Simplifying the Science: Using Evidenced-Based Practices to Increase Food Variety for Children with Autism

An essential part of ABA is providing evidence-based treatment. Research is consistently being done all around the world to determine best practices for working with learners with autism, as well as addressing many issues outside of the realm of special education. This week, we’re pleased to introduce the first in a new month series: Simplifying the Science. In this feature, BCBA Sam Blanco will highlight one paper from the world of research to help provide you with a deeper resource base. She’ll delve into the study and offer some strategies on how the findings apply to your programming needs. Our hope is that these monthly tips will shed a different light for you on the importance of looking to research for guidance.

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When faced with feeding issues, many parents or caregivers may not consider seeking out help from a BCBA or behavior analyst. There is a tendency to associate ABA with sitting at a table and completing discrete trials, but this is only one tool in a behavior analyst’s extensive toolkit. Whether you are providing intervention for feeding issues or seeking more information, it is essential to look to scientific research for help.

There are several studies available about feeding issues, and many of these studies are specific to feeding issues in individuals with autism. One such study was published in 2010 in the Journal of Applied Behavior Analysis (JABA) by Hildur Valdimarsdóttir, Lilja Ýr Halldórsdóttir, and Zuilma Gabriela SigurÐardóttir. “Increasing the Variety of Foods Consumed by a Picky Eater: Generalization of Effects Across Caregivers and Settings” provides one detailed case in which a five-year-old boy with autism refused to eat anything beyond meatballs, fishballs, fruits, and cereal. While his school had had some success with getting him to eat a few new items, the boy’s parents were unable to reproduce the same results at home.

The intervention the researchers used involved multiple steps that would require the assistance of a BCBA or skilled behavior analyst if you wanted to replicate it at home. In order to increase the number of foods this boy ate, the intervention included several behavioral techniques such as escape extinction (not allowing the child to escape mealtime upon refusing to eat or engaging in inappropriate behavior), stimulus fading (setting goals of increasing difficulty), and a schedule of reinforcement (frequency of reinforcement for appropriate behavior) that was systematically thinned as the child experienced success. By the end of the intervention, the boy was consuming 39 new, “non-preferred” foods, including 14 vegetables.

You can read the research study here, which I recommend you share with your child’s ABA provider. I also suggest taking a peek at the references listed at the end for insight into other resources. This particular study is of a five-year-old boy with autism, but you may find studies that are more relevant for your particular child.

In the end, when you’re feeling at a loss for strategies on improving your child’s eating, there is a lot of research out there. It takes time to go through it and set up a similar system for your own child, but the end result can have a huge impact on your child’s health as well as the stress-level in your home during mealtimes. It is definitely worth the effort to attain more information.

Written by Sam Blanco, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

Different Roads iOS Apps Now Feature Family Sharing

Apple has recently introduced a new Family Sharing feature, which allows up to 6 family members to browse and access each other’s iTunes, iBooks, and App Store purchases, as well as share photos, calendars, and locations with each other. We’re excited to announce that all of our Different Roads apps in the iTunes App Store have also begun to support this feature. Family Sharing also includes parental controls, enabling parents to approve purchases and downloads initiated by children first.

Different Roads to Learning Apps

Clean Up Cateogory Sorting AppClean-Up: Category Sorting  This highly-rated interactive program develops language, reasoning, and sorting and classifying skills in young learners. Players must “clean up” by putting 75 photographic images of toys, food, and clothing away in the correct shopping cart, refrigerator, or toy box. Each target is introduced by its label (“Where does the Apple go?”) in each round where players see 15 unique images. Correct responses receive visual and auditory reinforcement while incorrect answers are corrected by a visual prompt of the correct answer flashing. This app builds foundational sorting skills for students just developing their sorting and classifying skills. Available on iPhone and iPad.

Whats that Sound App

What’s that Sound? Learning to Listen and Identify Sounds  This interactive and easy-to-grasp game develops auditory discrimination and processing skills in young learners. Players will improve their skills by matching objects and their associated sounds. Simple auditory processing skills lay the foundation for learning how to read, speak and spell.
Available on iPhone and iPad.

 

What Goes Together App

What Goes Together?  This interactive program develops language, discrimination, and reasoning skills in young learners. Clear, colorful images of everyday objects promote an understanding of functions and the relationships between items that children encounter on a daily basis. With built-in reinforcement and error correction, this game provides a solid foundation in building critical expressive and receptive language skills. Available on iPhone and iPad.

Tell Me About It App

Tell Me About It!  Featured as Editor’s Choice on Best Apps for Kids, this universal app is specifically designed for children with autism and other speech and language delays. Based on the Applied Behavioral Analysis approach, this program mimics an actual one-on-one instructional session with a therapist. The app provides 15 categories of language targets, such as body parts, household items, clothing and food, and six levels of difficulty, which progressively become more difficult, from labelling to shared feature, function, and category. This app also features an easy-to-read report card, which provides tracking data for each child and an option to e-mail the report card results. Available on iPhone and iPad.

To discover all of our current apps and what Family Sharing can do for your family, visit our iTunes App Store page.

Tip of the Week: Teaching Money Skills to Students with Autism in Natural Social Situations

Recently I took a thirteen-year-old boy with autism grocery shopping for the first time. We had practiced all of the steps for paying: looking at the total on the register, taking out the necessary bills or coins, waiting for change, making sure we had correct change, returning the money to the wallet, etc. While I thought he was ready to do this in a natural environment, I did not expect what actually happened.

Standing at the counter with a line of people impatiently waiting behind us, my student dumped all the change from his wallet on the counter and slowly began counting out the exact amount. I could hear other store patrons grumbling behind us when my student finally finished paying, then dropped coins all over the floor, and swept his remaining money back into his wallet.

The concern here is that some of the behaviors associated with autism can place an individual in danger if misunderstood by a cashier or store patron. My student appeared to be oblivious to the frustration of the people around him, offering no apology or explanation. There are many resources out there for teaching children with autism about identifying coins, counting out exact change, etc. But it’s essential that we think beyond the fundamentals of managing money to the more complex skills of managing the social situations that arise during money transactions on a daily basis.

Here are some social skills related to money to practice with your students:

  • Keep your wallet in your hand, do not lay it on the counter.
  • Look for the total on the register. If there is not a place to see the total, ask for it after all the items have been rung up.
  • Put the money in the cashier’s hand.
  • Put your hand out to receive change.
  • Once you have completed payment, make sure your wallet is securely back in your pocket or bag.
  • Understand how to respond if a cashier asks “Do you have exact change?” or “Do you have a smaller bill?” or any variation of those questions.
  • Pay with speed.
  • Understand how to ask to put an item back if you do not have enough money.
  • Know basic scripts for what to say in challenging situations, such as if you accidentally bump into someone with your shopping basket or you are taking a long time and another patron says something rude about it.

My takeaway from this experience was that I needed to provide practice in the natural environment much sooner than I had thought. I must consider the fact that we simply can’t contrive the broad range of possible interactions with strangers in a home or classroom setting. My students require dozens, if not hundreds, of opportunities to practice a skill before mastering it, and generalization is frequently challenging, so presenting them with a variety of natural environment experiences is important. I also must recognize that a student’s behavior will often vary from one environment to another, so the sooner I know what he or she is doing in the natural environment, the sooner I can implement meaningful instruction and intervention to address any problems. Finally, because ABA providers and teachers have more limited access to the natural environment than parents and caregivers, we should provide specific goals and teaching strategies to help them practice with the learner when we’re not present.

Pick of the Week: “Expanding and Combining Sentences” Interactive Workbook

For students who are already able to talk or write in simple, choppy sentences, this interactive workbook will open gateways to success in language and literacy! Save 15%* on your purchase of Expanding and Combining Sentences by speech and language pathologist Marilyn M. Toomey this week only, by applying or mentioning our promo code EXPAND8 at check out!

Color picture pages, along with specific instructions, provide a means of evoking interesting and descriptive sentences from students.

Students will learn how to expand their sentences by using the color cues provided in the book, as pictures become progressively colorful and a new detail is added to the sequence. In no time at all, young learners will be able to tell an entire story by using complex and detailed sentences!

97 pages in total with 40 colored pages.  Preview the book.

This interactive workbook will be the perfect resource to teach the challenging task of making sentences more interesting with descriptive words.  Don’t forget – this week only, take 15% off* your order of Expanding and Combining Sentences by applying code EXPAND8 at checkout!

Marilyn M. Toomey is also the author of several other popular speech and language workbooks, such as Talking in SetencesVerbal Reasoning ActivitiesThe Language of Perspective Taking, and much more.

*Offer is valid until 11:59pm EDT on 6/10/2014. Not compatible with other offers. Be sure there are no spaces or dashes in your code at checkout!

Modified Instructions for Shopping List Memory Game

We’re excited to bring you the fourth installment of our series of Modified Instructions, created by Sam Blanco, BCBA.  Sam’s Modified Instructions present 3-4 additional ways to play a mainstream game to make it most useful and accessible for our students with special needs.  These alternative instructions break down each adapted game by:

  • Age/Skill Level
  • Number of Players
  • Object
  • Skills Required
  • Materials Needed
  • Prep
  • Instructions
  • Considerations

In this installment, we’re introducing Sam’s Modified Instructions for Shopping List, one of our favorite memory games. Shopping List is an adorable memory game that also develops personal and social skills.

The goal of the game is to be the first to fill your cart with all of the items on your shopping list.  It is designed with the objective to have players fill a trolley with the items on their shopping list. However, there are multiple games and activities that can be played with these materials to meet the specific needs of your learners.

Included in the game are 4 cardboard carts, 4 shopping lists, and 32 beautifully illustrated items with dry-erase surfaces. Don’t forget to download our free Modified Instructions for Shopping List today!

Tips for Traveling with Kids with Autism

Taking any long trip when you have a child with autism can be daunting, especially when it involves long periods of time in the car or on an airplane. Below are a few tips for reducing stress during travel time.

  • Create a visual or textual schedule for your child.  Because trips don’t always go as planned (e.g. planes are delayed, you get caught in traffic), it’s probably not a good idea to list specific times that activities will be occurring. But it is helpful to show the order in which they will be happening.
  • Prepare your child for potential problems.  If possible, talk about coping methods ahead of time and practice them if possible. What can you do if you’re stuck in traffic that isn’t moving? What are your choices if we experience turbulence on the plane?
  • Provide information for your child.  Show photos, books, maps, etc. of the locations you’ll be traveling to. You can also read books or show photos of activities you’ll be participating in, such as swimming or skiing.
  • If possible, pack more than one activity bag.  Bags filled with a few favorite activites or small toys can be useful for keeping kids entertained on trips. For long trips, your child may get bored with items in an activity bag. It’s useful to keep a second one stashed in a suitcase or other bag if you’ll be on a very long flight or car ride. It can also be useful to have a separate activity bag for the return trip if you know your child may lose interest in the first one.
  • Provide options when possible.  Access to choices can go a long way in keeping kids calm. Choices can include what videos to watch, snacks to eat, etc.
  • Check in advance with guest services at hotels, resorts, or theme parks.  Ask what modifications and accessibility options they may offer. Many places offer special accommodations and are open to any unique requests you may have.
  • Prepare in advance for any sensory concerns.  Bring noise-cancelling headphones, ear plugs, fidgets, etc. to have available, as needed.

Remember that long trips are difficult for all children, and many of the tips listed above are beneficial for siblings who do not have special needs.

Urge U.S. Congress to Cover ABA for Military Kids with Autism

A new bill was introduced requiring TRICARE to cover Applied Behavior Analysis (ABA) for all military children with developmental disabilities, including autism. The Caring for Military Children with Developmental Disabilities Act of 2014, sponsored by U.S. Representatives John Larson (D-CT) and Tom Rooney (R-FL), marks the latest effort in Congress to improve and standardize medical coverage of ABA therapy for military families affected by autism and other developmental disabilities.

It is estimated that 23,000 military dependents, including children of active duty, reserve and guard families, are affected by autism.

Excited returning soldier hugging her son

Given frequent duty station changes and social turmoil of military service, military children affected by autism often face additional challenges that their civilian counterparts do not necessarily face every day. “Our common sense bill helps ensure that the children of our troops and military retirees have access to the health care services they need,” Rooney said.

The bills, HR.4630 and S.2333, would provide access to ABA for all military children with developmental disabilities, improve coverage to address medically recommended treatment levels, and allow for coverage of the ABA tiered service delivery model which includes Board Certified Assistant Behavior Analysts and ABA Technicians.

TRICARE now has three different programs delivering ABA services in three different ways, and not one of them is permanent.

Please urge your U.S. Representatives and Senators to pass the new bill to make ABA coverage a permanent medical benefit under TRICARE for all military children affected by autism and other developmental delays. Visit Autism Speaks and take action by sending an email with your message of support for these military families in need.

Introducing Little Mixers: A Weekly Social Skills Playgroup in Brooklyn

Little Mixers BklnStacy Asay, one of our wonderful and beloved consultants, is launching the Little Mixers series, a social skills group based in Brooklyn! Headed by Stacy and Sharon Alkalay, this weekly Little Mixers series will be a special mix of fun, food, and friendship for young children between the ages of 3 and 7. Sessions will be held at Beansprouts at 14th Street and 6th Avenue in Park Slope.

Each meeting will consist of a guided lesson, group discussion, interactive games and a cooking activity, all thematically focused around a particular social skill. Each week a new social skill will be introduced with the session, culminating in an expanded repertoire of social skills and perhaps a new friend!

Parents will be provided a hand-out with suggestions and strategies to practice throughout the week in order to facilitate carry-over of a target skill.

Little Mixers will be holding 2 sessions for Spring/Summer 2014:
Mondays: 4:30 p.m. – 5:30 p.m. (ages 5-7)
Thursdays: 4:30 p.m. – 5:30 p.m. (ages 3-5)

For more detailed information, please visit the Little Mixers website at www.littlemixersbrooklyn.com, or email Stacy Asay at littlemixersbrooklyn@gmail.com.

About the Group leaders

Sharon Alkalay, MS, CCC-SLP, is a speech-language pathologist with over 8 years of experience working with infants, toddlers and children. As a classically-trained musician, she enjoys incorporating multi-modal/multi-sensory techniques into her therapy sessions through use of music, art, movement, sensory integration and dramatic play. She believes that successful engagement with a child should be accomplished gracefully with creativity, humor and compassion. Her special interests include working with children with social-language difficulties, apraxia of speech, autism spectrum disorders and language/learning disorders.

Stacy L. Asay, LMSW, is a licensed social worker, providing home and school based services to children and their families in the New York City area. With nearly 16 years of experience, her work with special needs children integrates a strengths-based, holistic approach to child and family augmented with the tools of Applied Behavior Analysis, a methodology that allows for reliable measurement, objective evaluation of behaviors, and the systematic teaching of language and learning skills.  This results in an individualized curriculum that equips children with the tools they need for learning and living while honoring their unique spirit.

Teaching Functional Living Skills to Children with Autism at the Grocery Store

We hear over and over again how children with autism may need hundreds or even thousands of opportunities to practice a skill before acquiring it. It’s important to keep this fact in mind when it comes to functional living skills (e.g. making the bed, cooking a meal, etc.). Many of the parents I work with prefer to focus on academic skills rather than functional living skills. Some feel that by focusing on functional living skills, they’re giving up on larger goals for their child, such as being placed in a general education environment, having the opportunity to go to college, and/or having the opportunity to have a career.

I always encourage parents to focus on both academic and functional living skills. While it may seem unnecessary to start thinking about teaching a nine year old how to grocery shop, it’s really just providing them with many, many opportunities to practice the skill. Typically developing children “practice” grocery shopping from a young age by watching their parents and playing “store” with friends, but children with autism are unlikely to observe their parents while they’re shopping or to play such games as “store” without explicit instruction. By practicing the skill with your child early on, you’re promoting future independence.

You can practice these skills when you are in the grocery store with your child, and you may just find that your child enjoys shopping. (Grocery shopping is a favorite activity for two of my current students.) It may be beneficial for you to just start out with one skill, choosing the one you think your child is the most likely to experience success with or that your child will be the most motivated by.

 BEGINNER SKILLS
  • Choosing if you need a cart or a basket (Is our list long or short? Do we have big or small items?)
  • Using a grocery list (reading the list, crossing off items already placed in cart/basket)
  • Using supermarket signs to find items (understanding categories, knowing where to look for signs)
  • Greeting cashier
 INTERMEDIATE SKILLS
  • Choosing good fruit or vegetables (looking for bruises, identifying ripeness)
  • Giving money to cashier
  • Accepting change from cashier
  • Taking bags when it’s time to leave
 ADVANCED SKILLS
  • Comparison shopping (looking at unit price, comparing prices of two brands)
  • Making sure you received correct change
  • Returning an item that is damaged

You shouldn’t limit these skills to just the grocery store either. All of these skills are useful in department stores, pharmacies, book stores, and more. Your child may be more motivated to use these skills at the book store or a toy store. You can help your child learn the skills there, then generalize them to other types of stores.

If you need help getting started, you should ask your child’s teacher or therapist to accompany you on your first trip. They can help you identify the appropriate steps to put your child on the path to independence.

Here’s What Was in YOUR ABA Toolbox

Thank you to all who participated in our ABA Toolbox giveaway last week! We’ve received some wonderful responses and feedback from parents, teachers, and therapists on their favorite products from our catalog and how they are using it with a special child, and we are thrilled to be sharing them with you!

Our biggest goal in this endeavor was to share with you the unbelievable wealth of experience and knowledge our community of parents, teachers, and therapists have in using our products in innovative and creative ways for their ABA programs.

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