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.
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:
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.
“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.
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.
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!
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.
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.
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!
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.
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.
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!
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.
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.
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.
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.
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.
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.
By: Jacob Papazian MS, BCBA – Regional Clinical Director, Michigan
Applied Behavior Analysis (ABA) is most commonly associated with intensive intervention for developmental disabilities. A quick search on Indeed.com in the Southeast Michigan area brought up 12 different companies asking for Board Certified Behavior Analysts to work with individuals diagnosed with Autism Spectrum Disorder (ASD) and one lecturer position for a university.
This is not terribly surprising considering that the highest proportion of the Behavior Analytic literature has focused on treating behavior disorders (Leblanc, Heinicke, & Baker, 2012).
What Jobs Can I Get With a Behavior Analysis Degree?
Despite the popularity, there are a variety of career avenues available to Behavior Analysts that have nothing to do with developmental disabilities. In this post we’ll be discussing 7 fantastic jobs that you can get with your behavior analysis degree.
1 – Clinical Behavior Analysis
Behavior Analysts have long been overlooked in the turf war that is psychotherapy. Psychologists, social workers and counselors are trained to shape verbal behavior in sessions to bring about changes with a heavy focus on emotions and internal events. Psychotherapy has evolved with manualized treatment that is behavioral in orientation. If you have the inclination to use self-reporting as a form of data collection and a thirst for Relational Frame Theory (Ruiz, 2018), then Clinical Behavior Analysis may be for you! Most states require a Ph.D. in Clinical Psychology or a similar terminal degree to perform and be reimbursed for psychotherapeutic services. However, several states allow Masters level clinicians to practice under the supervision of a Ph.D. Potential placements can include hospitals, schools, and private practices. Literature has been published in a variety of areas including personality disorders, depression/anxiety, psychosis spectrum, and obsessive compulsive disorders (formally under the umbrella of anxiety disorders).
2 – Clinical Research and Education
Are you a super nerd that has a passion for teaching?
Are you always reading the newest journal articles or dreaming of the next big research project for your clinical team?
If that is the case then you should consider a clinical research and teaching position with a local university. Many universities are offering coursework online and seek out Master’s level instructors. The advantage of having lecturers in their programs are twofold: they are typically less expensive than the core faculty and offer students an opportunity to learn from clinicians that are actively practicing. Research requirements are typically less intensive but offer resources most clinics do not have available.
3 – Comparative Animal Behavior
If you, like me, are a Disney fanatic and love animals, then there is the perfect job for you with the mouse! The Walt Disney Company hires Behavior Analysts that have experience with animal behavior. When new animals are introduced to the safari, they are taught to return to their night enclosures using conditional discrimination. Recreation specialists use phylogenically appropriate activities to keep the animals entertained and healthy. Most importantly, animal training occurs regularly for the wildlife shows throughout the parks to promote a message of conservation.
4 – Organizational Behavior Management
If working with neurotypical individuals is more your style, working in Organizational Behavior Management (OBM) might be a good fit for you. OBM practitioners typically work as independent contractors for companies to improve some aspect of performance through a variety of activities including functional assessments, interviews, and corporate trainings. Human Resources staff and recruiting also find that Behavior Analysts are great fits based on their understanding of motivation. Does helping the Olive Garden reduce food waste or increasing the average sale for a local pet supplies store sound interesting? How about helping managers become effective leaders? If so, OBM is a great option.
5 – Environmental Preservation
If the idea of protecting the planet is important to you then working in Environmental Preservation might be a good idea. Eco-friendly companies are always looking for specialists to not only market their products but to entice consumers to actually use them. Other organizations have been using Behavior Analysts in more traditional retail environments to increase use of biodegradable products. For example, researchers have recently been using extra stimulus prompts to reduce single-use plastics in restaurants with moderate success. For those that are interested in working in environmental policy this is a must consider.
6 – Theme/Amusement Park Safety and Security
Have you ever noticed that in theme and amusement parks, you feel relatively safe? So safe that you spend money on merchandise and food that you would normally never buy? There is an entire science behind keeping guests immersed and feeling safe to maximize spending. Behavior Analysts can provide valuable insight into the motivating operations to engage in target behaviors while in theme parks such as buying merchandise/food products and helping improve traffic flow to improve safety. Those that buy annual passes to their favorite attractions should look into these types of opportunities for free park admission and a paycheck!
7 – Health and Fitness
If you have been watching reality television shows lately, you may have noticed a small uptick in the realm of “life coaching.” Individuals are claiming to be “coaches” to improve quality of life. In most cases their goals center on health, fitness, and wellness. However, most of these individuals are not certified or licensed to be doing such work. Behavior Analysts are a logical fit to help consumers increase the frequency of engaging in healthy behaviors such as increasing cardiovascular exercise and reducing consumption of processed foods. Literature demonstrating the efficacy of basic behavior modification techniques to aid in weight loss is abundant. This specialization does warrants collaboration with other professionals such as dieticians, medical doctors and sports psychologists to ensure that clients are healthy enough for the activities and that they have an adequate caloric intake (Martin, 2015).
Regardless of the path that you take as a career, it is important to remember our ethical guidelines. As Behavior Analysts we stay within our competency. If you are interested in gaining more experience in an area, find a supervisor that can oversee your work and provide you additional support when needed.
What if I Like Developmental Disabilities?
If you have read up to this point and still are thinking “but I like what I do. I like working with Autism” then you are not alone. Working with ASD/DD is a lucrative option that has such a significant impact on the lives of those with which you work. As awareness increases, so do the opportunities for BCBAs ranging from direct care to clinical leadership. Attentive Behavior Care is one such organization that offers positions from technician to executive clinical leadership stressing clinical excellence.
Are you interested in joining the Attentive Behavior Care team? Apply today!
References:
LeBlanc L. A., Heinicke M. R., Baker J. C. (2012). Expanding the consumer base for behavior-analytic services: meeting the needs of consumers in the 21st century. Behavior Analysis in Practice, 5, 4-14.
Martin, J. (2015). Behavior analysis sport and exercise psychology. Behavior Analysis: Research and Practice, 15(2), 148-151.
Ruiz, F. (2018). A multiple-baseline evaluation of a brief acceptance and commitment therapy protocol focused on repetitive negative thinking for moderate emotional disorders. Journal of Contextual Behavioral Science, 9, 1-14.
By Heyde Ramirez, MA, BCBA, NYS LBA and Maria Pantelides, MA, BCBA, LBA (CT, MA, MD, NY)
The definition of the word advocate is to speak, plead or argue in favor of. When you have a child with special needs, one of the biggest roles you will ever undertake is that of being your child’s advocate. You are vigorously fighting for your child. As an advocate, you are your child’s voice to make sure he/she is treated fairly, recognized, and afforded access to all the services and resources they need in order to reach their full potential. A child can have multiple advocates; for example a lawyer, another family member, etc.
Things You Should Know
It is most important that you know your child’s rights. The disability and mental health systems are complex. Each state has their own set of laws and regulations, so become familiar with those laws. It could be helpful to hire a lawyer to better assist you and educate you on the laws. Be prepared to present facts and documentation in support of what you are fighting for. It is important that you ask questions and listen to the answers closely.
Who Should Be On Your Team?
The people on your team should be the people that know your child best and have his/hers best interests in mind. Your child may have several existing team members already set up.
Medical Team
His/Her medical team may be composed of the pediatric practice where he/she receives yearly checkups and gets cared for when he/she gets a virus or the flu, the dental practice and possibly even an eye and ear doctor. The medical team may also branch out and include other medical professionals such as a neurologist or psychiatrist.
Depending on your child’s individual needs, his/her pediatrician will make the necessary referrals so that your child gets the best care possible. As an advocate for your child, express your concerns. Remember that your medical team relies on the information you report, and input as well. Your concerns may not always be apparent to others when they meet with your child, so it is up to you to let them know.
Have you ever experienced your child sitting perfectly still and following instructions at the doctor’s office, but at home, he/she starts to scream at the slightest demand. Mention it! As these professionals meet with your child, they will get to know him very well. They are great sources of information for you, but remember if you do not ask, you may not get the answers you are looking for.
School Team
Children spend a large portion of their lives learning, sharing meals, and socializing in school. It is no wonder that the teachers, teacher’s aides and other school staff will get to know your child on an individual and personal level. You will likely meet with the school team several times a year at parent teacher conferences and other meetings such as individualized education plan (IEP) meetings. These people know best about how your child is doing from an academic standpoint and what goals might be strived for in order to transition your child into a less restrictive setting. As an advocate for your child, demand the best possible education for your child. Laws have been enacted and your child is deserving of the best there is. If you feel that your child is not making progress or that the school is not meeting his needs, speak up! Never feel bad; you are representing your child’s interests.
Related Services Team
If your child has an IEP, there is a chance he has a team that extends beyond teachers and aides, and includes various therapists. Speech/language, occupational and physical therapist, just to name a few, are some of the people who may work with your child in order for him to meet his goals.
ABA Team
The BCBA supervisor can be an invaluable member of your team. The supervisor is someone who by default is constantly analyzing your child’s behavior and can give you a great idea of what techniques work and don’t work when it comes to teaching your child new skills and also when it comes to implementing behavior intervention plans. Your ABA team also consists of the behavior technician who will be working with your child directly. As an advocate, do not shy away from asking questions and demanding the best services available. ABA therapy is already the treatment of choice for ASD as it is an evidence-based practice. Be an advocate, incorporate yourself into those direct care and parent training sessions, and be sure that the services you receive are provided with the highest integrity so that your child can reap the most benefits!
All of these people come together and form a gigantic team that also includes the family and of course your child. As an advocate for your child, you cannot be a passive member of your child’s team. You want to be a leader, paving the way for the best life possible for your child. Take advantage of the education that is out there and available to you. Take advantage of the training opportunities your BCBA Supervisor can offer through parent training.
In an ideal world, every child would grow up to be strong, healthy, and well adjusted. According to the Centers for Disease Control, one out of every 59 children has been diagnosed with an Autism Spectrum Disorder (ASD). Research has shown that early autism detection and prevention can benefit both children with ASD and their parents.
For the child with ASD, receiving early intervention can improve a child’s overall development by gaining essential social skills in order to react better in society, thus having the potential for a better life. For parents with children with ASD, early intervention may help parental relationships with their children especially through challenging behaviors and situations. In addition, early intervention may provide the parents the ability to prepare themselves both physically and mentally for the journey ahead.
During the child’s lifetime, vigilant parents can be on the look out for signs or red flags that may suggest that something may be wrong, and they should seek professional help depending on the child’s developmental stage.
For infants (0 months to 11 months), red flags may include:
Few or no smiles
Limited to no eye contact
Little or no back-and-forth interaction of sounds, smiles, or any other type of facial expressions
For toddlers (12 months to 36 months), red flags may include:
Limited to no babbling
Little or no back-and-forth gestures which may include pointing, waving, reaching
Limited or no response to name
Very few or no words
Very few or no meaningful, two-word phrases that are not imitated or repeated
For child (3 years old and older):
Delayed language development
Loss of previously acquired speech or social skills
Persistent preference to being alone
Avoidance of eye contact
Difficulty in understanding other people’s feelings
Constant repetition of words or phrases (echolalia)
Resistant to minor changes in routines or surroundings
Intense and/or unusual reactions towards the senses (textures, sounds, smells, tastes, lights and/or colors)
Short attention span
Aggression
Meltdowns
Causing self injury
Unusual eating and/or sleeping habits
Currently there is no cure for autism, and prevention is a debatable topic among different groups of people. The best course of action to take is to do things that will benefit the child such as having pregnant mothers eat healthy diets, get plenty of exercise and rest, and avoid harmful chemicals and/or substances.
For the child, have regularly scheduled check-ups, proper diet and exercise, and if there is a risk “red flag” detected, seek help immediately instead of having a “wait and see” attitude.
Note: The following is a fictional vignette created for the purposes of demonstrating common situations encountered by professionals in this field.
Every week, I meet with a fellow Board Certified Behavior Analyst (BCBA®), “Lauren,” my supervisee who has been working in the field as a BCBA® for almost one year, is currently earning her supervision hours and working towards licensure as a behavior analyst in New York State. We have weekly meetings where I give her feedback about specific clients, treatment plans, and anything else pertinent that she would like to speak about. Recently, we have been conversing about her patient, “Julie,” a non-vocal 7 year old girl with Autism Spectrum Disorder (ASD). Lauren supervises Julie’s home-based ABA therapy program. Recently, Lauren has been expressing frustration about the way treatment sessions have been going. This week the conversation went like this:
Me: “Hi Lauren! How have the sessions been going with Julie?”
Lauren: “Ugh. I am super frustrated; I feel like I have tried everything! Julie is not making progress on her treatment plan goals”
Me: “So let’s take a few steps back. What specifically is the major issue you are dealing with?”
Lauren: “After working for 30 minutes, Julie earns a break. Every single time she goes on her break, she has a severe temper tantrum.”
Me: “Is she requesting a break?”
Lauren: “No, she has a very limited mand repertoire. We are working on shaping her mands now.”
Me: “What are her reinforcers?”
Lauren: “M&M’s, IPAD, break.”
Me: “When did you conduct the last preference assessment? Did you conduct a reinforcer assessment?”
Lauren: “I haven’t.”
Me: “So how do you know that the “break” is a reinforcer for her?”
Lauren: “It states it in the initial assessment.”
Me: “What are the dates of the assessment?”
Lauren: “It’s from almost one year ago.”
Me: “So how do you know that the break is still a reinforcer for her?”
Lauren: “It states it in the report.”
Me: “Sometimes we need to reassess. Just because a break might have been reinforcing for her one year ago doesn’t mean that it is a reinforcer for her now.”
Lauren: “Do you think that is why she is having temper tantrums?”
Me: “It could be; perhaps she doesn’t want the break.”
Lauren: “So what are my next steps?”
Me: “First, you need to conduct a preference assessment to see what things might function as reinforcers for Julie.”
Lauren: “Okay.”
Me: “Then, I would test it out. Conduct a session using the suspected reinforcers that you identified during your preference assessment. This will help you determine if these “preferred” stimuli will actually function as reinforcers for Julie. In other words, does the presentation of these stimuli actually result in an increase in the future frequency of the behavior that preceded it?”
Lauren: “Okay.”
Me: “Let’s see how that goes first and then we will discuss the results the next time we meet.”
Lauren: “Okay. Thank you for your feedback.”
In ABA therapy, or any other type of therapy for that matter, it is true that sometimes treatment plans simply do not work out as planned. Problem behavior may increase, and the individual may not make progress with the specific treatment goals.
The great news for individuals receiving ABA therapy is that BCBAs® are perfectly equipped and trained to deal with this. ABA is a science, and because of that, the data guides our decision making. All of the data recorded during each session will be carefully analyzed on a regular basis so that the BCBA® can make immediate changes to the treatment plan when the outcomes aren’t what we expect.
Since data are recorded and analyzed constantly, an ineffective treatment plan will not stay in place for long. In fact, one of the 7 dimensions of ABA is that it is effective—therefore, if the treatment plan isn’t effective, it means that ABA is not being done correctly, and the treatment must be monitored and adjusted until there is a positive impact on the target behavior.
So, what can we do when this happens? The previous scenario is one example regarding what we can do when our treatment plan isn’t working the way it was planned: reach out to a colleague… (of course protecting PHI)
Here are some other recommendations:
Revisit the original assessment. When was it done? What are the behaviors targeted for increase? What are the behaviors targeted for decrease? Does it match the client’s deficits now?
Revisit the FBA/BIP. Does the FBA/BIP need to be updated? Do the interventions being implemented match the functions of the behaviors?
Is there treatment integrity? Is the treatment plan being implemented the way it was intended?
Are the patient’s reinforcers updated? When was the last preference assessment done? Was a reinforcer assessment conducted following a preference assessment?
Communication. Is everybody on the team communicating including parents, technicians, and the BCBA®?
Is parent training taking place? Have there been any significant changes in the individual’s life (e.g. moving, new sibling, change in school)?
Coordinate care. Did you coordinate care with other professionals who work with the individual? Is the individual on any medications? Are there any medical conditions or limitations you should account for? Are multiple treatments being implemented?
Collaborate with a fellow BCBA®. The field of ABA is very big and not one person knows everything!
Do the research! There is a vast amount of resources available to us including “ABAI”, Association for Applied Behavior Analysis International, “BACB”, Behavior Analyst Certification Board, JABA (Journal of Applied Behavior Analysis) and many more!
Consistency, Is the individual receiving the recommended frequency and duration of ABA therapy? Do adjustments need to be made to the schedule?
As a behavior analyst we have many options when our treatment plans are not working. I hope you found this information useful and can implement some of these recommendations.
Are you interested in joining the Attentive Behavior Care team? Apply today!
By: Maria Pantelides, MA, BCBA, LBA (CT, MA, MD, NY)
You have finished your coursework, you’ve completed all of your supervision hours and passed the BACB Exam, CONGRATULATIONS!
Behavior analysis is the science of behavior. Behavior is a product of its circumstances, particularly the event that immediately follow the behavior. (The Board Certified Behavior Analyst® (BCBA®), 2019).
In the role as a behavior analyst, you study behavior and how that behavior affects motivation. Our goal as behavior analysts is to improve the lives of the individuals and those who care for those individuals. Applied Behavior Analysis (ABA) “is a scientific approach for discovering environmental variable that reliably influence socially significant behavior and for developing a technology of behavior change that takes practical advantage of those discoveries” (Cooper et. al, 2007).
By utilizing the principles of ABA our goal is to provide the highest quality services possible to our clients, and increase socially important behaviors. There are various environments you can work as a behavior analyst (e.g., schools, homes, clinics, hospitals); regardless of the environment you are working it is important that every client has an effective treatment that is rooted in the evidence-based literature of ABA.
Often times, as a behavior analyst you spend an extensive amount of time working with other professionals (e.g., technicians, parent/caregivers). These individuals also work with the client and implement treatment that you have created. It is your responsibility to analyze the data, and be present as a BCBA in the client’s program and ensure that you are providing an effective treatment. We are constantly communicating with parents and other team members of our clients and in your role as a behavior analyst, it is important to remember that collaboration and consistency is critical to the success of your client.
As a behavior analyst you must be able to provide services that are within your scope of practice and area of expertise. You must abide by Behavior Analyst Certification Board’s Professional Ethical Compliance Code and Guidelines for Responsible Conduct (BACB, 2014) as well as all local, state, and federal laws with regards to the provision of services.
A behavior analyst plays a huge role in an individual’s team and can help decrease the challenges faced, enhance the lives of individuals, and increase an individual’s quality of life as well as their families. The field of ABA is constantly growing and there is always new research being conducted on how to improve our client’s socially significant behavior. There is no better job or field than that!
References
Applied Behavior Analysis Treatment of Autism Spectrum Disorder: Practice Guidelines for Healthcare Funders and Managers (2014, Behavior Analyst Certification Board Inc.(“BACB) Ver 2.0). Retrieved from http://bacb.com/wp-content/uploads/2016/08/ABA_Guidelines_for_ASD.pdf
Behavior Analyst Certification Board Professional and Ethical Compliance Code for Behavior Analysts(2014,
Behavior Analyst Certification Board, Inc. “BACB”). Retrieved from http://bacb.com/wp-content/uploads/2016/03/160321-compliance-code-english.pdf
It can be difficult when your child gets an autism diagnosis. It is normal to have a conflict of feelings – relief at the clarity and direction the diagnosis gives you, mourning over the loss of the dreams of typical development you may have had for your child, denial that the diagnostician really understood your child, and of course, confusion over what to do next.
First of all, there are a few things that are so important to keep in mind when initially dealing with the diagnosis and to continue to remember as you raise your child.
Your child’s diagnosis and conditions are not your fault. There is nothing to be ashamed or embarrassed of at having a child that is not exactly like every other kid his age. In fact, there are no kids that are exactly like every other kid their age!
Don’t let the diagnosis of autism take over who your child is. Your child is not just someone with autism. He is still your child with his unique personality, interests and strengths. Recognize him and celebrate him always!
And of course, remember that autism is not a death sentence. There is so much that you can do to help a child with autism, and research is constantly enhancing and augmenting the interventions available. Reach out to see how you can help your child and dare to dream of her successes even when you may be facing regressions and challenges.
Don’t forget yourself either. Find support through a support group or from friends with children on the spectrum. Share your successes and challenges.
For information on how Attentive Behavior Care can help your child, please contact us today.
Perhaps you had concerns for a while or maybe this is all brand new to you. Either way, here you are, now faced with the reality that your child has an Autism Spectrum Disorder (ASD) diagnosis. What happens now? What do you do?
For starters, take a moment. This can be a lot to digest. Breathe. Be kind to yourself. Remember, your job as a parent hasn’t changed. You are still going to be an advocate and do what whatever it takes to help your child have the best chance at the best life. Just remember you don’t have to do it alone. Your child has a team filled with doctors, teachers and therapy providers.
Has your doctor approached you about the possible treatment choices out there? Have you heard about applied behavior analysis (ABA)? I am here to tell you that ABA therapy is the right way to go! If your child can benefit from a therapy that can target the core deficits of ASD and increase his quality of life, then choose ABA. Ask for it, demand it, and make sure it’s provided by highly trained and qualified professionals.
What is ABA Therapy and How Will it Help Your Child?
ABA uses thoroughly researched strategies and procedures to change behaviors worth changing. Does your child demonstrate difficulties with communication? If your child cannot make requests for his wants and needs despite being vocal, we can use what we know about motivation and reinforcement among other behavioral principals to help your child communicate with you and the people in his environment.
Perhaps your child isn’t vocal at all and you are at a loss as to how to help your child even begin to communicate. We can use a behavioral approach to assess what, if any, alternative methods of communication may be appropriate. On the flip side, what if your child is most definitely vocal, and he engages in one-sided language or repeating words or phrases (i.e., echolalia)? We can create a treatment plan based on evidence based practices to help with these and other communication concerns.
ABA therapy also targets those social deficits that many individuals with ASD have. Whether it’s difficulties with eye contact, play skills, joint attention, understanding and using nonverbal cues, or any other social deficit, ABA can pinpoint the skills needed to alleviate these deficits. ABA employs a structured and systematic approach to targeting these skills.
ABA therapy can also be used to increase tolerance to changes, being told “No,” being asked to wait, among other important situations. ABA therapy can also be used as a way to increase the use of functional communication. After all, if your child is able to communicate with you and the others in his environment what he wants and needs in a safe appropriate manner, he will have less motivation to communicate with you by screaming, hitting, or otherwise engaging in behaviors that are unsafe, destructive and/or socially isolating.
What About Other Therapies?
As a parent, I am sure you want what’s best for your child. Perhaps you’ve searched Google or asked other parents what they have done. Maybe you’ve had a parent tell you that when they implemented a certain diet change or put their child on a certain vitamin regimen, they saw changes in their child’s behavior. Whether those changes really made a difference or were responsible for those changes cannot be determined without data and research.
The data and research supporting ABA therapy as a treatment for ASD is there, and it continues to build every day. I do caution you against treatments that have not been researched. These “fad” treatments have the potential of not only wasting valuable treatment time, but also can at times cause harm. The Bleach treatment for ASD definitely carried a risk for harm to the client, but when a treatment promises to be a cure-all, we can understand the allure. Equine therapy seems safer, and potentially even fun, but it is not a therapy that is able to target the core deficits of ASD and utilize evidence based practices in order to effect long lasting sustainable change that can be generalized across settings and people.
ABA therapy is a commitment, and hard work, for your child and the family and the team as a whole. The work put in has a great pay off; the benefits most definitely outweigh the costs. Choose ABA for your child when discussing the treatment that will be put in place. Ensure that the therapy is provided by trained professionals who have your child’s interests in mind and will provide treatment in an ethical evidence based manner.
For more information about Attentive Behavior Care and how we can help your child, please contact us today.
Every parent of a child with autism knows about challenging behavior. Whether it is perseveration on a preferred topic, inflexible adherence to routines, difficulty with transitions, challenges with new people, places, or activities, to tantrums, aggression and self-harm, raising a child with ASD often comes with managing a variety of challenging behaviors. It’s so common in fact, that a Google search of “autism problem behavior” returns 45 million hits.
Parents often report that while their child works well with their ABA provider, following directions, waiting for their reinforcer, tolerating non-preferred tasks, etc., once the therapist leaves their child acts out. Why do some children respond well during treatment sessions, but act out when the therapist is not there? There could be several factors at play. Let’s look at a few of these.
Attention
During treatment sessions, your child has the undivided attention of the therapist, in addition to social reinforcement such as praise, smiles, high 5s, etc., and possibly other preferred rewards. Often, our kids act out for attention, regardless of whether the attention comes in the form of smiles and praise or corrections and scolding. While parents cannot provide undivided attention at all times, there are some strategies that can help.
Reward Positive Behavior
Catch your child being good. Rather than focusing on the negative behavior, and consequently providing attention to it, look for opportunities to celebrate and praise your child for good behavior. Whether she’s following directions, sitting quietly watching TV, doing homework, putting dirty clothes in the hamper, a plate in the sink, or anything else that you would like to see them do more often, take a moment and say “Good job putting your plate in the sink.” “Thanks for placing your clothes in the hamper.” “I love the way you are watching TV so quietly.” The opportunities are many and the more you praise specific behavior, smile, give thumbs up, hugs, etc., the more likely your child will be to engage in this type of “good behavior” in the future.
Avoid Rewarding Negative Behavior
At the same time, as much as possible and safety permitting, avoid attending to problem behavior. Practice the art of maintaining a neutral facial expression and tone of voice; parents often report that this is the hardest skill for them to master. If you need to attend to your child during problem behavior, do so without reacting. Focus on the child not the behavior. For example, avoid saying “Stop banging on the table.” Instead, redirect them quietly to another activity.
Avoid using negative words such as “no,” “stop,” “don’t,” “can’t,” etc. Instead of telling your child what they can’t do, tell them what they can do! For example, let’s say Jimmy is drawing on the wall, you can say “You can draw on paper or on the white board” presenting these options to the child.
Remember that whatever you are directing your attention to, is what you are going to get more of.
Choose Your Battles
During therapy sessions, your child may be working and behaving toward earning preferred activities or items. The ABA therapist will be using schedules, token boards, timers, breaks, functional communication training, and other techniques, to help your child succeed in learning new skills and earning those preferred reinforcers for their hard work. In contrast, it’s not always possible for parents to provide frequent rewards for following directions and good behavior to their child. There are however, a few tactics that can help.
If you do say “no,” you will need to follow through.
If we tell Jane to stop jumping on the couch, and she does not comply, we will need to go help her get off the couch (thereby inadvertently providing attention to the behavior). At the same time, Jane can escalate this into a tantrum. If we do not follow through and get her off the couch, we are essentially teaching Jane that when mommy or daddy tell her to do something, she doesn’t have to do it.
What if Timmy asks for his tablet during dinner and we say no, and he subsequently starts screaming (or engages in any other inappropriate behavior)? Do we give him the tablet when he escalates, thereby teaching him that he can get what he wants when he “turns it up?”
This “battle of wills” can easily turn into a constant stream of no’s, stop’s and don’ts, as the child engages in one maladaptive behavior after another to get attention, access to an item or activity, or to avoid doing a non-preferred task. Most significant is that the child, at best, learns that these negative words don’t mean anything, or worse, that their behavior is garnering attention from the parent, albeit negative. These words lose their value in the absence of follow up. Children quickly learn to tune it out or “turn it up.”
Therefore, it is recommended to choose your battles. If playing on his tablet during dinner is disrupting Timmy from eating his meal, or dinner is sacred family time, then by all means, no means no. However, if the parents themselves tend to check their phones during meals then perhaps this is not a battle worth putting your foot down for. In order to provide consistency to our children, we should consider which behaviors we will not accept, and are willing to follow through with, in order for the “No” to be meaningful to our child.
Antecedent Interventions
Antecedent-based interventions, commonly referred to as antecedent manipulations, are various evidence-based strategies that modify the environment in some way before the target behavior occurs. They tend to decrease the likelihood that problem behavior will occur and promote the opportunity for replacement or desired behavior to take place.
Effective antecedent interventions include utilizing functional communication training to help your child communicate effectively their needs and wants for items and activities, attention, help, or when they need a break, as opposed to engaging in maladaptive behavior; providing your child with choices regarding what they will do and when they will do it; using pre-teaching which entails providing reminders to your child that an event is coming up to ease with transitions from preferred to less preferred activities as well as changes in routines; using reward charts and token boards to encourage good behavior; implementing a behavioral contract with your child; using picture or written schedules, and utilizing visual count-down timers.
These several tips are not meant to be exhaustive. There are many evidence-based strategies that can be utilized to decrease problem behavior. Work with your BCBA® to determine your child’s triggers and the consequences maintaining his or her problem behaviors and consistently implement the behavioral interventions they recommend to decrease maladaptive behaviors and increase replacement behaviors.
For more information or to discuss how Attentive Behavior Care can help your child, contact us today.
When I was asked to write to parents about having a child with autism and how it can be a blessing, I was excited. This initially sounded like an easy task. Of course it can be a blessing. Children are always a blessing. Why would a child with autism be any different? But then I thought about it some more. How could I write about an experience that I’ve never had. I’m not a parent of a child with autism. I’m not even a parent. How could I communicate this message that I wholeheartedly believe in without stepping on anyone’s toes or making broad sweeping statements about something that I really know nothing about?
The long and the short of it is, I can’t. What I can do though, is talk about my own experiences. I can talk about working with individuals with autism and their families. I can discuss the life lessons that I have learned from people who think differently from myself. I can talk about how diversity has brought richness to my life, and how neurodiversity is a critical piece of the diversity puzzle.
I want to share with you something that my mom reminded me of years ago when we were in the kitchen preparing dinner. We were talking about jobs, college majors, and what I should do after high school. She told me that I have often talked about wanting to work with the people that most view as “difficult.” I have always been interested by the ways our systems are designed to work for particular kinds of people and those who don’t fit that mold are often labelled as being “lesser” for needing different kinds of support. She was right. This was something I had naturally gravitated to long before I knew what it meant. What I’m trying to get at is that when someone is struggling to fit in, it’s because the system made it that way and not because who they are is “wrong.”
Getting a Diagnosis
Getting a diagnosis can be really scary. Hearing that your child has autims can feel devastating. Individuals who need different support than society is used to providing automatically go through life with new and different challenges, and it can be exhausting to be constantly fighting the system to get you and your child what you both need. Due to this, working with this community has taught me a tremendous amount, both about myself as well as the human experience.
My first piece of advice is to take a step back and pause before reacting. It can be easy to have a strong initial reaction to big news and to let our brains spiral to all of the worst case scenarios. But pause. Look at your child. Remember that he or she is the same amazing, lovable kid that he or she has always been. The only difference is now you have an extra tool to help you understand them and to understand how they might experience the world.
Also, remember that autism means something very different for each person. Saying that your child has an “autism diagnosis” actually means remarkably little. It doesn’t tell you anything about what their skills are or what they can bring to the table. It just means that they fit within a class of people that meet the diagnostic criteria for autism. Autism doesn’t mean that there are suddenly all sorts of things that they can’t do. It just means that there may be ways that you will need to adjust your current way of looking at the world in order to help meet their needs in specific ways.
Become an Advocate for Your Child
Put on your boxing gloves, and get ready to fight. Remember that it’s not your child’s fault that he or she needs support that the world doesn’t know how to give him or her. Advocate for your child. Tune in to what they need, and fight to get them just that. Find a community that can give you emotional support. Seek out parents who are going through similar experiences. They can serve as a critical support team if the system fails you or when you have a really rough day. They can also help you navigate the advocacy work by sharing experiences and learning together.
Don’t forget to give yourself a break. Advocacy can be all consuming, but you can’t pour from an empty cup. Give yourself time and space to just take care of yourself. And do that often. You deserve it.
For more information or to discuss how Attentive Behavior Care can help your child, contact us today.
