Teaching “Before” and “After” to Autistic Adolescents

Understanding temporal concepts—like “before” and “after”—is foundational for everyday skills such as following routines, recounting events, and planning ahead. Yet for many autistic learners, especially those working at early verbal levels, these concepts don’t develop automatically. This article examines a study that tested whether autistic adolescents could learn to answer “before” and “after” questions about sequences they observed, and offers practical guidance for clinicians looking to build this skill.

What Is the Research Question Being Asked and Why Does It Matter?

The researchers asked: can autistic adolescents learn to answer “before” and “after” questions correctly after watching two events occur in a clear order?

This is called nonarbitrary temporal responding—the “right answer” depends on what actually happened first and second. It matters because many daily skills rely on understanding sequence: following steps, describing what happened at school, or planning what comes next.

The study is also notable because the learners were teenagers working at early verbal levels on the VB-MAPP. That means “time words” can remain difficult even when a learner is older. If a learner can’t answer simple “before/after” questions about things they just saw, it may block later skills—like understanding schedules, grasping cause-and-effect, or following “first-then” directions.

Clinicians need a clear, teachable approach to build this foundation rather than assuming it will emerge on its own.

What Did the Researchers Do to Answer That Question?

They worked with three autistic adolescents (two females, one male) via telehealth. Sessions were short—about 10–15 minutes—and ran on weekdays. Each learner watched two pictures appear on screen in sequence, one at a time, then answered a question about the order.

Each session included 30 trials and two response types. In some trials, the learner named which item was “before” or “after.” In others, the learner answered “yes” or “no” to questions like “Was the house before the swing?”

Baseline sessions included no feedback, so the team could see what each learner could do without teaching.

Then they introduced multiple exemplar training (MET). This means they taught the same “before/after” concept across many different picture pairs, giving learners repeated practice with the pattern. Correct answers earned praise plus a small visual “sticker” on the screen. If the learner was wrong, the instructor re-presented the sequence, clearly labeled which was “before” and which was “after,” and asked again. If the learner was still wrong, the instructor provided the full correct answer as a vocal model, then moved on after the learner responded.

They used a multiple-probe design across participants—starting teaching at different times for each learner. This helps show that the skill changed because of teaching, not just the passage of time.

After mastery (100% correct for two sessions), they checked maintenance at 2 and 4 weeks with no prompts or corrections. They also tested “treatment extension” using new, untrained picture sets.

How You Can Use This in Your Day-to-Day Clinical Practice

If you have a learner who struggles with sequencing, start by checking whether they can answer simple “before/after” questions about something they just watched happen. Don’t assume they “know time” because they follow routines or because they’re older.

Run a quick probe: show two actions or pictures in order, then ask both question types used in this study—”What was before/after?” and “Was X before Y?” Keep consequences neutral so you get a true baseline. If accuracy is low and stable (these learners were under 50%), you have a clear teaching target.

Focus on Nonarbitrary Examples First

When you teach, use examples where the learner can see the order happen. Use many different examples so the learner learns the pattern, not just one pair of items.

In practice, this might look like: show two short actions (clap then wave), two pictures, or two quick events in a session (write name then close notebook). Mix up the items each trial, but keep the structure the same—event 1, pause, event 2, then the question.

This study used very short viewing times, but you can slow it down if the learner needs it, as long as “first” and “second” remain clear.

Build Flexibility Across Response Forms

Teach more than one response format, like the study did. Some learners answer yes/no more easily than open-ended questions—or the reverse. Teaching both helps the skill show up in more real-life situations, like answering a teacher’s question versus checking understanding during a routine.

If you only teach one format, you may get “test-specific” learning—the learner passes your program but can’t use the skill elsewhere.

Use Clear, Supportive Error Correction

A practical version of what they did: if wrong, calmly say, “Let’s try again,” show the sequence again, and label it out loud (“House is before. Swing is after.”). Then ask again. If still wrong, model the exact response you want, have the learner repeat it, then move on.

The goal is to keep trials moving, keep motivation steady, and make the “before/after” relation more obvious. Don’t turn it into a long lecture about time.

Plan Reinforcement Ahead of Time

Reinforcement in this study was simple: praise plus a small visual marker, and the learner picked a preferred activity after the session. In your setting, you can do the same with tokens, points, brief games, or access to a chosen activity.

Plan reinforcement ahead of time and keep it consistent. The baseline phase showed that just asking questions wasn’t enough for these learners.

Set Mastery Criteria and Check Maintenance

Plan for mastery and then check maintenance—not just acquisition. Here, mastery was strict (100% for two sessions), and they still checked again at 2 and 4 weeks with no help.

In your clinical work, decide what mastery means for your learner and setting. You might not need 100% for everything, but set a rule before you start, then test later with teaching turned off. If the learner drops, that tells you booster sessions or a different generalization approach may be needed.

Plan for Generalization—and Be Honest About Limits

The study showed extension to new picture sets, which suggests learners acquired a general rule. It did not show that learners used “before/after” correctly in daily conversations, classroom work, or real routines.

In practice, add your own generalization checks: use real activities (wash hands then snack), new people (parent or teacher), and new places (kitchen, classroom). Without these checks, you may overestimate how useful the skill is outside your teaching trials.

Match the Approach to the Learner

These participants could label common items, answer yes/no questions, and follow multi-step directions. If your learner can’t do those yet, you may need to teach those prerequisites or adapt the response mode—pointing, choosing from options, or using AAC.

Also remember the study taught only two-item sequences. If your real goal is “tell me what happened first, next, last,” you’ll need to build from two items to three and then into longer chains. Don’t assume this study guarantees that jump.

Keep Dignity and Choice in Mind

“Before/after” skills can support independence, but they can also feel like constant quizzing. Keep sessions short. Let the learner request breaks. Use meaningful examples tied to the learner’s life when you move beyond pictures.

Use the data to guide decisions, but don’t treat “time words” as a compliance goal. Treat them as a tool the learner can use to understand their day and communicate it clearly.

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