The coronavirus (COVID-19) pandemic has created unique challenges for educators, Applied Behavior Analyst (ABA) practitioners, parents and students alike. When schools began closing their doors to mitigate the spread of the virus in early 2020, families and practitioners were left with many unanswered questions. Specifically, how will children with Autism Spectrum Disorder (ADS) continue to receive medically necessary ABA services, as well as get their educational needs met?

This question did not linger for long before the community of ABA practitioners jumped to action. Behavior analysts quickly learned how valuable continuity of care would be for the autism community, as the government categorized ABA practitioners as an essential service. Kornack (2020 p. 543) stated, “ABA providers … have both the freedom and the great responsibility to make their own decisions about how to best keep their clients safe while continuing to provide medically necessary services.”

School Plans Released for Re-Opening

As the COVID-19 health crisis continued to grow, there were many concerns arising regarding how to safely provide services and educational opportunities to learners without increasing the risk of exposure.

Six ABA practitioners providing school support and two families receiving services during school hours were interviewed in early December 2020 through an electronic survey.

The objective of the interviews was to identify trends related to concerns with receiving ABA and resuming educational services via various modalities including virtual learning, home-school, or hybrid (both in-person and virtual).

The second intent of the survey was to identify trends related to tools, resources, and strategies currently being utilized during school times. The article will review specific behavioral strategies that some families and ABA providers feel have been helpful in increasing the learner’s success during educational services with the support of an ABA team.

Concerns Expressed by Families:

• • Time management of work responsibilities, while simultaneously providing support to their child, or multiple children in the home, completing virtual learning online.

• • Inability to manage assignments, schedule changes, or vital information from teachers without attending all live lessons, as their child struggled with communication, attending, and challenging behaviors when left unattended during lessons.

• • Health and safety concerns for those participating in hybrid models, virtual learning from home, and in-person services at their school, as many learners are unable to independently engage in safety and sanitation protocols without direct adult support.

• • Lack of knowledge with navigating various technical aspects of the online systems and programs. One parent with a student participating in middle-school via virtual means stated the child was assigned twelve different teachers and therapists across six classes, most of which utilized different virtual programs such as Zoom, WebEx, Google Classroom, and school platforms such as Buzz Learning and Campus Parents.

• • Some families did not have access to electronics or WIFI such as computers, tablets, home internet, or hotspot devices.

• • Additionally, one of the most common concerns for parents was how they were going to motivate their child who showed resistance to learning and attending school via virtual modalities. Families questioned their ability to adequately motivate their child to comply with school demands.

• • Last, parents expressed difficulty with managing behavioral aspects of virtual learning such as avoidance behaviors, escalation of challenging behaviors including yelling, refusal statements, elopement from learning areas, and potentially some aggression or property destruction.

• • One ABA practitioner, who has clinical experience working with clients receiving ABA support during educational times and through Telehealth modalities, shared a concern stated by a family member whose child is receiving ABA services and school support:

One of my clients transitioned to kindergarten this year and the family was very concerned with the client’s ability to respond to instructions (both academic and functional instructions) via virtual learning. The family was very worried about the client ‘losing out’ on learning opportunities that in-person school would have to offer and was very concerned over the client’s ability to respond to a virtual learning model.(Anonymous, personal communication, December 4th, 2020)

Concerns Shared by ABA Practitioners:

ABA practitioners also contributed personal insight regarding the concerns and challenges encountered prior to resuming in-person ABA services, as well as school resuming via a virtual modality, and expressed similar concerns as the parents of children receiving ABA services. Practitioners were concerned how front-line staff such as the Registered Behavior Technicians (RBT) and Behavior Analyst providing in-home and clinic-based services would ensure the safety of their clients, but also safety for themselves and family members in their home. The Council of Autism Service Providers (CASP) released practice parameters for telehealth services and shared how “ABA providers are faced with ethical dilemmas amid the COVID-19 crisis when determining how to proceed with patient care” (CASP p.3, 2020).

A common trend identified by the ABA practitioners included barriers to adequate communication and collaboration with their client’s educational team. The communication barriers presented some difficulty when streamlining strategies and understanding expectations of assignments and sudden changes of teachers or schedules. Most ABA practitioners contribute the gap in coordination being primarily due to the distress teachers and schools have faced when moving the entire state to virtual learning environments without prior experience or systems in place.

An ABA practitioner provided guidance for how to assist families with self-advocacy and identify helpful resources during these times, which included:

Continue to encourage the families that they are doing a [wonderful] job in the midst of a pandemic, through descriptive, in the moment praise, if that is possible! Remind families to give themselves some grace and have kind thoughts for [sic] themselves as well, considering they are being super humans during a pandemic. If there is a concern related to the child’s IEP and/or non-adherence to the IEP, coaching families on how to call an IEP meeting and/or send email correspondence to the client’s IEP team and/or special education director of their district requesting an update to their IEP accommodations for virtual learning. If correspondence or an IEP meeting is not successful, refer families to [local advocacy agencies] if applicable for concerns with IEP accommodations being made for virtual learning.(Anonymous, personal communication, December 4th, 2020)

Some students may also experience adverse thoughts and emotions regarding the changes with attending school. Some learners felt overwhelmed, frustrated, and discouraged, which resulted in increases of avoidance and escape-maintained behaviors. The learners’ apprehension and limited ability to cope with the changes, paired with teachers having similar struggles and feelings while attempting to move their students to a virtual classroom provided ABA practitioners additional challenges to problem-solve.(Anonymous, personal communication, December 5th, 2020)

As stated by Abera (n.d.), “Moving into virtual learning has been a challenge…but it has given our school wonderful opportunities to be more flexible, build more trust among staff, parents and students, and experiment with and learn from new ways of teaching.”

Another ABA practitioner provided further insight and shared her experience assisting a client with processing complex emotions and thoughts related to the changes COVID-19 caused:

…the client would often state ‘[I feel] like I have to work all day’ doing school, homework, and ABA all within the home [sic]. [This led] to increased noncompliance initially, which we did not see prior to school being within the home.(Anonymous, personal communication, December 4th, 2020)

Last, concerns mentioned by ABA practitioners included similar. For example, ABA providers described concerns for how to assist their clients with increasing independence with hygiene skills, sitting, and attending to electronic devices while non-preferred subject material is presented.

Additionally, how to assist students with anxiety and coping skills as they adapt to the changes of their home environment now being their school environment, and keeping their clients motivated to learn while ensuring maladaptive behaviors remained at manageable levels to avoid interference with learning during ABA services and school provided services

ABA Strategies for Supporting Behavioral Objectives During School Hours

Understanding the unique experiences of ABA practitioners, families and clients is essential for gaining knowledge regarding strategies that may help mitigate common trends being shared by the community of ABA service practitioners. With COVID-19 being an unprecedented health crisis, it is more important now than ever to learn from one another. Sharing evolving resources and research may help other families and providers continue to battle the everyday struggles of learning and growing during COVID-19. We will now review and discuss behavior analytic strategies that appear to have been beneficial for some clients during ABA sessions to support continued progress with educational services.

Request an Increase in Service Hours

For students who previously attended in-person classes and experienced success with the support the school had to offer, their need for medically necessary ABA service hours may have been much lower than what would be medically necessary for providing support in the home across the day.

It would be important to reassess what the recommended dosage of direct services hours are clinically recommended to ensure the client does not experience regression of skills, has direct support when opportunities to generalize behavioral skills to new situations and environments, as well as ensure the child maintaining low rates of behavior so the acquisition of new skills still occurs across the day.

One Parent’s Personal Account

For one parent, her child became non-compliant with all directives and would engage in physical and verbal aggression if anyone in the home prompted him to engage in virtual learning activities.

The parent recalled how emotionally traumatizing it was for her to continue to work full-time hours while attempting to have her son comply with the demands of virtual school. This quickly led to caregiver burnout within just a few weeks. The parent decided to speak with the ABA provider to assess options for additional support. The client was receiving only 15 hours of direct ABA services throughout the week, which resulted in a rapid decline both behaviorally, socially, and academically.

The ABA team made the decision to request the hours to increase by 50% or more (Anonymous, personal communication, December 5th, 2020).

Practitioner’s Response

The practitioner responded by taking the time to gather additional data demonstrating the child’s increase in more severe disruptive behaviors, which interfered with the client’s overall functioning across the day. Medically necessary goals were created which focused on tolerance, transitions, attending, and functional communication training. The increased hours were approved, and the client was able to have support throughout the day to complete hygiene routines, school support for attending and participating in lessons, and increased social interactions with the behavior technician.

It is important for ABA practitioners to recognize when clients would benefit from an increase in service hours, as some parents are not well versed in the processes of ABA and insurance authorizations. If this is identified as an option that would greatly benefit the client by decreasing maladaptive behaviors, increasing social-communication opportunities and maintain the highest quality of life and functioning across the day, then the next step would be to collect data and provide a medically sound rationale for the increase to provide to the insurance company. Increased service hours during the COVID-19 pandemic appears to be an incredibly helpful solution to support the continued success and mitigate regression client skills.

Another ABA practitioner shared her success with obtaining an increase in hours with her client, “Having availability during the day to increase ABA hours has been wonderful for many of my clients! We have been able to meet their full dosage of ABA and seen tremendous progress” (Anonymous, personal communication, December 2020).

Establishing Schedules & Routines

Independent Activity Schedules and task analysis are incredibly advantageous for learners across the school day. Both of which are popular behavioral strategies used by many ABA practitioners and appeared to be a common consensus with the ABA providers who completed the electronic survey. Abera (n.d.) stated: “Students rely heavily on their schedules to feel a sense of comfort in their routines, to understand expectations for their participation, and for support in executive functioning.” Changes to routines can be disruptive and stressful to many learners with ASD.

Independent activity schedules can be crafted in many different ways with the ultimate goal of the learner gaining independence with the routines and skills, thus requiring less supervision and support from adults. Activity schedules can be made for class schedules, morning routine or lunch routines, and even social and leisure time activities. Schedules can potentially help mitigate one main concern parents mentioned regarding the inability to manage work and keep their child on task with the school throughout the day. Independent activity schedules may include written checklists, picture schedules and timers.

Independent Activity Schedules “promote independent engagement in classroom activities for children with disabilities and programming the withdrawal of extra assistance from teachers, specialists, and classroom aides” (Hall et.al. p.208, 1995).

Task Analyses for Complex or Multi-Step Skills

Task analysis goes hand-in-hand with independent activity schedules. Once a task containing multiple subsequent steps has been mastered (i.e., the client can engage in the task without adult prompts) the task can be added to a behavioral chain with other known tasks, thus presenting an opportunity to create an activity schedule. Task analyses are used to teach more complex skills that have multiple small, successive steps and can be used across a wide variety of skills (Shcherbakov, 2020). Practitioners who participated in the electronic interview shared some of the skills they created a task analysis for which helped support their learners throughout the day during and outside of school.

These behavioral tasks included signing into video conference applications, using google drive to access assignments and google classroom, making a snack, retrieving and cleaning up materials, washing hands, helping sanitize workstations and materials, setting a timer, sending an email, and asking for help (Summarized from all respondents, personal communication, December 4th and 5th, 2020).

Organization of Materials, Learning Spaces, and Daily Routines

Whether a student is learning in-home or in-person, it is important to create a learning space that is comfortable for the learner and includes adequate space for the organization of all learning materials. Abera (n.d.) described how some providers “worked with families to create a consistent learning space for students at home…[and] provided recommendations to families for setting up workspaces and materials.” When the learner has an organized learning space it promotes fluency with tasks involving getting and retrieving materials before and after lessons.

One example of creating an individualized and comfortable workstation comes from a learner who participates in a private school for children with autism and has an ABA provider present for the full day. The parent helped facilitate an interview with the learner so his personal experience could be shared. The learner described how “comfortable” he feels knowing [the ABA provider] is with him at school to help him calm down when work is “too hard”.

He also appreciates the help with the transition from class to class, as he commonly loses focus, misplaces items, and even gets lost from time to time. The learner mentioned how he has his own desk with cubbies for school supplies and he is also permitted to decorate his area with pictures and special toys from home (Anonymous, personal communication, December 5th, 2020).

This is a great example of how an ABA provider is supporting a student behaviorally during school times, as well as the school providing the opportunity for students to feel a sense of independence and ownership with their personal workspace.

Antecedent Interventions for Increasing Success

Demand Fading Protocols

When schools resumed, experts hypothesized that demand fading procedures would assist learners with tolerating aversions by systematically increasing demands throughout the initial weeks until a desired level is achieved in the absence of challenging behaviors. “Demand fading, a schedule thinning procedure for escape-maintained behaviors, typically includes an escape extinction component,” (Davis, p. 343, 2018). In essence, when implementing a demand fade procedure all demands are initially removed until maladaptive behavior is low, at which point demands will gradually be increased.

Demand fading paired with differential reinforcement of alternative behaviors appeared to be an effective method for a particular learner who began to receive virtual learning when schools resumed. The ABA practitioner shared (December 2020) how the student would not leave his personal computer to transition to the individual learning space for live-lessons and would engage in aggression and property destruction if repeatedly reminded. The ABA practitioner decided to use demand fading paired with differential reinforcement of an alternative behavior, as well as pairing the demand with a preferred reinforcer (i.e., a tablet) (Anonymous, personal communication, December 4th, 2020).

The team initially began by having the student leave the computer, join the meeting, say hello in the chatbox, and then was permitted to play the tablet for the remainder of the target duration. The student was allowed to use FCT to request to leave the learning space, but only after the target duration had passed (i.e., initially started with 30 seconds). As the student transitioned with a preferred item and remained for the target duration of time, the ABA practitioner systematically increased the amount of time the student was required to put the tablet down after signing into class. Again, the practitioner started with 30 seconds. The ABA team moved through the systematic demand fade procedure and after 8 weeks the student was sitting and attending for 15 minutes of live lessons in the absence of challenging behavior (Anonymous, personal communication, December 5th, 2020).

This is one example of how demand fading was successful for a learner who struggled with transitions, engaged in severe challenging behaviors, and had difficulty attending to non-preferred activities.

Incidental Teaching and Known Skills

ABA providers utilize a collection of antecedent interventions to aid in the management of interfering behaviors that impede learning social-communication, increased psychological flexibility, and daily living routines. Mohammadzaheri (2015) discussed how children with autism manifest disruptive behaviors across all age groups and are typically due to poor communicative and cognitive abilities. Furthermore, the author stated, “given the interrelationship between these areas, creating communicative intervention programs that incorporate antecedent procedures shown to decrease disruptive behaviors becomes essential” (Mohammadzaheri, 2015).

One method shared by an ABA practitioner described how “starting all sessions with [highly preferred activities] for 10-15 minutes has been great! The kids feel like they are getting to make choices and have [also] been helpful for the interactions with [new] people they have not met before [sic]” (Anonymous, personal communication, December 5th, 2020). Abera, (n.d.) described a strategy where providers prioritized engagement and increased demands over time and stated, “to lower student stress and to facilitate a smooth transition to distance learning, we spent the first few weeks after the closure focused on reviewing topics and skills that the student had already been taught.”

Last, incorporating natural environment teaching procedures such as Incidental Teaching, Pivotal Response Treatment (PRT), and Natural Language Paradigm (NLP) provide opportunities during unstructured times and may assist with increasing a learner’s compliance with learning non-preferred skills, especially if it is away from a computer screen or a book.

Mohammadzaheri (2015) described using methods such as “…incorporating client choice, direct and natural rewards, reinforcing attempts, task variation and interspersal of previously-learned and newly targeted [skills]…during the context of naturalistic play interactions, [may] result in faster gains and generalized improvement…when compared to traditional adult-directed ABA approach.”

Additional antecedent strategies are recommended on the chart below, which is a combination of interventions from Geiger et. al. (2009) and Grow et. al. (2010).

Conclusion

School closures and virtual learning highlighted the need for rapid preparation of programs and materials to help students access educational services from home.

Behavior Analysts and families quickly recognized how ABA services were going to be an instrumental tool for continuing to assist learners to gain new repertoires of behaviorally essential skills necessary for virtual learning, home-school or other learning options, such as learning pods.

Children with ASD typically struggle with deficits related to compliance with non-preferred tasks, changes to schedules and routines, generalization of skills to new situations or environments, attending with and without distractions, participation in non-preferred subjects, prompt dependency, limited or defective motivating operations, and social-communication delays.

ABA practitioners, educators, and families came to realize each of the aforementioned behavioral deficits would require a greater level of support during educational times in order to maintain a learner’s ability to access academic opportunities and maintain academic and behavioral success.

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About the Author

Christan Griffin, M.Ed., BCBA, LBA

Christan Griffin has worked closely with neurodiverse learners in a variety of settings for over a decade now. Christan began her career in 2009 working 1:1 with a child diagnosed with Autism. This experience sparked a passion that ultimately led her to pursue her master’s degree in Special Education and certification as a Board Certified Behavior Analyst (BCBA). Christan has experience with curriculum development and program implementation for ages ranging from 18 months to 30 years old across individuals diagnosed with Autism, as well as many of the common comorbid conditions. Christan currently serves as the Interim Director of Training, Clinical Supervisor, and a Senior Clinician at Behavior Change Institute. Her responsibilities include the development of BCBA supervision and training content, providing direct support and consultation for BCBAs, and case management for the Adult population. Outside of her daily clinical responsibilities, she is currently serving as a stakeholder on a committee conducting research through the Patient-Centered Outcomes Research Institute (PCORI), and has recently published on telehealth implementation of ABA treatment in the Journal of Applied Behavior Analysis. Christan has a 12-year-old son who was diagnosed with Autism at the age of 2. The personal experience coupled with her clinical experience, continues to fuel her motivation to invest time and increase knowledge in the field of Applied Behavior Analysis.

References

1. 1. Council of Autism Service Providers (2020). Practice Parameters for Telehealth-Implementation of Applied Behavior Analysis: Continuity of Care during COVID-19 Pandemic. Wakefield, MA: Author.

1. 1. Davis, T.N., Weston, R., Hodges, A. et al. Functional Communication Training and Demand Fading Using Concurrent Schedules of Reinforcement. J Behav Educ 27, 343–357 (2018). https://doi.org/10.1007/s10864-017-9289-0

1. 1. Geiger, K. B., Carr, J. E., & Leblanc, L. A. (2010). Function-based treatments for escape-maintained problem behavior: a treatment-selection model for practicing behavior analysts. Behavior analysis in practice, 3(1), 22–32. https://doi.org/10.1007/BF03391755

1. 1. Grow, Carr, & LeBlanc (2010). Treatments for Attention-Maintained Problem Behavior: Empirical Support and Clinical Recommendations Journal of Evidence-Based Practices for Schools Vol. 10, No. 1. 70-92

1. 1. Hall, L., McClannahan, L., & Krantz, P. (1995). Promoting Independence in Integrated Classrooms by Teaching Aides to use Activity Schedules and Decreased Prompts. Education and Training in Mental Retardation and Developmental Disabilities, 30(3), 208-217. Retrieved December 6, 2020, from http://www.jstor.org/stable/23889172

1. 1. Kornack, J., Williams, A.L., Johnson, K.A. et al. Reopening the Doors to Center-Based ABA Services: Clinical and Safety Protocols During COVID-19. Behav Analysis Practice 13, 543–549 (2020). https://doi.org/10.1007/s40617-020-00462-7

1. 1. Mohammadzaheri, F., Koegel, L. K., Rezaei, M., & Bakhshi, E. (2015). A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Adult-Driven Applied Behavior Analysis (ABA) Intervention on Disruptive Behaviors in Public School Children with Autism. Journal of autism and developmental disorders, 45(9), 2899–2907. https://doi.org/10.1007/s10803-015-2451-4

1. 1. Shcherbakov, A. (2020). Free Resources: Task Analysis Sheet. Think Psych. https://thinkpsych.com/blog/task-analysis-free-download/