How to Take Family Conversations from Painful to Pleasant

A parent writes:  “Dear Behavior BFF, My son likes to talk about the Octonauts (Cartoon). If I hear one more thing about Kwazii the cat, I may stab myself in the ear. Help!”

I think so many parents can make this exact statement, just change out Octonauts for whatever your kid is into right now: Santa, trains, Frozen, the weather, a book, the number four, whatever! But please refrain from injuring your own eardrums. There are positive behavior supports to employ before resorting to anything extreme! 

Let’s get technical for a minute. Have you ever heard of DRL: Differential Reinforcement of Low Rates? If you are an ABA nerd like me, the answer had better be yes. If you are a mom (also like me), the answer is probably now. With DRL, you provide reinforcement for responses that are lower than a criterion you set.

How many times a day does your child talk about (insert preferred and rather annoying subject here)? Let’s say 20. Set a number lower than 20. Your child can talk about that subject 15 times tomorrow to earn positive reinforcement.

You set a number that is acceptable to us and achievable to the child. You can’t go from 20 times a day to 5 times a day. That may be acceptable to you, but will your child ever get to earn that positive reinforcement? Doubtful.

A structured way you can set this up in your family is to create a behavior contract (aka contingency contract). This is a physical document that outlines the exact behavior that must be completed to earn a specified reward. It also includes a place to keep track of that behavior & reward. It needs to be specific.

Write down the exact task to complete. The task in this situation would be talk about ___subject____   no more than __number___ times. 

Specify the reward. If this contract is going to last all day, the reward had better be pretty good — what is the reward, when will it be received, how much of it — be precise!

And finally, include a task record. This means you write down whether or not they achieved it that day. You could put some tally marks down to show the number of times your child talked about that subject. Or you could just put a check mark or happy face on days when the reward was earned.

What’s the purpose of documenting this? So you can review it again with your child and show them the progress they are making!

What if the contract isn’t working? If they aren’t making progress, then revisit your criteria. Do you need to raise the number of times they talk about Octonauts a little? Is the reward not awesome enough? Do you need more options? Is a whole day too long? Do you need to do a reward opportunity for the morning and the evening? There are options here! Step away from the silverware — do not stab yourself in the eardrum!

The physical visibility of the contract can be a helpful cue or response prompt to remind your child how many times they have left to talk about Octonauts or it may be a visual reminder of that potential reinforcer coming their way. Hang it on the fridge or some other prominent spot to serve as a helpful tool in and of itself!

Over time, you should be able to lower that daily goal. From 20 times a day, to 18 times a day, to 15 times a day, to 12 times a day, etc. Don’t go too fast. Let your child be successful at each level a few times before lowering that number of allowed times they can talk about their favorite thing. And don’t go too low. I don’t want my daughter to think I never ever want to hear about what she is into. I do, however, want her to learn some balance and variety when it comes to conversation topics.

If your son’s conversations about Octonauts are decreasing, does he know what else to talk about? You need to teach him some other replacement topics that are appropriate and interesting to him. We aren’t going to jump from Octonauts to the Blacklist or Grey’s Anatomy, but maybe he can talk about books instead of just his favorite TV show. How about talking about experiences he’s had? Making plans for the future? Give him some choices of topics and model those conversations. Encourage and provide positive reinforcement when he uses any different appropriate topic of conversation.

Here it is in a nutshell:

Set a reasonable & doable number of times your child can engage in that behavior (talking about Octonauts). Provide positive reinforcement when he stays at or under that level. This is called DRL: Differential reinforcement of low rates of responding.

Formalize it with a behavior contract. Be specific. Hang it where it can be seen. Document progress. Revise as needed.

Teach your child a replacement behavior. What CAN he talk about instead? Make it appropriate for your child, for the situation, but make it something he is interested in. Maybe he doesn’t love these other topics as much as Octonauts, but pick some interesting topics to keep him engaged.

And most importantly, don’t stab yourself in the ear!  Find a way to make pleasant conversations in your home possible.  No, more than just a possibility, make pleasant family conversations a regular occurrence. You can do it!


Leanne Page, MEd, BCBA, is the author of Parenting with Science: Behavior Analysis Saves Mom’s Sanity. As a Behavior Analyst and a mom of two little girls, she wanted to share behavior analysis with a population who could really use it- parents!

Leanne’s writing can be found in Parenting with Science and Parenting with ABA as well as a few other sites. She is a monthly contributor to bSci21.com, guest host for the Dr. Kim Live show, and has contributed to other websites as well.

Leanne has worked with children with disabilities for over 10 years. She earned both her Bachelor’s and Master’s degrees from Texas A&M University. She also completed ABA coursework through the University of North Texas before earning her BCBA certification in 2011. Leanne has worked as a special educator of both elementary and high school self-contained, inclusion, general education, and resource settings.

Leanne also has 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.

Leanne is now located in Dallas, Texas and is available for: distance BCBA and BCaBA supervision, parent training, speaking opportunities, and consultation. She can be reached via Facebook or at Lpagebcba@gmail.com.

Posted in ABA

Tips For Handling A Crisis

Take A Deep Breath

This advice seems so absolutely silly and obvious. I used to hate when people would tell me to take a deep breath. “Got it. I’m breathing. I’m not going to suffocate myself. Chill.” But then I realized that sometimes in a crisis I jump in split-second too early. Yes, when there is a safety risk we want to act as quickly as possible. But the 3 seconds of taking a deep breath before acting usually resulted in me responding not reacting. A reaction is based off of emotion, it’s impulsive, and it’s more likely to be wrong. A response is planned and thought. A deep breath is the difference.

Have A Crisis Plan

Sick of hearing me talk about crisis plans? Too bad! They are still THAT important. This is your insurance policy. Hopefully, you’ll never have to use it but you sure as heck better have one. Check out my mini video training series on Developing a Crisis Plan. You can also download my simple and visual crisis plan here

Keep Other Students Safe And On Task

What’s worse that one crisis? More than one crisis. Keep your other students safe but also try to keep them on their schedule and engaged in an activity. I always recommend keeping bins of puzzles, file folders, and other independent work in every area of the classroom so you always have something to give other students. If students are getting distracted, give headphones and an iPad to keep them occupied during this time. 

Gather Information

Every major behavioral incident is a chance to learn about your student. What are his triggers? What helps him deescalate? Even though you are working on keeping your student and others safe, be gathering valuable information while doing so. Write it down as soon as you can. This information may help prevent this issue in the future. 


About The Author 

Sasha Long, BCBA, M.A., is the founder and president of The Autism Helper, Inc. She is a board-certified behavior analyst and a certified special education teacher. After ten years of teaching in a self-contained special education classroom, Sasha now works full time as a consultant, writer, and behavior analyst. Sasha manages and writes The Autism Helper Blog, as a way to share easy to use and ready to implement strategies and ideas. Sasha also travels internationally as a speaker and consultant providing individualized training and feedback to parents, educators, therapists, and administrators in the world of autism. She is currently an adjunct professor in the school of Applied Behavior Analysis at The Chicago School of Professional Psychology. Sasha received her undergraduate degree in Special Education from Miami University and has a Masters Degree in Applied Behavior Analysis from The Chicago School of Professional Psychology. Contact Sasha at sasha.theautismhelper@gmail.com.

Posted in ABA

Build Desirable Behaviors

One of my favorite textbooks about ABA is Focus on Behavior Analysis in Education: Achievements, Challenges, and Opportunities. And one of my favorite chapters in that book is called “Building Behaviors versus Suppressing Behaviors,” which focuses on school-wide positive behavior change This is an often-overlooked key concept in behavior analysis that can have a huge impact on the school environment. Furthermore, when we think of ABA, we often think about individual interventions, but the principles of ABA can be highly effective when applied to large environments, such as an entire school.

The chapter references several studies about school-wide behavior change and offers evidence-based practices for achieving such change. It also outlines social behaviors that should be taught, such as how to apologize or how to make a request, then discusses strategies for rewarding the desirable behaviors. I appreciate that it focuses on getting students involved in making such changes.

Teaching these desirable behaviors can often feel challenging with the additional stresses of a special education classroom. One curriculum I have found effective in addressing this problem is Skillstreaming. I often use Skillstreaming in Early Childhood with young learners, and love that it clearly defines desirable behaviors, such as how to listen or how to offer help (see image below), but provides those definitions in simple terms with visual prompts that help our young learners. It also incorporates positive reinforcement for learners who are engaging in those desirable behaviors.

Listening Skill

In summary, there is lots of evidence out there that focusing on what kids should be rather than what they should not be doing is beneficial for the learner and the general culture of the classroom. Providing clearly defined desirable behavior and building instruction in those behaviors throughout the day is essential. And that instruction may need to be more frequent and more detailed for our learners with developmental disabilities.

REFERENCES

Heron, T. E., Neef, N. A., Peterson, S. M., Sainato, D. M., Cartledge, G., Gardner, R., … & Dardig, J. C. (2005). Focus on behavior analysis in education: Achievements, challenges, and opportunities. Pearson/Merrill/Prentice Hall.


Written by Sam Blanco, PhD, LBA, BCBA

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 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 and the Senior Clinical Strategist at Encore Support Services.

First Responders Educators In Autism

This month’s ASAT feature comes to us from Karen Parenti, MS, PsyD. 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!

I am a parent of a young man with autism. I also work in the area of law enforcement. What are some important considerations when teaching first responders and law enforcement personnel how to interact with individuals with an autism spectrum disorder?

This is a very important question and one on which many local communities are focused. In addition, treatment of individuals with autism spectrum disorders (ASD) by law enforcement is a common worry for parents. As such, the topic requires training to increase awareness of ASD for first responders and local community members, as well as collaboration between service providers and law enforcement. As in any crisis situation, it is important to focus on positive and preventative approaches, as most behavioral crises with individuals with ASD can be prevented or lessened. To promote awareness on the part of first responders and prevent crises, ASD service providers should proactively prepare individuals with ASD for a possible encounter with emergency personnel and law enforcement using understandable language, pictures, books, or video models about emergencies so they know what to expect and how to respond. Additionally, building rapport and familiarity between individuals with ASD and local police might help ensure the person with ASD perceives the first responder as a helper when a behavioral or medical event occurs. In many cases, situations will arise that require emergency intervention by first responders because of the unique challenges and behavioral escalations that commonly occur with individuals with ASD. Therefore, training for first responders is of the utmost importance.

Police officers expertly respond to a large number and variety of emergency situations on a daily basis. Each emergency situation has its own unique characteristics, and so do the individuals involved in that crisis. First responders and police receive standard and rigorous training on how to respond to emergencies compassionately and effectively. This training, while appropriate and efficient for the vast majority of situations, is not necessarily the best way to respond to a child or adult who is diagnosed with ASD. This can lead to an outcome such as this example of how an unfortunate misunderstanding can result in tragedy.

Whether the emergency is a medical or behavioral crisis, understanding ASD and how someone with ASD might behave is crucial to ensuring a favorable resolution to the incident. Individuals diagnosed with autism may have heightened emotional responses in these volatile and stressful situations. For persons with ASD, emergencies are difficult to comprehend. During these confusing events, a person with ASD may fail to respond to vocal directions, may exhibit a startle response when touched, may run when addressed, or may engage in self-injurious or aggressive behavior.

For emergency responders, interacting with individuals with ASD can be ambiguous and unpredictable. Therefore, it is essential that emergency personnel learn to respond as sensitively and efficiently as possible to individuals diagnosed with ASD, so attempts to speak with or care for the individual does not inadvertently cause the individual’s behavior to escalate. As you may know, this is especially important during a medical crisis because individuals with autism cannot always communicate feelings of pain or discomfort. A person with ASD may already be feeling frustrated and possibly agitated by his or her inability to convey his or her experiences and needs, thus when approached that individual may respond in an unpredictable and unconventional manner. It is important that first responders be prepared for such unusual responses, incongruent emotions, and failure to respond to directives and questions.

In addition to providing police officers and first responders with information about autism symptoms more generally, an important next step is to teach first responders how individuals with ASD might behave in a crisis. In particular, emergency personnel need to understand how individuals with ASD might act when they are agitated, confused, overwhelmed, or in pain.

A Child or an Adult Diagnosed with an Autism Spectrum Disorder May:
• Avoid eye contact.
• Walk away from familial residence or a group home to local pools or other places they enjoy. They may wander into traffic, not understanding environmental dangers.
• Be overstimulated and not comply appropriately to police or first responders’ instructions. For example, they may not respond to directives such as “get out of the street” or “let me see your hands.”
• Become preoccupied with certain objects or interests, such as planes, trains, fire trucks, or movies.
• Repeat or echo phrases, words, or actions.
• Not know how to relate, talk, or play with others.
• Have sensory sensitivity, manifested by stereotypical behaviors which may include covering their ears, flapping their hands, spinning, toe walking, or making unusual noises among others.
• Become agitated due to the disruption in their routine.
• Have unusual reactions to the way things in the environment look, feel, smell, sound, or taste.
• Be nonverbal and unable to communicate effectively.
• If verbal, may have difficulty understanding questions or may respond noncontextually. For example, they may simply script from a movie or speak about their special interests or ask repeated questions about the responder’s personal life.
• Be unable to communicate that they are in pain.

A first responder will be able to interact more appropriately with a person with autism if he or she is able to recognize that the person may have ASD. Once the first responder has learned to make this identification, he or she should become familiar with the following crisis response and intervention safety habits.

Crisis Response and Safety Habits:
• Take 30 seconds to assess the situation and the scene before responding.
• Remain calm.
• Use an even, controlled tone of voice with minimal directives, including simple phrases and visual cues such as pointing or using simple gestures that may be easily understood by minimally verbal individuals.
• Pay close attention to the person’s body language, tone of voice, gestures, and any other signs of potential agitation.
• Practice trauma-informed care and assume that everyone has experienced some type of trauma and is easily startled.
• Respect personal space, except when it is absolutely necessary to approach the person. Remember that getting too close may increase agitation in some individuals with ASD.
• Assess the situation objectively and ask the person or someone familiar with the individual with ASD what he or she wants/needs while maintaining a safe distance.
• Reduce stimulation and allow time and space for the person to process information and requests. For example, it might be helpful to clear the area of additional people, turn off the lights of the emergency vehicles, and eliminate other extraneous noises as possible.
• Be prepared and practice situational awareness. Know your surroundings and the location of the closest exit.
• Deflect aggression and block self-abuse when possible.
• If a physical intervention is necessary because the situation is unsafe, establish control in a safe, non-threatening manner. Remind the person that you are there to help.
• Recruit familiar and trusted persons to assist you in understanding how to approach the individual.

When police officers and first responders receive training in interacting and treating individuals with ASD, incidents in the community may be resolved quicker and more effectively. With quality training, headlines reporting distressing incidents, such as that above, may be a thing of the past. Instead, the type of training discussed here, when offered regularly to our dedicated police officers and first responders, could result in positive approaches similar to this:

Autism awareness is essential for all members of the larger community, but is truly imperative for first responders. In the absence of information, first responders may misinterpret the behavior of a person with ASD, may ascribe hostile intent to agitated behavior, may inadvertently escalate the behavior of the individual, or may fail to safely calm the individual. In cases such as these, there can be dangerous consequences. An opportunity exists for ASD service provider agencies to provide specialized training to local first responders. Providers can contact law enforcement officials and other emergency personnel to offer informational training sessions on a local level. In our experience, the administrators are routinely grateful and accommodating about arranging such training.

First responders need a dual skill set. First, they need accurate information about persons with ASD, including their behavioral characteristics, and secondly, they must use skills to de-escalate the situation when they engage with a person with autism who is in a confused and agitated state. With community outreach, negative outcomes can be averted, bridges can be built, and wider acceptance of persons with ASD can become a reality.

The following resource provides additional information related to first responders:
• Living with Autism – Autism Information for Law Enforcement and other First Responders
• Training for Indiana’s First Responders: Recognizing and Responding Appropriately to Individuals with Autism Spectrum Disorders
• Living with Autism – Autism Information for Law Enforcement and other First Responders
The reader may also be interested in the following ASAT articles:
• Teaching Safety Skills to Adolescents
• Bolting and Neighborhood Safety

Citation for this article:
Parenti, K. (2017). Clinical Corner: First responders’ education in autism. Science in Autism Treatment, 14(4), 6-8.


About The Author

Dr. Karen Parenti serves as the Executive Director of Melmark PA. Karen oversees the development and implementation of programs, as well as the daily operations of Melmark PA. She develops strategic objectives for the Pennsylvania Division, and provides leadership to direct reports in order to assure the achievement of these objectives. Karen also supports the CEO and the Board of Directors through various committees and activities, assuming responsibility for excellence in care and delivery of all services, policy development, quality assurance, risk management, regulatory compliance, and fiscal integrity. Joining Melmark in April 2016, Karen served as Senior Director of Adult Services. In this role, she was responsible for the oversight of all adult day and vocational programs, as well as the adult campus and community residential programs, which include intermediate care facilities that serve individuals with intense medical challenges. She has also served in the role of clinical trainer by teaching crisis prevention and intervention, dual diagnoses, ethics and boundaries, abuse prevention, and behavioral strategies. Karen earned her doctorate degree in clinical psychology, with a concentration in neuropsychology, from Immaculata University. A graduate of York College, Karen also holds a master’s degree in Human Services Administration from Springfield College in Wilmington, Delaware.

Posted in ABA

The Importance of Replacement Behaviors

I’ve written several posts about the importance of reinforcement, but now I want to turn my attention to another important concept: replacement behaviors. It can be very easy to slip into the habit of telling kids what NOT to do. “Don’t touch that! Don’t pick your nose! Don’t run!” However, if we can turn it around and tell kids what to do instead we often see higher rates of compliance.

Here are a few examples of replacement behaviors you can teach:

  • A student refuses to speak when he/she does not understand a question. You can teach the student what to say, such as “I don’t understand” or “Can I get help?” Teach through modeling and role playing in one-to-one settings, then generalize it to the classroom or other environments in which the skill is necessary.
  • When you begin a math lesson, one student frequently attempts to run out of the room. Introduce a signal or symbol (such as a holding up a stop sign) to request a break. Initially, you might give the break each time the student uses the sign correctly, then begin to require more and more math work before a break is received. This allows for appropriate and safe breaks without disrupting the rest of the class.
  • When your learner is done with dinner, he pushes his plate into the middle of the table. Teach your learner to instead put items in the sink. You might start with just placing the fork in the sink, then add more and more items until he/she is clearing the table independently. Another replacement behavior may be to use a symbol or signal as in the previous example to request to leave the table, or to teach the learner to say “May I go?”

Replacement behaviors should be simple to implement, should be taught one-on-one with multiple opportunities to practice and be reinforced, and should, if possible, be functionally equivalent to the undesirable behavior. (For example, if a child is engaging in one behavior to escape, the replacement behavior should teach a more appropriate way to escape.)

Sometimes, simply instructing the learner on a replacement behavior makes a huge change, but often you need to combine teaching a replacement behavior with other strategies (such as differential reinforcement). What I do know is that identifying and teaching a replacement behavior is a necessary part of almost any intervention and should not be overlooked.


About The Author

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 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 and the Senior Clinical Strategist at Encore Support Services.

Using Differential Reinforcement of High Rates of Behavior to Increase Preferred Behaviors

Differential Reinforcement of High Rates of Behavior (DRH) is “reinforcing only after several responses occur at or above a pre-established rate” (Mayer, Sulzer-Azaroff, & Wallace, 2013). There are times when a behavior is already in a student’s repertoire, but you may want to increase the rate of the behavior.

For example, let’s say Harold frequently won’t get up independently on weekdays before school. It’s driving his parents crazy, because they have to drag him out of bed several days a week. You may set up a DRH to increase the rate of him getting up independently. Since Harold currently gets up independently at least one time per week, you would set the goal for two times per week. (You don’t want to set the goal too high, because then Harold might not ever come into contact with reinforcement, and his behavior will likely remain unchanged.) Let Harold know that if he gets up independently two days in a row, you will make his favorite breakfast on the second day. Once Harold has met this goal a few time, increase the requirement for reinforcement. You would move from two days in a row to three days in a row in order to receive his favorite breakfast.

You would continue this until you had reached a pre-arranged goal. It’s important to be realistic in our expectations. You don’t want to change the goal to quickly or make it unreachable. You also don’t want to place higher demands on an individual with disabilities than you do the general population (as discussed in our previous Simplifying the Science article). Many people, for instance, hit the snooze button several times before they actually get up, so it may not be necessary to require an individual with disabilities to wake up the very first time the alarm clock rings 100% of the time.

You may discover that your intervention with Harold is working quite well for a couple weeks, then suddenly stops working. You may need to backtrack a bit, and require fewer consecutive days of independently waking up. Or, you may need to vary the reinforcement. It’s possible that having his favorite breakfast has lost some of its power as a reinforcer.

Finally, after the behavior has reached your goal rate, you should begin to fade the reinforcement entirely. Of course, Harold should still have access to his favorite breakfast, but you should not continue to give it to him on the fifth consecutive day of waking up independently for years to come!

DRH is yet another variation of differential reinforcement that can be very useful for you. It’s also provides an opportunity for a much more positive interaction than introducing punishment to Harold for not waking up independently, and can decrease everyone’s stress levels at the beginning of the day.


About The Author

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 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 and the Senior Clinical Strategist at Encore Support Services.

Posted in ABA

Focus on Generalization and Maintenance

On more than one occasion, I’ve been in the situation that a student will only demonstrate a skill in my presence. And I’ve heard from other colleagues that they have had similar experiences. This is highly problematic. When it happens with one of my students, there is only one person I can blame: myself.  A skill that a student can only demonstrate in my presence is a pretty useless skill and does nothing to promote independence.

So what do you do when you find yourself in this situation? You reteach, with a focus on generalization. This means that, from the very beginning, you are teaching with a wide variety of materials, varying your instructions, asking other adults to help teach the skill, and demonstrating its use in a variety of environments. Preparing activities takes more time on the front-end for the teacher, but saves a ton of time later because your student is more likely to actually master the skill. (Generalization, after all, does show true mastery.)

Hopefully, you don’t have to do this, though. Hopefully, you’ve focused on generalization from the first time you taught the skill. You may see generalization built into materials you already use, such as 300-Noun List at AVB press.

Another commonly cited issue teachers of children with autism encounter is failure to maintain a skill. In my mind, generalization and maintenance go hand-in-hand, in that they require you to plan ahead and consider how, when, and where you will practice acquired skills. Here are a few tips that may help you with maintenance of skills:

  • Create note cards of all mastered skills. During the course of a session, go through the note cards and set aside any missed questions or activities. You might need to do booster sessions on these. (This can also be an opportunity for extending generalization by presenting the questions with different materials, phrases, environments, or people.)
  • Set an alert on your phone to remind you to do a maintenance test two weeks, four weeks, and eight weeks after the student has mastered the skill.
  • Create a space on your data sheets for maintenance tasks to help you remember not only to build maintenance into your programs, but also to take data on maintenance.

Considering generalization and maintenance from the outset of any teaching procedure is incredibly important. Often, when working with students with special needs, we are working with students who are already one or more grade levels behind their typically developing peers. Failing to teach generalization and maintenance, then having to reteach, is a waste of your students’ time.


Written by Sam Blanco, PhD, LBA, BCBA

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 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 and the Senior Clinical Strategist at Encore Support Services.

What does it mean to become an advocate for my child on multi-disciplinary teams?

This month’s ASAT feature comes to us from Heyde Ramirez, MA, BCBA, LBA and Maria Pantelides, MA, BCBA, LBA. 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! You can read more of our ASAT featured posts here.

My 3-year-old daughter demonstrates symptoms of ASD and a diagnosis is pending.  I am encountering an array of professionals and am wondering who does what and how I can better understand these relationships while advocating for my daughter. 

Answered by Heyde Ramirez, MA, BCBA, LBA and Maria Pantelides, MA, BCBA, LBA

Attentive Behavior Care

Note: This article has been adapted with permission from Attentive Behavior Care and the authors and will be published in the December 2019 issue of Science in Autism Treatment, the monthly publication of the Association for Science in Autism Treatment.

The definition of the word advocate is to speak, plead, or argue in favor of. When you have a child with special needs, one of the biggest roles you will ever undertake is that of being your child’s advocate. As an advocate, you are your daughter’s voice to make sure she is treated fairly, recognized, and afforded access to evidence-based practices, as well as all the services and resources she needs in order to reach her full potential. Naturally, a parent is often the most important advocate although a child can have multiple advocates: for example, a lawyer or another family member.

Things You Should Know

Early intensive intervention will provide your daughter with a path to making the most gains. It will be important that intervention starts as soon as possible following a diagnosis, and is carried out by individuals who utilize best practices based on research.

Be prepared to present facts and documentation in support of getting your daughter’s needs met. It is important that you ask many questions, listen to the answers closely, and take lots of notes. Save all emails so you can refer back to them in the future and have a record of the communications regarding your daughter’s service provision.

It is also important that you know your child’s rights. The disability and mental health systems are complex. Having a knowledgeable “advocate” to assist you can be an invaluable support. Talk to other parents who have walked this path before you so you can learn from their experiences. Each state has their own set of laws and regulations, so it could be helpful to hire a lawyer if needed.

In your journey, you and your daughter will encounter an array of professionals:

Medical Providers

Medical providers will be your go-to resource when it comes to making sure that your child’s medical needs are met. They were probably your first contact, especially since your daughter is not yet in school.  Your child’s medical team may include several types of medical doctors.

Pediatrician/Primary Care Doctor: The pediatrician will oversee and manage your daughter’s health needs and monitor her development. At check-up visits, talk to the pediatrician about your concerns. Remember that your medical providers rely on the information you report.

Keep your pediatrician apprised of progress your daughter is making and any areas where you continue to have concerns.

Pediatric Dentist: The pediatric dentist has been trained to treat children from birth to adolescence. Dental visits can be difficult if your child has autism. Fill in the dentist on your daughter’s needs. Nowadays there are many pediatric dental clinics available that are willing to follow through with behavior intervention plans and work with you to make the dental visit less stressful for your daughter. Ask your pediatrician for a referral or talk with other parents who are happy with their dental care providers (please see a recently published resource list from ASAT).

Psychiatrist/Psychologist: If your daughter demonstrates various symptoms not related to an ASD diagnosis, then contact with a psychiatrist or psychologist would be beneficial. Other diagnoses can be extremely important when it comes to receiving the necessary individualized treatments which may include medication. In some cases, assessment is carried out by a psychologist who typically holds a PhD or a PsyD rather than a medical degree. A psychologist could provide counseling or behavioral treatment for behaviors that occur.

As an advocate for your child, you can seek out a comprehensive psychiatric/psychological evaluation for your child. These evaluations provide important information that should be shared with the entire team. The information provided can include, but is not limited to, direct observations, parental reports, autism diagnostic testing results, IQ testing results, findings from measures of adaptive behavior, other potential diagnoses, and recommendations for treatment. If anything you read is not clear or seems inaccurate, be sure to ask questions.

The School Team

Children spend a large portion of their lives learning, sharing meals, and socializing in school, and teachers, teacher’s assistants, and other school staff will get to know your child on an individual and personal level. The school team will quickly learn about how your child functions in school and what goals might be needed to ensure her success in school. If your daughter were to be diagnosed with ASD, you will likely meet with the school team several times a year at parent-teacher conferences and other meetings such as Individualized Education Plan (IEP) meetings.

Federal law provides for procedural safeguards to ensure your child receives the supports and accommodations needed to help her make progress and work towards her potential. If you feel that your daughter is not making progress or that the school is not meeting her needs, speak up and ask questions! Include related documentation to support or convey your concerns.

Special Education Teacher/General Education Teacher: Depending on the needs of your daughter and what type of classroom she is in, she may receive instruction from a special education teacher and/or a general education teacher. Special education teachers are trained to work with students who present with various disabilities. In general, teachers make themselves formally available to discuss academic growth at least twice a year at parent-teacher conferences. When you have questions or concerns about your daughter’s academic or social progress at school, request extra meetings with teachers or the school team.  If there are barriers in place that are slowing progress, the teacher can work with you and the team in order to address those barriers.

Teacher’s Assistants and Aides (Paraprofessionals): It’s possible for your daughter to have multiple teacher’s aides in the classroom. Their role is to assist the teacher in maintaining a safe and effective teaching environment. They may implement the education and behavior intervention plans developed for your child and/or other accommodations made so that your daughter has the appropriate support to work towards mastery of the goals on her IEP. There can be limitations on what exactly the teacher’s aide can do and this can vary by state. For example, in New York, a teacher’s aide with a teaching assistant certificate is allowed to provide direct instruction to students under the supervision of the certified teacher. You can request that the teacher’s aides also be present during team meetings. They will also know your child very well and may be able to provide additional information on how your daughter is doing.

Related Service Providers

If your child has an Individualized Education Plan (IEP) there is a chance she has a team that includes various therapists such as speech/language, occupational, and physical therapists. In some states, a prescription is necessary to receive a related service, such as occupational therapy. Keep the pediatrician up to date on the information you receive from related service providers.

Speech/Language Pathologists: Speech language pathologists (SLP) are trained to prevent, assess, diagnose, and treat speech, language, and communication disorders in children and adults. Many have also received training to address feeding issues. Whether your child is non-vocal, has difficulties being understood, gags when trying to swallow food, or presents with other communication or speech deficits, a speech/language pathologist can be a great resource and valuable member of the team. You can request that your daughter be evaluated and that goals be developed to increase your daughter’s receptive and expressive communication abilities.

Occupational/Physical therapists: These providers are recommended when your child has motor difficulties completing everyday activities. Occupational and physical therapists do their best to help your child develop and improve their fine and gross motor skills so that they can interact with their environment as independently as possible. Occupational Therapists typically focus on assessment and treatment of activities of daily living (such as eating, dressing, playing) and physical therapists focus on gross motor skills (e.g., walking, climbing stairs).  As an advocate, present your concerns regarding what your child can and cannot do. The aim is always to increase independence. For example, the ability to open a container can actually be life-changing.

ABA Providers

Applied behavior analysis is the treatment of choice for ASD as it is an evidence-based practice. So, you may have contact with providers who specialize in this method. The Board Certified Behavior Analyst (BCBA) and Registered Behavior Technicians (RBT) may be invaluable members of your team, particularly if your daughter is receiving services in the home or in an early intervention setting. Some schools may not have BCBA’s or RBT’s on staff and School Psychologists may be responsible for intervention development.

Board Certified Behavior Analyst (BCBA): The BCBA on your child’s team is responsible for assessing your child’s current ability and any barriers to learning that may be present. A certified behavior analyst conducts functional assessments in order to identify problematic behaviors, the events that trigger them, why behaviors are occurring (e.g., is it to get away from something, to gain access to something), and possible replacement behavior that can be taught. The BCBA on your team may provide you with training so that you can also implement recommended strategies with your child. They are also prepared to work with the team to best serve your child and increase her quality of life. In some cases, the school psychologist will fulfill this role.

Registered Behavior Technician (RBT): Registered Behavior technicians implement the behavior and skill acquisition treatment plan and collect data as directed by the BCBA.

All of these people come together and form a team that also includes the family and of course, your child. As you step into this new role as an advocate for your child, take advantage of supports and resources that are available to you. Members of the team may recommend webinars or other materials that will provide you accurate up-to-date information about the challenges your daughter faces and effective interventions.

Additional Resources

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


Heyde Ramirez received her Bachelor’s Degree in Psychology and her Master’s Degree in Applied Behavior Analysis from Queens College in 2012. As part of her graduate course work, Heyde worked with students with Autism and subsequently published a study on simultaneous prompting procedures. Following graduation, she became a Board Certified Behavior Analyst (BCBA) and continued to work with individuals with Autism and other developmental disabilities across various settings providing direct therapy, BCBA supervision, parent training, assessment and treatment planning.

Maria Pantelides is a Board-Certified Behavior Analyst and Licensed Behavior Analyst in the states of Connecticut, Maryland, Massachusetts, and New York with over 10 years of experience working with children, teens, and adults with autism and providing ABA services. Maria earned her Bachelor of Arts degree in Psychology with honors and her Masters of Arts degree in General Psychology with a focus in Applied Behavior Analysis, from Queens College, City University of New York. Maria has provided one to one instruction, supervision, training, parent training, and consultation to home and school programs. Maria specialized in the treatment of children with autism in both the home, community, and school setting. Maria is currently a Regional Clinical Director with Attentive Behavior Mental Health Counseling, PC. As Regional Clinical Director she supports and monitors BCBAs, technicians, and families in getting quality ABA services.

Posted in ABA

Cultural Competency in ABA Practice

The Behavior Analyst Certification Board (BACB) on their website lists credentialed behavior analysts from 99 countries spanning across 6 continents. Behavior analysts and consumers of behavior analysis are now establishing footprints across the globe. Each of these countries comes with its own set of cultural practices and norms. Leon Megginson, author of Small Business Management said, “it is not the strongest, or the most intelligent who survives, but the one most responsive to change”. Considering the high rates of global migration and the international dissemination that our field desires, practitioners find themselves serving an increasingly diverse population. A recent article in Behavior Analysis in Practice by Andrea Dennison and colleagues highlights the variations in cultural norms, caregiver and practitioner linguistic competencies that a culturally competent ABA therapist must consider when designing a home program.

What are the barriers?

The Professional and Ethical Compliance Code for Behavior Analysts from the Behavior Analyst Certification Board requires that behavior analysts consider the role of culture in service delivery (BACB code 1.05c), involve clients and families in treatment process (BACB code 4.02), and individualize the treatment plan to meet client needs (BACB code 4.03). Yet the BACB Fourth Edition Task List and the upcoming Fifth Edition Task List which define the scope of practice of a credentialed behavior analyst do not make much mention of culture – which means that training programs do not typically include cultural competence. Dennison and colleagues (2019) identified several barriers in ABA treatment for culturally and linguistically diverse families and highlighted ways to overcome them.

Do we hold stereotypes?

With the influence of the media or the people around us, we tend to categorize people into social groups and create a simplified conception of the group based on some assumptions – we create stereotypes and hold prejudices. Implicit biases held by a practitioner towards certain cultural sub-groups may result in a subtle, yet observable bias towards the client, and adversely impact treatment outcomes. Dennison et al (2019) suggest that a practitioner’s “self-reflection and introspection regarding cultural attitudes and practices towards clients” may be a first step towards undoing these biases.

Are we aware of cultural norms?

Practitioners often find themselves in a variety of contexts and situations with varying contingencies. Each culture comes with its own set of learned behaviors, beliefs, and norms. Dennison and colleagues add that some cultures might prefer a warm, informal discussion with a service provider prior to a formal meeting to discuss goals. A violation of this might seem off-putting to the client, and conversely, such an expectation for an informal discussion might catch the analyst unaware. In some cultures even a simple handshake for greeting might be offensive They recommend that practitioners monitor clients for signs of discomfort or displeasure during the course of the treatment to identify whether a cultural norm has been violated.

What to do when a practitioner doesn’t speak the home language of the client?

A language mismatch between the practitioner’s language and the home language of the client might lead to information loss. A client might not be able to completely express their priorities in terms of the services they need. Dennison urges practitioners to make every attempt to invite a bilingual practitioner or interpreter either in-person or online, to future family meetings. Providing the family with access to ABA textbooks written in their home language might be a good way to introduce ABA terminology and lead to better acceptability of services delivered. The authors caution against using loosely translated words; online tools might not be ideal for activities that require precise definitions.

Cultural analysis

“A cultural analysis involves an individual analysis of the cultural factors affecting an individual’s environment and the resulting contingency”, the authors add. A re-assessment of priorities in goals might be warranted, and a cultural analysis might inform what behaviors are identified as the primary targets for intervention. Dennison refers to the importance of social etiquette and the value placed on conflict avoidance in Latin cultures as an example. Measuring social validity might give the analyst information about whether the family sees the behavior change as meaningful.

Empathy grows as we learn

Try not to stigmatize immigrant families as “uncaring” for not seeking services earlier. Several socioeconomic stressors such as lack of housing and transportation availability likely play a role in their decision. The authors urge practitioners to empathize with these families and add that attempts to empathize can be made even if the practitioner and family do not share a common home language.

Finally, the lack of diversity in research with the omission of demographic details such as language and ethnicity of participants in scientific publications overlooks the critical value of such information. This calls for a shift in the field towards intentionally inclusive subject recruitment and the reporting of such information.

A culturally competent behavior analyst is not one who knows everything there is to know about every culture. This would be impossible. It is someone who can acknowledge that patterns of cultural difference may be present, and are then able to view a situation from a different cultural perspective than one’s own. Maintaining a curiosity about each client’s culture, and having an open dialogue with them about their background, ethnicity, and belief system can result in a positive outcome for the client and the analyst.

“If we are going to live with our deepest differences then we must learn about one another.”  ― Deborah J. Levine

References

Dennison, A., Lund, E., Brodhead, M., Mejia, L., Armenta, A., & Leal, J. (2019). Delivering Home-Supported Applied Behavior Analysis Therapies to Culturally and Linguistically Diverse Families. Behavior Analysis in Practice, OnlineFirst, 1-12.


About The Author

Maithri Sivaraman is a BCBA with a Masters in Psychology from the University of Madras and holds a Graduate Certificate in ABA from the University of North Texas. She is currently a doctoral student in Psychology at Ghent University, Belgium. Prior to this position, Maithri provided behavior analytic services to children with autism and other developmental disabilities in Chennai, India. She is the recipient of a dissemination grant from the Behavior Analysis Certification Board (BACB) to train caregivers in function-based assessments and intervention for problem behavior in India. She has presented papers at international conferences, published articles in peer-reviewed journals and has authored a column for the ‘Autism Network’, India’s quarterly autism journal. She is the International Dissemination Coordinator of the Association for Science in Autism Treatment (ASAT) and a member of the Distinguished Scholars Group of the Cambridge Center for Behavioral Studies.

Focus on Reinforcement

Teaching can be incredibly overwhelming, especially in a special education classroom. Between paperwork, lesson planning, updating bulletin boards, and actually teaching, the day can get pretty hairy. Sometimes, that stress leads to a short temper, which can lead to a punitive classroom environment.

If things seem to be going in the wrong direction in your classroom, the first thing you should do is focus on reinforcement. Here are a few steps to consider:

  1. Identify 1-3 behaviors you would like to see your students exhibiting. For instance, maybe you’d like to see an increase in hand-raising (as opposed to calling out.) Clearly define the behaviors you want to see.
  2. Set up a contingency for increasing those behaviors. Maybe you’ll wear a MotivAider to give yourself a reminder throughout the day to provide verbal praise to students exhibiting the target behavior. Maybe you’ll have students earn points that they can exchange for other things, such as a homework pass or lunch with the teacher. Maybe you’ll encourage students to recognize each other when they engage in the target behavior.
  3. Teach the students about the target behavior(s). Introduce the goals to the students. It’s helpful to create a sign or other visual to remind students about the new goals.

While these are simple steps, providing more verbal praise and other reinforcement can turn around a classroom with too much time spent on reprimands and punishments.

It’s also helpful to remember (especially for new teachers) that you can make changes at any time. One of my mentors in my first year of teaching told me to tell my class we had gotten off track, so we were having a brand new first day of school. (I was teaching fourth and fifth grade students with emotional behavioral disorders.) It was shocking how well that new first day of school went over. The students were excited about the idea of a “fresh start” in the middle of the school year, and it helped me get back on track with creating a more positive learning environment.

Ultimately, the goal is to teach students about appropriate behavior by spending more time showing them what they’re doing right than focusing on what they’re doing wrong.


Written by Sam Blanco, PhD, LBA, BCBA

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 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 and the Senior Clinical Strategist at Encore Support Services.

Posted in ABA