Matthew's verbal skills were not developing as quickly as his parents hoped
When Lauren began working with Matthew, he was not forming full words regularly; instead, he was making vocal utterances. He had been receiving ABA services for about two years prior to working with Lauren. His parents biggest concern was that he was not speaking as they would have expected or hoped. He was (and is) so adorable and his vocal utterances were sufficient for his communication at the time. His adorableness did allow him, in some way, to “get away” with not forming full words. However, this could only last for so long, and we needed to start working on expressive communication to help him in his present and future. Expressive communication can help build a foundation for forming relationships, succeeding in school and eventually in work, and engaging in appropriate behaviors by using your words.
Following an initial assessment, Lauren created a treatment plan for Matthew that included progressive steps to eventually reach intraverbal behavior (answering/asking questions and/or responding to another). This began with echoic behavior, or imitating sounds. This involved Matthew imitating sounds that the adult would make. He received access to reinforcers when he correctly imitated a specific number of sounds. The plan then moved to making requests. We would set up the environment to make it more conducive for him to have to request a preferred item. He would gain access once the request was made. This started with the adult modeling the request for Mathew, then prompting him to make the request, then having him make the request independently. Next, Matthew worked on labeling items. We used the same prompting and prompt fading techniques that we used with requests. Answering questions, then asking questions, followed. Again, we started with modeling answers and questions, then eventually faded through the lower prompts to independent. Matthew’s plan, began with a thick schedule of reinforcement for each new expressive communication goal, this was thinned over time. Labeling items progressed to labeling multiple items in the sequence in which they were shown in quick succession. He then moved on to naming related items of one item, such as saying “water” and “juice” when seeing a cup. Matthew is currently working on imitating tone and cadence of words and phrases, this allows him to help show the meaning or emotion behind the words. For instance, if he says “I like it” and his voice goes up at the end, it sounds like a question; if he says it in an excited tone, it sounds like he really means it.
During parent training, Lauren worked with Matthew’s parents to help create situations in the home that would encourage Matthew to use his words. They followed the prompt fading technique, with the end goal of having Matthew initiate his words independently. He was provided reinforcement on a thick schedule that was thinned over time.
Today, Matthew is speaking and has a lot to say! His parents are thrilled with his progress. As noted above, we are working on tone and cadence with him, to ensure that listeners can differentiate between questions, answers and meaning (ie. direction vs question). He has come a long way and we are all beyond proud!
Area of concern
Matthew was not using his expressive communication in a way in which his parents had hoped he would.
The Goal
We wanted to increase Matthew's expressive communication skills to intraverbal behavior, where he would respond to others.
The Tools
We worked on verbal behavior in stages and let upon his learned skills. We conducted parent training to help encourage Matthew to use these skills within the home.
Results
Matthew now uses his words to make requests, in question format. He engages in intraverbal behavior and is working on asking his own questions. Matthew has come so far and it is amazing to see him express himself.