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This month’s ASAT feature comes to us from Dr. Kirsten Wirth, C.Psych., BCBA-D. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!
My child is older now and the early years curriculum guides we have used (e.g., the Assessment of Basic Language and Learning Skills-Revised (ABLLS-R) and Verbal Behavior Milestones and Placement Program (VB-MAPP)) are no longer appropriate. How should we plan for his future and current goals?
Kirsten Wirth, C.Psych., BCBA-D
Wirth Behavioural Health Services
There may be some good curricula that can be used at an older age (e.g., Partington’s Assessment of Functional Living Skills (AFLS)). Curricula like the AFLS include measuring basic living skills, vocational skills, home skills, community participation, and independent living skills. That said, there are several reports that highlight areas to consider in programming for any individual. Peter Gerhardt (2009) developed a paper that covers what services are available for adults with autism spectrum disorder (ASD) and considerations that should be made. The Drexel Autism Institute put out a report discussing transitions into adulthood (Roux, Shattuck, Rast, Rava, & Anderson, 2015). This question will be answered using information from both reports as well as clinical experience working with children and adults with ASD over the past 18 years.
Both reports highlight the importance of starting early. For example, on average, transition planning and working towards future goals should begin by 14 years of age, although in some states this may happen earlier. In many high schools and programs this type of planning happens much later, but the reason 14 years is recommended is because it can take several years to teach job or recreational skills, as well as any skills that need to be taught well before the ultimate desired outcome. Also, more time allows for assessing and incorporating changing and developing interests over time. It is ideal that all these skills are incorporated into the students’ school program. Skill areas may include planning for a vocation, post-secondary education, recreation and leisure, community safety, transportation, vacationing, health and wellness, sexuality instruction, handling crisis and interacting with first responders, daily living, and communication.
Where to start? Start by thinking and talking with the individual, family, and staff involved that know the individual best. Think about each area and explore what the individual might be interested in 5-10 years down the road as a team. Once all the ideas are jotted down, start discussing what should be chosen to target or to explore further. Keeping in mind you should weed out things that are not realistic but keep things that may be a stretch. How do you know if it is realistic or not? Having a detailed and current assessment of the individual’s abilities and skills is helpful. For example, if an individual has intellectual and adaptive scores at or near the average range, a traditional college education may make sense and they may not need goals set in post-secondary education. However, making friends and enjoying leisure and recreation may be an area of weakness so goals should be set in those areas. As another example, if an individual has very low intellectual and adaptive scores, a college education may not make sense, but a part time job and skills around that job may need to be learned. Most importantly, goals should be set incorporating the individual’s existing skills, preferences, and interests.
Vocational goals: Is the individual able or interested in part-time or full-time work? If he is still in school, can he work part-time? What kind of work can he do independently right now? What kind of work is he realistically capable of gaining skills in during the next 5-10 years? Sometimes exploring different types of work through volunteer experience can be set up either with a one-on-one support person, or just on his own. If skills need to be taught, how much should they be broken down for the individual to perform all skills independently? Can all skills be taught at the same time or one at a time? For example, if he is going to do custodial work at a local small hotel, this might include vacuuming the hallways; sorting, putting laundry through the washers, and folding; sweeping up the breakfast area; and making small talk or hanging out during breaks. Each skill may need to be taught explicitly or not, dependent on the individual. Sorting laundry may include teaching matching skills and sorting skills before applying to daily life; or, many of these tasks could be taught by practicing in the school or leisure program on a regular basis. Making small talk or engaging in conversation during break may require setting goals in social skills and communication areas as well. Taking direction from supervisors or others in authority and learning how to ask appropriate questions might be another area of consideration. How will the individual get to work? Is he able to learn to drive a car to get himself there? Should a bus route and taking the bus be taught? Driving or even using transportation might have multiple steps to learn, especially if there are construction detours, or changes to timing that would have to be checked regularly. Do the vocational goals require further education? Do money concepts have to be taught? Counting out change? Entering an order into a computer system?
Post-secondary Education goals: Does the individual have any special skills or strengths that should be considered? Is the individual interested in a trade? Business? Graduate school? If the individual could realistically perform a job in their area of interest down the road, do goals need to be set for pre-requisite subjects at the high school level – even if it may take longer to meet them – such that entry requirements can be met?
Recreation & Leisure goals: What kinds of interests does the individual already have during downtime? Are interests limited? Developing new preferences might be required. This might include providing repeated exposure to new places or activities to see if the individual enjoys them, or providing additional reinforcement for participating in them. Do any barriers exist to participating in the new experiences? Does any desensitization (e.g., exposure to certain sounds or experiences in the environment while preventing problem behaviour) have to occur before going on outings? Are there refusals or problem behaviours to be decreased? If so, goals should be set in those areas as well. Does he or she need help with setting goals to earn a specific amount of money to go on a desired vacation or attend an event? Does the individual have a regular group of friends to attend events or hang out with? Do friendships need to be established? Are social and communication skills related to making friends required to be learned first or during? Should the individual get a ride with friends? Take the bus? Drive and offer to pick up friends? Establish a meeting place at the event with friends?
As you may have noticed, many of the areas described above overlap with social and communication areas, transportation, and others. Goals naturally should be set in each area to appropriately encompass all skills needed in one’s day-to-day life. Remember the other areas as well; i.e., health and wellness (e.g., exercise, healthy eating, good hygiene), sexuality instruction (e.g., how to have sex, when to have sex, protection from disease and pregnancy), daily living skills (e.g., laundry, cooking, shopping), and so on. Happy planning!
Gerhardt, P.F. (2009). The current state of services for adults with autism. Arlington, VA: Organization for Autism Research.
Roux, A.M., Shattuck, P.T., Rast, J.E., Rava, J.A., & Anderson, K.A. (2015). National Autism Indicator Report: Transition into young adulthood, Philadelphia, PA: Life Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel University.
About The Author
Dr. Kirsten Wirth (C.Pysch., BCBA-D) is a licensed psychologist and board certified behavior analyst-doctoral with a PhD in Psychology – Applied Behaviour Analysis (ABA) from the University of Manitoba. She is an Advisory Committee Member, Founder, and a Past President of the Manitoba Association for Behaviour Analysis (www.maba.ca). Dr. Wirth is the Co-Coordinator of Clinical Corner for the international organization, the Association for Science in Autism Treatment (www.asatonline.org). She is also the author of “How to get your child to go to sleep and stay asleep: A practical guide for parents to sleep train young children.” Dr. Wirth has 18 years experience working with children, adolescents, and adults, with or without developmental disabilities and autism using, teaching, and training others to use ABA. She provides screening and diagnostic assessment for children with autism, early intensive behavioural intervention (EIBI/ABA) programming to children with autism and their parents, or intensive behavioural intervention (IBI) for older children or adults with autism or developmental disabilities. Dr. Wirth also conducts assessment and treatment of severe problem behaviour, child behaviour management, parent coaching, sleep assessment and coaching, toilet training, social skills training, skill building, school or daycare consultation, and more, for children with or without psychiatric diagnoses. Dr. Wirth has been an invited speaker and presenter at local and international conferences and is a co-investigator of a number of research projects including comparison of comprehensive early intervention programs for children with autism and comparison of prevalence rates and factors related to delayed diagnosis.
While the holidays can be a very fun and exciting time, they often tend to disrupt regular routines. A disruption in routines can frequently lead to added stress, anxiety, and behavioral difficulties for individuals with autism and their families. So how can you maintain the fun in holidays but also manage the major changes in routine? Here are a few ideas that may be helpful:
• Use and/or modify tools your child already utilizes well. If your child uses an activity schedule, calendar, or some kind of app to prepare for transitions and upcoming events; be sure to include new icons, symbols, or preparation for the events related to holidays.
• Practice the event. It may be possible for you to role play an event such as a larger family dinner, loud music, or the arrival of a someone dressed up as a character (such as Santa Claus.)
• Take the time to list out what may be unique or new. While you cannot prepare for everything, it’s valuable to consider what your child may not have encountered in the past. For example, will there be lit candles within reach? Will there be appealing items your child is required to leave alone? Once you’ve brainstormed a bit, you’ll be better able to respond appropriately.
• Enlist some help. If there is a family member or friend who will be present and can help if you need it, ask for their help beforehand and be specific. This might be asking them to engage your child in an activity for a short period of time, or running interference for you when your distant aunt approaches with a litany of rude questions about autism.
• Make sure your child has an appropriate way to request a break. Whether your child is verbal or nonverbal, it’s helpful to teach them an appropriate way to exit a situation that is uncomfortable. This is a skill you can practice at home and use in other environments as well.
• Recognize your successes. The holidays can be a stressful time, but they can also be a great indicator of just how far your child has come. Relatives you haven’t seen in a year are far more likely to see the difference in your child’s growth than you are, since you’ve seen that steady growth from day to day. It can be a wonderful time to step back and acknowledge just how hard you have all worked in previous months.
These are simple steps that may be helpful in reducing stress during the holidays. Do you have special tips for how you prepare?
WRITTEN BY SAM BLANCO, PhD, LBA, BCBA
Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.
With all the new advances in technology some adults with disabilities are finding new ways to put them to use enabling them to gain independence and begin living on their own. A new article details life outside of assisted living and group homes to a new 24-hour monitored independent-living housing situation. A new system called Sengistics is able to monitor programmed activities of a household 24 hours a day. For example things like doors and windows opening after specifically programmed hours can trigger a phone call to a caretaker allowing the caretaker to check-in with the individual moments later. Other features that can be programmed include motion sensors for areas of the house alerting caretakers of possible injuries and accidents, alert systems for appliances to make sure they are secured properly after use, alerts for medications ensuring they are taken on the correct schedule as well as a variety of other individualized monitors that can be programmed to call and notify different contacts.
This type of living situation is ideal for those who cannot live in a fully independent housing situation but who are generally over-served in assisted living homes. It also fosters the use of previously learned living skills as well as helps by giving the individual the opportunity to acquire new sets of skills ranging from simple chores to shopping lists, money management and more. Lastly, for parents with adult children who continually need support and are unable to live fully independent lives this new type of housing situations enables them to gain a piece of mind about the future.
To learn more about the monitoring system and its features click on the following article:
This month’s ASAT feature comes to us from Beverley Sharpe, a founding member and Director of Families for Early Autism Treatment of B.C. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!
We have a home-based intervention ABA program for our son. What are some helpful suggestions for managing the steady stream of professionals in our home?
Answered by Beverley Sharpe, parent of a 22- year-old daughter with autism
Opening your home to therapists, behavioral consultants, and other providers is part of effective treatment for your child. However, it can sometimes be difficult to supervise a home that doubles as a work environment and the many opportunities and challenges that come with that arrangement. I am humbled by the high level of energy and dedication my therapy teams, past and present, have demonstrated within my own child’s program. Teamwork and collaboration are crucial elements to make home therapy effective. The following are some helpful tips I’ve learned over the years to help make home team coordination more manageable.
Be a Good Host/Hostess
I have struggled at times to balance being a “boss” and a “hostess” within my home. At the start of a shift, I recommend a five-minute exchange to greet and debrief the provider. No matter what job one has, people deserve to be acknowledged and greeted. I typically put on the tea pot or provide a cold drink, say hello, debrief, then let the provider begin the shift. With a new provider, I allow more time for him or her to set up materials, reinforcers, and data sheets before bringing in my child.
Define Your Expectations of Those Who Work with Your Child
An agency that provides home-based intervention will have a written job description or list of expectations for employees. If you are not working with an agency but are, instead, hiring and training your own team, please take the time to put important expectations in writing. Being on time, completing data sheets, communicating about behaviors observed, being prepared for shifts (including bringing appropriate task and reinforcer materials), and respecting other family members are examples of appropriate expectations.
Get Feedback from Staff
Over time I learned to explain to the team that it is hard for me to be both a boss and a friend. I truly did want to be a good listener, and at the same time a good manager of the team. I enjoyed the one-on-one time at the beginning of a shift with each provider and would ask, “How are you?” and “How are you finding the work with my child?” Their answers inspired me to make changes to the program, address issues with the behavioral consultant, and work on team building during team meetings that became more frequent when my daughter’s inappropriate behaviors became challenging.
When conflicts of any kind arise, talk about it and clear the air so that tensions or misunderstandings do not fester. Speaking about problems factually, face-to-face, with a hot cup of tea or coffee is a strategy that I have used. Also, I would make sure my daughter was engaged in an activity before starting the conversation. Remember, you can control yourself, your communication style, and the environment when you address an issue. Being respectful, honest and kind are great ways to be sure you have done your best to address issues. In my experience, new directions have come from allowing members of the team to share their perspective with you. Your child’s quality of life depends on effective intervention, and a home that is warm and inviting to the hard working providers who share your vision will help your son realize his fullest potential.
Keep in Touch with Former Providers
Email has enabled me to keep in touch with some of the former providers who have worked so hard with my child. One of Allison’s former providers is now professionally trained in hairdressing. Every year before Christmas this provider comes to our home to gift Allison a Christmas haircut! I love the expression, “Friends are like stars, you can’t always see them, but you know they are there.” I think of all past and present providers as being Allison’s stars, not all providers will maintain relationships with the family. The reality of employing people in your home is that some will choose, for reasons of their own, not to stay in touch with you or your child. Don’t take it personally. Life happens to everyone! Also, keep in mind that agencies may have policies forbidding contact outside of the current professional relationship.
Acknowledge Other Siblings in the Household
Shortly after putting together my first therapy team in 1997, I realized I had to address the issue of acknowledging siblings in the household. My daughter, Allison, who was receiving services in the home, was 3 years old at the time. She had a big brother, Jackson, who was 5 years old. Jackson came to think of it as normal that he would have to move from one room to another when Allison’s therapy sessions were in progress. He was always good-natured about this. I wanted to keep big brother Jackson involved with sessions, as appropriate, to help him feel more involved, instead of just frequently displaced. For example, turn-taking was a wonderful way to involve Jackson, as was the “Go Find” program.
I also reminded providers to acknowledge Allison’s brother whenever possible. I reminded them that a simple and genuine greeting will go a long way with his cooperation in the house! This helped to make Jackson’s cooperation more likely when he was asked to move to another room during a therapy session. Also, Jackson was taught to ask a provider, “What can I do to help my sister today?” when a provider started her shift. This simple act facilitated Jackson’s knowledge of his sister’s abilities, and gave him a lot of pride when he was able to tell his friends that he was helping his sister to learn! Big brother Jackson then became a big help during sessions by moving and sharing his play toys, games and puzzles and allowing space for his sister and her therapy team. Always remember, siblings are part of the household that supports the learning of the child!
Recognize That Housekeeping Is Important
Remember, your home is a provider’s work environment. I do my best to clean and tidy the therapy area before tackling any other room in the house on cleaning days. I also do a quick check of the bathroom area before sessions, as everyone appreciates a clean washroom! I make sure therapy notes, bulletins, communiqués are all neatly on their clipboards. I also make sure that my child is clean and presentable for the shift. Finally, I make sure that there is an “outing fund” with money for community activities. If my child worked towards a reward of an outing to the zoo, Dollar Store, or movie theatre, I wouldn’t want the lack of funds to delay the delivery of that reinforcer. Make sure your team knows to keep receipts for outings which are approved by the behavioral consultant and yourself. Also, remember to reimburse bus fare or gas money for a provider. Agencies will likely already have a policy in place for travel expenses as well.
Be a Good Employer, Which Means Advocating for Your Staff
Therapy time does not equate to babysitting. I had to correct a few well-intentioned neighbors who referred to my providers as babysitters. When my child is in the community, grocery shopping, at a gymnasium, or at work experience, these hardworking men and women are providing therapy, not just watching or transporting my child. Providers are important members of your child’s medically necessary treatment team. Correct misconceptions by family and friends along the way. Many family and friends may not be familiar with this type of therapy or treatment and may need some educating about the purpose and format of a home-based intervention based on applied behavior analysis. This education can help preserve the dignity and respect of your child, your team, and the discipline of applied behavior analysis for autism.
Stay in the Home During Therapy Time
For insurance purposes, many agencies require that a provider not be left alone in your home. Providers work in your home and deserve a safe and respectful environment. This means that a parent must remain in the home during a therapy session. This can be helpful for routine questions and support as well as in case of any emergencies.
Set Clear Expectations Around Cell Phone Use
The abundance of cell phones means that providers and families can be in real-time communication for shift or program issues relating to the child. However, they can also be a distraction from active treatment and supervision of my child. This has occasioned another hiring criteria for being on my child’s treatment team: Cell phone use for anything other than communication about the child, on their shift, is not acceptable. Cell phone games, texting, social media, and other social messaging are not acceptable. Even the ten seconds (as stated by one provider) it takes to text back to a friend means you are disengaged, not observing, and not “on” with your client – my child. Cell phone use expectations must be made clear from the very beginning and reiterated as needed.
Holiday time was always a tough time at my home. In British Columbia, there was zero funding for autism treatment when I started my daughter’s program in 1997. I wanted to give tokens of appreciation to my daughter’s home treatment team for the holiday season. My budget was beyond tight, but homemade cards were always appreciated. One family I knew put together a cookbook of favorite home recipes for their home team; another family made a huge holiday dinner, in conjunction with a team meeting, to thank their team. There is always a way to say thank you to your team that is respectful of one’s budget.
Please note that many agencies and ethical guidelines for behavior analysts have strict policies around gift exchange and it is often not permitted. Check with your agency and your providers if you have any questions around this topic. And please do not be offended if a member of your team is not able to accept a gift.
Use Different Cultures and Celebrations as Learning Opportunities
We took the opportunity to learn about different religious holidays when one of our providers shared that she was Jewish. This was a wonderful learning opportunity for everyone on the team. We even made a card for the start of the Jewish New Year – Rosh Hashanah. Over the years, my daughter’s providers brought the wonderful gifts of sharing their religious holidays, culture, and favorite recipes that have enhanced our lives!
Making birthday cards for therapy team members gave my child the opportunity to use pencil and coloring skills, printing skills, and to sing the “Happy Birthday” song. All of these skills took a long time for acquisition. However, after all the hard work, to see my daughter use her skills to put a smile on her providers’ faces was priceless. To hear my child use her voice (she was non-verbal for the first 6 years of her life), and to hear her sing Happy Birthday – well, it is a win-win situation!
With a therapy team, it is a wonderful opportunity to have a simple celebration for each of the several birthdays throughout the year. My child learned that birthdays are for others as well as for herself. This learning extended to teaching big brother Jackson that every time we celebrate a birthday, he does not always get a present!
As our programs progressed, our behavior consultant added a cooking and baking program to help include both children in all household birthday celebrations for family members and members of the treatment team. The beauty of a cooking program was that skills, such as: counting, measuring, mixing, pouring, baking, decorating with icing, and washing and putting away dishes, were all “taught” in a fun way. This was a very detailed program with the huge reinforcer of getting a tasty item to eat at the end of completing a recipe!
Managing an ABA treatment team in your home can be challenging but can be rewarding as well. There are many things you can do to help the team work well together and be effective in providing your child with the services he or she needs and deserves. Remember, it’s a learning process for all!
Please use the following format to cite this article:
Sharpe, B. (2017). Clinical corner: Managing a home-based ABA program. Science in Autism Treatment, 14(3), 17-20.
About The Author
Beverley Sharpe is a founding member and Director of Families for Early Autism Treatment of B.C. (FEATBC). Bev’s daughter Allison was diagnosed with autism twenty years ago and Bev became an advocate for effective autism treatment. She was a member of the Legal Steering committee for the Canadian landmark decisions (Auton and Hewko) regarding autism treatment. Bev participates in new parent intake, political lobbying, fundraising, and speaks regularly with parents regarding advocacy in the school system. She also helps new parents access funding for autism treatment.
ABA therapy can be used to teach/increase a variety of adaptive skills, such as tooth brushing, toileting, hair brushing, shoe tying, making a bed, etc. My favorite definition of an adaptive skill is anything that will have to be done for the learner, if the learner does not learn the skill. So if I don’t teach my child how to dress him/herself, then I will have to dress my child.
A common concern many of my clients have around adaptive functioning is the dreaded Morning Routine. Since my clients are usually school age, I have ample opportunity to help families target issues that regularly pop up during that frenzied time in the morning of trying to get the child out of the door on time. Issues like: task refusal, off task behavior, prompt dependency, skipping steps of the routine/completing the routine out of order, etc.
ABA interventions should always be individualized, but some of my most effective strategies for simplifying the morning routine include:
– Visuals! Visuals are your friend 🙂
– Use of auditory cues (timers)
With some simple tweaks here and there and adding in more supports, the morning routine can be less stressful, more efficient, and require less intrusive prompting which equals more independence for your child.
Let’s jump in:
Add visuals: I say “add visuals” and not “add more visuals”, because usually what I see is that families who struggle the most with the morning routine are not using any visual supports. If you are regularly struggling during the morning routine but you already have visual supports in place, then that’s a gold star for you. You are ahead of the game. If you are new to visual supports, just keep reading. Think of a visual support as a way to minimize prompting or assistance. If you have to stand in the bathroom doorway, physically assist your child, or keep giving the same demand over and over (“Make up your bed Evan ……. Evan, did you make your bed?”), then you definitely need to add some visuals. It is much easier to fade the prompt of a visual, than to fade your voice or your presence. Or to put it another way, do you want to have to stand in the doorway to make sure tooth brushing happens when your child is 25? Here are some awesome examples of visual supports, all were found on Pinterest.
Auditory cues: The use of a timer can be such a helpful addition to the morning routine because time is usually of the essence. We have to go, and we have to go now. For many of my defiant kiddos, those with attention issues, or those with lots of escape maintained behaviors, the simplest demand (e.g. “Put your socks on”) can take ages and ages to actually happen. Decide on a specific amount of time for the skill to occur, and then set a timer. If the child can beat the timer, then allow them to contact reinforcement. Depending on the child, this could mean a treat, getting to pick what they wear that day, 2 minutes of TV time, etc. Make the concept of “hurry up” more concrete by helping the child understand how quickly tasks needs to be completed.
Organization: This tip is more for you than the child. Organization or proper set up for the morning routine does not begin that morning, it begins the night before. Part of the bedtime routine can include setting up items for the next day. This could mean lining up the soap, face towel, toothpaste, and toothbrush by the bathroom sink. Or this could mean putting the backpack by the front door, so there is no frantic search for it in the morning. How you organize will depend on the specific issues you are having in your home. The point is to set the child up for success. For younger children (especially if you want to increase independence) line up needed items/materials in their correct order so your assistance is not needed. For example, in the bedroom line up underwear, socks, pants, shirt, and shoes. In the kitchen, line up the bowl, spoon, and cereal box. For some children you may need to put number cards on each item (e.g. put a “1” card on the underwear). Any step you can do the night before will save precious time the next morning, and the materials being visible helps serve as a prompt of what to do next.
*Bonus Tip: A good way to practice the skills required for a successful morning routine is to incorporate weekend practice. If these skills are only performed M-F with a time crunch, then you’re setting yourself up for lots of frustration. On the weekends, still have your child go through the morning routine. Use this to fine- tune skills, or provide more repetition than is possible on a Monday morning. If tooth brushing is always a struggle, consider modifying the visuals or making them larger/more detailed. Try removing yourself, and only checking on your child periodically. If the child is older or needs less support, try implementing a checklist that the child completes. As they perform each skill, they check a box. When all the boxes are checked they bring the checklist to you for review.
About The Author: Tameika Meadows, BCBA
“I’ve been providing ABA therapy services to young children with Autism since early 2003. My career in ABA began when I stumbled upon a flyer on my college campus for what I assumed was a babysitting job. The job turned out to be an entry level ABA therapy position working with an adorable little boy with Autism. This would prove to be the unplanned beginning of a passionate career for me.
From those early days in the field, I am now an author, blogger, Consultant/Supervisor, and I regularly lead intensive training sessions for ABA staff and parents. If you are interested in my consultation services, or just have questions about the blog: contact me here.”
This piece originally appeared at www.iloveaba.com.