G-4: Use stimulus and response prompts and fading (e.g., errorless, most-to-least, least-to-most, prompt delay, stimulus fading) ©
Important note: Fictionalized clients are used to demonstrate the skill items in the second half of the task list, sections F-I. They make the most sense when read in order. Please remember that there is not substitute for real-life supervision and consultation. Get your case-specific advice from professionals – not from the internet! These examples are just that – examples of how behavior analytic skills might be applied.
Jada
Case example: Jada is an elementary school student. She experiences Level 3 Autism Spectrum Disorder (ASD). Level 3 is the severity level of Autism which is characterized by “requiring very substantial support.” Jada has also been diagnosed with a severe Intellectual Disability (ID). Jada has just transferred to a private school for individuals with global needs. She loves all kinds of play and messy activities, such as finger paint and water play. She also enjoys swinging on the playground, eating popcorn, and watching Disney movies. She loves to be read to, and laughs when staff make dramatic gestures while reading picture books. Jada does not use any vocal speech. She makes noises sometimes, such as humming. Jada engages in motor stimming, including upper body tensing and flapping her arms. Jada engages in severe challenging behavior, including self injury (hand to head and head to surface) and aggression (including hitting and biting). Jada has a mom, dad, and older brother living together in one home. Jada’s family has advocated for her to attend a private program, and they are excited for her to get high quality services. Jada’s new behavior analyst is Dr. Brown-Davis, who is a BCBA-D employed by the private program.
Example of Item G-4: Dr. Brown-Davis decides to use errorless prompting to teach Jada to request access and escape. He makes this choice because he wants the intervention to quickly provide Jada with a replacement behavior to compete with her unsafe behavior. The errorless procedure involves using a second staff member as a prompter, who acts as an extension of Jada’s own body and immediately helps her to engage in the replacement behavior when the MO and SD for problem behavior are presented. That way, the staff interacting with Jada are able to immediately reinforce Jada’s replacement behavior (communication). Using errorless prompting from behind means that the new skill is unlikely to come under the control of irrelevant stimuli (such as becoming prompt dependent) because Jada will have limited opportunities to see or hear the prompter, and will instead be responding to her communication partner.
For life skills such as self care and food preparation, Dr Brown-Davis considers Jada’s current skill with each component of the task, as well as her motivation to achieve the task outcome, when choosing prompting strategies. For example, Jada has never been taught how to do laundry, and does not demonstrate any skills related to that task (for example, opening the washer, putting clothes in, pouring detergent, etc.) The intervention for this skill involves a most-to-least prompt for each step, so that Jada has an opportunity to demonstrate increasing skills as prompts are systematically faded back. Stimulus prompts (including brightly colored tabs on detergent cup and washing machine handle) are slowly faded out (cut down) after Jada no longer needs staff prompting.
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Donovan
Case example: Donovan is a high school student. He has been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD). He attends a public school and has been placed in a support program for students with social/emotional/behavioral needs. Donovan enjoys playing video games and drawing in his sketchbook. He would like to be a welder when he is an adult. Academic achievement and attendance have been challenges for Donovan historically, and he is currently not on track to graduate with his peers due to missed work and failing grades in several classes. Donovan’s team has identified challenges including frequent non-attendance to school, walking the halls during class times, non-attendance at expected guidance appointments, and non-completion of classwork. Donovan lives with his mother and older brother. Donovan’s mother is concerned about her son’s school challenges and expresses frustration about his “lack of commitment” to his education. She wants Donovan to understand how important it is to graduate from high school. Donovan’s behavior analyst is Ms. Bailey, who has just started contracting with Donovan’s school district through the agency she works for.
Example of Item G-4: Ms. Bailey is focused on encouraging Donovan to ask for breaks (negative reinforcement) when he gets overwhelmed with work instead of pushing over his desk and walking out of the room. She also wants him to appropriately ask for access to his sketchbook. Ms. Bailey’s goal is for Donovan to eventually say “I need to take a break from work and sketch” (terminal behavior). However, she starts by providing a break from work and access to his sketchbook anytime Donovan puts his head down instead of pushing over furniture and leaving the room. She then moves onto providing a break from work and access to his sketchbook whenever Donovan says “I’m done”. Finally Ms. Bailey allows a break from work and access to his tablet after Donovan says “I need to take a break from work and sketch”.
During the intervention, Ms. Bailey writes the current functional communication response that will be reinforced on a sticky note on his desk. After the terminal response in acquired, Ms. Bailey fades how dark she writes the FCR on the sticky note, eventually leaving no writing at all, then removing the sticky note from his desk. This is an example of stimulus fading as the salience of the prompt is gradually faded.