Autism, finger licking and face rubbing, again! TAGteach victory, again!

how-to-breaka-behavior-chain

A few weeks ago, a behavior popped up after a long absence: finger licking and face rubbing. Having already dealt with this once before, I was ready to tackle it again.

This time, my son (nonverbal, severe autism) added a new twist – a much more complex presentation of this behavior: he licked his fingers and rubbed vigorously around his mouth with one hand, then the other hand, and finished up by frantically rubbing his fingers together. The skin around his mouth was red and rubbed raw, with tiny white blisters popping up on his cheeks.

It took three long walks over three days to address this issue (often I use long walks as a time to work on behaviors). My plan was to tag and reinforce Hands Down behavior, also described in the previous post.

First Objective: Observe

On the first walk, I observed the behavior and saw that the licking/rubbing behavior chain was as follows:

  1. Licked fingers of right hand.
  2. Rubbed fingers around mouth.
  3. Licked fingers of left hand.
  4. Rubbed fingers around mouth.
  5. Rubbed fingers of both hands vigorously together.

This behavior chain was remarkably consistent. Every time he engaged in the behavior, it followed this pattern. Also, this chain was done at a high rate of speed. At first glance it looked like a blur of motion; careful scrutiny showed the actual steps in the chain.

Second Objective: Develop a Plan

I looked for opportunities to tag and reinforce Hands Down behavior and soon spotted them.  Further observation showed that the complete behavior chain was actually more complex, as follows:

  1. Licked fingers of right hand.
  2. Rubbed fingers of right hand around mouth.
  3. Right hand down!
  4. Licked fingers of left hand.
  5. Rubbed fingers of left hand around mouth.
  6. Left hand down!
  7. Rubbed fingers of both hands vigorously together.
  8. Both Hands Down!

autism face rubbing, autism parent help, solution, tagteachSuddenly I had three clear opportunities to tag and reinforce the desired behavior, Hands Down, since they were already occurring in this seven-step behavior chain! Off we went through the woods.

First Day – Minimal Change

During the first walk, I tagged and reinforced each of the three instances of Hands Down behavior during the licking/rubbing chain. There was a lot of licking and rubbing and not much progress in decreasing the behavior on the first day.

Second Day – Some Progress

I continued tagging Hands Down at the three opportunities during the behavior chain. I observed that the last behavior in the chain, rubbing fingers together, was much shorter in time. The full behavior chain was still happening, but the last finger-rubbing behavior (#7) was decreasing in duration. Progress!

Third Day — Victory

The third day saw remarkable progress! The behavior chain continued to diminish rapidly: the rubbing-fingers-together behavior (#7) disappeared completely. The licking/rubbing with left hand (#5) shortened in duration and soon after that the licking/rubbing with right hand (#2) shortened.

By the end of the walk, the entire behavior chain was gone. For the last half of the walk there was no licking or rubbing at all. He walked quietly and happily along the path, and we even spotted some deer.

A day or two later, the skin on his face had healed completely.

Conclusion

TAGteach, again, was a successful way to address this damaging behavior. In three days, the behavior was gone.

For me, the most interesting aspect was watching the behavior chain deteriorate from the end of the chain, as opposed to the beginning of the chain. I observed the same thing when addressing a self-stimulatory coughing behavior some time ago. Now I know to look out for this.

Why is a behavior chain weakest at the end?

I’ve noticed twice now that when I’m trying to break a behavior chain, the behaviors at the end of the chain disappear first. The reason for this is that the last behaviors in the chains were the weakest. This is true of most behavior chains. The first parts of the chain are practiced every time the chain occurs. As the chain becomes longer, more behaviors are added and at every occurrence the first behavior is practiced. The behavior at the end of the chain has been repeated many fewer times than the one at the beginning. Thus, when the chain starts to break down, it is the least practiced behaviors that go first.

Do you have questions about dealing with a behavior? If so, contact me here.

iclick circleWhat is TAGteach?

TAGteach stands for Teaching with Acoustical Guidance. TAGteach is a teaching and communication method based on the scientific principles of Applied Behavior Analysis (ABA).

TAGteach enables extremely precise positive reinforcement of behavior by using an acoustical signal to “mark” the behavior – at the precise moment the child performs the behavior! The acoustical signal is a short, sharp sound made by a handheld device (the “tagger”). When the child performs the correct action, the parent/instructor immediately presses the button on the tagger and hands over a treat (candy, treat, token, praise, social recognition, or money) as a reinforcer.

With TAGteach, it is easy to reinforce behaviors precisely, quickly, and intensively. The immediate, accurate feedback and positive reinforcement result in the child performing the correct action more often, and for longer periods of time. With immediate feedback and learning tasks broken down into small steps, children (and adults) can learn many new skills with TAGteach — at their own pace.

For more information visit the TAGteach website.

Join the free TAGteach Yahoo Group.

TAGteach taggers are available here.

See Martha’s book about TAGteach for Autism or feel free to ask me a question (with no obligation).

Sign up for my mailing list to receive updates, new articles and free tips right in your inbox!

If you liked this post, please share it. Thank you!

 

 

Autism, the coughing stim, and TAGteach

Children who cough. White isolated studio shots.

 

Recently my son with autism had a bad flu that lasted for ten days. As his illness unfolded, he developed a deep cough.

Initially, a sick child coughs because of the irritation. However, as many autism families have experienced, a deep cough can turn into an unpleasant self-stimulatory behavior.

Problems of the coughing stim

If this problem develops, you have a situation where the child may walk up to people and cough loudly into their faces or ears, or may cough over someone’s dinner or the produce aisle at the grocery store. It’s unsanitary and stressful for all concerned.

When my son’s cough developed I decided to take action to prevent the possibility of it turning into a stim. With TAGteach I had success in one day.

My son was spending his days in bed because he was too sick to be up, yet he was coughing loudly. Knowing this was going to be a lengthy project, I pulled up to the foot of his bed with a comfortable chair and a good book, and sat back to observe.

His bouts of coughing had this pattern: first a pause during which he raised his head slightly, then cough-cough, pause, cough-cough-cough, pause, cough, or CC-P-CCC-P-C.

TAGteach in Action

I set the tag point of Quiet Mouth.

As soon as he raised his head slightly and was not yet coughing I tagged that split second of Quiet Mouth. Then I tagged the interim micro-seconds of pause (Quiet Mouth) between the coughs. When the coughing episode ended I tagged Quiet Mouth again. It was tricky to tag the extraordinarily short pauses between the coughs, but I did my best to hit them exactly. The reinforcer was simple: a gentle pat on his foot.

For each coughing episode I was able to tag Quiet Mouth four times (on average). Within an hour, the last part of the pattern, the final cough was gone, so the pattern shortened to cough-cough, pause, cough-cough-cough, or CC-P-CCC. By early evening, the pattern shortened again to cough-cough, pause, cough-cough, or CC-P-CC.

I started at mid-day and continued through the evening. At bed time, I gave him cough suppressant so he could sleep through the night.

TAGteach Success

The next day was amazing: he coughed a few times, and that was it! The coughing was over! Best of all, our worries about a potential coughing stim were over too.

Once again, I was astounded by the power of TAGteach to change this behavior. This is why I recommend TAGteach to parents for consideration in supporting their children with autism!

autism coughing ABA TAGteachWhat is TAGteach?

TAGteach stands for Teaching with Acoustical Guidance. TAGteach is a teaching and communication method based on the scientific principles of Applied Behavior Analysis (ABA).

TAGteach enables extremely precise positive reinforcement of behavior by using an acoustical signal to “mark” the behavior – at the precise moment the child performs the behavior! The acoustical signal is a short, sharp sound made by a handheld device (the “tagger”). When the child performs the correct action, the parent/instructor immediately presses the button on the tagger and hands over a treat (candy, treat, token, praise, social recognition, or money) as a reinforcer.

With TAGteach, it is easy to reinforce behaviors precisely, quickly, and intensively. The immediate, accurate feedback and positive reinforcement result in the child performing the correct action more often, and for longer periods of time. With immediate feedback and learning tasks broken down into small steps, children (and adults) can learn many new skills with TAGteach — at their own pace.

For more information visit the TAGteach website.

Join the free TAGteach Yahoo Group.

TAGteach taggers are available here.

See Martha’s book about TAGteach for Autism or feel free to ask me a question (with no obligation).

Sign up for my mailing list to receive updates, new articles and free tips right in your inbox!

If you liked this post, please share it. Thank you!

“Behavior” is a lightning rod word in the autism community. Are we all on the same page when we talk about it?

Behavior (1)

“Behavior” is a huge concern in the autism community. Yet, when we talk about “behavior,” we’re actually using a technical term that has a specific meaning. Since so many issues in the autism community relate to “behavior,” it’s important that we all talk about the same thing!

The Mirriam-Webster on-line dictionary states that behavior is:

  1. the manner of conducting oneself
  2. anything that an organism does involving action and response to stimulation
  3. the response of an individual, group, or species to its environment (1)

The Iris Center for the study of disabilities says:

“Behavior is something that a person does that can be observed, measured, and repeated.” (2)

Autism expert Dr. Martin A. Kozloff explains:

“…behavior is movement. The two are the same thing. Whenever we use the word ‘behavior,’ we are talking about movements of the body. … (W)e use the word ‘behavior’ only when we are talking about movements that we can really observe (see or hear).” (3)

To summarize:

  • Behavior is “movement” of the body. (We “behave” by moving our hands, arms, feet, legs, torso, vocal and facial muscles.)
  • Behaviors can be seen or heard.
  • Behaviors can be observed, counted, and charted.
  • Behaviors are responses to factors in the environment.

When parents and professionals work together to observe and count physical movements (behaviors) of the child, and take note of the factors in the environment at that time, information comes to light that explains why, and under what circumstances, the child performs those physical movements (behaviors). At that point, decisions can be made and plans put into effect to address the situation scientifically and effectively.

Here’s an easy way to train your eyes to see your child’s “behaviors” as “physical movements of the body.”

Download a free copy of the Child Observation Chart. Set a timer for five minutes and observe your child. Write down how she moves her hands, arms, feet, legs, torso, vocal and facial muscles. If he vocalizes, write down descriptions of the sounds to the best of your ability.

At the end of the five minutes, stop, and review your list. You may be surprised. You may see things that you hadn’t noticed before.

  • What did you see?
  • Did anything surprise you?
  • What struck you when you looked over the chart?

If you have insights to share, please write them into the comments at the end of this article!

When you know what “behavior” is “physical movement” you can address it effectively

When you know that “behavior” is “physical movement” of the body, you won’t waste time and energy on uninformed guesses or emotional, judgmental reactions, such as:

  • “he’s a good boy”
  • “she’s a bad kid”
  • “he knows how to push my buttons”
  • “she’s doing that for attention”
  • “they’re mad because their friend didn’t come yesterday”

You will be able to observe the child’s physical movements (i.e., “behaviors”), take note of factors in the environment, and take appropriate action. Most importantly, we’ll all be using this lighting rod of a word with the same understanding.

Citations

1.     The Open Dictionary, Merriam-Webster, Merriam-Webster, Incorporated, http://www.merriam-webster.com/, 22 April 2016.

2.     Bicard, S. C, Bicard, D. F., & the IRIS Center. (2012). Defining behavior. Retrieved on 22 April 2016 from http://iris.peabody.vanderbilt.edu/wp-content/uploads/pdf_case_studies/ics_defbeh.pdf.

3.     Martin Alan Kozloff, Educating Children with Learning & Behavior Problems, (New York: John Wiley & Sons, 1974), pp. 8-9.

 

autism, solution, TAGteachWhat is TAGteach?

TAGteach stands for Teaching with Acoustical Guidance. TAGteach is a teaching and communication method based on the scientific principles of Applied Behavior Analysis (ABA).

TAGteach enables extremely precise positive reinforcement of behavior by using an acoustical signal to “mark” the behavior – at the precise moment the child performs the behavior! The acoustical signal is a short, sharp sound made by a handheld device (the “tagger”). When the child performs the correct action, the parent/instructor immediately presses the button on the tagger and hands over a treat (candy, treat, token, praise, social recognition, or money) as a reinforcer.

With TAGteach, it is easy to reinforce behaviors precisely, quickly, and intensively. The immediate, accurate feedback and positive reinforcement result in the child performing the correct action more often, and for longer periods of time. With immediate feedback and learning tasks broken down into small steps, children (and adults) can learn many new skills with TAGteach — at their own pace.

For more information visit the TAGteach website.

Join the free TAGteach Yahoo Group.

TAGteach taggers are available here.

See Martha’s book about TAGteach for Autism or feel free to ask me a question (with no obligation).

Sign up for my mailing list to receive updates, new articles and free tips right in your inbox!

If you liked this post, please share it. Thank you!

 

 

Interview with a TAGteacher: Occupational therapist Mary Handley on handwriting instruction

Interview Mary

 

Check out the latest in our Interview with a TAGteacher series. This time we talked to Mary Handley, a school-based occupational therapist who is working with a 3rd grader to improve his handwriting. Noah’s handwriting skills were not functional and this was affecting his grades and his attitude at school. Mary explains with several video examples how she helped Noah to improve significantly in just four sessions using TAGteach applied with her usual method of teaching.

“At that 4 week point I was amazed beyond my expectations. I knew this would work in the right circumstances, but it worked better than I anticipated. I just don’t see that in my week to week therapy. The retention was pretty amazing. His teachers were amazed. Even the librarian made a comment. This has positively impacted his whole attitude toward school.” – Mary Handley.

Here is a sample of Noah’s handwriting before the intervention. He is so frustrated because he can’t even read it himself that he scribbled it all out.

TAG

 

Here is a before and after sample (after 4 sessions, 1 week apart). In the before sample, Noah started almost all his letters from the bottom. In the after sample he started all except the final g from the top (the proper way).

before and after mary handley

Here is a portion of the interview.

There are additional videos showing TAGteach in action with Mary and Noah. Please watch these here: https://www.youtube.com/playlist?list=PLJMNefdXYPVX0zppaHeiqm0bTRDHMqqca. These are best watched in order from 1 to 7 according to the number at the start of the filename.

To see the entire 1 hour-long interview and hear additional discussion about the rest of the videos you can register here: http://tagteach.com/event-2222565

 

 

The Three Try Rule – How to Make Sure Your Learners Stay in the Game

3 try rule

 

How do you feel when you try something and make mistakes over and over? How do you feel when it seems that you are disappointing the person trying to teach you? Do you feel energized and excited to be “learning from your mistakes” or do you feel frustrated and discouraged? For most people and especially kids with autism, repeated failure and “just one more’s” make them anxious, frustrated and wanting to escape to do something less stressful. Sometimes the result of too much pressure to try something too hard results in a full-on meltdown. Once this happens, there is no more learning.

This is why we suggest the three try rule. If a learner fails three times (or fewer) to meet the specific learning goal (the tag point), go to a past point of success and move forward in smaller increments. A point of success is something earlier in the learning process that you are 100% sure the learner can get right. By starting at a point of success and moving forward in small steps you build on existing success instead of searching blindly for a good starting point. Of course the ‘three try rule’ isn’t really a rule. The learner doesn’t HAVE to fail three times. If it is clear the learner will not likely achieve the tag point criterion after the first failure, or the learner is very sensitive to failure, jump right in and clarify or break the skill down further and change the tag point.

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FREE Book with Practical Help for Autism Parents – April 3-6 2016

amazon_book_coverIn honor of the United Nations World Autism Day, the Kindle version of the book Chaos to Calm: Discovering Solutions to the Everyday Problems of Living with Autism is FREE in the Amazon Kindle store from April 3-6, 2016.

Please tell an autism parent about this. Change a life!

Click Here to get your free copy.

If you are outside the US and you don’t have an Amazon.com account, you can get the book at your own country’s Amazon site. Search Google for Amazon + [name of your country].

If you get your free copy of the book, please help us out by writing a review on Amazon.

“This remarkable book is something that any ABA person would be proud to offer parents. TAGteach has an important future in the treatment of autism and other developmental delays and this parent has shown the way. I will be recommending the book to both parents and ABA therapists.”
Joseph Morrow, PhD, BCBA-D
President, Applied Behavior Consultants
Professor of Psychology and Behavior Analysis (Emeritus)

California State University, Sacramento
Licensed Psychologist, State of California

“I am on the Autism Spectrum. I’m both high and low functioning but have achieved a level of integration in neurotypical society because of my higher functioning attributes. It has been a difficult path to walk alone though. If TAGteach had been around when I was a child I am one hundred percent sure I would have a had an even more successful, less frustrating, anxiety ridden childhood and been a higher achiever than I currently am.”
Katie Scott-Dyer

“I completely enjoyed this book. It was an engaging and easy read with the appropriate amount of personal testimonial and practical generalization. I wish I could have read it years ago. Parents and practitioners alike will benefit from reading this book regardless if your child is high functioning or severe. After reading, you’ll know that all those other books you read on autism, sensory processing disorder, auditory processing disorder, apraxia, etc. were mostly a big waste of time and money. Don’t let your child’s doctor or other professional convince you that nothing can be done. It’s not true and this book proves it.”
Aimee Taylor – Autism Parent

Click here for more reviews from parents and professionals

About the Book

Chaos to Calm describes how Martha Gabler discovered that effective solutions really did exist for the overwhelming behavior problems of her own son with profoundly nonverbal, severe autism.

Here are some of the things Martha explains in this book:

  1. How to observe your child
  2. How to use positive reinforcement to shape simple behaviors
  3. How to notice even tiny moments of desirable behavior
  4. How to break behaviors into tiny pieces
  5. How to add simple behaviors together to build complex behaviors
  6. How to communicate to the child “Yes!” without using words
  7. How to organize the child’s environment to maximize success
  8. How to arrange the day’s activities for maximum success
  9. How to stop tantrums, aggressive, destructive and self-injurious behaviors
  10. How to teach the child to go to bed, stay there and sleep
  11. How to manage and teach without force, threats or coercion

When Doug turned five, Martha realized that she and her family were basically on their own. During the “dreadful early years,” Doug’s behavior worsened and worsened. The family floundered. Daily, if not hourly or even more often, there were screaming, tantrums, self-stimulatory “verbal stimming,” running off, and even violent, self-injurious and destructive actions. The Gablers were exhausted beyond description by lack of community understanding, by lack of help that they could afford, and perhaps worst of all, by night after night of severe sleep deprivation.

A chance reference in an email listserve lead Martha to TAGteach, a teaching system based on the structured delivery of positive reinforcement. TAGteach gave Martha the tools she needed to observe Doug’s behaviors, break them down into manageable pieces, and reinforce his previously-rare positive actions – in fact, positive actions that sometimes lasted only a few seconds in the beginning, but which gave Martha the precious key she needed to unlock major improvements. With a few basic rules and a commitment to practice them, Martha was able to apply step-by-step solutions to Doug’s disruptive behaviors. In TAGteach, Martha found a powerful supplement to other scientifically-based behavioral interventions, many of which required difficult-to-find behavioral experts whose costs would have taxed the family’s financial resources in the extreme

The result? A boy who was once wild and chaotic now has the skills that enable him to be a charming teenager who loves life and enjoys going places.

This book explains, step-by-step, how Martha taught Doug to vocalize appropriately, go on walks, wait in line, go to the grocery store, ride a bike and many more skills that are normally taken for granted, but for a child with autism, they do not come easily if at all. Perhaps the most important skill was how to lie quietly in bed and go to sleep, so the other exhausted members of the Gabler family could themselves get some badly-needed sleep. Martha uses simple language and engaging prose to explain how she achieved all this. The book is in turn heartbreaking, humorous and brutally honest.

Every autism family seeks the light in an ocean of despair. Every autism mom, every autism dad, in fact every person who loves another person with autism, can use TAGteach with ease. This book shows you how.

What is TAGteach?

TAGteach stands for Teaching with Acoustical Guidance. TAGteach is a teaching and communication method based on the scientific principles of Applied Behavior Analysis (ABA).

TAGteach enables extremely precise positive reinforcement of behavior by using an acoustical signal to “mark” the behavior – at the precise moment the child performs the behavior! The acoustical signal is a short, sharp sound made by a handheld device (the “tagger”). When the child performs the correct action, the parent/instructor immediately presses the button on the tagger and hands over a treat (candy, treat, token, praise, social recognition, or money) as a reinforcer.

With TAGteach, it is easy to reinforce behaviors precisely and quickly. The immediate, accurate feedback and positive reinforcement result in the child performing the correct action more often, and for longer periods of time. With immediate feedback and learning tasks broken down into small steps, children can learn many new skills with TAGteach — at their own pace.

TAGteach in Action

Watch this video that shows TAGteach in action in an autism school setting. This approach is unique in that it allows the child to “be the teacher”. The child gets to be the teacher before he takes his turn to try the new skill. This is fun, gives him control over his own learning and lets the teacher know for sure that he understands the skill before he tries it himself. One of the critical features of the TAGteach approach is that only one aspect of a skill is worked on at a time. There is no error correction by the teacher. If the child makes a mistake, it is up to him to self assess or try again. There is also no physical prompting, nagging, coercion, cheerleading or verbal coaching in TAGteach.

In this example the teacher gives two tag points, with five tags for each. The first tag point is “paper in lines” so that the child will know how to position the paper for printing. The second tag point is “hand on paper” so that he learns to hold the paper still with his other hand. Notice that even when the tag point changes to “hand on paper”, the child still remembers and tries to position the paper properly.

Connect with Us!

 

autism, TAGteach, ABA, positive reinforcementCheck out the TAGteach International website.

Join the free TAGteach Yahoo Group.

See Martha’s book about TAGteach for Autism or ask a question (with no obligation).

Sign up for Martha’s mailing list  to receive updates, new articles and free tips right in your inbox!

If you liked this post, please share it on social media. Thank you!

Interview with a TAGteacher – Joey Iversen – Special Needs Tennis

Interview with a TAGteacher Joey

 

Have you wondered how to apply TAGteach in a group sports setting with special needs kids? Will it be too noisy for the learner to hear the tags? Will the learner be too distracted by everything else going on the room? How do you handle the reinforcers? Can you use TAGteach to manage behavior and social issues? Do coaches really think that kids taught with TAGteach learn better? Listen to this month’s interview with a TAGteacher and watch the accompanying videos to get answers to these and more questions.

This month, Martha Gabler interviewed TAGteacher Joey Iversen (in red shirt above). Joey is a Level 2 TAGteacher with extensive experience from both ends of the tagger. Joey has trained several tennis coaches to use TAGteach during her own lessons because she wants to learn in the most efficient way possible. Joey has also been working with a special needs tennis program and successfully integrated TAGteach into the teaching protocols.

Martha had questions for Joey on the following topics:

  • How did you get started with TAGteach?
  • What was the one feature that really “pulled” you in?
  • Where did you first start using TAGteach?
  • Tell us about TAGteach and tennis for special needs kids
  • How did the coaches react?
  • What were their positive comments?
  • Where there any negative reactions?

Joey referred to a couple of videos and these are shown lower down in this post so that you can watch them after you listen to the interview.

 

Video #1

This video shows a tennis lesson in which the tag point is “step forward”. The player is focusing on stepping forward with her right foot after hitting the ball.

Video #2

This video shows a group tennis lesson. Three players are hitting the ball and the other three are tagging. This means that everyone is participating, focusing on one thing and learning, even when it’s not their turn to play.

As part of our online course: TAGteach for Autism, we are holding monthly live Q&A sessions with author and mother of a child with autism, Martha Gabler.  A feature of these Q&A sessions is an interview with a TAGteacher. We will be posting the interview section in our blog each month for you to view for free. The full Q&A session will be available for purchase.

 

learn more course martha button

 

learn more qa martha button

 

 

 

Ten important things to build a strong relationship with your child’s support team

10 tips

Your special needs child will do best with a strong team of professionals and parents working together. You are the expert when it comes to your child. The professionals working with your child will have more success when you work to support a relationship with them. Here are 10 tips from Bethan Mair Williams to help you get the most for your child through a successful relationship with your support team. Bethan is a Speech Language Therapist/Board Certified Behavior Analyst (BCBA) with more than twenty years of experience in working with children with special needs, training and supervising classroom staff, and developing data collection and interpretation systems.

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Interview with a TAGteacher – Anne Wormald – TAGteach in the Autism Classroom

Interview with a TAGteacher

Have you wondered how to apply TAGteach in a classroom setting? Will it be too noisy for the learner to hear the tags? Will the learner be too distracted by everything else going on the room? Will you need to give too many food reinforcers? Can you use TAGteach to manage aggressive and dangerous behaviors? Is it OK to let the child use the tagger and be the teacher? Listen to this month’s interview with a TAGteacher and watch the accompanying videos to get answers to these and more questions.

This month’s interview is with Anne Wormald. Anne is one of the first TAGteachers and has extensive experience from both ends of the tagger, being the daughter of Joan Orr, one of the TAGteach cofounders. Anne is working on her BCBA and is a Level 2 TAGteacher. She has many years of experience working with special needs kids and at the moment is working in home and school settings with children with autism.

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