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燧石自闭症讲座系列： Understanding Principles of Reinforcement 认识行为强化的原理 讲座日期：2016年8月9日 主讲人：Tracy Shepler MA, BCBA行为分析师 技术支持：徐艺珊 临床心理博士 主持人：赵海雄 群主：周卫宇 笔记整理：雷春 英文稿通过Tracy认可，中文稿得到薛敏医生校阅，特此感谢！
主讲人简介：Tracy是有执照的行为分析师，在这个领域有10多年的工作经验。她有一个18岁的儿子是自闭症。Tracy is a board certified behavior analyst and has worked in the ASD community for over 10 years. She has a son who was diagnosed with ASD.
The main topic is to address the importance of understanding the principles of reinforcement and how to apply it when parenting a child with ASD. The “child” includes both young and adult children. 讲座的主题是讲解认识行为强化的原理 的重要性，以及如何用于养育自闭症孩子。这里的“孩子”包括幼小和成人的孩子。
Introduction介绍
Applied behavior analysis is a scientific approach to improving socially significant behavior. “Improving socially significant behavior” means changing an actual behavior that is meaningful, and does not mean changingany behavior just because we can. In the 1970s, applied behavior analysis used negative behavior change procedures such as electrically shocking the patients. However, the practices have changed significantly over the past 40 years. Nowadays, positive reinforcement and none punishment procedures are used to create behavior changes in a meaningful way. Procedures derived from the principles of behavior are systematically applied to improve socially significant behavior. Understanding what is being reinforced for the individual and how to use the information is very important. It is very important to be able to demonstrate experimentally that the procedures were responsible for the improvement in behavior instead of individual and unknown variables, so that the procedures can be used repeatedly and create consistent behavior outcome. 应用行为分析法是用科学的手段来改善具有社交意义的行为。“改善具有社交意义的行为”是指有目的地改变一个有意义的行为，而不是根据能力而随意改变一个行为。十九世纪七十年代，应用行为分析法使用了很多负面的手段来改变行为，比如：电击病人。但是，过去的四十多年间，其疗法发生了本质的变化。现在，我们有效地使用正相行为强化法和非惩罚性的措施来改变行为。从行为原理中衍生出来的方法会系统地应用于改善社交意义显著的行为。了解什么个人行为得到了加强并且如何将此信息得以运用是非常重要的。只有实验数据证明是某项行为疗法使得某类行为得以改善，而不是个体差异和未知因素的结果，这个行为疗法才具有重复使用的意义。
1. The basis of behavioral intervention行为干预的基本原理
It is essential to understand the concept of competing reinforcers. Individuals with autism spectrum disorders often do not naturally pay attention to the most relevant stimuli. They are more easily distracted by others such as a piece of lent on the carpet or flicking of a light than the words spoken to them. Autism Behaviors are characterized by behavior excesses and behavior deficits that indicate we want less of some behaviors and more of others. Behavior researches linked between environment factors and behaviors gave us understanding of the competing reinforcers. 要从根本上理解竞争性行为强化物的概念。自闭症谱系内的孩子不会自然地关注我们需要他们了解的社交信息。在我们和他们说话时，他们很容易受到干扰，比如：地毯上的一个线头，或者闪烁的灯光，从而无法理解话语的意思。自闭症行为有两大特点：行为过多和行为不足。对于过多的行为，我们要减少；多于过少的行为，我们要增加。系统的行为学研究使我们认识了环境因素和行为的直接关系。这是真正理解“竞争性行为强化物”的科学依据。
2. Influencing Behavior影响行为的因素
There are many factors influencing behavior. The key factor is motivations: We all have 9 natural motivations in life (hunger, thirst, fatigue, discomfort, etc.), which do not require any previous training or learning experiences and are naturally reinforcing. It is important to use these motivating factors whenever possible. For example, if you want to introduce a child to a new food, it is best to do it when the child is hungry or has not eaten for hours, using natural motivation of hunger. The sequence is very important as well. When you are offering a child a less desired food, it is best to also provide a highly preferred food right after so that the child can access something quickly that they will enjoy. For example, if a child really likes mashed potato but not peas, you can say: “If you have a bite of the peas you will have mashed potato.” And make the mashed potato present. As soon as the child gets a bite of the peas the child will be able to enjoy the preferred food. This method can also apply to neuro typical children when teaching them to say “please” and “thank you”. They usually spontaneously say “please” before they learn to say “thank you”. The motivation is quite less after they have received the item! 影响行为的因素很多。最主要的是内动力因素：我们所有的人都有9种自然内动力因素，其中包括饥饿、口渴、疲劳、不适、等等。这些天然的内动力因素不需要经过任何训练或学习，而且会自然地得到强化。我们要尽可能的利用这些内动力因素。比如，如果你希望孩子尝试新的食物，最好是在孩子饥饿或者很久都没吃东西的时候，这就是利用天然的内动力因素——饥饿；类似，如果我们想让孩子吃他们不太喜欢的食物，最好是同时准备好孩子爱吃的食物，在目的达到后，孩子很快会享受喜欢的。举例子说明，如果一个孩子特别喜欢吃土豆泥但不喜欢吃豌豆，你可以说：“如果你吃一口豌豆，你就可以吃土豆泥。”同时要把土豆泥放在孩子看得见的地方。孩子吃一口豌豆后就能够享受喜欢的食物。这个方法对普通孩子同样有效，特别是在教他们说“请”和“谢谢你”的时候。他们通常会先学会说“请”而不是“谢谢你”。因为，他们一旦得到了想要的东西，动力就少了很多！
Transitioning inside after playing outside can be a difficult transition time for ASD children. Thus, it is one of the most challenging tasks for many parents. They can play very well in the park for long time but as soon as it is time to leave, they will throw huge temper tantrum. We can attempt to capture the natural state of thirst, hunger, temperature (if a natural deprivation occurred while playing outside). Purposely not bring any food or drink to the park. When it is time to go to the car, simply say, “Let’s go to the car and have some water.” Then, to transition from the car to the house, you need to have some preferable food at home, and say, “Let’s go inside and have some snack.”对于自闭症孩子，在室外玩了一段时间后，很难回到室内。这是家长们面临的最困难的挑战之一。他们在公园可以忘乎所以地玩很长时间，一旦要离开，就会大吵大闹。我们要尽量利用自然的口渴、饥饿或天气变化等内动力因素来达到目的。故意不带水和食物去公园。要上车走的时候，只是说：“上车去喝点水吧。”然后，回到家时（事先要在家里准备好孩子喜欢的食物），说：“进屋去吃些点心吧。”
3. Learning history学习历程
It is helpful to understand previous learning history and how that impacts behavior (antecedents and consequences). Antecedents are things in environment before behavior occurs including varieties of stimuli. Consequences are what happen after behavior: the kid gets the preferred item or not.了解孩子的学习历程（前置因素和后果）和对其行为的影响非常有用。前置因素是在行为发生前的环境因素，包括很多种类的刺激信号。后果是行为发生后的结果：孩子是否得到了想要的东西。
One frequently heard complain from parents is: The items or activities that my child were highly motivated to work for lost reinforcing properties over time. It is because when parents are too excited seeing their child engaging in things they enjoy, and then allow the child to have unlimited access to the items or activities without any depravation stage it will loose its reinforcing properties. To help the child motivated by the stimuli, the access to the reinforcingitems need to be limited and controlled by the parents and other support providers. Limit access to reinforcers. If there is a history of engaging in an activity or task that is not liked by the child, then we want to use highly preferred reward for engaging in the task.经常听到父母抱怨：很多物质奖励或活动奖励，原本对激发孩子的行为很有效，但经过一段时间后，渐渐失去了效果。这是因为，当家长看见奖励的效果后高兴过头，使孩子们随时都能得到这些奖励，没有空档期，从而失去了新鲜感和行为强化功效。为了保证激励效果，家长和其他成人要限制孩子得到奖励的条件。如果让孩子做一件非常不喜欢做的事，就必须提供孩子非常喜欢的奖品作为鼓励。
4. Reinforcement Procedures行为强化的方法步骤
There are different procedures we can do to influence behavior: Reinforcement and Punishment. Reinforcement increases the occurrence of a behavior by either positive reinforcement or negative reinforcement. Punishment decreases the occurrence of a behavior by either positive punishment or negative punishment. The terminologies can be quite misleading and confusing. In ABA, “positive” does not mean pleasant and “negative”does not mean unpleasant, they have very different meanings. 我们可以用不同的方法步骤来影响行为：强化和惩罚。强化是通过正相强化或负相强化来增加一个行为发生的频率。惩罚是通过正相惩罚或负相惩罚来减低一个行为的发生频率。这些术语会非常容易误导和难理解。“应用行为分析法”所指的“正相”不代表“高兴”，“负相”也不代表“不高兴”，它们与我们常用的意思不同。
Positive reinforcement means that stimulus is added to increase likelihood of future behavior. When behaviors or items such as high fives, pad on back, verbal praise, food,candy result in helping a child to do more of something, we call them positive reinforcements. 正相强化是指通过增加外界因素而提高未来行为发生的可能性。当行为或物品，比如：互相击掌、拍后背、赞美、食物、糖等，能够帮助孩子多做需要做的事时，我们就称之为“正相强化物”。
Negative reinforcement is the most misused and misunderstood term, even by professionals. However, as a parent herself, Tracy believes that it is important for parents to be equipped with the knowledge and apply it to their daily practice at home. Negative reinforcement means that removing stimulus from the environment results inincreased behavior. For example, if crying results in eliminating or delaying a child’s homework, then the behavior of crying will be reinforced by eliminating or delaying the homework. Another example of negative reinforcement for an ASD child is that when a certain social situation is aversive to the child, then the situation is removed when the child engages in certain behavior, such as stimming (rocking, hand flipping, making certain noises over and over again). It is very common to see an ASD child making very loud noises when in noisy and or uncomfortable environment. In this example, noise making is being negatively reinforced when the child does not haveto listen to annoying social stimulus. Another example is taking a medication to relieve pain. Because taking Tylenol will remove the pain, thus removing the pain will negatively reinforce the likelihood of taking that medication. 负相强化是一个最难理解和应用的概念，甚至对于专业人士也是如此。但是，作为自闭症孩子家长，Tracy认为家长需要掌握这一知识并且应用到日常生活当中。负相强化是指通过移除某个环境因素而导致某个行为频率的增加。比如，第一个例子，如果哭闹会使孩子达到不做或延迟做作业的目的，那么，哭的行为会因“不做或延迟做作业”的结果因素而加强——也就是，从此以后，每一次要做作业的时候，孩子都会哭闹。另一个自闭症孩子特有的负相强化的列子是，在某种不喜欢的社交场合时，孩子会专注于某个行为，比如自我刺激行为（不停地摇晃、摆手、发出噪音等），来逃避社交。自闭症孩子在噪音大或不喜欢的环境，通常会大叫。他们大声叫喊的行为，由于自己的声音屏蔽了环境中的噪声而得到了负相强化。第三个例子是吃止痛药，由于吃Tylenol会使疼痛消失，止痛的事实就负相地强化了吃药的行为。
http://media.psychology.tools/worksheets/english_us/operant_conditioning_en-us.pdf https://wikispaces./display/PSYCH484/3.+Reinforcement+Theory http://psychology./human-behavior/pages/cmxyrryar7/social-child-parent-aversive.html
Positive Punishment means that stimulus is added to decrease the behavior. Scolding and or spanking a child are common examples of positive punishment. We need to avoid punishment procedures at all cost because they can have a lot of unexpected side effects. 正相惩罚是指通过刺激物的加入来减少行为。打骂孩子是很常见的正相惩罚的例子。我们必须最大限度地避免使用惩罚措施，因为它们往往会产生难以预料的负面后果。
Negative Punishment means that stimulus is removed to decrease the behavior. Timeout is a common example of negative punishment. 负相惩罚是指通过刺激物的移除而减少行为。Timeout（关黑屋子）是最常见的负相惩罚的列子。
If we want to decrease aggression, can we just implement a punishment strategy to decrease aggression? No, and it’s not the treatment of choice anyway!如果我们想要减少攻击行为，我们能通过惩罚孩子来减少攻击行为吗？绝对不行！
Side effects of punishment include惩罚的负作用包括： 1. Resentment over being punished commonly by being scolded, spanked, excessive timeout etc. 打骂和长时间的关黑屋子会导致怨恨情绪。 2. Attempts to escape the punishment/avoid the punisher: when trying to avoid timeout, a child may aggressivelyattempt to escape. 企图逃跑或避开惩罚人：当试图避免被关黑屋时，孩子可能竭尽全力地企图逃跑。 3. Expression of pain and negative emotions associated with punishment due to spanking. 被打了之后，孩子可能因疼痛和负面情绪而嚎啕大哭。 4. Recognition by the punished individual between the punishment and the person delivering it—The person mostly likely a parent delivering the punishment becomes paired (respondent conditioning) with an aversive/punishing experience. When the person (punishment condition) is not present (available) the child will more likely to act up (increase undesirable behavior). Thus, in the end, punishment procedure does not teach the child what we want them to do. On the opposite, positive reinforcement and negative reinforcement procedures give the child clear signals what we want more of their behaviors. Both positive punishment and negative punishment procedures must be implemented by board certified behavior analysts or at least licensed professionals who were adequately trained in behavior change technics. The extreme harmful self injure behaviors, which may need punishment procedures to decrease, are very rare and definitely need licensed professionals to monitor. 孩子可能会把惩罚人（大多是父母）与被惩罚的事件对应地联系起来。当惩罚人不在的时候，孩子可能会变本加厉地做不该做的事。因此，最终，惩罚不能教会孩子我们想要他们做的事。与之相反，正相强化和负相强化策略能清楚地告诉孩子我们要他们做什么和怎么做。正相惩罚和负相惩罚必须由经过专门训练的有执照的专业人士执行。那些非常危险的自残行为需要使用惩罚的方法来减低，但是这类行为极少，而且一定需要有执照的专业人士来监督。
5. Functions of Behaviors行为功能
There are only four functions of behaviors that individuals can demonstrate. Before we target a behavior for change, we have to identify the function of the behavior. The four functions are access attention, escape/avoidance, access items and automatic reinforcement. Attention does not have to positive. Negative attention is still attention. After all the chaos (temper tantrum) settles down, did the individual access an item? It is also important to understand: Escape/removal of attention; Escape/removal of items; Positive automatic reinforcement; Negative automatic reinforcement. 总的来说，所有的人类的行为都可以归类为仅有的四种功能。在我们改变孩子的某个行为之前，我们必须知道这个行为的功能是什么。这四种功能是：得到关注、逃避、得到东西和自动强化。孩子想得到的“关注”，并不一定是正面的关注；负面的关注也同样是“关注”。在哭闹之后，孩子是否得到了想要的东西？那么，“哭闹”的功能就是“得到东西”。同时，家长也要了解逃避关注及避免事件的功能；还有，正相自动强化和负相自动强化功能的概念。
Parents and even teachers regard scolding as punishment. But it is actually a function of access negative attention which reinforcing the behavior. Accessing attention can be both positive and negative attention. 大部分家长甚至老师把“骂”孩子当作“惩罚”。但是，这实际是满足了孩子“负面关注”的需要，反而会强化孩子的不当行为。记住，孩子要得到的关注，可以是正面的关注，也可以是负面的关注。
To escape from something that they don’t want to do, or to avoid something they don’t like is a motivation for ASD children to change their behaviors. 逃避做不想做的事是自闭症孩子改变行为的一个动机。
If after the tantrum the child gets the item he/she wants the behavior is reinforced. For example: A child was crying in a store for a toy. Even after the parent scolded the child and said no, the child would not stop the tantrum until the parent gave in. Then crying serves the function of access the toy. Next time when the child wants something, it is very likely he/she will cry until he/she gets it.如果孩子在哭闹后能够得到想要的东西，那么，这种行为就得到了强化。比如，孩子在商店里哭着要一个玩具。虽然父母责骂孩子，说不可以，孩子还是无法停止哭闹，直到父母让步为止。那么，哭闹就具备了得到玩具的功能。下一次，当孩子想要其它的东西时，很可能会哭到得到为止。
Automatic reinforcement means that the behavior reinforces itself. Stimming behaviors such as hand flapping, rocking are typical automatic reinforcement behaviors. However, when an unwanted task is present, they can have a different function (escape). Thus, same behavior can have different functions. 自动强化是指行为本身有强化功能。自我刺激行为，如摆手、摇晃身体都是典型的自动强化行为。但是，当自我刺激行为，在需要做一个不想的做的事的情况下出现时，就成了另一个功能——逃避功能。因此，同一个行为在不同环境下，可以有不同的功能。
It will be very challenging for parents to understand and grasp the concept of all the 4 functions of behaviors at once. However, trying to think like a behavior analyst will help parents to analyze your children’s behaviors and aware what functions their behaviors serve. Behavior analysts often use different types of assessment tools to understand what may reinforce a behavior and what function a behavior appears to be. 对于父母，一下子理解和掌握这四个行为功能是非常具有挑战性的。但是，父母还是可以尽量向行为分析师学习，从行为分析的角度思考和辨别孩子的行为，意识到孩子行为的功能是什么。行为分析学家会使用不同的工具来帮助分析和理解强化行为的因素是什么，以及这个行为的功能表现为什么。
1. Access Attention得到关注: Examples of questions to ask yourself: what functions does this appear to be?每当孩子的一个行为发生时，要问自己：这个行为的功能是什么？
Does this behavior occur when you are talking to other people in the room?这个行为是不是在你和房间里其他人说话时发生的？ Does this behavior occur whenever you stop attending to the child? 这个行为是不是在你停止照顾孩子时发生的？ Does the child engage in this behavior to upset or annoy you when you are not paying attention to him or her? 孩子是否在你不关注他／她时，故意这样做来烦你或惹你生气？ Does the child seem to do this behavior to get you to spend some time with him or her?孩子这样做是否想让你多陪陪他／她？
If when you were on the phone with a friend your child started crying and pulling your pants, then it is an attention seeking behavior. 如果你打电话和朋友聊天时，孩子开始哭闹而且拉你的裤子，那么这就是寻求关注的行为。 If you were playing with the child, as soon as you walked away, the child started crying, then it is another indication of attention seeking behavior. 如果在和孩子玩时，你一走开，孩子马上就哭了起来，那么，这也是寻求关注的行为。 If a child purposely engage in a behavior (such as knocking on the table) to upset you it is an attention seeking behavior. 如果孩子故意做事（如敲桌子）来惹你生气，这也是寻求关注的行为。 If the child has to sit on your lap while engaging in playing a toy or hug you when with him/her, it means he/she wants more time with you.如果孩子玩玩具时要坐在你的腿上，或者你和他／她在一起时一直要抱着，这意味着他／她需要你花多点时间陪。
2. Automatic Reinforcement自动强化: Examples of questions to ask yourself: what functions does this appear to be? 每当孩子的一个行为发生时，要问自己：这个行为的功能是什么？
Would this behavior occur continuously if the child were left alone for long periods of time (for example, one hour)?如果孩子自己呆很长一段时间（如一个小时）这个行为是否会一直持续着？ Does this behavior occur repeatedly, over and over, in the same way (for example, rocking back and forth for five minutes)? 同一个行为一遍一遍地重复（比如每隔一段时间，前后摇晃5分钟）？ Does it appear to you that the child enjoys performing this behavior and would continue even if no one was around?即使周围没人，孩子也会很高兴地不间断地表现这个行为？ When this behavior is occurring, does the child seem unaware of anything else going on around him or her? 这个行为发生时，孩子是否对周围发生的事毫无察觉？
When a child is left in a room for long period of time, he/she engages in stimming (hand flapping, rocking, flipping objects in front of face), and then the function of the behavior is automatic reinforcement. Even when a child is in an automatic reinforcing behavior, we can be creative, and are able to redirect, introduce and engage him/her in other reinforcing behaviors. 当一个孩子自己在房间呆很长时间时，他／她有自我刺激的行为（摆手、摇晃、把东西在面前翻来倒去），那么这个行为的功能就是自动强化。孩子有自动强化的刺激行为时，我们要根据具体情况，来分散和转移注意力，并引导孩子做其它更有趣的事。
3. Escape or Avoidance逃避任务: Examples of questions to ask yourself: what functions does this appear to be? 每当孩子的一个行为发生时，要问自己：这个行为的功能是什么？
Does this behavior occur following a command to perform a difficult task?这个行为是否是在告知要进行困难的工作后发生的？ Does this behavior occur when any request is made of the child? 这个行为是否是在和孩子提要求时发生的？ Does the child seem to do this behavior to upset or annoy you when you are trying to get him or her to do what you ask? 每次在你试图让孩子按你的要求去做时，他／她似乎都会这样做来惹你生气吗？ Does this behavior stop occurring shortly after (one to five minutes) you stop working or making demands of him or her? 在你停止强迫孩子做事后很短的时间内（一至五分钟），这个行为就消失了吗？
When children struggle with verbal communication, they are asked to say a word, they may start to cry or throw a tantrum at that point. 在孩子语言交流有很大困难，但又被要求用一个词表达自己时，可能会大哭大闹。 When parents ask the child to use sign language or say a word to ask for a preferred item，the parent says, “OK, say train please!” then the child cries or starts to stimming or other behavior other than follow instruction. The behavior is motivated by escape or avoidance—they are trying to get out of the task. 当父母要孩子用手语或一个词来要一个想要的东西时，家长说：“好了，请说火车！”孩子立即哭闹起来，或者开始自我刺激，或者其它行为，而不是按照要求去做。这个行为的动机是逃避——他们企图避免按要求做。 When you were trying to get the child take a bath, he/she threw a tantrum. Then suddenly, you stopped trying to demand him/her to take a bath, he/she stopped crying. It is an indication that the function of crying is avoidance. 当你想给孩子洗澡时，他／她大哭大闹。一旦你不要求了，他／她的哭声突然停止。这就是说，“哭”的功能是逃避。
It is challenging to change behaviors that are motivated by escape or avoidance. There are two parts involved in the behavior intervention. The first is to block the individual from being able to escape the task. The second is offering reinforcement of engaging in the task or an easier form of the task. 改变以逃避为动机的行为是很有挑战性的。这个行为干预有两个重要的部分。第一个部分是阻止逃避的可能。第二个部分是提供做事的强化物（奖励），或者把任务变得容易一些。
4. Access items得到东西: Examples of questions to ask yourself: what functions does this appear to be? 每当孩子的一个行为发生时，要问自己：这个行为的功能是什么？
Does this behavior ever occur to get an object, activity, food, or game that the child has been told he/she can’t have?这个行为是否在被告知不能得到某一个物品、活动、食物或游戏时发生？ Does this behavior occur when you take away a favorite object, activity, or food? 这个行为是否在你拿走一个最喜欢的物品、游戏或食物时发生？ Does this behavior stop occurring shortly after you give the child the object, activity, or food he/she has requested? 这个行为是否在你给回孩子物品、游戏或食物不久后就停止？ Does this behavior seem to occur when the child has been told that he/she can’t do something he or she wanted to do?这个行为是否在被告知不可以做孩子想做的事时发生？
When you take away the iPad, the child starts to cry, then the function of crying is to access the iPad. To check the function of the crying behavior is to access items, you can give the iPad back to the child and see if he/she stops crying. 当你拿走iPad时，孩子哭了起来，那么，哭的功能就是得到iPad。如果要证明哭的功能是要得到物品，你可以把iPad给回孩子，然后观察他／她是否不哭了。
If the function of the behavior is to access an item, the intervention is relatively simple. Sign language, picture selection and approximation (partial sound) of the word can be taught to the child to access the item. 如果一个行为的功能是得到物品，所需的行为干预会相对容易。可以教会孩子使用手语、选图和类似那个词的声音来得到那个东西。
Review of the 4 functions行为四功能的综述: When a behavior function is identified as to gain attention, we can teach the child how to get the attention in a socially acceptable way. For a child who is none verbal, walking to a person and tapping to the arm or shoulder, pointing to a picture of mommy or a preferred teacher can be used to obtain the needed attention. Caregivers need to observe any hint of such socially appropriate behavior and reinforce it by providing immediate access to the attention. To reinforce a behavior of an ASD child, it is very important to give him/her immediate attention without a period of waiting. For reinforcers, the more immediate they are the more effective they will be. 如果一个行为的功能是得到关注，我们可以教会孩子如何通过合适的社交途径来得到别人的注意。对于一个不会讲话的孩子，走到那个人跟前，轻轻地拍胳膊或肩膀，手指着妈妈或一个喜欢的老师的照片，都是合适的得到所需关注的行为。保育人员需要观察孩子任何这类合适的社交行为的迹象，并通过提供即时的关注而进行强化。要强化一个自闭症孩子的行为，即时的关注非常重要，真的是刻不容缓。对于强化物，越是即时就越有效果。
It is definitely trickier to intervene with automatic or self-stimulating behaviors. It is important to encourage the child’s stimming behavior for a certain period of time to satisfy the need, then redirect and engage the child into a highly preferred activity. For example, Tracy worked with a child who was constantly focusing on hand flapping and paid no attention to the environment. It was almostimpossible to teach him anything in the beginning. Tracy flapped her hands with the child to catch his attention, and laugh together with him to gain his trust. Then she set a timer. As soon as the timer went off she presented him a very desirable food and gave him a lot of verbal praise while eating. After stabilizing the transition from hand flapping to food, Tracy added trampoline jumping as the following activity, and eventually faded away the food. Over time, the hand flapping behavior was reduced to 10 minutes every hour. 对自动或自我刺激的行为进行干预一定要谨慎。在一定时间范围内，鼓励并满足孩子自我刺激的需要十分重要。在这个基础上再分散和转移注意力，并引导孩子做非常喜欢的事。举例说明， Tracy曾经教过一个只对摆手感兴趣的孩子，他对周围环境全然不知。刚开始几乎无法教他任何东西。Tracy和孩子一起摆手并得到了他的关注，和他一起大笑并取得了他的信任。过了一段时间后，她开始使用计时器。计时器一响，她就给孩子非常喜欢吃的食物。他一边吃一边使劲表扬他。在从摆手到食物的转换过程稳定后，Tracy又引入蹦床的游戏，并慢慢减少食物，直到完全不需要食物就可以从摆手转换到蹦床游戏。经过一点时间的训练，摆手的时间减少到了每小时10分钟。
For escape or avoidance behavior, it is a two-part process. We need to break tasks down into smaller components. If an escape or avoidance behavior works for the child, he/she will continue the behavior. The challenge for parents is to make the behavior not effective. For example, if a child can escape from his/her math homework whenever he/she cries,he/she will cry whenever asked to do the homework. The first step to stop the behavior is to tell the child that he/she will need to do the homework no matter how long he/she cries—crying will not get him/her out of the homework. Since it is a highly aversive activity for the child, we will need to be creative and use reinforcers to meet the child where he/she is. It is very important to know the learning history of a child including all the difficult tasks such as math time, bath time, etc. We need to use the information to set the child up for success in the future. If we know that math is challenging for the child, we need to adjust our expectations accordingly. For example, instead of forcing the child to do 20 math problems at once, we may ask him/her to come to the tale to do just one math problem, and then immediately reinforce it with highly preferred activity. If a child is unwilling to take a bath, the first step may be just putting a washcloth on the child’s forehead. In the field of behavior analysis, this process is called shaping, which means we breakdown the task into small steps, and each time we apply lots and lots of reinforcement, and each time we get closer to the end goal of the task. 逃避行为的干预需要两个步骤。我们必须将任务分解成一些小的部分。如果逃避行为能够达到目的，这个行为就会持续下去。父母的挑战是使这个行为无效。比如，如果哭闹后可以不做作业，那么，每次叫他／她做作业时孩子就都会哭闹。第一步是告诉孩子无论他／她哭多久，作业最终还是要做的——他／她逃避不了作业这个任务。由于做作业是孩子非常不喜欢的事，我们需要有灵活性，并且用强化物来帮助孩子做他／她力所能及的作业量。了解一个孩子的学习历程非常重要，包括所有对于孩子来说非常困难的学习科目和日常生活的任务，比如：数学、洗澡、等等。我们要用这个知识来帮助孩子不断成长。如果我们知道数学对一个孩子很困难，我们要根据情况调整期望值。例如，我们不去强迫孩子一次做20道题， 而是要他／她到桌子前来只做一道题，然后立即通过让他／她做非常喜欢的事来强化这个行为。如果一个孩子不喜欢洗澡，第一步也许只是把湿毛巾放在前额上。在行为分析领域，这个过程称为行为“塑造”，意思是，我们把任务分割成小的步骤，每一次小的进步，都给予大量的行为强化（奖励），因此每一次我们就离目标更近一步了。
Questions and Answers问题解答
Q1: What can be used to as appropriate reinforcement? I think candy is a no while preferred activities are better. 合适的行为强化物有哪些？我认为糖果不好，但游戏很好。 A1: Candy is not good to be used as reinforcement in long term since a lot of ASD children are obese due to food as reinforcer. The categories of reinforcers are primary reinforcers and secondary reinforcers. Food is considered as primary reinforcers. Primary reinforcers are items that do not need learning curve. A food that taste good to an individual does not require learning history to want more of the food. In the beginning stages of behavior analysis, food is incorporated into early practice because most of the time, food is the only reinforcement option available. Food will become a problem if it is not faded away. In the hand flapping case, the child was able to transition from hand flapping to jumping on a trampoline, which actually engaged him in physical activity. ABA intervention uses ABLLS (assessment of basic language and learning skills). One of the first tasks that a child is taught to learn is a task of having a reinforcing toy, learning how to play with a toy, and learning how to find that toy is reinforcing. The way is to pair a toy with food or stimming to give the child a range of choices to choose from that are considered reinforcers. 糖果不可以长期用于自闭症孩子的行为强化，因为很多自闭症孩子由于过度使用食物作为行为强化物而有肥胖的问题。行为强化物有原始和次级两大类。食物是原始强化物。原始强化物是指不需要学习过程的强化物。美味食品一旦品尝后，不需要任何学习历程，孩子就会还要吃。行为分析学的行为干预过程的初级阶段，食物往往被用做行为强化物，因为大部分时候，实在是别无选择。如果食物不渐渐被其它强化物所取代，就会有问题。在前面的摆手案例里，那个孩子最后可以不需要食物就从摆手转换到蹦床游戏，反而使他增加了体能活动。应用行为分析学的行为干预步骤，会以ABLLS作为参考。孩子首先要学会的技能之一是能够玩行为强化玩具，要学会玩这个玩具，并且发现这个玩具有强化功能（越玩越有趣）。方法是把这个玩具和食物或自我刺激对应起来，让孩子选择强化物。
Q2: What do you do if kids no longer react to positive reinforcement, but negative ones (warning, punishment)?如果正相强化物无效了怎么办？能用负面的警告、惩罚吗？ A2: We don’t call something reinforcement unless it increases behavior. For example, a parent says， “Good job！” that initially increases a behavior; after a while, it stops working, then we would no longer call it reinforcement because it does not have any effect on behavior. Periodically, we have to go back to the starting point and we have to figure out again what are positive reinforcers for the particular individual. A couple of months into a program, behavior analyst needs to evaluate the reinforcers and frequently change and swap those out. The reality is that people will get used to certain things and don’t find them exciting anymore, which is a good indication that it is time to change to a different reinforcer. The ideas of reinforcers can be easily found online by Google.只有增加行为的事物才是行为强化物，否则就不是。比如，一个家长说“做得好！”刚开始有行为强化作用；过了一阵子，就没用了；那么，我们就不能叫它强化物，因为它对行为没有影响。时不时的，我们必须回到起点，重温哪些是这个孩子的正相行为强化物。每两个月左右，行为分析师都需要重新评估孩子的行为强化物，并经常调换。实际情况是，每个人都会对事物逐渐习惯，当失去新鲜感时，就要及时更换行为强化物。网上有很多行为强化物的建议，可以根据孩子的情况选择。
Q3: What are the effective positive reinforcement techniques for autistic teenagers, i.e., hands flapping in public, pinching mom’s arms, repeating the same questions or sentences all the time, staying up late and refusing to see psychologists? 对于十几岁的自闭症孩子，有什么有效的正相强化方法？孩子会在公共场合不停地摆手、掐妈妈的胳膊、重复不断地问同一个问题或说同样的话、晚上不睡觉而且拒绝看心理医生。 A3: The “hand flapping in public” can be due toautomatically reinforcing and it feels good; or can be due to feeling uncomfortable in public and doing so can help him avoid feeling uncomfortable. There may be certain stimuli in the environment that the individual finds uncomfortable, thus he need to find a way to control that before he goes to public. Knowing the child will pinch mom while walking, then he needs to put his hands in his pockets. “Repeating the same questions or sentences all the time” and “hand flapping in public” are very common automatic reinforcement behaviors in ASD children, which is calledPerseveration. Perseveration is very difficult to treat. However, it just requires a lot of redirection and a lot of reinforcement. “在公共场合不停地摆手”可能是一种自动强化行为，孩子从中有快感；也可能是孩子不喜欢这种环境，这样做会逃脱不舒服的感受。如果环境中有令孩子焦虑的事物，在去之前，我们首先要帮助他找到控制的方法。如果知道孩子会边走边掐妈妈的胳膊，他就需要把手放在口袋里。“在公共场合不停地摆手”和“重复不断地问同一个问题或说同样的话”是自闭症孩子常有的自动强化行为，被称作“言行持续症”。“言行持续症”是个很具挑战的病症，但是，通过坚持不懈的转移注意力和坚持不懈的行为强化，会有显著的改善。
Q4: How to use reinforcer to help a child be more focused when there is an elevator in sight, and he is obsessed with elevator? Whenever in malls, he just looks for elevators, nothing can gain his attention. 如何运用强化物来转移孩子对电梯的痴迷？每次在商城，孩子只是在找电梯，对其它事物都没有兴趣。 A4: ASD child does not naturally pay attention to the most relevant stimuli in the room because it is not reinforcing. The strategies can be moving his chair to face away from the elevator, blocking his view to the elevator and providing lots of reinforcement when he is focusing on something other than the elevator. In general, visual and auditoria distractors are frequently present in the environment. We need to try to block them as much as possible. When a child is easily distracted by visual distractors, we need to seat the child in a place with minimum visual distractions. When a child is easily distracted by noise while reading, we can provide headphones to block the noise. 自闭症的孩子不会自然地关注身边最相关的社交信息，因为他们会觉得无聊、无强化性。可以采取的措施有，让椅子面对与电梯相反的方向，挡住视线，不让他看到电梯，并提供很多他感兴趣的事，当他关注其它事情时用强化物进行奖励。总之，环境中有很多视觉和听觉的干扰，我们要尽力屏蔽。当孩子很容易受到视觉干扰时，我们得让孩子坐在视觉干扰最少的地方。如果孩子读书时容易被噪音干扰，我们可以用耳机帮助屏蔽噪音。
Q5: Is there an efficient way to look for local ABA/BCBA? How to find out if he/she is a good match to my child at a particular period of time? 如何寻找当地的行为分析师？如何知道他／她适合我的孩子？ A5: The best way to look for a local ABA/BCBA is to go on the board website最好的方法是在这个网页上找: http://info./o.php?page=100155 To find out if a behavior analyst is right for your child, it has to go through trial and error. It is very important he/sheis a right match for your child. Parents have to be comfortable with the intervention style that the behavior analyst is recommending in order to follow through.Interview and trial processes are very important. If after a period of time a behavior analyst is not right, parents need to fire him/her, and find someone else who is a better fit. All parents are encouraged to do so. However, we need to be careful about the reason that the parents don’t feel right, and ask: is it because the behavior analyst is asking the parents to do something they don’t like to do (for example, to ride out tantrums of a child), or the personality of the behavior analyst is not a good match? The website also provides information regarding RBTs (registered behavior technicians). The person who works with an ASD child hasto at least have RBT credential and under supervision of a BCBA. 要知道一个行为分析师是否适合你的孩子，没有捷径，只能是通过试用。适合孩子非常重要。父母也要喜欢行为分析师的干预方案和本人个性，否则无法坚持。面试和试用都很重要。如果过了一段时间，父母觉得这个行为分析师不合适，就应该解雇他／她，找更合适的人。鼓励所有的家长都这样做。但是，家长要清楚自己不喜欢这个行为分析师的原因，并问自己：是给的任务太难做到了（如让孩子哭个够）？还是这个行为分析师的性格不合适？这个网页还有RBT的信息。教自闭症孩子的老师，至少要是在BCBA行为分析师指导下的RBT。
Q6: How do you teach a child about “joint attention” from the beginning step? What will be the next step? 如何培养孩子的“分享式注意力”？步骤是什么？ A6: “Joint attention” is a difficult area to study, and there are a lot of researches in this area. The child is initially taught how to play with the therapist. It begins with lots and lots of prompting and lots and lots of reinforcement. Then it follows the generalization training. The child should be able to engage in the same play behavior with other people including parents and other children. Teaching an ASD child how to play often requires tons of prompting in the beginning and then the prompts are faded over time. “分享式注意力”是一个非常不容易理解的领域，目前这方面有很多研究。孩子首先要学会和治疗师玩。刚开始的时候需要很多对兴趣的激发，并给予大量的奖励强化。然后要进行概念化训练。孩子应该逐渐可以和其他人（包括父母和其他孩子）玩同样的玩具游戏。教自闭症孩子学会玩游戏，刚开始需要很多的激励，然后逐渐减少物质刺激，直到不需要。
Q7: What do you suggest parents do to prevent vocal stimming (grinding teeth, singing songs, talking nonsense) especially in public? 如何防止孩子在公共场所进行声音刺激行为（磨牙、唱歌、胡言乱语）？ A7: It is a good and tough question. These behaviors are self-simulative and automatically reinforcing. We want to be thoughtful about them when we think about different interventions. If a child can keep their mouth occupied then the grinding teeth, singing songs, talking nonsense behaviors can be reduced. For example, we can teach a child how to chew gum or even Laffy Taffy (a very chewy candy), which will give him/her sensory stimulation that he/she is looking for. Meanwhile, we can encourage his/herbehaviors in a car, but as soon as in public we can ask him/her to stop by saying: “Now it is time to chew this.” 这是一个非常好而且有难度的问题。这些是自我刺激和自动强化的行为。在考虑不同的行为干预方案时，一定要慎重。如果一个孩子的嘴不停地忙活，那么这些行为就会减少。比如，我们可以教孩子嚼口香糖，甚至Laffy Taffy糖， 这会满足孩子感官刺激的需要。同时，孩子在车里的时候要鼓励或允许这些行为，但是，一旦到了公共场所，我们可以通过说：“现在是嚼这块糖的时候了。” 进行行为转换。
Q8: Preschooler started to be scared of sleeping alone at night. Is there any way to handle it since he couldn’t explain what scared him or should I co-sleep? 学龄前儿童开始害怕晚上自己睡觉。有什么办法吗？他说不清害怕什么。家长应该和他一起睡吗？ A8: It is a tough question. It has a lot of culture factors involved. Some families encourage co-sleeping for a number of years, and other families have strong feelings about not having their children in their bed. The expectations and plans need to be consistent every night, which include trying to sooth the child, and then teachingthe child how to sooth him/her self so that he/she can fall asleep on his/her own. Tracy has three children. She decided to train her 3rd child who was frequently waking up at night. Instead of taking the baby to her bed, she would frequently go to the baby’s room, start singing, and in the mean time, rub her back for 5 minutes, lay her back down in crib, rub her back again for 5 minutes, and stand by her crib, then gradually move out of the room. Occasionally, if the baby started crying very loud, she would go back in and rub the baby’s back again. It is not perfect plan but there are three more people sleeping in the house. It is the best she can do. After about one and half months, the baby finally was able to sleep through the night without waking up. 这是一个不容易回答的问题。与文化因素有关，有的家庭鼓励和孩子同睡很多年，而有的家庭坚决不让孩子睡在父母床上。不论是哪种情况，父母对孩子的期望和实施计划必须每晚都一致。做法包括：安慰孩子，然后教孩子学会安慰自己，自己睡着。Tracy有三个孩子。她决定训练晚上经常醒来的老三自己睡觉。宝宝醒来时，她没有把孩子抱到自己的床上，而是经常去宝宝的房间，抱起宝宝并开始唱歌，同时给她按摩后背5分钟，然后让她躺在婴儿床里，又按摩后背5分钟，接着站在小床边，唱着歌慢慢蹭到门外。有时候，如果宝宝大哭起来，她会又走回去，再次给宝宝按摩后背。这不是完美的方案（没有保持一致），但家里还有三个人在睡觉，算是尽力了。大约一个半月之后，宝宝终于可以自己睡过夜了。
Q9: How to deal with inappropriate behaviors seeking attention or negative enforcement in social settings? For example, my son likes touching peer’s hairs or disrupting class music and other inappropriate behaviors, and laughing about repeat comments like “no touching friends hair” or “no opening doors” etc. 如何应对孩子在社交场合通过不合适的行为来引起注意的行为？比如，我儿子喜欢摸同学的头发，干扰课堂音乐，嘲笑并重复别人的话“不要摸朋友的头发”或“别开门”等。 A9: It is a very good question and appropriate. First, we need to make sure the child receives as little attention as feasible for the negative attention seeking behaviors. Sometimes it can be very difficult. Some kids learn very quickly how to push the buttons and how to aggregate people in a way to provoke them and get large response. The teacher has to involve the class to selectively give attention to the behaviors that you want more of, and try to give less and less attention to those type of negative behaviors. Responding in a very neutral and calm tone and then providing appropriate and logical consequences for inappropriate social behavior is a really good place to start. Then, we need to make sure the child will have opportunities to gain attentions through positive social skills. 这是一个很好的问题，也很适合在这里分享。首先，我们要保证对寻求负面关注的孩子的行为给予尽可能少的关注。有时候这是一件非常难做到的事。有的孩子非常聪明，很快就学会了如何惹别人发怒，得以大闹一场。老师要教会班级的同学如何选择性地关注想要的行为，尽力逐渐减少对负面行为的关注。在孩子有捣乱行为时，如果能用平静的语气和他／她说话，同时提供合适的和自然的行为后果，就是一个好的开始。之后，我们必须保证孩子能有机会通过正面社交行为得到关注。
Q10: There are many different intervention methods out there, for example, DTT, VB, ESDM, RDI, etc. Does certain method work better with certain functioning level?行为干预的方法很多，比如DTT、VB、ESDM、RDI等等。不同程度的自闭症孩子适合某个不同的方法吗？ A10: There are a ton of intervention methods out there. Tracy has extended experience with DTT and VB. Her friend’s child was involved in RDI. What she can tell you is that as part of ABA, DTT and VB have the largest amount of research that demonstrates their efficacy. Parents can research other methods. However, ABA is the only one that is covered by insurance, which is considered as the gold standard. 行为干预的方法确实很多。Tracy在DTT和VB方面经验丰富。她的朋友的孩子用过RDI。她可以确切说明的是，由于DTT和VB是ABA的一部分，有大量的研究证明其有效性。家长可以探索和尝试其它方法。但是，ABA是唯一保险付费的方法，被认为是金标准。
Q11: How to help kids with delayed echolalia? 如何帮助延迟“仿说”的孩子？ A11: Echolalia is a common behavior among ASD children some time in their lives, especially during language acquisition years of childhood. Tracy has no experience with “delayed” echolalia. The strategy she can come up with is to block the behavior through occupying their mouths. It is also very important to have the child thoroughly checked for neuropsychological conditions to see if there are any medical causes such as auditoria processing issues. “仿说”是自闭症孩子中常见的行为，特别是孩子在学习语言的童年期。Tracy对“延迟仿说”没有经验。如果不想孩子说，最好的方法是让他们的嘴巴忙着嚼东西。同时，带孩子去神经心理医生那里做全面的检查也是很必要的，有的仿说可能是“听觉处理障碍”引起的。 https://www.iidc./pages/Functional-Categories-of-Delayed-Echolalia
Q12: My 4 years old will sometimes start talking about books he read or show he watched out of nowhere. What can be done to reduce that behavior?我四岁的孩子有时会在，毫无关联的情况下，讲起他读过的书或者看过的表演。如何减少这种行为？ A12: It depends on how it interferes with social situations. If it is not interfering with learning or functioning, it is best to be left alone. If it is interfering, you need to find competing reinforcer. During normal language development, it is common that while a child is falling asleep, he/she can tell a complete story about his/her day, which sounds not very sensible, but it is a normal part of language development. Thus, we need to be thoughtful and careful about the behavior, and make sure it is a socially significant problem. 这要看干扰社交的程度。如果不干扰学习和正常生活，最好不要当回事。如果有干扰，你要找有竞争性的强化物。在正常的语言发育过程中，常常看到，孩子快睡着时，他／她会讲他／她一天的故事。听起来词不达意，但确实是语言发育中正常的现象。因此，我们必须谨慎小心，只有被专家诊断出是一个社交问题后再进行干预。
Some links一些链接: http://www.specialconnections./~specconn/page/behavior/fba/pdf/completedabcchart.pdf http://www.specialconnections./~specconn/page/behavior/fba/pdf/blankabcchart.pdf |
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来自： wangyancnpe > 《选择性jm》
