Home Speech-Language Pathology Put ABA to Work: Tie Behavior to Language Goals for Kids on the Spectrum

Put ABA to Work: Tie Behavior to Language Goals for Kids on the Spectrum

by Kerry Davis
Photo of marshmallows

Photo of marshmallows

(photo credit)

When I was in graduate school in the mid-90s, a family hired me to take care of their two-year old son, Jayden. He did not imitate or make any sounds. Jayden was an adorable toddler with autism who preferred to stare at the patterns on his kitchen floor or the spinning fan in his living room. His loving family flew halfway across the country several times a month to learn about the Lovaas method of applied behavioral analysis (ABA).

To get their son to speak, they flew in ABA-trained specialists, who wrote a binder of lesson plans and left them for graduate students like me to carry out. There were four fairly clueless graduate students who implemented the lessons in four-hour shifts. From our combined efforts, their little boy received eight hours of ABA services a day—every day—focused on communication and play.

Our lessons would go something like this: First, I would show Jayden a picture of an ordinary item, such as an apple. Then I would say, “Apple.” If the toddler made an approximated sound, I gave him a mini-marshmallow. We repeated this exercise in succession dozens of times. My novice grad-school self would wonder, “Does this kid understand the experience of an apple? Or does he now think an apple is a marshmallow?”

Twenty years later, I am a school-based practitioner. Eighty percent of my kids are children with autism, a majority with severe communication challenges. I work closely with several board-certified behavioral analysts, and many behaviorally trained paraprofessionals. I’ve developed an understanding of ABA principles, and the realization that reinforcement compels behaviors to continue or change. We all abide by these principles: You go to work, you get money and derive some job satisfaction. Because your duties are reinforcing (some days more than others), you continue to come into work. It is the same with language and ABA: I show you something is worth requesting, and you start to learn to ask for it by whatever means—pictures, signs, gestures—you need to.

Holistic learning

As practitioners, we must re-examine skill mastery. Mastery is beyond 4/5 opportunities in my speech session, or 8/10 trials with a paraprofessional in a cubicle. Skill mastery demands holistic consideration. We learn through schemas—that is, our experiences shape our understanding of the world. If we have no prior knowledge, then our ability to retain that information is reduced dramatically. If I talk about my vacation to the beach, we all produce a somewhat similar multi-sensory image in our head: There’s an ocean or a lake, sand and the various sounds and smells of a beach. Now imagine if you have never been to the beach (or heard of one) and someone shows you a picture. Then they hand you a marshmallow … do you think marshmallow is another word for beach? Have you really learned about a beach?

On occasion, I will inherit an individualized education program chock-full of language objectives written by someone other than an SLP. However, some of the most effective IEPs I have seen have been created through the coordinated efforts of SLPs collaborating with board-certified behavioral analysts.

Here are some good ways to keep meaningful language consideration alive and well when thinking about IEPs, communication, language and ABA principles:

Tease out language versus behavior.

Although language may provide a function, it does not always reduce behavior. This is why it is important for the team to use tools like preference assessments and functional behavior analyses. Little Susie may be pulling your hair because she wants your attention, or perhaps she is pulling your hair because she doesn’t want to wait. In the first example, the SLP could teach the language (e.g., “I want to talk to you.”). But in the second example, teaching the language “I don’t want to wait” may not be sufficient, because the child may act out anyway (picture a two-year-old being told to wait). In this case, a behavioral intervention with something other than words may be more appropriate.

Examine the language-behavior plan connection.

Behavioral support plans are a great way for the team to address behavior in a consistent way. Many behavior plans that come my way are language-laden. This is a great opportunity to work with board-certified behavioral analysts and other team members in refining what language to use with the child at his or her developmental level, while also refining functional communication.

Combine ABA with language and academic goals.

For my students whose IEPs include ABA, one great way to work on generalization through immersion is having the paraprofessional run programs that address “speech and language” goals. For many of my students who have a board-certified behavioral analyst, each goal area on the IEP has an ABA program that corresponds to each objective. I collaborate with the board-certified behavioral analyst on presentation and prompt hierarchies so that we can all agree on the student’s current performance and level of independence. Paraprofessionals take data for each program. Come progress report time, I consult the data collected from staff and combine it with my own. This allows the team to identify discrepancies in how content is delivered, and provides a great opportunity for the team to troubleshoot any issues in terms of skill mastery or curriculum modifications.

Final thoughts.

The overlap between language, communication and behavior is undeniable. Keeping language separate from behavior can ultimately compromise your teaching process’s efficiency. Schools and special education teams need to carve out opportunities for behavioral specialists and speech-language pathologists to collaborate, and think beyond the “reward” of the mini-marshmallow.

Dr. Kerry Davis is a city-wide speech-language pathologist in the Boston area. Her areas of interest include working with children with multiple disabilities, inclusion in education and professional development. The views on this blog are my own and do not represent those of my employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.

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Paula Stone,M.S.,C.C.C.-SLP March 21, 2013 - 10:22 am

Thank you for supporting the scope of practice and expertise of a SLP. It is more than getting 8/10 trials of a structured task. It is the clinical expertise of linking the child’s world to language. Not always a planned event as we cannot always predict when a child is going to make a connection to meaning. Sometimes it is a very spontaneous series of verbal and non verbal expressions facilitated by the skilled SLP’s single stimuli input and not a marshmellow.

kerry peterson March 21, 2013 - 6:43 pm

As an SLP for 25 years and a BCBA for three, I could not agree more. You do a wonderful job of explaining how the two disciplines can work cooperatively and creatively to provide the most evidence based treatment for kids with ASD.
I often say I came “kicking and screaming” to ABA….because the ABA I saw 15 years ago was nothing like what I now provide in my center-based ABA program! I encourage any SLP who specializes in ASD to consider the BCBA track. I am a much better clinician now because of it! And no BCBA should oversee a communication program for a child with ASD without the input of a great SLP!

kerry Davis March 21, 2013 - 8:10 pm

Hi Paula,
It’s funny how my perspective has changed over the years…I definitely feel ABA plays a role, and provides opportunities for structure…but the piece that’s missing is the next step….generalization into the real world. Thanks for your comments!

Clair Fortner March 21, 2013 - 9:43 pm

Any BCBA worth their salt will include targets for generalization. If generalized responding is not a part of an ABA program, there is a problem. This is the most important piece, but unfortunately often neglected.
8/10 correct trials is the industry standard for moving to the next level of difficulty, or a step down in a prompting hierarchy. It should not indicate a skill is mastered without the final step of generalization. Accomplishing this goal is best addressed by including as many people in the child’s life as possible.

Kerry DAVIS March 23, 2013 - 9:05 am

I couldn’t agree more. I travel between several schools, so the differences in philosophies on this matter can be striking. 8/10 may be a “clean” way to measure perceived mastery, but it just changing one variable (the setting, person, activity) often reveals how “mastered” a skill truly is. Thanks for your thoughts.

Diane March 22, 2013 - 9:02 am

Great comments and definition of role of SLP on a team.

Alexis hill, ms ccc-SLP March 22, 2013 - 1:05 pm

Thank you for this post, Kerry. This conversation is so relevant to my experience. I have always struggled with ABA, because it invokes in me images of an SLP alternating between forcing speech cards and then candy on a kid who’s mostly just noticing the candy. Learning happens when an activity is meaningful to the learner, and when he/she is actively involved, and generalization takes scaffolding of using a new skill in less structured settings. Like you said, the generalization part often seems to be ignored in written objectives and programming. Thank you so much for getting us thinking about this.

Kerry DAVIS March 23, 2013 - 9:09 am

Thanks for your comments. I’ve found lots and lots of modeling for staff is the key to weaning off the child (and staff) from the old stand-by reinforcers…which can be a tough sell sometimes!

cAROL wHITE March 22, 2013 - 8:00 pm

Part of the reason I came “kicking and screaming” was a reflexive need to “protect my turf”. Who were these BCBAs who were telling me about language. But your Final Thoughts section is a clear explanation of all that can be gained. However, a lingering concern of mine remains and that is the focus of some behaviorists placed on an answer or end product and the discounting of the importance of working through a process. Yet even there, I think progress is being made in bringing SLPs and BCBAs closer together through the use of techniques like webbing and thematic prompting.

Wendy Marshall March 22, 2013 - 9:45 pm

Thank you for a wonderful article. I am an Australian-based speech pathologist who works in the area of autism, and I am also part of the team that developed TOBY Playpad (www.tobyplaypad.com). I have always been a strong advocate of functional, play based intervention that engages the child so that it’s motivating and fun for them, but teaches them the skills they need to engage with their world, and the people in their world, in a functional and effective way. I couldn’t agree more with the issues raised in your article, and also the comments to the post so far. I have experienced both ends of the spectrum in terms of “ABA” – I’ve seen it done both ‘well’ and also very ‘badly’. However the holistic principles for teaching and learning that I now understand of ABA have helped me become a better speech pathologist and also a stronger advocate for children’s learning. And I have seen incredible progress. Thank you again.

kerry Davis April 16, 2013 - 4:33 pm

Nicely stated. Sometimes there seems to be a resistance to integrating ABA into a functional context…I have found this both on the part of SLPs, and on the part of ABA specialists. We are both evidence-based disciplines, which make our combined efforts that more effective.

RI Special Education March 22, 2013 - 9:55 pm

This was a great article. Real life use, being immersed in real life is what makes all the difference. You hit that right on the head. The candy/marshmallow piece always bothers me. We use the instant reward of a sticker on her chart where she needs to earn 50 stickers to earn her time on ipad which her motivator right now.

It would be great if schools and therapists can get away from the candy as the reward

Richard McManus April 14, 2013 - 5:46 pm

Excellent piece on the need to understand both speech AND behavior change tools. Another piece that is VERY important is helping the student to become a FLUENT speaker! Our work with Autistic students has frequently involved building each skill to be both more accurate and highly fluent in their speech and reading performances. Our everyday language is paced at 175 to 300 words per minute–and less fluent speech simply will not be sufficient to keep up with everyday language useage.

So ABA techniques, while an excellent place to start, are typically controlled operants–discrete trials. These are insufficient for proper language development, which requires free operant instruction and practice. A stream of behavior is critical for language impaired learners to become fully able to communicate well. In addition they must learn the social nuance behaviors that start and end conversations, and the nonverbal cues we all use to communicate with each other.

That’s a lot to learn–and needs to be done at the speeds that make the interactions meaningful and understandable.

kerry Davis April 16, 2013 - 4:37 pm

Interesting perspective, fluency is a huge part of communication that is difficult to overcome. I agree the “nuances” of communication as you noted is such a difficult task to break down, operationalize, and generalize, particularly in a discrete trial format. However, one thing I like about ABA is it makes you think of things more clearly, and break tasks down into tiny parts, which sometimes, helps you pin-point and prioritize skills.
Thanks for your post!

Richard McManus April 17, 2013 - 7:27 pm

Hi Kerry,

Actually Precision Teaching, which is as old as ABA and MUCH more data driven is primarily concerned with looking at the frequency of critical behaviors–and mostly has concerned itself with skill acquisition. Discrete Trials offer the problem of long waits, which can be especially difficult for students on the spectrum.

In a nutshell the PT approach is “Wax on, Wax off.” Se we DO the breakdown of behavior of every sort into tiny bits, just as a good task analysis would do. But we go a lot further, accelerating each of those elements of behavior to HIGH frequency skills. So we teach students to read at 120 wpm (k-2) to 200 wpm( 9th and up) aloud even if the content is limited at first. As the student masters a limited content at high speeds, we add more.

It’s a great way to teach, and to my mind the only way to get at those social nuances. The other great thinker about social exchanges is Erving Goffman, who looks at how we put on and take off social behaviors in response to varied situations. We once started work on using a combination of Goffman and PT to teach social interaction skills, with our consultant of that period, Marty Kozloff. Unfortunately there were problems at the top and I left that school. I think we were on an excellent track. Check out our website for more information–there are quite a few PT programs serving students on the spectrum exclusively.

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