Dr. Vincent J. Carbone, Director 614 Corporate Way, Board Certified Behavior Analyst – Doctoral Valley Cottage, NY 10989 Phone: 845-267-0920 Kristin Albert, M.Ed., Assistant Director Fax: 845-267-0921 Board Certified Behavior Analyst www.carboneclinic.com

SESSION ASSESSMENT REPORT

Learner: Zaire Date of Birth: May 10, 2006 Age: 4 years, 6 months Disability: Autism Parents/Guardian: Monique and Larry Clinic Start Date: November 1, 2010 Reported By: Laura Ferguson, M.Ed., BCBA Kristin M. Albert, M.Ed., BCBA Date of Report: November 15, 2010 Background and Brief History Zaire is a 4-year-old boy who lives at home in New Jersey with his parents, Monique and Larry, and his siblings, Tyquan, Zackhary, and Zakiyya. He was diagnosed with autism in September, 2008, at the age of 2. At the beginning of the 2009 – 2010 school year, Zaire attended a special education preschool classroom in his home school district. Part way through the school year it was determined that this classroom was not an appropriate placement for Zaire as he was emitting high rates of problematic behaviors that interfered with instruction. Since January, 2010, Zaire has been attending an out-of-district, special education preschool classroom at a program in New Jersey from approximately 8:30 a.m. until 2:30 p.m., Monday through Friday. This classroom utilizes applied behavior analysis (ABA) methodologies and incorporates discrete trial instruction. There are five other students and six staff in the classroom, including one lead teacher, Tina, and five classroom aides. In addition, a behavior analyst, M, BCBA, consults to the classroom. Through the program Zaire’s parents have also attended parent training workshops and received in-home consultation services provided by P, BCBA, and W to address their concerns about promoting school-based structure at home, working through tantrums, and dealing with non-compliance. In September, 2010, the home school district contacted the Carbone Clinic regarding placement for Zaire because of continued problem behaviors that interfered with instruction. Based on the District’s recommendations, Zaire’s parents came to observe the program. On October 4, 2010, Zaire’s parents attended the Carbone Clinic for an intake meeting with Dr. Vincent Carbone, BCBA-D. The purpose of this meeting was for Zaire’s parents to meet with Dr. Carbone to address concerns about their son’s problem behaviors, both in home and at school, and to obtain recommendations on what services would be appropriate for Zaire. Dr. Carbone recommended that Zaire should attend the Carbone Clinic for at least 9 hours of instruction per week to focus

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on increasing his mand repertoire, developing a behavior plan to decrease problem behaviors, providing training and consultation to a home team, and providing training to school personnel. On November 1, 2010, Zaire began attending the Carbone clinic for 10 hours of services per week provided Monday through Friday from 9:00 a.m. to 11:00 a.m. General Impressions When Zaire arrived at the clinic he eagerly came into the building accompanied by either a school bus aide or his mother. When instructed to sit in a chair in the front waiting area, he attempted to sit on his knees and reached for the wall behind him, so he required assistance and frequent reminders to sit and wait appropriately. When the instructor approached Zaire he presented as a happy 4-year-old boy, who was eager to begin his sessions. When the sessions started Zaire easily transitioned away from the waiting area without problem behavior regardless of who had brought him. However, he required reminders to stay with the instructor when walking down the hallway because he attempted to run ahead of the instructor. Throughout the course of the 10-day assessment period the instructor gave fewer reminders and Zaire walked more independently down the hallway. Each day Zaire’s session began at the table in the classroom. When entering the classroom Zaire immediately went towards the Wii, which was set up for him at his table. He then began playing the Wii Sports video game. Zaire stood in front of the television, looked directly at the screen, and navigated through the game appropriately. He played each sport (e.g., boxing) for several minutes before switching, but played with game for extended periods of time without losing attention. He frequently became excited, jumped up and down, and smiled while playing. When assistance was needed he moved towards the game console and hit the reset button. When he could not independently navigate his way through the game, he would say “dah wuh” (for that one) and point towards the screen. If the instructor had to guide him to complete certain areas of the game resistance to hand over hand prompting was seen. This resistance was sometimes accompanied by the word “No.” When the instructor first presented a demand to give up the Wii remote, Zaire began reaching and grabbing for everything in sight (e.g., Wii remote, gummy snacks, DVD player, picture exchange book). With guidance the instructor taught Zaire to give up preferred items, sit with his hands folded while responding to the instructor’s questions, and then ask for items to get them back again. During assessment at the table, Zaire initially complied with only a few demands and then asked for the Wii. If more than seven demands were presented, there was an increase in problem behavior (e.g., tilting chair, standing up, looking away). When about six demands at a time were placed, however, Zaire demonstrated quick and appropriate responses. When transitioning from the table and the Wii, Zaire flopped to the floor and began crying, kicking, and screaming. On the first day of assessment he remained on the floor for almost 1 ½ hours, until it was time to leave on the bus. During this period on the floor, the instructor first tried to repeat the demand to stand up while physically guiding Zaire to comply. When doing this, Zaire’s problem behaviors began to escalate. Next, the instructor tried standing several feet from Zaire until he stood up on his own, then moving towards him and telling him to walk with her. Zaire stood up more often during this procedure, but kept flopping back to the ground as soon as the instructor blocked him from getting back to the Wii. When it was time to leave, Zaire had to be assisted out of the building and onto the bus. On subsequent days, Zaire did not engage in problem behavior when the instructor asked him to leave the table and walk out of the classroom.

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When allowed to play independently in the natural environment teaching (NET) area, Zaire immediately jumped on the trampoline. Although he spent the majority of his time on the trampoline, he also played on a large ball, on a banana rocker, and with toys that were spread out on the floor within a few feet of the trampoline. For instance, he dumped the balls out of a gumball machine and attempted to put a marble down the marble track. Zaire moved quickly between these activities, spending up to 2 minutes at a time on the trampoline but less than 20 seconds at a time with any other activity. He also did not attempt to explore any of the shelves or toys along the walls of the large NET room, nor did he attempt to retrieve items off any of the shelves. When the instructor tried to join Zaire in his preferred activities, such as jumping on the trampoline or rocking on the banana rocker, Zaire would say “No” and attempt to push the instructor away or get up and leave the activity. He did, however, play with balloons and bubbles with the instructor without attempting to run away. When the instructor offered up various toys and activities, Zaire did not accept most things or quickly placed them to the side or behind him. If he did accept the toys, such as with the trains, the musical instruments, and a few music and movement toys, as soon as the instructor moved towards him or attempted to touch the toys he flopped to the floor or tried to move away to access a more preferred item such as the trampoline or the ball. Over the course of several days Zaire did play with some toys appropriately, such as by putting the marbles down the marble track or using a ball to knock down the bowling pins. But, he required demonstration or guidance to do the same with most other activities (e.g., putting balls in gumball machine, putting the trains on the track, playing various musical instruments). When it was time to leave, Zaire frequently had problem behavior because he was not allowed to go back and play on the Wii or because he did not want to go to the bathroom. Problem behavior included flopping, saying “No,” pushing, and crying. Over the course of several days Zaire became more compliant with the dismissal routine and transitioned to his cubby, to the bathroom, and to the chairs in the front waiting area more independently. He continued, however, to require frequent guidance and delivery of highly preferred items to sit and wait appropriately while the instructor packed up his backpack. With the exception of the first day, Zaire walked calmly out to the bus. Along the way he attempted to play in the stones, but was easily redirected to keep walking. Once on the bus he sat down with minimal guidance when provided with a snack and/or preferred activity such as his Nintendo DS. Assessment Information During the first 10 sessions, from November 1 to November 12, 2010, the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP; Sundberg, 2008) was administered in order to determine Zaire’s current levels of performance and guide the development of appropriate program objectives. The VB-MAPP is an assessment that is based upon B.F. Skinner’s Verbal Behavior (1957), an analysis in the study of language. There are five components to the VB-MAPP (i.e., Milestones Assessment, Barriers Assessment, Transition Assessment, Task Analysis, and Curriculum Placement Guide) that are used to assess language and other skills, to determine appropriate educational placements, and to assist in developing instructional objectives. Zaire was administered the Milestones Assessment and Barriers Assessment. The Milestones Assessment is designed to provide a representation of the learner’s existing verbal and related skills. Language and learning milestones are sequenced according to typical development and are separated into three levels. Level 1 ranges from birth to 18 months old, Level 2 from 18 months old to 30 months old, and Level 3 from 30 months old to 48 months old. By assessing skill development across these milestones, more effective

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and appropriate instructional objectives can be identified. The Barriers Assessment provides an assessment of 24 common learning and language acquisition barriers confronted by children with autism or other developmental disabilities. By identifying these barriers, specific instructional practices can be developed to help overcome these issues and lead to more effective learning. The Social Skills Checklist (McKinnon & Krempa, 2002) was also completed to assess Zaire’s social skill development. The Social Skills Checklist was developed to break down specific social skills within a module system. The first four modules (Joint Attention, Greetings, Social Play and Self Awareness) were completed.

These assessments were administered in both intensive teaching and natural environment settings at the Carbone Clinic over the span of these 10 days. Information provided by these assessments was used to develop appropriate and individualized goals, objectives, and specific teaching strategies. Skill areas targeted for development include mand (requesting), tact (labeling), listener responding (receptive language), play/social, motor imitation, and echoic (vocal imitation). Present Levels Mand (Requesting) Zaire met full criteria for one milestone and half criteria for another milestone within Level 1 of the Mand domain, indicating his mand repertoire is within the birth to 18 month range.

Figure 1. Mand milestones for birth to 18 months (Level 1) At the beginning of the assessment period Zaire demonstrated a weak mand repertoire that consisted mainly of problem behavior in the form of bolting and grabbing or pointing towards items visible within the environment while saying “dah wuh” (for that one). Because he had previously mastered up through Phase IV of the Picture Exchange Communication System (PECS), a PECS book provided by the family or school was made readily available to Zaire by placing it on the table directly in front of him (when at the table) or on a surface nearby him (when in the NET) throughout the first five sessions of the assessment period. Zaire attempted to

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access this book only 10 times during the first session and once during the second session. Over the next three sessions he did not attempt to use the book in any way. The majority of his attempts to use this book during the first two sessions occurred when he was engaging in problem behavior related to transitioning away from preferred items or activities. The few times that he attempted to navigate through the book when he was not engaging in problem behavior, Zaire flipped through the pages but did not select any picture and instead reverted to attempting to mand by pointing and vocalizing. For example, on one occasion he opened the book, flipped through the pages and past the pictures of the drink and the juice, pulled out an entire page and laid it to the side, then reached over the book and pointed to the juice box that was on the shelf and said “de.” When Zaire demonstrated motivation for an item and the instructor modeled the vocal mand, however, Zaire immediately emitted some approximation to that vocal mand. With relatively few trials, he began emitting independent vocal approximations on his initial mand attempt (e.g., “we” for Wii, “bo” or “buh” for bubbles, “baw” or “bawl” for ball, “duhme” for gummy). Furthermore, although the quality of these independent vocalizations was not perfect, the strength of Zaire’s echoic repertoire resulted in frequent improvement following echoic prompting by the instructor. Therefore, it was determined that mand training should be conducted by teaching Zaire to vocally mand without use of any augmentative communication system. Throughout the assessment period, mand training was conducted during intensive table teaching (ITT) and NET. Trial-by-trial mand data were recorded to assess the frequency, spontaneity, and variety of Zaire’s mand repertoire. Throughout the 10-day assessment period, Zaire emitted mands for 35 different reinforcers, with an average variety of mands for 10 different reinforcers per session. Each session Zaire emitted an average of 49 mands (i.e., about one mand every 1 minute). Of these, an average of 6 mands per session was emitted solely under the control of an MO; these mands were all “No” (when he didn’t want something) with the exception of one mand for his mom, one mand for a ball, and the occasional mand “that one” while pointing towards another room. An average of 28 mands per session was emitted under the multiple control of an MO and the presence of the item; these were primarily for the Wii or gummy candies, but also included mands for rice, jump, bubbles, and the general mand “that one” while pointing to a specific object. The remaining 15 mands per session were all emitted under the multiple control of an MO, the presence of the item, and a vocal prompt provided by the instructor; they included mands for reset (for the Wii game), juice, change, fruit snack, and a variety of other reinforcers. Trial by trial data were also used to transcribe the quality of Zaire’s vocalizations emitted while manding. These vocalizations were transcribed and scored across vocal response categories:

Speech Sounds: any vocal production that contains at least one phoneme (i.e., any C or V sound) or any combination of phonemes (not found in the adult form of the word) independent of the relevant controlling variables.

Word Approximations: any vocal production with at least two phonemes included in an adult form of an American English word and emitted more than once throughout the session under the control of relevant variables.

Intelligible Words: any word that effectively controls the behavior of an unfamiliar listener without contextual cues but does not include all phonemes of adult form under the controls of relevant variables.

Adult Form: any word that contains all the phonemes of the adult form under the control of relevant variables.

Over the 10-day assessment period, an average of 6% of Zaire’s vocal mands were emitted as speech sounds, an average of 37% of Zaire’s vocal mands were emitted as word approximations,

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an average of 0% of Zaire’s vocal mands were emitted as intelligible words, and an average of 57% of Zaire’s vocal mands were emitted as adult form. While there was a high percentage of vocal mands emitted as adult form, the mands comprising this percentage were all for Wii or no. When Zaire emitted mands without a vocal prompt (i.e., under the control of the MO and/or the presence of the item), if he did not emit an adult form vocal mand the instructor presented up to five echoic prompts to attempt to evoke an improved vocal production. Improvement of vocal responding was defined as: any vocal response that is more easily understood through the addition of appropriate phonemes or the removal of inappropriate phonemes (i.e., more closely represents the adult form of the word through the addition of appropriate phonemes or the removal of inappropriate phonemes). Following echoic prompting, an average of 35% of Zaire’s vocal mands improved. During the second week of the 10-day assessment period repetitive manding was observed to occur during an average 11% of Zaire’s mand attempts. Repetitive manding occurred when, for example, Zaire was motivated for the Wii, but instead of requesting it one time he would repetitively mand (i.e., “Wii, Wii, Wii”). When Zaire began the repetitive manding, the instructor would look away, wait for a break in repetitive manding, and then vocally prompt the correct mand. When Zaire emitted the appropriate vocal mand, the reinforcer was immediately delivered. In addition, Zaire emitted mands for items in the form of problem behavior (e.g., bolting, flopping, grabbing, kicking, standing up) and average of six times per session. When Zaire engaged in these topographies, a count and mand procedure was used. To implement this procedure the instructor stated, “there is no grabbing for (reinforcer name),” counted out loud lifting the fingers to correspond to each number counted, and then when there was a 5 second break without problem behavior the instructor vocally prompted a mand for the reinforcer. Tact (Labeling) Zaire met criteria for four of the milestones within Level 1 of the Tact domain, indicating this repertoire is at a developmental level of about 18 months.

Figure 2. Tact milestones for birth to 18 months (Level 1)

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When presented with non-verbal stimuli at the table Zaire attempted to label/tact the items by emitting some vocalization, but it was difficult as a listener to understand the vocal responses he emitted. He did tact 2 reinforcers (i.e., Wii and gummy candy), 4 objects (i.e., car, cup, dog, and ball), over 20 pictures (e.g., pig, popcorn, puzzle, shoes, TV, cow, swing), and 4 colors (i.e., red, orange, green, and blue) using vocal approximations that were intelligible enough for the listener to clearly distinguish them as relevant to the picture or object being displayed (e.g., “duhme” for gummy). Zaire did not generalize tact responses when shown different pictures of the same object (e.g., labeled only one out of three pictures of a car). He also did not emit generalized tact responses from 2-D to 3-D stimuli. In other words, he was more likely to tact a picture of an item than the actual object. Zaire also tacted the names of himself and his family members using either word approximations (e.g., “iear” for Zaire), intelligible words (e.g., “dahe” for daddy), or adult form words (e.g., “mohme” for mommy) when shown a family picture. When in the NET or classroom area Zaire never spontaneously labeled items. Listener Responding (Receptive Language) In the area of Listener Responding Level 1, Zaire met full criteria for four of the milestones and half criteria for another milestone. He also met half criteria for one of the milestones in Level 2. These results indicate that developmentally Zaire’s receptive language/listener responding repertoire is at about 18 months.

Figure 3. Listener Responding milestones for birth to 18 months (Level 1)

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Figure 4. Listener Responding milestones for 18 to 30 months (Level 2)

When he was not engaged in highly preferred activities, Zaire attended to a speaker’s voice and oriented towards the speaker upon hearing his name. He also attended to a speaker’s voice when someone cheered for him after he knocked over the bowling pins. In the NET, Zaire did not need any prompting when told to do enjoyable activities (e.g., jump on the trampoline, go bounce on the ball, or go to the rocker when he was within close proximity to those items in the NET). He did require physical prompts to follow instructions to go to areas to play with or attend to items that were not physical play items, such as musical toys, games, etc. He also required physical prompts to comply with instructions in routine situations (i.e., washing hands, taking off his jacket, and hanging up his backpack). Zaire followed demands to look at and touch reinforcing items in any position, although he only looked at a common item if it was positioned directly in front of him. He also completed 4 different actions upon request (i.e., stand up, sit down, clap, and high five), selected 8 common items (e.g., a ball, books, cat, chips, play-doh, shoes, computer, and TV), pointed to fewer than 20 items pictured in books, and pointed to himself and various members of his immediate family (i.e., his mom, dad, and sister) in a picture. Listener Responding by Function, Feature, and Class Because Zaire demonstrated such a limited a basic listener responding repertoire, listener responding by function, feature, and class was not assessed. Visual Performance Zaire met full criteria for all five milestones within Level 1 and also met criteria for one of the milestones in Level 2 of the Visual Perceptual/Match to Sample domain. According to the Milestones Assessment, Zaire’s visual performance repertoire is developmentally within the 18 to 30 month range.

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Figure 5. Visual Perception Skills and Matching-to-Sample milestones for birth-18 months (Level 1)

Figure 6. Visual Perception Skills and Matching-to-Sample milestones for 18-30 months (Level 2)

Zaire tracked moving stimuli throughout the assessment period (e.g., moving objects on the Wii, stimuli that moved across the table, and marbles going down the marble track). He picked up five pennies using a pincer grasp and attended to items in a book for 30 seconds. During the assessment he placed items in a container (e.g., bears, blocks), stacked blocks, and placed rings on pegs. Zaire also matched 12 identical sets of items (e.g., cups, bears, balls, cookies, forks) in a field of three, correctly sorted shapes (i.e., circle, square, triangle, star, and heart) and colors (i.e., red, yellow, purple, green, and blue) when given models, and completed two different 8-piece shape puzzles. Play/Social Skills To help in assessing these skill areas, observations were made of Zaire’s play and social skills during NET. These observations were structured by the VB-MAPP Milestones Assessment and

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Task Analysis (Sundberg, 2008) and by the Social Skills Checklist (Krempa & McKinnon, 2002). Zaire met full criteria for four of the milestones and met half criteria for one milestone in Level 1 in Independent Play. These results indicate that developmentally Zaire’s independent play skills are at about 18 months.

Figure 7. Independent Play milestones for birth to 18 months (Level 1)

In the area of Social Behavior and Social Play, Zaire met half criteria for one milestone in Level 1. This indicates that Zaire’s social akills are within the birth to 18 month developmental level.

Figure 8. Social Behavior and Social Play milestones for birth to 18 months (Level 1)

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When Zaire’s name was called he looked at the person who called him. Also, when Zaire’s motivation was high (i.e., during manding) he turned and oriented towards the listener as well as looked at the object that was being presented. When greeting instructors at the clinic Zaire never initiated a greeting, but he always waved and echoed “hi” when he was prompted to do so (e.g., when told “say hi”). When playing in the NET Zaire did not glance at peers, sit in close proximity to peers, pay attention to what peers were doing, or attempt to initiate any social interactions. When playing he did demonstrate a strong motivation for only one age appropriate toy, which was the Wii. He also moved between activities frequently, not staying with the activities for an appropriate amount of time; the exception to this was with the trampoline and ball. When the instructor attempted to join in activities with Zaire, he would turn his back, say “No,” push the instructor away, flop to the floor, or attempt to move away from the instructor. Zaire frequently emitted problem behavior when ending a preferred activity and transitioning to a less preferred activity. During less preferred activities the instructor had to frequently deliver previously conditioned reinforcers (i.e., edibles) to be able to sit near and talk to Zaire, to condition the new activity as a reinforcer, to reinforce appropriate play behaviors, and to compete with the value of escape. Without these teaching adjustments Zaire did not remain in one area to play for more then a minute at a time. Motor Imitation During the assessment of the Motor Imitation domain, Zaire met full criteria for four of the milestones within Level 1. This indicates that his motor imitation skills are developmentally around 18 months.

Figure 9. Motor Imitation milestones for birth to 18 months (Level 1) During the assessment Zaire was instructed to copy the motor movements of his instructor. He imitated over 40 gross motor movements involving his legs, hands, feet, and arms (e.g., kick, rub hands together, arms up, stomp foot) and 10 fine motor movements (e.g., touch index fingers or thumbs together, draw line on table with index finger). When instructed to imitate actions with objects, Zaire correctly imitated 14 movements (e.g., stack blocks, put bear in cup, slide bear, roll ball) when objects were presented in isolation but imitated only 3 movements when objects were presented in a field of three.

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Echoic (Vocal Imitation) Zaire’s echoic (vocal imitation) repertoire was assessed using the Early Echoic Skills Assessment (EESA) that is included within the VB-MAPP. This assessment evaluates vocal skills when asked to repeat a speech model. The EESA samples the echoic repertoire by looking at five different groups and gathering a total raw score by combining the scores from each group. Group 1 focuses on imitation of simple and reduplicated syllables (e.g., ah, wow, bee, oo, no no). Group 2 assesses imitation of two-syllable combinations (e.g., baby, bow wow, pokey, daddy, cookie). The imitation of three-syllable combinations is assessed in Group 3 (e.g., tubby toy, yummy food, hey me too, peek a boo). Within Group 4 the EESA assesses prosody in spoken phrases (e.g., no WAY, MY mommy, ONE bunny). In the last group, Group 5, the focus is still on assessing prosody, this time through contexts such as pitch, loudness, and duration (e.g., echoes continuous warble like a fire truck sound OO-oo-OO-oo-OO, whispering, sustains the sound oo for 3 seconds echoically). During assessment of the Echoic domain, Zaire met criteria for all of the milestones in Level 1 and met half criteria for one milestone in Level 2. This indicates that his echoic skills are at about an 18 month developmental level.

Figure 10. Echoic milestones from birth to 18 months (Level 1)

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Figure 11. Echoic milestones from 18 to 30 months (Level 2)

Zaire imitated the majority of the words within Group 1 correctly (e.g., oo, no no, me). For those that he did not imitate correctly, he still emitted a response that was recognizable (e.g., “poh” for pop). For several of the words within Group 2 and one word within Group 3 Zaire responded by emitting responses that were incorrect but still recognizable (e.g., “go e” for go eat). According to these results, Zaire’s raw score on the EESA was 40.5 points. Spontaneous Vocal Behavior Zaire met full criteria for two of the milestones and half criteria for one of the milestones in Level 1 for the Spontaneous Vocal Behavior domain. This indicates that Zaire’s spontaneous vocalization repertoire is within the developmental range of birth to 18 months.

Figure 12. Spontaneous Vocal Behavior milestones for birth to 18 months (Level 1)

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During the assessment period Zaire occasionally emitted various sounds or words when engaged in enjoyable activities, such as when playing Wii or jumping. The sounds heard were “ah, “ “e,” “wow,” “de,” “bo,” “buh,” “dah wuh,” “dah wuhn,” “dih wohn,” “duhme,” “bawl,” and “duh.” Also, on one occasion Zaire emitted a long utterance while playing on the Wii, stating, “I wohn uh babaw ga mohme.” Intraverbal This area was assessed but Zaire did not meet criteria for any of the milestones within Level 2 of the Intraverbal domain. Developmentally, his intraverbal repertoire is below 18 months.

Figure 13. Intraverbal milestones for 18 to 30 months (Level 2) Zaire occasionally but inconsistently emitted a few simple fill-in responses (e.g., “ready, set … go”), but primarily attempted to repeat the lead-in statement spoken by the instructor or just manded for the Wii when the instructor paused to allow him to respond. Classroom Routines and Group Skills Zaire did not meet any of the milestones for Level 2 of the Classroom Routines and Group Skills domain. This indicates that developmentally Zaire’s classroom and group skills are below 18 months.

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Figure 14. Classroom Routines and Group Skills milestones for 18 to 30 months (Level 2) During week two of the assessment Zaire’s group responding skills were assessed by having him attend a small group activity, circle time. The instructor brought Zaire to circle with one other peer and an unfamiliar instructor leading the group instruction. When the instructor presented the first group instruction of “clap your hands,” Zaire flopped to the floor. He remained there for the remainder of the circle time, except when he stood up to put an instrument away. The instructor attempted to use physical prompting to guide Zaire back to his seat, but he physically resisted. He did not attend to the other student, the instructor, or the instructional materials. Linguistic Structure Zaire did not meet any of the milestones for Level 2 of the Linguistic Structure domain. This indicates that Zaire’s linguistic structure is within the developmental range of birth to 18 months.

Figure 15. Linguistic Structure milestones for 18 to 30 months (Level 2)

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Although Zaire tacted more than 20 pictures or objects using approximations that were clearly specific to the relevant non-verbal stimuli, he did not emit 10 tacts that could have been understood without the context provided by seeing the non-verbal stimuli. Reading, Writing and Math Receptive selection and intraverbal naming of letters and numbers was assessed, but Zaire did not perform these skills accurately. Because Zaire did not demonstrate these prerequisite skills additional reading, writing, and math milestones within the VB-MAPP were not assessed. Personal/Self Care This area was not formally assessed, but informal observations were made when Zaire was in the bathroom. Zaire did not initiate trips to the bathroom when he had to urinate, however, he did void in the toilet when he was instructed to go (approximately every 2 hours). During the toileting routine, Zaire required physical prompts to pull down his pants and to flush the toilet. He was compliant with the demand to wash his hands, but required prompting to get soap, adequately wash his hands, turn off the water, get a towel, and to adequately dry his hands. Barriers Assessment The VB-MAPP Barriers Assessment was conducted to identify potential factors that have impeded instruction and affected Zaire’s learning across the various skill domains that were assessed. Scores indicate that there are certain factors that present moderate (score of two), persistent (score of three), or severe (score of four) barriers that may have affected Zaire’s progress within various instructional programs. These barriers have likely had a significant adverse effect on Zaire’s acquisition of new skills. Across all domains, frequent emission of problematic behaviors and poor instructional control have made it difficult for Zaire to be exposed to and benefit from instructional activities. During instruction Zaire did not attend to the instructional materials as much as he attended to other distracting stimuli within the environment, which has affected how quickly, accurately, and independently he learns new skills. Acquisition of new skills has been further impacted by Zaire’s limited variety of reinforcers, his dependence upon the use of these reinforcers to acquire new skills, and the quick loss of motivation that is observed when the response requirement becomes too effortful. As a result, Zaire has developed defective mand, tact, imitation, echoic, visual performance, listener, intraverbal, and social skills repertoires. Identifying these barriers is important because an analysis of why and how learning has been impeded can lead to the development of more precise instructional practices that are designed to decrease the impact of these barriers. With Zaire it will be necessary early on in programming to place a large focus on teaching a mand repertoire and consistently implementing effective behavior reduction procedures so as to decrease the barriers presented by high rates of problematic behaviors and poor instructional control. Precise instructional practices such as utilizing a quick pace of instruction and a dense schedule of reinforcement, maintaining an appropriate balance of easy to difficult responses, implementing errorless teaching procedures that incorporate precise and systematic prompt and prompt fading procedures, and teaching to fluency (Carbone, Morgenstern, Zecchin-Tirri, & Kolberg, 2010) will also be necessary to decrease rates of problem behaviors, improve instructional control, increase Zaire’s attention during instruction, increase Zaire’s accuracy and independence when responding, and improve his rate of acquisition of new skills. These instructional practices should be used to teach various

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instructional objectives within the mand, tact, echoic, motor imitation, and listener responding domains prior to beginning instruction in the intraverbal or social skills domains. In addition, NET should incorporate a large focus on conditioning new reinforcers and expanding Zaire’s mand repertoire prior to beginning to teach appropriate play, social, or group responding skills. Suggested Goals The following objectives were selected from the Assessment of Basic Language and Learning Skills (ABLLS; Sundberg & Partington, 1998) curriculum and are suggested as goals for instruction over the course of the next year. Mand F3 - mand for items when they are present (but not asked “what do you want?) F5 - mand for items solely under control of MO F6 - mand for others to perform actions F8 - mand for missing items needed to complete an activity Tact G1 - tact reinforcers G2 - tact common objects G4 - tact pictures of common objects Listener Responding C2 - follow instructions to do enjoyable activity in context C7 - follow instructions to do enjoyable activity out of context C8 - follow instructions in routine situations C10 - follows instructions to perform simple motor actions C23 - select common /reinforcing objects C24 - select pictures of common/reinforcing objects Listener Responding by Function, Feature, and Class No goals are suggested at this time. Visual Performance No goals are suggested at this time. Play/Social Skills K2 - independently play with cause and effect toys L3 - spontaneously look at other children L4 - engage in parallel play near other children L6 - imitate peers L7 - take objects from peers Motor Imitation D1 - motor imitation using objects D2 - motor imitation using objects in discrimination Echoic E4 - vocal imitation of words

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Spontaneous Vocal Behavior No goals are suggested at this time. Intraverbals No goals are suggested at this time. Classroom Routines and Group Skills No goals are suggested at this time. Linguistic Structure No goals are suggested at this time. Reading, Writing and Math No goals are suggested at this time. Personal/Self Help Skills No goals are suggested at this time. Problem Behavior Reduction During the 10-day assessment at the clinic, sequence analysis (Antecedent-Behavior-Consequence; ABC) data were recorded on Zaire’s problem behavior. Across the 10-day assessment period, Zaire emitted an average of 13 episodes of problem behavior lasting for an average cumulative duration of 37 minutes and 5 seconds per session. These episodes of problem behavior included the following topographies: bolting, crying, flopping, grabbing, kicking, non-compliance, pushing, screaming, standing up, throwing objects, and whining. Of the133 total episodes of problem behavior:

12 episodes occurred when Zaire was interrupted or transitioning 6 episodes occurred when Zaire was denied access to a reinforcer (told “no”) 57 episodes occurred when Zaire wanted something that he could not have 30 episodes occurred when Zaire was presented with demands at the table 10 episodes occurred when Zaire was presented with demands in the NET 18 episodes occurred when Zaire wanted something but the MO was unclear

The program to reduce problem behavior will include:

MO Manipulations/Antecedent Curricular Revisions to abolish the reflexive conditioned motivating operation (CMO-R)

Extinction of problem behavior Differential reinforcement of alternative (appropriate) behaviors Removal of the Demand followed by Escape Extinction Count and Mand Procedure for inappropriate manding during daily routines Interruption/Transition Protocol during Daily Routines Accepting No Protocol during Daily Routines

Program Management

Schedule of Reinforcement: Variable Ratio (VR) 7 60 % NET 40% ITT

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References

Carbone, V. J., Morgenstern, B., Zecchin-Tirri, G., & Kolberg, L. (2007). The role of the

reflexive conditioned motivating operation (CMO-R) during discrete trial instruction of children with autism. Journal of Early and Intensive Behavior Intervention, 4, 658-680.

McKinnon, K., & Krempa, J.L. (2002). Social skills solutions: A hands on manual for teaching

social skills to children with autism. NY: DRL Books Inc. Sundberg, M. L. (2008). VB-MAPP Verbal Behavior Milestones Assessment and Placement

Program. Concord, CA: AVB Press. Sundberg, M. L. & Partington, J. W. (1998). The assessment of basic language and learning

skills (ABLLS). Pleasant Hill, CA: Behavior Analysts, Inc.