SHAIMAA SALEH: QULIFIED BEHAVIOR ANALYST

Qualified Behavior Analyst (QBA)

Level Coursework

Shaimaa Saleh
Behavior Analyst (QBA)

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Autism Spectrum Disorder Basics

 Define Autism Spectrum Disorder (ASD) and common
characteristics and deficits.
Autism spectrum disorder (ASD) is a complex developmental condition
involving persistent challenges with social communication, restricted interests and
repetitive behavior. While autism is considered a lifelong condition, the need for services
and supports because of these challenges varies among individuals with autism.

While every child with ASD is unique, common characteristics include effects on the five
senses, social interactions, and emotional expression.

These are some of the characteristics of ASD:

 Problems with social interaction with others. This may include problems talking
back and forth, working, or playing with others.
 unusual interest in objects
 need for sameness
 great variation in abilities
 under or over reaction to one or more of the five senses: sight, touch, taste,
smell, or hearing
 repeated actions or body movements
 unusual emotional reactions and expressions

Children with ASD usually have difficulty with social interaction. Some parents have said
that before their child’s diagnosis of ASD, they thought their child was just very shy.

Children with ASD may have an unusual interest in objects. They may play with toys in
different or unusual ways. For example, they may be able to tell you everything you

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need to know about car engines. Or they may be able to sit for hours spinning the
wheels on a toy vehicle.

Children with ASD often have a need for sameness. They may have difficulty with
changes in routines, clothes, food, caregivers, and other parts of their environment.

Children with ASD may have great ability in one area and great difficulty in another. But
not all children with ASD have the same abilities. For example:

 A child with ASD may have difficulty holding a pencil but have a strong memory
for the words of songs or movies. On the other hand, they could be fabulous
artists or have perfect pitch.
 A child may have difficulty knowing how to play a game with a peer but may have
a very good understanding of how computers work.
 A child who does not speak may be able to build complex structures out of Lego.

Children with ASD may also have unusually strong reactions to one or more of their five
senses. For example, some children with ASD may react to bright sunlight. Others are
excessively bothered by tags on their clothing or by loud noises. Many children may be
bothered by these things, but children with ASD often have a stronger reaction to them.

Children with ASD often have difficulty with the colour, smell, or texture of certain foods.
This may limit what they will eat to only a few foods.

Children with ASD may also do the same thing over and over again. For example, they
may repeatedly flap their hands, jump, or walk on tiptoes. This is common. It is
something that many parents talk about when they describe their children. Your child
may be doing these things to help calm themself during stressful situations or to help
occupy or entertain themself.

Children with ASD may also have unusually intense and prolonged emotional reactions.
For example, they may get very angry when asked to stop playing and get ready for
lunch. These emotions do not match the situation they find themselves in. These
reactions may occur as a result of anxiety they feel when making changes in routine.

Children with ASD may talk constantly about specific things that interest them and be
unaware that other people might not have the same level of interest.

 Identify historical definitions of ASD, such as PDD-NOS

or Asperger’s Syndrome.
Autism was considered to be an expression of schizophrenia or psychosis in
childhood and the cause is the mother not loving the child.
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PDD and Asperger’s disorder are old terms, belonging to the previous
diagnostic (DSM IV) criteria. There are a total of five different PDDs,
explained below.

 Childhood autism
 Asperger’s syndrome
 Childhood disintegrative disorder
 Rett’s disease
 PDD NOS or Autism Spectrum Disorder not otherwise specified

These terms are no longer in use, as they belong to the previous (DMS IV)
criteria, but you may still hear some professionals use these when talking
about a child diagnosed with Autistic disorder prior to 2013.

A. Childhood autism

Always presents before 36 months of age, these children may have some
speech developmental and social interactive regression, usually around 18
months of age. The diagnosis of childhood autism must meet the specific
DMS IV criteria and will therefore present with poor eye contact, pervasive
ignoring, language delay, and other features. Per definition, these children
will have a severe impairment in speech, communication, or social
interaction. Many of them will be completely non-verbal and “in their own
world,” with lifelong, severe impairment.

B. Asperger’s syndrome

(Also known as just Asperger’s) is a developmental disorder. It is one form

of the autism spectrum disorder diagnosis (ASD). It causes impaired
language and communication skills as well as repetitive or restrictive
thinking and behavior. People diagnosed with Asperger’s syndrome
typically have high intelligence and no speech delays. However, they tend to
play, learn, speak, and act differently from others. Symptoms of Asperger’s
syndrome Children may appear to show signs of Asperger’s syndrome at an
early age. Signs your child may have Asperger’s syndrome include:
Obsessing over a single interest. Craving repetition and routine (and not
responding well to change). Missing social cues in play and conversation.
Not making eye contact with peers and adults. Not understanding abstract
thinking. Your child also may have trouble with pretend play, not want to be
held or touched, or have unusual reactions to noises, smells, or tastes. These

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things may be noticeable to your child’s doctor, teacher, and even to you as
a parent. See your doctor if you suspect your child’s communication and
social skills are not developing appropriately. Your doctor may refer you to
a developmental specialist.

A typical example of a child with Asperger’s syndrome would be that of a

child who has some odd behaviors, poor eye contact, “sluggish” social
interaction abilities, and an extreme interest in a central topic such as a
washing machine. The child likes to sit and watch the washing machine door
rotate, knows everything about it including its operative and professional
manual and may spend hours perseverating about it. Such a child when he
has a play date, may try to involve his “friend” in his most exciting interest
(the washing machine) without realizing how boring it is to others and that
will be the end of the play dates forever. This pattern may present itself in
different degrees and circumstances, but the prinicipal is the same: the lack
of the ability to understand how other people perceive what you do, say, or
express with body language and facial expressions.

C. Childhood disintegrative disorder

These are kids who develop normally for the first 3 years of life. Later they
seem to regress and develop some autistic features associated with a severe
functional impairment. These children must be thoroughly evaluated for the
possibility of the development of seizures, affecting the speech areas of the
brain, or Landau Kleffner syndrome (acquired epileptiform aphrasia), where
seizure activity “robs” the brain from previously acquired speech.

D. Rett’s disease

This affects only girls. These are girls who develop normally until 6 months
of age and regress. Their regression is associated with microcephaly (small
head). The head size seems to stop growing from 6 months and on, from the
time of the observed regression. Recently a specific chromosomal marker
(MEC-P-2) has been associated with this disorder and is now commercially
available in some laboratories.

E. PDD NOS

PDD NOS will present similarly to the kids who have autism, but will have
a lesser degree of a severe impairment. These kids are more likely to be
verbal and have some degree of verbal or non-verbal effective
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communication, yet they must have the autistic features (as per the DSM IV
criteria) and a severe impairment in social interaction, communication, or
repetitive stereotype behavior. This term is reserved for children with a
severe impairment who do not fully qualify for any other autistic diagnosis,
due to age of onset or combination of autistic features.

 Identify the differences between DSM IV and V.

Clinicians use criteria from a collection of guidelines called the Diagnostic
and Statistical Manual of Mental Disorders (DSM) to diagnose individuals
with autism, among other psychiatric conditions. Before 2013, the 4th
edition of the DSM (DSM-4) was used.

When the 5th edition of the DSM (DSM-5) was published, some diagnostic
and classification changes were made to some conditions based on new
research and clinical recommendations. Autism was one of these conditions.
This article explores how Autism used to be classified, and is classified
today.

How the DSM-4 classified Autism

Published in 1994 and active until 2013, the DSM-4 recognized what we
now call Autism as Autistic Disorder.

Autistic disorder was categorized as a pervasive developmental disorder

(PDD), a term used to describe conditions characterized by delays in social
and communication skills.

Autistic disorder was further classified into a sub-category of PDDs known

as ‘Autism spectrum disorder’.

DSM-4 and Autism Spectrum Disorder

This sub-category of PDDs included the following conditions: Autistic

disorder Asperger’s disorder Pervasive developmental disorder, not
otherwise specified (PDD-NOS) so, how were these three conditions
different from each other?

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Asperger’s disorder was distinguished from Autistic disorder in the DSM-4

due to a couple of factors:

No clinically significant delays or abnormalities in language acquisition

No clinically significant delays in cognitive development within the first

three years of life

PDD-NOS was distinguished from Autistic disorder and Asperger’s disorder

through its use to describe conditions with “a severe and pervasive
impairment in the development of reciprocal social interaction… or with the
presence of stereotyped behavior, interests, and activities, but the criteria are
not met for a specific pervasive developmental disorder”.

PDD-NOS encompassed presentations considered to be “atypical Autism”,

which did not meet the criteria for Autistic disorder due to any of the
following criteria:

Late age of onset Atypical symptoms Too few symptoms or symptoms with
minimal severity

DSM-4 and other Pervasive Developmental Disorders

There were other PDDs that did not have their own sub-category, including
Rett’s disorder and Childhood disintegrative disorder (CDD).

Rett’s disorder is a genetic condition characterized by multiple deficits or

regressions after a period of normal functioning or development, usually
around age one to two years. Children with Rett’s disorder develop Autistic-
like behaviors; however, only females are born with the condition.

The DSM-4 described Rett’s disorder as different from Autistic disorder

because of this pattern of its pattern of inheritance, and the fact that children
with Rett’s disorder develop specific symptoms that don’t usually affect
Autistic people specifically, like slowed rate of head growth and decreased
mobility.

CDD is a condition in which development and previously acquired skills

regress after birth, but in this case, it’s after at least two years of normal
development. This can lead to a presentation of Autistic-like behaviors.

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In the DSM-4, it was distinguished from Autistic disorder because Autistic

disorder usually presents with developmental changes within the first year of
life.

How the DSM-5 classifies Autism

The DSM-5 no longer groups developmental conditions under the label of

‘pervasive developmental disorders.’ Instead, the new edition of the
diagnostic manual introduced Autism spectrum Disorder (ASD) as a
condition in itself, rather than a categorization.

ASD provides a single name and set of criteria for the previously defined
conditions of Asperger’s disorder, Autistic disorder, PDD-NOS, CDD, and
Rett’s disorder.

Two core symptom domains characterize ASD:

Deficits in social communication and interaction Restricted repetitive

patterns of behavior, interests, and activities. Some of these conditions had
in the past been known by other names, which the DSM-5 now considers
ASD.

These included early infantile Autism, childhood Autism, Kanner’s Autism,

high-functioning Autism, and atypical Autism.

The change in criteria meant that some people no longer met the threshold
for diagnosing what was previously considered a pervasive developmental
disorder.

For this subset of individuals, a new condition was classified as social

communication disorder (SCD).

Why did the DSM-5 make this change?

The reclassification was performed due to the large crossover between these
conditions, which may have affected some people’s ability to receive an
accurate diagnosis. New research that provided updated information about
the symptoms and presentations of these previously identified conditions
bolstered this.

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In short, Autism used to be one of many conditions known as pervasive

developmental disorders. It was grouped in a sub-category known as Autism
Spectrum Disorders, along with Asperger’s disorder and PDD-NOS. Now,
Autism Spectrum Disorder is a single condition that encompasses various
presentations that affect social communication, social interaction, and
patterns of behavior, interests, and activities.

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 Identify the severity levels of ASD in the DSM V.

In 2013, the American Psychiatric Association (APA) released the fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the handbook used to
diagnose of mental disorders, including autism.

The DSM-5 introduced three ASD levels of severity: level 1 (“requiring support”), level 2
(“requiring substantial support”), and level 3 (“requiring very substantial support”). The
full-text of the DSM-5 severity levels for autism spectrum disorder (ASD) is provided
below with permission from the APA.

Severity levels for autism spectrum disorder

Level 3 autism: “Requiring very substantial support

Social communication

Severe deficits in verbal and nonverbal social communication skills cause

severe impairments in functioning, very limited initiation of social
interactions, and minimal response to social overtures from others. For
example, a person with few words of intelligible speech who rarely initiates
interaction and, when he or she does, makes unusual approaches to meet
needs only and responds to only very direct social approaches

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Restricted, repetitive behaviors

Inflexibility of behavior, extreme difficulty coping with change, or other

restricted/repetitive behaviors markedly interfere with functioning in all
spheres. Great distress/difficulty changing focus or action.

Level 2 autism: “Requiring substantial support”

Social communication

Marked deficits in verbal and nonverbal social communication skills; social

impairments apparent even with supports in place; limited initiation of social
interactions; and reduced or abnormal responses to social overtures from
others. For example, a person who speaks simple sentences, whose
interaction is limited to narrow special interests, and how has markedly odd
nonverbal communication.

Restricted, repetitive behaviors

Inflexibility of behavior, difficulty coping with change, or other

restricted/repetitive behaviors appear frequently enough to be obvious to the
casual observer and interfere with functioning in a variety of contexts.
Distress and/or difficulty changing focus or action.

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Level 1 autism: “Requiring support”

Social communication

Without supports in place, deficits in social communication cause noticeable

impairments. Difficulty initiating social interactions, and clear examples of
atypical or unsuccessful response to social overtures of others. May appear
to have decreased interest in social interactions. For example, a person who
is able to speak in full sentences and engages in communication but whose
to- and-for conversation with others fails, and whose attempts to make
friends are odd and typically unsuccessful.

Restricted, repetitive behaviors

Inflexibility of behavior causes significant interference with functioning in

one or more contexts. Difficulty switching between activities. Problems of
organization and planning hamper independence.

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 Identify the triad of primary impairments.

Introduced in 1979 by Dr. Judith Gould and Lorna Wing OBE, the Triad of
Impairments model emerged from their research on autism prevalence in
children. The model describes three significant challenges individuals with
autism might face:

1. Social Communication

Difficulty understanding and translating body language, metaphors, and

sarcasm are can all be signs of autism.

Common difficulties include:

 It can be hard for autistic adults to engage in social conversation

naturally. Many avoid social situations altogether, but this can lead to
feelings of loneliness resulting in people feeling anxious or depressed.
 Problems with social communication can manifest in an unusual use
of gaze, facial expression and gesture. This differs from the persistent
avoidance of gaze seen in shyness or depression.
 Difficulties with the non-verbal aspects of speech can make it very
hard to understand conversations, leading to problems in relationships
or at work.
 Understanding another person's opinion or point of view.

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2. Social Interaction

Many autistic people struggle with social interaction. This is when someone
finds it difficult to build and maintain friendships, work in teams and know
how to manage social situations. Difficulties may include:

Social awkwardness
Limited ways of responding socially
Finding it hard to hold conversations
Making social blunders
Coming across as unconcerned for others
Finding it hard to make or maintain friendships

3. Repetitive behaviors

A characteristic common across the autism spectrum is ‘restricted,

repetitive’ behavior. This can appear as an almost obsessive interest in a
topic, repetitive body movements, such as rocking or hand flapping,
particularly when stressed, or a strong preference for a set routine or way of
doing things and huge discomfort if this does not happen.

Restricted interests or activities are interests or hobbies that are unusual in

their intensity, content or the amount of time they absorb, particularly when
they lack a social aspect. At their most extreme, the world of an autistic
person might narrow to something (for instance, railway timetables or a TV
program) to exclude all other interests. These interests, whilst sometimes
seeming a little eccentric to others around them, are key to the autistic
person’s wellbeing and happiness

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 Identify the ‘red flags’ to early diagnosis.

The earliest sign of ASD is a lack of responsiveness. The child neither responds
to its name, nor does it attempt to make eye contact. There is a lack of imitation
of actions, speech or facial expressions. Additionally, speech delay and lack of
interaction are also observed. Some children show regression in symptoms; they
show normal development till a certain age and then regress in terms of speech,
eye contact and learning. Many parents feel like the child is "lost in its own
world". They seem unconnected to others even around their families. Certain
medical and mental health issues frequently accompany ASD. They include
gastrointestinal (GI) disorders, seizures, sleep disturbances, attention deficit and
hyperactivity disorder (ADHD), anxiety and phobias

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Developmental Red Flags (1 to 3 months)

 Doesn't seem to respond to loud noises

 Doesn't follow moving objects with eyes by 2 to 3 months
 Doesn't smile at the sound of your voice by 2 months
 Doesn't grasp and hold objects by 3 months
 Doesn't smile at people by 3 months
 Cannot support head well at 3 months
 Doesn't reach for and grasp toys by 3 to 4 months
 Doesn't bring objects to mouth by 4 months
 Doesn't push down with legs when feet are placed on a firm surface by 4
months
 Has trouble moving one or both eyes in all directions
 Crosses eyes most of the time (occasional crossing of the eyes is normal in
these first months)

Developmental Red Flags (4 to 7 months)

 Seems very stiff, tight muscles

 Seems very floppy, like a rag doll
 Head still flops back when body is pulled to sitting position (by 5months still
exhibits head lag)
 Shows no affection for the person who cares for them
 Doesn't seem to enjoy being around people
 One or both eyes consistently turn in or out
 Persistent tearing, eye drainage, or sensitivity to light
 Does not respond to sounds around them
 Has difficulty getting objects to mouth
 Does not turn head to locate sounds by 4 months
 Doesn't roll over (stomach to back) by 6 months
 Cannot sit with help by 6 months (not by themselves)
 Does not laugh or make squealing sounds by 5 months
 Does not actively reach for objects by 6 months
 Does not follow objects with both eyes
 Does not bear some weight on legs by 5 months

Developmental Red Flags (8 to 12 months)

 Does not crawl

 Drags one side of body while crawling (for over one month)

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 Cannot stand when supported

 Does not search for objects that are hidden (10-12 mos.)
 Says no single words ("mama" or "dada")
 Does not learn to use gestures such as waving or shaking head
 Does not sit steadily by 10 months
 Does not show interest in "peek-a-boo" or "patty cake" by 8 mos.
 Does not babble by 8 mos. ("dada," "baba," "mama")

Developmental Red Flags (12 to 24 months)

 Cannot walk by 18 months

 Fails to develop a mature heel-toe walking pattern after several months of
walking, or walks exclusively on toes
 Does not speak at least 15 words by 18 months
 Does not use two-word sentences by age 2
 By 15 months does not seem to know the function of common household
objects (brush, telephone, bell, fork, spoon)
 Does not imitate actions or words by 24 mos.
 Does not follow simple one-step instructions by 24 mos.

Developmental Red Flags (24 to 36 months)

 Frequent falling and difficulty with stairs

 Persistent drooling or very unclear speech
 Inability to build a tower of more than 4 blocks
 Difficulty manipulating small objects
 Inability to copy a circle by 3 years old
 Inability to communicate in short phrases
 No involvement in pretend play
 Failure to understand simple instructions
 Little interest in other children
 Extreme difficulty separating from primary caregiver

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Developmental Red Flags (3 to 4 years)

 Cannot jump in place

 Cannot ride a trike
 Cannot grasp a crayon between thumb and fingers
 Has difficulty scribbling
 Cannot copy a circle
 Cannot stack 4 blocks
 Still clings or cries when parents leave him
 Shows no interest in interactive games
 Ignores other children
 Doesn't respond to people outside the family
 Doesn't engage in fantasy play
 Resists dressing, sleeping, using the toilet
 Lashes out without any self-control when angry or upset
 Doesn't use sentences of more than three words
 Doesn't use "me" or "you" appropriately

 Identify deficits associated with ASD, such as social-

emotional reciprocity, nonverbal communication,
stereotyped motor movements, and restrictive or ritualized
behaviors, pragmatic language, etc.
Social-emotional reciprocity:

Social-emotional reciprocity is the back-and-forth interaction that takes

place in communication. We take a social approach to having conversations
with others, and we share our interests in our conversations with others. Part
of that social-emotional reciprocity is knowing how and when to initiate or
respond to others' social interactions.

Some of the skills necessary to engage in social-emotional reciprocity

include:

 Talking to someone
 Making eye contact
 Demonstrating something
 Using a chart or graph
 Writing a note, email, etc.

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Let’s examine some foundational skills that underlie these methods of

information sharing.

Joint Attention

One of the basic skills involved in social-emotional reciprocity is joint

attention. This typically develops in the first year or two of life. Joint
attention is actively paying attention to the same object or activity at the
same time with another person. We see babies do this all the time. As you're
holding a baby, for example, and he hears an airplane in the sky and sees
you look up, he'll also look up to see what it is. He may point at the airplane
and look back at you, wanting you to look back at that. This tends to be a
skill that children with autism are missing. The lack of joint attention may be
one of the early signs of autism.

Imitation

Imitation is another basic skill for social-emotional reciprocity. Parents,

teachers, and peers are all people that young children will imitate. Imitation
is one of the ways that children learn. If children with autism have that break
in that social-emotional reciprocity, if they have that break in that ability to
imitate others, then their social communication is negatively impacted.

Reciprocal Engagement

Once we have joint attention in place and we have imitation in place, then
we usually enter into that reciprocal engagement. Again, it's the back and
forth that we need to maintain long enough to learn something, enjoy
something, and share something with another person. It's paying attention to
people versus paying attention to objects. Children with autism have a
tendency to focus strongly on objects. Objects are much more predictable
than people and much easier for them to understand because of the deficits
in their social communication.

Social Communication Challenges

One of the three aspects of the triad of impairment in autism is social communication
challenges. This refers to difficulties in both verbal and nonverbal communication and
understanding social cues, which can significantly impact individuals' relationships and
daily interactions.

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Some common social communication challenges faced by individuals

with autism include:

 Literal Interpretation: Individuals with autism may have difficulty

understanding figurative language, sarcasm, or jokes that rely on non-literal
meaning.
 Difficulty with Turn-Taking: Engaging in conversations and taking turns can
be challenging for individuals with autism. They may struggle to initiate and
maintain conversations, often dominating or withdrawing from social
interactions.
 Limited Eye Contact: Maintaining eye contact during conversations may be
difficult for individuals with autism. They may look away or find it
uncomfortable to maintain eye contact.
 Lack of Facial Expressions: Individuals with autism may have difficulty
interpreting and displaying facial expressions, making it challenging to
understand others' emotions and intentions.
Understanding these difficulties can help parents provide appropriate support
and interventions to improve social communication skills

Verbal and Nonverbal Difficulties

People with autism often struggle with both verbal and nonverbal communication. On
the verbal side, these challenges can include delayed speech, limited vocabulary, and
difficulties in initiating and maintaining conversations.

 Delayed language development

 Articulation difficulties
 Atypical speech patterns
 Limited vocabulary
 Difficulty initiating and maintaining conversations
 Literal interpretation of language

To support individuals with verbal communication challenges, it is important for parents

to provide a supportive and patient environment. Encouraging speech therapy and
using visual aids or social stories can also be beneficial.

On the nonverbal front, individuals may have difficulties with eye contact, facial
expressions, and body language. These are essential elements of communication that
most people take for granted, but for someone with autism, they can be a significant
hurdle.

 Difficulty interpreting facial expressions and body language

 Limited use of gestures

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 Challenges in understanding social cues

 Difficulty expressing emotions nonverbally

To support individuals with nonverbal communication challenges, parents can focus on

building their child's understanding of nonverbal cues through visual supports, social
skills training, and role-playing. It is also important to create a safe and inclusive
environment where individuals feel comfortable expressing themselves.

Understanding the communication impairments within the triad of impairment is

essential for parents of individuals with autism. By recognizing and addressing these
challenges, parents can help their children develop effective communication skills and
enhance their overall quality of life. Remember, every individual with autism is unique,
and it is important to tailor interventions and support to meet their specific needs.

Verbal Difficulties Nonverbal Difficulties

Delayed speech Difficulty with eye contact
Limited vocabulary Challenges with facial expressions
Difficulty maintaining Body language difficulties
conversations

Restricted and Repetitive Behaviors

The third component of the triad of impairments in autism focuses on restricted and
repetitive behaviors. These behaviors can vary widely among individuals with autism
and significantly impact their daily functioning.

Types of Behaviors

Restricted and repetitive behaviors are a significant aspect of the triad of impairments in
autism. These behaviors often manifest in various ways, including repetitive body
movements, adherence to strict routines or rituals, intense focus on specific topics or
objects, and sensory sensitivities.

Some common examples of these behaviors include:

 Repetitive Movements: This can involve hand-flapping, rocking, spinning, or

repeating certain sounds or words.
 Adherence to Routines: Individuals with autism often follow strict routines or
rituals and may experience distress when these routines are disrupted.
 Intense Interests: They may show an intense focus on specific topics, objects,
or activities and spend a significant amount of time on these interests.
 Sensory Sensitivities: Many individuals with autism have heightened sensitivity
to sensory stimuli, such as lights, sounds, textures, or tastes.

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These behaviors are a significant aspect of the triad of impairments in autism and can
greatly vary from one individual to another

Restricted and repetitive behaviors can significantly impact the daily life of individuals
with autism. These behaviors can interfere with their ability to function in different
environments, such as school, work, or social settings.
For example, a strict adherence to routines can make it challenging for individuals with
autism to adapt to changes in their schedule or environment. This can result in
difficulties in transitioning between tasks or coping with unexpected occurrences.

Similarly, intense interests or sensory sensitivities can also affect their ability to engage
in a range of activities. For instance, a child with autism may refuse to participate in a
group activity at school if it does not align with their specific interest or if the
environment is too sensory stimulating.

It's important to remember that while these behaviors can present challenges, they can
also provide opportunities for support and intervention. With appropriate strategies,
individuals with autism can learn to manage these behaviors and improve their quality of
life

Pragmatic Language Challenges in Autism Spectrum Disorder (ASD)

Autism spectrum disorder affects social communication skills, making it difficult for
individuals to understand and use language in social contexts. Some specific pragmatic
language difficulties in individuals with ASD include:

 Trouble initiating and maintaining conversations

 Literal interpretation of language
 Difficulty understanding sarcasm or figurative language
 Limited use of gestures and facial expressions
 Challenges with perspective-taking and understanding others’ emotions

These challenges can have a significant impact on daily life and relationships.
Individuals with pragmatic language disorder on the autism spectrum may struggle to
make friends, participate in group activities, and navigate social situations. They may
also experience difficulties in academic settings, as communication plays a crucial role
in learning and collaboration.

IV. Identifying Pragmatic Language Disorder on the Autism Spectrum

Early identification of pragmatic language disorder is essential for providing timely

interventions and support. Parents and educators should be aware of the early signs
and red flags to look out for, such as:

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 Lack of eye contact

 Delayed language development
 Difficulty following social cues
 Repetitive or rigid language patterns

A comprehensive evaluation by a speech-language pathologist (SLP) is crucial for

diagnosing pragmatic language disorder on the autism spectrum. SLPs use various
assessment tools, such as standardized tests, observations, and interviews, to gather
information about an individual’s communication skills and social interactions. This
evaluation helps determine the appropriate interventions and therapy techniques.

V. Strategies for Supporting Individuals with Pragmatic Language Disorder on the

Autism Spectrum

Supporting individuals with pragmatic language disorder on the autism spectrum

requires a collaborative approach involving parents, educators, and therapists. Creating
a supportive environment for communication is crucial. Here are some strategies that
can be helpful:

 Use visual supports, such as social stories and visual schedules, to enhance
understanding and promote predictability.
 Engage in role-playing and social skills training to practice and generalize social
communication skills.
 Utilize video modeling techniques to demonstrate appropriate social behaviors
and interactions.
 Encourage peer interactions and provide opportunities for individuals to practice
social skills in real-life situations.

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 Identify risk factors to ASD.

Currently, the potential causes and factors that can increase your chances of having
ASD include: having a family member with ASD (including siblings or parents) exposure
to heavy metals and other environmental toxins being born male, as boys are more
likely Trusted Source to be diagnosed with ASD than girls being born to older parents
being born very premature or at a low birth weight having genetic conditions, such as
fragile X syndrome or Rett syndrome In addition, if a pregnant person takes certain
prescription drugs that have been linked to ASD, it raises the chance.

 Identify current CDC statistics and rates for the prevalence

of ASD.

The Autism and Developmental Disabilities Monitoring (ADDM) Network

of the Centers for Disease Control and Prevention (CDC) has updated the
prevalence of Autism Spectrum Disorders from 1 in 68 children in 2012, to a
staggering 1 in 59 children in 2014, which clearly indicates that the

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incidence and prevalence of autism is on the rise. It is above 4 times more

common in boys than in girls.

 Identify common co-morbid diagnoses.

Autism spectrum disorder (ASD) has a number of co-occurring physical and
mental health conditions that are crucial for general pediatricians, family
doctors, and nonspecialists to be aware of, since they provide the bulk of
healthcare services for people with ASD. These include:

 Epilepsy/seizures
 Sleep disorders/disturbance
 ADHD
 Gastrointestinal disorders
 Feeding/eating challenges
 Obesity
 Anxiety
 Depression
 Bipolar disorder

These issues can last throughout life, but may also appear or diminish at
different developmental stages. Alarmingly, multiple studies show that
people with ASD have significantly shorter lifespans not due to autism itself,
but to accompanying mental and physical health conditions.

Diagnosis of comorbidities can be challenging because many people with

ASD have difficulty recognizing and communicating their symptoms.
Physical discomfort might prompt spikes in self-soothing repetitive
behaviors as well as irritability, aggression, self-injury, and other
challenging behavioral issues. That makes it difficult to tease out whether
these behaviors are related to ASD or to physical discomfort caused by a co-
occurring condition. A brief overview follows.

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 Identify terminology related assessments and differential diagnoses, such as

pragmatic language, receptive language, expressive language, sensory-motor
skills, social skills, joint attention, restrictive or repetitive behaviors,
learning disabilities, and processing disorders.

The Applied Behavior Analysis (ABA) Skills Assessment is a widely used tool for
determining the best supports for children with autism. This assessment
measures skills across domains such as social, language, visual, motor,
independent play, early academics, and classroom skills. It is incredibly useful,
not necessarily for diagnosing autism spectrum disorders, but rather for
establishing a treatment plan that will build on a child’s strengths and set
achievable goals for growth in those domains. An ABA assessment is the first
step in putting various services in place. What types of therapy may be most
beneficial? How many ABA hours will provide sufficient support to the child and
parents? These questions and more are answered through an ABA Skills
Assessment.

Conducted as an independent evaluation, the Skills Assessment seeks to assess

whether a child is progressing within the context of the school district’s current
program, including such components as staff to student ratio, instructional
practices, and professional development opportunities for staff. If progress is not
evident, the child’s team will need to consider and establish modifications to the
child’s educational program. The results of the assessment also serve to provide
insight into what kinds of modifications may be most successful.

The ABA may require up to 20 hours of interviewing, observation, and direct

testing. Individual ABA Skills Assessments may include: the Assessment of
Functional Living Skills (AFLS), the Assessment of Basic Language and Learning
Skills (ABLLS), and the Verbal Behavior Milestones Assessment and Placement
Program or VB-MAPP. An ABA Skills Assessment may be used in conjunction
with a Neuropsychological Assessment to provide the clearest picture of a child’s
strengths and abilities.

While the Applied Behavior Analysis Skills Assessment may sound similar to a
Functional Behavior Assessment (FBA), an FBA is yet another set of
assessments, one that specifically evaluates problem behaviors. An FBA
examines the purpose of the problem behavior and the factors that may interfere
with a child’s progress. For more information on the FBA.

Understanding Receptive and Expressive Language

Receptive Language Receptive language refers to the ability to understand and

comprehend spoken or written language. It involves processing and interpreting
information from others, such as following instructions, identifying objects, comprehending
questions, and understanding concepts. Individuals with strong receptive language skills
can understand the meanings of words, sentences, and conversations. Expressive

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Language Expressive language, on the other hand, pertains to the ability to

communicate thoughts, ideas, emotions, and needs to others. It involves using words,
sentences, gestures, and nonverbal cues to convey messages. Expressive language
skills encompass speaking, signing, writing, and using communication devices.

Significance of Receptive and Expressive Language in ABA

In the context of ABA, both receptive and expressive language play vital roles in
facilitating effective communication and social interaction. Addressing these language
skills is essential for promoting academic success, building relationships, and enhancing
overall quality of life for individuals with ASD. Receptive Language Assessment:
Assessing receptive language skills involves evaluating an individual’s ability to
comprehend verbal and nonverbal information. This assessment might include tasks such
as:

 Following one-step and multi-step instructions.

 Identifying objects, colors, shapes, and body parts.
 Responding to yes/no questions.
 Matching pictures or objects to spoken words.

Intervention Strategies: Interventions for receptive language aim to improve an

individual’s understanding of language. ABA-based strategies might include:

 Using clear and concise language during instruction.

 Gradually increasing the complexity of instructions.
 Incorporating visual supports, such as visual schedules and cues.
 Providing immediate reinforcement for accurate responses.
 Creating a structured learning environment to minimize distractions.

Expressive Language Assessment: Evaluating expressive language skills involves

assessing an individual’s ability to convey thoughts, feelings, and needs through verbal
and nonverbal means. Assessment tasks might include:

 Requesting desired items or activities.

 Answering questions.
 Initiating conversations.
 Describing objects or events.
 Engaging in turn-taking during social interactions.

Intervention Strategies: Interventions for expressive language aim to develop an

individual’s ability to communicate effectively. ABA-based strategies might include:

 Implementing communication systems, such as augmentative and alternative

communication (AAC) devices.
 Teaching functional communication skills, such as requesting, rejecting, and
commenting.

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 Breaking down complex language into smaller components for teaching.

 Using prompting and fading techniques to shape appropriate language use.
 Encouraging social interactions through group activities and play.

The Importance of Individualization It’s important to note that every individual with ASD
is unique, and their receptive and expressive language skills vary widely. ABA
practitioners recognize the significance of individualized assessment and intervention
plans. What works for one individual may not work for another, emphasizing the need for
tailored approaches.

Strategies for Enhancing Communication Skills

1. Pairing and Establishing Motivation

Before addressing language skills, ABA practitioners focus on building rapport and
establishing motivation. Pairing involves associating the practitioner with positive
experiences, creating a foundation for learning.

2. Building Basic Communication

For individuals with limited or no language, ABA practitioners often start by teaching basic
communication skills. This might involve using PECS (Picture Exchange Communication
System) or other AAC methods to request desired items or activities.

3. Expanding Language Skills

As individuals progress, ABA practitioners work on expanding their language skills. This
includes teaching receptive skills (following instructions, identifying objects) and
expressive skills (requesting, labeling, commenting).

4. Generalization and Maintenance

ABA focuses on generalization—ensuring that communication skills are used across

various settings and with different communication partners. Maintenance strategies aim to
prevent the loss of acquired skills over time.

5. Functional Communication Training (FCT)

FCT is a common ABA intervention for individuals with limited language. It involves
teaching alternative, socially acceptable ways to communicate needs and wants.

6. Prompting and Prompt Fading

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ABA practitioners use prompts to guide individuals toward the correct response. Prompt
fading involves gradually reducing prompts to promote independence.

7. Reinforcement and Data Collection

Positive reinforcement is integral to ABA. Providing immediate reinforcement for correct

communication encourages individuals to use their language skills. Data collection helps
track progress and make informed decisions about intervention adjustments.

8. Collaborative Approach

Effective ABA communication interventions involve collaboration between practitioners,

families, educators, and speech therapists. Consistency across environments enhances
learning outcomes.

Social Communication and Joint Attention

In addition to receptive and expressive language, ABA communication interventions often

focus on social communication skills and joint attention. These skills are critical for
engaging in meaningful interactions and building connections with others. Social
Communication Social communication involves using language and nonverbal cues to
convey emotions, thoughts, and intentions during social interactions. This includes
understanding social cues, maintaining appropriate eye contact, taking turns in
conversations, and understanding humor and sarcasm. Joint Attention Joint attention
refers to the ability to share attention with others, often involving a shared focus on an
object or event. It’s a crucial precursor to more complex social interactions and language
development. Individuals with ASD may struggle with joint attention, impacting their ability
to engage in reciprocal conversations.

ABA Interventions for Social Communication and Joint Attention

 Modeling Social Interaction:

ABA practitioners model appropriate social interactions and cues to teach

individuals with ASD how to engage in conversations, use eye contact, and
interpret nonverbal cues.

 Visual Supports:

Visual supports, such as social stories and visual schedules, are used to help
individuals understand social expectations and navigate social situations.

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 Social Skills Training:

ABA-based social skills training focuses on teaching individuals how to initiate

conversations, ask questions, and respond appropriately in different social
contexts.

 Joint Attention Exercises:

Interventions to promote joint attention may involve games and activities that
encourage individuals to focus on and share attention with others. Gradually, joint
attention can be extended to more complex interactions.

 Demonstrate and be able to identify descriptions of social

(pragmatic) communication disorder, ASD, social emotion
reciprocity, expressive language, sensory-motor disorder,
receptive language, non-verbal, verbal communication,
executive functioning, restricted interests, join attention.
Look at page (17-22)
Executive Function Impairments

Executive functioning refers to advanced cognitive skills, such as attention,

working memory, planning, reasoning, sequencing, and flexible thinking. In
typically developing people, these skills benefit not only social interactions but
also academics, learning, self-regulation, and activities of daily living.

Individuals with ASD may have difficulty with a wide range of executive
functioning tasks, such as sequencing the order in which to dress themselves, tie
their shoes, pack for a trip, or complete a homework assignment.

Rigid, inflexible thinking is a common characteristic of individuals with ASD, and

therefore individuals may have trouble problem-solving or generating more than
one solution to a problem.

Individuals with ASD may have executive functioning difficulties at more basic
levels, such as sustaining prolonged attention to an activity, or dividing their
attention between two activities at once

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 Identify methods of diagnosis.

Methods of Diagnosis for ASD

1-Developmental Screening

2-Comprehensive Diagnostic Evaluation

 Identify typical and atypical milestones.

• Typical Milestones Social Emotional 4 years old: enjoys doing new things,
interacts with others, prefers social interaction to isolation

5 years old: show concern for others, agree to more rules, aware of gender,
more independence in social scenarios

6-8 years: more attention to friendships, wants to be liked and accepted,

thinks about tuture, understands place in the world

• Iypical Milestones: Language and Communication

4 years old: Knows basic rules of grammar, can tell stories, can say first and
last name

5 years old: speaks, tells a simple story in complete sentences, uses future
tense, says name and address.

• Typical Milestones: Cognitive

4 years old: name some colors and numbers, understand the idea of
counting, start to understand time, remember parts of a story, know the
difference between same and different, play board and card games, say what
will happen next in a book

5 years old: can count 10 or more things, can print some letters and numbers,
can copy basic geometric shapes, knows about things used everyday like
tood and money

6-8 years: rapid development of cognitive skills, more concern for others

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• Typical Milestones: Motor

4 years old: hops/stands on one foot for up to 2 seconds, catches bounced

ball most of the time, pours and cuts with supervision, mashes own food

5 years old: stands on one foot for 10 seconds or longer, hops, skips,
somersaults, use eating utensils, use the toilet independently

Typical Milestones: 4 years old

Social-Emotional: enjoys doing new things, interacts with others, prefers

social interaction to isolation

Language and Communication: knows basic rules of grammar, can tell

stories, and last name

Cognitive:

name some colors and numbers, understands the idea of counting, starts to
understand time, remembers parts of a story, knows the difference between
same and different, plays board and card games, says what will happen next
in a book

Motor:

Hops&stands on one foot for up to 2 seconds, catches bounced ball most of

the time, pours and cuts with supervision, mashes own food

• Typical Milestones 5 years old

Social-Emotional: show concern for others, agree to more rules, be aware of

gender, more independent in social scenarios

Lanquage and Communication: speaks, tells a simple story in complete

sentences, uses future tense, says name and address

Cognitive: can count 10 or more things, can print some letters and numbers,
can copy basic geometric shapes, knows about things used everyday like
food and money

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Motor: stands on one foot for 10 seconds or longer, hops, skips, somersaults,
use eating utensils, use the toilet independently

• Typical Milestones 6-8 years old

Social-Emotional: more attention to friendships, wants to be liked and

accepted, thinks about the future, understands place in the world

Cognitive: rapid development of cognitive skills, more concern for other

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Legal, Ethical, and Professional Considerations

 Demonstrate understanding of the role and scope of
practice of a QBA and responsibility to professional
standards, evidence-based practices and knowledge
of updates on new diagnostic, assessment, and
intervention strategies.
Responsibility as a Professional

Behavior analysts have an obligation to develop themselves

professionally
Promote truthful behavior and avoid creating fraudulent or illegal
situations
Accountable for their actions while practicing within scope and
competence
Remain aware of current issues, trends, and developments in the
field
Continuing education through conferences, journals, research
Avoid multiple relationships, exploitative relationships, and
discrimination
Gifts to clients, stakeholders, supervisees, or trainees must be less
than $10 in value
No sexual relationships with clients or stakeholders for a minimum
of two years after service ends
Must document that professional relationship has ended before
engaging in a relationship with supervisees or trainees
Do not accept supervisees or trainees with whom they’ve had a
relationship with until six months have passed

Responsibility in Practice

Provide effective treatment, protect confidential information, ensure

accuracy in billing and reporting
Share information only when consent is obtained, to protect the
client, to resolve a contract, or when compelled by law or court
order
Behavior analysts use non-technical language and ensure the client
understands when explaining assessments, interventions, and
plans
Behavior analysts collaborate with colleagues
Always consider medical needs first

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Select interventions that are conceptually systematic, based on

data, and minimize risk of harm
Continually evaluate behavior-change interventions
Remove or minimize environmental variables that may interfere
with service delivery
Normalization an approach to intervention where typical settings
and procedures that are socially valid and relevant to the cultural
norm are increasingly used to help integrate individuals into society

 Demonstrate understanding of the role and scope of practice for other

QABA certificants (ABAT, QASP-S) and limits to their scope of
practice.

The ABAT is an entry level interventionist who serves as a direct one-to-one

instructor. They are under the supervision of a QASP-S (mid-tier interventionist)
and/or QBA or other master’s level or above licensed or credentialed
professional.
The QASP-S is a mid-tier interventionist who serves as an experienced instructor
and may also provide training to staff/families, monitor the progress of goals and
objectives, and provide supervision to entry-level staff. They are under the
supervision of a QBA or other master’s level or above licensed or credentialed
professional.
QBAs are mastery level interventionists who provide ABA program oversight,
supervision, assessment, analysis of data, goal development, and other aspects
of treatment and ethical integrity.

 Demonstrate thorough understanding of the QABA policies,

procedures, and Code of Ethics.
Paraprofessionals provide treatment only when receiving the prescribed
supervision as outlined in QABA Policies and Procedures.
Paraprofessionals who practice independently without the appropriate
supervision and/or knowingly assist other participants to obtain
certification or re-certification by fraud or deception may be grounds for
immediate revocation or denial of certification.
Only qualified professionals as outlined in the QABA Policies and
Procedures in Candidate Handbooks) may provide supervision.
Supervision is not delegated to unqualified individuals.

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Supervisors do not need to be employed at the same site as supervisees,

but remain available in-person, via phone, email, or other appropriate
technology.
Supervisors and supervisees comply with the QABA regulations, as well
as institutional rules as they relate to supervision.

Supervisors take responsibility for those they supervise and ensure that
best practice is always adhered to, and that supervisees follow the QABA
policies and regulations, ethical code of conduct, and any governing laws
as it relates to treatment of client and client care.
Supervisors are responsible for the accuracy and effectiveness of service
provision, confidentiality, and professional development of each
supervisee.
Supervisors obtain client background information and clinical/medical
history for each client for which they supervise care.
Supervisors provide data-driven ethical treatment of all clients under their
supervision.
Supervisors provide ongoing clear and objective feedback in keeping with
the individualized goals and criteria for the supervisee at the onset of
supervision.
Supervisors ensure that all training is effectively designed and relevant to
the nature of the supervisee’s profession.
supervisors ensure that clients are notified when treatment is being
provided by a trainee, and that services will include supervisor oversight,
including disclosure of all treatment-related information.
Supervisor have a crisis plan in place and are available in-person or by
phone to assist trainees in the event of a client emergency.
Supervisors should not supervise family members, a spouse, or others
with whom they share a close relationship. In situations where this is
unavoidable, supervisors will contact the QABA board for guidance in
adhering to supervision requirements.
Supervisors refrain from supervising if they do not feel professionally,
psychologically, or physically competent to provide appropriate
supervision.
Supervisors do not require supervisees to disclose personal information
except when used to evaluate the supervisee’s competency to provide
services.
Supervisors maintain an active certificate, complete required CEUs,
obtain the appropriate training and relevant experience needed to
effectively supervise trainees. Supervisors are unable to supervise if their
certification status becomes inactive.
Prior to beginning supervision, supervisors ensure that agreements are in
place between the supervisor and supervisee that is clear, legally binding,

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and identifies objective outcomes, criteria, and termination provisions.

Both supervisor and supervisee always maintain all documentation of
supervision.
The supervisor guides and assists the trainee in correctly completing all
required documentation. Only the time periods that adhere to the
restricted definition of supervision in QABA Policy and Procedures are
calculated toward fieldwork and acknowledged on logs and verification
forms.
Will contain set fees that are fair and commensurate with the services
provided in that location, and with objectively defined terms for services.
Services are not provided under a barter agreement, unless a clear and
legally binding agreement is in place and customary for the area where
services are provided.

 Define and understand the use, benefits, and limitations of the

Health Insurance Portability and Accountability Act (HIPAA).
Health Insurance Portability and Accountability Act (HIPAA) Legislation that
provides data privacy and security provisions for safeguarding medical
information; Title II establishes national standards for processing electronic
healthcare transactions and requires healthcare organizations to implement
secure electronic access to health data

 Identify guidelines for management or records, such as retention,

storage, transportation, security, etc.

Certificants appropriately and accurately document all professional work,

to include progress, data, reports, disclosure of confidential information,
electronic communications, records in a manner consistent with scientific
and legal representation.
Certificants ensure that all records (electronic, written, and other medium)
are created, maintained, transferred, stored, and disposed of in
accordance with applicable state/country laws, HIPAA regulations, and
QABA Policies and Procedures.
Certificants maintain all client records in a confidential manner for a
minimum of 7 years after termination of services or as otherwise required
by law.

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 Summarize the legal and ethical requirements regarding client

confidentiality and its exceptions.
All information regarding clients, identifying information, diagnosis,
assessment, treatment, and prognosis are confidential.
Certificants are to comply with all privacy and confidentiality rules in the
state or country of residence/practice. In the U.S.
certificants follow the Health Insurance Portability and Accountability Act
of 1996 (HIPAA) rules and/or individual state rules/guidelines, whichever
is more stringent. Outside of the U.S., if a country has no existing privacy
or confidentiality guidelines
certificants abide by the minimum standards described in HIPAA laws and
ensure the safeguarding of the client’s privacy.
In countries other than the U.S., all communications and identifying
information in email, fax, or other written documents are to comply with
HIPAA and/or state laws and country of residence guidelines.
Certificants utilize appropriate security measures or encryption when
transferring confidential information.
All supervision through video recording or tele-supervision will be
compliant with state/country’s privacy and confidentiality laws, and HIPAA
compliant where applicable.
Certificants keep confidential all QABA examination information, other
proprietary information and will prevent unauthorized disclosures of exam
information.
Certificants maintain confidentiality of all client information.
Certificants avoid social media content with client or client-related
information, disclosure of client records, data, photographs, videos, and
discussion of clients to unauthorized individuals.
Utilizing client information for clinical discussion or presentations will only
be on a need-to-know basis and all identifying information should remain
closely guarded.
After Termination of a Relationship All privileged communications
between client and organization and/or certificant remains confidential for
the life of the client and after the client’s death.
Disclosure and Expressed Authorization Disclosure of confidential
communication is prohibited unless such disclosure is made by written or
expressed authorization, or when it is mandated by law to avoid serious
threat to the health and safety of the client or any other person
Inadvertent Disclosure of Confidential Communication
Procedures to prevent inadvertent or unauthorized disclosure of
confidential information should be observed. In the event of unauthorized
disclosure, the client should be immediately notified of the confidentiality
breach.
Clients are to also be informed of all procedures to prevent additional re-
disclosure and to mitigate any impact.

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 Identify the limits to consent for treatment.

Clients should consent to treatment prior to services and be provided
guidelines for services, confidential information, and rules for mandatory
reporting.
At the onset of services, certificants discuss and document criterion for
completion of services or criteria for discontinuing or transferring services.
Certificants obtain informed consent prior to conducting assessments,
treatment, consultative services, research, other professional services, or
any change in treatment
Informed consent will provide an explanation of the process, procedures
and/or assessment being conducted.
Informed consent will be provided in writing or approved electronic
signature form and maintained in the client’s file. Consent information is
expressed in language that is understandable to the client receiving
services.
Informed consent is obtained only from the individual receiving services,
legal caregiver, or other person legally authorized to represent the client.
Consent to share any information is obtained in writing by clients for each
specific and individual incident; except where this information protects the
client from mortal harm or when required by law.

 Define privileged information.

communication is prohibited unless such disclosure is made by written or
expressed authorization, or when it is mandated by law to avoid serious
threat to the health and safety of the client or any other person.
Procedures to prevent inadvertent or unauthorized disclosure of
confidential information should be observed. In the event of unauthorized
disclosure, the client should be immediately notified of the confidentiality
breach. Clients are to also be informed of all procedures to prevent
additional re-disclosure and to mitigate any impact.
All client-related work product remains confidential and archived up to 7
years after treatment or as indicated by HIPAA or state/country laws,
whichever is more stringent. 28
Certificants maintain confidentiality of all client information.
Certificants avoid social media content with client or client-related
information, disclosure of client records, data, photographs, videos, and
discussion of clients to unauthorized individuals.
Utilizing client information for clinical discussion or presentations will only
be on a need-to-know basis and all identifying information should remain
closely guarded.

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 Demonstrate an understanding of unethical relationships and how

those relationships may occur, including dual relationships.
Certificants avoid multiple relationships with clients, supervisors,
supervisees, colleagues, and stakeholders.
They also avoid accepting gifts which could negatively impact the
certificants’ effectiveness, objectivity or competence in their current
function. Exceptions may be made in the case of cultural consideration,
where gifts (i.e., food, tokens of appreciation) may be customary and to
refuse would be insensitive. If a multiple relationship has inadvertently
occurred, the certificant takes reasonable steps to resolve the matter and
immediately contacts the supervisor or the supervisor’s superior.
Certificants refrain from engaging in exploitative relationships with
subordinates, supervisees, clients, and any others they interact with in a
professional capacity.
Certificants avoid sexual or intimate relationships with subordinates,
supervisees, clients, and their family members or those close to clients.
Relationships with former adult clients should be avoided for a minimum of
two years.
Certificants make a reasonable attempt to identify their
personal/professional biases. They refrain from engaging in professional
roles where personal, scientific, legal, financial, or other interests impacts
their effectiveness, objectivity, or competence in their performance.

 Identify duty to warn vs. duty to protect.

Suspected misconduct or known child, elder, and/or dependent adult
abuse/neglect is immediately reported to a supervisor or department
leadership, including additional agencies as required by the certificant’s
state or country’s laws.
If certificants are aware of any Code of Ethics violation by a fellow
certificant, they are responsible for informing the certificant of the violation.
If the unethical conduct continues, the certificant will report the violation to
the QABA board. Awareness of any violation by a fellow certificant that
involves neglect, endangerment, safety, or legal consequences should be
reported to the QABA board immediately and to local authorities.
Any certificants under professional/employer investigations or facing legal
charges should report to the QABA board within three business days of
becoming aware of the investigations and/or charges.
Concern over adherence to professional standards and/or compliance with
the QABA Ethical Code of Conduct will be reported to a
supervisor/leadership within the scope of service. When in doubt, it is best
to review the code of conduct and utilize supervision relationships for
further discussion.

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Discussion of individual situations provides learning experiences for all

professionals and ensures integrity of the profession.
Certificants’ ultimate responsibility lies with the care of the client.
If a conflict of interest arises with a third party, active steps are taken to
resolve the conflict, make all issues transparent, and transition services if
no resolution can be made in the best interest of the client.

 Identify the steps in mandated reporting.

If certificants are aware of any Code of Ethics violation by a fellow
certificant, they are responsible for informing the certificant of the violation.
If the unethical conduct continues, the certificant will report the violation to
the QABA board.
Awareness of any violation by a fellow certificant that involves neglect,
endangerment, safety, or legal consequences should be reported to the
QABA board immediately and to local authorities.
Any certificants under professional/employer investigations or facing legal
charges should report to the QABA board within three business days of
becoming aware of the investigations and/or charges.

 Define and identify the use of IDEA, LRE, IEP, ADA, 504 Plan,
and the Rehabilitation Act.
Educational laws

1. Individuals with Disabilities Education Act (IDEA):

Legislation that ensures students with a disability are provided with Free
Appropriate Public Education that is tailored to their individual needs.

2. Least Restrictive Environment (LRE):

Provision in IDEA that requires students with disabilities to be educated with non-
disabled beers to the maximum extent appropriate

[Link] Education Program (IEP):

A document developed for each public school child in the U.S. who needs special
education; defines the individualized objectives of a child

[Link] with Disabilities Act (ADA)

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A civil rights law that prohibits discrimination based on disability.

5. Rehabilitation Act:

Prohibits discrimination based on disability in programs conducted by federal

agencies or funded by federal programs

6. 504 Plan:

A plan developed to ensure that a child who has a disability receives

accommodations that will ensure their academic success and access to the
learning environment

 Demonstrate understanding of compliance with IDEA, IEP, and

LRE’s.
It has been discussed in detail above

 Demonstrate the role and scope the QBA, QASP-S, and ABAT in
the IEP and LRE’s and meetings, design, and development of goals
and objectives one them.

 The ABAT

Evaluate where each child excels and where challenges arise, establishing a
baseline for intervention.
Conducting FBA (ABC) for behavioral problems.
Implementing the child’s goals in the individual learning plan (IEP).
Preparing and enrich the environment suitable for the child’s needs that
encourages him to learn and achieve therapeutic goals using various applied
behavior analysis techniques.

 The QASP-

Provide training to staff (ABAT), monitor the progress of goals and

objectives in IEP
Ensure that the educational and classroom environment is appropriate for
the child's needs in LRE

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 The role of QBAs

choosing the right data collection method based on the goals of an IEP
The role of the behavior analyst in IEP supervising the program is to notify the
other therapists on what works to motivate a child and to appropriately coordinate
the IEP objectives and learning goals to help the child achieve maximum
progress. Children can realize their greatest potential when teaching techniques
are consistent across all settings. Best results are achieved when the therapeutic
team works in synergy to implement the program in accordance with behavioral
principles.
In LRE promising a more equitable and supportive learning environment for all
students through inclusive education is transformative. By harnessing the power
of tailored, evidence-based strategies, ABA equips children with necessary skills
for academic success and personal growth.

 Identify the purpose and components of effective positive behavior

supports (PBS).
Positive behavior support plan:
Typical plans involve an objective for the intervention, prevention strategies,
replacement behaviors, reinforcers, attention to what should not be reinforced,
and ways to monitor children's progress.
Positive behavioral supports
Focus on personal competence or quality of life
4 components of a PBS plan:
Antecedent Manipulations, Alternative Skill Training, Consequence Training,
Lifestyle Intervention

 Identify the purpose, key elements, and fundamentals of person-

centered planning (PCP).
Person-centered planning (PCP - John O'Brien and Hebert Lovett Person-
centered planning is a process for identifing goals and implementing intervention
plans that stands in sharp contrast to traditional program-centered planning.
The primary authorities on the person's life direction

The person at the focus of planning and those who love the person, are the
primary authorities on the person's life direction.

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Who is involved in PCP?

The focus person & whoever they would like. Works best when there is an
unbiased facilitator & and a person record what is shared. Family members,
professionals, friends, etc may invited

 Identify the need for a risk and benefits analysis to determine

treatment, such as punishment, aggressions, SIB, etc.
Reinforcement procedures are used prior to considering punishment procedures.
If punishment procedures are necessary following evidenced-based assessment,
they are used in conjunction with a functionally equivalent reinforcement
procedure and an appropriate schedule of reinforcement.
If a punishment procedure is implemented, certificants monitor the behavior to
ensure the procedure is not having an adverse effect on the client or behavior. If
the client’s behavior puts the client’s health or safety at risk, becomes more
frequent or more intense, the procedure is immediately removed.
certificant actively protect their client from harm throughout treatment.
Reinforcers are chosen so they are not potentially hazardous to the client’s
health or safety. In addition, client specific abilities are taken into consideration
when choosing reinforcers

 Demonstrate a thorough understanding of ensuring safety in

extinction procedures, especially related to dangerous and self-
injurious behavior.
If an extinction procedure is implemented, certificants monitor the behavior to
ensure the procedure is not having an adverse effect on the client or behavior.
If the client’s behavior puts the client’s health or safety at risk, becomes more
frequent or more intense, the procedure is immediately removed.
Environmental variables are evaluated on an ongoing basis to promote the best
opportunity for success. b. In order to increase treatment efficacy, certificants
communicate with the appropriate parties about any recommended modifications
or alternatives to the client’s environment.

 Identify the need for collaboration in treatment planning and

implementation, such as behavior contracts, referral methods,
multi-team communication and assessment, treatment adherence,
etc.
At the onset of services provided at the request of a third party, a clear
explanation is provided to all parties as to the relationship, financial responsibility
to the client, and any potential conflicts and limits to confidentiality.

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Certificants’ ultimate responsibility lies with the care of the client. If a conflict of
interest arises with a third party, active steps are taken to resolve the conflict,
make all issues transparent, and transition services if no resolution can be made
in the best interest of the client.
certificants submit qualified referrals to clients when asked to provide services
outside of their scope of competence or their current training. In emergency
situations, certificants consult with a supervisor and/or receive training for the
requested service but referrals are provided as soon as possible.
Certificants advise clients to seek assessment and consultation with a 29
specialty outside the scope of behavior analysis when deemed a behavior may
relate to other factors. Specialties may include, but are not limited to: medical,
biological, developmental, speech and language, occupational therapy, physical
therapy, psychological, psychiatric, nutrition, or other related disciplines.
Certificants develop treatment plans with input and consent from the client and/or
legal guardian.
Certificants ensure that proposed interventions are in alignment with the client’s
needs, values, beliefs, and social significance.

 Identify ethical and legal responsibility in reduction and

termination of services.
Certificants take reasonable steps to transfer client care if services are
interrupted or terminated and will make a reasonable effort to coordinate care for
all aspects of treatment.
Certificants provide sufficient notice (minimum 2 weeks) to clients and employers
when there is an impending change of service.
Certificants ensure any pending client-related documentation is complete when
terminating treatment and provide any information 34 post transition that serves
in the best interest of the client’s care.
Discontinuation of services occurs if: the client requests termination, the client is
not benefiting from treatment, or the client no longer needs the service. Referrals
and alternative steps towards treatment are completed prior to discontinuation if
treatment is ineffectual unless precluded by the client or third-party payors.

 Define advocacy.
Certificants are aware of client’s legal and ethical rights and will act if those rights
have been violated or are at risk of violation.
Certificants do not engage in unfair discrimination based on age, race, ethnicity,
gender or gender identity, sexual orientation, socioeconomic status, religion,
disability, or any other basis prescribed by law.
Clients will receive accurate and thorough data, reports, and treatment progress
information that is jargon-free and presented in a clear and comprehensible
manner.
Clients may request the current valid credentials of any service provider.

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 Define self-determination.
Supervisors refrain from supervising if they do not feel professionally,
psychologically, or physically competent to provide appropriate
supervision.
Supervisors do not require supervisees to disclose personal information
except when used to evaluate the supervisee’s competency to provide
services
Certificants practice within their scope of competence as established by
their education, training and experience. Any requests to provide services
outside of the certificant’s role are to be directed to a supervisor or qualified
authority.
Certificants submit qualified referrals to clients when asked to provide
services outside of their scope of competence or their current training. In
emergency situations, certificants consult with a supervisor and/or receive
training for the requested service but referrals are provided as soon as
possible.
Certificants maintain competence through continuing education
requirements and will self-initiate any additional training and education to
provide the highest level of best practice standards of the field.
Certificants cease treatment if there are physical, psychological, or legal
factors impeding their ability to provide objective and effective treatment,
or if other issues render them ineligible to maintain the certificate.
Consultation, supervision, and transition of clients is to occur without delay.
The certificant is encouraged to seek the appropriate help to restore their
work preparedness.
Certificants’ ultimate responsibility lies with the care of the client. If a
conflict of interest arises with a third party, active steps are taken to resolve
the conflict, make all issues transparent, and transition services if no
resolution can be made in the best interest of the client.
Certificants take reasonable steps to transfer client care if services are
interrupted or terminated and will make a reasonable effort to coordinate
care for all aspects of treatment.
Certificants provide sufficient notice (minimum 2 weeks) to clients and
employers when there is an impending change of service.
Certificants ensure any pending client-related documentation is complete
when terminating treatment and provide any information 34 post transition
that serves in the best interest of the client’s care.

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Discontinuation of services occurs if: the client requests termination, the

client is not benefiting from treatment, or the client no longer needs the
service.
Referrals and alternative steps towards treatment are completed prior to
discontinuation if treatment is ineffectual unless precluded by the client or
third-party payors.
Before disclosure of any public statement or information, certificants ensure
the accuracy, context of the information and completeness of the
communication.

 Define Best Practice.

Credentialed professionals maintain the highest standards of
professional behavior and always act in the best interest of the client.
Certificants always demonstrate trustworthiness, honesty, fairness,
and sincerity.
Certificants uphold the principals of behavior analysis, utilizing scientific
methods for treatment and intervention.
Certificants engage with clients, colleagues, families, and stakeholders in
a manner that promotes honest and trustworthy working environments.
Certificants provide truthful, thorough, and accurate information to the
QABA board.
Certificants adhere to rules and regulations regarding examination and
testing procedures, audits, and safeguard any and all materials related to
examination and QABA materials.
Certificants provide accurate and prompt information to QABA regarding
application, certification and renewal. It is the responsibility of the
certificant to maintain current and accurate contact information, records,
up-to-date public registry and current employment status.
Certificants maintain competence through continuing education requirements and
will self-initiate any additional training and education to provide the highest level
of best practice standards of the field.

 Define evidence-based treatment.

Certificants develop treatment plans with input and consent from the client and/or
legal guardian.
Certificants ensure that proposed interventions are in alignment with the client’s
needs, values, beliefs, and social significance.
Certificants explain results of assessments and/or client progress in clear terms
that are jargon-free.

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Certificants develop clear and concise behavior change programs that can be
implemented by all team members.
All behavior change programs will be supported by data and/or research.
Certificants develop goals and objectives that have clear mastery criteria.
Client consent is obtained prior to any alteration of a behavior change program
which significantly changes the direction of the treatment (e.g., change in
behavior, change in procedures not previously discussed, addition or
modification of goals).
Language used in the behavior change program is written in a way that is
understandable to the client receiving services.
Behaviors and goals outlined in the behavior change program has a clear
definition and topography that is observable and measurable by all members of
the team.
Behavior plans provide clear goals necessary to client success, including
objectives, expectations, and environmental [Link] procedures
are used prior to considering punishment procedures.
If punishment procedures are necessary following evidenced-based assessment,
they are used in conjunction with a functionally equivalent reinforcement
procedure and an appropriate schedule of reinforcement.
c. If a punishment procedure is implemented, certificants monitor the behavior to
ensure the procedure is not having an adverse effect on the client or behavior. If
the client’s behavior puts the client’s health or safety at risk, becomes more
frequent or more intense, the procedure is immediately removed.

Best wishes for success and happiness

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