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!

Is ABA Therapy Really an Effective Treatment for Autism?

Is ABA Therapy Really an Effective Treatment for Autism?

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

There are many therapies marketed towards treating autism all claiming to be effective. According to Autism Speaks, ABA therapy is one of the most popular therapies used to treat autism. Despite it’s popularity, most of the articles I found about ABA present information subjectively. Selecting what treatment to pursue for treating autism spectrum disorder can be an overwhelming task. What information do parent’s need to know to objectively determine if ABA is an effective treatment for autism?

What is ABA?

Applied Behavior Analysis (ABA) is the science of human behavior. ABA focuses on improving specific behaviors through a system of rewards and consequences. The principals of ABA were founded on B.F. Skinner’s research which measured the effects of consequences in teaching behaviors to animals.

How did ABA go from animals to autism?

ABA remained laboratory based until the 1970’s when Dr. Oscar Lovaas developed a method of teaching children who have autism using B.F. Skinner’s theories of behavior. The effectiveness of his method was validated by Dr. Lovaas’ research. The data showed that the children who received daily, intensive instruction demonstrated significant improvements in their symptoms with almost half being classified as having “normal intellectual and educational functioning”. Dr. Lovaas method became known as ABA therapy and has been used as a treatment for children who have autism for over 40 years.

Ok, but Lovaas’ article was only one study. How did it become the model for modern ABA therapy?

Since ABA is a data driven therapy its methods can be replicated evaluated using the scientific method. Being able to replicate data ensures that behavior change is direct result of ABA therapy. ABA studies have been peer reviewed, which means that the methods were deemed effective after being evaluated by an outside group of researchers.

Don’t other therapies have research to support their effectiveness?

Many therapies claim to be effective treatments for autism. The difference between ABA therapy and the other therapies is science. ABA is the only therapy whose methods have been validated through the scientific method. ABA’s roots in science is the reason that ABA has been endorsed by state and federal agencies, such as the US Surgeon General. It is also the reason why doctors deem ABA therapy medically necessary and why is covered by health insurance.

I’m a parent, not a scientist! How can parents determine if ABA is an effective treatment for autism?

Effectiveness of ABA therapy is easy to evaluate as a parent as well. ABA is one of the few therapies covered by insurance that provides parents with parent training hours. These hours are to be used for collaboration between the BCBA® and the parents and caregivers to discuss the child’s progress, answer parents’ questions, and provide training to carry over effective methods outside of therapy sessions. The role of data is extremely important for determining if ABA is an effective treatment. BCBAs® choose goals and instructional procedures based on data from studies in ABA journals. Progress is evaluated by analyzing data collected during instruction and indicates what changes should be made in a student’s program to ensure that learning is occurring. For a parent, data is an objective way to evaluate progress which enables parents to make informed decisions about how their child is doing in ABA therapy instead of relying on anecdotes.

But you’re a BCBA®! You’re biased. How can you objectively consider other therapies?

Unbeknownst to the families I work with, I was not always a believer in ABA. In college I was introduced to complementary and alternative therapies used to treat Autism. They all made so much sense to me. Each therapy had multiple clinicians and parents raving about the life changing effects of these therapies. I spent hours and hours studying the theory behind each therapy. Outside of my classes I sought out further training from the top practitioners in different therapies to improve my practice. In my first jobs working with individuals who have autism I used these methods to teach my students. I believed that complementary and alternative therapies were the effective methods of treating autism.

Until my Intro to ABA class.

I first heard about ABA from a high school teacher after I told her I wanted to teach individuals who have autism. I watched the videos and read articles and I was not impressed. I viewed ABA therapy was outdated, cold and rigid, basically the opposite of the educator I wanted to be.

I came into the class ready to challenge everything the professor said, armed with years of knowledge from studying complementary and alternative methods for treating autism.

I tried over and over again to disprove what we were learning with examples of other methods that could be used to achieve the same goal. Any evidence I used to support my beliefs was quickly refuted by my professor. I found myself unable to challenge his responses- his beliefs supported by data unlike mine which were derived from anecdotes. In a few weeks my beliefs about what therapies were effective for treating autism completely changed; ABA replaced complementary and alternative therapies as the most effective treatment for autism.

I’m a BCBA® because I believe ABA is an effective therapy for autism.

So, is ABA an effective therapy for treating autism?

As the only scientifically proven, data driven, and objective therapy for treating autism: my answer is ABSOLUTELY YES.

Still not convinced?

For more information about ABA therapy or how to determine effective treatments options for autism contact Attentive Behavior Care today.

How Can I Help Reinforce at Home What My Child Learns in ABA Therapy?

How Can I Help Reinforce at Home What My Child Learns in ABA Therapy?

By: Megan Miller, MSED, BCBA, LBA

Perhaps this is your first experience with ABA therapy, or maybe your child has received services before. Either way, collaboration/caregiver involvement is key for maximum effectiveness when using applied behavior analysis as a treatment option. Think about it, your child may be receiving 10-20 hours a week of ABA therapy, and while that may seem like a lot and a therapist may be in your home working with your child every single day of the week, this also means that a therapist is not present for 148-158 hours of that week. When you think of it from this perspective, how can you ensure that your child still works on these crucial skills when they are not receiving direct therapy services?

Observation

The best place to start is simply observing your child’s session and becoming familiar with the programs that are being run on a daily basis. If you don’t understand something, ask questions! The therapist will be able to explain the skills that are being taught and can also model the teaching procedures for you. It is recommended that you learn a few of the programs that your child is working on and set aside a time to work on them at home using the same techniques as the therapist. The best skills to begin practicing at home are skills that your child is already doing well with so that they will be successful.

Reinforcement

One of the most often used strategies in ABA is reinforcement. The definition of positive reinforcement is “when a behavior is followed immediately by the presentation of a stimulus that increases the future frequency of the behavior” (Cooper, Heron, & Heward, 2007). It is important to keep in mind that just because the child might like something, it doesn’t mean that it will be an effective reinforcer. A true reinforcer will increase the likelihood of a desired behavior happening. When choosing reinforcers, it is important to ensure that the reward is worth the amount of work and effort that the child is expected to exert. Remember – if the desired behavior is not increasing, then your reinforcer might not be effective.

Tips for Reinforcement

Individualize rewards: Whatever your child is interested or motivated by in a particular moment can be used as a reward to reinforce the child for completing a task that was asked of them. This could be playing a game of chase, eating a favorite snack, or playing with a specific toy.

Make yourself the ultimate reinforcer: Teach your child that you are the giver of all good things. Let them know that all of the fun things they love will be available to them when they are working with you. This will motivate them further to want to work with you, as it indicates that good things are coming their way.

Be specific with your praise: Whenever you are rewarding your child for doing something well, be sure to indicate exactly what they did to receive that reward. For example, instead of just saying “Good job” you should say, “Great job matching the letter A!”

Reinforce immediately after the desired response: Ideally, you want to deliver your reward as quickly as possible after the child responds correctly. For example, if you ask your child to match the letter A and they do so correctly, you would want to say “Great job matching letter A” as you give them a piece of a cookie. Delaying reinforcement can inadvertently reinforce another response or behavior. For example, if you ask your child to match the letter A and they do so correctly, then they engage in yelling as you’re delivering reinforcement, they may think that they were just rewarded for the yelling as opposed to the matching. If this continues to happen, it is likely that the child will engage in yelling more often because they think they get rewarded for that behavior.

Behaviors

Many children may be receiving ABA because they have behaviors that interfere with learning or day to day functioning. Discuss the current targeted behaviors with your BCBA® and learn the strategies that are being used to help reduce these behaviors and increase replacement behaviors. Always keep the phrase “Catch them being good” in the back of your mind. What this means is that you should always being looking for opportunities to reinforce your child for doing appropriate things. For example, if you know that your child has a tendency to get up out of their seat often, but you notice that they are sitting nicely, use this an opportunity to reward them for doing the right thing. Remember – reinforcement increases the likelihood of a behavior happening again!

Communication

A lot of children on the spectrum have difficulty communicating their wants and needs with others. Every good ABA treatment program will include some type of goals to help the child to increase or expand upon their current level of communication. Whether your child is working on exchanging pictures, using sign language, a speech output device, single words, or complex sentences, the same expectations should be set across all people and settings. This means that if during ABA sessions, the therapist is having the child request items using a 3 word sentence, then everyone else should make sure that they are only giving that child them item for requesting it with 3 words. If the family provided requested items to the child when they only used a single word, the child would learn that ta single word is acceptable (at least when requesting from that particular person). This can potentially cause behavioral issues when the child tries to request an item from the therapist by using a single word and is then denied the item because the expectation is for them to use a 3 word phrase.

Parent Training

Parent training is part of every child’s treatment plan and is a crucial component. Parents will be provided with time where they can meet one on one with the BCBA® assigned to their case. During this time, parents will learn about ABA procedures and receive first hand training on how to implement their child’s programs appropriately. Parents may be asked to perform skills with their child while being guided by the BCBA®. Parents might also be taught how to record data in order to monitor their child’s progress.

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 people, materials, and settings. Any time a parent works on skills at home or within the community with their child, they are promoting generalization of skills. 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.

Resources for Parents:

The following resources will help you to learn how to use reinforcement to increase positive behavior at home.

 

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

What to Expect From ABA Therapy

What to Expect From ABA Therapy

By: Julie Bates, MA, BCBA, NYS LBA

Your child has a diagnosis of Autism Spectrum Disorder and is starting ABA therapy. Perhaps you are wondering what that entails? What is ABA exactly? What is the process to begin ABA therapy? What happens during an ABA therapy session? What should I expect?

 

What is ABA?

ABA (Applied Behavior Analysis) is considered an evidence-based best practice treatment for Autism Spectrum Disorder 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 applies our understanding of how behavior works to real situations. The goal is to increase behaviors that are helpful, such as communicating with others, and decrease behaviors that are harmful or affect learning, such as aggression.

Positive reinforcement is one of the main strategies used in ABA. When a behavior is followed by something that is valued (a reward such as verbal praise, a tangible item or activity), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change. Reinforcers vary for each individual child and may change from moment to moment.

 

It Starts With an Assessment

A Board-Certified Behavior Analyst (BCBA®) will assess your child to determine what goals will be beneficial to them. This assessment will very likely occur in your home. You will be asked questions about what your child is able to do and what areas are difficult for them. Based on the assessment, reviewed reports, and input from parents, the BCBA® will develop a treatment plan.

There will be goals selected to increase skills that we want your child to learn and goals to decrease any behaviors that may interfere with your child learning and functioning to the best of their ability. To decrease interfering behaviors, the behavior analyst will develop a behavior intervention plan for your child. After these goals are selected, the behavior analyst will select smaller objectives within each goal to begin.

These goals will include working on increasing language and communication skills, increasing play and social skills, and reducing behaviors that may be interfering with progress, such as leaving the work area or aggressive behaviors. Alternative, more appropriate skills will be taught to replace interfering behaviors. The individual treatment plan will continually be updated with new goals as your child acquires skills.

Your treatment team will consist of a BCBA® and one or more therapists. The therapist will provide much of the direct treatment hours and the BCBA® will monitor progress across your child’s goals. The BCBA® will provide direct supervision to the therapist based on the number of hours your child is receiving direct treatment.

 

A Typical Day of ABA Therapy

The BCBA® and therapist’s goal is to have your child be excited and looking forward to each session. An ABA therapy session in the child’s home will look a bit different for every child as it is unique and individualized for each learner. Therapy is usually for an hour to several hours at a time depending on each individual child. The first few sessions will be about fun and play rather than working on specific goals. The therapist will be “pairing” with your child. They will begin to develop a rapport with your child and will get to know what activities your child likes, such as games, toys, high fives, hugs, and snacks.

Once your child is more comfortable with the therapist and the therapy environment, the work can really begin. The therapist will keep demands to a minimum at first and then slowly begin to increase demands. Reinforcers, or rewards, will be used to increase learning and appropriate behavior. Reinforcers may include high fives, verbal praise, tangible items, snacks, tokens, and many other possibilities. A reinforcer is dependent on what your child prefers and is motivated by.

ABA therapy is conducted through Discrete Trial Training (DTT) and Natural Environment Training (NET).

Discrete Trial Training (DTT) is a method of teaching in simplified and structured steps. Instead of teaching an entire skill at once, the skill is broken down and then “built-up” using discrete trials that teach each step one at a time. It includes presenting an antecedent, the child’s response, and the therapist providing reinforcement for a correct answer or a correction for an error. Often, DTT will be done at a desk or a table like when your child is at school. Trials may be presented in blocks of ten or twenty consecutively, allowing for learner to have more opportunities to practice the skill. This is a very effective way to teach new skills quickly.

Here is an example of a discrete trial teaching for identifying foods (apple):

  • Therapist: presents a picture of apple and cookie and says “Point to apple”
  • Learner: points to the apple
  • Therapist: “Great pointing to apple. You did it!” (May give child a tangible reward).

Natural Environment Teaching (NET) is a method of teaching for when skills are taught or generalized within the natural environment. For example, during DDT you might teach a student to receptively and expressively label colors of items at the table. Then, during NET the student would get to practice the skill by labelling colors of crayons that you’re coloring with or asking for colors of Playdoh that you’re playing with. NET is also very useful in teaching play skills and social skills to a learner while prompting generalization of newly acquired skills.

This is an example of natural environment teaching (label colors).

  • Learner: is painting a picture at an easel.
  • Therapist: asks “What color?” and points to (the color) red on the paper.
  • Learner: responds “Red”.
  • Therapist: “Correct, that is red”.

A combination of DTT and NET will likely be used with your child during an ABA session. Each session the therapist will take data on your child’s progress for each target or goal. The BCBA® will review progress and intervene when necessary or add additional goals for your child as they master current goals. Again, ABA therapy is individualized for your child.

 

Caregiver Involvement

Caregiver and family involvement are a very important part of ABA therapy. Parent training is provided by the behavior analyst. This is very beneficial as it allows continuation of the treatment outside of therapy sessions and to other settings with the child’s family members. This may include parents, siblings, and other caregivers. It gives these family members the tools to maintain the child’s new skills, promote generalization in the natural setting, as well as techniques for managing behavior issues. Parents play an essential role in the child’s treatment plan because no one knows the child’s needs and personality better than the parent.

 

References:

Cooper, J., Heron, T., & Heward, W. (2007) Applied Behavior Analysis, Second Edition. Upper Saddle River, NJ: Pearson Prentice Hall.

Ozonoff, S., & Cathcart, K. (1998). Effectiveness of a home program Intervention for young children with autism. Journal of Autism and Developmental Disorders, (1), 25-32.

 

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

What Do We Do in ABA Therapy and Why?

What Do We Do in ABA Therapy and Why?

By: Jacob Papazian MS, BCBA – Regional Clinical Director, Michigan

Applied Behavior Analysis (ABA) has become an incredibly popular treatment for individuals diagnosed with Autism Spectrum Disorder and Developmental Disabilities (Foxx, 2008). ABA is a loaded acronym that includes a long list of skills and techniques all based on the basic science of behavior. Board Certified Behavior Analysts (BCBAs®) are trained to identify behaviors of interest, assess the reason(s) why they occur, and create plans to teach alternative behaviors that are more appropriate.

Those are all great things, but you may observe the BCBA® or technician working with your child and wonder “why are they doing that?” or “what on earth did I sign myself up for?” BCBAs® do things that seem counterintuitive or just plain strange. Our goal is to demystify some of the stranger practices in ABA and explain our backing in science.

Assessment

The first step in any treatment process is the assessment. Very little you will ever do in the ABA process is more important than this initial assessment. This is the first of many opportunities to ask questions, express concerns, and discuss your hopes and dreams for your child. The BCBA® likely asked numerous questions that were overwhelming. This is normal. A good treatment plan has an exhaustive record of medical, psychological, developmental, educational, and social history. After what probably felt like a grueling conversation, the BCBA starts working with your child pulling out toys, books, and enough laminated/velcroed pictures to cover your walls. The formal testing portion of the assessment is used as a “baseline” or starting point for treatment. This way, the BCBA® can gauge just how much progress was made over time.

Treatment Planning

Once the assessment was done, you likely received a formal treatment plan that looked more like a manuscript for a novel. This treatment plan, only partially written in plain English, is the document that provides your insurance company with information about what the plan is for the next six months. You will likely come across technical jargon that makes no sense. You may find things referencing “manding,” “tacting,” or “stimulus control.” Behavior Analysis, by definition, includes seven core dimensions: one of them focusing on using technological language that ensures continuity between providers, just in case another clinician needs to step in. it is also more efficient in the writing process. However, your BCBA® should make the time to answer any question(s) you have and translate the document from behavioranalyticease to English. Never be shy to question what you are reading and ask for clarification.

Intervention

BCBAs® do strange things when they are working with your child. Technicians will follow plans created by your BCBA® that just seem counter-intuitive. They will stretch their face like a cartoon character over the smallest things and repeat questions and activities over and over. Your BCBA® may ask you to take data about behaviors that might seem insignificant or to do and say things that seem strange. There is a reason for all of these things occurring.

First, and most importantly, behavior analysis thrives on the concept of reinforcement. Reinforcement, simply put, is providing some type of reward for engaging in the correct behavior. Think of this like your paycheck at work. You deserve to be compensated fairly for your time and effort. If you were not going to be paid, would you continue to work? Probably not! Behavior Analytic interventions operate on the same principle. Your child will be expected to complete tasks and engage with the technician, but will receive their own version of a paycheck in a variety of ways like games, music, snacks and other preferred activities and items.

Reinforcement has specific rules. It should only be given, in most cases, when the person has done something correctly. This is why BCBAs® start out small, sometimes with skills your child may already have. The BCBA® may have to teach your child that in order to get something, they have to do something. There is no easier way to teach that skill than having your child complete an activity they are able to do with minimal effort. Teaching procedures use a similar idea. Skills are broken down into small component pieces called “discrete trials” and repeated several times in a row. By breaking skills down they are less intimidating and easier to learn. Most often, these discrete trials are run consecutively five to ten times. Research has shown that when an individual practices the same skill in short bursts like this, sometimes called discrete trial training, the skill is learned faster (Lerman, Valentino, & LeBlanc, 2016).

You may have also noticed that your technician uses very short phrases when working with your child and rarely speaks in full sentences when giving instructions. This is actually incredibly important. Although it may seem odd to speak in short sentences, BCBAs® have found that the shorter the instruction the better the result (Dickenson & Wit, 2003). As the number of words increases, comprehension decreases significantly. By keeping sentences short and to the point, compliance from your child is likely to follow. As your child’s language grows, so will the length of your technician’s interactions. As for the teaching itself, there is lots of hands on practice. And by hands on practice, we mean the technician is guiding your child’s every step. This is something called “errorless learning.” Again, more research has shown that the more errors you make, the more likely you are to do them in the future (Mueller, Palkovic, & Maynard, 2007). By starting with lots of help and slowly cutting it back (fading) we may have better results.

Problem Behavior

If your child engages in problem behavior you will have likely heard your BCBA® say: “all behavior is communication.” Although true, it is not incredibly helpful at the very beginning. The clinician is likely to first start with asking you questions about what you do when the problem behavior occurs. This may feel invasive, but it is only intended to understand what you normally do in response to problem behavior. Nobody is perfect. More importantly, your BCBA® is not there to judge you for offering a candy bar to keep your child distracted while you go through the grocery store at a dead run. (The author of this blog having done that a few days previously!) In some cases the BCBA® may actually perform an experiment where they want you to give in to the problem behavior. They may ask you to take away the toy they are playing with, provide tons of attention for screaming, or tell them that they do not have to eat that broccoli. It is crazy to think that the BCBA® would be happy to see problem behavior occurring. But their job is to try and find a pattern and sometimes finding that pattern means giving in. We call that a Functional Analysis (Iwata et al., 1994). Once that pattern emerges, it’s time to roll up your sleeves and start intervening.

Then things can get even stranger. Charts start flying everywhere, dollar store stickers come pouring out of the BCBAs® bag, and you are now expected to play interventionists. Your BCBA® is probably looking at you with a wide smile and beaming with enthusiasm for the behavior plan they just created. As the parent, all you may see are ten new things to remember to do on top of the 30 other responsibilities you have. This is normal. You are allowed to be overwhelmed. BCBAs® are trained to not only be effective at changing behavior, but also how to work with families. Speak up and express your concerns if the behavior plan seems overwhelming or complicated.

Your BCBA® may ask you to do any number of ridiculous activities: tell your child maybe later, tell them to clap their hands, have them repeat nonsense syllables three times in a row. Just remember that there is a reason for every intervention. Recall those core dimensions of Behavior Analysis we mentioned earlier? One of them is “effective.” This means that BCBAs® only implement interventions that are proven to work based on research. And that research is peer reviewed, scrutinized, and validated several times over before it is accepted as a practice. Despite the evidence, you may feel like you are wasting your time or that it is not working. That is normal. BCBAs® expect there to be a bit of a lag between when the intervention starts and when progress is more noticeable. You can definitely teach new skills to your child, but it is going to take time. Your child will have to unlearn all of their usual ways to get what they need or what they want in order to make room for the new skills that you are trying to teach. Think about how long it takes you to pick up a new habit. It is the same way for your child.

We Made It!

From the day that you received a diagnosis of ASD for your child, you have been on a journey. That journey may have brought you to the field of ABA. Perhaps you are involved in a treatment regimen now. Maybe you are reading this blog trying to see if ABA would a good fit for you and your family. BCBAs® do a lot of strange things, but all in the name of helping your child grow and have the best developmental experience possible. Additionally, they are here to be a guide on the journey. Speaking as a BCBA®, I have had the honor and privilege of working with some of the most hard working and dedicated families. I have laughed and cried with them. I have joined them in celebrating the major milestones, and shared in their frustration over less than effective interventions. I have written my fair share of strange behavior plans and have had the look of utter bewilderment pass over my parents’ faces. Despite this, we were able to make effective change because we worked together as a team through the ups and downs. We may do strange things, but together they will become great things. In the words of Derice Bannock: “Cool runnings. Peace be the journey.”

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

 

References

  • Foxx, R.M. (2008). Applied behavior analysis treatment of autism: The state of the art. Child and Adolescent Psychiatric Clinics of North America, 17(4), 821-834.
  • Dickinson, A., & Wit, S.D. (2003). The interaction between discriminative stimuli and outcomes during instrumental learning. The Quarterly Journal of Experimental Psychology 56B(1), 127-130.
  • Iwata, B.A., Dorsey, M.F., Slifer, K.J., Bauman, K.E., & Richman, G.S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27(2), 197-209.
  • Lerman, D.C., Valentino, A.L., & LeBlanc, L.A. (2016). Discrete trial training. Early Intervention for Young Children with Autism Spectrum Disorder, 47-83.
  • Mueller, M.M., Palkovic, C.M., & Maynard, C.S. (2007). Errorless learning: review and practical application for teaching children with pervasive developmental disorders. Psychology in the Schools, 44(7), 691-700.
What Does a Behavior Analyst Do?

What Does a Behavior Analyst Do?

By: J M Coimbra, MS, BCBA, LBA

Scrolling through a list of occupations on an electronic document, I don’t see my title – behavior analyst. I’m forced to choose the closest option, but what is it? I’m left contemplating, “What does a behavior analyst do?

The short, first response to this question is “analyze behavior.” Seeking a better description, I reviewed the Behavior Analyst Certification Board’s (BACB) website to find a similar description, if not more ambiguous – behavior analysts are “practitioners who provide behavior-analytic services.”

Alright, so we do behavior analysis – what is that? Applied behavior analysis (ABA) by the definition found in my fundamental, graduate-program textbook, is “the science in which tactics derived from the principles of behavior are applied systematically to improve socially significant behavior and experimentation is used to identify the variables responsible for behavior change.”

Basically, the work of a behavior analyst is to make evidence based changed to an environment to affect behavior positively and systematically.

Also, check out this video, made by the BACB, which provides an overview of behavior analysis:

But how does it all translate to the more palatable occupation titles?

Advocate

Sooner or later it is the role of a behavior analyst to be an advocate – to fight for the rights of our clients. It is in the very definition of ABA that the science focuses on understanding and improving behaviors that are socially significant. That means, we change behaviors that are important to change that result in improved conditions. We fight to be ethical and fair to the client. This can take the form of teaching the client to stand up for himself or herself in unfair situations or even supporting the best interests of the client ourselves during attempts to coordinate care with others.

Consultant

As challenges arise, questions amount. Why is this happening? What do we do about this problem? Where did that action come from? It is the job of the behavior analyst to act as consultant for their clients, whether it be a family, a school, or organization. We are given a list of variables, we generally observe these variables, come up with solutions, and develop plans to realize those solutions. We may serve as a consultant for an isolated occurrence (e.g., a single assessment) or we may work for years with a client shaping continuous change and development.

Educator

One of the most generalized roles that a behavior analyst has is to educate. Yes, we can go in and cause behavior change in our presence. However, more often than not, the real concerns will not be addressed until members of the normal environment (parents, bosses, teachers, etc.) learn how to do some of the basic techniques of ABA (e.g., differential reinforcement, prompting, programming, etc.).

Engineer

Even though we teach technicians, caregivers, and other practitioners the basics of ABA, behind the scenes, we are engineering complex behavior change plans. One truism from my graduate program is ‘Behavior does not occur in a vacuum’. The solution to a behavior problem may be delivering a gummy bear at a specific time, but coming up with a contingency diagram and evaluating all variables in the setting to determine exactly when, how much, and by whom that gummy bear should be delivered requires true engineering.

Philosopher

If behavior analysis were to be considered a natural science (see the behaviourologists for the argument that it should be), it would seek to answer why behavior happens. Let’s also remember that just about everything an organism does is behavior. Crime and punishment, religion, ethics and values – all of these philosophical topics can be viewed through the lens of behavior analysis – and have been by Skinner (e.g., in About Behaviorism). Behavior analysts commonly work in micro-environments now, but the potential to produce meaningful change in communities and macro-environments exits using the laws of behavior, in which behavior analysts specialize.

Psychologist

Take Psychology 101 at any university and without question, you will come across the behaviorism section that focuses on some of the old scientists, like Pavlov and Watson. You will learn about how salivating can be shaped just like a phobia can be shaped. Behavior analysts shape processes that occur in the “mind” like any other psychologist may, but we do it using the principles of ABA. We consider reinforcement history and derived relations, for example. We look at a personality as a behavioral repertoire and we enhance that personality by teaching new skills and replacing undesirable behaviors with desirable ones.

Scientist

With clipboards, tablets, and/ or clickers in hand, you will see us behavior analysts, always collecting data. We use data to inform our decisions (inductive examination) so that we remain unbiased. We write our procedures using specific, technical, objective language, so clear that another behavior analyst, who is unfamiliar with the intervention could implement the program. Behavior analysts systematically evaluate behavior change variable by variable and determine interventions based on evidence taken for each individual.

Social Worker

Just like behavior does not occur in a vacuum, and organism does not exist independent of a network. It is the case for many behavior analysts working with individuals, that the social system in which the individual is enmeshed is also examined. Behavior analysts ensure the safety and well-being of their clients and are mandated reporters in cases of neglect and abuse. We try to help clients and their families or those in their networks cope with disability, disadvantage, trauma, and other social deficits or challenges.

Student

Proudly behavior analysts have a commitment to continuing their education. Not only are the attitudes of science drilled into us during our formal education, but the BACB requires all board certified behavior analysts to received approved continued education credits to ensure we are utilizing the most up-to-date, evidence based practices relevant to the populations we serve. Conferences are offered multiple times a year and the BACB has approved countless other resources (e.g., webinars, videos, seminars, etc.) that are available even from our own homes.

Supervisor

The Board Certified Behavior Analyst may have a formal role of supervising students, Registered Behavior Technicians, and those seeking board certification themselves. The role of supervisor requires preparing educational materials, delivering feedback, modeling procedures, testing skills, meeting regularly, and guiding supervisees through the ethical guidelines and practice of ABA. Furthermore, behavior analysts may be supervisors, who manage a clinic or manage other behavior analysts. Since it is less likely that a behavior analysts works alone for a client, we at a minimum supervise an intervention team for each client – whether it be a technician or a faculty.

Writer

Aside from writing the occasional blog, which may not be so common for the average behavior analyst, we write proposals, behavior change plans, behavior intervention plans, insurance-based progress reports, analyses of assessments, manuscripts, teaching procedures, recommendations, translations, books, tips, and anything else to help produce the results we seek.

So given all of these roles – what might a behavior analyst do in a typical day? Well, it varies greatly because of all of the roles and because of all of the fields in which a behavior analyst may be employed – autism & intellectual disorders, behavioral gerontology, behavioral pediatrics, clinical behavior analysis, education, health, fitness, & sports, organizational behavior management, intervention in child maltreatment, and sustainable practices. However, I can give a basic rundown of my typical day as a clinical supervisor in the field of autism and intellectual disorders.

A Day as a Behavior Analyst at Attentive Behavior Care

At 9:00, I begin my day doing some treatment planning so that I can slowly sip my coffee. I access the electronic data for a specific client and look at the data that have been collected over the last week or two, since my last treatment planning session. I look at the graphs to see if the interventions I have in place are effectively changing behavior (scientist). I input updated goals as some had been mastered and I write a teaching procedure for the technicians, who work with the client daily, so they know how to target that goal (writer).

By 10:00, I travel to a school, where I have a meeting with the school professionals, who are writing a new Individualized Education Plan for another one of my clients. Here I present data to support interventions that address my client’s needs best (advocate). I coordinate care with the teacher, when he asks me about a new problem behavior. We discuss the events that occasion the behavior, and I offer to conduct an observation the following week (consultant).

By 12:00 I begin traveling to a client’s home. En route, I turn on a podcast about feeding procedures that informs me for behaviors I plan to target in the next authorization period (student).

At 1:00 I arrive to the client’s house for parent training, and I help the parents practice following through with demands and giving reinforcement equal to their child’s effort in a given task. I prompt them and explain the rationale for more reinforcement or less in each trial (educator). Following the training, my client’s parents reveal to me that they are in need of additional support for respite services and seek guidance (social worker).

At 3:00 I am at clinic, where I take an hour to review a new client’s initial assessment. I review the qualitative data collected during observation and the quantitative data collected during formal assessment, and I create a plan for intervention (engineer). I see this client has stereotypical behavior and fixates on objects obsessively, and hypothesize other stimuli that I could use to expand his interests to vary his thoughts and interests for enrichment (psychologist).

When my next client is home at 4:00, I arrive to oversee the treatment fidelity of one of the technicians working with this client (supervisor). I provide feedback and instruction. She asks me a broad question about why a method is selected over another, and why it works, and if that method works then why does another exist and I tell her to email me or schedule a time to chat about it outside of session time (philosopher).

Each day will be different as a behavior analyst, but each day a behavior analyst will do his or her best to make meaningful change to improve lives – to achieve better living through behavior analysis.

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

Better Understanding the Principles of ABA

Better Understanding the Principles of ABA

By: Frank Kou, MSEd, BCBA, NYS LBA

What Are the Principles of ABA?

In order to learn and understand them, one must know what ABA is. Applied Behavior Analysis (ABA) is the science in which tactics derived from the principles of behavior are applied to improve socially significant behavior, and experimentation is used to identify the variables responsible for the improvement in behavior (Cooper, Heron, Heward, 2007).

Three Terms of Applied Behavior Analysis (ABA)

1) Applied – In terms of ABA, it is the commitment to affecting improvements in behaviors that enhance and improve people’s lives. In addition, it is also to improve the relationships of the client with his/her environment including the interactions with those around him/her. Practitioners must select behaviors to change that are socially significant for the client that may include but not limited to social, language, academic, daily living, self-care, vocational, and/or recreation and leisure behaviors.

2) Behavioral – In terms of ABA, behaviors must meet three criteria. First, the behavior in question must be the behavior in need of improvement. It cannot be a similar behavior that serves as a proxy for the behavior of interest or another person’s description of the behavior. Second, the behavior must be observable and measurable. Behaviors have to show change over time. Third, when changes in the behavior do occur, it is necessary to ask whose behaviors have changed. Is it that of the clients or that of the practitioners? All behaviors of the both parties should be monitored if possible.

3) Analysis – In terms of ABA, analysis is analytic meaning that there was a demonstration of functional relation between the manipulated events and a reliable change in some measurable dimension of the targeted behavior. In other words, the practitioner can control the behavior from happening or not happening.

Applied Behavior Analysis Principles

By using ABA principles, practitioners can support individuals in multiple ways that may include the following:

  • Teach new skills that an individual previously did not have. For example, teaching an individual how to use utensils when eating when previously individual only used fingers to eat.
  • Increase positive and/or more socially acceptable behaviors. For example, having individual greet a peer or attend to a speaker.
  • Maintain behaviors. For example, having an individual continue with a conversation using skills that were previously learned.
  • Generalize or transfer behaviors from one environment and/or person to another environment and/or person. For example, having an individual put on his/her coat both at home, and at school.
  • Reduce interfering or challenging behaviors. For example, reducing an individual’s out of seat and wandering around the classroom behavior.

Using Applied Behavior Analysis in the Real World

Now that Applied Behavior Analysis and its principles have been discussed, how is ABA used in the real world? Practitioners use the ABC model in order to observe and change behaviors. ABC stands for antecedents, behaviors, and consequences. Each of the components will be discussed below.

a) Antecedents – Antecedents are situations or events that come before a behavior. Oftentimes they are described as the “trigger” for the behavior that follows. An antecedent can have many forms ranging from an event (i.e. loud phone ringing), to a person (i.e. regular teacher versus substitute teacher), or an object (i.e. stop sign) in the environment that cues a person to do something. An example of an antecedent is child having a tantrum because teacher said it was time to come in from recess {antecedent}.

b) Behaviors – Behaviors are any actions that can be observed, timed, or counted. Everything that a person does can be described as a behavior. In ABA, practitioners try to understand “why” or the function of the disruptive “problem” behavior in question in order to change it for the better. There are four main functions for behavior: 1) Escape or avoid a situation 2) Attention from other people 3) Tangible – to gain access to something he/she wants 4) Sensory – pleasing to the person “automatically rewarding.” When working with behaviors, it is important that the behaviors are described in specific details in order for all parities involved to observe and measure the same thing. For example “tantrum” is vague versus screaming in a loud voice and stomping a foot against a hard surface, which is a better description.

c) Consequences – Consequences is the term used to describe what happened immediately after the behavior occurred. It is also known as a response to the target behavior. Consequences can occur in two different ways. The first is natural in which they are the inevitable result of the person’s own action. For example, a person gets burned and hurt for touching an open flame. The second is logical in which they are imposed by another person, usually an authoritative figure. For example, a person receives a ticket by the police for speeding.

In the real world, practitioners use the ABC model to get a better understanding of the behavior in question. By manipulating the antecedents and/or consequences of the behavior, practitioners can increase a positive behavior, decrease a problem behavior, or maintain a behavior.

References:

  • Bearss, K., Johnson, C.R, Handen, B.L., et.al. (2018). Parent Training for Disruptive Behavior – The RUBI Autism Network. New York, NY: Oxford University Press.
  • Cooper, J., Heron, T., & Heward, W. (2007) Applied Behavior Analysis, Second Edition.  Upper Saddle River, NJ: Pearson Prentice Hall.
  • Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3-9.
  • https://www.behaviorbabe.com/
  • https://vcuautismcenter.org/resources/factsheets/printView.cfm/982

 

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