Autism and Technology

by admin | Feb 27, 2020 | ABA Therapy, Parent

By: Amy Black, MS, BCBA®, LBA

Technology is used in almost all areas of life to simplify tasks, save time and improve convenience. But perhaps one of the most valuable uses of technology is when it is used to help individuals with Autism Spectrum Disorder (ASD).

Individuals with ASD struggle in many areas and ABA therapy can be used to teach them the skills they are missing to help them attain a happy and independent life. However, many times, therapy sessions alone are not enough. Many individuals need more permanent assistance to help them reach their goals of integrating into the community and accessing all that they need. Here is where technology enters the picture. There are many forms of technology that can be used to help individuals access the skills they are lacking, and when we use technology alongside ABA therapy, we can accomplish so much more.

Technology to Assist with Communication

Communication deficits are one of the core and primary symptoms of ASD. According to recent research, approximately 1 in 59 children are diagnosed with ASD and approximately one third of those children are non-verbal (Autism Speaks, 2020). Assistive and augmentative communication (AAC) devices started being commonly used in the 1980’s to help individuals communicate with others without the use of vocal speech. These devices have evolved over time and with the advancements of technology have become increasingly complex in capability and simpler to use. With electronic devices becoming more readily available, many individuals don’t require a dedicated, costly, and intrusive AAC device anymore. There is a large amount of assistive communication apps available that can be downloaded and used on any personal device. So if an individual already has personal device that is used throughout the day (e.g., smartphone, tablet, PDA), instead of carrying around an additional AAC device, the individual can simply use his existing device to communicate with others.

Communication Apps

Knowing which communication app to choose is important since every person is unique and has specific needs and capabilities. A speech language pathologist and/or BCBA® can assist in determining which app would suit an individual best.

A commonly used assistive communication app is one where the individual can select one word pictures or icons, create sentences out of pictures, or use a keyboard to type. The words or sentences selected by the individual are vocally spoken out by the app allowing the individual to have a method of communication that is audible and easily understood by others. These apps are extremely customizable and can be set up for both early learners and advanced communicators.

There are also other communication apps that use gestures instead of selections. Instead of the individual selecting the specific word or picture, a gesture is made on the screen (e.g., swipe up, double tap) which then causes the app to speak out the word or phrase that is paired with that gesture.

Lastly, for individuals with severely limited motor movement, eye gaze AAC devices can be used. This device tracks the individual’s eye gaze and the individual can select words, pictures, phrases or type using a keyboard.

Collaboration between the BCBA® and speech therapist is key when teaching an individual to communicate using any of the above options.

Technology to Assist with Task Completion

Many individuals with ASD benefit from having a clear schedule of tasks or activities to complete. This can be for leisure purposes or work purposes and is helpful in increasing independence. However, when teaching individuals with ASD to complete tasks that contain multiple steps, for some, prompts can be difficult to fade out and true independence is difficult to achieve. To assist with this, there are many apps that can be used to provide built in prompts, reminders or checklists.

Visual schedule apps can help the individual stay on task and progress from one activity to the next. Some apps just have a list of activities or steps of activities that the individual can check off as they complete. Others have more detailed instructions within each step coaching the individual on how to complete that step or activity. These instructions can be set up via pictures, text or videos. Additionally, some apps have a time component in which the individual is reminded to move on to the next task/step after a specified amount of time has passed. The timer can be visual, auditory, or a combination of both. All of these apps can be crucial in helping individuals who are prompt dependent enjoy a more self-sufficient life by being able to carry out both leisure and required activities on their own.

Technology to Assist with Social Skills Training

Social skills deficits are another core and primary deficit of ASD that are worked on during ABA therapy. With all skills taught during ABA therapy, repetition is key in ensuring acquisition of the skill. Additionally, role modeling is strategy commonly used with teaching social skills. When working on interpersonal skills, having a peer accurately role play the scenario multiple times can be challenging. Therefore, the use of a simple video camera can be very helpful in contriving multiple practice opportunities. In addition to using a video camera to create role play opportunities, it can also be a powerful tool when used to video the individual himself in a social situation so that the individual can watch a playback of the scenario and point out what should have been done and what shouldn’t have been done.

Another interesting use for videos to assist with social skills training is for behavioral prompts. For some individuals, it is difficult for them to remember how to act in difficult or unexpected situations. What can then happen, is that the individual becomes dependent on someone else to coach them on how to react and what to do every time a situation arises. To address this issue, short coaching videos can be created, labeled by type of situation and stored on any device that the individual uses. Then, if a situation comes up and the individual is unsure how to react, instead of requiring a live person’s coaching, the individual can find the relevant video on their device and get coached independently.

Technology as a Reinforcer and Leisure Activity

Technology is often a strong attraction to individuals with ASD and can be channeled into a leisure activity. There are hundreds of educational apps that can be used for constructive leisure purposes and furthermore, these leisure activities can be used as motivators and reinforcers during ABA therapy. The more the individual enjoys the activity, the stronger and more potent of a reinforcer it can become. When it functions as a strong reinforcer, it can then help the individual acquire skills in all areas being targeted.

Using Technology with Caution

The key goal of ABA therapy is to increase the individual’s social interaction and social communication skills so that they can access social reinforcement in their lives. Therefore, when choosing goals to target in therapy and types of assistive technology to use, one must always make sure that they are socially significant to the individual. The goals and tools being used need to be easily used in daily life and help the individual attain a happy, productive and independent life.

Source:

Autism Speaks. (2020). Autism facts and figures. Retrieved from (https://www.autismspeaks.org/autism-facts-and-figures)

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Preparing Children with ASD for a Brighter Future

by admin | Feb 20, 2020 | ABA Therapy, Parent

By: Catherine Witanowski, M.A., BCBA, LBA

Your child has been receiving ABA therapy since he was two years old. He wasn’t talking, now he is, he’s gained a bunch of new and useful skills, but what is the big picture? When your child is first diagnosed, you’re encouraged by your doctor to research ABA therapy, start early intervention services, etc. As the years go by, you start to wonder, “Well, now what?” Is my kid going to go to college, get a job, or both? Okay. Short term. What about kindergarten? Has ABA therapy prepared my child for the “real world?”

First Things First, Let’s Talk Kindergarten

How does ABA therapy prepare your child for kindergarten? Good question! This a huge transition for all kids; neurotypical kids and for kids on the ASD spectrum. The structure is going to be so different from anything else that they have experienced thus far. Therefore, anything that can help kids cope with the transition and become better at adjusting to change is going to be major. Most times, someone at the school your child is going to attend will be trained in ABA and working with your child. If that is the case, then these routines previously learned during private ABA therapy carryover more naturally and make school feel a lot safer and more comfortable.
 As far as social interactions, this is also considered one of the biggest transitions in any child’s life because they are going to be around so many novel people and the set of expectations is so different from being at home. Essentially, this means all the social skills and rules that they have learned either from their ABA therapist or just from simply observing now have to be relearned and generalized for a new setting. The more adaptable a child is to learn new behaviors as well as decrease behaviors that are maladaptive or inappropriate, the more successful they are going to be in school with academics and peers.

I interviewed a Special Education kindergarten teacher and she said, “The hardest thing for me transitioning kids into kindergarten is the fact that most have never been in a structured school or setting and just the expectations and rules are totally foreign. On top of learning how to be around so many other people, they also have to deal with the input from teachers constantly expecting them to follow one million directions. In my experience, kids who have previously received and/or are continuing to receive ABA therapy help make this transition smoother in general. Kids on the spectrum who have familiarity with learning how to adjust their behavior and maintain their emotional regulation in other contexts have a much easier time with the transition.”

All of the above does not only pertain to kindergarten, but the following grades as well. Once individuals are able to continue within the school setting, their skills will continue to grow with the right care and intervention. ABA therapy is not a cookie cutter treatment, it is a completely individualized process. As your kiddo grows, the trajectory of their ABA therapy will grow too!

How Will ABA Therapy Help Your Child be Successful in the Workplace?

Be consistent, stick to a schedule, and reinforce appropriate behavior. What do these things mean? When I go to work, I wake up at about the same time every day, work a similar set of hours, and every two weeks, I get reinforcement. This structure helps me be efficient. Schedules help us be proficient, reduce the need to plan, save time, and build confidence in our daily lives. ABA therapy provides a similar system every day to individuals with autism. Starting with early intervention, kiddos are encouraged to explore their likes and determine their strengths and weaknesses. Throughout receiving ABA therapy, these children are being prepared for a bigger picture – school, work, and socialization.

Think about when you interact with any kid and you ask them the question, “What do you want to be when you grow up?” This question encourages little ones to use their imagination and creates a fun topic of conversation. Growing up and becoming a part of a workplace creates a sense of belonging. ABA therapy techniques are often used as a part of vocational training as your child grows up. Vocational training is conducting ABA therapy with specificities to the individual’s job interest. This could include but is not limited to following a work schedule, teaching appropriate workplace communication, self-regulation in response to a wide range of emotions one may experience in a work environment, etc. These skills are extremely beneficial when navigating any workplace.

General Socialization With Peers

Let’s touch on the myth that ABA therapy is only about intensive structure and table time goals or skills. As discussed earlier, ABA therapy is a very individualized type of therapy. If your kiddo is in need of learning how to sit at a table, and everyone agrees that is a socially significant goal, then yes, it will be worked on. If your child needs to learn how to play functionally, independently, with peers, etc., then that will be worked on during their ABA therapy. Teaching functional play skills including pretend play is extremely beneficial to a child’s social development. The more socially developed an individual is, the more successful relationships they will have. In an article by Dr. Rachel E. White, she discusses how play supports children in regulating their own behavior, lays the foundations for future academic learning, assists in figuring out the complexities of social relationships, and helps develop problem solving and executive functioning skills. It is important for adults to assist in directing children’s play to facilitate significant growth. That is where ABA therapy comes in. The therapists working with your child have the resources to consistently contrive different learning opportunities reflecting all of the above.

Final Thoughts

Everyone wants the best for their kid. Raising a child involves a ton of decisions and sometimes those decisions can be very stressful. When thinking about your child’s future, you want to feel confident in the choices you make whether it is the school they go to, the friends they have, or the food they eat. All in all, every parent hopes their child has a promising future ahead of them filled with happiness and success.

Referencing the topics throughout this post, the purpose of them is to help you organize the steps you will take to prepare your child with ASD for tomorrow. Therefore, the important takeaway here is not only does ABA therapy help your child prepare for kindergarten, the work place, and teach them social skills, it also serves the purpose of helping prepare your child for a better, brighter, and more successful future.

References:

• White, R. E. (n.d.). THE POWER OF PLAY: A Research Summary on Play and Learning.
• In Minnesota Children’s Museum. Retrieved from https://www.childrensmuseums.org/images/MCMResearchSummary.pdf

If you are interested in learning more about Attentive Behavior Care or how we can help, please contact us today!

Considering ABA Therapy? (A Helpful Guide)

by admin | Jan 30, 2020 | ABA Therapy, Parent

You have heard about Applied Behavior Analysis (ABA) therapy and may be considering whether it is appropriate for your child.

What is ABA Therapy?

Applied Behavior Analysis is an evidence-based treatment that is founded on the science of learning. It is a scientific approach to understanding behavior and systemically applies behavioral laws to change socially significant behavior that improves the lives of individuals.

Decades of research has established that ABA is the most effective treatment for individuals with Autism Spectrum Disorder (ASD), and has been endorsed by the United States Surgeon General, David Satcher, MD, PhD, who recommended intensive behavioral intervention for individuals with autism, stating, “Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior.”


Numerous organizations have endorsed the efficacy of ABA including: American Academy of Pediatrics, American Academy of Occupational Therapy Association, 
American Psychological Association, American Speech-Language Hearing Association, 
Society for Developmental and Behavioral Pediatrics, Autism Society of America 
and the National Institute of Child Health & Human Development.



Bringing Out the Best

ABA has been effective in teaching language and improving communication, developing social skills, teaching life skills, working on academics, increasing attending skills, deceasing maladaptive behaviors such as aggression, noncompliance, self-harm and restrictive and repetitive behaviors, and in teaching individuals coping strategies and replacement behaviors. ABA therapy also trains caregivers to teach their child important skills, and to manage their behavior.

For more information about ABA therapy or how we can help your child, contact Attentive Behavior Care today.

In-Home ABA Therapy

by admin | Jan 16, 2020 | ABA Therapy, Parent

By: Pranali Hoyle, MA, BCBA

How to Create an Appropriate Instructional Environment

In-home ABA therapy is now an approved service that is covered by many insurance companies. Parents, therapists, and BCBAs® each play a role in how an effective session can be conducted. Each person is crucial in carrying out a session that may lead to positive outcomes for the learner. Some standards that have been developed are based on benchmarks of best practices. These can be used as guidelines when a session is conducted within the home.

Setting Up the Environment in Your Home for Success

As behavior analysts, we are trained to work in many different settings including homes, clinics, schools, community, and even employment settings. When providing services in the home, It is important that an area of the home be designated for therapy sessions. This can limit distractions from other family activities and provide a successful interaction between the therapist and the child. When the child is not in a session, materials that are pertinent to therapy can be kept in this space. It is encouraged that the child does not have free access to the space or the materials. This will limit the loss of materials that need to be readily available for the therapist during sessions. Your BCBA® supervisor can be an asset to determining the space. This also does not need to be a large room full of furniture and wall decorations, it can be a simple corner with a desk, chair and perhaps a shelf.

Limiting Attention and Access to Items

When a learner first begins his/her therapy, the session may not look as fluid as what most of us tend to observe in schools or clinics. This could be due to the fact that the child is not accustomed to receiving therapy in home, they have unlimited attention and access to toys without having to engage in specific responses. It is important to build a relationship with both the learner and the family. While parents are present during these sessions, it is best if boundaries are established from the start. This will help the learner establish a rapport with the therapist and limit escape-maintained behaviors that can be inadvertently reinforced. Parents should keep certain items that can be used as reinforcers during session time, this will allow the therapist to easily pair with the learner. It will also help the learner correlate session time with fun rather than work.

Use Your BCBA® as a Resource

Even though BCBAs® are accustomed to different situations, especially when it comes to learners. Each learner and family will bring along their own set of unique characteristics. It is important to communicate with your BCBA® what the expectations are for you and your family. The BCBA® in return should also review the policies and procedures for sessions to avoid any confusion in the future. The BCBA® is also a source of information and should be available to answer questions post session for parents. This will help to clarify what goals may be pertinent and how to achieve them. Parent training time therefore is essential and can be useful in determining aspects of therapy that are crucial for the family on a day to day basis.

If you are interested in learning more about Attentive Behavior Care or how we can help please contact us today!

Navigating Transitions for Young Adults and Adults With Autism

by admin | Jan 2, 2020 | ABA Therapy, Parent

By: Lauren Fernandez, B.A.

Life transitions can be scary; especially for those diagnosed with Autism Spectrum Disorder (ASD). Transitioning out of adolescence and into the adult word is a crucial time for an individual with ASD. During this time, support is needed by family members/caregivers to help maximize the opportunities for the individual to participate fully in society (Thompson, Bölte, Falkmer, Girdler, 2018).

Some important life changes that are inevitable to occur may include transitioning to a new school, entering college, starting a job, or even living independently. Coming up with a transition plan and preparing for the transition in advance are two strategies that may be beneficial to help make any transition easier for the individual and their family (Autism Speaks, 2019). Government law, Individuals with Disabilities Education Act (IDEA), mandates students diagnosed with ASD have the right to a comprehensive transition service during high school. This was implemented to ensure that while in high school the student has access to resources and supports needed to meet their desired goals to the best of their ability upon graduation. Even though a majority of planning the specifics regarding continuing education or employment occurs during the teen/high school age, it is best to start preparing early.

For example, Daily Living Skills are skills that the individual is going to need through life, so starting young may be beneficial to help ease future life transitions. With advocacy for Autism becoming more and more popular, there are many colleges, universities, and employers that welcome those with ASD. Some establishments even partner with ABA providers to ensure the individual is fully prepared for their journey into their new chapter of life.

Some Autism Focused Colleges

• Syracuse University: Syracuse University houses the Lawrence B. Taishoff Center for Inclusive Higher Learning. It is an institute that serves students with any intellectual or developmental disability. Syracuse has a separate program specifically for students with ASD, “InclusionU.” It is a program where students with ASD can participate fully in the college experience with supports in place.
• The University of Alabama: The University of Alabama offers “UA-ACTS”, which is a platform that helps students move from the high school environment into college living. UA-ACTS also advocates for and facilitates a campus that is ASD friendly.
• Rutgers University:  Rutgers is home to the Douglass Developmental Disabilities Center (DDDC), an ABA program which serves the needs of those diagnosed with ASD. The center offers a College Support Program (CSP) that guides students both academically and personally. Social groups, parent workshops, weekly meetings, and academic counselling are just a few of the services that are available through CSP.

Some Autism Friendly Employers

• Ford Motors: In 2015 Ford Motors announced their pilot program, “FordInclusionWorks” specifically designed for those with ASD to gain work experience through Ford. Ford collaborated with Autism Alliance of Michigan to offer on-site job training specifically tailored to each worker with ASD.
• Walgreens: Since 2012 Walgreen has partnered with Turning Pointe Autism Foundation to support the employment of those with ASD. Walgreens hosts “Walgreen Career College” that trains individuals in various areas of retail prior to entering the workplace. The Walgreen Career College in Illinois even has a mock Walgreen retail store for students to practice in!
• Home Depot/CVS Pharmacy/Fairway/Boscov’s (Part of “Kens Krew”): Kens Krew is a nonprofit organization that teaches vocational training skills and offers job placement services to young adults with ASD.

Like all individuals, those with ASD need support and encouragement to achieve their ambitions and goals. While facilitating an individual, it is important to remember this is their transition that needs to include independence and self-advocacy. Luckily, there are resources to help the individual navigate their transition, as well as their family.

ASD Transition Tool Kits

Below you will find a “Transition Tool Kit” that was put together by Autism Speaks for those living in New Jersey and New York:

• https://www.autismspeaks.org/sites/default/files/2018-10/new-jersey-ttk.pdf
• https://www.autismspeaks.org/sites/default/files/2018-10/new-york-ttk.pdf

More can be found at https://www.autismspeaks.org/tool-kit/transition-tool-kit.

Sources

• Autism Speaks, 2019
• Thompson C, Bölte S, Falkmer T, Girdler S (2018) To be understood: transitioning to adult life for people with autism spectrum disorder. PLoS One 13:e0194758
• U.S. Department of Education Office for Civil Rights. (March 2011). Transition of Students With Disabilities to Postsecondary Education: A Guide for High School Educators.

If you are interested in learning more about Attentive Behavior Care or how we can help please visit contact us today!

Holidays and Autism

by admin | Nov 21, 2019 | ABA Therapy, Parent

It is slowly becoming that time of year again. Leaves are already starting to change here in Michigan. The days are getting shorter and the temperatures are mercifully dropping from the scorching summer heat.

That means it is time for the holiday season to begin. Was that a collective shudder? Great, so it wasn’t just me! The holidays can be stressful even during the best of times. Throwing in a family member with specific needs only adds to the difficulty. So, to help potentially reduce some of the stress here are a few tips and tricks.

1. Stick to your routines: Trying to stay on a schedule during the holidays is… challenging? What is halfway between difficult and impossible? (Anyone else have this struggle or is it just me?) However, structure is critical to success for any child not just someone with ASD. Keep bedtimes and other routines as close to normal as possible. It may make things more complicated during the holiday, but the transition back to “normal” life will be far smoother.
2. Have realistic expectations: You know your child’s limits in the best and worst of times. Expecting perfection or trying to push their boundaries is likely to just set yourself up for additional stress and pressure. Set realistic expectations for how long to spend at events and what level of engagement you want to see.
3. Make sure everyone is on the same page: Nothing is more frustrating than when you noticed great aunt Susan slipping your child candy because “it will keep him/her quiet” as soon as they start to cry. What started as a well meaning gesture is now going to be a significant hurdle you have to overcome. The holidays are a time to be lax, but make sure that everyone is aware of what to do in case problem behavior occurs so you don’t run the risk of undoing any work you have done.
4. Have an escape route/safe space: This is just as much for your child’s benefit as it is for you. Have a specified space away from everyone that is the “safe space.” This is a room where the lights are dimmed, maybe some calming music, and a preferred activity. If you notice your child getting a little overstimulated take them to the safe space. Give them some time to decompress and relax. If your child is able to reliably request things, show it to them before hand and show them how to request it. This is a great way to not only help your child through a difficult time, but teaching a valuable life skill at the same time: it’s ok to say I need a break.
5. Have a visual schedule: Having a visual schedule of activities can be incredibly helpful, particularly if visual schedules work well for your child in other settings. These types of schedules are excellent if telling time or the abstract concepts of time management are beyond your child’s skills at the moment. That way there is an easy to access way to see what is coming up and when.
6. Social stories: Creating a social story about what to expect during the day can be helpful. Describe the activities in detail and go over what to expect.
7. Come prepared: Make sure you have everything you will need to be successful. Things like charging cables, preferred snacks and comfort objects can be great reinforcers in a pinch.
8. Don’t forget your ABA: Remember to reinforce behavior you want to see. Catch your child being good and make sure you are telling them what they are doing right. It may seem like a small thing, but these can go a long way.

Unfortunately, we can’t make the holidays less stressful. However, we can do things to ease them a bit so they are less difficult. Making sure that we stick to routines and prepare ahead of time will mean a smoother transition and hopefully fewer headaches.

If you are interested in learning more about ABA therapy or how we can help please visit contact us today!

“I Think it’s Time for ABA Therapy…”

by admin | Nov 14, 2019 | ABA Therapy, Parent

By: Jonelle Lupero, M.Ed., BCBA, LBA (NY) 

Note: The following is a fictional vignette created for the purposes of demonstrating common situations encountered by professionals in this field.

“My name is Susan and I have an eight-year-old son John who is diagnosed with Autism Spectrum Disorder. I received John’s diagnosis when he was 3 years old; at the time John’s autism seemed “mild” to me and I never sought outside help. Recently he has been displaying more severe behaviors and I’m not sure I can manage them; I think it might be time for ABA therapy but I’m still not certain. When is it time for my child to receive ABA therapy?”

Susan is a common example of many parents today who do not know if their child would benefit from ABA therapy. Let’s explore this subject further…

What is Applied Behavior Analysis (ABA)?

Applied Behavior Analysis (ABA) is a therapy based on the science of learning and behavior. Behavior analysis helps us to understand: how behavior works, how behavior is affected by the environment, and how learning takes place.

ABA therapy applies our understanding of how behavior works to real situations. The goal is to increase behaviors that are beneficial and decrease behaviors that are harmful or affect learning. ABA therapy programs can help: increase language and communication skills, improve attention, focus, social skills, memory, and decrease problem behaviors.

The methods of behavior analysis have been used and studied for decades. They have helped many kinds of learners gain different skills – from healthier lifestyles to learning a new language. Therapists have used ABA to help children with autism and related developmental disorders since the 1960s. (cited from autismspeaks.com)

Why ABA Therapy?

ABA is considered an evidence-based best practice treatment by the US Surgeon General and by the American Psychological Association.
“Evidence based” means that ABA has passed scientific tests of its usefulness, quality, and effectiveness. ABA therapy includes many different techniques.  All of these techniques focus on antecedents (what happens before a behavior occurs) and on consequences (what happens after the behavior).

More than 20 studies have established that intensive and long-term therapy using ABA principles improves outcomes for many but not all children with autism. “Intensive” and “long term” refer to programs that provide 25 to 40 hours a week of therapy for 1 to 3 years. These studies show gains in intellectual functioning, language development, daily living skills and social functioning. Studies with adults, though fewer in number, show similar benefits. (cited from autismspeaks.com)

When Should Your Child Start ABA?

There is a large body of research that underscores the critical importance of early intervention services for children with autism. The right age for a child to begin working with an ABA therapist is as soon as he or she shows signs of autism or is diagnosed with a developmental disorder. According to the well-renowned source, “Autism Speaks,” in a study with toddlers, intensive behavioral intervention helped all ages, but those who started before age 2 were most likely to make dramatic gains.

This All Sounds Wonderful But…

As we know it is most beneficial to start ABA as early as possible but it doesn’t always happen like that for many reasons; to name a few, many families don’t receive an autism diagnosis right away, sometimes they will receive it later in the child’s life, 3-4 years old. Furthermore, many families are not aware of ABA therapy, and finally many families think that they have the “situation under control” and they don’t require outside support.

But Guess What …

Just like ‘Susan’ many families start to see signs and/or behaviors that indicate their child might need ABA Therapy however they are still not certain; Here is a list of some scenarios (using Susan’s son John as an example) to help parents know “It’s time for ABA therapy….”

It’s time for ABA therapy when…

1. My child’s behaviors are starting to interfere with our family’s normal day to day routine. For example, John’s mother is not able to take him into the supermarket because John has a temper tantrum every time he needs to leave the car and enter a store.
2. John’s Mom is noticing that he has been lining up his toys in a specific way and has a very hard time coping if the order is not the way that he prefers it to be.
3. School reports; John’s family is receiving feedback from his teachers that John’s aggressive behaviors are starting to interfere with his learning and are preventing him from learning and establishing relationships with his peers.
4. John isn’t able to tell his parents his wants and needs on a daily basis and as a result there has been an increase in problem behaviors including aggression and noncompliance in the home.
5. John’s language is not developing as a typical child’s would; for example, he is not able to engage in a normal back and forth conversation with a peer.
6. John’s Mom is seeing that John does not make eye contact with other people.
7. John has been having a hard time when his parents tell him “no” and as a result is exhibiting aggressive behaviors both in the home and in the public.
8. John is fixated on his routine during the day and is displaying noncompliant and aggressive behaviors if his routine is changed.
9. John is having difficulty sleeping throughout the night and it is affecting his family’s routine/well-being.
10. His mother notices John is not interested in making friends and prefers to be by himself; he rarely initiates any social interaction…
11. John has a very hard time tolerating loud sounds and is putting his hands over his ears when he goes into a public place that is “noisy.”

This is a list of some typical scenarios, however there can be plenty more reasons why it’s time for ABA therapy.

References:

• Cooper, J., Heron, T., & Heward, W. (2007) Applied Behavior Analysis, Second Edition. Upper Saddle River, NJ: Pearson Prentice Hall.
• American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
• https://www.autismspeaks.com

Top Characteristics of an ABA Therapy Provider

by admin | Oct 31, 2019 | ABA Therapy, Parent

By: Alyssa Joyce, MS, BCBA and Lauren Fernandez, BA

Applied Behavior Analysis (ABA) is an evidence-based therapy that is deemed a treatment for individuals diagnosed with Autism by the US Surgeon General and by the American Psychological Association. Due to the data driven backing of ABA therapy, it is important to find an ABA provider that is both a great fit for your child and family, as well as a provider that truly understands the science of learning and behavior (Baer, D. M., Wolf, M. M., & Risley, T. R.1968). It is crucial to remember that quality of service is directly linked to the quality of the provider. Unfortunately, finding the “perfect” provider can be difficult. Below are several key factors and/or skills that caregivers should be on the lookout for when choosing a provider.

What an ABA Therapy Provider Should Have Clinically

When it comes to your child, “good” is not good enough. That is why, clinically, a provider should have four strong essential qualities; Credentials, Training, Staffing and Scope of Practice. The very first key ingredient that is necessary to outstanding ABA service is the credentials of the agency as a whole. Caregivers should seek a provider that abides by the Behavior Analyst Certification Board’s Professional Ethical Compliance Code and Guidelines for Responsible Conduct (Carr, J. E., & Nosik, M. R.2017). It is also imperative for the agency to comply with all local, state, and federal laws with regards to the provision of services. Another, highly sought after, achievement that professional providers should hold is the Behavioral Health Center of Excellence® Accreditation (BHCOE®). The BHCOE international accreditation is awarded to agencies, like Attentive Behavior Care, that display and have met an assortment of clinical and administrative standards according to a qualified third-party evaluator.

Like stated earlier, training and staffing are two ingredients that go hand and hand when choosing an ABA provider. Apart from the agency as a whole, individuals who are administering direct care and supervision for ABA services must have their own individual credentials. Team members working with your child must include a Board Certified Behavior Analyst (BCBA®), Behavior technician (some states require a Registered Behavior Technician certification), and usually includes a case coordinator. In order to practice as a BCBA®, the individual has to obtain a master’s degree from an accredited institution completing specific coursework related to the field of Applied Behavior Analysis, have a minimum number of 1500 hours of supervision from a BCBA®, as well as sit and pass the BCBA® national examination. But because credentials only show that a BCBA® has passed an exam, it is important to question their personal experience and ask about the agency’s training program/continuing education programs. Reputable agencies, like Attentive Behavior, have a department that is dedicated to come up with and implement rigorous training programs for its staff to meet the standards of the agency.

These training programs ensure that both BCBAs® and Behavior Technicians are well rounded in all areas of ABA and are fully prepared to handle a wide variety of unique cases. ABA is an ever-changing field with new advancements made constantly, which is why continuing education programs (CUs) are also vital. Agencies that promote and support their staff attending CU conferences, meetings and events are what every parent should be looking for when it comes to who will be serving their children. Lastly, a fundamental piece to choosing the correct provider for your child has to do with scope of practice. Scope of practice refers to the techniques, procedures and protocols that BCBAs® are extensively trained in. Your child’s BCBA®, Behavior Therapist, must follow strict guidelines to ensure that your child is getting the highest quality of service possible.

What an ABA Therapy Provider Should Have Executively

Your child’s diagnosis with Autism can be scary. A provider that has both a strong Clinical team and Executive team is essential to best help you, your family and your child overcome what can be viewed as a stressful process. First, it is of most importance the agency you are interested in accepts your health insurance. Before researching which ABA provider is a best fit for your child, you must know what type of health benefit you have. Luckily, due to much advocacy, all fifty states have taken action to require some sort of ABA coverage. Some plans are “full coverage” meaning the state implements benefit regulations while others are “self-funded,” which is regulated by federal law. There are other options for families effected by Autism as well; Medicare, Marketplace Health Insurance, TRICARE, and Federal Employees Health Benefits (FEHB) Program (TRICARE, 2006). Reputable ABA agencies usually have an intake department where parents can verify health benefits, discuss co-pays, ask questions, and receive plenty of information with respect to health coverage.

Most ABA agencies are home based, which data has proven to be an effective treatment for those diagnosed with Autism (Lovaas, Koegel, Simmons, & Long.,1973) But providers that truly are well rounded offer more than one location for their services. For example, Attentive Behavior offers in home ABA therapy, clinic-based therapy, group socialization sessions, and community outings. One study by Dixon, Burns, Granpeesheh, Amarasinghe, Powell, and Linstead (2014) has actually shown that individuals receiving center-based services over home-based services demonstrated higher rates of learning during treatment. This alone can demonstrate providers who offer many service locations truly know the benefits of a wide variety of service delivery forms. It is also important to ask what other evolving programs the agency coordinates; summer camps, day-programs, Early intervention programs, transition programs, etc. It is imperative to find this information about a provider early on so as your child grows there is no need to find a new agency that can support their progression.

Finding a “perfect fit” ABA agency for your child can be tough and stressful. The above traits and characteristics are great points of reference to help caregivers find an agency that provider unparalleled services. The hope for this blog was to shed light and help the decision-making process easier to meet your child and family’s needs.

References:

• A Program Evaluation of Home and Center-Based Treatment for Autism Spectrum Disorder. Behav Anal Pract. 2016;10(3):307–312. Published 2016 Oct 25. doi:10.1007/s40617-016-0155-7
• American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, Va: American Psychiatric Association.Dixon DR, Burns CO, Granpeesheh D, Amarasinghe R, Powell A, Linstead E.
• Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91-97. doi:10.1901/jaba.1968.1-91
• Behavior Analyst Certification Board. (2016). Professional and ethical compliance code for behavior analysts. Retrieved from http://bacb.com/ethics-code
• Carr, J. E., & Nosik, M. R. (2017). Professional Credentialing of Practicing Behavior Analysts. Policy Insights from the Behavioral and Brain Sciences, 4(1), 3–8.8© 2019 Behavioral Health Center of Excellence (2015). Retrieved from https://bhcoe.org
• Lovaas OI, Koegel R, Simmons JQ, Long JS. Some generalization and follow-up measures on autistic children in behavior therapy. J Appl Behav Anal. 1973;6(1):131–165. doi:10.1901/jaba.1973.6-131
• TRICARE. (2016). Autism care demonstration. Retrieved from http://tricare.mil/Plans/SpecialPrograms/ACD

For more information about ABA therapy or how we can help your child, contact Attentive Behavior Care today.

Being a Savvy Consumer

by admin | Oct 17, 2019 | ABA Therapy, Parent

By: Jacob Papazian MS, BCBA – Regional Clinical Director

Receiving an autism diagnosis for your child or loved one is an overwhelming process that brings a flood of emotions: relief that there is finally an answer, fear of the unknown, trepidation for battles to come. The list is endless, and they all come crashing in waves that relentlessly beat at you with no warning. I am writing this blog post not only as a Board Certified Behavior Analyst (BCBA®), but also the parent of a child on the autism spectrum.

Personally, it was the uncertainty that shook me to the core: what will my loved one’s life be like in the future? Will he be happy? Will he require support his entire life? What will happen when my partner and I are gone and he is alone? The relentless search for interventions began creating a whirlwind of confusion that still plagues us to this day.

A simple Google search for “treatment for autism” brings a plethora of interventions: ABA, Floor Time, Equestrian, Speech, Occupational Therapy, Recreational Therapy, SonRise, Music Therapy, and the list simply continues to grow. How do you choose the “right” one? What is the “best” option? How do you, as the parent, make an informed decision that minimizes your resources (i.e. time, money, travel, etc.) while maintaining progress.

How Do I Become a Savvy Consumer?

The first step to being a savvy consumer is to do your research and determine which are going to be the most effective. With so many options to choose from as far as interventions are concerned, it can be completely overwhelming. A quick Internet search can provide a plethora of information regarding efficacy, side effects, and testimonials for and against. Although these data are helpful¸ they are not evidence. Testimonials are simply expressions of an experience and not necessarily reflective of the true nature of that treatment. More importantly, the individuals expressing these opinions may not necessarily be experts in that intervention and may not be able to speak fully to all aspects of the treatment or not provide a full or impartial depiction of each component.

The most important thing to do is to find the empirical evidence that supports the intervention of choice. You will find many interventions that are not based on scientific data or those in which only very weak forms of evidence exist. It is strongly recommended that these types of interventions are not implemented simply because they take up resources that could be used for those that are evidence based and have a long history of effectiveness.

So I Chose an Evidence Based Service. Now What?

The second major step to being a savvy consumer is to advocate for what your loved one needs. You will be encouraged to try things that seem strange in any intervention (see our ABC blog about the strange things we do in ABA and why we do them!)

But if something does not seem right or just plain wrong, voice your concern. If your loved one is not receiving the services they require or the provider is not following through with what they prescribed or recommended, speak up. Any professional worth their copay is going to listen to your concerns. They may continue to recommend services in a manner that is confusing or difficult to attain in its entirety, but those that simply dismiss your concerns are not worthy of your time or resources.

The third major step: look at the qualifications of the professionals working with your loved one. What type of credentialing do they hold? Does your state have a license for their intervention and if so, are they licensed and in good standing? Is there a national credential or certificate that is recognized by insurance companies? Remember that licensing and certifications provide standards for education and experience and screening. Don’t be shy to ask about their educational background and their current licensing. Transparency about history and experience is a critical feature of effective and ethical service delivery. Ensuring that person delivering services is either certified/licensed or supervised by someone that is can dramatically improve the quality of services delivered.

The final step to being a savvy consumer: constantly evaluate progress. If you are spending your time, energy, and effort to engage in a treatment or therapy, it is important that it is effective. If the professional you are working with is not actively monitoring progress or keeping you involved in changes to the overall plan, it may be time to discuss your concerns with them. In order to ensure that effective decisions are being made, BCBAs® routinely review data collected in session and make decisions.

Being a Savvy ABA Consumer

Up to this point we have discussed being a savvy consumer of any type of service. However, Applied Behavior Analysis programs have their own specific accreditation and intervention styles that require specific consideration to see if they are a good fit for your family. Not all programs are created equal and each BCBA® is going to approach your child’s treatment differently based on their experience, training, and clinical style. Here are things to look for when trying to find a quality ABA provider.

Look for a program that meets your family’s needs.

ABA programs can be offered in a plethora of settings but are most commonly in home or in a center/clinic for outpatient treatment. If you know that scheduling will be difficult or the drive to the program is going to be a barrier to treatment, home based services may be a viable alternative. Perhaps home is going to be incredibly distracting for your child or there simply is not a private enough area to complete treatment for the day. A center based program may be more appropriate to promote learning and progress. If you are concerned about leaving your child at a center based program, ask to observe a session. You may be asked to observe from an observation room or similar to protect the privacy of other consumers in the clinic, but a quality program encourages participation in treatment. (Attentive Behavior Care offers both home and clinic based program in most of its locations!)

Ask about accreditation.

Ask if the program is accredited. Although not required for insurance reimbursement, accreditation demonstrates that program administration has gone through the process of evaluating their systems for quality control, clinical excellence, and consumer satisfaction with services delivered. Remember that all accredited programs have pain points and problems and that non-accredited programs can be fantastic and provide incredible services. This is simply a way for you to gather more information about the program. (Attentive Behavior Care is a 2-year Accredited Behavioral Health Center of Excellence – BHCOE)

For more information about ABA therapy or how we can help your child, contact Attentive Behavior Care today.

What to Look for in a High-Quality ABA Therapy Program

by admin | Oct 10, 2019 | ABA Therapy, Parent

By: Gabrielle Galto, MS, BCBA, NYS LBA

Autism Spectrum Disorder (ASD) presents us with unique and challenging symptoms across a number of areas including, but not limited to engaging in problem behavior, limited communication skills, decreased social interactions, and abnormal play and/or leisure abilities. These challenges can impact any individual’s daily life functioning and well-being.

This leads to some important questions when looking into Applied Behavior Analysis (ABA) programs for your child with ASD;

1.  What does a high-quality ABA program look like?
2.  How can I tell if my child has an effective ABA program?
3.  What are the key indicators?

I will go into all three of these questions as best I can to illustrate what a well-rounded ABA program should look like and present those key indicators to identify for families already enrolled or address at the onset of services.

ABA involves many techniques for understanding and creating behavioral change that will lead to socially significant outcomes. In order to ensure you are obtaining high-quality care it is important that treatment is supervised by a Board-Certified Behavior Analyst (BCBA®). The BCBA® would oversee, supervise and train the behavior therapist or registered behavior technician (RBT). The therapist will then work directly with your child on goals outlined by the BCBA®. If you hear someone simply say they “do ABA,” that probably means they are not a qualified provider or have quality training.

Assessment

First off, an ABA program is not a “one size fits all” treatment modality, meaning it should be individualized to your child. I am sure you have heard the saying, “If you’ve met one person with autism, you have met one person with autism.” Even with common features of ASD, there is also great variability between individuals. This is why you want to make sure treatment is developed for the individual, not just the ASD since that can lend itself to ineffective treatment. Okay, so now that we got that out of the way, what is next?

Prior to the onset of treatment, a comprehensive assessment is needed to develop an individualized treatment plan. The assessment should include a thorough evaluation utilizing a variety of measures such as indirect and direct assessment of the child’s skills and functioning level. The assessment tools can vary depending on functioning level, for example some individuals may require a more language-based assessment (i.e., VB-MAPP), others social (i.e., Socially Savvy), or functional skills (i.e., Essential for Living). Regardless of what type of assessment tool is used (multiple may also be used), a main goal will include teaching and increasing independence of skills.

Next, a well-rounded treatment plan and recommendations should be based upon the assessment results that target the core deficits of autism spectrum disorder. Another factor to look out for is the inclusion of caregivers within the treatment process to provide for the most comprehensive treatment package. Some useful questions for caregivers can include: 1) How will care be coordinated across providers and teachers? 2) Is involvement with caregivers and/or siblings required? 3) How are the therapists trained? 4) How will you manage problem behavior? and 5) How do you plan on evaluating progress?

Programming

What does an effective ABA program look like, you ask? The treatment plan should include goals across the core deficits of autism, reduce any barriers to learning, and increase independence across environments (i.e., home, school, community). When looking at a treatment plan it is important that there are clear, concise objective goals that are building upon your child’s strengths. Next, goals should be taught systematically through the use of evidenced based practices emphasizing reinforcement systems. If services are not building upon a child’s strengths or do not have a reinforcement system in place, this could be a red flag. In contrast, if punishment systems are in place without any alternative reinforcement system, that is a big red flag.

Programing should be consistently monitored by a BCBA®, where if progress is not demonstrated this should be discuss with the provider(s). I always stress to my providers that if the child is not showing progress that is a signal for us that we are doing something wrong. A key indicator for quality care includes consistent oversight of the BCBA®, specifically when progress is not demonstrated assessment should be conducted and appropriate changes made to further facilitate behavior change. The BCBA® should schedule regular direct oversight supervising the client’s treatment plan and implementation. The number of hours can vary from case to case that typically will correspond with the amount of direct treatment hours provided. High-quality ABA should include consistent oversight of the client’s progress, technician’s implementation of behavior analytic techniques, and communication with the family.

Program goals can look immensely different across each person, which makes me a little resistant on describing what exactly an ABA program should look like. Again, with what I have described prior make sure that goals are targeting those core deficits of ASD; communication skills, social skills, and restrictive-repetitive behavior (including maladaptive behavior). It is important that goals are balanced across each of these areas, however programing may need to first focus upon reducing restrictive behavior prior to other areas to ensure success across additional domains. Important areas that indicate a quality ABA treatment plan include goals that target barriers to learning such as, compliance to tasks, weak or limited communication such as ability to request for wants and needs, problem behavior, self-stimulatory behavior, and/or obsessive-compulsive tendencies to name a few.

Instructional methods can include very structured teaching techniques to facilitate learning, but teaching should be further incorporated within multiple areas and environments. When teaching skills, it is important to see not only structured training sessions, but once mastered, a systematic plan for assessing and training within a more naturalistic approach. Therefore, some ABA programs can look very much like play to mimic how a natural environment may be set up for a child. When looking at a program targeting natural environment teaching some goals could include increasing appropriate play, language, and social skills. The therapist may start with a game or preferred play activity to work on turn taking, waiting, and may even refrain or hold back from giving the child an item to encourage communication. All the skills just mentioned often can occur on a day to day basis for a family and are required across a lifespan. These are the type of goals you want to see your child learning! Things that will continue throughout life, lead to other social interactions, and an overall happy healthy life!

Lastly, it is important that caregivers are able to replicate mastered skills to ensure that a child is able to demonstrate generalization, meaning they are able to exhibit skills learned with one person across a novel person (such as a parent). The BCBA® should plan on targeting this process and create a plan to ensure that success is observed with others. It won’t be socially significant if a child is only able to comply to a demand or communicate their needs in the presence of the therapist and not a caregiver. The treatment modality described is called parent training, which targets generalization and maintenance of skills. During these sessions other skills could be further targeted that may only be a concern when in the home or community with the parents or other caregivers. It is important that this part is included to ensure effective treatment is provided as this will further lead to the most progress for a family’s overall daily living.

References:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
• Bailey, J. S., & Burch, M. R. (2005). Ethics for behavior analysts: A practical guide to the Behavior Analyst Certification Board guidelines for responsible conduct. Mahwah, N.J: Lawrence Erlbaum Associates, Publishers.
• Ellis, J.T., & Almeida, C. (2014), Socially Savvy: An assessment and curriculum guide for young children. New York, NY: Different Roads to Learning Inc.
• McGreevy, P., Fry, T., & Cornwall, C. (2012). Essential for Living. Winter Park, FL: Patrick McGreevy.
• National Autism Center (2009). National Standards Report. Randolph, MA.
• Sundberg, M. L. (2008). VB-MAPP: Verbal Behavior Milestones Assessment and Placement Program. Concord, CA: AVB Press.

For more information about ABA therapy or how we can help your child, contact Attentive Behavior Care today.

7 Dimensions of Applied Behavior Analysis

by admin | Oct 3, 2019 | ABA Therapy, Parent