The SBT Process Is A Radical Change From Traditional ABA Procedures
“This treatment process is one in which the starting point is a happy, relaxed, and engaged autistic person. The themes of I see you, I hear you, and I am here for you persist through the entire process. It bears repeating that there is no obligation to teach children that are upset in any way or under any duress. Hasty efforts at promoting compliance or assessing the developmental status of an autistic person are not championed in this process. That which is being championed is establishing trust, engagement, authenticity, and agency. Cooperation in shared experiences follows. Acknowledgment in this process is that skills will be learned both during therapist, teacher, and parent-led times as well as during times in which the autistic person is leading. Also recognized is the understanding that developmental assessment is best undertaken once trust in difficult tasks has been established…”
Greg Hanley, Todays ABA, 2020
Safety
We ensure safety throughout the assessment and treatment phases by reinforcing problem behaviors to stop escalation, create trust with the child, and use that information to identify what expectations were “too much.” We show children that when they are upset, we hear them, avoid power struggles, and “live to teach another trial.”
Choice
The client makes choices and has control throughout the assessment process. Choice allows the child to explore our clinic, identifying their most valuable and favored reinforcers to create their ideal learning environment.
Collaboration
Decisions about treatment, reinforcement, and the skill acquisition process are made in collaboration with the child. The child’s behavior guides instruction, trial by trial. When you value the child’s happiness and cooperation over compliance, collaboration is a necessity.
Trustworthiness
The child’s voice and behaviors are responded to, never ignored. We know that ignoring children often escalates the problem behaviors. Establishing trust is imperative in any learning context, so we keep expectations clear and provide unambiguous signals when teaching trials are presented.
Empowerment
We empower children by identifying their most challenging contexts, predictably and gently presenting those contexts, and making it easy for them to successfully and appropriately get away from those challenges. We focus on skills that are needed in the real world; communication, toleration, and cooperation.
Practical Functional Assessment (PFA)
The Practical Functional Assessment process is highly individualized, consisting of two parts: The Interview and The Test. Throughout the Assessment process, we also collect information on what makes your child happy!
The Interview
A meeting with the parents/caregivers, typically on Zoom, to gather information regarding all of the essential details about your child.
Our goal is to make sure that we understand your child before we begin teaching them new skills. Specifically, what makes them Happy, Relaxed, and Engaged? What types of situations do you find to be the most challenging? What do the concerning behaviors look like? What are your goals as a parent?
Interview Informed Synthesized Contingency Analysis (IISCA)
During the testing process, the information obtained in the interview is put to the test. Specifically, we create an environment where the child is Happy, Relaxed, and Engaged, then test to determine if we have identified a challenging and convenient context under which to teach the skills of communication and tolerance.
Happy Relaxed, and Engaged
During the assessment, we show the child that they can trust us to build a safe, fun, therapeutic environment. This step is critical to the success of our Skills-Based therapy. When the child is HRE, they will be more willing to trust us, have fun, cooperate, learn, and grow in various ways. In most cases, the children who see us LOVE to come to therapy. That’s the first step to ensuring therapy is successful.
Skills-Based Treatment (SBT)
Once we have identified the separate contexts under which your child is happiest and most challenged, we have established an ideal learning environment! We then begin the skills-based treatment process, consisting of the following:
Communication
Therapy begins by teaching the child that communication is effective!
We start with the same, individualized setting we identified in the assessment (HRE) and make this most preferred context available to children throughout the treatment process. We then briefly interrupted this ideal context and prompt the child to calmly communicate their desire to get back to HRE. Depending on the individual child, this might be vocal language, sign language, Picture Exchange Communication System (PECS), or a speech-generating device.
In many cases, this lesson is achieved in just one session. Sometimes, it can take a few sessions, but just about all clients learn this lesson quickly.
Toleration
It is wonderful when the child starts to learn to communicate his wants and needs. But as every parent knows, it is necessary to say “no” at least some of the time. If the child is used to getting every request granted, they need to learn appropriate toleration skills.
Some kids give a thumbs up, a high-five, a fist bump, or they learn to say “OK”, “That’s cool,” or other phrases to demonstrate that they understand and are flexible with the “no.”
Cooperation
After the child has learned to tolerate “no,” we focus on teaching children to cooperate with the most essential tasks identified in the Parent Interview. During this phase of treatment, the child’s response guides our decision-making. By using the child’s response as our guide, we can systematically ensure that we teach them all of the tolerance and communication skills necessary to earn their cooperation.
Cooperation in adult-led activities may involve learning language skills, social skills, independent activities, self-help skills, or academic skills. Initially, the client’s expectations are very simple. As the child learns skills, the expectations progress in a step-by-step fashion until the child can complete activities in realistic situations while challenges are presented.
Social Skills
In most cases, we also teach complex social skills during the process. The child will learn to get the attention of a communication partner, wait for acknowledgment, request using a complete sentence, and wait for an answer. All the while, the child is making eye contact, gaining information from the face of a communication partner, and remaining calm, among other social skills.