What Do We Do in ABA Therapy and Why?

What Do We Do in ABA Therapy and Why?

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

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

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

Assessment

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

Treatment Planning

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

Intervention

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

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

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

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

Problem Behavior

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

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

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

We Made It!

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

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

 

References

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

What Does a Behavior Analyst Do?

By: J M Coimbra, MS, BCBA, LBA

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

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

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

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

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

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

Advocate

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

Consultant

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

Educator

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

Engineer

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

Philosopher

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

Psychologist

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

Scientist

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

Social Worker

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

Student

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

Supervisor

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

Writer

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

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

A Day as a Behavior Analyst at Attentive Behavior Care

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

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

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

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

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

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

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

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

Better Understanding the Principles of ABA

Better Understanding the Principles of ABA

By: Frank Kou, MSEd, BCBA, NYS LBA

What Are the Principles of ABA?

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

Three Terms of Applied Behavior Analysis (ABA)

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

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

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

Applied Behavior Analysis Principles

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

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

Using Applied Behavior Analysis in the Real World

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

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

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

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

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

References:

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

 

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

What Does it Mean to be an Advocate?

What Does it Mean to be an Advocate?

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.

Additional Resources

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

Early Autism Detection and Prevention

Early Autism Detection and Prevention

By: Frank Kou MSed, BCBA, NYS LBA

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
  • Repetitive behaviors (flapping, spinning, rocking, etc)
  • Limited, restrictive interests
  • 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.

Sources:

 

For more information or to discuss how Attentive Behavior Care can help your child, contact us today.

My Child Was Just Diagnosed…Now What?

My Child Was Just Diagnosed…Now What?

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.

Why ABA Therapy is the Right Way to Go

Why ABA Therapy is the Right Way to Go

By: Heyde A Ramirez, MA, BCBA, NYS LBA

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.

When Your Child Won’t Stop Acting Out

When Your Child Won’t Stop Acting Out

By: Catherine Tsiris, Ph.D., BCBA-D, LBA

You’re Not Alone

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.

Your Child Has Autism: How to Handle the News

Your Child Has Autism: How to Handle the News

By: Nahoma Presberg, MS BCBA

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.

The Importance of Caregivers in ABA Therapy

The Importance of Caregivers in ABA Therapy

By: Paige Sands BS, ABA Graduate Student, and Maria Pantelides, MA, BCBA, LBA (CT, MA, MD, NY)

Caregivers have one of the hardest jobs in the world. Whether you are a parent, grandparent, aunt, uncle or other form of primary caregiver, you know how big of a responsibility it is to be in charge a little life twenty-four seven.

When your child has special needs, additional challenges can arise. It’s around this time that you may begin to look for outside support. This is an important first step! So, you find an agency and begin your ABA journey. Your family has been assigned a BCBA® and supporting technicians…now what?

Your team will work to get your child on the right path, but we cannot do it alone! ABA therapy requires a team effort. We are only one link in the chain. In order for what we bring to the table to stick, we need caregiver support. BCBA’s® and technicians need parents to be part of their child’s treatment during every step of the process so results can have maximum impact.

Why Be Involved?

Your provider will be working very hard on their programming to ensure your child is able to apply skills learned, which can be translated across multiple environments and people. As your child begins to approach mastery criteria with their technicians, your treatment team will start to move toward handing the new skill or behavior reduction techniques off to you as a caregiver.

This can really happen during almost any point in the process, but most of the time occurs once your child is used to the expectation. Caregiver training allows you to spend time learning how your technician has been approaching teaching your child to set you both up for long-term success. Bennett (2012) outlines that when caregivers are not involved, then a disconnect between treatment and everyday life can occur making it more difficult for skills to generalize.

How Can You Be Involved?

It is one thing for us to say we want you to be an involved caregiver, however you may be thinking; “How do I do that?”

The easiest and quickest answer is to be willing to participate in caregiver training, but there is a lot you can do. Communication with your treatment team is huge. If you notice changes in your child’s behavior when the treatment team is not around or if a previous learned skill is not being shown, tell your team. Your team will work with you to find what may be contributing to this. Additionally, if there is a specific skill you want worked on, let your BCBA® know and they will work with you to add it to your child’s goals.

Long Term Benefits

Look at ABA therapy as an investment. It’s an investment for your child and for yourself. The goal for your provider is to teach themselves out of your need for them, to give you control back. Grindle et al (2009) showed that 86% of female caregivers and 52% percent of male caregivers saw practical benefits for themselves after introducing ABA into their lives.

More importantly, both parties saw 100% improvement in their child. Other research shows that “parental involvement is the one invariable factor and an integral part of the success of early intervention programs for children with autism” (Ozonoff & Cathcart, 1998). Take the time, make the investment and be an active part of your child’s success in ABA!

References:

  • Bennett, A. (2012) “Parental Involvement in Early Intervention Programs for Children with
    Autism” Master of Social Work Clinical Research Papers.
  • Grindle, C., Kovshoff, H., Hastings, R., & Remington, B. (2009). Parents’ experiences of home-based applied behavior analysis programs for young children with autism. Journal of Autism and Developmental Disorders, 39(1), 42-56. doi:10.1007/s10803-008-0597-z.
  • 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.

Autism: Debunking the Myths

Autism: Debunking the Myths

By: Jonelle Lupero, BCBA, LBA (NY)

Unfortunately, some commonly held beliefs about Autism, which we know to be untrue, still continue. This lack of understanding can make it difficult for people on the autism spectrum to have their condition recognized and to access the support they need, in addition to compounding the worries of the average parent.

The following is a list of 12 myths about autism which aims to expand autism awareness as well as put an and end to any misconceptions.

1. Myth: Autism is Just a Mental Health Disorder

The truth: Autism is a neurodevelopmental disorder that impairs an individual’s ability to communicate and interact with others. There is more than one type of autism caused by different genetic combinations and environmental factors. In children with autism, the brain develops differently to typically developing children, affecting many areas of development.

2. Myth: Autism Only Affects Male Children

The truth: Children with autism grow up to become adults with autism. Boys are much more likely to be diagnosed with autism than girls, with ratios ranging from four boys diagnosed to every one girl (http://autismspeaks.org). Girls with autism are more likely to have stronger social skills than boys with autism at the same level of cognitive functioning, and they are more likely to have stronger social interests. “Being aware of these key differences in boys and girls with higher functioning ASD can help in awareness and identification of girls with ASD” (Audrey Carson, Ph.D., assistant professor of pediatrics-psychology at Baylor).

3. Myth: People With Autism Don’t Experience the Full Range of Emotions

The truth: People with autism may have difficulty expressing emotions, or may express them in a different way. Children with autism experience the full range of emotions. It is common for people with autism to have difficulty identifying and understanding the emotions of others which can lead to misinterpretations.

Children with autism can build skills and learn to respond to other people in ways that are more typical or expected. Children with autism can and do show physical affection but often on their own terms. For some children, typical means of showing affection are more difficult, such as maintaining eye contact and physical contact.

4. Myth: People With Autism Don’t Want Friends

The truth: Most people with Autism do want to have friends, but have difficulty engaging socially with others, which may make it difficult to interact with peers. The social skills required to form friendships often need to be taught clearly to children with Autism.

In contrast to the previously dominant idea that they prefer social isolation, recent studies have demonstrated that most people with ASD want to form relationships with others. (Brownlow, Rosqvist, & O’Dell, 2015)

5. Myth: People With Autism Don’t Have Other Disorders or Conditions

The truth: Although many people with Autism do not have other conditions, many do. Research has shown that people with autism also have co-occurring conditions such as Intellectual Disability, Epilepsy, gastro-intestinal disorders, food sensitivities, allergies, and Fragile X Syndrome.

6. Myth: All People With Autism Have an Outstanding “Savant” Skill

The truth: There’s an iconic moment in Rain Man, in which Dustin Hoffman’s autistic character counts in an instant the exact number of cocktail sticks dropped on the floor by the waitress. In other scenes he demonstrates incredible powers of memory and calendar calculation. The success of this film has helped spread the incorrect idea that all or most people with autism are savants.

Although many people with autism have amazing “savant” abilities such as extraordinary math or musical skills, the reality is that approximately 10% of the autistic population has an extreme talent or genius level gift (according to the Autism Research Institute), the majority do not.

Children with autism have a wide range of IQ scores and skill sets, and every child is different. 31% of children with ASD have an intellectual disability (intelligence quotient [IQ] <70), 25% are in the borderline range (IQ 71–85), and 44% have IQ scores in the average to above average range (i.e., IQ >85).

7. Myth: Vaccinations Cause Autism

The truth: There is no reliable scientific evidence that childhood vaccinations cause Autism. There is evidence that not vaccinating children has led to an increase in preventable diseases.

In 1998 the British pediatrician Andrew Wakefield and his colleagues published a small story in the respected Lancet medical journal that implied that the MMR (measles-mumps-rubella) vaccine plays a causal role in autism. The Lancet paper was withdrawn in 2010, judged to be flawed and untrue. The same year Wakefield was struck off the doctor’s register after being found guilty of dishonesty and professional misconduct. Several large-scale studies have since examined the possibility of a link between MMR and Autism and have found no evidence to support the link.

According to the Autism Society, no single cause (https//www.autism-society.org/what-is/causes) triggers autism.
Studies (https//www.cdc.gov/ncbddd/autism.data.html) also show that genetics and other chromosomal disabilities tend to be linked to autism.

8. Myth: Children With Autism Don’t Speak

The truth: Although some children with Autism may have delayed speech or may not use words to communicate, many have very well-developed speech. In fact, some children may speak earlier than typically developing peers, but may have an unusual style of communication, such as overly formal speech or a strong preference to talk about particular subjects. There is a very wide range of skills and abilities among children with autism in relation to speech.

9. Myth: Children With Autism Are More Aggressive

The truth: As with other children there are those with autism who may shout or hit when they are distressed, but this is certainly not the case for all children with autism. When problem behavior occurs, it is often related to a lack or deficit of alternative skills or difficulties coping in the sensory environment, regulating emotions or communicating needs.

According to the Autism Society (http://www/autism-society.org) people with ASD are more likely to be victims of violence than to perpetrate it.

Challenging behaviors are often a communication of last resort. It is rare for a child with autism to intentionally cause harm to another person.

10. Myth: Autism is Caused by Bad Parenting Style

The truth: In the 1950’s, a theory called the “refrigerator mother hypothesis” arose suggesting that autism was caused by mothers who lacked emotional warmth. Even though we do not yet know the exact causes of Autism, the research that has been conducted supports the view that parenting style does not cause autism.

Because of difficulties with sensory processing and communication, some children with Autism respond negatively to some typical parenting behaviors, such as touch and hugs, and may require direct communication in order to understand others. When parents adapt their behavior to respond to their child’s needs it may appear unusual to others, but it is important not to assume that the parenting style is causing the child’s difficulties.

There is no known single cause for autism spectrum disorder, but it is generally accepted that it is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brain in children with autism compared to in neurotypical children. (autism-society.org)

11. Myth: We Are in the Midst of an Autism Epidemic

The truth: Prevalence in the United States is estimated at 1 in 59 births. (CDC, 2018,) Prevalence of autism in U.S. children increased by 119.4 percent from 2000 (1 in 150) to 2010 (1 in 68). (CDC, 2014)

While it is true that autism diagnoses are on the rise, it doesn’t necessarily mean that there are more cases of autism than there have been in the past. The increase is better explained by a broader definition of autism and more efficient diagnostic methods.

Before 1980, autism wasn’t considered a diagnosis, but a trait of schizophrenia. Over time, the Diagnostic and Statistical Manual for Mental Disorders (DSM) has expanded its description of autism, and it has reduced the number of traits that doctors need to identify in patients in order to diagnose them as autistic.

An autism diagnosis has been expanded to include all spectrum disorders which covers a wide variety of symptoms, severities, and conditions.

In addition, since the late 1980’s and early 1990’s, awareness has also increased over time; more paents, pediatricians, and educators are learning to recognize the early signs of autism and are more likely to seek an Autism evaluation.

12. Myth: Autism Can be Cured With Medicine

The truth: Autism is a life-long disorder; it cannot be cured with medicine. While there is no known cure for autism, there are treatment and education approaches that can address some of the challenges associated with the condition. Intervention can help to lessen disruptive behaviors, and education can teach self-help skills for greater independence. But just as there is no one symptom or behavior that identifies people with autism, there is no single treatment that will be effective for everyone on the spectrum. Individuals can use the positive aspects of their condition to their benefit, but treatment must begin as early as possible and focus on the individual’s unique strengths, weaknesses and needs. (autism-society.org)

According to Autism Speaks (https//www.autismspeaks.org), “We do know that significant improvement in autism symptoms is most often reported in connection with intensive early intervention.

On the other hand, medication can be used to deal with gastrointestinal disorders or problem behaviors that are caused due to autism.

References:

For more information or to discuss how Attentive Behavior Care can help your child, contact us today!

Does My Child Have Autism?

Does My Child Have Autism?

Do you sometimes wonder if your child falls on the autism spectrum? Is your child developing at a different rate than his peers or does he have unusual ways of keeping himself occupied?

There are a number of indicators that a child may be on the autism spectrum, otherwise known as ASD (Autism Spectrum Disorder). Remember that each child is unique and develops at his own pace. It is normal for each child to have his own quirks and behaviors. However, if you can identify with a number of the symptoms below, you may want to seek a professional opinion and an evaluation. Although it may be hard to face a diagnosis, the sooner a child with ASD starts getting intervention, the better his outcome can be.

Communication

Does your child have a hard time communicating at an appropriate age level? A younger child with ASD may have a hard time indicating or requesting his needs, while an older child may point or make gestures instead of using language to communicate. Does he have a hard time describing things, getting stuck on unimportant details instead of focusing on the bigger picture? Does he have a hard time making eye contact or engaging in a back and forth conversation? Do you notice that he often gives answers that have little to do with the question being asked? Language deficits, such as non-verbal communication, failure to make back and forth conversation, and not making eye contact can be associated with ASD.

Social Behavior

Does your child choose to play on his own instead of joining the group activity, whether in class or with a group of friends or siblings? Does he have a hard time engaging in appropriate turn taking during play? Can he play out a pretend story like driving a car to his grandma’s house, getting to grandma’s house and giving her a kiss or does he get stuck in the car driving? Does he have the same way of playing with toys each time he uses them, like lining them up or watching the car wheels spin?

Transitions and Rigidity

Does your child have a hard time with transitions, going from one activity to the next, like stopping to play and getting ready to go to school? Does he have a hard time when there is a change in schedule or plans? Does he get fixated on certain topics that are of interest to him, but not necessarily to anyone else around him? Does he engage in repetitive motor movements or constantly repeat certain phrases? Children with ASD often engage in repetitive stereotypical behavior, inflexible with routines, rigid thinking, and hyper focused on specific topics.

Sensory Processing

Does your child have extreme reactions to noises or textures that others don’t even notice? Does he react adversely to loud noises or regular background noise? Do you find that he is very picky about what he will wear or what texture foods he will eat? Does he seek constant touch or activity? Does he shrink from the touch of others? Perhaps he doesn’t seem to hear or feel what everyone around him is aware of. It is common for children with ASD to have unusual reactions, either overreacting or under-reacting, to noise, textures, lights, smells and tastes.

What Do I Do Next?

If you do think your child fits into a number of the above criteria, discuss your concerns with your child’s doctor. Ask for a referral to a specialist who can give your child a full evaluation If your child does have a diagnosis of ASD, remember that there is help! Behavioral therapy, otherwise known as ABA therapy, can help your child by addressing the negative behaviors he may engage in and developing the skills he needs to function and become the best he can be.

For more information or to discuss how Attentive Behavior Care can help your child, contact us today.

The Definitive Guide to ABA Therapy and How it Can Help Your Child

The Definitive Guide to ABA Therapy and How it Can Help Your Child

By: Jessica Basir and Nahoma Presberg

What is ABA?

ABA stands for Applied Behavior Analysis. ABA is currently the leading treatment which has been scientifically proven to treat the symptoms of Autism Spectrum Disorder.

Let’s discuss what ABA is, and why it actually works.

The technical definition of 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, p. 20).

Let’s break down the key components Cooper is trying to say. Firstly, we address socially significant behaviors. Hold onto that, we’ll come back to it later.

Second, we’re talking about using a scientific process to analyze the contingencies that motivate and act on behavior. By understanding the reasons why behaviors are occurring, we can increase all that good stuff we want to see more of, and decrease the things causing challenges for your child and your family.

What is Social Validity?

Coming back to social validity: Social validity is a huge component of ABA therapy and is what the Board Certified Behavior Analyst® (BCBA®) working on your child’s case will take into account for every program they design. So what is social validity?

Social validity refers to the satisfaction and acceptability of the interventions and procedures effecting behavior change, based on the opinions of the individuals who receive services and implement them. Simply put, this means that YOUR opinion matters and so does YOUR CHILD’s.

Yes, you are under the care of highly trained professionals who have done the research and received the training necessary to implement effective strategies and identify behaviors that need to be increased or decreased, but the science is also founded on the opinions of the individuals on the receiving end.

Social validity also changes based on factors specific to the individuals receiving services. Cultural, religious, and environmental variables may alter what is socially valid in certain families and certain parts of the world.

The main take away from this is that your child’s program is tailored for who he or she is, what he or she needs, and what will make a difference in his or her life. Your child is unique and so are his or her circumstances.

The science of ABA understands this and tailors programming to match these needs, ensuring programs and interventions are effective for each and every individual.

 

 

Now that we’ve learned a little bit about what ABA therapy is, and how it relates to you and your child, let’s talk about some of the specific ways that behavioral interventions are effective. We are going to discuss: functional communication training, antecedent manipulations, generalization, parent training, task analyses, and reinforcement.

Functional Communication Training

Functional communication training (FCT) will most likely be a large part of your child’s ABA program. As we know, one symptom of Autism is difficulty with communication and/or language delays. Functional communication training focuses on increasing functional language. Functional in this sense means communication that has a purpose and is practical.

For example, if your child hits his or her sibling every time he or she wants to play, or cries each time he or she wants you to pick him or her up, he or she is trying to ask for attention, but in a non-functional way. Crying and hitting are behaviors that ABA would want to target for decrease, while teaching your child a functional response as a replacement.

For hitting and crying, we may teach the child to sign the word “play,” to tap their sibling on the shoulder, or verbally say, “Can you play with me.” FCT teaches words, signs or gestures that your child may not currently have, allowing him or her to communicate effectively with you and their environment.

Antecedent Manipulations

Antecedent manipulations refer to changing aspects of an environment in order to either reduce or increase the frequency of a behavior. Many management strategies for problem behavior are focused on how we are reacting to behavior. We refer to this as consequence interventions.

However, antecedent interventions are a proactive approach. When it comes to problem behavior, it is often helpful to utilize antecedent strategies to reduce the behavior in order to allow for an opportunity to increase alternative skills.

We can use antecedent manipulations to increase functional behaviors. For example, if you give a child a bowl of ice cream but no spoon, they might ask you for a spoon so they can eat the ice cream. However, if you gave them the spoon along with the bowl of ice cream, you would have lost the opportunity to practice functional communication.

Creating a lot of situations like this can support a child in the acquisition of functional language because you start with things that they are highly motivated for, and then you can expand to a broader range of language.

Antecedent strategies are also common in behavior intervention plans to reduce problem behavior you want to decrease. For example, if a child tends to engage in problem behavior in order to seek attention from a caregiver, you could provide a lot of attention to the child that is not contingent on engaging in problem behavior.

By increasing the amount of attention they are receiving, you are reducing their motivation to engage in the problem behavior and it is likely to decrease. With a reduction in the rate of problem behavior, there are more opportunities to teach skills to support that child’s ability to get what they want using appropriate methods.

You can teach them to request your attention using a gentle tap on the shoulder and then start ignoring the attention-seeking problem behavior. This combination of interventions results in a “treatment package” that in combination will have lasting results on behavior.

Generalization

Have you ever noticed that your child is able to do something in one environment, but not in another environment? Or maybe they know how to do something with a therapist or babysitter, but have trouble engaging in the same behavior with their teacher or parent?

There are a lot of reasons why a child’s behavior may differ across people or environments. One of the ways that this problem can be addressed is through teaching generalization. Generalization means that a behavior is taught in multiple settings or with multiple people in order to help the child utilize the skills in more functional ways.

Generalization doesn’t just refer to behaviors in different environments or with different people. It also means that you don’t have to teach every single thing a person encounters in their environment. If you teach a child the word for horse using a picture of a horse, and then they see a horse in real life, they should be able to generalize that instruction to know that the real horse is also called a horse.

Many children with autism have trouble generalizing things that they learn to new contexts/people/situations. This can mean that it takes a lot longer to learn because a lot more direct instruction is required. Behavior therapy addresses this by including explicit programming for generalization. A therapist will work with a child on a new skill in multiple environments, with multiple people, and with multiple different examples so generalization can emerge.

Parent Training

Maybe you’ve noticed that your child comes home from school every day with a glowing report from the teacher, but the minute he or she arrives home, all of the problem behavior that you know so well comes right back.

It can be difficult to understand why your child’s behavior can be so different at home than in other environments. Parent training is a critical component of behavior therapy. It ensures that the child is learning consistently across all environments and can support parents in understanding how to respond to difficult situations.

Additionally, working with a professional can be helpful in understanding contingencies in the environment that you might not be able to see if you live it every day. Parent training can also support the acquisition of skills that happen outside of therapy time.

It is not uncommon for parents to experience challenges with daily routines like getting ready for school, getting ready for bed, mealtimes, and hygiene routines. Parent training allows for a parent or caregiver to work closely with a BCBA® to identify specific challenges in those routines and collaborate on solutions for making everyday situations more manageable.

Task Analyses

Task analyses are terrific teaching tools and highly effective teaching procedures that break down a task into smaller components. Think recipes.

A good chef would not throw you into a kitchen and say, “bake chocolate chip scones” without providing you with a recipe or the steps to do so. Task analyses focus on the same method; breaking down one large task into smaller steps that you can learn independently in order to learn the entire task over time.

Some examples of skills where a task analysis may be used could include:

  • Tooth brushing
  • Shoe tying
  • Making a sandwich
  • Doing laundry
  • Hand washing
  • Cleaning a room

The possibilities are endless. How do we know these are effective? It allows specific teaching to occur for one or multiple steps that a learner may be struggling with, and ensure all the smaller skills needed to complete a task have been learned and are efficient.

Back to our baking example: if you didn’t know how to measure flour or roll out dough, how could you make a scone? These steps would need to be taught before you were expected to follow the scone recipe, and this is where a task analysis (or recipe) would come into play.

Task analyses can also help to break down a task that may seem very overwhelming to start. It can be difficult to approach a whole new skill, but if you break it down, then you might find that it isn’t as complicated as you first thought.

Reinforcement

Reinforcement is the most basic principle of ABA therapy and of behavior in general. Reinforcement is the reward for doing a behavior and will increase how much you do that behavior in the future.

Let’s use the example of going to work. You wake up, go to work, come home, and repeat this every day and 5 days per week. Why? Odds are it’s because you are getting paid. Each time your paycheck hits your account, you are reinforced for the behavior of showing up to work, so you continue to do it.

We encounter reinforcement every day and so do your children. ABA understands the principles of reinforcement and uses them to target specific behaviors that should occur more often. Reinforcement can be used to increase all types of behavior. Some examples include:

  • Verbal speech
  • Functional communication
  • Appropriate meal time behavior
  • Appropriate voice volume
  • Independent dressing
  • Safety skills
  • Attending skills
  • Play skills
  • Social skills

The list goes on and on. Reinforcement has been proven to shape appropriate, functional behaviors and is an essential part of every ABA program.

ABA therapy is unique in that it uses scientific principles to analyze specific behaviors and the specific contingencies that surround those behaviors. Other therapies seek to address significant challenges in an individual’s life, but may lack the analytic power to understand those challenges in the same ways. These techniques are the core of many behavioral interventions.

However, every child receives an individualized plan based on their unique needs. This means, that you can be sure that your child is being supported in the exact way he or she needs. It also means that there’s lots of room for parent and family involvement.

 

Behavioral therapy can help, and we can help show you how! Contact Attentive Behavior care today for more information.

 

* Cooper, John O., Heron, Timothy E. Heward, William L.. (2007). Applied behavior analysis. Upper Saddle River, N.J.: Pearson/Merrill-Prentice Hall.

Confronting the Challenges of ASD

Confronting the Challenges of ASD

By: Catherine Tsiris

Let’s Get Personal

I got into this field to help people. I wanted to make a difference, to help make a positive impact on people’s lives. And a day doesn’t go by that I am not reminded in some way that I made the right decision.

When a mom calls me Monday morning to tell me they had a tantrum free weekend, or when I get a text that Johnny let dad brush his teeth, when the child that used to throw herself on the floor when her tablet was removed even briefly independently goes to the work area when the therapist arrives ready to do work, when parents convey to me that their child’s teachers are noticing a positive change, when the child that had a single word in his repertoire a year ago now has over a hundred words and growing, and when week after week I see our children mastering goal after goal, I know I made the right decision.

ABA Therapy Works. Period.

I know ABA is an effective therapy. I have lived and breathed it for over 16 years, but it’s when the parents I work with tell me they see the positive changes ABA therapy made in their child’s behavior and skills, and in their family’s life, I know I made the right decision.

It’s not an easy job and it’s certainly not a glamorous job, but it is immensely rewarding. However, it is also a job where we, the professionals are often isolated. Where the treatment team consists of the child (our client), his or her parents/caregivers, the therapist and the supervisor. At least this is the model I have encountered in many organizations that provide ABA services to children with ASD and their families.

A Different Model

It wasn’t until I started working for Attentive Behavior Care that I encountered a different model. Where the child, their family, and their ABA providers are part of a greater family. An organization that cares about them, and about their child’s progress. They care about helping them overcome their challenges and celebrates their successes.

From the case coordinators who work tirelessly to match families with providers and ensure that each child is receiving top notch ABA services, to recruiters who carefully vet providers, to the clinical team that oversees treatment, to all the folks behind the scenes, every single person in our organization has one purpose in sight. To provide the best possible ABA therapy to each and every child.

I’ve lost count how many times parents tell me how happy they are that the case coordinator checked in with them, making sure they were happy with their services, and how many parents have told me how much they appreciate that their treatment providers go above and beyond for their child.

I think it’s best summed up by something one of my moms said to me:

“I can’t imagine life without ABA now. I can’t imagine going back to how things were. I can get my hair done now! I can take a nap or watch a little TV. ABA has changed my life, and thank God for my neighbor who told me about Attentive Behavior Care.”

Do you think your loved one could also benefit from ABA therapy? Enroll today or contact us for more information.

Behavioral Therapy Techniques That Actually Work

Behavioral Therapy Techniques That Actually Work

By: Heyde Ramirez MA, BCBA, NYS LBA & Frank Kou MSEd, BCBA, NYS LBA

When a family receives ABA therapy, oftentimes parents wonder: “What is happening?” and “What is this person doing to my child that is helping?” The most important question they ask is, “Will this work?”

To help concerned parents wondering if ABA is the right therapy for their child, here are five behavioral therapy techniques that actually work to help reduce problem behavior.

1 – Differential Reinforcement of Alternative Behavior (DRA)

Using this technique, a problem behavior is reduced by reinforcing a different behavior. For example, John hits his peers to get their attention. During ABA therapy, John gets lots of attention and praise for using his words instead of hitting others to gain attention. John learns to use his words because he can earn the attention he seeks without hurting others. The DRA in this example is getting attention for “using words” instead of “hitting.”

2 – Differential Reinforcement of Incompatible Behavior (DRI)

Using this behavioral therapy technique, a problem behavior is reduced by reinforcing the complete opposite behavior. For example, John always gets up from his seat in class, which gets him attention when the teacher yells at him. During ABA therapy, John gets attention and praise for being in his seat, which he likes. John learns to remain in his seat in class. The DRI in this example is getting attention and praise for being in his seat rather than getting up from his seat.

3 – Differential Reinforcement of Other Behavior (DRO)

Using this technique, a problem behavior is reduced by delivering reinforcement when that problem behavior does not occur during specific times. For example, John likes to pull strands of his hair when he does his work. During ABA therapy, a 5-minute timer will be set and John will get rewarded for not pulling his hair during the 5 minutes. When he pulls his hair, the timer is reset. The DRO in this example is being rewarded for not pulling his hair.

4 – Premack Principal

Using this behavioral therapy technique, an ABA technician will encourage a child to complete a non-preferred activity by following the activity with the opportunity to complete a highly preferred activity. Think of this like Grandma’s Rule: “First eat your broccoli and then you can have desert.” This increases the probability that the child will complete the non-preferred activity. For example, John does not want to complete his math homework because it is hard and boring. During ABA therapy, John gets to watch his favorite cartoon only after he completes his math homework.

5 – Token Economy

Using this technique, a child learns how to earn tokens for engaging in positive behavior. These tokens can then be exchanged for a variety of preferred items and activities. Think of this like an allowance: “If you clean your room, you will earn $2 towards your video game.” Not only can this technique be effective for teaching new skills, but it also helps teach children how to tolerate instruction for increased periods of time and respond to more natural conditions of reinforcement (e.g., earning money to buy something vs. earning the item itself). For example, John’s teacher notices that he is not participating in class. During ABA therapy, John is given a token every time he raises his hand to participate in class. At the end of class he exchanges his tokens for time to play his favorite iPad game.

These are just a few of the many ABA techniques that can be used to increase desirable behavior and decrease non-desired behavior. Remember, ABA is a toolbox where the data guides the treatment, so techniques should always be tailored to the individual needs of the child, guided by the data, and overseen by a qualified professional such as a BCBA® or Licensed Behavior Analyst.

For more information on how Attentive Behavior Care can help your child, contact us today.

What is ABA Therapy?

What is ABA Therapy?

ABA stands for Applied Behavior Analysis. ABA is an evidence-based approach to treating individuals with Autism Spectrum Disorder (ASD). ABA is backed by decades of research and has helped countless children diagnosed with autism learn new skills and gain greater independence.

The goal of ABA therapy is to improve meaningful behavior in real world, every day settings using techniques that are based upon the principles of behavior. ABA therapy applies an understanding of behavior to affect real life situations. The goal of ABA therapy is to increase helpful behavior in your child and reduce behaviors that are harmful or negatively affect learning.

Research has shown that ABA therapy is one of the most effective treatments for individuals with ASD. ABA therapy can help your child learn new skills and gain greater independence. It can also help to reduce problematic behavior. It can teach critical life skills—including language skills, communication skills, social skills, and daily living skills—which are the building blocks of success.

ABA therapy increases your child’s opportunities for meaningful personal relationships and involvement in the community. It can also help him or her manage throughout the day and become successful in school and at home, all while decreasing difficulties to learning.

How Does ABA Therapy Work?

ABA is a recognized and effective treatment for children with Autism when performed in a high-quality and intensive manner. ABA often utilizes positive reinforcement to increase desirable behaviors and advance the skills of the child. ABA therapy utilizes a research-based approach based on the principles of behavior. ABA programs are driven by data, so success can be measured and programming can be adjusted if the treatment is not effective.

A Board Certified Behavior Analyst (BCBA) is the primary provider of ABA therapy services. BCBAs establish concrete ways to measure behavioral changes and improvements and identify whether behavior modification is appropriate or not. A BCBA must have a master’s degree or doctorate degree in behavior analysis or psychology and must take and pass a certification exam that recognizes specific training in the principles of applied behavior analysis. Some states require an additional license for the BCBA as well.

ABA therapy programs also involve ABA therapists – sometimes referred to as Paraprofessionals or Registered Behavior Technicians (RBTs). Therapists are trained and supervised by a BCBA. They interact directly with patients and work toward the specific and individualized goals written by the BCBA, typically in a 1:1 setting. It is common for more than one ABA therapist to work with a child.

ABA therapy programs are highly individualized, and each treatment program will differ from one child to the next. Your child will be guided through an assessment process and a treatment plan with appropriate goals will be developed. Your child’s plan will then be implemented through regularly scheduled sessions either in your home or at a location of your choosing.

For more information about ABA therapy and how it can work for your child, please contact us today.