In-Home ABA Therapy (Everything You Need to Know)

In-Home ABA Therapy (Everything You Need to Know)

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.

 

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Importance of Self-Study in the Field of Behavior Analysis

Importance of Self-Study in the Field of Behavior Analysis

By: Gabrielle Galto, MS, BCBA, NYS LBA

In many fields it is important, even required to partake in continuing education courses. I believe in order to be successful and grow as a professional it is necessary to have a scholar-practitioner outlook; meaning, even after obtaining your degree it is important to continue to seek learning opportunities and educational growth as a practitioner.

Of course, it is also a requirement within the field of applied behavior analysis (ABA) as both a Board-Certified Behavior Analyst (BCBA) and Board-Certified Assistant Behavior Analyst (BCaBA). Therefore, it is not only necessary but essential to maintaining one’s credentials. Unfortunately, this does not mean that practitioners within the field see the importance of continuing education courses or engage in self-study, which is the main focus of what I would like to speak upon.

What is Self-Study?

Self-study, what is it exactly? Does it include continuing education courses? Definitely! But isn’t it really just studying by yourself, well maybe? But I believe it is more than that. I believe that within our practice it is important to engage in not just what is required, but truly go out and seek opportunities to learn. As a scholar-practitioner some ways to engage in self-study can include partaking in relevant webinars, studying texts from previous courses, conducting literature reviews, and reading up on new studies and findings within the field of behavior analysis, which is very important within our growing field! Self-study can go a step further by taking a closer look into the subject or area you are learning. Truly becoming not just a researcher but your own teacher. This can be such a huge advantage as a clinician to ensure the most appropriate and individualized interventions are provided, expanding our skills and competence on a more daily basis can further reinforce past knowledge through daily practice.

Self-study is a way of learning without relying on others to directly teach or train as a way to strengthen one’s own knowledge. For example, when working with a client you hold the credentials and are competent with the areas required, however notice a lack of progress and decide to conduct a literature review within the past 5 years. When doing so you learn a more effective, empirically evidenced based intervention package, opposed to the same cookie-cutter techniques typically used. This can then lead to teaching oneself how to set up the intervention package, train your technicians or practitioners on the specific strategies and finally apply the new treatment plan with your client. Self-study is not just more convenient but a practical way for a clinician to learn new or improve one’s skills at a much faster rate than other methods. It is not to say that a more structured way of learning will never be needed. For ethical reasons it could be required for a clinician to seek out further support or training when expertise is needed in order to become competent. Nevertheless, as a professional engaging in self-study prior to seeking additional support from other colleagues can exemplify initiative as a resourceful and self-driven professional.

Implementing the Technique

Make sure that prior to implementing any technique, strategy or behavior change procedure that you follow the BACB ethical guidelines, which could be a whole other blog post in and of itself! Applying new strategies, findings, and techniques can further provide our clients with the most successful outcomes.

The opposing outlook of only doing the bear minimum, which I assume if you are reading this then you are already part of the other side who are self-driving and motivated to grow within the field! Which I love! Congratulations! Anyway, back to my point on if you are a part of those that only get just enough CEU’s and barely sit through the lectures without scrolling on your phone or falling asleep. As a professional within the field of behavior analysis, doing so will only hurt you in the long run.

It is clear that our field continues to grow in and of itself with new research findings, intervention packages, and evidenced based practices. Where if you feel that you do not need to engage in self-study this can lead to a very tunnel vision mindset, one that may not be able to see the bigger picture or implement a different strategy than the one you were trained on 10 years ago. I am not saying I am perfect. I have had cases that I thought I had the answers, I knew exactly what needed to be done without question and when it didn’t work I was completely stunned. In those moments it was hard to think of any next steps as I was in such disarray, which is a huge hindrance for any clinician. Imagine if we never engaged in self-study, we could continue to be providing hot sauce to patients as a punishment procedure opposed to incorporating the most recent empirically validated treatment plans.

Behavior intervention plans may be created based only on topography and not function or including functional alternatives. These are all an exaggeration of course, but it is clear that self-study is important based on how it can expand our knowledge and practice as well as lead to future research within our ever expanding field of behavior analysis!

 

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Navigating Transitions for Young Adults and Adults With Autism

Navigating Transitions for Young Adults and Adults With Autism

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:

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.

 

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The Role of Trial Based Functional Analysis (TBFA) in ABA Therapy

The Role of Trial Based Functional Analysis (TBFA) in ABA Therapy

By: Jacob Papazian MS, BCBA – Regional Clinical Director

The Walt Disney company said it best in their iconic ride “Spaceship Earth”: “we are on the brink of a new communication renaissance.” Behavior Analysis is on one such brink. As a field we are expanding into new contexts and populations. As the ABA sector becomes more well known, resources are becoming more scarce (Harvey, Harvey, Kenkel & Russo, 2010). Analysts are charged with implementing services without compromising ethical integrity. One such area is the functional analysis. Although crucial to ethical treatment, analog assessments are time consuming, expensive, and can be dangerous to staff and students (Hanley, 2012).

What is Trial Based Functional Analysis (TBFA)?

The Trial Based Functional Analysis, a relatively new form of assessment, was created to combat these difficulties by offering a fast and inexpensive form of assessment that informs behavior plan implementation. Rather than requiring 20+ minute conditions per each individual condition, two minute conditions that rapidly alternate are implemented in a pairwise fashion that are used to evaluate the potential antecedents and consequences that contribute to the initiation and ongoing maintenance of a targeted behavior. Using a control-test-control-control format, each analogous “condition” takes approximately six minutes to complete resulting in approximately ten conditions per hour of direct analysis which could potentially result in an interpretable result. Conditions are terminated after a single instance of the target behavior following delivery of the reinforcer being assessed. These probe data are usually presented as percentage of trials with problem behavior but have recently been analyzed using equal interval graphs (Bloom et al., 2013).

The current literature has validated this assessment using the Litmus Test (i.e., using reduction in problem behavior when interventions are based on the function derived in the assessment) and by comparing results from analog assessments (Austin, Groves, Reynish, & Francis, 2015). These two forms of validation have resulted in very different conclusions. Comparing the TBFA to standard analog assessments has resulted in an approximate 60% match (Austin et al. 2015). Those validating using the Litmus Test have found a near 100% validation rate (Bloom, Labmert, Dayton & Samaha, 2013; Kodak, Fisher, Paden, & Dickens, 2013; Lambert, Bloom, & Irvin, 2012). Studies using the Litmus Test have incorporated multiple baseline across participant designs, which add to the internal validity of their claims, but do not account for this discrepancy.

Understanding the Current Limitations of TBFA

So that’s fantastic: when we build a behavior plan off of the TBFA it works. However, the discrepancy between analog and alternative methods exists in a fairly significant chasm. Very little literature has been conducted in an attempt to determine why this discrepancy exists. Hypotheses abound ranging from lack of experience or training with the assessment method to failure of conditional discrimination or that the TBFA is simply an inferior form of analysis when compared to the analog. The questions abound but with such limited data and research it is difficult to make proper assertions.

The problem here: we simply do not have the research yet to back up any claims! We have emerging evidence but nothing that truly compares apples to apples the differences between the assessment methods to make a truly informed decision regarding clinical utility. As the great Dylan Thomas once said: “do not go gentle into that good night.” Research on, my fellow nerds!

References:

  • Austin, J. L., Groves, E. A., Reynish, L.C., & Francis, L. L. (2015). Validating Trial Based Functional Analyses in Mainstream Primary School Classrooms. Journal of Applied Behavior Analysis (48)2, 274-288.
  • Bloom., S. E., Lambert, J. M., Dayton, E., & Samaha, A.L. (2013). Teacher Conducted Trial- Based Functional Analyses as the Basis for Intervention. Journal of Applied Behavior Analysis 46(1), 208-218.
  • Hanley, G.P. (2012). Functional Assessment of Problem Behavior: Dispelling Myths, Overcoming Implementation Obstacles, and Developing New Lore. Behavior Analysis in Practice 5(1), 54-72.
  • Harvey, C.A., Harvey, M.T., Kenkel, M.B., & Russo, D. C. (2010). Funding of applied behavior analysis services: Current status and growing opportunities. Psychological Services, 7(3), 202-212.
  • Kodak, T., Fisher, W.W., Paden, A., & Dickes, N. (2013). Evaluation of the Utility of a Discrete Trial Functional Analysis in Early Intervention Classrooms. Journal of Applied Behavior Analysis 46(1), 301-306.
  • Lambert, J.M., Bloom, S.E., & Irvin, J. (2012). Trial-Based Functional Analysis and Functional Communication Training in an Early Childhood Setting. Journal of Applied Behavior Analysis 45(3), 579-584.

 

Are you interested in joining the Attentive Behavior Care team? Apply today!

Safety Awareness Skills for Children Diagnosed With Autism

Safety Awareness Skills for Children Diagnosed With Autism

By: Lauren Fernandez, BA

Those diagnosed with Autism Spectrum Disorder (ASD) often lack safety awareness skills. Safety awareness skills include but are not limited to the following: safely crossing the street, avoiding situations that may cause harm to oneself or others, “stranger awareness,” fire safety skills, and knowledge of community signs. Safety awareness skills are important throughout all stages of life; from early childhood, to adolescence, to adult life and necessary across all environments (e.g., home, community, school, workplace). Teaching these skills are not only crucial to keeping individuals safe but also giving them the tools to lead a more independent life.

Those diagnosed with autism can be taught safety awareness skills using Behavioral Skills Training (BST), video modeling, a combination of both and/or In-Situ training (Gunby, Carr & LeBlanc, 2010).

Behavioral Skills Training

Behavior Skills training (BST) is a research-based intervention that is comprised of several different teaching components; instruction, modeling, rehearsal, and feedback (Miltenberger, 2004). BST has successfully taught those diagnosed with autism to avoid consuming poisons (Dancho, Thompson, & Rhoades, 2008), how to behave after discovering a firearm (Miltenberger, Flessner, & Gatheridge, 2004) and teaching abduction-prevention skills (Gunby, 2010). These are just a few examples of safety awareness skills that have successfully been taught via BST. Although BST has been found to be a beneficial safety awareness teaching strategy independently, research shows that BST in combination with in-situ training produces greater results (Miltenberger, Flesser, Gatheridge, Johnson, Satterlund, & Egmo, 2004). In-situ training entails pausing the individual in real-time when a skill is not being performed correctly, having the trainer immediately enter and direct the learner in correctly carrying out the safety skill. This is followed with corrective verbal feedback and reinforcement/praise. Below are the four BST steps broken down with an example.

Safety Skill: Crossing the Street Properly

Step 1: Instruction: Provide a description of the skill, including when to do this skill and when not to, and the rationale behind the skill. Give examples and non-examples.

Example: “When properly crossing the street, remember to stop on the curb, look both ways for cars, and then proceed when the road is clear. It is important to stop and look in both directions so you do not get injured.” *Here you can show a video of correct and incorrect ways to cross the street.*

Step 2: Modeling: Physically model the skill you are trying to teach the learner.

Example: Physically model for the learner the correct way to cross the street while emphasizing the steps that were talked about during Step 1. Here it might be helpful to use a task analysis to correctly address each step to crossing the street.

Step 3: Rehearsal: Practice is crucial! Have the learner practice the targeted skill as many times as possible. This can be done by creating opportunities for the skill to be practiced naturally or through role playing. A single- instance of rehearsal may not be beneficial, which is why it is important to continue practicing until the learner displays 100% accuracy in novel settings before transitioning the rehearsal setting out into the real world.

Example: Have the learner role play the appropriate way to cross the street multiple times during a therapy session, with novel individuals (i.e., Mom, Grandma, friend) in the home setting. Set a criteria the learner must meet (i.e., 100% accuracy across 2 different sessions, on 2 different days, with 2 novel individuals) in the home setting first before rehearsing outside.

Step 4: Feedback: Give the learner specific feedback as the skill is being practice in the real-world. This is where in-situ training comes into play.

Example: Have the learner cross the street in the real world. If the learner incorrectly crosses the street the trainer should immediately step in, explain what was incorrect, remind the learner the appropriate procedure while also giving reinforcement to the safety skills displayed correctly. Reinforcement example: “ I love how you remembered to stop at the curb, that was amazing! Next time remember to look both ways before stepping off the curb. Let’s try again.”

If the learner properly displays the appropriate safety awareness skill taught, there is no need to intervene. Let the learner finish out the procedure independently and come into contact with the natural reinforcement of getting to the other side of the street.

Safety awareness skills are so important for all individuals to learn, especially those diagnosed with ASD. There are so many safety concerns that individuals with autism are at a much higher risk of experiencing, but luckily teaching safety awareness skills can promote learner safety. Collaborating with parents, teachers and other individuals in the learner’s life can also be beneficial to ensuring that the safety skills being taught are individualized. There is no one-size-fits-all in safety awareness skills training!

Sources:

  • Dancho, K. A., Thompson, R. H., & Rhoades, M. M. (2008). Teaching preschool children to avoid poison hazards. Journal of Applied Behavior Analysis, 41, 267–271.
  • Gunby, K. V., Carr, J. E., & Leblanc, L. A. (2010). Teaching abduction-prevention skills to children with autism. Journal of applied behavior analysis, 43(1), 107–112. doi:10.1901/jaba.2010.43-107
  • Miltenberger, R. (2004). Behaviour Modification: principles and procedure (3rd ed.) Belmont, CA. Wadsworth Publishing.
  • Miltenberger, R. G., Flessner, C., Gatheridge, B., Johnson, B., Satterlund, M., & Egemo, K. (2004). Evaluation of behavioral skills training to prevent gun play in children. Journal of Applied Behavior Analysis, 37(4), 513-516.

 

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

PDC-HS: The Who, What, When, Where, Why, and How

PDC-HS: The Who, What, When, Where, Why, and How

Within the realms of autism intervention, it is incredibly common for providers to use a tiered model of service delivery to increase billing propensity and meet an ever growing demand for behavior analytic services (BACB, 2017).

As a tiered model requires trained technicians, it is imperative that clinicians have a data based way to evaluate technician skill deficits in an empirically validated and quantitative format. The Performance Diagnostic Checklist for Human Services (PDC-HS) is an informant based tool that is specifically designed to assess environmental factors that contribute to specific deficits in employee performance specifically when working in the human services sector. Research has been conducted that demonstrates its efficacy to not only identify key performance deficits but also recommends evidence based strategies to remedy performance issues (Wilder, Lipschultz, & Gehrman, 2018).

The… What?

The PDC-HS, created by Carr, Wilder, Majdalany, Mathisen, and Strain (2013) was created to fill a significant gap in our understanding of organizational behavior: a behavior analytically informed performance diagnostic. Although common operant models have been utilized in performance management since the early 1970’s, very little research has been conducted in the realm of Organizational Behavior Management (OBM) as far as validation (Austin, 2000). Therefore, the PDC-HS was developed to inform performance analysis specifically within the human services context.

Implementation

The assessment itself is fairly simple. There are a series of 20 questions separated into four distinct sections: Training, Task Clarification & Prompting, Resources, Materials, & Processes; and (d) Performance Consequences, Effort, and Competition. Each section is includes four to six questions regarding employee performance. 13 questions can be answered based purely on an interview of the employee’s direct supervisor while seven require an actual observation. Each item scored as “no” on the assessment correlates with a potential intervention that can be used to improve performance (Carr et al, 2013). A pilot study conducted by Grubbs and Papazian (2019) reported that the average duration of assessment was 30 minutes inclusive of both the direct observation and interview with the direct supervisor.

Choosing an Intervention

Once the assessment is completed it is time to choose the intervention(s). As we discussed, each “no” is a potential option for an intervention. To make things simple, a handy scoring guide is listed with assessment that has corresponding interventions that are functionally based with references for further examples of how to implement the intervention in an evidenced based format. Each of the references are easy to find: a simple google scholar search results in pdfs available for download.

Concerns Using the PDC-HS

Interestingly enough, very little research has been conducted to validate the indicated interventions beyond the litmus test (i.e. testing out interventions in a quasi-experimental format.) Although this does demonstrate the internal validity of the assessment, the current empirical literature contains a significant gap: what if we used a contra-indicated intervention? Would we still see a change in behavior simply due to observer reactivity?

Wilder et al (2018) argued that further research was necessary as all the previous literature had not evaluated task clarification and prompting and resources, materials, and processes. In addition to simply evaluating the predictive nature of the assessment based on the litmus test, comparisons to contradicted interventions using multiple baseline logic was implemented to demonstrate the overall efficacy of the assessment to predict and control behavior. Spoiler alert: findings indicated that not only was the predictive nature of the assessment validated but contraindicated procedures did not result in reliable behavior change when compared to indicate assessments.

Conclusion

As need for behavior analytic services grows our need for a valid quantitative performance diagnostic assessment is even more important. The PDC-HS is one such emerging assessment that offers significant promise in this area. However, the literature is so sparse, with only FOUR peer reviewed studies to date. In order for a broader use of this assessment further research is needed for validation.

References

  • Austin J. Performance analysis and performance diagnostics. In: Austin J., Carr J. E., editors. Handbook of applied behavior analysis. Reno, NV: Context Press; 2000. pp. 321–349.
  • Carr, J. E., Wilder, D. A., Majdalany, L., Mathisen, D., & Strain, L. A. (201S3). An assessment-based solution to a human services performance problem: An initial evaluation of the performance diagnostic checklist for human services. Behavior Analysis in Practice, 6(1), 16-32.
  • Grubbs, K., & Papazian, J. (2019, March). Improving graduate student performance in practicum settings using the performance diagnostic checklist – human services. (Poster Presentation at the Texas Association of Behavior Analysis Conference. Fort Worth, Tx)
  • Wilder, D. A., Lipschultz, J., & Gherman, C. (2018). An Initial Evaluation of the Performance Diagnostic Checklist – Human Services diagnostic checklist – human services across domains. Behavior Analysis in Practice, 11(2), 129-138.

 

Interested in learning more? Contact Attentive Behavior Care today!

Putting the Pieces Together: The Importance of Coordination of Care for ABA Treatment

Putting the Pieces Together: The Importance of Coordination of Care for ABA Treatment

By: Nechame Cziment, BCBA

“Alone we can do so little, together we can do so much” -Helen Keller

Puzzle pieces have become universal symbols for autism. The puzzle pattern reflects the complexity of the autism spectrum. A recent study released on Autism Spectrum Disorder (ASD) in JAMA Psychiatry concluded that individuals with ASD have a higher rate of co-occurring disorders than the general population. This study further emphasizes the complex needs of individuals with ASD and begs providers to answer the question, “How can we be sure these needs are being met?”

The answer to this question lies in coordination of care.

What is Coordination of Care?

Coordination of care involves bringing together various providers to coordinate services, patient needs and information to help better achieve the treatment goals and improve the quality of care. Research has shown that care coordination increases efficiency and improves clinical outcomes as well as patient satisfaction with care. Care coordination is not only a factor to consider in the treatment of ASD rather, it is fundamentally critical to the provision and management of ASD services.

Who is Involved?

An individual with a diagnosis of ASD may have many providers that are involved in treatment. Since a diagnosis of ASD usually affects the entire family not just the child, the child and his/her family network are at the center of the collaborative team.

Coordination of care should involve all members of the child’s ASD treatment team, including medical, educational, psychological, and other mental health providers and therapists.

The primary care physician is oftentimes the referral source who may be following the child’s progress and response to treatment and is a critical member of the team. The diagnostician who may either be the pediatrician, developmental pediatrician, psychiatrist psychologist, etc. remains a part of the team as long as they continue to treat the patient or reevaluate for responses to treatment or other health related matters. Speech/language therapists, occupational therapists, physical therapists, feeding therapists, and other related service providers should also be involved. Special education providers such as the classroom teacher, IEP coordinator, school psychologists, special education directors/administrators, and other school personnel also play a key role. Finally, any counselors or psychologists who treat the patient should also be included in the coordination of care plan.

What Does Coordination of Care Look Like?

A common misconception that parents and caregivers often have is that providers and professionals working with their child are separate entities, having nothing to do with each other. This however, is not the case and this mindset may prevent treatment from being implemented efficiently.

Let’s look at an example to illustrate this point:

Meet Max.

Max is a 13-year old boy with a diagnosis of ASD, anxiety and Attention-Deficit/Hyperactivity Disorder (ADHD). Max attends a special education classroom and also receives ABA services in a clinic 5 days a week. In addition to that he also receives Speech therapy and Occupational therapy twice a week. Max is also being followed by a psychiatrist who prescribed medication to address his anxiety and ADHD symptoms.

In school, Max is having a difficult time regulating his behaviors and interacting with his peers in an appropriate manner. He is punished multiple times a day for being off task and is even sent home occasionally due to his aggressive behavior. During his ABA sessions, Max is learning skills to address his social deficits and how to manage his behavior. Max’s parents are giving him the prescribed medication every day as indicated and then report back to his psychiatrist at their follow up appointment. During Speech therapy, Max is able to focus and he was reported to have great problem-solving skills when presented with a contrived situation. During Occupational therapy sessions, Max’s therapist is focusing on strengthening his fine motor skills to help him improve his handwriting skills.

The above scenario represents an approach in which each provider is working as a solo provider, targeting areas of deficit in isolation to treat the same child.

Now let’s look at a more coordinated approach to the same scenario.

Max’s BCBA®, coordinates with the school to share strategies and evaluate progress and offers to train staff on the implementation of a reinforcement system or behavior intervention plan to address the aggressive behaviors. The BCBA®, also shares the data as well as the results of the school coordination with the parents and trains the parents in these procedures to further generalize the skills learned to the home setting. The BCBA®, creates a simple data collection tool that stays with Max throughout the day and is completed by the school team, ABA team, parents, Speech therapist and Occupational therapist to gather information regarding behaviors related to the medications he is taking. The parents share this information with the psychiatrist at their next follow up meeting. The Speech therapist shares the terminology that is being used during the session so that it can be more consistently applied when providing feedback to Max for pertinent social scenarios. The Occupational therapist shares strategies with the school team, ABA team, Speech therapist and parents to help Max with focusing and other relevant issues.

As illustrated in the example provided above a collaborative approach results in a more streamlined and effective treatment. The child is less likely to become confused about how to use the skills taught in therapy sessions to achieve his goals.

What Next?

The benefits of a coordinated approach to care are countless. But what can be done to ensure that coordination of care is actually happening? The following are a few steps that parents and providers can take to ensure coordination between a child’s treatment service providers:

  • Knowing the treatment team – get to know the group of individuals providing services or care for the child.
  • Consent – make sure each the proper releases/permission to communicate have been set up to allow providers to communicate with each other.
  • Plan – develop a specific coordination of care plan that outlines the specific individuals who will coordinate care, at what frequency and when, and what the goals of the coordination efforts will be.
  • Implement – work together to implement the coordination of care plan.
  • Revise – members of the child’s treatment team may change from time to time, and the need to coordinate care may change over the course of treatment. Regularly revisit the coordination of care plan and revise and adjust as necessary.
  • Report back – keep everyone informed of the results of the coordination of care and document those efforts.

 

References:

  • Plana-Ripoll O, Pedersen CB, Holtz Y, et al. Exploring Comorbidity Within Mental Disorders Among a Danish National Population. JAMA Psychiatry. 2019;76(3):259–270. doi:https://doi.org/10.1001/jamapsychiatry.2018.3658
  • SAMHSA-HRSA Center for Integrated Health Solutions. Care Coordination. Retrieved from https://www.integration.samhsa.gov/workforce/care-coordination

 

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

How to Increase Skill Development and Reduce Inappropriate Behaviors

How to Increase Skill Development and Reduce Inappropriate Behaviors

By: Deirdre Kozyrski, MS, BCBA, LBA

In providing ABA services to individuals with a diagnosis of autism, proactive strategies are often used to help our clients gain critical language, social & self-help skills and reduce inappropriate and/or behaviors of concern. A proactive strategy is used before a behavior of concern occurs to help prevent that behavior from occurring. One such proactive strategy is the use of social stories. This article will focus on the following aspects of social stories.

  1. What are social stories?
  2. What skills can they help teach?
  3. Has there been research on the effectiveness of social stories?
  4. How can social stories be implemented in home- based ABA treatment?

Social stories are great tools to help to prepare people with the diagnosis of autism for new settings and for learning new skills. Social stories are written stories that provide information about a specific topic/setting. They can also provide some instruction on choices of appropriate behaviors that can occur within that topic/setting. Social stories can be used with all different ages, being able to read is not a requirement. For those clients who do not read, a social story could be read to them. Social stories often have pictures in them to help increase understanding of the topic, but do not have to have pictures/photos. The length of a social story often depends upon the age and skill level of the reader.

Guidelines of a how social story is written can vary depending upon the author. Social stories are often written in the first or third person. For example, a first – person sentence is “I am going to the beach with my family”. An example of a third person sentence is “Some families go to the beach for their vacation”. In her book, The New Social Story™ Book, 2015, Carol Gray describes 10 components of a Social Story™. (When the words Social Story™ are capitalized that is indicative that the story meets all of the Gray’s current 10.1 criteria). She also includes a CD in this book that has printable Social Stories™ that can be edited to meet a reader’s individual needs.

Carol Gray initiated the use of the Social Story™ approach approximately 30 years ago. In her 2015 book, she describes using both descriptive sentences and coaching sentences in a Social Story™. A descriptive sentence provides information about a topic without any kind of judgement or opinion. A coaching sentence offers choices of appropriate words or actions that could be used in the specific setting or situation. Throughout her book, Gray emphasizes the importance of respecting the intended readers. Aligning with that respect is her dedication to using positive statements in a Social Story™. She also suggests including sentences about the reader’s strengths & accomplishments in the Social Story.™

There are thousands of topics that can be written about in a social story. Here are some topics that I have helpful with my clients:

  1. ADL /Safety Skills – Learning how to : tie shoes, brush teeth, safely take medicine, take a shower, get dressed/undressed in a private setting, brush hair, accept getting a hair – cut without a tantrum, safely cross a street, safely walk through a parking lot, safely use a pool, appropriately interact with the family cat, etc.
  2. Social Skills – Learning how to: acclimate to a new school, how to play on the school playground, how to order lunch in the lunch room, go to the supermarket with your parents, go through security at the airport, use safe behaviors while on a family vacation, take turns with peers for choices of games/activities, eat at a restaurant, etc.
  3. Communication Skills – Learning how to: ask a peer to play, what can be said if that peer says “no”, ask for help, etc. Learning about the choices one can say when: a game is lost, a game is won, when a food is disliked, when a gift is disliked, feeling frustrated, angry, etc.

Some research that have been done on the effectiveness of Social Stories™ are:

  1. Thiemann & Goldstein (2001) combined the use of social stories with written text cues and video feedback to improve specific social communication skills ( contingent responses, securing attention, initiating comments and initiating requests) in 5 students with diagnoses of autism. They used Carol Gray’s 1995 criteria for social stories. Comprehension questions were also used after the reading of the social stories. A 10 minute social interaction time with typical peers was implemented after the instructional phase ( reading of the social story, comprehension questions & practice written text cue cards). This social interaction time had a specific social goal. The interaction times were video recorded and the 5 students were able to view their interactions. Students checked off on a yes/no form if they saw themselves demonstrating the specific social goal. The results of this study determined the combined treatment package did in fact increase the above specific communication skills.
  2. Chan & O’Reilly ( 2008) used Social Stories™ in an intervention package for 2 students with diagnoses of autism who were in a kindergarten inclusion classroom. The Social Stories™ were written using Carol Gray’s 1995 criteria. The reading of Social Stories™ were followed with comprehension questions and role play. The specific social communication skills targeted during this study were : increase in appropriate hand raising, increase in appropriate social initiations, decrease in inappropriate social interactions (personal space difficulties) and decrease in inappropriate vocalizations. The results of the study were increased appropriate social communications skills and decreased inappropriate social communication skills for both students.

Based on the above research, I have found it helpful to implement social stories/Social Stories™in combination with both comprehension questions and role play in home-based ABA treatments. I have also found it helpful to involve the parents of the client in the creation of the story by asking them to provide details of the topic/setting. Parents also are a great resource for providing pictures/photos for the story. Once we have the details of the story, I can ask the parents to provide specific photos that will help clarify the information in the story.

If a client is going on a family vacation, I usually start using the story in the client’s sessions at least 1 month before the vacation. I also ask the parents to read the story to the client a few times a week before the vacation and to take the story with them on vacation for further review. During the client’s session, I usually include 3-4 comprehension questions regarding the story in his/her program. I have found the client’s answers to the comprehension questions to be helpful in determining on how many times a social story needs to be read/reviewed. If the client continues to have difficulty correctly answering the questions, the story probably needs to be modified. After the comprehension questions have been discussed, we start to role play the targeted skills of the story.

Depending upon the topic/skills being learned and the age of the client, role play can be done with stuffed animals/dolls or with the client and team members. For example, with a 6-year old client learning how to accept taking medication without tantrumming, we role play with stuffed animals/dolls who are “sick or injured” and need to take “pretend medicine”. For an 8 -year old client who is going on a family vacation that requires him to go through airport security, we set up a mock security station with him and other team members in his home. He practices putting his belongings in a bin and walking through a mock metal detector. We practice different potential scenarios – the metal detector going off and the client having to walk back through it again, the metal detector not going off, etc.

Social Stories™ /social stories have been implemented as part of proactive interventions to help increase socially significant skills in people diagnosed with Autism. Many skills can be introduced through these stories. If you would like more information about this topic, please refer to a review of literature by Karel & Wolfe (2018).

 

Additional Resources:

 

References:

  • Chan, J.M., & O’Reilly, M.F. (2008). A Social Stories™ Intervention Package for Students with Autism in Inclusive Classroom Settings. Journal of Applied Behavior Analysis, 41, 405-409.
  • Gray, C. (2015) The New Social Story™ Book, 15th Anniversary Edition. Arlington, TX: Future Horizons.
  • Karal, M.A., & Wolfe, P.S. (2018). Social Story Effectiveness on Social Interaction for Students with Autism: A Review of the Literature. Education and Training in Autism and Developmental Disabilities, 53(1), 44-58.
  • Thiemann, K.S. & Goldstein, H. (2001). Social Stories, Written text Cues, and Video Feedback: Effects on Social Communication of Children with Autism. Journal of Applied Behavior Analysis, 34, 425-446.

 

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Holidays and Autism

Holidays and Autism

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…”

“I Think it’s Time for ABA Therapy…”

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

Top Characteristics of an ABA Therapy Provider

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.

How Do I Choose an ABA Assessment?

How Do I Choose an ABA Assessment?

By: Ellen Barnett, MA, BCBA, LBA

Assessment of skill repertoires for individuals with autism is the foundation from which we develop appropriate and effective intervention. Currently, there are several assessments available in the field of ABA therapy. Given the many options, how do we confidently choose an appropriate assessment based on the needs of our clients? One study reports that the more familiar a BCBA® is with an assessment, the more likely he/she will choose it (Mathewson, 2018). Choosing an assessment based only on familiarity does not ensure the most effective treatment program or optimal outcome for our clients. It is necessary that we understand the similarities and differences, as well as the limitations of various assessments. I am guilty of relying on the same old assessment due to comfort level and familiarity. Recently, however, I have started working on developing competence with a larger variety of assessments and this has helped me become a better clinician. The following descriptions offer a starting point toward an increased understanding of some commonly used skill assessments that are currently available in our field. They include: the Assessment of Basic Language and Learning Skills- Revised (ABLLS-R), the Verbal Behavior- Milestones Assessment and Placement Program (VB-MAPP), Promoting Emergence of Advanced Knowledge (PEAK), Assessment of Functional Living Skills (AFLS), Essential For Living (EFL), and the Early Start Denver Model (ESDM).

Assessment of Basic Language and Learning Skills – Revised (ABLLS-R)

Developed by Dr. James Partington, the ABLLS-R is a commonly used criterion-referenced assessment and curriculum that addresses the skills most typically developing children acquire by kindergarten. Based on Skinner’s analysis of verbal behavior, the ABLLS-R is designed to identify and address skill deficits. It is comprised of 544 skills from 25 skill sets including language, social interaction, self-help, academic, and motor skills. The ABLLS-R is made up of two components, the ABLLS-R Protocol and the ABLLS-R Guide. The Protocol provides a detailed task analysis of language skills. The Guide provides instructions for scoring and strategies for developing appropriate goals. It is important to keep in mind that the hierarchy of skills in the ABLLS-R does not match typical development; nor does it address problem behavior. In spite of a lack of published studies evaluating its reliability, the ABLLS-R remains a popular assessment tool. The ABLLS-R may be appropriate for young children (ages two through six) and older children (ages seven and eight) who exhibit delays primarily in language and social skills.

Verbal Behavior –Milestones Assessment and Placement Program (VB-MAPP)

Developed by Dr. Mark Sundberg, the VB-MAPP is a criterion-referenced assessment and curriculum that focuses on skills for typically developing young children. It focuses primarily on language and social skills but also includes some academic-related skills. Like the ABLLS-R, the VB-MAPP is based on Skinner’s analysis of verbal behavior and it provides a detailed task analysis of language skills based on the verbal operants. Unlike the ABLLS-R, the VB-MAPP is written to match the progression of typical development and allows for the assessment of problem behavior.

The VB-MAPP contains five components. The Milestones Assessment is comprised of 170 measureable developmental milestones. The Barriers Assessment focuses on assessing common barriers that impede skill acquisition, including prompt dependence, failure to generalize, and impaired skill sets. The Transition Assessment serves as an assessment for potential transitions to less restrictive settings. It addresses rate of acquisition, adaptability to change, ability to learn in the natural environment, and ability to independently care for oneself. The Task Analysis and Supporting Skills component provides a list of skills that support the developmental milestones and that may be taught prior to each milestone. The VB-MAPP Guide provides information necessary for developing IEP goals and identifying interventions based on the results of other components of the assessments.

The VB-MAPP has little to no research supporting its reliability but, nonetheless, remains a popular tool for establishing the baseline level of a child’s verbal behavior repertoire and determining the interventions to follow. The VB-MAPP may be an appropriate choice for young children (ages two through six) who exhibit delays primarily in language and social skills.

Assessment of Functional Living Skills (AFLS)

Developed by Dr. James Partington and Dr. Michael Mueller, the AFLS is comprised of the AFLS guide and six assessment protocols that assess functional, practical, and age-appropriate daily life skills. The authors define functional skills as “commonly age appropriate skills that are used everyday for typical activities and routines and are essential for independence.” Created and formatted as an extension of the ABLLS-R, each AFLS assessment protocol breaks down functional skills into two to four levels. Each assessment protocol can be used alone, but together form a comprehensive assessment that covers a life-long continuum of skills. It is important to know that the AFLS guide provides an exhaustive list of functional skills, but does not provide specific methods for teaching these skills. The six assessment protocols are Basic Living Skills, Home Skills, Community Participation Skills, School Skills, Independent Living Skills, and Vocational Skills. Examples of skills included in the protocols are dressing, grooming, laundry, grocery shopping, cooking, money management, job interviews, and computer skills. The AFLS is well suited to older learners, particularly ages 16 and up, who need to develop independent, daily living skills. This includes learners with dual diagnoses, learners who have exhibited little to no progress in skill acquisition programs, and learners with limited functional communication skills. When considering this assessment, one can keep in mind the authors’ words, “There is a certain point in a learner’s life when conceptual learning, like sorting shapes and colors needs to be replaced with specific practical skills required to improve a learner’s independence (Partington and Mueller, 2012).

Essential For Living (EFL)

Developed by Dr. Pat McGreevy, The Essential For Living is an evidence-based, communication, behavior, and functional skills assessment, curriculum, and skill-tracking instrument for children and adults with moderate-to-severe disabilities. The EFL is based on the principles and procedures of ABA and Skinner’s analysis of verbal behavior. Like the AFLS, the EFL focuses on functional life skills but offers a much wider scope that allows for the identification and remediation of problem behavior. While the AFLS is far easier to administer, the EFL guides the development of meaningful goals and objectives for individual education plans, behavior plans, and instructional programs.

The EFL is not a developmental instrument and does not categorize skills by age. It is divided into five categories of skills, seven skill domains, and one domain of problem behavior. The EFL offers the option of a Quick Assessment for those who are new to the EFL or those with a learner who exhibits severe forms of self-injurious, aggressive, or destructive behavior. The EFL also offers an evaluation that assists the practitioner in selecting an appropriate alternative, primary method of speaking for individuals who cannot communicate effectively with spoken language. Central to the EFL is The Essential Eight that are referred to as “must-have skills” and are necessary for a “happy, fulfilling, and productive life as a child or an adult.” These skills are necessary for the reduction of problem behavior.

The EFL may be an appropriate choice for young children, ages two and older, who exhibit significant global delays, specific syndromes, have limited language, hearing and vision impairments, or other medical conditions. It may also be an appropriate choice for older children, ages nine and up, as well as teens and adults who have difficulty answering questions or participating in conversations, and/or have not acquired academic skills at a first or second grade level.

Promoting Emergence of Advanced Knowledge (PEAK)

Launched in 2011 by Mark Dixon, the PEAK is an evidence-based assessment and curriculum that combines the traditional verbal behavior (VB) approach with the science of derived relational responding, or learning through relations between stimuli without needing to be taught directly. This sets the PEAK apart from the ABLLS-R and the VB-MAPP that focus on direct instruction and stimulus generalization. The PEAK is currently the only assessment/curriculum that provides a technology for Relational Frame Theory (RFT), which is characterized as responding to one stimulus in terms of another. The author has noted that some perceive the PEAK as controversial, as it surpasses the long accepted account of verbal behavior as defined by Skinner. However, it is a novel approach to verbal behavior and teaches skills beyond those found in the ABLLS-R and the VB-MAPP. By emphasizing an approach to language consistent with Relational Frame Theory, the PEAK provides practitioners with the tools to build more complex repertoires that individuals need to effectively respond to novel stimuli in their environment.

The PEAK contains four modules. The Direct Training module has many of the same skills included in the ABLLS-R and the VB-MAPP (i.e. requests, labels, imitation, etc.). The Generalization module is common-core driven and focuses on taking the basic concepts across contexts, people, and stimuli. The Equivalence module focuses on deriving skills from other previously taught skills and addresses concept formation. The Transformation module is designed to promote an understanding of abstract concepts and perspective taking. This module starts with basic items such as shape-to-shape matching and progresses to abstract logical reasoning.

The PEAK may be appropriate for children birth to 16 years and can also be used with adults. Because the PEAK expands beyond the scope of skills taught in the ABLLS-R or VB-MAPP, it may be a good choice for children who have already moved quickly through skill acquisition in those assessments.

Early Start Denver Model (ESDM)

Developed by Sally J. Rogers and Geraldine Dawson, the ESDM is an evidence-based assessment and curriculum designed for young children who are diagnosed with or at risk for autism. The ESDM is a play-based, developmental, early intervention approach that is based on the naturalistic procedures of ABA. Its goals are to reduce the severity of ASD in young children and to increase functioning across developmental domains including imitation, communication, cognitive, social emotional, social play, adaptive, and motor skills. The ESDM is an intervention that is comprised of an assessment (The Early Start Denver Model Curriculum Checklist for Young Children with Autism) and a curriculum that includes heavy parent involvement. Many studies support the efficacy and effectiveness of the ESDM in a variety of settings and formats including intensive delivery, parent coaching, and daycare/preschool delivery. The ESDM may be a good choice for young children ages 12 months to 60 months who exhibit the classic traits of autism.

Summary

Choosing an appropriate assessment for our clients can be challenging. As BCBA’s® we need to move past our comfort zone and continually develop fluency with a variety of the assessment tools available in our field. In this way, we will be able to choose the best fit for our clients and ultimately provide gold-standard care.

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

Being a Savvy Consumer

Being a Savvy Consumer

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

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

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

7 Dimensions of Applied Behavior Analysis

By: Maria Pantelides, MA, BCBA, LBA

What is Applied Behavior Analysis?

Before understanding the 7 dimensions of Applied Behavior Analysis, one must first understand what Applied Behavior Analysis is.

Applied Behavior Analysis is a scientific approach for discovering environmental variables that reliably influence socially significant behaviors and for developing a technology of behavior change that is practical and applicable (Cooper, Heron, Heward, 2007).

In simpler terms, one of the main purposes of Applied Behavior Analysis is to target functionally appropriate behavior that can increase an individual’s quality of life. This is done by teaching appropriate, functional behaviors and skills as well as by reducing problematic ones.

What are the 7 Dimensions of Applied Behavior Analysis?

While Applied Behavior Analysis is based on scientific methods, it is founded on 7 core dimensions, which were first outlined by Baer, Wolf and Risley in 1968 in the first edition of the Journal of Applied Behavior Analysis (JABA).

All Applied Behavior Analytic interventions fall within or are defined by these 7 core dimensions, which are outlined below. As a whole, these 7 dimensions make up the framework of proper Applied Behavior Analytic interventions and they support techniques used during therapy sessions.

  1. G- Generality (AKA generalization) – A behavioral change may be said to have generality if it proves durable over time, if it appears in a wide variety of possible environments, and/or if it spreads to a wide variety of related behaviors (Baer, Wolf, Risley, 1968). In other words, a behavior demonstrates generality when the taught behavior carries over into other contexts than just the training environment. We want these taught behaviors to be used in multiple settings, across multiple people, and to continue to be used in the future.
  2. E- Effective – interventions are effective when they improve a behavior in a practical matter. If the application of behavioral techniques does not produce large enough effects for practical value, then the application has failed (Baer, Wolf, Risley, 1968). An intervention is effective when it changes the behavior it seeks to change.
  3. T- Technological – Procedures are described clearly and concisely so that others may implement the procedures accurately. Think of this dimension like a recipe – all steps are written in detail to get the desired result. You would not be able to follow a recipe if it did not list the specific ingredients and measurements. Same thing goes for Applied Behavior Analytic interventions!
  4. A- Applied – A behavior change is applied when it enhances and improves the everyday life of a learner, and those who are closest to a learner (e.g., parents, siblings, peers), by improving a socially significant behavior.
  5. C- Conceptually Systematic – Interventions are consistent with the principles demonstrated in the literature and the research. It is important that practitioners continue to use research-based techniques, and avoid using any shortcuts in our teaching methods.
  6. A- Analytical – Using data to make informed decisions. The practitioner is able to show that whenever he/she applies a certain variable, the behavior is produced, and whenever he/she removes this variable, the behavior is lost (Baer, Wolf, Risley, 1968).
  7. B- Behavioral – The behavior chosen must also be observable and measurable. By defining a behavior that makes it easily observable and measurable, we are able to study it for proof of improvement, as well as lack of improvement. By defining a behavior, practitioners are able to collect data and show change over time.

Effectiveness of Applied Behavior Analysis

Now that you are familiar with the 7 dimensions of Applied Behavior Analysis, you may be wondering if they are an effective treatment for individuals diagnosed with Autism Spectrum Disorder. Applied Behavior Analysis has produced remarkably powerful interventions in fields such as education, developmental disabilities and autism, clinical psychology, behavioral medicine, organizational behavior management, and a host of other fields and populations (Slocum, et al., 2014).

Using the 7 dimensions of Applied Behavior Analysis ensures that the interventions are data driven and supported by research, that the interventions are effective and socially significant to the individuals, and that interventions are closely monitored to ensure consistent progress or to make modifications to interventions if and when necessary. Because these 7 dimensions make up the framework for Applied Behavior Analysis, research has demonstrated their effectiveness and the research continues to grow each day.

Applied Behavior Analysis is evidence-based, which means that this method of teaching is based on empirical evidence. Research and studies have been conducted and found that Applied Behavior Analysis is effective in treating individuals diagnosed with Autism Spectrum Disorder. This emphasizes the research-supported selection of treatments and data-driven decisions about treatment progress that have always been at the core of Applied Behavior Analysis. As a field, Applied Behavior Analysis continues to evolve and change as new research and technology become available.

References:

 

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

When Should My Child Stop ABA Therapy?

When Should My Child Stop ABA Therapy?

By: Nahoma Presberg, MS BCBA

ABA therapy is highly individualized and very personal. From the decision to seek this therapy for your child, to finding the right practitioners, to when to discontinue services, there are no concrete rules.

In this article, we will discuss the factors that should be considered when thinking about discontinuing ABA therapy including progress on treatment goals and assessments, socially significant progress, availability, support system and resources, and funding. We will then discuss some tips for appropriate titration, or reduction in services, and ultimately, a successful discharge.

Progress on Treatment Goals and Assessments

Let’s consider this scenario: Your child has been enrolled in ABA therapy for some time and you think that it might be time to consider terminating. What are the thoughts that are going through your head?

The first thing you might think about is what progress your child has demonstrated, or what have been the outcomes of his or her therapy so far. Your child’s ABA therapy provider should be supplying you with a regular progress report, usually every 6-months or so. This should include two things: a description of your child’s progress on the treatment goals worked on during the period and a description of your child’s progress utilizing some regularly administered assessment tool.

First let’s discuss how you might analyze progress on treatment goals. Each goal should display your child’s level of performance prior to the start of treatment, or baseline data, and then display your child’s current level of performance. With the help of your BCBA®, you should be able to analyze your child’s rate of progress. If you find that your child is regularly not making progress on his or her treatment goals, and that these goals are not being updated in order to meet his or her needs, this might be a time to consider either changing ABA providers, or, seeking additional resources. Alternatively, if you see that your child’s rate of progress is very good and that they are mastering treatment goals in baseline or very quickly, this might also be a time to consider reducing or terminating ABA therapy.

Next, you should also look at your child’s progress on the assessment tools your ABA provider is utilizing. This might be something like the Vineland, VB-MAPP, Essential for Living, or something else. The results should inform you of your child’s level of performance before they started treatment and his or her current level of performance. The results may also compare your child’s scores to other children his or her age, or provide some other indicators of progress. It is best to analyze these results with your BCBA®, but the results of these assessments can be a good indicator of when it might be appropriate to discontinue ABA therapy.

Socially Significant Progress

Now that we’ve talked about the progress measured by your ABA provider, let’s talk about the most important thing: progress measured by your family. In ABA, we refer to this as “social significance.” Think about what you were hoping to get out of ABA when you first entered treatment. What was the original reason that you reached out for support? Has your family’s life significantly improved as a result of the progress your child has made with ABA therapy? One of the biggest indicators that it may be time to move on is if you’ve met your goals. For example, you may have requested ABA because your child was struggling with his or her morning routine. Maybe it was a battle to get your child up and ready for school every day. Is that still an issue? If your child has made progress in those goals then you might be ready to move on. If they haven’t, there could be an issue in the treatment plan itself and it might be time to consult with your BCBA® about making program modifications to better support these goals, but it is also probably a sign that you would benefit from continued services. However, once you’ve met the goals that you’ve set out to accomplish, it is worth having a conversation about whether there are additional skills that should be worked on within the context of ABA therapy or if it is a natural time to discontinue or begin to decrease the number of hours of therapy.

Availability

ABA therapy isn’t like taking a pill. It takes a lot of time and energy on the part of both the parents and the child. One of the considerations when determining how many hours of ABA your child should have, is thinking about what other things they would be doing with that time if they weren’t in therapy. Sometimes, parents may choose to prioritize other kinds of opportunities such as sports or camps or other kinds of activities that may be important for a child’s social skills development. If your child needs the support that ABA can provide, then it is worth the investment of time and effort to work on the skill development that they will learn in ABA. However, it is important to identify clear goals and priorities and make sure that time is being spent working towards those goals.

Support System & Resources

When considering a discontinuation of any treatment, it is important to consider what additional supports and resources are available to pick-up where that treatment left off. Although your child may have made significant progress on his or her treatment goals and assessments, your family’s life has improved dramatically as a result of the improvement in your child’s behavior, and you’ve made plans for your child’s schedule to be full of new and exciting extra-curricular activities in lieu of ABA therapy, it is important to take a step back and consider what might be left behind. Does your family have adequate training to implement the techniques that were successful in getting your child to this point? Do you have an appropriate transition plan that will guide you into the next phase of your child’s life? Are there any major changes coming up that might result in the continued need for therapy, such as a change in schools, a new sibling, changes to medication, puberty, or a move to a new town? Discuss all of these with your ABA provider so that they can support you through this transition so that your child will continue on the path for success. In addition, be sure you know how to contact your ABA provider in order to resume services should the need arise, or if you need any additional support throughout the transition.

Funding

Finally, another reason you may choose to stop ABA therapy might be financial.

ABA therapy is intensive and requires a team of highly skilled professionals who work closely on creating an individualized approach for your child. This often comes with an expense that can place a large burden on families and take away from other needs. Currently, all fifty states have coverage requirements for autism treatment. This can significantly improve access and reduce the cost of treatment. That being said, this does not always apply to all individuals. If you are considering stopping ABA therapy due to high costs, reach out to your ABA therapy provider to see if they can provide you with financial support. There are also organizations that provide grants and other support options for families in need.

Alternatively, funding sources may attempt to dictate when ABA therapy should stop based on variables that are not in line with the recommendations of the ABA provider or the family. If this is the case, your ABA provider should be able to give you resources to appeal these decisions and, if necessary, file appropriate reports for wrongful action on behalf of the funder.

The most important take-away from this section is that although ABA is an expensive treatment, if it is medically deemed necessary, and your child is benefiting from therapy, there are many options for funding and financial support that could allow therapy to continue.

Titration and Discharge

Typically, ABA services aren’t simply discontinued. Once your child begins to master goals, it is common to slowly decrease the number of hours of therapy until it is time to stop completely. Decreasing these hours slowly is a way to make sure that the skills maintain outside of the context of ABA and also that additional issues don’t unexpectedly arise. Slowly decreasing the number of hours helps to ease the transition both for the child but also for the family as a whole.

Another consideration is whether you can involve your child in the decision-making process. ABA is often something that a parent decides for their child, However, if it is possible, involve your child in the decision-making. They know themselves better than anyone. While sometimes it may not be possible and each circumstance is different, talking to your child about their goals and priorities can sometimes provide a huge amount of insight about what is best for them.

Lastly, as a parent, this is not something that you have to decide for yourself. The process of reducing and then discontinuing ABA services is something that should be an ongoing conversation between the family and your team of providers. Make sure that you are advocating for the needs of your child and encouraging these conversations on a regular basis so that you can plan for any upcoming transitions that your child or your family will face. The goal of ABA therapy is to teach skills that improve the quality of life. This means that there is always room to make the adjustments that you need so that ABA works for you.

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

When Should My Child Start ABA Therapy?

When Should My Child Start ABA Therapy?

By: Tobey Lass M. Ed., BCBA, NY LBA

The time after a child receives a diagnosis can be filled with many unknowns. There are many decisions that families must make for their children and there is no crystal ball that can instruct a family towards what services will provide a favorable outcome.

There is only one course of treatment that all special education experts agree will set a child up for future successes: beginning therapy as early as possible.

Early intervention is a national program for children 3 years old and under geared towards allowing families and children access to therapies such as ABA starting as young as infancy. A child’s early experiences play a critical role in brain development. Receiving therapy from a young age can have a significant impact on a child’s ability to learn new skills and overcome challenges and can increase success in school and life (CDC, 2019). According to the Institute of Child Health and Human Development there are significant negative effects of delaying early access to therapies such as ABA. “It takes four times as long to intervene in fourth grade as it does in late kindergarten because of brain development and because of the increase in content for students to learn as they grow older”. Children can avoid future learning challenges by receiving Early ABA therapy. Teaching children targeted, individualized skills when they are young increases their potential for success since It is easier for a child to acquire skills when a child is younger because of the brains plasticity to learn new things.

The Research

Research shows that a child that starts ABA therapy in childhood has the potential to make significant improvements but emphasizes that ABA therapy is most effective the earlier it is begun. One of the original studies of the benefits of early ABA therapy found that children who began ABA therapy before turning 5 had better outcomes that children who started ABA therapy after 5 years old (Fenske, Zalenski, Krantz, & McClannahan,1985). Subsequent studies demonstrated that children who began ABA therapy as early as 2 and 3 years old led to significant cognitive and adaptive skills. Access to inclusive educational settings in a mainstream classroom is among the significant long term gains made by children who received early access to ABA therapy.

Using ABA as early as possible to address the deficits of Autism can address and decrease many situations frequently experienced in autism families. Deficits in skills associated with an autism diagnosis, such as not being able to communicate their wants and needs effectively, can often result in problem behavior (Koegel, Koegel, Ashbaugh, Bradshaw, 2014). A child might also engage in behaviors such as screaming and tantrum to gain access to an item if they lack functional communication. Behaviors become a form of communication because parents often respond to these behaviors by giving a child what they want when they exhibit the maladaptive behavior to try and stop the behavior from occurring. What parents don’t realize is by engaging in the cycle in the short term stops the behavior from occurring, but in the long term causes the behavior to happen more frequently because the child learns that they will get what they want by engaging in the behavior. The longer a child engages in these behaviors, the more resistant the behavior becomes to change.

Why Start ABA Therapy Early?

Starting ABA therapy early and as close to the onset of behaviors will teach critical skills to both the child and the family to decrease any maladaptive behaviors. ABA therapy can teach a child skill such as functional communication training to replace maladaptive behaviors and parents learn how to respond when their child is engaging in maladaptive behaviors in a way that reinforces the replacement skill not the behavior. These supports have been shown to help both family members and the child gain skills that enable the child’s needs to be better met.

There are so many reasons why families do not start ABA therapy early. Parent’s did not know about it. They did not think their child’s deficits were permanent, they thought their child would “grow out of it”. Parent’s did not want to label their child and stigmatize them too early. The list of reasons for not starting ABA therapy as early as possible is endless. By delaying early access to ABA therapy it is likely that there will be significant negative consequences for children with ASD (National Research Council, 2001). This is why it is crucial for families to speak with their pediatrician if they suspect their child has any developmental delays.

I have never worked with a family who has regretted starting ABA therapy early, I have only heard regrets from families who didn’t start soon enough.

To any family who is at the beginning of navigating their child’s delays or autism diagnosis- don’t delay. Find out how your child can begin receiving ABA therapy as soon as possible in your local area.

To any seasoned autism families who have not yet started ABA therapy, it’s never too late to get your child the help they need.

For more information on the benefits of early intervention and ABA please reference:

 

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

Why is an ASD Diagnosis so Important?

Why is an ASD Diagnosis so Important?

By: Gabrielle Galto, BCBA, NYS LBA

The following information provided is not meant to diagnose or treat and should not be taken in replacement of a medical professional or behavioral consultation.

Speaking on behalf of this question, I remind myself of how difficult and overwhelming it can be to hear that your child has Autism Spectrum Disorder (ASD). Receiving an ASD diagnosis, as a parent or caregiver, can result in shock and is a really hard pill to swallow. However, an accurate diagnosis can provide some relief since it can help lead to receiving appropriate treatment and services.

An ASD diagnosis comes with many concerns and questions. That said, what I would like to focus on is what follows a diagnosis for a child or other individual with Autism Spectrum Disorder.

Difficulties Without a Diagnosis

In this case, ignorance is not bliss. Without a diagnosis, it could be really difficult to obtain appropriate care and treatment. This could also come with many hardships both emotionally, physically, and financially for families. Individuals, no matter how young or old, without a diagnosis can encounter many difficulties in life that can result in maladaptive behaviors or outbursts, social isolation, and negatively affect their educational abilities. Once diagnosed, the deficits and hardships encountered can be worked on through evidenced based treatment packages designed to help diagnosed individuals reach their full potential. A young child can then start to engage in more appropriate ways to support social development, build friendships, and can be taught skills for independence or even job placements.

Early Diagnosis

Furthermore, early diagnosis is just as important because it provides treatment at such a critical juncture. During this time, treatment can be provided to assess and teach skills to help a child catch up to their peers, providing for a comprehensive intervention package promoting growth across domains. According to the Center for Disease Control and Prevention (2019), ASD can sometimes be detected as early as 18 months but many children may not receive an ASD diagnosis until much later. Developmental screening tests provide an assessment on learning basic skills to determine if a child has delays, and screenings for ASD should be routinely checked. With early detection comes early treatment. However, autism is a spectrum disorder, which means symptoms are presented across a wide range of differences within type and severity.

Therefore, an accurate autism diagnosis is important so that appropriate therapeutic services are provided. Autism spectrum disorder is an extremely complex condition and there has yet to be a single cause for the disorder, which makes it far more difficult to diagnose. ASD affects many areas of functioning including social interactions, communication, idiosyncratic behavior and interests in children and adult alike. Signs of ASD can be presented very differently between each individual, which can make identifying and diagnosing more difficult.

Additional Benefits

An ASD diagnosis can also provide additional resources such as necessary benefits or disability living allowances, and a delayed diagnosis would only further prolong access to these benefits. Furthermore, one  can obtain a diagnosis no matter what age. This diagnosis would provide eligibility for supports, services, and protection under the Americans with Disabilities Act (ADA), which details specific rights and accommodations at work and school for individuals with disabilities. There are also services that provide support with vocational placements and rehabilitation programs such as counseling and job placement services.

For more information about Attentive Behavior Care and how we can help your child, please contact us today.

How Will ABA Help My Child?

How Will ABA Help My Child?

By: Megan Miller, MSEd, BCBA, NYS LBA

ABA Therapy

“Applied behavior analysis is the science in which the principles of analysis are applied systematically to improve socially significant behavior and experimentation is used to identify the variables responsible for behavior change” (Cooper, Heron, & Heward, 2007). In simpler terms, ABA makes changes to the environment in order to replace current behaviors with more appropriate behaviors. Keep in mind that “behavior” refers to anything a person does.

What ABA is Not

There are often several misconceptions regarding what ABA actually is. Let’s clarify that by telling you exactly what ABA is not. ABA is not, bribery, doesn’t turn kids into robots, it is not a “one size fits all” approach, it is not only for individuals with autism, it doesn’t only involve discrete trial training, it is not boot camp style, and lastly, it is not just a theory.

Who Can Provide ABA Therapy?

In most cases, a therapist, or registered behavior technicians (RBTs) will provide direct therapy to your child. Therapists and RBTs are trained and supervised by a Board Certified Behavior Analyst (BCBA®). A BCBA® holds a Master’s Degree or PhD in psychology or behavior analysis, is required to pass national board certification exam, and holds a state license (in some states). The primary role of a BCBA® is to assess the child and develop an individualized intervention plan for them which will be implemented by the therapist and overseen by the professional behavior analyst. In most cases, the BCBA® will attend sessions weekly to supervise the therapist and will also provide a parent training session to the family.

Although you may only see your BCBA® on a weekly basis, there are a lot of things that they are responsible for behind the scenes. The BCBA® will also review records, interview parents and caregivers, conduct assessments, develop behavior intervention plans to decrease maladaptive behaviors, develop treatment intervention plans based on the individual’s strengths and weaknesses, develop written procedures, train behavior technicians, caregivers, and others, provide ongoing supervision and monitoring of interventionists, provide ongoing, frequent direct observation and measurement of target behaviors and review and analysis of graphed data, adjusts protocols and targets based on the data, train interventionists to implement the revised protocols, review progress with the client, caregivers, and intervention team, provide coordination of care with other providers (e.g. medical doctors, school teachers), and write up reassessment reports.

What Does ABA Look Like?

It varies based upon the child’s individual needs, but most ABA programs will incorporate various teaching strategies throughout a single therapy session. Below are a few of the most common teaching strategies.

Discrete Trial Training (DTT)

  • 1:1 teaching method
  • Involves intensive learning of specific behaviors
  • Big learning tasks are broken down into smaller steps

Natural Environment Teaching (NET)

  • Teaches skills in settings where your child will naturally use them
  • Uses the child’s natural motivation in the moment to provide meaningful learning opportunities

Individualized Treatment Plan

Most treatment plans will work on increasing skills in a wide variety of areas such as, communication, social skills, play and leisure skills, and daily living skills. The skills being taught must be socially significant to the individual. Typically skills that impede most on the individual’s ability to learn and function independently are targeted for intervention. When receiving ABA therapy services for insurance funded programs all skills that are taught must directly be related to the core deficits of autism spectrum disorder, which are deficits in social communication, social interaction, and restricted, repetitive patterns of behavior, interests, or activities.

Data Collection

Data on your child’s performance will be recorded throughout each therapy session. Continuous data collection and analysis of this data, allows treatment protocols to be constantly assessed and tailored to meet the needs of a specific individual. The BCBA® overseeing your case will review records, provide ongoing supervision and monitoring of interventionists, provide ongoing, frequent, direct observation and measurement of target behaviors, review and analyze all graphed data, adjust protocols and targets based on the data, and train the therapist to implement the revised protocols.

Skill Acquisition

Individuals will be taught more appropriate skills to replace problem behaviors. Positive behaviors will be targeted for increase, while interfering behaviors will be targeted for reduction. Skills are chosen based on the individual’s specific needs and can be provided in a one to one or group setting. ABA therapy can be provided in a variety of settings such as, home, school, and within the community.

Generalization

Generalization is a key component in any ABA treatment program. Generalization means that the learner can apply the skills that they have learned to outside the learning environment, across various materials, people, and settings. Some individuals may require more explicit training in order to generalize skills that are taught during therapy sessions. It is important to keep in mind that the ultimate goal is to have the child independently display the skills that they have been taught.

Behavior Reduction

All behaviors serve a function and are likely occurring for one of the following reasons, escape, attention, access to a tangible, and/or self-stimulation. Once we determine the function of a behavior, then we can teach a more appropriate behavior to help the individual get what they want.

Parent/Caregiver Training

Parent/caregiver training is provided to families whose children are receiving ABA services. The purpose of family training is to support the family by providing them with strategies and tools to better help support their child outside of therapy sessions. Families will also learn how to interact with their children in a way that teaches them how to reinforce and help generalize skills that are targeted during therapy sessions.

Effectiveness of ABA

ABA is a research-based science that has data to back it up. The United States Surgeon General (1998) concluded, “Thirty years of research demonstrated the efficacy of applied behavioral methods, in reducing inappropriate behaviors and increasing communication, learning and appropriate social behavior.” Continuous data collection and ongoing analysis of this data allows treatment protocols to be constantly assessed and tailored to meet the needs of a specific individual.

When Will I See Results?

There is no set timeline for how fast or slow an individual will learn. Interventions are constantly being monitored and adjusted to account for maximum progress. Some individuals are better in some skill areas than other areas, which means faster progress in some skill areas and slower progress in other skill areas. Consistency across people and settings will help skills to be generalized. It is also very important to stick to your recommended number of treatment hours in order to receive the best outcome from therapy.

References:

  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
  • Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Columbus, OH: Merrill Prentice Hall.
  • Kanchwala, A. (n.d.). ABA 101. http://theautismhelper.com/wp-content/uploads/ 2015/09/ABA-101-Handouts-The-Autism-Helper.pdf.
  • United States Surgeon General (1998). Mental health: A report of the Surgeon General. Washington, DC: Author.

 

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

Back to School: 7 Tips and Tricks to Ease Your Child’s Transition

Back to School: 7 Tips and Tricks to Ease Your Child’s Transition

Can anyone believe it is back to school time? To many families, back to school means a time of stress and frustration. It can be incredibly difficult to transition from the free flowing days of summer to the structure and rigor of the classroom.

Getting into the routine may be met with some interesting behavior. It’s important to remember that no transition is going to be completely smooth, but there definitely ways to make it a bit less challenging.

Here are 7 tips and tricks to help ease the transition back to school.

  1. Keeping a routine is key: If you have not started already, it might be helpful to start getting a consistent bed time and wake up time similar to what it will be like in the school year. This will help not only set the expectation for when school begins, but also get your child’s biological clock on the right schedule. If you’re interested check out this cool resource on how to reset your circadian rhythm. #science!
  2. Calendar marking down the days: Some individuals may find it helpful to have a visual of when their vacation is over and school begins. Take time each day to cross the current day off with your child and remind them that the school year is starting soon. Creating a concrete picture of when “freedom” ends and the work begins can help some individuals.
  3. Take a trip to the school: If your child lives by the motto “I’ll believe it when I see it” set a time to go by the school and walk up to the front doors. Perhaps show them where they will enter each day or where the bus will drop them off. Practice walking from your home to the bus stop. Any combination of these types of activities can reduce problem behavior by simply exposing your child to the routine.
  4. Create a visual schedule or social story for the school year: By now you probably have some idea of who your child’s teacher may be or what classroom they may be in. If you have that information, write a social story about what the first day may be like. Focus on the positive aspects of starting a new school year: new friends to meet, a new teacher, learning really cool stuff and new school supplies!
  5. Prepare the night before: Nothing can be worse than scrambling the night before a big event. The night before school starts, make sure everything is in order: backpacks are made, lunches are ready to go, and breakfast is ready to be made in the morning. It’s quite a bit of extra work but the morning will likely flow better and the transition will be a bit smoother.
  6. Drop off and pick up place: As annoying or redundant as this may sound, having a specific place to put a jacket, backpack, and shoes can be an incredibly helpful way to establish a routine. Anyone ever watch Karate Kid with the jacket? It’s kind of like that. It not only provides a consistent routine, it provides a level of independence. Eventually you can say to your child “go get your shoes and backpack” and continue about your morning routine.
  7. Get into routines: Once the school year starts the transition does not fully end. Establish a few nightly routines to help keep things going strong. Have time set aside for relaxation time, homework, meals and extracurricular activities. Make sure that these times are consistent, but be flexible. You may have a homework-light night or just want to watch a movie as a family.

Unfortunately, there is no one simple way to help your child transition from summer vacation to school without any problems. With some planning and preparation the transition can be less difficult.

If you are interested in learning more about Behavior Analysis, join us for our Parent Engagement webinars!