Discussing Concerns With Family Members

This month’s ASAT feature comes to us from Peggy Halliday, MEd, BCBA and David Celiberti, PhD, BCBA-D. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!


I am concerned that my two year old grandson may have signs of autism, but I am uncomfortable bringing this up with my son and daughter-in-law. Do you have any suggestions about how best to approach them?

 

It is natural to be unsure of how to share your concerns with your grandson’s parents. As is the case with many concerned family members, you may worry that such a discussion will not be well received or may cause some discomfort or tension in your relationship. If autism is a possibility, you would not want to delay screening and referral for possible evaluation and services because this may waste valuable time during which intervention can be most beneficial for your grandson. Even knowing that the best outcomes are associated with early diagnosis and intensive intervention, it still may be difficult to talk to your son and daughter-in-law if they have not expressed their concerns to you.

As a grandparent, you have already raised at least one child, so you probably have a good sense of what is typical in child development, and what is not. You may feel that your grandson is not making expected gains or may appear delayed in some areas such as communication or play relative to other children his age. Also, you may not have day to day contact so slower development of skills may be more apparent to you. This may create a sense of urgency in you that should be balanced with the need to support your son and daughter-in-law.

There are several important considerations. The way in which you approach your son and daughter-in-law will depend in large part on the quality of your pre-existing relationship and on the nature of how you communicate with one another. You may possess a relationship where difficult issues are frequently and easily discussed. On the other hand, this may not typify the type of relationship that you have. Regardless of your relationship, it is important that you bring this up from a place of love and concern, rather than judgment and blame. Many parents who have been carefully and respectfully approached by a relative later admit that they already had concerns of their own, and it was a relief to discuss them with someone else close to the child.

We would like to offer some concrete suggestions that may increase the likelihood that your discussion will be positive and constructive.

Planning Ahead:

  1. Take some time to think about what you want to share and how you want to frame your concerns. You might begin by commenting on the child’s strengths and praising the parents’ love and dedication to their child. It is important not to appear judgmental or focused only on the concerns.
  2. Plan your discussion ahead of time. Find a time and place when you will not be interrupted. It may be best when the child is with another caregiver.
  3. The role you take in the child’s life depends, of course, on geographic proximity, but be poised to offer concrete, practical help whenever possible. For example, you might offer to babysit siblings while parents pursue evaluation of the child, or offer a respite weekend of childcare so that your son and daughter-in-law might have time to discuss the situation without interruption. Whatever assistance you offer, the important thing is that your grandson’s parents perceive it to be helpful, so try and gauge their reactions carefully.

Having the Conversation:

  1. Try to keep the conversation free flowing. You may want to ask a few questions that will allow the parents to express their own concerns, if they have them (e.g., “I noticed that Billy became very upset when the phone rang. Has that happened before?” or “Does he seek you out when he is upset?”).
  2. Avoid labels and technical terms, which may trigger fear or upset from the parents. Focus instead on discussing milestones, which are observable indicators of a child’s development and accomplishments.
  3. In some cases, it may be beneficial to think about the discussion as a series of tiny conversations. This would be more appropriate if you have frequent contact with your son or daughter-in-law. It may then be helpful to share some observations that may provide a backdrop for later discussion (e.g., “Little Peter seems overwhelmed by noise levels.” or “I have noticed that he does not seem to know how to use words to get his needs met.). It may also be helpful to discuss observations surrounding worrisome or absent peer or sibling interaction.
  4. Emphasize the need to simply get any concerns checked out in order to “rule out” anything serious or to get some guidance and support in how to promote skill development. You might follow this up by mentioning that the earlier a potential problem is recognized and addressed, the easier it is to help the child.

Other Considerations:

  1. Most parents begin to become concerned that something may be wrong when their child is between the ages of 12 and 18 months. If the parents are beginning to realize a potential problem exists, you want to gently urge them not to delay a preliminary assessment and evaluation.
  2. You should never take for granted that developmental concerns will automatically be addressed during routine visits to the pediatrician. Refer parents to resources such as good websites and resources they can explore on their own (we emphasize the word “good” as there is a tremendous amount of misinformation about autism both in the media and on the Internet, particularly many false promises about autism treatment). The most helpful websites at this stage are typically the ones that discuss developmental milestones. Parents often know when to expect their infant and toddler to sit up or take their first steps, but they do not know when they should begin to babble with inflection, point to things they notice or want, imitate gestures, or show interest in another child.
  3. If the child is in a daycare, speak to his or her teachers and directors about the child’s progress. They should be keeping records on how the child is developing in different areas such as social interaction, verbalization, etc. They are also a good resource to use to help evaluate your child in a school setting.

The following websites include milestones checklists, booklets, and charts, and a wealth of other helpful information.

  • Association for Science in Autism Treatment (ASAT): On the ASAT website, you will find extensive information about the scientific support (or lack thereof) behind the full array of treatments proposed for autism, research reviews, articles and guidelines on how to make informed choices, and weigh evidence in selecting treatment options, a section of frequently asked questions such as the one you asked, information about upcoming conferences of interest, and links to helpful sites and other science-based organizations.
  • Centers for Disease Control and Prevention: The Act Early website contains an interactive and easy- to-use milestones checklist you can create and periodically update for children ages three months through five years, tips on sharing concerns with the child’s doctor, and free materials you can order, including fact sheets, resource kits, and growth charts.
  • First Signs: The First Signs website contains a variety of helpful resources related to recognizing the first signs of autism spectrum disorder, and the screening and referral process. There is a directory of local resources for at least eight states and that number is likely to increase over time.
  • American Academy of Pediatrics (AAP): The AAP website contains information for families, links to many other web sites, information about pediatrician surveillance and screening, and early intervention. This site contains great tools for pediatricians, as well as parents.
  • Autism Speaks: The Autism Speaks website includes an Autism Spectrum Disorder Video Glossary of clips designed to help parents and professionals learn more about the early ‘red flags’ of autism, information about how autism is diagnosed, and a resource library. They also offer a free 100 Day Kit designed to help families of newly diagnosed children make the most of the first 100 days following a diagnosis of autism.

About The Authors

Peggy Halliday, MEd, BCBA, is a Board Member of ASAT, and serves as the JCH Director of School Consultation at the Virginia Institute of Autism (VIA) in Charlottesville, Virginia, where she has been a practitioner since 1998. Peggy oversees trainings for parents and professionals and provides consultation to public school divisions throughout Virginia. She also oversees BCBA and BCaBA training experiences. In addition to serving as a presenter at state and national conferences, including the Organization for Autism Research (OAR), Commonwealth Autism Service (CAS), and Association for Behavior Analysis International (ABAI) Peggy was selected as an autism expert for the “how-to” website monkeysee.com. Peggy has been on the board of ASAT since 2010 and serves on the Public Relations Committee.

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.

 

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Got Questions: Help for Socially Anxious Preschooler Who Has Autism

This piece originally appeared at Autism Speaks as part of their Got Questions? series.

My almost 3-year-old was recently diagnosed as having autism spectrum disorder. We struggle going places such as open gym or even the library because he doesn’t like other kids in his space. He does okay with adults, but other kids make him extremely anxious. How do I help him become more comfortable when other children are playing in the same area or with the same set of toys?

I commend you for seeking support for your son at this young age. Receiving a diagnosis of autism spectrum disorder can be challenging and confusing. Yet research shows that early intervention can help maximize cognitive, language and social development.

In my pre-doctoral work at UCLA and my post-doctoral training at Pediatric Minds Early Childhood Treatment Center, my colleagues and I have seen many forms of anxiety in children and teens who have autism. Like your son, many of them experience anxiety around other children, especially groups of children. Understanding the reasons for this anxiety can help select approaches that help.

For example, you mention that your son “does okay” with adults, but not other kids. This is very common. While adults tend to be more consistently friendly and accommodating, children can be very unpredictable. For instance, it’s not unusual for three-year-olds to grab toys from each other, cry, get very close to each other and just be loud! This can be particularly anxiety provoking for someone with autism.

In addition, many people with autism are hypersensitive to sensory input. As a result, public places such as open gyms or even a lively children’s library can be over-stimulating. The sights, sounds and smells can feel intense, uncomfortable and overwhelming. Understandably, this can lead a child to avoid these environments and become upset in the midst of them.

I strongly encourage you to work with your son’s therapists to develop a personalized intervention plan. Children with autism who are under age 3 can qualify for such services through their state’s Early Intervention program. After age 3, these services can be accessed as part of an Individualized Education Plan (IEP) through your school district.

Also see “Access autism services,” for more information on early intervention and individualized education services.
Fortunately, many programs are available to help young children with the type of social anxiety you describe. These include play-based forms of Applied Behavioral Analysis, occupational therapy that includes sensory integration, communication-focused intervention, social skills play groups and other options. Many children do best with a multidisciplinary approach that combines two or more of these methods with close collaboration among the care providers.

Also see, “Autism therapies and supports,” in the “What is autism?” section of this website. While every child has different needs, here are some strategies you can try – ideally in collaboration with your son’s therapists.

Practice. Are there specific social situations that tend to trigger your son’s anxiety? For instance, does he get upset when another child tries to take his hand or pull him into a game? Consider teaching him simple phrases he can use in these situations. For example, a simple “no.” You can also teach and practice toy sharing and turn taking at home. If your child enjoys play dough, for example, place just a few pieces on the table and take turns modeling each of the pieces, handing them back and forth. This can help him learn sharing and even waiting for gradually increasingly periods before getting what he wants. These skills can be difficult to learn. So start with brief periods of waiting and offer plenty of praise along the way. Providing this type of structured opportunities to practice social skills can encourage your son to use them in social settings.

Start slow. A room full of children may be too overwhelming for your child to use the new skills that he’s practiced with you at home. Consider hosting a playdate with one other child who is relatively calm and engaging. Sometimes, a slightly older child will understand how to be more accommodating.

In selecting where to have the playdate, consider your son’s comfort level. You might start at home or maybe a relatively quiet place at a nearby park.

Choose some relatively structured activities such as games or sharable toys that your child knows and likes. Keep the playdates relatively short to further the chances of success.

Bring the familiar. When entering a loud or anxiety producing environment, a comfort object may help provide a sense of security in an otherwise overwhelming environment. Consider allowing your son to bring a familiar toy, stuffed animal or book. Another possibility is a toy or game that actively engages his attention – and so directs his attention away from the hubbub around him.

Be patient. I encourage parents to appreciate that their child’s stage of development may not match what’s typical for his or her age. This is particularly true of social development in children on the autism spectrum. By focusing on small steps, you can foster your child’s confidence and decrease the likelihood of setbacks.

Remember, your child – like all children – is continually developing. You can support his social development – while decreasing anxiety around other children – by providing ample opportunities for success.


About The Author 

Dr. John Danial is a 2012 Autism Speaks Weatherstone predoctoral fellow. Dr. Danial’s fellowship supported his work with mentor Jeffrey Wood at the University of California, Los Angeles, developing and evaluating behavioral interventions that reduce anxiety in children, teens and adults with autism and low verbal skills. He is currently completing his post-doctoral placement at Pediatric Minds Early Childhood Center, working with families of children with developmental delays and social-emotional challenges.

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Prompt Fading For Parents

This week, Leanne Page M.Ed, BCBA, offers advice on how to avoid prompt dependence. 

This piece originally appeared on bsci21.org.


“Dear Behavior BFF, I am not a parent myself but am writing you about my nephew. My sister and brother in law are constantly telling him what to say. “Tell her thank you. Say good morning. Say I want to eat dinner now.” I rarely hear the kid saying anything other than the exact words he is told to say. Is this normal? It seems like a terrible idea to me.”

The principles of behavior analysis can be helpful to anyone, not just parents.  What you are describing here is a high level of prompting that is likely leading to prompt dependence. The boy’s parents are giving so many prompts that he is not responding independently.

Is this normal? With parents – who knows?! We each do our own thing. We almost always start something with the purest of intentions as I’m sure your sister and brother in law have here. They want to help their son to speak, help him to participate in social interactions, and help him to learn to be respectful. But maybe they are helping too much.

It’s likely time for some prompt fading. When teaching new skills, it is common to start with high levels of prompting to help the learner practice success and receive positive reinforcement. But we can’t stay there forever. We have to fade out those prompts.

Other situations where parents are likely to over-prompt and be ready for some prompt fading strategies: toileting schedules and your child never initiates, always giving choices and never letting your child come up with a request independently, doing things hand over hand, doing daily living activities for your child, etc.

Step back one step on your prompts. Still provide a prompt, but scale it back a bit. Find where you are on this list and go down one.

  1. Full physical – hand over hand. Doing things FOR your child.
  2. Partial physical – still doing some parts hand over hand, but letting the child do some independently.
  3. Full verbal – telling them what to say as given in the original question above.
  4. Partial verbal – give part of the response, not the whole thing.
  5. Gestural – give a gesture or a cue

*This is not an exhaustive prompt hierarchy. There is more detail within behavior analysis but will stop here as parents are the intended audience and may not need that level of technicality.

Some ideas to fade out the full verbal prompt are to give an indirect or partial verbal prompt. From the examples you gave, instead, you could say:

“What do you say?”

“Do you need something?”

“Good ……”

Prompting your child can be a good thing, a great thing, even a research based thing. But when all you do all day is prompt- maybe it’s time to take a step back. Don’t drop the prompts all together. We still want to be sure the child is successful in each situation so they can gain reinforcement and see an increase of the desired behaviors in these situations.

Step back one prompting level at a time. When your child is successful at that level, step back again. Fade out the prompts until he is able to respond independently and the constant telling him what to say is a distant memory!

We barely scratched the surface on prompts and prompt fading. Here are some good places to start learning more about it!

Alberto, P. A., & Troutman, A. C. (2012). Applied behavior analysis for teachers. Pearson Higher Ed.

Cooper, J. (2009). 0., Heron, TE, & Heward, WL (2007). Applied behavior analysis.

MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. (2001). Prompts and prompt-fading strategies for people with autism. Making a difference: Behavioral intervention for autism, 37-50.


About The Author

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.

 

Using Contingency Contracts in the Classroom

As adults, we’re fairly accustomed to contracts for car loans, new employment, or updates to our smartphones. But contracts can also be beneficial in the classroom setting.
A contingency contract is defined as “a mutually agreed upon document between parties (e.g., parent and child) that specifies a contingent relationship between the completion of specified behavior(s) and access to specified reinforcer(s)” (Cooper, Heron, & Heward, 2007). There are several studies that indicate using a contingency classroom can be beneficial in the classroom setting.
Cantrell, Cantrell, Huddleston, & Wooldridge (1969) identified steps in creating contingency contracts:
(1) Interview the parent or guardian of the student. This allows you to work together to identify problem behaviors to be addressed, identify the contingencies currently maintaining these behaviors, determine the child’s current reinforcers, and establish what reinforcement or punishment procedures will be used.
(2) Use this information to create a clear, complete, and simple contract. The authors provide examples of how these contracts might look. You can vary the contract based upon the behaviors you are addressing with your student and the student’s ability to comprehend such contracts.
(3) Build data collection into the contract itself. You can see an example from the article below. For this example, it is clear how points are earned and how the child can utilize those points, and the contract itself is a record of both the points and the child’s behaviors.

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There are clear benefits to utilizing such contingency contracting: building relationships across different environments in which the student lives and works, addressing one or more challenging behaviors simultaneously, and providing opportunities for students to come into contact with reinforcement. You can read the entire article here:

Cantrell, R. P., Cantrell, M. L., Huddleston, C. M., & Wooldridge, R. L. (1969). Contingency contracting with school problems. Journal of Applied Behavior Analysis, 2(3), 215-220.

And much more has been written about contingency contracting. If you’d like to learn more, we suggest taking a look at one or more of the following:

Bailey, J. S., Wolf, M. M., & Phillips, E. L. (1970). Home-based reinforcement and the modification of pre-delinquent’s classroom behavior. Journal of Applied Behavior Analysis, 3(3), 223-233.

Barth, R. (1979). Home-based reinforcement of school behavior: A review and analysis. Review of Educational Research, 49(3), 436-458.

Broughton, S. F., Barton, E. S., & Owen, P. R. (1981). Home based contingency systems for school problems. School Psychology Review, 10(1), 26-36.

Miller, D. L., & Kelley, M. L. (1991). Interventions for improving homework performance: A critical review. School Psychology Quarterly, 6(3), 174.


WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently a PhD candidate in Applied Behavior Analysis at Endicott College. She is also a lecturer in the ABA program at The Sage Colleges.

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