Autism and the Peer Review Process

Autism peer review process

If one wanted to market a scientifically-unproven intervention, device, or pill as a valid autism treatment to families affected by autism, how would one go about it? Glossy pictures? Glowing testimonials? Miracle claims? Hyped social media pitches? Charming infomercials? Answer: All of the above.

And, here’s another marketing strategy: portraying one’s product as having scientific validation when, in fact, such validation does not exist. To do this, one might make references to “scientific evidence” in material that, upon systematic inspection, is less than convincing.

I was reminded of this when I recently reviewed a web page that boldly claims, “SCIENTIFIC RESEARCH Verifies The Son-Rise Program® WORKS!” Findings support the efficacy of parent-delivered SRP intervention for promoting social-communicative behavior in children with autism spectrum disorders.”

What are these findings? On the website, the Son-Rise marketers provide a link to a key source of their “verification” – a paper entitled “Training Parents to Promote Communication and Social Behavior in Children with Autism: The Son-Rise Program”. This paper, written by a trio of Northwestern University researchers, presents a study of the purported benefits of intervention delivered by 35 parents of children with autism who participated in a five-day parent-training course on Son-Rise Program methods, as well as an advanced follow-up course 3-12 months later. Parents completed The Autism Treatment Evaluation Checklist (ATEC), a rating scale that contains items on communication, sociability, cognition, physical status and behavior.

The authors divided the 35 parents into three groups based on how many hours of intervention the parents reported giving their child each week during the interval between their first and second Son-Rise trainings (i.e., no intervention [11 parents], 1–19 hours [13 parents], 20 or more hours [11 parents]). The authors present results reflecting statistically significant higher ATEC scores at second ATEC completion relative to the first, and they suggest that these higher scores reflect real improvements in communication, social skills, and sensory and cognitive awareness. They go on to point out that children with greater gains were more likely to have had more hours of parent-administered SRP.

As linked on the Son Rise web-site, this study is typeset like a published research article, prompting me to try to determine which peer-reviewed journal had published it. Through email correspondence, the third author, Cynthia K. Thompson, reported that the study had not been published because the team had decided to collect additional data prior to submission for peer review. In other words, this study is a “work in progress” and certainly not a verification of treatment effectiveness. In fact, this practice of repeatedly analyzing results prior to the close of data collection is, in itself, problematic from a scientific standpoint, as the process involves conducting many analyses that often yield varying results but are never reported (see Simmons, Nelson, & Simonsohn, 2011).

One of the mechanisms that make science such a powerful engine for progress is the reliance on the peer review process. The scientific method requires that, when a scientist makes an assertion (e.g., “This treatment works!”), (s)he knows that there exists a responsibility to show other scientists how they arrived at their conclusions with enough specificity that others can replicate the study. It is through this process of peer review that faulty assertions about the data are challenged and, hopefully, rejected in short order.

Typically, in the peer review process, an editor reviews a manuscript and, if deemed appropriate, shares the manuscript with a team of reviewers with demonstrated expertise in the relevant subject area. In many cases, these reviewers are “blind” to the identity of the authors and vice-versa, so as to minimize personal biases (e.g., affiliations, personal grudges). The reviewers are charged with the task of evaluating the contents of the manuscript on the basis of scientific merit, including the methodology, statistical analyses of the data and logic of the authors’ conclusions. The reviewers then describe, in writing, their opinions regarding the strengths and weaknesses of the study and make a recommendation regarding publication. The editor synthesizes this feedback and provides a summary to the author(s). In many cases, the editor will reject the manuscript for publication altogether. In other cases, he or she may require revisions, acknowledge limitations, temper conclusions or make other substantive changes prior to publication.

In the case of the manuscript written by Thompson and her colleagues, I suspect that, if it were submitted to a journal with a legitimate peer review process, a multitude of questions would be raised about it, including:

  • participant recruitment (35 self-selected parents out of a pool of 430 parents, many of whom participated in the first training but apparently did not return for more)
  • group distribution (non-random group assignment)
  • the outcome measure (one brief checklist completed by parents)
  • treatment fidelity (no way of verifying the quality or quantity of actual treatment), and
  • control for placebo effect, expectancy bias or any number of potential threats to the validity of responses.

And, despite some effort on the part of the authors to control for this, there is no real way of knowing what other interventions the child was engaged in during the interval between their parents’ first and second Son Rise training.

Of course, scientists who make up peer review committees are vulnerable to the same kinds of human frailties as the rest of humanity (i.e., jealousy, ego, bias, profit motive); however, the communal nature of the process, as well as another scientific safeguard- replication of results by others- helps to minimize the degree to which these frailties impact decisions regarding the quality of a study and our confidence in the results. The scientific method is far from perfect, but it is probably the best game in town for vetting new interventions.

Parents and other consumers of product pitches can watch for treatment claims that look like they have been established through the scientific process but in actuality fall short. Discuss potential treatment options with licensed and/or board certified experts whom you trust. Practice skepticism, especially when fantastical claims are made. Use resources, such as ASAT’s Treatment Summaries for quick reference. Families affected by autism deserve honest, direct communication about the state of the science for treatment options. Accept nothing less.

References

Simmons, J. P., Nelson, L. D., & Simonsohn, U. (2011). False positive psychology: Undisclosed flexibility in data collection and analysis allows presenting anything as significant. Psychological Science, 22, 1359–1366.

Cite This:

Mruzek, D. W. (2012). Focus on science: “Verification” and the peer review process. Science in Autism Treatment, 9(3), 18-19.

About The Author

Daniel W. Mruzek, Ph.D., BCBA-D is an Associate Professor at the University of Rochester Medical Center (URMC), Division of Neurodevelopmental and Behavioral Pediatrics in western New York. He received his doctoral training in Psychology at the Ohio State University and is a former Program Director at the Groden Center in Providence, Rhode Island. Currently, he is an associate professor and serves as a clinician and consultant, training school teams and supporting families of children with autism and other developmental disabilities.

Mruzek coordinates his division’s psychology postdoctoral fellowship program in developmental disabilities and is an adjunct faculty member in the University of Rochester Warner School of Education. He is actively involved as a researcher on several externally funded autism intervention research studies and has authored and co-authored more than 20 peer-reviewed articles and book chapters on autism and other developmental disabilities. Dr. Mruzek is on the editorial board for the journals Focus on Autism and Other Developmental Disabilities, Behavior Analysis in Practice, Journal of Mental Health Research in Developmental Disabilities, and Intellectual and Developmental Disabilities. Dr. Mruzek is a former member of the Board of Directors of the Association for Science in Autism Treatment.

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!

Who’s Most Qualified To Work With Your Child.txt

Parents of children with autism are faced with a wide range of choices when it comes to the education and support of their children. The most important question of all is who’s most qualified to work with your child? Although a great deal of research supports Applied Behavior Analysis (ABA) as the only effective treatment for autism, there are still many other interventions that are touted as potentially helpful. Research shows that combining ABA with other interventions is less effective than implementing it alone, with high fidelity and intensity (Howard, 2005).

Who's Most Qualified To Work With Your Child? Not all behavioral professionals are created equal. There is little control over the use of terms like “behavior specialist,” “behavior therapist,” and “behaviorist.” Just about anyone can claim to be one of these, often on the basis of very limited training and virtually no on-going supervision.  Consumers are often not aware that these are uncontrolled titles, and may put their trust in untrained, unsupervised practitioners. 

The problem of lack of quality control in behavior analysis was addressed by the development of state certifications for behavior analysts, and eventually the Behavior Analyst Certification Board (BACB) was formed. 

BACB credentials allow consumers some degree of confidence in the education, training, and supervision of the professionals they entrust their children to.  If someone claims to have one of these credentials, consumers should be able to find them on the BACB registries, easily accessed online at www.bacb.com

What does the BACB mean for consumers?  Those seeking behavioral interventions for themselves or others can look for professionals who have met the standards of the Behavior Analyst Certification Board with the confidence that that they have a minimum level of education, experience, and supervision and that they are obligated to follow an ethical and professional code.  Whether looking for a school program, privately hiring a professional, or seeking insurance coverage of services, the BACB designations can help consumers to determine if professionals and staff members providing services are well-qualified. They are also not at all easy to accomplish, so it is safe to say that someone with one of these credentials has achieved a high level of understanding of the science of behavior and the practice of behavior analysis.

Some states now license and certify behavioral professionals, and the standards for state licensure and/or certification may be more or less than those required by the BACB.  Having a BACB credential in addition to state licensure ensures that the professional also meets the BACB’s high standards. 

Credential Minimum education requirement Type of work Supervision
Registered Behavior Technician (RBT) High school diploma or equivalent Direct implementation of behavioral interventions (paraprofessionals) Ongoing by a BCaBA, BCBA, or BCBA-D
BCaBA Bachelor’s degree Practice under supervision, supervise RBTs Ongoing by a BCBA or BCBA-D
BCBA Master’s degree Independent practice, supervision of BCaBAs and RBTs None
BCBA-D Doctoral degree Independent practice, supervision of BCaBAs and RBTs None

 

Guest post written by Dana Reinecke, PhD, BCBA-D.

 

References

www.bacb.com, retrieved January 28, 2017

Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H.  (2005).  A comparison of intensive behavior analytic and eclectic treatments for young children with autism.  Research in Developmental Disabilities, 26, 359-383.

National Autism Center.  (2015). Findings and conclusions: National standards project, phase 2. Randolph, MA: Author.

Spotting The Difference Between Fake and Real News

Spotting The Difference Between Fake and Real News

The decisions of many consumers are influenced by what they read in the newspaper or on the Internet and hear about on television or radio. It is our belief that access to effective treatment for the autism community is enhanced by accurate representations of autism treatment by these media outlets. Unfortunately, many media representations are fraught with inaccuracies. Here’s what you need to know about spotting the difference between fake and real news.  

Effective treatments typically receive less press attention because their providers are often focusing on maximizing outcomes in an accountable manner rather than on soliciting media attention. They are also limited by ethics codes on how they can promote their treatment and services.

Many of you may be familiar with the Latin phrase, “Caveat Emptor,” which means “the buyer alone is responsible for checking the quality and suitability of goods before a purchase is made.” With scores of “miracle cures” and “breakthroughs” for autism receiving widespread media attention well before they have been shown to be beneficial through credible, peer-reviewed research, “Caveat Lector: Let the Reader Beware” seems to be a very suitable guiding principle across all media platforms (e.g., print, radio, television, Internet) particularly at a time when “fake news” is becoming commonplace. In other words, the reader is put in the position of being him/herself responsible for evaluating the quality and suitability of information being presented to him or her.

As a consumer, you bear a responsibility to scrutinize sensational claims related to various autism treatments and to be knowledgeable enough to consider such stories through a skeptical lens. We wish you did not need to work so hard to differentiate good information from bad, but that is the sad reality of autism treatment today, with 500+ treatments being touted. Unfortunately, many writers and journalists are not well versed in research methods, unless they specifically write about science, which is a very small portion of all individuals writing about autism out there.  With all this in mind, when reading or hearing about an autism story in the media, please consider the following questions:

About the Intervention

  • Does the article or story describe how the intervention actually helps individuals with autism? In what ways?
  • Are those ways observable and measurable? Substantial? Meaningful?
  • Does the article or story report the costs of the intervention? Are these costs reasonable, both in monetary and human resource terms?
  • Is there any report of harm imposed by this intervention? What are the risks? What are the side effects? Does the article or story appear balanced between these?
  • Who can carry out this intervention? What kind of education, training and supervision do individuals need to have before implementing the intervention?

About the Experts

  • Whom did the author interview for this story and what are this person’s qualifications? Is he/she presented as an expert?
  • Is the interviewee making claims of efficacy/effectiveness that are supported by scientific data? What does the interviewee/expert stand to gain from this story? Who may benefit financially from this particular media exposure? How would they benefit?

About the Underlying Scientific Support

  • Did the article or story mention the existence of research articles published in peer-reviewed journals documenting the efficacy of the intervention method discussed? If not, could it mean that no such research exists?
  • If so, did the writer comment on whether these studies were well designed? Are any limitations to the studies revealed?
  • Is this study or studies presented as an extension of existing work, or rather sensationalized as a “breakthrough,” keeping in mind that often interventions are pitched as a “breakthrough” when indeed, they are not?
  • On the other hand, does the author acknowledge the absence of underlying research?  Is this acknowledgement rightly framed as a concern or rather just potentially baseless but encouraging statements suggesting that “groundbreaking research” is coming soon?

Some Final Questions to Consider

  • Are other media outlets reporting on this story or topic? If yes, favorably or unfavorably? Did they consider research data in their articles?
  • Has ASAT responded to this article via its Media Watch efforts? Please visit this page to peruse our library of archived media watch letters.
  • Has the author consulted with an unbiased and knowledgeable individual for his/her input about the intervention described (e.g., someone who is not personally benefitting from the story or someone with a strong grasp of research)?

 

Sadly, inaccurate and biased portrayals of autism treatments in the media are abundant.  In our experiences, inaccurate portrayals often fall within the following themes:

  • Exaggerating the research support for an intervention for which little or no research exists;
  • Ignoring the research basis that may already exist for the treatment in focus;
  • Disregarding the relevance of science;
  • Disregarding position statements from various professional organizations that may warn against or discourage the use of a particular treatment; and
  • Failing to acknowledge research that does NOT support a particular intervention.

Being mindful of these themes will enable you to truly embody the principle of “Caveat Lector.”  Please consider liking our Facebook page as we routinely showcase our Media Watch efforts. ASAT’s Media Watch responds to both accurate and inaccurate media portrayals of autism treatment in an effort to increase access to effective treatment for the autism community.

Citation:

Celiberti, D., & Wozniak, R. (2016). Caveat Lector: Let the reader beware. Science in Autism Treatment, 13(1), 8-9.

Author Biographies:

David Celiberti, PhD, BCBA-D, is the part time Executive Director of ASAT and Past-President, a role he served from 2006 and 2012. He is the Co-Editor of ASAT’s newsletter, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis, and early childhood education, and been an active participant in local fundraising initiatives to support after school programming for economically disadvantaged children. He works in private practice and provides consultation to public and private schools and agencies in underserved areas. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. In prior positions, Dr. Celiberti taught courses related to applied behavior analysis (ABA) at both the undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.

Renee Wozniak, PhD, BCBA-D, joined the ASAT Board of Directors in 2016. Prior to serving as a Board Member, Renée was a part of ASAT’s Externship, where she assumed the roles of Media Watch Co-Coordinator and Media Watch Lead. Renée received her Ph.D. in Special Education, focusing on Autism Spectrum Disorders (ASD) and Applied Behavior Analysis (ABA), from Arizona State University. She has worked in the fields of ASD and ABA in a variety of capacities since 1998, serving in public schools as a special education teacher, behavior intervention teacher specialist and district-wide autism trainer, and in clinical and home-based ABA programs as a research assistant, clinical/behavior interventionist, and program supervisor. Renée has trained families, therapists, teachers, teacher candidates, paraprofessionals, administrators, and others working with individuals with autism, and has instructed master’s level ABA, ASD, research and special education courses. She continues to stay involved in the field as a home-based ABA program supervisor, and as an instructor in ABA and ASD master’s degree programs. Renée is passionate about helping individuals with autism and their families by supporting and disseminating scientific research in autism treatment.

The Difference Between Saying A Child with Autism vs. Autistic Child

In the autism community, one of the most fiercely debated topics is how to refer to people on the spectrum. Here’s the difference between saying a child with autism vs. autistic child. While some prefer the term ‘people with autism’, others lean towards ‘autistic person’. Then there are those who remain indifferent, and prefer to take a tomato [tomayto]; tomato [tomahto] view of things. More than simply conveying meaning, words convey sentiment and ultimately shape how people are perceived.

A Child with Autism vs. Autistic Child

As a parent and someone whose life has been impacted by autism, you’re likely to have your own thoughts on the topic. The way you refer to your child, as either a child with autism or an autistic child, says something about how you see your child’s condition. 

Unpacking the term a ‘child with autism’

Autism is not something which defines our special children. This is the same thinking that would be applied when describing someone with any other illness or disability. A good example is when referring to a cancer sufferer, you’d say ‘someone with cancer’. This acknowledges that the person is more than their illness, and places emphasis on the fact that first and foremost they’re a person.

The well known autism blogger Autism Daddy had this to say on why he tends to use the terminology ‘child with autism’: “Anyway, the same way you say “she has cancer” I say “Kyle has autism”. It doesn’t define him as a person, it’s just something that he has and he has to live with and fight…the same way you fight cancer.”

Another important idea which this term conveys is that autism is merely one trait which makes up who a child is. It highlights the fact that there are many other facets and intricacies which make up a special child’s personality. Another parent blogger explains the significance of not focusing solely on your child’s autism: “I have a son with autism, twinkling green eyes, long brown hair, the cutest smile, an infectious laugh, and an apparent lifelong obsession for the freakin Wiggles. Not an autistic son.”

Unpacking the term an ‘autistic child’

The term ‘autistic child’ conveys the idea that autism is an integral and defining part of who a child is. This isn’t necessarily a negative way of describing someone, it’s simply a different way of perceiving the condition. The important distinction is that a term like ‘autistic’ implies that the child would be completely different if not for autism. In other words, autism makes a child who they are. Some also argue that this term is perhaps more reflective of reality as unlike an illness, autism will always be part of who this child is. And in that way, autism does make special children who they are.

Alex Lowery wrote a compelling piece in which he explains why he identifies more closely with the term autistic: “Personally, I don’t see anything offensive about the term “autistic.” I use it quite frequently to describe others and myself on the spectrum… Why is it considered offensive to say someone is autistic? And why is it better to say that they “have” autism? To me, that kind of implies that autism is an illness that needs to be cured — which it isn’t.”

Like Lowery, some people on the spectrum find the term ‘people with autism’ offensive because they perceive autism as a part of who they are. Unlike an illness, autism isn’t something someone simply ‘has’ and can recover from. Autism is a lifelong battle; an indelible part of one’s identity and the way one sees the world. And for those who perceive autism in this way, ‘autistic’ conveys these ideas clearly.

What does the research say?

In 2015, a variety of people were surveyed – including those with the condition, family members and professionals – to get a better sense of the autism community’s preferences.  The survey clearly shows that there has been a shift towards language which in some way identifies autism as an integral part of a person’s identity.

All those surveyed identified with terms like ‘on the autism spectrum’ and ‘Asperger syndrome’. However, a significant distinction can be found when it comes to terms like ‘autistic’ and ‘Aspie’. According to the survey, those with the condition prefer identity-first terminology like ‘autistic’ while family members didn’t.  The survey also found that terms like ‘low functioning’ and ‘classic autism’ are strongly disliked by most people surveyed.

What can we learn from all this?

It’s important to be aware of the language used to describe autism, and to take into account the preferences of those with the condition. But perhaps the biggest takeaway is that just as perceptions about autism are continually evolving and changing so too is language. We all need to be aware of this, and to accept that there isn’t such as thing as a correct way to describe autism. It’s largely a matter of personal preference.

Guest post by AngelSense. Check out their latest product here

Why All Parents Should Use Token Economies

Why All Parents Should Use Token Economies

As parents, we want our kids to want to have good behavior. They should want to behave because it’s the right thing to do, right? Yeah right. This is why all parents should use token economies.

Have you met a 3 year old with an innate desire to good for this world? It’s in there somewhere but at age 3, it’s more like threenager-ville. Little humans do what gets them what they want. They behavior in a certain way to achieve a certain outcome.

A threenager is likely to tantrum to get access to their favorite toy, TV show, candy, a left shoe they can see on the other side of the room — you name it. They are acting a certain way (tantrum) to achieve a certain outcome (getting whatever they want).

What can we do about this? Is there any way to teach them to behave?! Well, we can make sure they get what they want not by having a tantrum, but by engaging in desired behaviors.

We can use positive reinforcement in a more structured and specific way than just handing out praise and rewards willy-nilly.

The definition of a token economy is: a behavior change system consisting of three major components: (a) a specified list of target behaviors; (b) tokens or points that participants receive for emitting the target behaviors; and (c) a menu of backup reinforcer items.

Token economies can possibly take the form of sticker charts, chore charts, marble jars, etc. You need a physical token that your child can earn when they engage in the desired behavior. You do NOT need to go out and spend $50 at the nearest school supply store making a big fancy chart. You can draw 5 circles on a piece of paper. When they do the desired behavior, draw a check mark in the circle. Done. Grab that piece of junk mail off the kitchen counter and a half-eaten, I mean half-broken, crayon.

The next step is to define the behaviors. Again, you don’t need a big fancy dictionary. Just pick one to three behaviors that will earn the tokens. You need your Little to understand this so it can’t be a big grown up idea like ‘being responsible’ or ‘showing respect’. What does that mean to a Little? Be specific. You earn a token for: (1) following instructions without yelling; (2) eating 5 bites of every food Mom puts in front of you; and (3) putting on your shoes when instructed to.

Pick your battles. You may have a list of 20+ things your Little could stand to improve. I’m pretty sure I have a list of 20+ things to put myself on a token economy. Let’s prioritize and make it understandable by the kiddo.

Lastly — what can they earn with these tokens? You can give choices before earning and they can decide at the beginning or at the end. You can make a fancy menu of reinforcers — Chuck E Cheese is the perfect example of this. This many tickets = this super awesome toy.

Or, you can just say: get all the stickers, get 5 check marks, get 10 marbles and earn a fun activity. You can pick from: extra screen time, trip to the library, a new toy from the dollar spot, etc.

All of that in short form:

  1. Pick 1-3 behaviors and make sure your Little understands what they are.
  2. Have an actual token they can earn and set a goal.
  3. Provide the reward when they reach that goal. Make it a big deal!

Tips:

  • When you first start out, set the goal low. If it’s too hard to achieve, that won’t motivate anyone, especially a Little who is struggling with those behaviors to begin with.
  • Over time, raise the goal. Make the reward bigger for a bigger goal, smaller for a smaller goal. Play with it to see what is successful for your Little and doable for you in your busy day.
  • Make every token earned a big deal — lots of praise and excitement.
  • Don’t spend a lot of time and money setting up a fancy system. Like all things we do as parents — as soon as we get a good system down, our Little changes things up on us and we have to be flexible. My own daughter sees a strip of printer paper and thinks I’ve made her a new sticker chart. That’s how fancy sticker charts are at my house!
  • Be creative!
    • My aunt gave this idea from her life: She had a picture of a poodle and her daughter glued cotton balls on it. When she filled the picture, they actually got the poodle!
    • My sister let her oldest pick out his marbles for a marble jar on a special shopping trip to the craft store (less than $5 — don’t go overboard, folks!). That helped him buy into the process form the get go.
    • Cut up a picture of the prize like a puzzle. They get a puzzle piece as a token. The finished puzzle earns the prize!
    • Look in the app store. Seriously — there are many apps for reward charts.
    • Google ‘behavior chart’. You’ll find a gazillion cute templates if that’s what you’re into — cutesy.
    • I once made a necklace for a student who was really into jewelry. It was a laminated sticker chart necklace and she loved it.

One last thought: Someday you will find that things are going well and the token economy goes by the wayside. Remember it when a new problem behavior crops up and you are once again at your wit’s end. Start over. Pick new behaviors, new rewards, same system.

Don’t take my word for it — this is just the tip of the iceberg in behavior analytic research supporting token economies.

If you’re not a crafty person, you can always check out our reward chart here

Citations:
Cooper, J., Heron, T., & Heward, W. (2007). Basic Concepts. In Applied Behavior Analysis(2nd ed., pp 560-567). Columbus: Pearson.

Kazdin, A. E. (Ed.). (1977). The token economy: A review and evaluation. Plenum Publishing Corporation.

Kazdin, A. E. (1982). The token economy: A decade later. Journal of Applied Behavior Analysis15(3), 431-445.

Skinner, B. F., Ferster, C. B., & Ferster, C. B. (1997). Schedules of reinforcement. Massachusetts: Copley Publishing Group.

Reitman, D., Murphy, M. A., Hupp, S. D., & O’Callaghan, P. M. (2004). Behavior change and perceptions of change: Evaluating the effectiveness of a token economy. Child & Family Behavior Therapy26(2), 17-36.


Leanne Page, M.Ed, BCBA
 has worked with kids with disabilities and their parents in a variety of settings for over 10 years. She has taught special education classes from kindergarden-grade 12, from self-contained to inclusion. Leanne has also managed a center providing ABA services to children in 1:1 and small group settings. She has extensive experience in school and teacher training, therapist training, parent training, and providing direct services to children and families in a center-based or in-home therapy setting. Since becoming a mom, Leanne has a new mission to share behavior analytic practices with a population she knows needs it- all moms of littles! Leanne does through her site parentingwithaba.org and through her book ‘Parenting with Science: Behavior Analysis Saves Mom’s Sanity”.  You can contact her at lpagebcba@gmail.com.

The Pitfalls of Testimonials

When searching for a great restaurant or choosing a movie to go see, often we consider the personal reports of neighbors, work associates and friends. Why not? Their “testimonies” give us a quick method for judging the probability that a particular restaurant or movie will be a good investment. Of course, our friends and associates are not always right, but their testimonials serve as either shortcuts or as corroboration of other sources of information (e.g., restaurant or movie reviews). As such, they contribute to efficient decision-making about relatively low-stakes events. Here’s what you need to know about the pitfalls of testimonials.

the pitfalls of testimonials

We commonly see testimonials made by happy consumers presented by marketers of autism treatments. Indeed, testimonials are a standard feature on for pills, exercises, devices, interventions and therapies to potentially unwary consumers. Many testimonials take the form of simple, quoted statements (e.g., “The [marketed treatment] has had an amazing effect on my son!”). On the internet, video testimonials may be particularly compelling. Marketers know that the testimonials of some people, including attractive people, familiar celebrities, and people who may remind the potential consumer of him — or herself may be particularly effective. Adding pleasant theme music and using artful filming may complete the effect and increase the probability that families separate from their hard-earned money.

But, how should we use testimonial evidence in selecting potential autism treatments? When confronted with testimonials about possible autism treatments, it is recommended that families be especially cautious, particularly when the testimonials are the only source of support for the intervention. Marketers can find a few individuals who provide testimony that their product is effective, even when the product is wholly ineffective. This is because, as consumers, our opinions about the quality of a product — including perceived effectiveness — are colored by our previous experience, what we have been told by others, and our expectations. Furthermore, because human behavior — including the behavior of individuals with autism — is variable (i.e., changes across time), a treatment benefit may appear to exist, even when it does not exist at all.

For example, imagine that a marketer sold a “special” trampoline to 100 parents with the guarantee that daily use of the trampoline by their child would “open learning channels” and “promote language acquisition”. Of those 100 parents, it is reasonable to expect that at least a small number of them — perhaps 5 or 10% — may report that the product “seems to help”, even if the trampoline is not at all effective as an intervention in the way described by the marketer. A savvy marketer is watching for members of this small subgroup of consumers as their source of new testimonials!

And, how about all of the parents who purchased the trampoline and, subsequently recognized that it did not “open learning channels” and “promote language acquisition”? You can be assured that their opinions will not grace the marketer’s website, social media or glossy print advertisement. As a result, the marketers promote an illusion of product effectiveness where one may not exist at all.

It is for these reasons that parents and other consumers of autism “treatments” are cautioned to view testimonials skeptically. Testimonials are a wonderful way for business people to market merchandise but a poor way for families to determine true effectiveness of a treatment, device or intervention. Decisions regarding autism treatment are best guided by the scientific record, as supplied by trusted sources (e.g., a competent physician, psychologist or other autism expert). When it comes to making decisions about expensive autism interventions and the allocation of precious resources, persons with autism — and their families — deserve nothing less.

Cite This:

Mruzek, D. W. (2012). The pitfalls of testimonials. Science in Autism Treatment, 9(2), 12

 About The Author

Daniel W. Mruzek, Ph.D., BCBA-D is an Associate Professor at the University of Rochester Medical Center (URMC), Division of Neurodevelopmental and Behavioral Pediatrics in western New York. He received his doctoral training in Psychology at the Ohio State University and is a former Program Director at the Groden Center in Providence, Rhode Island. Currently, he is an associate professor and serves as a clinician and consultant, training school teams and supporting families of children with autism and other developmental disabilities.

Mruzek coordinates his division’s psychology postdoctoral fellowship program in developmental disabilities and is an adjunct faculty member in the University of Rochester Warner School of Education. He is actively involved as a researcher on several externally funded autism intervention research studies and has authored and co-authored more than 20 peer-reviewed articles and book chapters on autism and other developmental disabilities. Dr. Mruzek is on the editorial board for the journals Focus on Autism and Other Developmental Disabilities, Behavior Analysis in Practice, Journal of Mental Health Research in Developmental Disabilities, and Intellectual and Developmental Disabilities. Dr. Mruzek is a former member of the Board of Directors of the Association for Science in Autism Treatment.

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!

 

 

Overcoming 3 Barriers To Earning Your BCBA

Working toward a BCBA or BCaBA is hard work – attending classes, getting experience hours and, working, often full time, and for many, doing all this while raising a family. The good news is that all of this hard work will someday pay off. After all, the ultimate goal of this is to be qualified to provide help to individuals who desperately need it. Working in the field as a BCBA is a noble cause and many families will be grateful for your support.

But along this path there are many details to manage, details which can easily slow, or derail your path, if not properly managed. You know the details I’m referring to – direct supervision hours, indirect supervision hours, correct ratios of experience to supervision, weekly forms to be signed, tracking hours for each of these and sorting through the multiple supervisors who have provided fractions of the needed hours to you this month. This can get confusing and quickly create barriers – but it doesn’t have to.

Overcoming 3 Barriers To Earning Your BCBA

Learn more about overcoming 3 big barriers to earning your BCBA, and read along for our tips on how to maneuver past them.

Barrier #1 – Lack of a plan.

It is easy to get carried away with the busyness of your life and forget to take some time to create a plan for meeting your requirements. 2 years often gets tossed around as the time it takes to earn your BCBA. This is a fine time frame to aim for, but without a concrete 2-year plan, it is easy for life to get in the way, and fall short on that goal.

Taking an hour to plan your course of action now can save you months later. Identify some concrete, measurable goals and create a plan. The BACB website has the information you need to get started. Find the requirements – course sequence, experience hours, supervision hours, etc., and create your goals based on those. For example, if you are doing supervised independent fieldwork to reach your experience hours, you will need to accumulate 1,500 total hours to qualify for the exam. This can now be your basis for your experience plan.

Once you have figured out how many experience hours you need, grab that 2 year time frame and calculate how many hours per week you need to acquire in order to reach your goal in time. If we use our 1,500 number, and you are able to work 50 weeks a year, that comes out to 15 hours per week. This weekly goal of 15 experience hours is much more manageable and accomplishable than a goal of 1,500 in 2 years. With this weekly goal too you can begin to plan how you will get your 15 hours per week.

Barrier #2 – No control over experience and supervision.

This is a barrier that is a little bit harder to overcome, depending on how you are acquiring your hours. If you have set your weekly goal at 15 hours of experience per week, but you don’t currently receive 15 hours of work per week, then something needs to change. Either lower your hours to a number you do currently receive on the regular, and adjust your timeframe accordingly, or talk to your practicum site to see if you can arrange for more hours.

Be cautious about tightly planning around the number of hours you are promised to work each week, especially if you don’t already work this much. It is more difficult to provide those hours than some practicum sites would like to admit. One strategy is to request 10% to 20% more hours than you need, to account for cancellations. After you agree on a weekly goal of experience hours with your practicum site, add that number along with the corresponding supervision hours required into your supervision contract. While you have responsibilities as a supervisee, your supervisor also has responsibilities to provide you with the training you need. Both of these contingencies should be in writing in your signed contract.

Barrier #3 – Disorganization.

Now that you have overcome the first 2 barriers to earning your BCBA it is time to actually accumulate those hours. This is where the responsibility truly falls on your shoulders. Make sure you stay organized from the start.

A great way to keep yourself organized is to write down your your goals for experience and supervision and track your progress each week. You can track this information in any form that is easy for you. Some people use Excel, others use Google Calendar, but I like to use my Self Management Planner for things like this, because it incorporates an appointment book with a place to write weekly goals and track progress toward that goal every day of the week. Whatever you use, make sure your tracking system is easy to use and portable. Write down your progress every day, and include the number of experience hours and the number of supervision hours you logged.

Write down your supervisor name next to your hours too. This way you won’t forget who provided supervision and when. The experience forms you need to fill out from the BACB have a section to write in your experience hours for the supervision period along with the supervision you acquired during that period. But if you wait to write down your supervision when you are filling out these forms every week or two, it will be very difficult to remember all the hours you got. This is especially hard when your experience is broken up over 5 different clients at 6 different locations and 2 different supervisors. Logging this daily in your planner, or whatever system you use will help immensely. Staying up to date with this will pay off 2 years from now when you are filling out your forms to take your exam.

Earning your BCBA is hard enough, with the challenging courses, rigorous exam, and complex nature of learning about behavior analysis. But planning for and tracking experience hours does not have to add to these difficulties. By removing these three barriers, you will remove a big stressor, and get yourself one step closer to successfully earning your BCBA in the time you want.

Daniel Sundberg is the founder of Self Management Solutions, an organization that operates on the idea of helping people better manage their time. Towards this end, he created the Self Management Planner, which is based on an earlier edition created by Mark Sundberg in the 1970s. Daniel received his PhD from Western Michigan University and currently consults with organizations on performance improvement.

Lisa Sickman supports Self Management Solutions with ongoing content and product development. She received her Masters degree in behavior analysis from Western Michigan University, and then worked for several years as a BCBA at an autism center. Lisa currently teaches future BCBAs and BCaBAs as a co-instructor for ABA Technologies.

To All Autism Parents

This is for all autism parents who’ve once heard “your child has autism.”

This comment from my experiences has came with different emotions for different people. Sadness of the uncertainty…Happiness about finally knowing what the diagnosis was… And often a neutral look where I cannot see any expression.

To All Autism Parents

Over the years I’ve been contacted by thousands of parents asking for advice about their child’s autism diagnosis based on my experiences navigating the world growing up on the autism spectrum. During those times there have been many of these emotions I’ve seen from parent.

I was thinking about this recently when a mom reached out to me online telling me that her child was just diagnosed with autism. I asked her some preliminary questions such as “When were they diagnosed” and the follow up hit me when she said “my 2-year-old was diagnosed with autism today.”

This was one of the first times I ever talked to a parent the actual day of their child’s diagnosis. She told me more about how she was feeling right now. How her heart was breaking for her child. How she had seen signs for so long and how it had finally become confirmed.

Then she said I inspired her and I honestly didn’t know what to say. For her to contact me had left me at a loss for words. I took a few minutes to compose myself before following up. I than wrote this letter to the mom saying…

“Thank you for your kind words. Remember that you are never alone in this community and there are so many people who you can rely on. Many of them will have already walked similar roads to yours. Lean on these people. Listen to their stories and most importantly, cherish each and every single day that you have with your child. We are learning more about autism everyday to provide them with supports to see them progress.

I know today may have left you with so many different emotions. My parents had those same feelings when I was diagnosed with autism when I was 4. But my parents were able to get through that day and so will you. You will become a champion for your child and their greatest advocate they will ever have. I wish you nothing but the best for you and your child in the future.

Your friend, Kerry 

 

She followed up hours later with gratitude and saying that she would look into the Tool Kit. To this day I’ve been thankful to this mom for sharing her story with me. Stories like hers is why I’m an advocate today. For those other parents out there whose child is diagnosed I hope this message I shared will be helpful for you as well. If I can ever be a resource you can message me on my Facebook Fan Page here.

My hope by sharing my successes and challenges on the spectrum is that I can provide our community with resources that they can use to help their children. That’s one of my hopes that won’t be changing anytime soon.

Kerry Magro is an award winning national speaker and best-selling author. Kerry has become a rolemodel in the disabled community. Non-verbal at 2.5 and diagnosed with autism at 4, Kerry has overcame countless obstacles to get to where he is today. A recent Masters graduate from Seton Hall University, he currently is CEO and Founder of KFM Making a Difference, a non-profit corporation focused on disability advocacy and housing.

 Today Kerry travels the country sharing his story and telling our society to define their lives and their dreams in the best way they can. Of his highlights include publishing 2 best-selling books (Defining Autism From The Heart and Autism and Falling in Love) and working on the 2012 Motion Picture Joyful Noise. Kerry currently resides in New Jersey and works in New York as the Social Media Coordinator for Autism Speaks.

Educating for Inclusion

I am a special education teacher interested in learning more about educating for inclusion. How can I set up my small groups to target skills that will serve my students well in the classroom?  

Answered by Renita Paranjape, M.Ed., BCBA, Director, Intake, IBI and Group and Transition Services, Geneva Centre for Autism

Presenting a special guest post by Renita Paranjape from ASAT.  

Preparing students for group instruction in inclusion classrooms requires careful consideration of the responses required in that setting as well as the strengths and needs of the child with autism. What follows are some considerations that may ease the transition of students from one-to-one instruction to group-based instruction within inclusion classrooms.

Educating for Inclusion

Investigate the next setting

Take time to visit and observe group instruction in the inclusion classroom. There are a few questions to keep in mind when observing the inclusion setting, including:

  • What is the content of the group instruction?
  • How large are the groups?
  • How does the teacher engage the students (e.g., visual stimuli, choral responding)?
  • How long are the group activities?
  • How often are students required to respond during group?
  • Are there reinforcement systems in place within the group lessons?
  • What are the teacher’s general behavioral and learning expectations of the students during group instruction?

Once you have a clear idea of what transpires during group instruction, attempt to replicate, as closely as possible, the activities observed in the inclusion environment during small-group lessons.

Setting up the group

Here are some pointers for setting up group instruction:

  1. Group children according to their skill level so that those who require skill building in more foundational skills are grouped together, while the students with more advanced skills are placed together.
  2. Alternatively, you may want to consider mixing students by skill level, so that students with more advanced skills can serve as a model for students who require models of responses during the lesson.
  3. All students should have a clear view of the teacher and the instructional material, with distracting items kept to a minimum.
  4. One adult should be the “teacher,” delivering all instructions in front of the group and providing the reinforcers to the students.
  5. Position other adults behind the group to serve as “prompters” of responses. These adults should stand, not sit, behind the students, fading their proximity to the students as independence increases. These adults should only prompt if necessary, and the students should be expected to follow the instructions provided by the teacher who is leading the group.
  6. Have available the student’s individualized motivation system in view of the student. The teacher leading the lesson should provide the reinforcers to the students based on the student’s individualized program.
  7. The other adult or “prompter” can also record data on the responses of the learners during group instruction.
  8. The teacher of the group and the prompters should communicate regularly before and after the group lessons to identify roles and student goals. Discussion should not occur during the lesson.

Readiness skills for small group instruction

The following are a few examples of what learners may benefit from in order to participate in group instruction, but they are not necessarily prerequisites. Some of these goals require group instruction in order for the goals to be taught, whereas other goals can be introduced in smaller groups or in one-to-one instruction.

  1. Attending to the teacher with peers present. In most ABA programs, attending is one of the first foundational skills that is taught. This is accomplished either by teaching students to provide eye contact or teaching them to orient toward the communicative partner. Once this skill is established, the next step for group instruction would be to teach attending even when there are peers present and when the teacher is standing and moving around the classroom.
  2. Tolerating the presence of peers. Since small-group instruction requires the presence of other students, it is important to assess whether the student can sit alongside a peer without being distracted.
  3. Sitting for longer periods of time without frequent breaks. Group instruction will require the student to sit for longer periods of time. Collect baseline data on how long the student will sit appropriately before accessing a reinforcer; then systematically increase that time so that the student can sit for longer periods of time to earn access to a bigger reinforcer (e.g., recess).
  4. Remaining on task for longer periods of time. This may seem similar to number 3 above, but it is not only important to consider how long your students can sit appropriately, but also how long your students will work efficiently before becoming off task and or requiring breaks. In small group settings, students are typically required to complete independent seatwork for upwards of 15 minutes or more. As a readiness skill, assess how long your students can remain on task and systematically increase how long they are required to work independently.
  5. Preparing the student for thinner schedules of reinforcement. Consider your students’ current schedule of reinforcement and develop a plan to thin that schedule. This would apply primarily to appropriate behaviour, such as attending and sitting appropriately, as correct responses in group would likely be reinforced on a continuous schedule initially.
  6. Responding to name and following distal instructions. Can your students respond to their names from varying distances and in different contexts? Can they follow directions given from afar? In addition to being able respond to their name in a classroom setting, students must also learn to not respond in certain situations. Distinguishing between, and responding to, instructions such as “everybody,” “[student’s name]” and “[other student’s name]” are key foundational skills for small-group instruction.
  7. Following complex instructions. Your students should not only be able to complete one-step directions (e.g., “Get a pencil”), and two-step directions (“Get a pencil and write your name”), but they should also be taught to follow even more complex directions (e.g., “Get a pencil, turn to page 5 of your workbook, and write your name at the top”).
  8. Waiting for attention and instructions. When a student makes the transition from one-to-one instruction to a group setting, the teacher’s focus is no longer solely on one student, but he or she is balancing his/her attention from one student to another. It is important to teach the student how to occupy his or her time without engaging in stereotypic, or other challenging behavior, as the teacher’s attention is diverted.
  9. Hand raising. Hand raising is a skill that requires attending, performing a gross motor action, inhibition of responding until cued by teacher, and discrimination of instructions. Initially, students can learn to raise their hands to access a preferred item with an embedded prompt in the instruction (e.g., “Raise your hand if you want candy!”). The instructions can then become increasingly more complex and students can learn to raise their hands to answer questions, to refrain from raising their hands when they are not able to answer a particular question, to request an item they might need for a task, and to volunteer to participate in an activity.
  10. Observational Learning. One of the benefits of small-group instruction is the abundance of opportunities to learn appropriate responses by attending to the responses of other members of the group. Often times, students with autism need explicit instruction in attending to the responses of others, in differentiating whether those responses were appropriate based on teacher feedback, and in being able to repeat those correct responses when directed by the teacher.
  11. Choral Responding. Another key response of small-group instruction is being able to say responses aloud and in unison with other students. For example, the teacher may say, “Everyone tell me what is two times two,” and all of the students would be expected to say, “Four.” This skill can first be introduced in one-to-one instruction.

Effective teaching strategies to include in small-group instruction

The research in small-group instruction has identified specific strategies that have been found to be particularly effective for learners to acquire skills in a group setting (e.g., Heward & Wood, 1989; Kamps et. al, 1991).

  1. Creating many opportunities for learners to respond: Given that the density of instructions will likely be less in a group situation than in a one-to-one teaching interaction, it is important to create as many opportunities as possible for your students to practice responding, and, in turn, acquire skills. Ensure that there are many instructions delivered for each student.
  2. Frequent rotation of materials: This is a necessary strategy to help alleviate boredom with the content of the curriculum, and it also helps to promote generalization of responding across various stimuli.
  3. Interspersing known targets with unknown targets: This strategy creates a momentum for responding fluently, provides the opportunity for reinforcement to occur, and also ensures that mastered targets are maintained.
  4. Choral responding: Having your students respond in unison is a useful strategy, and is important to target, because it occurs frequently in most general education settings. It is beneficial for learners, as it allows them to have more opportunities to respond, as well as allows them to be cued by their fellow classmates rather than their teacher.
  5. Random responding: Random responding refers to presenting instructions in an unpredictable format so that students are not aware of when they might be called upon. This method can improve attention and motivation, as students will not be able to predict when it is their turn to respond.
  6. Repeating peer responses: Requesting that students repeat the correct responses of their classmates can help further observational learning skills by requiring students to attend to and assimilate the responses of others.
  7. Student-to-student interaction: Another effective teaching strategy is to promote interaction among students. Specifically, students can learn to listen and repeat each other’s responses to general curriculum-related questions, ask peers to clarify if an instruction was missed, or ask peers for items needed for a task.

Small-group instruction can be a highly effective way to prepare students for less restrictive settings. With appropriate environmental manipulations, as well as effective teaching strategies, students who participate in group instruction can acquire skills needed for fuller inclusion.

References

Carnahan, C., Musti-Rao, S., & Bailey, J. (2009). Promoting active engagement in small group learning experiences for students with autism and significant learning needs. Education and Treatment of Children, 32(1), 37-61.

Harrower, J. K., & Dunlap, G. (2001). Including children with autism in general education classrooms: A review of effective strategies. Behavior Modification, 25(5), 762-784.

Heward, W. L., Gardner, R., Cavanaugh, R. A., Courson, F. H., Grossi, T. A., & Barbetta, P. M.(1996). Everyone participates in class: Using response cards to increase active student response. Teaching Exceptional Children, 28(2), 4-10.

Heward, W. L., & Wood, C. L. (2009). Let’s make some noise! Using choral responding to improve the effectiveness of group instruction. In W. L. Heward, Exceptional children: An introduction to special education (9th edition) (pp 158-159). Upper Saddle River, New Jersey: Merrill-Pearson Education.

Kamps, D. M., Walker, D., Dugan, E. P., Leonard, B. R., Thibadeau, S. F., Marshall, K., & Grossnickle, L. (1991). Small group instruction for school-aged students with autism and developmental disabilities. Focus on Autism and other Developmental Disabilities, 6(4), 1-18.

Ledford, J. R., Gast, D. L., Luscre, D., & Ayres, K. M. (2008). Observational and incidental learning by children with autism during small group instruction. Journal of Autism and Developmental Disorders, 86-103.

Rotholz, D. A. (1990). Current considerations on the use of one-to-one instruction with autistic students: Review and recommendations. Focus on Autism and other Developmental Disabilities, 5(3), 1-5.

 

Renita Paranjape, MEd, BCBA, is a Board Member of ASAT. Renita joined the ASAT Board of Directors in 2015. Prior to serving as a Board Member, Renita served as ASAT’s Social Media Coordinator. Renita received her Master’s degree in Developmental Psychology and Education from the University of Toronto, and completed courses in Behavior Analysis from the University of North Texas, in 2009. Since 2002, Renita has worked in the fields of ABA and ASD in several capacities, including supervising an ABA program in a private school, supervising ASD consultants in public schools, and managing an ABA program in group homes serving adults with severe behavior disorders. In her current role, Renita has been fulfilling the role of Director of Intake, IBI Services, and Group and Transition Services at Geneva Centre for Autism in Toronto. Renita is passionate about the dissemination of science based treatments for autism, and working with families to access those resources.

 

The Truth About Having A Sibling With Autism

Here’s the truth about having a sibling with autism. When we were younger, I tried so hard to reach out to my brother, but he seemed to reject me. I would try to play with him, and he would either push me away or run away. It was frustrating. I knew my brother had a disability, but I didn’t really understand the different characteristics of autism. I couldn’t understand why if I showed him how to catch a ball, he would just let it hit him or drop to the floor. He wouldn’t look at me when I called his name. He wouldn’t even stay in one place to figure out how to play the game. Whatever was going on in his own head was much more fun than his big sister, and it ticked me off.

Things are really different now. I’m much more educated about autism. I understand that individuals with ASD have communication deficits. The disability also makes it difficult for people to learn social skills. Observational learning is something that isn’t instinctive, but has to be taught. There’s also a piece to the disability where people are really rigid in their behaviors. They might engage in repetitive behaviors and that’s much more motivating for them to do than interact with others. It’s just the disability. Everyone has different manifestations of these traits, and to varying degrees with different combinations. They often say, “If you met one person with autism, you met one person with autism.” It’s so true.

The Truth About Having A Sibling With Autism

The Truth About Having A Sibling With Autism

Deborah with her brother and worship band.

In our mid and late twenties, my brother and I hang out much more. We even hang out with other people. This took over twenty years to develop. I don’t want to paint a picture that my brother and I had only painful memories in our childhood, because we didn’t. It’s just now, we have a much more interactive relationship. Not only with me, but with others. As you can see in the pictures above, my brother is just one of the gang.

This is us hanging out at a cafe after a band practice. My boyfriend and I are part of a church worship band. My brother comes to our practices and listens to us. He loves music, and live music amplifies the experience. He often paces the room, and listens to us sing. Afterwards, we often all go out to eat and hang. When we hang, my brother is just part of the gang. He’s just as much a goofball as our friends are, and fortunately, they all treat him like one of the gang. I can’t say how much it means to me that we can hang out with friends together. It’s not always picture perfect, but this night definitely was.

How did we get here?

  1. On my end, the more I understood about the disability, it made me realize he wasn’t being a jerk. There are things you have to teach him, such as looking at your eyes. Now he does that really well.
  2. It helps being a practitioner in the special education field. I’ve encountered some learners who never learn a new skill and some learn really fast. Everyone is different. It’s not lessening your expectations, but understanding that he may or may not acquire the new skill you just taught him. For example, even after 26 years, the man still does not catch a ball outside of his periphery. At this point, as long as he doesn’t let a ball hit him in the face, I’m OK with him and his hand eye coordination. That doesn’t mean I don’t play catch with him or try, but it just doesn’t discourage me or bum me out.
  3. I realized real quick that my attitude towards my brother affects how everyone else treats him. I’ve had strangers and acquaintances give weird or concerned looks towards us. Even now, I get that from time to time. Whatever. I love this man, who is my brother. Just let the love shine!

To any families out there… Be brave! Have hope! Press on!

 

We’re incredibly honored to publish this guest post by Deborah Chang, an autism blogger. Visit Deborah’s blog here. If you’re interested in submitting a guest post for our blog, please email elizabeth@difflearn.com for more info.