How Does Video Modeling Work?

Two studies* have been done in this area and they have concluded that videos depicting appropriate behaviors proves to be effective in helping children and adolescents with autism learn various social and daily living skills.

Getting Started

Usually the supervisor of your ABA program will suggest doing a video model of a social skill or daily living skill. Sometimes ABA therapists will act out in the video or get a brother or sister or even the child with autism to perform the behavior on video. Teams may also add an additional of reenacting the behavior after watching it on TV. Practice is essential in an ABA program.

There are also companies that supply videos of various social skills. Some great websites are -

• Model Me Kids
• Teach2Talk
• TD Social Skills
• Watch Me Learn

References

*Bellini, S., Akullian, J., & Hopf, A. (2007). Increasing social engagement in young children with autism spectrum disorders using video self-modeling. School Psychology Review, 36, 80-90.

*Bellini, S. & Akullian, J. (2007). A meta-analysis of video modeling and video self-modeling interventions for children and adolescents with autism spectrum disorders. Exceptional Children, 73, 261-284.

A great resource to use to help children with autism are Social Stories. Developed by Carol Gray, a Social Story describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format. It explains what is happening and why it is occurring. It is primarily used for social behaviors and routines you want to increase and those situation that are new and anxiety-provoking. Stories are always personal, positive and short. Within an ABA program, Social Stories are used to help with transitions, school routines, dentist trips, hair cut trips and any other social behavior you want increased.

Components Of The Social Story

All Social Stories should have certain components in order to make it a Social Story. There are four types of sentences found in a Social Story.

1. Descriptive Sentences – Sentences that describe where the situation occurs, the individuals involved and what they are doing and why. They also describe the social setting and the steps involved for completing the activity within the situation.
2. Perspective Sentences – These describe how other people feel and how they react to the situation. These are used primarily to reflect others’ perspectives.
3. Directive Sentences – These describe the responses the child should make and the actions to complete the activity. The behavior the child should exhibit is always described in positive terms. Since the stories are personal, sentences usually begin with, “I will try to,” or “I will work on.”
4. Control Sentences – The child usually writes these sentences and they are strategies to remind them about the social story’s information. This step doesn’t have to be used for lower-functioning or smaller children.

Social Stories Characteristics

Social Stories should always be written in the first person and describe a present or future social situation that the child is having difficulty with. A key characteristic of Social Stories is pictures or illustrations as many children with autism are visual learners. Vocabulary is appropriate to the development of the child.
When writing the story, maintain two to five descriptive sentences for every directive sentence, no matter the length of the story. Read the story to the child several times and it is always a good idea to model the behavior afterward.

Do The Following When Writing Social Stories

• Describe the setting in simple terms
• Use 1-3 sentences per page with visual representations to simplify the story
• Name the people in the story
• State the events in order
• Provide reasons why things occur
• Provide responses for the child that is appropriate for the situation

An Example Of A Social Story

Asking To Play

At school, there are many toys to play with like: cars, trains, blocks, puzzles and bead mazes.

When it is play time, all the children pick toys to share and take turns. If I want to play with a toy I must remember to:
– First go to the person and ask, “Can I play with you?” or “Do you want to play together?” or “Can I join you?”
- Next I need to wait and listen. They might say, “Okay” or “Sure” and they might say “No.” This is no big deal.

It’s important to always ask to play with a toy. When I remember to ask, my teachers and friends are happy with me.

Applied Behavioral Analysis (ABA), however, is the only scientifically based treatment available for autistic children (McEachin et al., 1994; Lovaas, 1987). As an experienced ABA therapist, ABA incorporates discrete trial teaching in which skills are broken down into minute components and systematically taught to children on a one-to-one basis. For example, since many autistic children lack imitation, ABA first teaches imitation of objects, then of body movements to finally following the leader as a way for them to naturally imitate from others (Bohdanna Popowycz Kvam, personal communication Novemeber 1, 2002). In 1987, Ivar Lovaas conducted a study on the effects of ABA on autistic children under the age of 4 with IQ scores falling in the mild to retarded category. The experimental group of 19 children received 40 hours a week of one-to-one intensive therapy while the first control group only received 10 hours a week and the second control group did not receive intensive behavioral treatment through Lovaas’ Young Autism Project (Lovaas, 1987). His short-term goals consisted of teaching compliance, imitation and appropriate toy play that many autistic children lack, generalizing treatment in the community, and reducing self-stimulatory behaviors such as hand-flapping (Lovaas, 1987). Long-term goals that were emphasized in years two and three of therapy consisted of teaching receptive and expressive language, playing with peers, teaching emotions, pre-academic skills such as reading and writing, and observational learning (Lovaas, 1987). Results and follow-up data reveal that subjects in the experimental group gained an average of 30 IQ points, and were higher than both control groups in school and intellectual functioning (Lovaas, 1987).

Of the 19 children in the experimental group, 47% achieved normal or above average IQ scores, went on to a normal first grade, and were indistinguishable from their peers (Lovaas, 1987). Subjects in both control groups had IQ scores that remained stable over time (Lovaas, 1987). McEachin, Smith and Lovaas (1993) went on to evaluate the long-term outcome of children in Lovaas’s 1987 study at a mean age of 11 ½. McEachin et al. (1993) found that the 19 children in the experimental group maintained their level of intellectual functioning and had higher scores than the control groups on adaptive behavior and personality. The children in the control groups did not gain such an outcome. In contrast, they fared poorly, which coincides with the poor prognosis of autistic children if no early intervention was administered (McEachin et al., 1993). McEachin et al. (1993) went on to state that there is reason to believe that alterations in neurological structures are possible as a result of change in the environment in the first few years of life for young children with autism, based on past studies on laboratory animals (as cited by Rutter & Schopler, 1987).

Early assessment and detection can make an extraordinary difference in the lives of autistic children. Although there was no standardized list for diagnosing autism prior to the Diagnostic Statistical Manual of Mental Disorders, Third Edition, many new assessment tools have been developed such as the CARS and CHAT (Baron-Cohen et al.,1992; Ritvo et. al, 1989) in helping with early detection. As well, before Lovaas’ research experiment on ABA, the prognosis of autism was considered to be, “very poor, and medical therapies [did] not [prove] effective” (Lovaas, 1987, p.3). Upon testing the effectiveness of ABA, Lovaas (1987) soon witnessed that behavior modification does work with autistic children to a point of bringing some of them to a normal IQ level. Currently, Lovaas (1987) revolutionized the way we think about autism; no longer is autism thought of as a, “[severe], lifelong disability” (Maurice, 1993, p.22), but is now viewed as a temporary halt in development in which ABA can “re-map” the brains of children with autism to learn from their environment.

Autism afflicts approximately 5 children per 10,000. Ritvo et al. (1989) has indicated a genetic basis in autism, but it is not considered a causal factor in the etiology since none has yet to surface. Ritvo et al. (1989) cited 20 families out of 207 having more than one autistic child. They also noted that there is no correlation between autism and racial makeup, religious affiliation, parental employment and education (Ritvo et al., 1989).

Thus, autism can “crash” into a family of any race and educational background and crush any hopes and dreams they may have had for their child. While autism is blind to race, religion, and socioeconomic status (SES), it is not blind to the sex of the child. Autism afflicts more boys than girls with a ratio of 4:1 (DSM IV, 1994). Girls are also at an increased risk of severe mental retardation and maladaptive behavior problems such as face hitting, a form of self-injurious behavior (DSM IV, 1994).

In her book, “Let Me Hear Your Voice: A Family’s Triumph over Autism” (Maurice, 1993), Catherine Maurice shared her uncertainty, confusion, and immediate hopelessness upon hearing the word autism as a description of her daughter, Anne-Marie. Indeed, many mothers and fathers feel a sense of uncertainty when their child is lining up cars instead of pushing them and confusion when their child does not respond to their own name. Most of all, parents are heart broken and feel hopeless when hearing that their beloved child has autism, for when a child is deemed autistic, they are also deemed to a, “‘severely, lifelong disability’” (Maurice, 1993, p.22). As well, parents are thrust into an unknown world that is autism and must form a path out by researching what autism is and finding appropriate treatment to help their child. Parents will soon learn that autism covers an array of characteristics and that the word “autism” lies on a continuum along with disorders such as Rhett’s, Pervasive Developmental and Asperger’s (Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, 1994). They must also weave through countless approaches to treating autism until they come across Applied Behavioral Analysis, a form of behavior modification that is scientifically proven to be successful in treating autism (Lovaas, 1987).

The Occurrence of Autism

Autism afflicts approximately 5 children per 10,000. Ritvo et al. (1989) has indicated a genetic basis in autism, but it is not considered a causal factor in the etiology since none has yet to surface. Ritvo et al. (1989) cited 20 families out of 207 having more than one autistic child. They also noted that there is no correlation between autism and racial makeup, religious affiliation, parental employment and education (Ritvo et al., 1989). Thus, autism can “crash” into a family of any race and educational background and crush any hopes and dreams they may have had for their child. While autism is blind to race, religion, and socioeconomic status (SES), it is not blind to the sex of the child. Autism afflicts more boys than girls with a ratio of 4:1 (DSM IV, 1994). Girls are also at an increased risk of severe mental retardation and maladaptive behavior problems such as face hitting, a form of self-injurious behavior (DSM IV, 1994).

Characterizing Autism

The varied behaviors of autism make the disorder extremely difficult to detect. While some children acquire language and can play appropriately, others can be mute and play in odd eccentric ways. As with many other parents, Catherine Maurice (1993) was puzzled by her daughter’s peculiar behaviors at 1 year of age. Maurice (1993), however, brushed off any of her daughter’s behaviors to, “the uniqueness of [Anne-Marie’s] personality,” since, “she was passing her regular pediatric checkups with flying colors” (p.5). It is true, as in Maurice’s (1993) case, that in approximately 20% of children, development is normal in the first 2 years of life (DSM IV, 1994). Between the second and third year of life, however, parents report a regression of language and then finally an abrupt stop in development (DSM IV, 1994). According to the DSM IV (1994), there are core deficits and excesses in autism that must occur before the age of 3 for a proper diagnosis.

Main deficits in children with autism can affect communication, play and social interaction (DSM IV, 1994). Impairments in communication are primarily associated with expressive and receptive language. Language can be delayed (DSM IV, 1994), or non-existent in which other forms of communication such as Picture Exchange Communication (PEC) might be used (Bohdanna Popowycz Kvam, personal communication, November 1, 2002). Language can also be impaired in the form of a lack of spontaneity (i.e. “I see a car”) or reciprocal statements (i.e. “Tickle my tummy”), pronoun reversal (i.e. “This is your [instead of my] bedroom”), echolalia in which children repeat words said to them and in, “pitch intonation, rate, rhythm [and] stress” (DSM IV, 1994; Schopler, Riechler, DeVellis & Daly, 1980). When children do acquire some language, it can be extremely limited and can largely encompass an array of unique idiosyncrasies such as phrases from books, movies, songs or funny sounding words like “gasoline” which can be spoken during inappropriate times (DSM IV, 1994). Not only is expressive language affected, but so is receptive understanding of spoken language. An impairment of receptive understanding may cause enormous frustration for children trying to understand language and for parents who ask children to do simple commands such as, “go get your shoes and coat” (DSM IV, 1994). Parents often complain that the first sign of something wrong was that their child did not respond to their own name (Bohdanna Popowycz Kvam, personal communication, November 1, 2002).

The areas of parallel, associative, cooperative, imaginary and interactive play can also be impaired in children with autism (DSM IV, 1994). Some children with autism unfortunately do not know how to play since they may lack imitation skills. When they do play they usually engage in perseverative play of doing the same actions over and over again. They can also form ritualistic patterns during play in which play sequences must be exactly the same each and every time (Bohdanna Popowycz Kvam, personal communication, November 1, 2002).

As well, social interaction can be severely affected since autism means to be isolated from others (Maurice, 1993). Deficits in social interaction can take the form of a lack of sustained eye contact, asking questions, nonverbal cues such as tapping a person’s shoulder to get their attention and including other people in their play (DSM IV, 1994). Children with autism also may not recognize other people as sources of social enjoyment and might prefer to be isolated from others since it is more reinforcing to be alone and comfortable than to be forced to engage with other people (Bohdanna Popowycz Kvam, personal communication, November 1, 2002).

Autism can also be characterized by a series of marked excesses. Besides perseverative and ritualistic behaviors, self-stimulatory behaviors can also exist in children with autism (Bohdanna Popowycz Kvam, personal communication, November 1, 2002; Lovaas, 1987). These behaviors appear to look odd to others since they do not represent normal development in children. Examples of self “stims” include verbal (i.e. repeating a word), visual (i.e. using your peripheral vision to look at everything) or tactile (i.e. licking books) (Bohdanna Popowycz Kvam, personal communication, November 1, 2002). Children with autism can also exhibit self-injurious behaviors or severe aggression and tantrums (DSM IV, 1994). As well, some children can be hypersensitive or hyposensitive to any of our five senses (DSM IV, 1994).

Screening Tests for Autism

There are many assessment tools for detecting autism in children, all of which have their strengths and weaknesses. One such test is the widely used Childhood Autism Rating Scale (CARS) which was developed in the 1980’s (Schopler et al., 1980). The CARS specifically looks at 15 behavioral based items in which children receive a score ranging from 1 as exhibiting normal behavior to 4 as indicative of autism on assessment of each of these 15 items (Schopler et al., 1980). Children with a total score of less than 30 are not considered autistic while a total score exceeding 36 and scores of 3 or higher on 5 of the behavioral items are considered to be severely autistic (Schopler et al., 1980). Although the CARS is an objective measure for assessing autism, suitable for children younger than 6, and measures severity of autism on a continuum, there are some flaws. Unfortunately, the CARS is relatively old and may not reflect current information on autism. As well, Schopler et al. (1980) had subjects widely dispersed in age from under 6 and over 10, making it difficult to examine young children who might have benefited from early detection. As a result, the CARS assesses children, such as at age 3, who obviously display noticeable deficits and excesses in language and social interaction. Very early detection of children less than 24 months old was thought to be difficult to find since autism affects a small proportion of children per year (Baron-Cohen, Allen & Gillberg, 1992). Baron-Cohen et al. (1992), however, have developed the Checklist for Autism in Toddlers (CHAT) which can detect autism in children as early as 18 months of age, making it an extremely useful assessment tool. The CHAT is a questionnaire for parents and looks at the behavior of the target child (Baron-Cohen et al., 1992). Parents are asked a variety of questions, some of which pertain to social play, joint attention, pointing to ask for something to indicate interest, and motor development (Baron-Cohen et al., 1992). The 3 key elements that indicate a possibility of autism are an absence of: (1) pointing at an object for joint attention; (2) gaze-monitoring or turning to look in the direction that others are looking; and (3) pretend play (Baron-Cohen et al., 1992).

Effective Treatment for Autism

Once parents have a diagnosis, research must begin for intervention, since it has been proven that early intervention greatly benefits children (Lovaas, 1987). While the types of intervention vary in their approach to helping diminish the signs of autism, most of them are not scientifically proven to be effective. Applied Behavioral Analysis (ABA), however, is the only scientifically based treatment available for autistic children (McEachin et al., 1994; Lovaas, 1987). As an experienced ABA therapist, ABA incorporates discrete trial teaching in which skills are broken down into minute components and systematically taught to children on a one-to-one basis. For example, since many autistic children lack imitation, ABA first teaches imitation of objects, then of body movements to finally following the leader as a way for them to naturally imitate from others (Bohdanna Popowycz Kvam, personal communication Novemeber 1, 2002). In 1987, Ivar Lovaas conducted a study on the effects of ABA on autistic children under the age of 4 with IQ scores falling in the mild to retarded category. The experimental group of 19 children received 40 hours a week of one-to-one intensive therapy while the first control group only received 10 hours a week and the second control group did not receive intensive behavioral treatment through Lovaas’ Young Autism Project (Lovaas, 1987). His short-term goals consisted of teaching compliance, imitation and appropriate toy play that many autistic children lack, generalizing treatment in the community, and reducing self-stimulatory behaviors such as hand-flapping (Lovaas, 1987). Long-term goals that were emphasized in years two and three of therapy consisted of teaching receptive and expressive language, playing with peers, teaching emotions, pre-academic skills such as reading and writing, and observational learning (Lovaas, 1987). Results and follow-up data reveal that subjects in the experimental group gained an average of 30 IQ points, and were higher than both control groups in school and intellectual functioning (Lovaas, 1987). Of the 19 children in the experimental group, 47% achieved normal or above average IQ scores, went on to a normal first grade, and were indistinguishable from their peers (Lovaas, 1987). Subjects in both control groups had IQ scores that remained stable over time (Lovaas, 1987). McEachin, Smith and Lovaas (1993) went on to evaluate the long-term outcome of children in Lovaas’s 1987 study at a mean age of 11 ½. McEachin et al. (1993) found that the 19 children in the experimental group maintained their level of intellectual functioning and had higher scores than the control groups on adaptive behavior and personality. The children in the control groups did not gain such an outcome. In contrast, they fared poorly, which coincides with the poor prognosis of autistic children if no early intervention was administered (McEachin et al., 1993). McEachin et al. (1993) went on to state that there is reason to believe that alterations in neurological structures are possible as a result of change in the environment in the first few years of life for young children with autism, based on past studies on laboratory animals (as cited by Rutter & Schopler, 1987).

Early assessment and detection can make an extraordinary difference in the lives of autistic children. Although there was no standardized list for diagnosing autism prior to the Diagnostic Statistical Manual of Mental Disorders, Third Edition, many new assessment tools have been developed such as the CARS and CHAT (Baron-Cohen et al.,1992; Ritvo et. al, 1989) in helping with early detection. As well, before Lovaas’ research experiment on ABA, the prognosis of autism was considered to be, “very poor, and medical therapies [did] not [prove] effective” (Lovaas, 1987, p.3). Upon testing the effectiveness of ABA, Lovaas (1987) soon witnessed that behavior modification does work with autistic children to a point of bringing some of them to a normal IQ level. Currently, Lovaas (1987) revolutionized the way we think about autism; no longer is autism thought of as a, “[severe], lifelong disability” (Maurice, 1993, p.22), but is now viewed as a temporary halt in development in which ABA can “re-map” the brains of children with autism to learn from their environment.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.,

text revision). Washington, DC: Author.

Baron-Cohen, S., Allen, J., & Gillberg (1992). Can Autism be Detected at 18 months? The Needle, the

Haystack and the CHAT. British Journal of Psychiatry, 161, 839-843.

Lovaas, O.I. (1987). Behavioral Treatment and Normal Educational and Intellectual Functioning in Young

Autistic Children. Journal of Consulting and Clinical Psychology, 55, 3-9.

Maurice, Catherine (1993). Let Me Hear Your Voice: A Family’s Triumph Over Autism. New York:

Ballantine Books.

McEachin, J., Smith, T., & Lovaas, O.I. (1993). Long-Term Outcome for Children with Autism who

Received Early Intensive Behavioral Treatment. American Journal on Mental Retardation, 97, 359-372.

Rivo, E., Freeman, B.J., Pingree, C., Mason-Brothers, A., Jorde, L., Jenson, W., et al. (1989). The UCLA-

University of Utah Epidemiologica Survey of Autism: Prevalence. American Journal of Psychiatry, 146,

194-199.

Schopler, E., Reichler, R.J., DeVellis, R.F., & Daly, K. (1980). Toward Objective Classification of

Childhood Autism: Childhood Autism Rating Scale (CARS). Journal of Autism and Developmental

Disorders, 10, 91-103.

The use of ABA therapy to teach a child with autism has changed the way we look at treatment for these individuals. In the past, some parents were told that these children did not learn and will not function in society. Limited options were given to parents of children with autism such that most children were institutionalized.

As well, mothers in the Bettleheim era were told that they were the cause of autism in their child. With such negative outlooks, it is no wonder that many parents felt hopeless in making a difference in the lives of their children.

Fortunately, Bettleheim’s “refrigerator mother” theory was disproved since autism is found to be a developmental, rather than a psychological, disorder.

Other theories about autism have surfaced since the time of Bettleheim. One such theory, behaviorism, became popular in the 1960’s, since it promoted change in children with autism.

The basic principles on which behaviorism uses is to introduce a stimulus as a method to increase or decrease the likelihood of a behavior. Since autism is objectively characterized by a series of behaviors, theorists of behaviorism felt that by changing maladaptive behaviors and teaching behaviors that were lacking in these children might result in increasing the likelihood of age-appropriate behaviors.

Applied Behavioral Analysis

One such theorist, Ivar O. Lovaas used behaviorism to teach children with autism. As well, he used a form of a teaching strategy called Discrete Trial Teaching (DTT) to maximize learning in children with autism.

In 1987, he organized the Young Autism Project to study the effects of ABA on autistic children under the age of 4 with IQ scores falling in the mild to retarded category.

His experimental group of 19 children received 40 hours a week of one-to-one intensive therapy and a control group only received 10 hours a week.

Lovaas’ short-term goals in an ABA program consisted of teaching compliance, imitation and appropriate toy play, generalizing treatment in the community, and reducing self-stimulatory behaviors such as hand-flapping. In essence, Lovaas was teaching these children skills that they lacked due to their diagnosis.

Long-term goals that were emphasized in years two and three of ABA therapy consisted of teaching language, playing with peers, emotions, pre-academic skills such as reading and writing, and observational learning.

His results revealed that children in the experimental group gained an average of 30 IQ points, and were higher than the control group in school and intellectual functioning.

Of the 19 children in the experimental group, 47% achieved normal or above average IQ scores, went on to a normal first grade, and were indistinguishable from their peers. This is a remarkable statistic considering that before the Lovaas Young Autism Project, the future of autistic individuals was bleak.

Children in the control group had IQ scores that remained stable over time (Lovaas, 1987).

In 1993, McEachin, Smith and Lovaas wanted to evaluate the long-term outcome of the children in Lovaas’ 1987 study.

They found that the 19 children in the experimental group maintained their level of intellectual functioning and had higher scores than the control group on adaptive behavior and personality at a mean age of 11.

The children in the control group did not gain such an outcome. In contrast, they fared poorly, which coincides with the poor prognosis of autistic children if no early intervention was administered.

These two reports prove that ABA is the only scientifically based treatment available at this time for children with autism.

While there are many other therapies out there for children with autism, there is no data to support them. This does not mean that ABA does not incorporate other forms of teaching.

ABA is a broad category that is not specific to children with autism. When it is applied to these children, ABA incorporates DTT, operant conditioning, with the possible use of Picture Exchange Communication (PEC) developed by Andrew Bondy, Ph.D. and Lori Frost, fluency teaching endorsed by Michael Fabrizio, errorless learning developed by Terrace, verbal behavior that is promoted by Dr. Vincent Carbone, Mark Sundberg and Jim Partington, or social stories developed by Carol Gray.
Autism Information References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. text revision). Washington, DC: Author.

Bondy, A. & Frost, L. (1994). The Picture Exchange Communication System. Focus on Autistic Behavior, 9, 1-19.

Grey, C. (2000). The New Social Stories Book. Future Horizons.

Lovaas, O.I. (1987). Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children. Journal of Consulting and Clinical Psychology, 55, 3-9.

Maurice, C. (1993). Let Me Hear Your Voice: A Family’s Triumph Over Autism. New York: Ballantine Books.

McEachin, J., Smith, T., & Lovaas, O.I. (1993). Long-Term Outcome for Children with Autism who Received Early Intensive Behavioral Treatment. American Journal on Mental Retardation, 97, 359-372.

Terrace, H.S. (1966). Stimulus control. In W.K. Honig (Ed.), Operant behavior: Areas of research and application. New York: Appleton-Century-Crofts.