Teaching Intraverbal Questions and Answers to Kids with Autism

Transcript for Podcast Episode: 081
Teaching Intraverbal Questions and Answers to Kids with Autism
Hosted by: Dr. Mary Barbera

You're listening to another episode of The Turn Autism Around podcast. I'm your host, Dr. Mary Barbera. And today I'm doing a solo show by myself and talking all about how to get kids to answer W.H questions, talking all about the power of the intraverbal, and a great free intraverbal assessment tool created by Dr. Marc Sundberg. I'm going to talk all about it. Whether your child or client is not talking at all. We're going to talk about the first intraverbals to teach, or if your child is relatively "high functioning", how you can help him or her get to a higher level through learning intraverbals. So let's get to this important episode on the intraverbals.

So we are going to talk about teaching a child to answer questions. And when we think about conversational skills, if you say is Lucas conversational? He's actually not conversational. He's 23 years old. But, you know, typically developing, of course, my typically developing son was conversational at three or four years of age, and that's usually when kids become conversational at three, four years of age. But kids with autism, often some of them do become conversational. And some of them don't. But what I've learned over the past two decades, and especially since 2003 when I became a board-certified behavior analyst, is we don't just have to, like, cross our fingers and hope that our child is conversational. There are actually building blocks we can teach to help a child get conversational.

So if we think about a conversation, say I run into you at the grocery store and I haven't seen you for a while and I say, Hey, Suzy, how have you been? I heard your son graduated from high school. What's he doing? I am asking questions. And Suzy, assuming she has time, she understands English. She's conversational. She answers. Yeah. He just graduated. He's going to temple for this or that. Oh. And if she has more time and she likes me and she's not with somebody, she might ask me a question. Well, how have you been doing in the past two months since I've seen you? And then I would answer back.

So that conversation is made up mostly of what we call advance mands or requests for information and advanced intraverbals. So you might be like,"Intraverbals I don't understand what you're talking about. Where'd you come up with that word?". So back in 1957, B.F. Skinner wrote a book called Verbal Behavior. Not about autism. It's about language and the fact that language is a behavior and it can be taught. And so there's a lot in B.F. Skinner is verbal behavior book about learning a second language. And up until the point of 1957 and even still now, today, many people think that language is just a cognitive thing that happens, kind of magically. They don't really believe that language can be broken down and taught as systematically as I know it can. And as B.F. Skinner knew it could.

So in the book Verbal Behavior, B.F. Skinner talks about four verbal operants; four elementary verbal operant or main verbal operant. So if you said my child has 10 words, I would want to know how he uses those words. Does he ask for Cookie? Does he go around and say car? Does he just label Dora the Explorer characters? Whatever he says, does he answer questions or sing little songs? So we have four operants. The mand, which is a request that starts off with just a request for water or cookie. Just a basic request. And that doesn't have to be vocal verbal language. That could be a sign. It could even be a gesture. And it can also be crying like newborn babies mand to be fed. Mand to have their diaper changed by crying.

So problem behaviors are almost always related to the inability to mand verbally or through signs or through pictures or through a device. So the mand is totally important for so many reasons and it needs to be the centerpiece of a child's program. Child with speech delays or with autism. OK. The second verbal operant that B.F. Skinner talked about and coined the term is tact, T-A-C-T. You can remember by coming in contact with one of your senses. So most of the time when we talk about tact, we talk about things you see. So in my environment, I might see the light in front of me, or my phone, or a pen and I label it. So a tact is important. But a lot of times tacts are due to sudden changes. And it doesn't have to just be a visual tact. It could be a smell, like I smell something burning. So that would be a tact. That would be an important tact if I yelled, "I smell something burning!" to another person. That would be a tact, but it would also be a mand for attention.

So a lot of times the mandand the tact are combined. So oftentimes if I see water and I'm thirsty, I might say water if somebody else is in the room and I get water. Now, if I just see water and I take it and I sip it, that's not really a verbal operant. That's a private event that I'm just managing myself. But what we're talking about really little kids or even babies where an adult's required to give them a lot of things. That's when we really have to separate it out. Or if I were learning a foreign language, I'd have to learn the name for water, both as a mand, as a tact, and oftentimes we combine those because it's a lot easier to learn language when we have a visual. So mands and tacts are super important.

Echoics are certainly important as well. I've done video blogs and a whole podcast on echoic control. The ability for me to say this is water or if I were speaking another language, this is ooby, ooby, ooby. I'd be like, OK, I have to know that because I'm going to need water. So let me remember that's ooby. So mand, tact, echoic. And the fourth one that we're going to talk about today is the intraverbal. So the intraverbal, again, coined by Dr. B.F. Skinner. And it is the answer part of a W.H question. It's basically like, I say something and you say something in response. And unlike in an echoic where we have, "point-to-point correspondence, I say water, you say water, that's an echoic. I say water, now you say drink. Or I say water and you say, I like spring water. I like water that's cold or whatever. We are still having me say something, you say something, but they don't match like the echoic matches.

So intraverbals are always the hardest operant. So we're going to have mands, tacts, and echoic's first. Intraverbals come in later in typically developing children or in a foreign language acquisition. But that intraverbal is super important because most of what we learn in life, most of going to school and listening and learning are intraverbals. And so they're super important. They usually come in for typically developing kids, according to Dr Mark Sundberg, who wrote the VB MAPP assessment, usually start to come in around 18 months of age. So that early, early stuff with intraverbals, I'm going to tell you a little story about Lucas. Before I knew he had autism, before I knew anything about ABA I mean, he was two years old, not even. My husband was starting to get concerned. He brought it up to me. I told him, I don't want to hear it. He doesn't have autism and went into a deep state of denial. But what my husband did do is he started playing around. Neither of us knew anything about how to teach kids to talk. So he goes, hey, watch this. And there used to be a cartoon named Arthur, like a little kid show. And it had a theme song. And so my husband goes, hey, watch this.

And he said, so Charlie said and I said and Lucas said, "hey", Charlie said, "What a wonderful kind of... ".

Lucas said "Day".

Charlie said, "You can learn to work and.....".

And Lucas said, "Play".

"And get along with each other".

So he was doing fill in the blanks to the last word of songs, which was an intraverbal fill in, which is the most baby kind of fill ins, the most baby kind of intraverbals. But I had no idea what that was. I was like, Oh, that's cool. And you could do the same thing with Twinkle, Twinkle Little Star.

How I wonder what you ...... You can do the same thing with prayers. Our father, who art in..... Hallowed be thy...... You can do the same thing with nursery rhymes.

Hey, diddle diddle, the cat in the fiddle, you know, one, two, buckle my shoe. And a lot of ways because of my experience with Lucas early on when I didn't even know what an intraverbal was. A lot of times with completely non-vocal kids, kids that are not talking at all, I will try to go in the back door with songs. And song fill ins and pairing songs and leaving that last word blank. So that's the early intraverbals.

I'll give you another story with a kid who because I'm going to talk about this intraverbal subtest that Dr. Mark Sundberg created. But I first want to show you how important it is, whether your child's talking, not talking, or your clients, how to quickly assess how high functioning they are, how their language is. Do you need a VB MAPP assessment? Is this child too high for a VB MAPP assessment? And this is the way I have found over the past 20 plus years how to assess very quickly.

Another story: I was behavior analysts in a classroom in a public-school autism classroom. And the teacher said, oh, we got a new student, Timmy, over there. And yeah, he's really high functioning because we in our verbal behavior classrooms, we used to have pretty moderate to severe kids, maybe some mild kids, but most of them were not able to be included very much into regular education without an assistant going with them. A lot of times they were able to go to like General Inclusion, General Ed for specials or for recess or lunch. But academics were particularly hard, especially for the little kids that in the elementary school grades with autism. So she said, "This child's really high functioning". Great. So I go over to Timmy and she told me his name was Timmy. So I go, "Hey buddy, what's your name?". And I think he said, Timmy. But he kind of mumbled it. I was like, okay. And then I said something else, like, maybe, what's your favorite color? So I'm trying to see if he can answer W.H. questions.

I forget what he said for that. And then I said, hey, what flies in the sky? Which is a very basic question. And he said, well, I mean, he knew like sky and stuff, but he goes, "Three, two, one, blast off!". And, you know, for a second-grade student, that's not high functioning in my book. You know, he has language, great. He has some associations of flies and rockets. And he could maybe answer what's his name and what's your favorite color. So he had some good skills. But I have found that it is a quick, easy way to determine how high functioning language wise a child is.

I had another client. I did an independent evaluation one time, went in. Mom got a phone call. So she was nine. Mom decided to homeschool her because she was afraid she was going to get kicked out of school. She was overturning desks. She was getting so upset. And I started asking her, hey, what are some things you wear? Dresses, shorts, pants, capris, socks, shoes, underwear, you know. Sounds really great. What are some animals listed? A full, full host of animals. What? Some colors. OK. She's fine with that. Then I got a little more abstract, which is: tell me some things that are usually red. Now, it was Christmas time as I remember her staring at the Christmas tree and she said Christmas lights. But I am looking for an intraverbal, which is no visuals. So basically, close your eyes and picture something that's red, which would be like a stop sign, a strawberry, those sorts of things.

So I go, Oh, honey, can you close your eyes and tell me something that's red? Because I didn't want her looking around the room and saying, well, there's a red chair and there's a red bird. That's a statue. So I was like, Oh, could you close your eyes and tell me something is red? And she started screaming at me, "Don't tell me to close my eyes!".

I was like, oh, my gosh. So when it went from relatively easy for her categories that she had learned since preschool, remember, she was nine years old, to really hard for her. Which was tell me some things that are usually red, which isn't that hard. But she didn't know it. And so she would get very upset when the questions would go from relatively easy that she knew to hard. She also I think somebody asked a question earlier. She would also get upset if you mark her as having an error. I remember the same girl I was assessing later in the day with, like, why do you brush your teeth? And she would say things like, because there's toothpaste.

So obviously she's like that other boy that was "high functioning". She had some association memory and that sort of thing. But that's not why you brush your teeth. So I would write like a negative down or circle the negative. So I could kind of keep track of, like, where she was at. And she got very angry that I was marking her as negative, even though I was trying to do it very discreetly. And she started screaming at me, grabbing the pencil. And so all of these examples, whether we're talking about Lucas very early on, filling in the Arthur song to Arthur fill-ins, whether we're talking about the boy, the new boy at school who said three, two, one, blast off. When I asked him what flies in the sky. Or this girl who was really good at answering some category questions but then got very confused with others. So, yeah, these are all intra verbal responses.

And so Mark Sundberg, Dr. Mark Sundberg, who wrote the foreword for my first book, The Verbal Behavior Approach. He also wrote the VB MAPP assessment, which is a brilliant assessment. My verbal behavior bundle of courses, really dives deep into assessing and programing using the VB MAPP assessment. But part of the VB MAPP assessment are the supplements that are not. Well, they're not really a part of the VB MAPP assessment, but they are really helpful. And today, I want to talk a little bit more about the VB MAPP assessment.

Now, in the comments or show notes below here, we are going to put in a link that you can go to Mark Sundberg's Web site, AVBpress.com. Under the VB MAPP supplementary information you can download for free this intraverbal assessment subtests. It is really quite tricky to assess a child who has deficits. I think this is the best way I know how to assess kids as quickly as possible and then to learn how to program for for them. I'm not going to really show that, be able to show that or talk to you about programing specifically, because obviously it involves a lot more of these processes. And you want to be careful that you program for intraverbals very carefully other ways you're going to end up with kid who scripts, who gives rote responses and who's not very flexible.

So the intraverbal subtests, again you can download it for free. It has eight groups of responses. So the first group of responses are those fill in the blanks to songs or the easy things. Like one, two, blank. Ready, set, blank. Peek a..... Boo. Happy birthday to...... Head, shoulders, knees and.. And then others. Just word fill ins like a dog says..... And a kitty says......

So some song fill ins and some animal sounds. So the other thing I want to say is if you go through these, some kids can't really sit and attend as you go through everything. But if they get eight out of 10 right in the group, then you can pretty much go to the second group. That could be a different setting. You don't have to do this sitting at a table. You could do this assessment on a swing. It doesn't require any visuals. In fact, you can't have any visuals. So you can't have a star in on the table. When you say Twinkle, twinkle little, you know. You can't hold up a star. You can in terms of teaching. That is one of the teaching techniques that I use. But in terms of just an assessment, there's no materials needed.

I do sometimes like to use a little clicker. You can just Google online clicker counters. I do like to keep track of especially positive responses. And then I also have this sheet out where I'm actually writing down their responses. So if it's close, like the girl with the why do we brush our teeth? And she says because there's toothpaste. Actually, in addition to writing minus for that one and not giving her credit, I would write down the exact response. Even typically developing kids might have very different kind of responses. OK. So Group one is those fill in the blanks songs and then some animal sounds group two are things like what's your name? Shoes and socks. You ride a.....? Now, if you say you ride, they're supposed to say a bike or scooter, wagon maybe.

But ride a car, you know, I would probably count cars. Fine, because maybe they have a little play car. But you have to be careful about going well close enough because a lot of kids, especially as you get to the harder questions, will have errors, but they'll be kind of close. But you don't want to overcount. So what's outside? You know, they might say window. Well, you know, we wouldn't want them looking outside, as you're saying that. But if they're sitting at a room and they can't really see out the window, but you say what's outside and they say window because they're looking towards, you know, that's wrong. Like outside is like trees, grass, you know, those sorts of things could be correct.

So as we get to the groups, three and four, they start to get harder. Where is the refrigerator? Where do you take a bath? And so to teach those things in group four, we would get pictures of the kitchen, pictures of the bathroom. We would teach them features. But you don't want to teach to the test. You don't want to say so. You don't want to just teach a kid, he says and a dog says you want to teach animal sounds both in that direction, in the other direction. Moo says the cow, what's a cow say? A cow says, Moo Moo. And you have to be super careful because if they don't have mands, if they don't have tacts, you can end up making a really big mess of teaching intraverbals.

And then your hardest question. This should be, for a typically developing 18 month, up to four year old, five year old Max. So if you have somebody that you're like, I don't know if he has autism, he's five. He seems to talk okay to me. I would take this the central verbal assessment. I might only do groups three, four, five, six, seven, eight, you know, maybe start at eight if they can get all of group eight. They're probably fine in terms of language, not saying they don't have autism, but in terms of language for a five year old. But if you have an eight year old functioning here, then they might not be fine. If they have some holes in here. That means that they're eight functioning at a four year old level of language. And there's a big gap then. So group 8 are things like what's in a balloon?

What do you take to a birthday party? So they might say cake or so you would want them to answer gift present, not birthday cake.

Blow out the candles. Those would be wrong. Where do you go if you're sick? Why do you wear a coat? What do you do before bed? So you can see how these get really tricky. So filling this out is a good first step. But my verbal behavior bundle bonus videos, it just systematically teaches you what to do. So you don't end up making mistakes that are going to cause language to be weirder. So and in summary, whether you have a child that isn't even talking or just saying a few words, know that the first intraverbal skills are going to be fill in the blanks to songs, fill in the blanks to animal sounds, things like that. And then as the child progresses, or if you're getting to a child and they're older but their language is still not conversational, the best way I know how to assess that intraverbal language is by completing the VB MAPP supplemental material, which is the intraverbal subtests created by Dr. Marc Sundberg.

So I hope you enjoyed that little tutorial on the intraverbal and the importance of doing the intraverbal subtests for both parents and professionals. I think it's super accessible and super important.