Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


35th Annual Convention; Phoenix, AZ; 2009

Event Details

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Symposium #470
CE Offered: BACB
Skill Acquisition: Alternatives for Teaching Tooth Brushing to Children Diagnosed With an Autism Spectrum Disorder
Monday, May 25, 2009
3:30 PM–4:50 PM
North 124 B
Area: AUT/EDC; Domain: Applied Behavior Analysis
Chair: Paula Ribeiro Braga-Kenyon (NECC)
Discussant: Cynthia R. Blackledge (UHS Schools, Inc.)
CE Instructor: Joel Hundert, Ph.D.
Abstract: Tooth brushing is an important skill for increasing independence among individuals diagnosed with an autism spectrum disorder. Commonly used training methods for teaching tooth brushing include forward or backward chaining but are not always effective. The current symposium will describe three teaching procedures for training teenagers diagnosed with autism to brush their teeth. The first study describes the use of frequent training sessions and a modified task analysis, one that isolates a few steps from the total sequence to be taught. The second study evaluates whether isolating skill deficits prior to training the tooth brushing sequence would be helpful. Deficits identified were problems with fine motor skills and the occurrence of an incompatible behavior. The third study evaluates the utility of video prompting for teaching tooth brushing. All three studies have positive results.
Tooth Brushing: Overcoming Interfering Behaviors
LEAH KARA (The New England Center for Children), Sorrel Ryan (New England Center for Children), Paul Mahoney (New England Center for Children), Paula Ribeiro Braga-Kenyon (NECC)
Abstract: The current study presents a method for training tooth brushing for two teenagers diagnosed with autism. The participants engaged in stereotypy (e.g., water play and turning on and off faucets) that interfered with skill acquisition. Tooth-brushing task analyses were modified by excluding tooth-brushing preparation steps (e.g., turning on the water and applying toothpaste). In addition, participants were required to complete multiple trials per day. Task analyses were conducted every hour during the school day. Results indicated that the inclusion of mass trials and removal of preparatory tooth-brushing steps resulted in both participants efficiently acquiring the steps of a tooth-brushing task analysis. The steps that were removed from the task analysis during skill acquisition are currently being re-introduced as part of the routine, and both students continue to make progress.
Tooth Brushing: Overcoming a Fine Motor Skill Deficit and an Incompatible Behaviors
PAUL MAHONEY (New England Center for Children), Paula Ribeiro Braga-Kenyon (NECC), Leah Kara (The New England Center for Children), Sorrel Ryan (New England Center for Children)
Abstract: The current study presents alternatives for teaching tooth brushing to one 9-year-old female diagnosed with autism. The participant was being trained on a tooth brushing sequence using a forward chain task analysis. The participant presented fine motor deficits that interfered with acquiring the step of turning the toothbrush from bottom teeth to upper teeth. In addition, the participant engaged in the incompatible behavior of sucking on the toothbrush. The specific tooth brushing steps associated with poor performance were isolated and re-trained, using a new strategy to turn the tooth brush (rolling the toothbrush on fingers instead of moving wrist); and the sequence was trained multiple times per day in a different setting, the classroom. Removal of the water was also implemented to address sucking on the toothbrush. After the two identified steps were trained to criteria, and the student met mastery criteria in the new setting, the entire task, including preparatory and terminal steps, was transferred to the natural environment; and water was again added to the sequence. Results of this study showed that identifying deficits in performance and modifying the training program to target there areas led to independent acquisition of the tooth brushing task analysis for this participant.
Tooth Brushing: Overcoming Lack of Motivation Related to a Task
SORREL RYAN (New England Center for Children), Paul Mahoney (New England Center for Children), Paula Ribeiro Braga-Kenyon (NECC), Leah Kara (The New England Center for Children)
Abstract: The current study evaluated the utility of video prompting to teach a 9-year-old boy diagnosed with autism to complete the steps of a tooth brushing chain. Forward and backward chaining procedures had been attempted and found ineffective. It was hypothesized that lack of motivation and attention to the stimuli were interfering with acquisition. At times, the student would also engage in incompatible behaviors, such as biting on the toothbrush. Direct observation indicated that the student enjoyed watching videos, suggesting the use of video prompting. Results showed that the participant learned to perform most of the steps of the tooth brushing behavior chain independently using the video prompts. In addition, progress was faster than previously attempted procedures and mastered steps were maintained over time.



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