Case Examples of CBM

Example #1 - Alan: Teaching Preschooler an Arrival Routine at School

Alan is a 4-year-old with ASD who attends a preschool program for children with ASD. Alan is verbal and interested in what the other children are doing. He is very distractible and often seems to forget what he is supposed to be doing, especially during self-care routines, such as the arrival routine and washing his hands. If an adult is not within close proximity, reminding him to do each step in the routine, he will stand in one place watching the other children play.

Planning

Alan’s teacher, Jill, decided to use CBM to teach Alan the arrival routine at school. Jill knew that Alan could do each step in the routine independently, but maintaining attention and remembering the steps in the sequence was difficult for him. Jill decided to try breaking the routine down into smaller tasks. She developed a visual system Alan could use to monitor his progress along the way, and she had him participate in selecting the reinforcer he received when completing the routine. She designed a task list using pictures. The pictures were attached with Velcro to a small board next to Alan’s coat hook. She also made a choice board with pictures of Alan’s favorite toys and activities. An envelope was attached to the bottom of the task list so that pictures of finished tasks can be removed and put in the envelope. Jill posted Alan’s picture task list by his coat hook. It looked like left picture:

Teaching the Skill

The next day when Alan came to school, Jill showed him the choice board of pictures with his favorite toys and asked him to select which toy he would like to play with when he went to the play area. Alan selected the dinosaurs, and Jill showed him where to place it on his task list. She then showed him his picture task list and guided his finger to point to each picture as she read what he was to do. The last item on the list was to play with dinosaurs.

Teaching the System of Self-management

Jill pointed to the first picture and read, “Coat on hook.” She then guided Alan to start taking off his coat and hang it on his coat hook. Jill helped Alan take the picture of the coat on the hook and put it in the envelope. She then pointed to the second picture and read, “Backpack on the hook,” and helped Alan take off his backpack and hang it on the hook. She guided Alan’s hand to take the second picture that he then put in the envelope. Jill and Alan continued through the list in this manner until he got to the picture of the dinosaur. Jill showed Alan how to take the dinosaur picture to the play area and give it to the teaching assistant, Kathy. Kathy took the picture and said, “Oh, Alan you’re all done hanging up your things. You want to play with the dinosaurs. Here they are.”

Over the next few days, Alan learned to follow the sequence of pointing to the pictures, “reading” them, doing the task and putting the picture in the envelope when he completed the task. Jill enthusiastically acknowledged him for reading each picture aloud as he pointed to it and when each task was completed. He had most difficulty starting to do the task after “reading” the picture. Knowing how easily Alan became dependent on verbal prompts, Jill used physical guidance to get him started immediately after he “read” the picture in order to teach him the direct relationship between each picture and the desired behavior. Jill made a conscious effort to fade the use of these prompts quickly, and in a few weeks Alan was able to follow the routine and use the system without prompting. She also was able to fade her verbal reinforcement for reading the pictures and completing each individual task.

Moving to Independent Use of the System

Jill closely monitored Alan’s use of the system. She noticed that because Alan could see some of his classmates at play, he occasionally became distracted and seemed to forget to look at his task list. She made a simple adaptation to the environment by putting a small divider between the arrival area and the play area. Alan was very aware of Jill’s presence and frequently looked to her for reassurance and approval as he went about his routine. Jill began to fade her presence by telling Alan “I need to go talk to Kathy for a minute, I’ll be right back.” Upon her return she praised Alan for working independently. Jill gradually increased the time she was away from the arrival area until Alan was able to follow his task list and complete the entire routine on his own. He was quite proud of himself.