Teaching “Before” and “After” to Autistic Adolescents: What Clinicians Can Learn from Multiple Exemplar Training

Many autistic learners can label objects and answer questions, yet still struggle with sequence-based tasks. Understanding “before” and “after” is foundational for routines, storytelling, and academic success—but it’s often assumed rather than directly assessed. This study offers clinicians a clear, teachable target and a practical method for building this skill.

What is the research question being asked and why does it matter?

The main question was whether multiple exemplar training (MET) can help autistic adolescents learn a basic “before/after” skill called nonarbitrary temporal responding—answering based on what they just saw happen first and second.

This matters because many daily tasks require “before” and “after”: following routines, recounting events, understanding sequence in school and life. Some learners can label items and answer questions but still get confused when the task involves order. If a learner cannot answer “What happened before?” then goals like planning or describing events become harder to build later.

For clinicians, this study points to a specific, assessable skill you can teach directly—rather than hoping “time concepts” emerge on their own.

What did the researchers do to answer that question?

They worked with three autistic adolescents (ages 15–18) who had basic language skills: labeling common items, answering yes/no questions, and following multi-step directions. All teaching and testing happened via telehealth using screen-shared slides.

First, they assessed temporal skills and found all three learners scored well below perfect on the simplest step: two-picture sequences. The learner saw one picture, then another, then answered questions about which came before or after. Because none reached 100% correct, this became the teaching target.

They used a multiple-probe single-case design across the three learners. During baseline, learners received no feedback. During teaching, the instructor reinforced correct answers with praise and a visual “sticker” on screen. When wrong, the instructor re-taught the trial, labeled the order (“this was before, this was after”), and asked again. If the learner still missed it, the instructor provided a full verbal model. Mastery was 100% correct for two consecutive sessions.

After mastery, they checked maintenance at 2 and 4 weeks with no prompts or corrections. They also tested whether the skill generalized to new, unpracticed pictures.

How you can use this in your day-to-day clinical practice

If you have a learner who can label items and answer questions but struggles with sequence, add a short “before/after” screening to your assessment. Don’t assume they understand these concepts just because they follow a schedule or repeat the words.

Show two quick events or pictures in order, then ask “What was before?” and “What was after?” Include a few yes/no checks like “Was the house before the swing?” This study used both formats—and some learners do better with one than the other. Low performance gives you a clear, teachable target.

When teaching, keep the task truly nonarbitrary at first: the learner answers based on what they directly saw. In this study, each picture stayed on screen for about 1 second, but you can slow down if needed. The key is that the learner experiences the order, then answers about it. Jumping too fast to abstract worksheets or spoken stories means teaching a harder skill before the foundation is solid.

Use multiple exemplars deliberately—not just more trials of the same stimuli. The teaching set included many categories: animals, household items, colors, personal items, leisure items. Rotate stimulus types so the learner doesn’t “game” the task through memorization. Plan a large pool of familiar pictures or short actions and shuffle often. Success with only a tiny set may reflect memorization, not flexible skill.

Reinforcement and error correction were central, but correction stayed calm and instructional. A useful pattern: acknowledge effort, re-present the sequence, label the relation (“before” and “after”), and re-ask. If still incorrect, provide a full verbal model and move on. You can fade prompts by moving from full to partial model, or by adding a brief time delay. The study only counted unprompted answers as correct—so track independent responses separately to ensure the skill is genuinely growing.

Set a clear mastery goal, but don’t make it too strict too soon. This study used 100% across two sessions, which worked here, but may not fit every learner or setting. You can use the same teaching structure with a more realistic initial criterion—high accuracy across several sessions plus stable independent responding. Choose mastery criteria that support learning without creating unnecessary pressure. Keep sessions short (10–15 minutes here) and allow breaks.

Plan maintenance and generalization checks as part of the program, not an afterthought. These learners retained the skill at 2 and 4 weeks and answered correctly with new pictures. Schedule quick “cold probes” after teaching ends, and include novel stimuli. If a learner only responds correctly with your teaching cards, you don’t yet know if the skill is usable. Build in practice with new pictures, new instructors, and different question formats—while staying within the same basic nonarbitrary task.

Don’t overreach beyond what was tested. This study didn’t show that learners now use “before/after” correctly in conversations, schoolwork, or daily routines. It also didn’t test more advanced time skills where learners derive relations from language alone. Treat this as a strong option for teaching the basic “I saw it happen first, then second” repertoire—not proof it will fix planning, organization, or time management. If your goal is functional use, add direct programming for everyday situations, like talking through a real routine (“What did you do before you brushed your teeth?”) and checking whether the learner can answer when events aren’t pictures on a screen.

Finally, consider who this fits best. These learners already had basic expressive language, could label common items, and could answer yes/no questions. If your learner doesn’t have those skills yet, teach prerequisites first. And since this was done via telehealth with three learners, use it as a guiding example, not a guarantee. Watch for stress and assent cues, adjust pace and format, and protect dignity while building a meaningful “before/after” skill.

Works Cited

Barry, D., Neufeld, J., & Stewart, I. (2024). Teaching nonarbitrary temporal relational responding in adolescents with autism. The Analysis of Verbal Behavior, 40, 135–152. https://doi.org/10.1007/s40616-024-00210-w