stronger, perhaps artificial, consequence
to reinforce the behavior. For example, if the child who has
Using Clear Instructions difficulty transitioning into the classroom is directed to put
Clear instruction refers to use of an antecedent that away his backpack, sit at his desk, and start silent reading,
elicits the target behavior; therefore, careful selection of the he may need to receive a sticker placed on his “star chart” or
stimuli and use of developmentally and pragmatically ap- some other form of tangible consequence to reinforce the
propriate language are key. When determining whether one behavior. Again, the SLP can assist the team in determining
is consistently using clear instruction, a video review again if the child’s behavior is truly a function of the strength of
may be helpful; if the antecedent is unclear to the clinician, the reinforcer, or if the child’s receptive language skills or
then the behavior expectation was unclear to the child. One verbal working memory plays a role in his/her successful
common pitfall is the repetition or modification of the ante- performance of the behavior.
cedent before the child has had the opportunity to demon- Because motivation and consequences are so inter-
strate the behavior. For instance, during a pretend picnic twined, it is important not to use reinforcers past their po-
scenario while targeting pronouns, the clinician might give tency. For example, when a child who has been actively
a plate to the child and ask the child to give it to “him” engaged in a bubble-blowing activity with the clinician
(referring to a boy puppet or doll). However, before the moves away and starts to seek a different toy, the potency
child responds, the clinician might repeat, “Give it to him” of the bubbles as a reinforcer must be questioned. If the
or modify, “Here, give the spoon to him.” Repetition or child requires prompts to remain engaged in the activity, the
modification of the antecedent may cause confusion for the bubbles no longer serve to reinforce the desired behavior.
child with ASD, who may require additional processing
time to respond.
Varying Task Demands
Another key principle to maintaining motivation is
Ensuring the Effectiveness of the Consequence interspersion of skills that are easy and difficult for the child
Another common pitfall in use of the ABCs relates (L. K. Koegel et al., 1999). Expecting a child to constantly
to delivery of the consequence; the consequence should perform at maximum level of acquisition not only decreases
directly follow the behavior and serve to either reinforce or his/her motivation to participate (thus, increasing the like-
shape the target behavior. A common error is to place addi- lihood one will need to use an artificial reinforcer, such as
tional demands (antecedents) after the child demonstrates an edible or sticker), but also does not allow the clinician to
the desired behavior rather than providing an immediate monitor the maintenance of previously acquired skills (e.g.,
consequence. For example, a child might be learning use of Dunlap, 1984). There are many creative ways to increase
a gesture to greet another person (such as a hand wave). student motivation at the antecedent level through incorpo-
If the child performs the wave, but then is prompted to say ration of preferred materials. For example, using highly
the person’s name before the communication partner re- preferred toys such as trains to teach counting skills or writ-
sponds to the greeting, the consequence does not directly ing a paragraph about a favorite superhero rather than
follow the behavior. By adding an additional antecedent about summer vacation may be an effective way to main-
(the prompt to say the person’s name) and expecting an ad- tain student motivation when targeting social and com-
ditional behavior, it may not be clear to the child that the munication skills. Collaboration among team members
waving behavior was desired and appropriate. Although re- can help professionals identify motivating materials and
sponses, such as waving and saying a person’s name, can be activities.
combined (referred to as chaining) to increase the accuracy
or complexity of the child’s behavior (i.e., shaping the be-
havior), one should be cautious about adding such expec- Making Data-Driven Decisions
tations prior to the child’s mastery of the initial targeted Data collection and analysis are key components
behavior. The SLP can assist the team in determining when of service provision for both SLPs and behavior analysts.
the child is reliably demonstrating the communicative intent Data not only inform teaching, but also determine effec-
of greeting across environments and communication part- tiveness of intervention (Olswang & Bain, 1994; Dollaghan,
ners, and advise the team on the child’s readiness to add 2007). Within ABA, analysis of behavior, as recorded by
verbal language to the greeting based on the child’s speech regular data collection, is used to ensure that one continues
and language skill levels. interventions that are effective and discontinues methods
Another common error is providing a consequence that are not (Cooper et al., 2007). Behavior analysts have
that does not have the strength or value to reinforce or extensive training in repeated measurement of behavior,
shape the behavior. For example, for a child who is working consistent graphing of data, and regular analysis of progress.

270 Language, Speech, and Hearing Services in Schools • Vol. 45 • 261–276 • October 2014
 Given the heterogeneous nature of ASD, data collec- detailed and comprehensive assessments of a child’s com-
tion and analysis ensure that one’s teaching aligns with each munication skills. For example, a team member with a dif-
child’s skill profile. Sharing data with other intervention ferent background might consider a child either verbal or
team members allows for analysis of performance across nonverbal. However, an SLP can discriminate with much
environments and with varied communication partners. greater sensitivity the communicative level of the child (e.g.,
Team members can also benefit from sharing data collection preintentional behavior, intentional behavior, unconven-
and analysis methods across disciplines; determining effec- tional presymbolic communication, conventional presym-
tive and efficient data collection methods/measures facilitates bolic communication, concrete symbol use, abstract symbol
ease and accuracy of repeated measurement. In addition to use, language use; Rowland, 2009). Thus, coordination
day-to-day progress monitoring, data also guide goal devel- across service providers can ensure use of appropriate ante-
opment for student Individualized Family Service Plans cedents to maximize the effectiveness of intervention.
(IFSPs) and IEPs. Assist in development of program targets. SLPs can
Even within naturalistic interventions, where data guide the team in determining the types of social and com-
collection may be perceived as interfering with the social munication goals for a child with ASD to ensure they are
engagement of the child, data collection and analysis are developmentally appropriate and that they are targeted in a
paramount. As Olswang and Bain (1994) indicated, a clini- manner that ensures spontaneous and flexible performance.
cian need not take data across an entire intervention session, For example, behavior-based programs often focus on
but rather may collect a representative sample. Regularly moving to multiple word phrases quickly when a student
plotting such data on a graph for analysis is a key premise may not be flexibly or consistently using single words. This
of ABA and allows intervention teams to quickly determine may lead to the use of rote phrases that the child does not
through visual analysis the effects of different teaching fully comprehend. Additionally, prompting carrier phrases
methods and the developmental appropriateness of goal such as “More X” or “I want X” is common in some types
selection. of behavior-based therapy. However, coaching teachers
Given large school-based caseloads, for many clini- and other team members to use more focused and specific
cians, regular and systematic data collection and analysis language (e.g., “Throw the ball” or “Blow the bubbles”)
(outside of typical IEP procedures) may seem daunting. may increase vocabulary and language flexibility while de-
However, a clear responsibility of evidence-based practice creasing overgeneralization of carrier phrases.
for SLPs is the use of practice-based evidence (Lof, 2011), Provide consistency in addressing behavioral challenges.
also known as internal evidence (Dollaghan, 2007), for inter- Understanding and use of ABA principles can be particu-
vention planning and progress monitoring. A primary larly useful across disciplines by helping team members
component of practice-based evidence for SLPs is the clini- identify and modify challenging behaviors. A key principle
cian’s systematic and repeated data collection on each stu- of ABA is to try to determine the intent or function of the
dent’s individual performance. The up-front time and effort behavior in order to appropriately respond in a manner that
may likely result in back-end rewards, as clinicians can reinforces new behaviors and provides replacement skills
quickly discontinue methods that are not effective for a spe- for challenging behaviors.
cific student, increasing intervention efficiency. In addition, Positive behavior supports and functional behavior
clear data collection and analysis might be used to support assessments, as described above in the section on the use of
discussions with school administrators with regard to case- LEAP, are often used to address behavioral concerns and
load sizes and allocation of resources. develop plans to support use of alternative behaviors to
express the child’s intent. There are typically four possible
functions of challenging behaviors: for attention, for escape/
Additional Opportunities for Collaboration avoidance, for sensory stimulation, or to gain something
In addition to those strategies previously described, tangible. The methods used to change a specific behavior
there are many specific areas in which collaboration be- will vary based on the specific function of that behavior.
tween SLPs and behavior analysts is necessary when serving For example, if a child is exhibiting aggressive behavior
children with ASD. Both professionals are often asked to in order to gain something (e.g., a toy car), removing toys
consult with classroom teachers, work with children one- and activities during the aggression will likely help to re-
on-one, lead small groups, and conduct assessments to ex- duce the behavior. However, if the child is engaging in ag-
amine current functioning. There is often overlap between gressive behavior to escape or avoid a teaching demand,
skills being addressed or measured by both types of pro- then removing toys and activities may actually increase
fessionals. As such, here are some more specific ideas for the behavior as it allows the child to escape the teaching
collaboration: demand.
Determine the appropriate developmental level for in- Thus, a behavior plan would be developed to deter-
structions. Given their expertise in language development, mine antecedent manipulations (to avoid situations the
SLPs are best equipped to determine the types of instructions elicit the challenging behavior), consistent consequences
(antecedent) a student can understand, as well as commu- matched to the intent of the behavior, and teaching of a
nication expectations that the team member should place replacement or alternative behavior to express the child’s
on the child. Indeed, SLPs are skilled in completing highly intent. In the example above, this might mean teaching the

Donaldson & Stahmer: Team Collaboration: The Use of Behavior 271

child to request either the toy or a break, depending on the by each professional can provide a well-rounded view of
intent of the challenging behavior. the child’s progress. Collecting and sharing individual stu-
Collaboration among team members in development dent data will increase mutual respect and understanding of
and implementation of behavior plans is particularly im- each discipline’s intervention plan and progress.
portant to ensure that the child is not unintentionally rein- Activity planning. School-based professionals must
forced for a challenging behavior. If all adults interacting use their time efficiently because they often support large
with a student are consistent in how they respond to specific caseloads of children with a variety of special needs. Identi-
behavioral challenges, the challenges will likely decrease fying activities that most effectively promote skill acquisi-
more quickly. Working with a behavior analyst who is tion and maintenance can be time intensive. Team-based
trained to determine the functions of challenging behaviors planning that capitalizes on team members’ activity successes
in various environments and in development of behavior and challenges will prevent intervention teams from indi-
plans will support implementation of the plan across pro- vidually “reinventing the wheel” for each student’s goals.
viders and school environments. As indicated above, SLPs Teams might maintain a student activity list (that could be
often lead the team in determining functional communi- housed in the child’s classroom), briefly documenting activ-
cation that is appropriate to replace challenging behaviors ities that were successful at eliciting behaviors of interest;
serving a communicative function (Bopp et al., 2004). The team members can add to, and borrow from, the list to
replacement behavior must work as well, or better than, make the most of each interventionist’s time with the child.
the disruptive behavior to be effective. Avoid assumptions about intervention methods. One
Without such a systematic and data-driven approach potential barrier to effective collaboration between colleagues
to assessment, and consistent adherence to the subsequent may be a misunderstanding about each professional’s
behavior plan, a team member could inadvertently reinforce methods and/or overarching philosophy (Ogletree & Oren,
a challenging behavior rather than decrease it. As such, 2001). That is, one should not assume that because a pro-
careful collaboration among team members is needed to fessional subscribes to a particular methodology or interven-
both develop the plan for reducing maladaptive behavior as tion approach, that he/she is restricted only to that method.
well as monitor the effectiveness of the intervention over Professionals may (and should) employ a continuum of
time. methods, depending upon the child’s individual profile of
Cross train. As aforementioned, SLPs have extensive strengths and challenges. For example, naturalistic ABA-
knowledge about language and social development and dis- based interventions such as the Early Start Denver Model
orders that is vital when developing programs for children (Rogers & Dawson, 2009) provide clear decision-making
with ASD and educating other team members. Similarly, tools for when to increase supports across three areas: rein-
the principles of ABA can help enhance speech-language forcement, structure, and visual supports. If a child is not
therapy by maximizing motivation and reducing behavioral progressing, based on regular data collection and analysis,
challenges that interfere with therapy. Training across disci- the clinician is instructed to add supports moving along the
plines is an excellent way to build understanding as well continuum from naturalist teaching all the way to use of
as to enhance intervention effectiveness. Not only can team massed trial practice and artificial reinforcement (e.g., edi-
members provide training to each other, but also within bles and unrelated toy/activity) until the child demonstrates
both speech-language pathology and behavior analysis dis- learning progress (Rogers & Dawson, 2009). Flexibility
ciplines there are opportunities for further cross teaching is key.
and education. ASHA offers many continuing education Communicate about the level of intervention supports.
opportunities focused on ABA-based interventions and In addition to flexibility, it is important to be able to indi-
methods (e.g., presentations at the Autism: Supporting vidualize one’s approach to each child’s pattern of skill
Social Cognition in Schools online conference: http://www. acquisition. If a child requires additional supports for one
asha.org/events/autism-conf/ ), and the Association for skill, it does not mean that s/he requires that same level of
Behavior Analysis International (ABAI) provides program- support for all target behaviors. Just as one approach to
ming related to social and communication intervention, as autism intervention for all children is not advocated, a one-
well as specific to speech-language pathology (e.g., Speech size-fits-all approach to teaching for an individual child
Pathology and Applied Behavior Analysis Special Interest does not account for that child’s unique profile of strengths
Group: http://www.behavioralspeech.com/ ). and needs. Professionals can assist each other in determin-
Assess goal progress. Sharing common methods of ing what skills and in which environments a child may re-
data collection and assessment of goal mastery can help quire greater or fewer supports. They can also complement
lead to more effective IFSP and IEP planning and enhance each other’s intervention methods. For example, a child
our understanding of child progress. The SLP and behavior learning reciprocity might receive support from one profes-
analyst may have differing perspectives on a child’s prog- sional during a structured board game with peers, whereas
ress based on their own methods of data collection. For ex- another professional might target this during a less structured
ample, the behavior analyst may see increases in the use recess activity.
of three-word phrases, but the SLP may have concerns regard- Recognize team member’s training. Each professional
ing flexibility and generalization of these skills. Keeping data on an intervention team serving children with ASD brings
on aspects of the child’s skill acquisition deemed important a unique set of skills and training to the collective group.

272 Language, Speech, and Hearing Services in Schools • Vol. 45 • 261–276 • October 2014
Mutual understanding and respect for this knowledge and Board (BARB) or of any BARB member, and such endorsements
training is paramount to successful collaboration. Speech- should not be inferred. We express our appreciation to Teresa Car-
language pathology certification and licensure requirements don and Sara Vank for their influence on preliminary discussions
of this topic.
reflect their extensive skills and knowledge related to com-
munication and social skills, as well as their rigorous ap-
plied training. Many SLPs may have an understanding of
the level of training of teachers and other related service
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