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141-501: The training protocol is based on the principles of applied behavior analysis . The goal of PECS is spontaneous and functional communication. The PECS teaching protocol is based on B. F. Skinner 's book, Verbal Behavior , such that functional verbal operants are systematically taught using prompting and reinforcement strategies that will lead to independent communication. Verbal prompts are not used, thus building immediate initiation and avoiding prompt dependency. PECS begins with teaching

282-474: A social science . The field of behaviorism originated in 1913 by John B. Watson with his seminal work "Psychology as the Behaviorist Views it.". In it, Watson argued against the field of psychology's focus on consciousness and proposed the field instead focus on the relationship between stimuli and observable behavioral responses (S-R behaviorism). The field of experimental behaviorism, which

423-717: A 1997 U.S. Census Bureau report less than 10% of severely disabled individuals were employed. Despite the various barriers to employment, some AAC users achieve success in educational endeavours and employment, though often in lower paying jobs. Factors that have been found to be related to employment are a strong work ethic and access to AAC technology, the support of family and friends, education, and work skills. Individuals with ALS who use AAC may continue working; factors supporting continued employment include access to AAC, support from employers, governmental programs and others. Employers of AAC users report that skills in time management , problem solving , communication, technology and

564-419: A 1:1 teaching setting at a table using errorless discrete trial training (DTT) with a trained student therapist. The treatment was implemented at home by student therapists. Parents were trained on the teaching techniques to allow near-constant ABA instruction. During episodes of aggressive or self-stimulatory behavior, interventionists used planned ignoring, reinforcing appropriate alternative behavior, and "as

705-537: A base in a naturally occurring language. For example, the Amer-Ind code is based on Plains Indian Sign Language , and has been used with children with severe-profound disabilities, and adults with a variety of diagnoses including dementia , aphasia and dysarthria . The benefits of gestures and pantomime are that they are always available to the user, usually understood by an educated listener, and are efficient means of communicating. In contrast, sign languages have

846-427: A behavior (B) and its context (A) is because of consequences (C), more specifically, this relationship between AB because of C indicates that the relationship is established by prior consequences that have occurred in similar contexts. This antecedent–behavior–consequence contingency is termed the three-term contingency. A behavior which occurs more frequently in the presence of an antecedent condition than in its absence

987-623: A behavioral engineer" in 1959 was the first to utilize the concepts of behaviorism to effect meaningful change in the subject's behavior. The successful and meaningful use of behavior analysis in human subjects led researchers at the University of Kansas to start the Journal of Applied Behavior Analysis (JABA) in 1968. A group of researchers at the University of Washington , including Donald Baer , Sidney W. Bijou , Bill Hopkins, Jay Birnbrauer, Todd Risley , and Montrose Wolf , applied

1128-679: A communication device as helping to promote an individual's self-determination, i.e., the ability to make one's own decisions and choices. However, cultural and religious factors may affect the degree to which individual autonomy is a valued construct, and influence family attitudes towards AAC. Training can help the user make use of their AAC system to communicate effectively with others, to control their environment through communication, and to make choices, decisions and mistakes. Skilled users of AAC show communicative competence in four interrelated areas: linguistic, operational, social and strategic. Linguistic competence refers to language skills in

1269-464: A communication symbols particularly for individuals with visual impairments and/or significant intellectual impairments. Both low- and high-tech devices can incorporate the use of symbols. With low-tech devices, a communication partner is involved and must interpret the symbols chosen. Picture Communication Exchange System (PECS) is a commonly used low-tech communication system that teach individuals how to request, comment, and answer questions through

1410-724: A facilitator) guiding a disabled person to type on a keyboard or point at a letter board. It has been shown that the facilitator, rather than the disabled person, is the source of the messages generated in this way. There have been a large number of false allegations of sexual abuse made through facilitated communication . The Convention on the Rights of Persons with Disabilities defines augmentative and alternative communication as forms of communication including languages as well as display of text, large-print , tactile communication, plain language , accessible multimedia and accessible information and communications technology . The field

1551-503: A fixed positions on paper overlays, which are changed manually. To increase the vocabulary available, some static devices have multiple levels, with different words appearing on different levels. On dynamic AAC devices, the user can change the symbols available using page links to navigate to appropriate pages of vocabulary and messages. High-tech devices vary in the amount of information that they can store, as well as their size, weight and thus their portability. Access methods depend on

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1692-684: A good education are important to employers. Several studies of young adults who had used AAC since childhood report a generally good quality of life , though few lived independently, or were in paid employment. The young adults used multiple modes of communication including aided and unaided AAC approaches. More positive quality of life outcomes often correlated with better quality of communication and interaction, as well as personal characteristics, family and community support, and excellent AAC services. Poorer outcomes were related to lack of access to appropriate AAC supports and resources, problems with technology and negative attitudes. Cerebral palsy

1833-613: A head/mouth stick. Alternatively, they may indicate yes or no while a listener scans through possible options . High-tech AAC aids permit the storage and retrieval of electronic messages, with most allowing the user to communicate using speech output. Such devices are known as speech generating devices (SGD) or voice output communication aids (VOCA). A device's speech output may be digitized and/or synthesized: digitized systems play recorded words or phrases and are generally more intelligible while synthesized speech uses text-to-speech software that can be harder to understand but that permits

1974-402: A high level of success during learning, prompts are given in a most-to-least sequence and faded systematically. During this process, prompts are faded as quickly as possible so that the learner does not come to depend on them and eventually behaves appropriately without prompting. The overall goal is for an individual to eventually not need prompts. As an individual gains mastery of a skill at

2115-474: A last resort...the delivery of a loud "no" or a slap on the thigh contin- gent upon the presence of the undesirable behavior." The outcome of this study indicated 47% of the experimental group (9/19) went on to lose their autism diagnosis and were described as indistinguishable from their typically developing adolescent peers. This included passing general education without assistance and forming and maintaining friendships. These gains were maintained as reported in

2256-468: A linguistic base and permit the expression of an unlimited number of messages. Approaches to signing can be divided into two major categories, those that encode an existing language, and those that are languages in their own right. In the United States of America, Signing Exact English may be considered the most widely used example of the former and American Sign Language as a common example of

2397-427: A mix of flexibility, simplicity, and associated reliability. In this case, a keyboard and audio speaker are configured to be create a "talking keyboard" where typed text is spoken directly in an audio speaker. This allows any phrase to be spoken as it is typed using unlimited vocabulary text-to-speech conversion. One simple benefit is that a talking keyboard, when used with a standard telephone or speakerphone can enable

2538-486: A modest increase in speech production. Users who have grown up with AAC report satisfying relationships and life activities; however, they may have poor literacy and are unlikely to be employed . While most AAC techniques controlled by the user are reliable, two techniques ( facilitated communication and the rapid prompting method ) have arisen which falsely claim to allow people with intellectual disabilities to communicate. These techniques involve an assistant (called

2679-423: A particular boost has been given before the objective way of behaving happens. In applied behavior analysis, all experiments should include the following: Task analysis is the process of breaking down a multi-step instruction into its component parts. The student is then taught to complete a task analysis through chaining. For example, a task analysis of washing hands might include the following steps: Turn on

2820-436: A particular prompt level, the prompt is faded to a less intrusive prompt. This ensures that the individual does not become overly dependent on a particular prompt when learning a new behavior or skill. One of the primary choices that was made while showing another way of behaving is the manner by which to fade the prompts or prompts. An arrangement should be set up to fade the prompts in an organized style. For instance, blurring

2961-455: A phenomenon. Despite not being directly tied to specific dimensions, these measures provide valuable supplemental information. In applied behavior analysis (ABA), for example, percentage is a derivative measure that quantifies the ratio of specific responses to total responses, offering a nuanced understanding of behavior and assisting in evaluating progress and intervention effectiveness . Trials-to-criterion, another ABA derivative measure, tracks

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3102-496: A prompt being removed, where thinning refers to an increase in the time or number of responses required between reinforcements. Periodic thinning that produces a 30% decrease in reinforcement has been suggested as an efficient way to thin. Schedule thinning is often an important and neglected issue in contingency management and token economy systems, especially when these are developed by unqualified practitioners (see professional practice of behavior analysis ). Generalization

3243-407: A reason, and the cause can be understood based on the subject's learning history and current conditions. This represents a shift away from methodological behaviorism , which restricts behavior-change procedures to behaviors that are overt, and was the conceptual underpinning of behavior modification . Behavior analysts emphasize that the science of behavior must be a natural science as opposed to

3384-504: A recent review of several peer-reviewed studies found that "there is no evidence within the reviewed studies to suggest that PECS inhibited speech; to the contrary, if any effect was observed, it was facilitative rather than inhibitory." When difficulties do arise, it is often due to a lack of powerful reinforcers and/or trainer error. A systematic review of interventions for children with autism spectrum disorder reported that use of PECS resulted in short-term improvement in word acquisition, but

3525-421: A response class. Repertoire refers to the various responses available to an individual; the term may refer to responses that are relevant to a particular situation, or it may refer to everything a person can do. Operant behavior is voluntary behavior that is sensitive to, or controlled by its consequences. Specifically, operant conditioning refers to the three-term contingency that uses stimulus control . In

3666-469: A role. The most literate AAC users often report having access to abundant reading and writing material at home as well as in school during childhood. Studies have shown that many children who use AAC have literacy experiences that are reduced quality, quantity, and opportunity at home and at school as compared to children without disabilities. Research suggests that with explicit reading instruction, AAC users can develop good literacy skills. According to

3807-411: A sequence to produce words or phrases. Prediction is a rate enhancement strategy in which the device attempts to predict the letter, word or phrase being written by the user. The user can then select the correct prediction without needing to write the full word. Word prediction software may determine the words predicted based on their frequency in language, association with other words, past choices of

3948-409: A series of articles that described a pioneering investigation of the antecedents and consequences that maintained a problem behavior, including the use of electric shock on autistic children to suppress stimming and meltdowns (described as "self-stimulatory behavior" and " tantrum behaviors" respectively) and to coerce "affectionate" behavior, and relied on the methods of errorless learning which

4089-420: A single session. Phase 4 – using phrases: Within phase 4, the student learns to construct simple sentences on a detachable sentence strip making requests such as "I want ____ ". The requests consist of a sentence starter, "I want", and a picture of the desired activity or item. The communicative partner reads back the sentence after it has been exchanged by the student. After the student has learned to construct

4230-528: A small number of words frequently, in a core-fringe vocabulary organization, the words and messages that are communicated most frequently appear on a "main page". The fringe vocabulary—words and messages used more rarely and that are specific to an individual—appear on other pages. Symbols may also be organized by category, grouping people, places, feelings, foods, drinks, and action words together. Another form of grid organization groups vocabulary according to specific activities. Each display contains symbols for

4371-1489: A speech disorder resulting from neurological damage to the motor-speech system, occurs in an estimated 31% to 88% of those with cerebral palsy. Such individuals may require AAC support for communication. Approximately one half to one third have some degree of intellectual impairment, and visual and hearing problems are also common. Gross and fine motor challenges are often of particular concern in accessing an AAC device. Appropriate seating and positioning are important to facilitate optimum stability and movement. Extensive motor training and practice may be required to develop efficient AAC access and use. The trend towards custom-placed sensors and personalized signal processing may assist in facilitating communication for those who are incapable of using other AAC technologies. Individuals with intellectual impairments face challenges in developing communication skills, including problems with generalization (the transfer of learned skills into daily activities). They may lack communication opportunities in their daily lives, and responsive communicators who understand their communication methods. AAC intervention for this population emphasizes partner training as well as opportunities for integrated, natural communication. Studies have shown that appropriate use of AAC techniques with children and adults with intellectual impairments can enhance communication skills, increase participation in activities, choice-making, and even influence

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4512-403: A step independently. A prompt is a cue that encourages a desired response from an individual. Prompts are often categorized into a prompt hierarchy from most intrusive to least intrusive, although there is some controversy about what is considered most intrusive, those that are physically intrusive or those that are hardest prompt to fade (e.g., verbal). In order to minimize errors and ensure

4653-516: A strategy to support communication alongside more traditional speech therapy to improve speech production. A wide variety of AAC systems have been used with children with developmental verbal dyspraxia. Manual signs or gestures are frequently introduced to these children, and can include the use of fingerspelling alongside speech. Manual signs have been shown to decrease errors in articulation. Aided AAC systems typically include communication boards and speech generating devices. A multimodal approach

4794-404: A student has successfully mastered learning colors at the table, the teacher may take the student around the house or school and generalize the skill in these more natural environments with other materials. Behavior analysts have spent considerable amount of time studying factors that lead to generalization. Shaping involves gradually modifying the existing behavior into the desired behavior. If

4935-483: A student to exchange a picture of a desired item with a communicative partner, who immediately honors the request. After the student learns to spontaneously request for a desired item, the system goes on to teach discrimination among symbols and then how to construct a simple sentence. In the most advanced phases, individuals are taught to respond to questions and to comment. Additionally, descriptive language concepts such as size, shape, color, number, etc. are also taught so

5076-584: A table or going to another location to find a communicative partner, and initiate spontaneous communication. Training should progress across different settings, with different communicative partners, and different types of highly motivating and preferred items to assist in the generalization of PECS usage. Phase 3 – discrimination between symbols: As soon as the student has demonstrated distance and persistence in multiple settings with multiple communicative partners, they are ready to be introduced to phase 3A – visual discrimination. During structured training sessions,

5217-441: A training program based on teaching Bergan's skills. A similar approach was used for the development of microskills training for counselors. Ivey would later call this "behaviorist" phase a very productive one and the skills-based approach came to dominate counselor training during 1970–90. Task analysis was also used in determining the skills needed to access a career. In education, Englemann (1968) used task analysis as part of

5358-438: A user's abilities and requirements for AAC will include the individual's motor, visual, cognitive, language and communication strengths and weaknesses. The evaluation requires the input of family members, particularly for early intervention. Respecting ethnicity and family beliefs are key to a family-centered and ethnically competent approach. Studies show that AAC use does not impede the development of speech, and may result in

5499-407: A voice impaired individual to have a two-way conversation over a telephone. Game accessibility often utilizes high-tech solutions to allow individuals with disabilities to participate in conversations and use "call outs". In all cases of use, low tech systems are often recommended as a backup in case of device failure. Symbols are visuals used to represent objects, actions, and concepts through

5640-413: Is a field of study that focuses on using the principles of behaviorism to make changes in a client's behavior that are relevant to their everyday life. The social validity of interventions is what differentiates ABA from experimental analysis of behavior , which focuses on basic experimental research. Behavior analysis adopts the viewpoint of radical behaviorism , which states that all behavior occurs for

5781-496: Is a scientific discipline that utilizes the principles of learning based upon respondent and operant conditioning to make socially significant changes in a subject's behavior. ABA is the applied form of behavior analysis . The impact ABA has on meaningful behaviors is a defining feature, and what differentiates it from experimental analysis of behavior , which focuses on basic experimental research. The term applied behavior analysis has replaced behavior modification because

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5922-399: Is a term referring to a non-progressive developmental neuromotor disorder with an upper motor neuron lesion origin. Depending on the location of the brain lesion, individuals with cerebral palsy can have a wide variety of gross and fine motor challenges, including different forms and areas of the body affected. Fine motor planning, control and coordination are often affected. Dysarthria ,

6063-761: Is also used in a broad range of other areas. Recent notable areas of research in the Journal of Applied Behavior Analysis include autism, classroom instruction with typically developing students, pediatric feeding therapy, and substance use disorders . Other applications of ABA include applied animal behavior, consumer behavior analysis , forensic behavior analysis, behavioral medicine , behavioral neuroscience , clinical behavior analysis , organizational behavior management , schoolwide positive behavior interventions and support , and contact desensitization for phobias. ABA has been successfully used in other species. Morris uses ABA to reduce feather-plucking in

6204-414: Is associated with specific activities or routines. For example, a photo of a child's room may be included in the child's AAC system. Objects and events within the photograph are then used as symbols for communication. Research suggests that visual scene displays are easier than grid displays for young children or those with cognitive impairments to learn and use. Augmentative and alternative communication

6345-586: Is beginning to suggest that there are two different ABA teaching approaches to acquiring spoken language : children with higher receptive language skills respond to 2.5 – 20 hours per week of the naturalistic approach , whereas children with lower receptive language skills need 25 hours per week of discrete trial training —the structured and intensive form of ABA. A 2023 multi-site randomized control trial study of 164 participants showed similar findings. Although most research in ABA focuses on autism intervention, it

6486-414: Is called a discriminated operant. The antecedent stimulus is called a discriminative stimulus (S ). The fact that the discriminated operant occurs only in the presence of the discriminative stimulus is an illustration of stimulus control . More recently behavior analysts have been focusing on conditions that occur prior to the circumstances for the current behavior of concern that increased the likelihood of

6627-540: Is directed towards the linguistic and social abilities of the child, including providing the person with a concrete means of communication, as well as facilitating the development of interactional skills. AAC systems for this population generally begin with communication boards and/or object or picture exchanges such as the Picture Exchange Communication System (PECS). A 2009 descriptive review provided preliminary evidence that PECS

6768-399: Is easily learned by most autists, provides communication to those with little or no functional speech, and has some limited positive impact on social interaction and challenging behaviours . A study that compared the use of a speech generating device to a picture exchange system found that both were reasonable options for autistic children, as the ease and speed of acquisition of each system

6909-606: Is most commonly associated with autism intervention , it has been utilized in a range of other areas, including organizational behavior management , behavior management in classrooms , and acceptance and commitment therapy . ABA is controversial, and generally rejected by the autism rights movement . Among other reasons, this is because of a history of suppressing autistic behaviors such as stimming ; using aversives , such as physical pain, or in modern forms, withholding stimuli that bring comfort; and because of its weak evidence base and failure to investigate possible harms. ABA

7050-435: Is often used for indirect selection. Message generation through AAC is generally much slower than spoken communication, and as a result rate enhancement techniques have been developed to reduce the number of selections required. These techniques include prediction, in which the user is offered guesses of the word/phrase being composed, and encoding, in which longer messages are retrieved using a prestored code. The evaluation of

7191-424: Is often used, with several AAC approaches introduced so that the child can take advantage of the most effective method for a particular situation. Traumatic brain injury can result in severe motor speech disorders; dysarthria is the most common such disorder, accounting for roughly a third of all cases. Depending on the stage of recovery, AAC intervention may involve identifying consistent communication signals,

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7332-483: Is probably best used as an initial intervention to teach manding and the basic elements of what is a communicative exchange," and is not the best selection "for a long-term intervention as it does not address question asking and may be better implemented as part of a multimodal system for when picture communications are more socially appropriate." There is emerging research that suggests adults with developmental disabilities and severe communication deficits may benefit from

7473-432: Is required. Low-tech communication aids are defined as those that do not need batteries, electricity or electronics. These are often very simple communication boards or books, from which the user selects letters, words, phrases, pictures, and/or symbols to communicate a message. Depending on physical abilities and limitations, users may indicate the appropriate message with a body part, light pointer, eye-gaze direction, or

7614-474: Is that "PECS is recommended as an evidence-based intervention for enhancing functional communication skills of individuals with ASD." On the other hand, the 2009 National Standards Report from the National Autism Center lists PECs among emerging treatments that do not have sufficient evidence of effectiveness. An initial concern was that PECS might delay or inhibit speech development. However,

7755-424: Is the expansion of a student's performance ability beyond the initial conditions set for acquisition of a skill. Generalization can occur across people, places, and materials used for teaching. For example, once a skill is learned in one setting, with a particular instructor, and with specific materials, the skill is taught in more general settings with more variation from the initial acquisition phase. For example, if

7896-418: Is the temporary increase in the frequency, intensity, and/or duration of the behavior targeted for extinction. Other characteristics of an extinction burst include an extinction-produced aggression—the occurrence of an emotional response to an extinction procedure often manifested as aggression; and b) extinction-induced response variability—the occurrence of novel behaviors that did not typically occur prior to

8037-629: Is the textbook Behavior Modification: Principles and Procedures . In 2005, Heward et al. suggested the addition of the following five characteristics: Although there are many applications of ABA outside of autism intervention, a large majority of ABA practitioners specialize in autism , and ABA itself is often mistakenly considered synonymous with therapy for autism . Practitioners often use ABA-based techniques to teach adaptive behaviors to, or diminish challenging behaviors presented by, individuals with autism. ABA methodologies such as differential reinforcement, extinction, and task analysis, are among

8178-452: Is the use of video modeling (the use of taped sequences as exemplars of behavior). It can be used by therapists to assist in the acquisition of both verbal and motor responses, in some cases for long chains of behavior. Augmentative and alternative communication Augmentative and alternative communication ( AAC ) encompasses the communication methods used to supplement or replace speech or writing for those with impairments in

8319-445: Is to identify potential AAC approaches that can bridge discrepancies between a potential user's current communication and their present and future communication needs. AAC evaluations are often conducted by specialized teams which may include a speech-language pathologist , occupational therapist , rehabilitation engineer , physiotherapist , social worker and a physician . Users, family members and teachers are also key members of

8460-820: Is typically much slower than speech, with users generally producing 8–10 words per minute. Rate enhancement strategies can increase the user's rate of output to around 12–15 words per minute, and as a result enhance the efficiency of communication . There are two main options for increasing the rate of communication: encoding and prediction. Encoding is a technique permitting an AAC user to produce an entire word, sentence or phrase using only one or two activations of their AAC system. In numeric, alpha-numeric, and letter encoding (also known as abbreviation-expansion), words and sentences are coded as sequences of letters and numbers. For example, typing "HH" may retrieve "Hello, how are you?". In iconic encoding strategies, such as Semantic compaction , icons (picture symbols) are combined in

8601-421: Is used by individuals to compensate for severe speech-language impairments in the expression or comprehension of spoken or written language. People making use of AAC include individuals with a variety of congenital conditions such as cerebral palsy, autism, intellectual disability, and acquired conditions such as amyotrophic lateral sclerosis, traumatic brain injury and aphasia. Prevalence data vary depending on

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8742-500: The 1993 study, "Long-term outcome for children with autism who received early intensive behavioral treatment". Lovaas' work went on to be recognized by the US Surgeon General in 1999, and his research were replicated in university and private settings. The "Lovaas Method" went on to become known as early intensive behavioral intervention (EIBI). In 2018, a Cochrane meta-analysis database concluded that some recent research

8883-620: The Butterfly , based on books by AAC users Christy Brown and Jean-Dominique Bauby respectively, have brought the lives of those who use AAC to a wider audience. Unaided AAC systems are those that do not require an external tool, and include facial expression, vocalizations, gestures , and sign languages and systems. Informal vocalizations and gestures such as body language and facial expressions are part of natural communication, and such signals may be used by those with profound disabilities. More formalized gestural codes exist that lack

9024-574: The abilities of the user, and may include the use of direct selection of symbols on the screen or keyboard with a body part, pointer, adapted mice or joysticks , or indirect selection using switches and scanning. Devices with voice output offer their user the advantage of more communicative power, including the ability to initiate conversation with communication partners who are at a distance. However, they typically require programming, and can be unreliable. High-tech systems can also include keyboard-based solutions that do not require programming with

9165-408: The actual brief of directing a kid's hands might follow this succession: (a) supporting wrists, (b) contacting hands softly, (c) contacting lower arm or elbow, and (d) pulling out actual contact through and through. Fading guarantees that the kid does not turn out to be excessively subject to a specific brief while mastering another expertise. Thinning is often confused with fading. Fading refers to

9306-413: The age and cognitive level of the user, the time to master PECS will vary. One study found that it takes an average of 246 trials for users to master all six phases of PECS. There is evidence that PECS is easily learned by most students, with its primary benefit being a means of communication for children and adults who have limited or no speech due to autism or other communication disorders. With regard to

9447-406: The behavior occurring or not occurring. These conditions have been referred to variously as "Setting Event", "Establishing Operations", and "Motivating Operations" by various researchers in their publications. B. F. Skinner's classification system of behavior analysis has been applied to treatment of a host of communication disorders. Skinner's system includes: In applied behavior analysis,

9588-473: The best-known user of AAC, had amyotrophic lateral sclerosis, and communicated through a speech-generating device . Modern use of AAC began in the 1950s with systems for those who had lost the ability to speak following surgical procedures. During the 1960s and 1970s, spurred by an increasing commitment in the West towards the inclusion of disabled individuals in mainstream society and emphasis on them developing

9729-401: The black vulture ( Coragyps atratus ). Behavior refers to the movement of some part of an organism that changes some aspect of the environment. Often, the term behavior refers to a class of responses that share physical dimensions or functions, and in that case a response is a single instance of that behavior. If a group of responses have the same function, this group may be called

9870-447: The cases studied, with the remainder showing no change. A descriptive review looking specifically at Picture Exchange Communication System (PECS) intervention studies found that several studies reported an increase in speech, often during later phases, while one noted little or no effect. Researchers hypothesize that using an AAC device relieves the pressure of having to speak, allowing the individual to focus on communication, and that

10011-519: The child, such as signing or pointing to symbols and codes as they communicate, including using the individual's communication system themselves. They also benefit from focussed and explicit reading instruction. Several reviews have found that the use of AAC does not impede the development of speech in individuals with autism or developmental disabilities, and in fact, may result in modest gains being observed. A 2006 research review of 23 AAC intervention studies found gains in speech production in 89% of

10152-485: The communication partners and the context. There were three, relatively independent, research areas in the 1960s and 1970s that lead to the field of augmentative and alternative communication. First was the work on early electromechanical communication and writing systems. The second was the development of communication and language boards, and lastly there was the research on ordinary (without disability) child language development. Augmentative and alternative communication

10293-769: The communication signals of a severely disabled individual, particularly because there is a danger that learned helplessness can be the result of repeated failure to communicate successfully. Parties may need assistance to avoid the directive communication style that can lead a child user of AAC not to develop a full range of communication skills such as initiating or taking the lead in conversation, using complex syntax, asking questions, making commands or adding new information. Young AAC users benefit from rich language and literacy experiences to foster vocabulary development, discourse skills, and phonological awareness , all of which supports successful literacy learning. Communication partners are encouraged to provide augmented input with

10434-675: The communication system. In general, the goal is to facilitate efficient and effective communication, especially when the individual's AAC system contains a large number of symbols. Communication books and devices are often presented in a grid format; the vocabulary items displayed within them may be organized by spoken word order, frequency of usage or category. In the Fitzgerald Key organization, symbols from different semantic and syntactic classes are organized grammatically in groups from left to right to facilitate sentence construction. Since research has shown that children and adults use

10575-444: The consequence of a behavior makes it more likely for that behavior to occur in the future. Reinforcing consequences can be either positive, where something preferred is added, or negative, where something aversive is removed. Reinforcement is the key element in operant conditioning and most behavior change programs. There are multiple schedules of reinforcement that affect the future probability of behavior. Punishment occurs when

10716-566: The consequences of a behavior make the behavior less likely to occur in the future. As with reinforcement, a stimulus can be added ( positive punishment ) or removed ( negative punishment ). Broadly, there are three types of punishment: presentation of aversive stimuli (e.g., pain), response cost (removal of desirable stimuli as in monetary fines), and restriction of freedom (as in a 'time out'). Punishment in practice can often result in unwanted side effects. Some other potential unwanted effects include resentment over being punished, attempts to escape

10857-514: The country and age/disabilities surveyed, but typically between 0.1 and 1.5% of the population are considered to have such severe speech-language impairments that they have difficulty making themselves understood, and thus could benefit from AAC. An estimated 0.05% of children and young people require high technology AAC. Well-known AAC users include physicist Stephen Hawking , broadcaster Roger Ebert and poet Christopher Nolan . Award-winning films such as My Left Foot and The Diving Bell and

10998-445: The decision making team. Sensitivity to and respect of cultural diversity contributes to ongoing family involvement and to the selection of the most appropriate AAC system. For members of some cultural groups the presence of an AAC device increases the visibility of disability and is thus viewed as stigmatizing. A user's motor abilities, communication skills and needs, cognition and vision are assessed in order to determine

11139-481: The development of social closeness through such things as jokes and cheering, and finally social etiquette practices such as "please" and "thank you". These four purposes vary in terms of the relative importance of the content, rate, duration and the focus of the interaction. It is important that the AAC systems selected also reflect the priorities of the individual and their family. In Western cultures, professionals may see

11280-729: The duration of each response or the duration of all responses during a specific timeframe, which is then recorded as a percentage. Latency specifically measures the time that elapses between the event of a stimulus and the behavior that follows. This is important in behavioral research because it quantifies how quickly an individual may respond to external stimuli , providing insights into their perceptual and cognitive processing rates. There are two measurements that are able to define temporal locus, they are response latency and interresponse time. Derivative measures are additional metrics derived from primary data, often by combining or transforming dimensional quantities to offer deeper insights into

11421-590: The effects were not maintained over time. Evidence from meta-analyses indicate that PECS does not result in equal communicative outcomes for all children with ASD. PECS training appears to have the most beneficial effects for younger learners. Research also relays that the use of PECS as a communication intervention may yield more effectiveness in children that have challenges with sustaining joint attention. In addition, evidence of maintenance and generalization effects of functional communication gains achieved through PECs training has been mixed. Research indicates that "PECS

11562-643: The efficacy of ABA techniques on autistic and schizophrenic children. While Lovaas's work was instrumental in establishing ABA as an effective treatment of autism through the Lovaas method, his use of shock treatment has considerable ethical concerns, and the practice has been condemned by the Association for Behavior Analysis Interntational . Over the years, "behavior analysis" gradually superseded "behavior modification"; that is, from simply trying to alter problematic behavior, behavior analysts sought to understand

11703-468: The essential information to assess intervention effectiveness and make informed decisions about program modifications . Therefore, precise measurement and assessment play a pivotal role in ABA practice, guiding practitioners to enhance behavioral outcomes and drive significant change. Behavior analysts utilize a few distinct techniques to gather information. A portion of the ways of collect data information include: Latency refers to how much time after

11844-454: The extinction procedure. These novel behaviors are a core component of shaping procedures. In addition to a relation being made between behavior and its consequences, operant conditioning also establishes relations between antecedent conditions and behaviors. This differs from the S–R formulations (If-A-then-B), and replaces it with an AB-because-of-C formulation. In other words, the relation between

11985-524: The facilitation of reliable yes/no responses to questions, and the ability to express basic needs and answer questions. Individuals who do not recover natural speech to a degree sufficient to meet their communication needs typically have severe impairments related to cognition. Difficulties with memory and learning new skills may influence AAC choices; well-established competencies such as spelling may be more effective than AAC systems that require navigation through multiple pages to access information. Aphasia

12126-564: The fact that expressive language is limited by more than the children's language knowledge. Unlike speaking children, children who use AAC do not always have access to their AAC system, and do not select the content available on the device. These external characteristics may impact language learning opportunities. Most children in this category do not achieve literacy skills beyond that of a typically developing 7–8 year old. Cognitive, language and learning delays contribute to difficulty with literacy development, but environmental factors also play

12267-408: The floor with a broken bit of yellow chalk gripped between my toes, was my road to a new world, my key to mental freedom. The poet and author Christy Brown describes his communication breakthrough at 5 years in the book My Left Foot . An evaluation of an individual's abilities, limitations and communication needs is necessary to select appropriate AAC techniques. The purpose of the assessment

12408-415: The function of that behavior, what reinforcement histories (i.e., attention seeking, escape, sensory stimulation , etc.) promote and maintain it, and how it can be replaced by successful behavior. Baer, Wolf, and Risley's 1968 article is still used as the standard description of ABA. It lists the following seven characteristics of ABA. Another resource for the characteristics of applied behavior analysis

12549-433: The groups scanned consecutively. Once a particular group is selected, items within the group are scanned. One of the most common group-item strategies is row-column scanning in which each row forms a group. The rows of items are scanned, and when a row is selected, the items in the row are scanned one at a time until a message is selected. There are three main selection control techniques in scanning. In "automatic scanning",

12690-490: The implementation of PECS. Others tried to combine PECS training with video modeling . Research conducted by David F Cihalk Et al. combined the use of PECS and video modeling to increase independent communicative initiations in preschoolers with autism and developmental delays. The founding of the study indicated that the use of video modeling facilitated student’s ability to become proficient in using PECS. Applied behavior analysis Applied behavior analysis ( ABA )

12831-399: The initiated social interaction by creating motivation for the student to seek out the communicative partner even when he or she is not nearby and waiting. The goal of this phase is to have the student generalize his or her requests across places and people and to increase the likeliness of spontaneous communication. The student is taught to communicate over longer distances whether it be across

12972-600: The intervention setting for AAC training, there is evidence that PECS is most readily learned when instruction takes place in a general education setting. Evidence also indicated that learners initiate a higher number of picture exchanges when PECS is taught in a single setting versus multiple settings. Research also advocates for the use of PECS training by non-professional implementers such as camp workers, counselors, or volunteers in their respective naturalistic settings, to better communication outcomes for those with complex communication needs. The consensus among most researchers

13113-439: The item for which he or she is asking. is taught discrimination of symbols and how to select the symbol which depicts a desired item. If students have difficulty with discrimination, there are systematic ways of incorporating error correction and alternative strategies. The ECS phase 3 App created by Pyramid Educational Consultants provides an easy way for teachers to practice picture discrimination with one or several learners within

13254-417: The items are displayed in a circle and then scanned one at a time. It is often the first type introduced to children or beginning AAC users because it is the easiest to understand. In "linear scanning", items are organized in rows and are scanned one at a time until a choice is made. Although more demanding than circular scanning, it is still easy to learn. Finally, in "group-item scanning", items are grouped and

13395-485: The latter approach suggested changing behavior without clarifying the relevant behavior-environment interactions. In contrast, ABA changes behavior by first assessing the functional relationship between a targeted behavior and the environment, a process known as a functional behavior assessment . Further, the approach seeks to develop socially acceptable alternatives for maladaptive behaviors, often through administering differential reinforcement contingencies . Although ABA

13536-441: The latter limits the number of people able to understand the person's communication without training. An AAC aid is any "device, either electronic or non-electronic, that is used to transmit or receive messages"; such aids range from communication books to speech generating devices . Since the skills, areas of difficulty and communication needs of AAC users vary greatly, an equally diverse range of communication aids and devices

13677-405: The latter. Signing is used alone or in conjunction with speech to support communication with individuals with a variety of disorders. The specific hand shapes and movements of sign and gesture require an individual to have adequate fine motor and motor planning skills. Sign languages require more fine-motor coordination and are less transparent in meaning than gestural codes such as Amer-Ind;

13818-412: The learner to determine which one(s) they want. This preference assessment is completed throughout the day in a variety of activities. Once the desired item or activity is determined, the communicative partner will entice the student with the item(s) by holding or showing the item. This way, no verbal prompting is needed. The chosen reinforcers should be assessed to ensure they are consistently motivating to

13959-438: The methods to design the direct instruction curriculum. Chaining is the process of teaching the steps of a task analysis. The two methods of chaining , forward chaining and backward chaining, differ based on what step a learner is taught to complete first. In forward chaining, the ABA practitioner teaches the learner to independently complete the first step and prompts the learner for all subsequent steps. In backward chaining,

14100-457: The most appropriate match to a communication system. Depending on the individual's physical status, recommendations of an alternative access method, a change in seating/positioning, a mounting system and/or communication aid adaptations may be needed. For example, someone with spastic arm movements may require a key guard on top of the keyboard or touchscreen to reduce the selection of non-target items. The person's needs and abilities determine

14241-490: The most well-researched evidence-based practices for autism intervention. Early development of the techniques that would later become the Lovaas method involved use of electric shocks, scolding, and the withholding of food. By the time the children were enrolled in this study, such aversives were abandoned, and a loud "no", electric shock, or slap to the thigh were used only as a last resort to reduce aggressive and self-stimulatory behaviors . In 1965, Ivar Lovaas published

14382-436: The number of response opportunities needed to achieve a set level of performance. This metric aids behavior analysts in assessing skill acquisition and mastery, influencing decisions on program adjustments and teaching methods . Applied behavior analysis relies on meticulous measurement and impartial evaluation of observable behavior as a foundational principle. Without accurate data collection and analysis, behavior analysts lack

14523-403: The other trainer acts as the physical prompter, who prompts the student after he makes an initiation towards the desired item. The student is taught to pick up the picture through the use of hand over hand techniques and reach towards the communicative partner with the picture, in exchange for the requested item. Phase 2 – distance and persistence: During phase 2, the student is taught to expand

14664-457: The people, places, objects, feelings, actions, and other relevant vocabulary items for a specific activity or routine. Visual scene displays are a different method of organizing and presenting symbols. These are depictions of events, people, objects, and related actions in a picture, photograph, or virtual environment representing a situation, place, or specific experience. They are similar to activity displays in that they contain vocabulary that

14805-573: The perceptions and stereotypes of communication partners. In Ireland , a system of manual communication (a simplified sign language ) called Lámh is used by those with developmental disabilities, their family, carers and friends. Although most individuals with intellectual disabilities do not have concomitant behavioural issues , problems in this area are typically more prevalent in this population than others. AAC approaches may be used as part of teaching functional communication skills to non-speaking individuals as an alternative to "acting out" for

14946-618: The person's native language as well as the linguistic code of the symbol system selected. Operational competence involves the skills in the use and maintenance of the tool of communication, while social competence and strategic competence reflect knowledge and judgment in communicative interactions, including the compensations required for a slow speaking rate, communication breakdowns and those unfamiliar with AAC. An AAC user may require specific device programming and/or training to achieve competency in these areas. Communication partners may also require training to notice and consistently interpret

15087-409: The practitioner prompts all steps except the last step. As the learner begins to respond independently, the practitioner systematically removes the prompts and teaches the next step in the task analysis. Total task presentation is a variation of forward chaining where the practitioner asks the learner to perform the entire task analysis and provides prompting only when the learner is unable to complete

15228-603: The principles of behavior analysis to treat autism, manage the behavior of children and adolescents in juvenile detention centers, and organize employees who required proper structure and management in businesses . In 1968, Baer, Bijou, Risley, Birnbrauer, Wolf, and James Sherman joined the Department of Human Development and Family Life at the University of Kansas, where they founded the Journal of Applied Behavior Analysis . From 1960 through 1997, Ivar Lovaas researched

15369-437: The production or comprehension of spoken or written language. AAC is used by those with a wide range of speech and language impairments , including congenital impairments such as cerebral palsy , intellectual impairment and autism , and acquired conditions such as amyotrophic lateral sclerosis and Parkinson's disease . AAC can be a permanent addition to a person's communication or a temporary aid. Stephen Hawking , probably

15510-442: The punishment, expression of pain and negative emotions associated with it, and recognition by the punished individual between the punishment and the person delivering it. ABA therapist state that they use punishment is used infrequently as a last resort or when there is a direct threat caused by the behavior. Respondent (classical) conditioning is based on involuntary reflexes. In his experiments with dogs, Ivan Pavlov usually used

15651-485: The purpose of exerting independence, taking control, or informing preferences. Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behaviour. Typically there is particular difficulty acquiring expressive communication skills. People with autism have been found to have strong visual processing skills, making them good candidates for an AAC approach. AAC intervention in this population

15792-400: The quantifiable measures are a derivative of the dimensions. These dimensions are repeatability, temporal extent, and temporal locus. Response classes occur repeatedly throughout time—i.e., how many times the behavior occurs. The temporal extent refers to the duration of the response, which is the measure of time from the start to the end of the response. The duration of a response is either

15933-680: The reduction in psychological stress makes speech production easier. Others speculate that in the case of speech generating devices, the model of spoken output leads to an increase in speech production. Language and literacy have far reaching effects as they facilitate self-expression and social interaction in a variety of settings. Furthermore, literacy fosters independence by providing access to educational and vocational opportunities. Children whose disabilities require AAC often experience developmental delays in language skills such as vocabulary knowledge, length of sentences, syntax , and impaired pragmatic skills. These delays may be due in part to

16074-683: The response does not produce a reinforcer or punisher (e.g., the dog does not get food because it salivates). Extinction is the technical term to describe the procedure of withholding/discontinuing reinforcement of a previously reinforced behavior, resulting in the decrease of that behavior. The behavior is then set to be extinguished (Cooper et al.). Extinction procedures are often preferred over punishment procedures, as many punishment procedures are deemed unethical and in many states prohibited. Nonetheless, extinction procedures must be implemented with utmost care by professionals, as they are generally associated with extinction bursts. An extinction burst

16215-444: The salivary reflex, namely salivation (unconditioned response) following the taste of food (unconditioned stimulus). Pairing a neutral stimulus, for example, a bell (conditioned stimulus) with food caused the dog to elicit salivation (conditioned response). Thus, in classical conditioning, the conditioned stimulus becomes a signal for a biologically significant consequence. Note that in respondent conditioning, unlike operant conditioning,

16356-530: The same time and later a delay is established between the question and gestural prompt. Ultimately, the student should answer the question before additional prompts are provided. Phase 6 – commenting: The student can now make spontaneous requests and respond questions such as "What do you want?" by building the sentence "I want ___" Within phase 6, the student is taught to respond to commenting questions as well as to spontaneously comment on items, people, or activities present in his or her environment. In this phase,

16497-432: The scan proceeds at a pre-determined speed and pattern until the user selects an item. In "inverse scanning", the switch is held down to advance the scan, and released to choose the desired item. In "step scanning", the AAC user activates one switch to move the indicator through the items, and another switch to select the item. Vocabulary organization refers to the way pictures, words, phrases, and sentences are displayed on

16638-428: The scanning may be visual using indicators such as lights, highlighting, and/or contrasting borders, or auditory using spoken prompts from a communication partner or device. When the desired message is reached, the AAC user indicates the choice using an alternative selection technique such as a switch , vocalization or gesture. Several different patterns for switch access scanning are available: in "circular scanning",

16779-407: The sentence and point to the pictures, a delay between "I want" and the picture of the desired item is inserted as a way to encourage vocalizations. Speech/vocalizations are celebrated by providing the student with a greater amount of the requested item/activity and additional preferred items as a way to promote speech on future exchanges. Speech/vocalizations are never demanded, just encouraged through

16920-460: The sink, put hands in the water, put soap on hands, scrub hands, rinse hands, turn off water. Task analysis has been used in organizational behavior management, a behavior analytic approach to changing the behaviors of members of an organization (e.g., factories, offices, or hospitals). Behavioral scripts often emerge from a task analysis. Bergan conducted a task analysis of the behavioral consultation relationship and Thomas Kratochwill developed

17061-1042: The skills required for independence, the use of manual sign language and then graphic symbol communication grew greatly. It was not until the 1980s that AAC began to emerge as a field in its own right. Rapid progress in technology, including microcomputers and speech synthesis , paved the way for communication devices with speech output, and multiple options for access to communication for those with physical disabilities . AAC systems are diverse: unaided communication uses no equipment and includes signing and body language , while aided approaches use external tools. Aided communication methods can range from paper and pencil to communication books or boards to speech generating devices (SGDs) or devices producing written output. The elements of communication used in AAC include gestures, photographs, pictures, line drawings, letters and words, which can be used alone or in combination. Body parts, pointers, adapted mice , or eye tracking can be used to select target symbols directly, and switch access scanning

17202-465: The student can make their message more specific. For example, I want big yellow ball. ‹The template Manual is being considered for merging .›   Reinforcer inventory: Prior to implementing the PECS protocol, it is highly recommended that the teacher, parent, or caregiver develops an inventory of items such as toys, books, and edibles that the learner enjoys. Preferred items are presented to

17343-549: The student engages with a dog by hitting it, then they could have their behavior shaped by reinforcing interactions in which they touch the dog more gently. Over many interactions, successful shaping would replace the hitting behavior with patting or other gentler behavior. Shaping is based on a behavior analyst's thorough knowledge of operant conditioning principles and extinction . Recent efforts to teach shaping have used simulated computer tasks. One teaching technique found to be effective with some students, particularly children,

17484-440: The student is also taught the meaning of sentence starters to differentiate between appropriate responses to the questions "What do you see?", which results in a social outcome and "What do you want?" which results in a tangible outcome The teacher should structure the environment to give the student plenty of opportunities to have a variety of communication opportunities that encompass all of their communication skills. Depending on

17625-449: The student is taught to respond to the question, "What do you want?" The goal of this phase is for the learner to respond "I want ___ " after being asked some form of the "what do you want" question. This phase adds upon the already established skill of building a sentence while still using the desired item to motivate the user to respond. A delayed prompting procedure is used in which the question and gestural prompt are initially presented at

17766-412: The student will begin to work on discriminating between highly preferred and non-preferred items. During other times throughout the day, the learner should continue to generalize phase 2 skills. The next step is to teach discrimination between two items that are both contextually relevant and desirable to the learner. This is done with correspondence checks to ensure that the learner is requesting and taking

17907-484: The symbols chosen and their organization, with the goal being that the communication system can be used as efficiently as possible in different contexts, with different communication partners, and for different social purposes. Researcher Janice Light identified four social purposes of communicative interaction in AAC: the expression of needs and wants to a listener, the transfer of information as in more general conversation,

18048-438: The three-term contingency, first, a discriminative stimulus signals to the subject that reinforcement (or, less commonly, punishment) is available. Then, the subject performs a behavior. After performing a behavior, a consequence will occur that either adds (positive) or removes (negative) something that will make the behavior either occur more (reinforcement) or less (punishment) frequently in the future. Reinforcement occurs when

18189-403: The types of selection methods available for individuals with communication impairments. In "Direct Selection", the selection is made by pointing to the desired symbol using a finger or an alternative pointer, such as eye gaze, a head stick, head- or eye-controlled mouse. To accommodate motor control difficulties some users use alternative activation strategies; for example in "timed activation",

18330-404: The use of items such as the physical object itself, colored or black and white photographs, line drawings, and written words. For users with literacy skills, alphabet-based symbols including individual letters, whole words, or parts thereof may be used in combination with the other types of symbols. Tactile symbols which are textured objects, real objects or parts of real objects that are used as

18471-525: The use of line drawings known as Picture Communication Symbols (PCS). Symbols are placed in fixed position on the screen which allow users to develop motor patterns associated with certain requests or statements. The choice of symbols and aspects of their presentation, such as size and background, depend on an individual's preferences as well as their linguistic, visual, and cognitive skills. This can be determined using an assessment for symbolic understanding. Technological advances have dramatically increased

18612-422: The use of the delay. Teaching PECS users to create a sentence using expressions such as "I want ___" is the first step in developing more complex sentence structures. After the student learns the basic sentence structure, descriptors such as color, shape, size, number are taught so that learner can make their preferences more specific, such as "I want 3 cars". Phase 5 – answering a direct question: During phase 5,

18753-487: The user maintains selection of the symbol for a predetermined period of time until it is recognized by the system. With the "release activation", the selection of the item is only made when the person releases contact from the display. Direct activation of an AAC system is generally the first choice of access method as it is faster and cognitively easier. Those unable to do so may use indirect selection or "scanning". In this method, items displayed for selection are scanned;

18894-570: The user to spell words and speak novel messages. High-tech systems may be dedicated devices developed solely for AAC, or non-dedicated devices that run additional software to function as AAC devices. These options are typically more affordable than a dedicated device. Examples of AAC applications that function on non-dedicated hardware include Avaz and Spoken . The freedom to use existing, personal devices like smartphones for AAC has resulted in more users. High-tech AAC may be static or dynamic in form. Static communication devices have symbols in

19035-589: The user, or grammatical suitability. I stiffened my body and put my left foot out again, for the third time. I drew one side of the letter. I drew half the other side... I set my teeth so hard that I nearly pierced my lower lip. But – I drew it – the letter 'A'... Shaky, with awkward, wobbly sides and a very uneven centre line... I had done it! I had started – the thing that was to give my mind its chance of expressing itself. True, I couldn't speak with my lips, but now I would speak through something more lasting than spoken words – written words. That one letter, scrawled on

19176-487: The user. The PECS Protocol occurs in six phases: Phase 1 – how to communicate: During phase I, the focus is on teaching the student to initiate social communication by exchanging a picture of a desired item. This exchange is taught presenting one picture, selected by the trainer based on the student's observed preferences. Within Phase 1, two trainers are utilized. One trainer acts as the student's communicative partner, and

19317-513: Was initially used by Charles Ferster to teach nonverbal children to speak. Lovaas also described how to use social (secondary) reinforcers, teach children to imitate, and what interventions (including electric shocks) may be used to reduce aggression and life-threatening self-injury. In 1987, Lovaas published the study, "Behavioral treatment and normal educational and intellectual functioning in young autistic children". The experimental group in this study received an average of 40 hours per week in

19458-426: Was originally called "Augmentative Communication"; the term served to indicate that such communication systems were to supplement natural speech rather than to replace it. The addition of "alternative" followed later, when it became clear that for some individuals non-speech systems were their only means of communication. AAC communicators typically use a variety of aided and unaided communication strategies depending on

19599-405: Was partially based on Waton's work, was founded by B. F. Skinner in the 1930s and 1940s. Skinner is credited with being the first person to describe the principals of operant conditioning and the philosophy of radical behaviorism, which are the foundations of Applied Behavior Analysis. Skinner was also one of the founders of the Journal of Experimental Analysis of Behavior (JEAB) in 1958, which

19740-446: Was similar. Developmental verbal dyspraxia , also known as childhood apraxia of speech, is a developmental motor speech disorder involving impairments in the motor control of speech production. The speech of a child with developmental verbal dyspraxia may be unintelligible to the point that daily communication needs cannot be met. A child with developmental verbal dyspraxia often experiences great amounts of frustration, so AAC can be

19881-402: Was the first academic journal focused on the publication of research in experimental behaviorism. The first experiments studying the effectiveness of behavior analysis on human subjects were published in the 1940s and 50s, including B.F. Skinner's "Baby in a box" in 1945 and Paul Fueller's 1949 "Operant conditioning of a vegetative human organism." Jack Michael 's study "The psychiatric nurse as

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