One in 68 Children has Autism

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Positive Behavior Intervention and Supports: Transition Routines

February 22, 2016 3:00 pm Published by

At the QSAC Preschool and Day School, we strive to implement as many proactive strategies as possible to increase independent prosocial behavior and to prevent and decrease the occurrence of problem behavior. These proactive strategies are part of a system of Positive Behavior Intervention and Supports (PBIS). PBIS is a decision making framework that aims to improve staff and student behavior through reward systems, careful environmental manipulation, the use of evidence based practices and ongoing data analysis to monitor staff and student progress. Our PBIS framework includes 13 proactive/preventative strategies for increasing prosocial skills and improving overall behavior. One very important proactive strategy is the use of student and staff schedules to ensure predictable, seamless transition routines. As transitions between and within activities are often difficult for individuals with Autism Spectrum Disorders (ASD), transition routines including activity schedules can serve as one antecedent strategy to increase independence and decrease problem behavior, thereby alleviating the need for intense staff support (Pierce, Spriggs, Gast & Luscrea, 2013).

An activity schedule is a group of photographs, videos, computer images, drawings, symbols or text, sequentially arranged on a display for individuals to follow. They can include single or multiple items in sequence. Activity schedules can be used between routines as a transitional tool or within routines to cue specific steps of an activity (Banda & Grimmit, 2008).

Banda and Grimmit (2008) conducted a systematic review of studies using activity schedules to improve social interaction skills and decrease problem behaviors. Behaviors targeted for increase included social exchanges and initiations, on-task and on-schedule behavior, independent daily living skills and independent play skills and behaviors targeted for decrease included hitting, kicking, biting, crying, and screaming, other undefined problem behaviors during transitions and long latencies in completing transitions. While most studies focused exclusively on either increasing or decreasing one target behavior, four focused on increasing on-task behavior while simultaneously decreasing problem behaviors. Nine studies utilized photograph, computer or video activity schedules, two used line drawings, one used PECS icons (Bondy & Frost, 1993, 1994) and one used text. All interventions were applied by psychologists, teachers, and/or graduate assistants.


According the results of their review, Banda and Grimmit (2008) reported that activity schedules enhanced social interactions and on-task behavior and decreased problem behavior during transitions. The authors noted that in several studies reporting generalization across settings and persons and in five studies reporting social validity measures, caregivers indicated activity schedules as beneficial and efficient in improving learner behavior.

At the QSAC Preschool and Day School, we have prioritized the use of activity schedules to aid in all student transition routines. Our teachers also often use extra cues to aid in the predictability of a routine such as frequent time warnings (e.g. “ Five more minutes until lunch”), musical cues and other sound cues (e.g. a bell) to indicate when it will be time for students or staff to review their respective schedules and change activities accordingly. Schedule use is also an important transitional skill for students. At QSAC Day School, in particular, we are currently working on teaching our students working in vocational training to follow and be responsible for their own daily schedules. Transitioning activities following a schedule is an essential skill for all those striving to work and live as independently as possible. It is one of a myriad of important prosocial skills targeted at the QSAC Preschool and Day School via our PBIS framework.



LMaffei-Blog-BubbleLindsay Maffei-Almodovar, MS Ed, MA, BCBA, has worked in the field special education since 2001. She joined Quality Services for the Autism Community (QSAC) in 2011 and is currently the ABA Training & Development Coordinator. She is responsible for designing, evaluating and monitoring staff training initiatives at both the preschool and Day School programs. Lindsay is a certified New York State Early Childhood General & Special Education Teacher and a Licensed Behavior Analyst. Lindsay is also a doctoral student in the Behavior Analysis Training Area of the Psychology Department at Queens College and The Graduate Center City University of New York (CUNY). Her research focuses on efficient methods of training staff members in evidence based behavior analytic procedures.



Banda, D. R., & Grimmett, E. (2008).Enhancing social and transition behaviors of persons with

autism through activity schedules: A review. Education and Training in Developmental

Disabilities, 43, 324-333.


Maffei-Almodovar, L., & Sturmey, P. (2013). Evidence-based practice and crisis

intervention.In D. D. Reed, F. D. DiGennaro Reed & J. K. Luiselli (Eds.), Handbook of Crisis Intervention and Developmental Disabilities (pp. 46-69). New York: Springer.


Pierce, J. M., Spriggs, A. D., Gast, D. L., & Luscre, D. (2013). Effects of visual activity

schedules on independent classroom transitions for students with autism. International

Journal of Disability, Development and Education, 60, 253-269.



Obesity and the Autism Population

February 8, 2016 3:00 pm Published by

According to the Center for Disease Control (CDC), more than one third of adults in the United States are obese. The prevalence of obesity in the United States has more than doubled over the past 40 years; however, these prevalence rates do not make mention to individuals with developmental disabilities.

In another report published by the CDC in 2014, obesity was reported to be the highest among teens with learning and behavioral developmental disabilities, and greater among children diagnosed with autism spectrum disorder (ASD). Adolescents with ASD were two times more likely to be obese than their typically developing peers.

Being overweight can put children at increased risk for numerous health problems, both in childhood and as adults, including diabetes, cardiovascular disease, bone and joint problems, and even depression. The effects of these conditions may take an even greater toll on individuals with autism, in combination with common autism symptoms and some highly co-morbid conditions such as gastrointestinal problems as well as depression and anxiety.

Unfortunately, little is known about the correlations of obesity within the autism community. A study by Dreyer et al. (2015) reported that children with ASD engaged in less physical activity in comparison to their typically developing peers. Contributing factors which may add to the risk of obesity included selective eating habits (i.e., eating only fried foods or other specific food items), and lacking the skills necessary to engage in activities which encourage physical activity.

Even less is known about the overall health status of adults with autism. A study by Croen et al (2015) described the psychiatric and medical conditions of a large, diverse population with autism within the United States. Nearly all medical conditions examined were significantly more common in adults with autism including obesity, hypertension, diabetes, gastrointestinal and sleep disorders, seizures, and immune conditions.

Given the current obesity prevalence rates within the United States, and specifically within the autism population, it is important to consider weight management strategies and approaches for individuals with ASD. In addition, the varying degrees of communication and social deficits within the population requires approaches that must be individualized in order for weight management to be possible.

As part of a recent partnership with Title Boxing Club Forest Hills, the club has graciously extended their personal trainers and services to one of our ASP students in order to help him lose weight and become healthier. Mohmad Abdelnabi (a.k.a as Mo), is a 23 year old young man who has attended QSAC’s after school program since the age of five. Mo has struggled with his weight from an early age. Mo was recently selected to participate in a fitness program designed by Title Boxing Club Forest Hills. Mo has been assigned two personal trainers who will help him to gradually build up his cardio endurance, as well as build muscle strength in order to lose weight. QSAC’s ASP will work with Mo and his family to help teach him healthier eating habits through the use of applied behavior analysis. Mo’s progress will be monitored and documented throughout the next few months.





Rocio Chavez, MA., MSEd., LBA is currently the Assistant Director for the Quality Services for the Autism Community’s (QSAC) After School Programs. She also facilitates a social skills group for children with high functioning autism and a sibling support group. Rocio holds a Master’s degree in Clinical Behavioral Applications from Queens College, and a dual master’s degree in General and Special Education, Birth-Grade 2 from Touro College. Rocio is also a licensed behavior analyst. She has provided clinical consultations in school and home based settings, and most recently provided consultation for the Broadway play The Curious Incident of The Dog in the Nighttime. Rocio has also assisted in designing staff training and student curriculum and has co-authored a chapter in the book Behavioral Detectives: A Staff Training Exercise Book in Applied Behavior Analysis. She has presented on various topics including stimulus-stimulus pairing and reinforcer assessments at The New York State Association for Behavior Analysis (NYSABA) convention as well as The Association for Behavior Analysis International (ABAI) convention. Rocio has conducted research on self-management training in preschoolers with autism and stimulus-stimulus pairing. She has worked with children and young adults on the autism spectrum for over ten years.



Center for Disease Control. (2015) Adult Obesity Facts. Retrieved from

Center for Disease Control. (2014). Key Findings: Prevalence and Impact of Unhealthy Weight

in a National Sample of US adolescents with Autism and other Learning and Behavioral

Disorders. Retrieved from

Croen, L. A., Zerbo, O., Qian, Y., Massolo, M.L., Rich. S., Sydney, S., and Kripke,

C., (2015) The health status of adults on the autism spectrum. Autism, 19 (7). doi:


Dreyer, G.L., Borner, K.B., Nadler, C.B., Poppert, K.M., Odar-Stough, C., Swinburne-Romine.

R., and Davis, A.M., (2015) Prevalence and health correlates of overweight and obesity in children with autism spectrum disorder. Journal of Developmental and Behavioral Pediatrics. 36 (7). doi: 10.1097/DBP.0000000000000198.



QSAC is a New York City and Long Island based nonprofit that supports children and adults with autism, together with their families, in achieving greater independence, realizing their future potential, and contributing to their communities in a meaningful way by offering person-centered services.

QSAC pursues this mission through direct services that provide a supportive and individualized setting for children and adults with autism to improve their communication, socialization, academic, and functional skills.