Early Intensive Behavior Treatment

Purpose & goals

The purpose and goal of ABC’s Center Based Early Intensive Treatment Program (EIBT) is to provide 1:1 ABA programs for children from birth to 6 years 6 months, with a diagnosis of Autism or ASD.

The program is intended to increase the child’s behavioral repertoire across essential domains so that he or she will ultimately be successful in typical community environments. 

ABC is committed to providing ABA intervention directly to the child and to the training of significant caregivers so as to increase the likelihood that she or he will be able to function in as natural a context, as quickly as possible. 

Teaching objectives focus on communication, academics, socialization, self-help, and play skills. Generalization of these skills across trainers, materials, and environments is especially emphasized from the beginning of intervention. 

Competing behavior problems are also reduced primarily through a combination of increasing functionally related skill deficits and direct intervention with the behavior excesses.

Measurable Outcomes

The main focus of any child’s program is functional and educational. The acquisitions of skills are related to deficits in the child’s learning repertoire.  Each lesson has specific target responses that are observable and measurable and allow for accurate data taking.  Ongoing data and functional analyses are taken on all behavior excesses identified in order to make appropriate modifications and effectively determine if the excesses are decreasing to a satisfactory level. The ongoing data collection and analysis allows for the team to review recommendations regarding the child’s program.

Typically after 24 months of intensive behavioral treatment programming the child will transition to a less restrictive environment. It is possible that integration following a systematic fading plan could occur prior to this time frame based on the child’s own rate of progress. All programs are individualized and dependent upon on-going assessment. Specific lessons are developed to address each child’s individual deficits and learning style.  Programs begin with an assessment utilizing one if not a combination of the following formal assessment tools namely; the “Verbal Behavioral Milestones Assessment and Placement Program” (VB-MAPP), and the “Carolina Curriculum”. These instruments are re-administered on a quarterly basis, usually coinciding with IEP/IPP/IFSP and PTM update reports.

On at least a weekly basis the Behavior Analyst will update lessons as the child progresses, troubleshoot lessons where the child is having difficulty, demonstrate the hands-on implementation of new lessons and behavioral procedures (teaching strategies, behavioral techniques such as behavioral momentum, contriving establishing operations, backward chaining with leaps, play skills, etc.), and provide for the generalization of mastered lessons within ABC’s behavioral framework for teaching generalization as well as conduct parent education training. 

The child’s progress will also be reviewed regularly including analyzing the data collected on the child’s acquisition during the week to determine learning patterns, acquisition rates and the child’s learning style.

The Curriculum

Although the curricula implemented by ABC’s Center Based Early Intensive Behavior Treatment Program (EIBT) is intended to meet the basic needs of children with autism, each child’s specific program is designed to address the objectives identified in their IEP/IPP/IFSP and/or established from their Planning Team Meeting (PTM).  Many lessons taught involve concepts the child needs to know in order to learn basic play skills including independent and interactive play.  Along with basic verbal imitation lessons, language programs specific to mand and tact training are incorporated into all lessons to enhance functional communication and to increase the child’s motivation to learn.  Behavior problems that arise during programming are generally managed by extinction and/or redirection and prevention techniques.  A specific behavior plan is written if the identified behavior excess is constant throughout the child’s lesson(s) and clearly interferes with his/her acquisition rate.  All behavior excesses are managed by a “positive programming” philosophy and procedures are written in the child’s behavioral assessment/intervention reports when needed.  

ABC has developed a particular behavioral framework (Recreating Environments to Accelerate Learning - R.E.A.L) that allows us to thoroughly assess the specific generalization of concepts where these children have significant deficits.  Based on this analysis, ABC includes generalization training throughout the duration of the child’s program.  This has assisted ABC to better meet the individual program needs of the child based on his/her learning style and acquisition rate. Below is a list of sample lesson categories according to the approximate age of the child in order to illustrate the types of skills and concepts that are more appropriate for children at different levels of development.

General areas in which lessons are developed to address the child’s skills needed for successful integration/transition into school district classrooms:

• Persistence, exploring the environment, problem solving, and anticipation of upcoming events in the routine

• Mands, i.e. requests for desired items, to increase the child’s motivation for learning, basic instruction following and imitation.

• Play skills-fine and gross motor, cause and effect, independent and interactive play, and initiating play with others.

• Displaying Speaker Behavior Skills by utilizing functional language and communicative intent such as initiating wants and needs using gestures, looks, vocalization, signing or PECS (Picture Exchange Communication System). Through the appropriate response form effective for the child, tacts (i.e. labels) are taught to increase the child’s awareness of his environment and the people in it and intraverbals, (i.e. conversation) are taught to allow the child to interact and socialize with others.

• Adaptive Daily Living skills such as, dressing, grooming, hygiene, eating and toileting.

• Matching, sorting, categorizing and development of concepts (e.g. hot/cold, big/little).

• Tacting, which is labeling of objects, actions, features of property, verbs, emotions of others and self.

• Displaying Listener Behavior skills by responding correctly to communication from others in and out of programming time.

• Vocal imitation, 2-3 word sentence structuring, and vocabulary building.

• Circle time activities, pretend and imaginative play.

• Socialization skills such as engaging in conversation, displaying empathy, self-regulation, problem solving skills, complex play with peers, and participation in group learning activities.

• Generalization across ABC’s generalization levels in the areas previously listed above.

General areas in which training is provided to parents are as follows:

• Setting up the environment so that the child is successful.

• Application of basic behavior analysis principles such as reinforcement, shaping, fading, planned ignoring, and extinction.

• Teaching methods such as incidental, three term contingency, and task analyses.

• Increasing their child’s independence in Adaptive Daily Living Skill routines.

• Parent responses to correct and incorrect responses from their child.

• Promotion of verbal behavior (e.g. signs, gestures, vocals).

• Establishing and maintaining routines.

• Analysis of behavior excesses.

• Development and implementation of behavior intervention plans.

Location, Program Hours, and Staffing Ratio

The Center Based Program can accommodate up to 30 children (10 in each classroom) for 47 weeks per year as determined by the Regional Center’s schedule (i.e., following their mandatory days off schedule). Center Based is located at Keller Hall at the ABC school in Sacramento. The children provide their own lunch and snacks and all programs are individualized to provide teaching during lunch and recess relevant to feeding/eating, toileting and play skills. The children are provided with one-to-one intervention in order to establish basic repertoires.  Parent observation and training occurs within those hours at Center Based. Parent training will also occur in the home environment, the Behavior Analyst/Behavior Consultant will schedule visits to the home during training to ensure consistency in program implementation, trouble shooting problem behaviors, and addressing clinical issues.  As soon as the child demonstrates this basic repertoire he or she is provided with learning contexts with another child within the center in order to apply these skills and to develop new skills across routines throughout the day.

The program is available Monday though Friday between 8:00am and 5:00pm. Staff will be hired to cover the child’s entire schedule of programming hours.  The child’s therapy team (including the Behavior Analyst/Behavior Consultant, Lead Tutor, and Tutors) will be responsible to provide the one-to-one intervention.  Each child’s total number of hours will be based on the program hours recommended in the initial assessment. In general most children will have a 15-40 hour weekly program although some may begin with fewer hours and build up to the maximum number of programming hours as their tolerance increases. A child’s individual daily schedule is determined by their initial and ongoing assessment.  Parent observation and training will occur within those hours and determined on an individual basis.

ABC’s experience has dictated that the length of a child’s intensive behavioral treatment program is typically structured as follows:

• 9-12 months in program: Intensive 1:1 intervention implementing Applied Behavior Analysis principles and procedures.

• 9-18 months in program: Continued intensive behavioral treatment using 1:1 staffing for those specific programs that are appropriate for discrete trials training but also structured teaching on daily life routines and systematic generalization of learned concepts in functional situations in more natural environments, such as the community.

• 18-24 months in program: The use of intensive 1:1 training is limited to only those lessons where the child is not able to learn the concept in the natural environment, e.g. conversation skills, interactive play, or conflict resolution.  Even in this case the 1:1 training is not tutor-child specific but rather the tutor facilitates and uses prompts that are environmental or natural to encourage the child to learn and accept instruction and requests from Behavior Analysts/Behavior Consultants, parents, siblings and most importantly peers.  For children who have not progressed to a level where abstract learning is possible, their programs continue to be functionally based.