Category Archives: Behavior

ABA Is Fun!

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ABA is Functional. Unique. Natural.

Here’s a great process to create a FUN ABA goal:

1. ABA goals are functional. This means goals are chosen because they are of importance to the child and the child’s ability to be a part of the community. That is, within the family, school, at the grocery store, etc.

Sam (not an actual client!) is doing really well with his preschool peers and the teachers are excited to move him up to Kindergarten. Our goal is to work on Kindergarten readiness skills: playing with toys in a functional manner, reading grade level words/letter sounds, and identifying numbers.

2. Each child is unique. The first thing we have to do is find the appropriate motivation. Children don’t fit into cookie cutter therapy programs. Every child is UNIQUE and will prefer different activities, experiences, foods, or toys. Identify a few of these highly preferred things your child enjoys.

Sam is pretty good at playing with a variety of toys, but ABSOLUTELY LOVES vehicles. In fact, this is the first thing he runs to during free play time and will sit for 15 minutes and play with airplanes and firetrucks. Sam will also consistently and quickly finish worksheets when told that he can play with vehicles after work.

3. Natural. A lot of people think that ABA only occurs at the table, but it actually occurs everywhere. ABA therapists may have to begin skill building at a table, but they will quickly work on generalizing skills to the natural environment. We want the child to be able to use all of that wonderful knowledge in all environments.

Time to piece it together! For Sam, we made a parking lot and filled in the parking spots with “targets.” Programs covered during his therapy time included:

– Receptive and Expressive identification of words and numbers (park the airplane in spot 11, what is parked in the spot that says “that”)
– Multiple step instructions (grap the red train, fill it up at the gas station, and park it in spot 20)
– Colors
– Block imitation from a model (Vehicles need gas to go! build a gas station pump that looks like mine!)
– Following instructions (Parking lots need stores! Go get the pile of blocks and build your favorite store)
– Receptive and Expressive Categories (where are the numbers/words/vehicles, what vehicle do you want?)
– Math, Counting (how many empty spots do we have left? How many more vehicles need spots?)
– Positional words (put the airplane on top of the store)
– Yes/no/not (is this a firetruck? find the airplane that is NOT yellow)
– Answering questions (the kids on this bus are hungry…where should they go?)

Remember: It’s important for children to play and have fun while they learn!

About The Author

Elizabeth Ginder, MSSW, BCBA, LBA is the Clinical Director of ABA Interventions, LLC. Elizabeth specializes in working with children ages 2 through early adulthood. She has experience working with children diagnosed with intellectual and developmental disabilities, as well as children with severe, challenging behaviors. Elizabeth also has a strong background in parent, teacher and staff training. Her focus is on verbal behavior, skill acquisition and teaching children how to have fun! You can find more information on ABA Interventions at their Facebook page or at www.aba-interventions.com.

The NR Blues

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What’s “NR” you ask? A common way to collect data after a trial in which the learner not only did not give a correct response, but didn’t respond at all, is to score “no response” (NR).

While motor actions can be prompted if the learner does not do anything, vocal responses cannot. I say to my staff all the time, “we can’t reach into his/her throat and pull out words”. So if you say to your client “What color is the sun? YELLOW” and they just stare at you, then that was a “no response” trial.

Many, many moons ago I worked at an early intervention clinic. We had one client in particular there, let’s call him Sam. Sam was the bane of my existence for a while, because he made me feel like an incompetent idiot.

 See, Sam was a very bright little boy with the most beautiful smile who could sing songs, answer questions, do simple academic tasks, and engage in various play skills. But then, Sam would hit a wall in his responding. He would remove all eye contact, stop smiling, and just stare blankly at…nothing. I haven’t met anyone since who could be looking directly at you, yet not looking at you at the same time. When Sam got like that he would not emit any of his target responses independently. This meant all motor actions were prompted, and good luck trying to do anything that required vocalizing. I just did not know what to do when this would happen, and it made me nervous to work with Sam because I knew it wouldhappen at some point.

Sam is who I think about when I am working with staff who are having a hard time “connecting” with a client in the session. I can absolutely relate to how it feels to bring your A-game, put on your animated face, and get a lot of nothing in return. It’s frustrating, and makes you doubt your skills.

When correct responding disappears from the session, some clients may turn super silly and distractible, or some may have a spike in aggression. Just between you and me, I would much rather deal with one of those scenarios. It’s the completely checked- out individual that I find to be the most difficult…..it is kind of like your clients body remained in the chair, but the rest of them got up, walked out of the building, and is headed somewhere FAR more exciting.

So if you are working with a Sam or two, here are a few things that definitely do not work, are ineffective, and should be avoided:

  • *Waiting the client out – I have seen a few therapists try this one, and usually the client is perfectly content to keep staring into space as you wait them out.
  • *Continue teaching/Keep up the status quo – Think of it like this, if your client has completely stopped any correct responding and you just keep plugging away: Is learning happening?
  • * Speak louder – Sound silly? I see it a lot, and back in the day I was guilty of this one too.
  • * “Saaaam…..Sam!….Helloooooo, Sam?” – If your client is not responding to demands to touch, give, open, or talk, odds are they also will not respond to their name being called.

Now that we got all the stuff that does not work out of the way, I really only have one suggestion for what you SHOULD try when those non- responsive blues kick in. It may be just one suggestion, but it can look about 900 different ways depending on the learner. 

Change something about YOU.

What my staff usually say to me (and how I used to look at this back in the day) is: “I tried this, and that, and this, and Sam just won’t attend/listen/respond! I don’t know what else to do to get him to (insert whatever response the therapist is expecting)”.

What I am suggesting, is flip that statement on its head and instead ask yourself: “What can I do differently that will motivate Sam to respond? Am I interesting? Am I reinforcing? Would I want to attend to me? Is this program interesting? Are these materials engaging? When did I last reinforce any of his behavior? Is my frustration/annoyance showing on my face? Does my voice sound irritated? Am I moving through targets too quickly? Too slowly? How can I be more fun?”.

See the difference? Instead of unintentionally blaming Sam for his lack of responding, first blame yourself. Then, look at your options and start trying them out to see what is effective.  I am a big fan of “Let’s try this and see what happens”. Even if you try something and it fails, you just learned 1 thing that does NOT work. Which is still progress.

About The Author: Tameika Meadows, BCBA

“I’ve been providing ABA therapy services to young children with Autism since early 2003. My career in ABA began when I stumbled upon a flyer on my college campus for what I assumed was a babysitting job. The job turned out to be an entry level ABA therapy position working with an adorable little boy with Autism. This would prove to be the unplanned beginning of a passionate career for me.

From those early days in the field, I am now an author, blogger, Consultant/Supervisor, and I regularly lead intensive training sessions for ABA staff and parents. If you are interested in my consultation services, or just have questions about the blog: contact me here.”

This piece originally appeared at www.iloveaba.com. 

 

Back to Basics: Core Strategies in ABA

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Applied Behavior Analysis (ABA) is the practice of the science of behavior. Often misunderstood as a collection of techniques (or worse, one particular technique), ABA is much more complex and is based in analysis so that all interventions are individualized, functional, and effective. That being said, there are some core strategies that are useful to know about in the application of ABA to individuals with autism.

• Reinforcement is probably the best known and most widely recognized ABA strategy. The principle of reinforcement is simple: behavior that is followed by preferable outcomes increases in future probability. If the preferable outcome is something given, like praise, a toy, or a fun activity, that’s called positive reinforcement. If the preferable outcome is something taken away, like work being removed during a break, or an unpleasant noise stopping, that’s called negative reinforcement. Contrary to popular belief, negative reinforcement is not the reduction of behavior or the application of punishment. Both positive and negative reinforcement are highly individualized and will look different for different people, but the principles remain the same no matter who you are: behavior increases because it is followed by a preferable outcome.

• Prompts are another commonly used strategy in ABA, and they also look different for different people. Prompts are any stimuli added to the natural environment to make behavior more likely. We all use prompts throughout our daily lives, often without realizing it. Smart phone reminders, highway signs, and fire alarm bells are all every day prompts. Additional prompts may be added to support individuals with autism in many ways. For example, some children with autism are taught to follow activity schedules, which are prompts for sequences of actions. These prompts may be used to help the child to be more independent in an activity of daily living, like making a sandwich, or just to transition between play activities and remain actively and appropriately engaged for longer periods of time.

• Structured teaching procedures are often used to break down and teach important skills such as communication, social skills, self-care skills, and academics. Sometimes these procedures are highly structured and repetitive, such as discrete-trial teaching, and sometimes they are looser and less structured, such as natural-environment teaching. Most individuals with autism who are learning using these strategies are provided with a combination of more and less structured learning opportunities, depending on their individual needs.

• Self-management is the set of skills that enables independence. For many individuals with autism, these skills need to be explicitly taught. ABA programs should include opportunities to learn and use self-management skills, as the ultimate goal of any ABA intervention should be independence.

About The Author 

Dana Reinecke is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA).   Dana is an Assistant Professor and Department Chair of the Department of Special Education and Literacy at Long Island University Post.  Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities.  She has presented original research and workshops on the treatment of autism and applications of ABA at regional, national, and international conferences.  She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism.  Current areas of research include use of technology to support students with and without disabilities, self-management training of college students with disabilities, and online teaching strategies for effective college and graduate education.  Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA), and is currently serving as President (2017-2018).

Your Behavior Plan Made Everything Worse!

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“We have been working with a behavior analyst and it seems like every time they give us a new behavior intervention things just get worse, not better. What gives?”

Well, if you are working with a Board Certified Behavior Analyst, I’d like to believe that the interventions they are recommending for you are good ones. (i.e. research-based, effective, only have behavior analytic principles). So it’s likely that you are just experiencing an extinction burst.

Got it? Okay, now go do the steps your behavior analyst gave you.

Wait, what? You don’t know what an extinction burst is? Let me try to clear things up for you a bit.

Here is the definition of an extinction burst (Cooper, Heron, & Heward, 2007): an increase in the rate of responding when reinforcing consequences are withheld after the occurrence of the target behavior.

Basically, things usually get worse before they get better.  Great news, I know.  You’re welcome.

Why is this? Let’s try an example to make sense out of this technical stuff.

What if my daughter screeched and yelled every time she saw something on the kitchen counter? I could give her the item each time she screamed. She would then be quiet.  But who wants to live with a toddler who screams and yells constantly for things that are out of reach?

So one day I realize this isn’t a great plan and decide to teach her a replacement behavior- to ask nicely for things. I stop giving her the item every time she yells and instead wait for her to ask nicely for it.

What do you think will happen first? She’ll scream louder and longer. This has worked for her for so long that she just increases the intensity of the problem behavior to try to get access to the items out of reach (aka the reinforcers for the problem behavior). This is the extinction burst.

My daughter is probably thinking, “This screaming thing has worked forever. I just need to do it louder and more often to make sure she hears me and gives me what I want!” My girl gets louder and louder and eventually stops, realizing that the stuff just isn’t coming.

The behavior got worse before she recognized that screaming was not going to get her access to the desired item.

In behavior analytic terms:

Child screaming = problem behavior

Me giving her whatever she wanted= reinforcer

I stop providing the reinforcer to try to extinguish the behavior = intervention

Child screams louder and longer= extinction burst

Child stops screaming altogether= success

Now what would have happened had I given in to the louder screaming? Next time my daughter saw something she wanted, she would probably start screaming at the louder volume immediately to get access to the reinforcer, the preferred item.

I would have to stay strong and make it through the loud screaming without giving in so that the problem behavior would stop.

If I want this plan to be successful – if I want her to ask nicely for things – I need to stay strong through the increased screaming. Eventually she will realize that the screaming just isn’t working and that all she has to do is ask nicely for items. We can move on with our lives and be ready to teach more appropriate behaviors with less screaming and yelling involved.

The exact same thing applies to the interventions your behavior analyst is recommending. If the problem behavior gets stronger, more frequent, more intense, more anything as soon as you stop reinforcing it – you’re doing the right thing!

Stick to your guns, even though it can be really hard. Follow the steps your behavior analyst laid out and ride the wave of the extinction burst. To decrease that problem behavior and replace it with something appropriate will be so very worth it.

If an extinction burst leads to an increase in aggression, unsafe behaviors toward self or others, or a level of problem behavior you cannot reasonably live with – talk to your behavior analyst. Let them know what will or will not work for your child or your family and work together to create a plan that will work.

Extinction bursts aren’t fun for anyone. But replacing a problem behavior with something functional for your child is worth it. You can do it!

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis.

Lerman, D.C., & Iwata, B.A. (1995). Prevalence of the extinction burst and its attenuation during treatment. Journal of Applied Behavior Analysis, 28, 93-94.

Lerman, D.C., Iwata, B.A., & Wallace, M.D. (1999). Side effects of extinction: Prevalence of bursting and aggression during the treatment of self-injurious behavior. Journal of Applied Behavior Analysis, 32, 1-8.

This piece originally appeared at www.bsci21.org. 

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.

Simplifying The Morning Routine

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ABA therapy can be used to teach/increase a variety of adaptive skills, such as tooth brushing, toileting, hair brushing, shoe tying, making a bed, etc. My favorite definition of an adaptive skill is anything that will have to be done for the learner, if the learner does not learn the skill. So if I don’t teach my child how to dress him/herself, then I will have to dress my child.

A common concern many of my clients have around adaptive functioning is the dreaded Morning Routine. Since my clients are usually school age, I have ample opportunity to help families target issues that regularly pop up during that frenzied time in the morning of trying to get the child out of the door on time. Issues like: task refusal, off task behavior, prompt dependency, skipping steps of the routine/completing the routine out of order, etc.

ABA interventions should always be individualized, but some of my most effective strategies for simplifying the morning routine include:

–          Visuals! Visuals are your friend 🙂

–          Use of auditory cues (timers)

–          ORGANIZATION

 With some simple tweaks here and there and adding in more supports, the morning routine can be less stressful, more efficient, and require less intrusive prompting which equals more independence for your child.

Let’s jump in:

Add visuals: I say “add visuals” and not “add more visuals”, because usually what I see is that families who struggle the most with the morning routine are not using any visual supports. If you are regularly struggling during the morning routine but you already have visual supports in place, then that’s a gold star for you. You are ahead of the game. If you are new to visual supports, just keep reading. Think of a visual support as a way to minimize prompting or assistance. If you have to stand in the bathroom doorway, physically assist your child, or keep giving the same demand over and over (“Make up your bed Evan ……. Evan, did you make your bed?”), then you definitely need to add some visuals. It is much easier to fade the prompt of a visual, than to fade your voice or your presence. Or to put it another way, do you want to have to stand in the doorway to make sure tooth brushing happens when your child is 25? Here are some awesome examples of visual supports, all were found on Pinterest.







Auditory cues: The use of a timer can be such a helpful addition to the morning routine because time is usually of the essence. We have to go, and we have to go now. For many of my defiant kiddos, those with attention issues, or those with lots of escape maintained behaviors, the simplest demand  (e.g. “Put your socks on”) can take ages and ages to actually happen. Decide on a specific amount of time for the skill to occur, and then set a timer. If the child can beat the timer, then allow them to contact reinforcement. Depending on the child, this could mean a treat, getting to pick what they wear that day, 2 minutes of TV time, etc. Make the concept of “hurry up” more concrete by helping the child understand how quickly tasks needs to be completed.

Organization: This tip is more for you than the child. Organization or proper set up for the morning routine does not begin that morning, it begins the night before. Part of the bedtime routine can include setting up items for the next day. This could mean lining up the soap, face towel, toothpaste, and toothbrush by the bathroom sink. Or this could mean putting the backpack by the front door, so there is no frantic search for it in the morning. How you organize will depend on the specific issues you are having in your home. The point is to set the child up for success. For younger children (especially if you want to increase independence) line up needed items/materials in their correct order so your assistance is not needed. For example, in the bedroom line up underwear, socks, pants, shirt, and shoes. In the kitchen, line up the bowl, spoon, and cereal box. For some children you may need to put number cards on each item (e.g. put a “1” card on the underwear). Any step you can do the night before will save precious time the next morning, and the materials being visible helps serve as a prompt of what to do next.

*Bonus Tip: A good way to practice the skills required for a successful morning routine is to incorporate weekend practice. If these skills are only performed M-F with a time crunch, then you’re setting yourself up for lots of frustration. On the weekends, still have your child go through the morning routine. Use this to fine- tune skills, or provide more repetition than is possible on a Monday morning. If tooth brushing is always a struggle, consider modifying the visuals or making them larger/more detailed. Try removing yourself, and only checking on your child periodically. If the child is older or needs less support, try implementing a checklist that the child completes. As they perform each skill, they check a box. When all the boxes are checked they bring the checklist to you for review.

About The Author: Tameika Meadows, BCBA

“I’ve been providing ABA therapy services to young children with Autism since early 2003. My career in ABA began when I stumbled upon a flyer on my college campus for what I assumed was a babysitting job. The job turned out to be an entry level ABA therapy position working with an adorable little boy with Autism. This would prove to be the unplanned beginning of a passionate career for me.

From those early days in the field, I am now an author, blogger, Consultant/Supervisor, and I regularly lead intensive training sessions for ABA staff and parents. If you are interested in my consultation services, or just have questions about the blog: contact me here.”

This piece originally appeared at www.iloveaba.com. 

 

Are We Ready For A Play Date And Social Groups?

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This piece was originally posted at www.aba-interventions.com. 

Play skills and social skills should be a part of an ABA treatment plan and are absolutely important for children with autism or I/DD. Many parents eagerly place their child in social groups, play dates, or insist that their child participates in group activities. These are WONDERFUL if your child is ready, but can be difficult and stressful if they are placed in these groups too soon. First, ask yourself these questions to determine if your child is ready for play dates and social groups:

Does my child allow peers into his space and allow peers to touch his toys?

Is my child able to successfully sit and engage in leisure activities?

Does my child have an interest in toys and activities?

Is my child able to engage in parallel play and turn taking?

If you responded “no”, work with your child’s therapist to write specific play date goals into the treatment plan. If your child engages in frequent, aggressive behaviors or stereotypic behaviors, they may also struggle in play groups.

Simply placing a child in a group environment is NOT social training or an effective play date. Our goal is to teach a child successfully without having to constantly do “damage control.” If a child has a history of negative experiences with peers, your child may be very averse towards peers. Imagine how you would feel if EVERY time you walked into Kroger people bumped into you, yelled and screamed around you, and followed you around asking questions and stealing your shopping cart. If this was your experience every single time, you would most likely avoid grocery shopping. It is our goal to turn that aversive peer experience into an experience that is motivating and positive.

When I first begin play dates and social skills groups with early learners, I like to start with a peer model or sibling. Once certain goals have been mastered with a peer model, we can begin generalizing skills to other peers and environments. Remember, we want successful peer interactions…even if our play date is 8 minutes long! We can work up to that 30 minute karate class, the birthday party at the zoo, or some of the other amazing social groups Knoxville has to offer!

Here is a fantastic blog article on special needs playdates!

Remember, appropriate play skills includes more than sharing and sitting next to a peer. Other goals may include:

  • Keeping hands to self
  • Greetings, initiating and reciprocating conversations, staying on topic
  • Responding and asking questions
  • Eye contact
  • Imitating peers
  • Social manners (i.e. asking “what happened” if someone is crying or very excited)
  • Problem solving with peers

About The Author

Elizabeth Ginder, MSSW, BCBA, LBA is the Clinical Director of ABA Interventions, LLC. Elizabeth specializes in working with children ages 2 through early adulthood. She has experience working with children diagnosed with intellectual and developmental disabilities, as well as children with severe, challenging behaviors. Elizabeth also has a strong background in parent, teacher and staff training. Her focus is on verbal behavior, skill acquisition and teaching children how to have fun! You can find more information on ABA Interventions at their Facebook page or at www.aba-interventions.com.

Reaching Up! Setting Goals that are Realistic, Functional, and Meaningful

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Happy New Year!  Many people are inspired by the start of the new year to set goals for themselves.  This is also an ideal time for parents to think about their goals for their children.  In setting goals for a child with a disability, there are a few important considerations that will improve the likelihood of the child’s success, as well as the parent’s satisfaction.

It’s usually a good idea to start with big picture goals, and then narrow them down.  You might start by asking yourself what your ultimate goal for your child is, and then where you would like to see him or her in 5 years.  Then, what would you like to be accomplished in this coming year? 

Let’s say your big picture goal is for your son to have a happy social life.  Your 5-year goal might then be for him to have at least 3 friends that he sees on a regular basis.  Your goal for this year might be to get him involved in an afterschool club on a regular basis. 

To take another example, your big picture goal might be for your daughter to communicate effectively with other people.  Your 5-year goal might be for her to have conversational exchanges with other people in the absence of prompts or augmentative communication.  And your goal for this year might be for her to ask for what she wants when she wants it (to “mand” for desired objects).

Starting with the big picture goal and thinking about the 5-year goal can help parents to maintain their focus.  If you start with small goals and build up, you might find yourself building in the wrong direction.  Most importantly, keeping the big picture and 5-year goals in mind help to keep your more immediate goals functional and meaningful.  When time and resources are precious, you want to make sure that you use them only to address goals that are going to help your child to attain his or her best, most important possible outcomes.

A second consideration in setting year-long goals is how realistic they are.  No one knows your child better than you, as his or her parent, but even parents can have difficulty gauging just where their child may wind up after a year.  Many factors can impact the success of any goal, including the interventions available and other, unexpected barriers or supports that may arise.  It can be helpful to break year-long goals down even further into smaller steps, which will be easier to predict and monitor. 

So, for the son who you want to see be more social, consider breaking the goal of joining an afterschool club down into its parts, each of which will be easier and faster for him to accomplish than the whole:  investigate the clubs that are available, discuss his top two choices with a guidance counselor, attend the first meeting, etc.  Each of these smaller goals can be measured and celebrated, helping to keep momentum and motivation towards the bigger year-long and further aspirations.  Similarly, the daughter who is working on communication can achieve smaller goals by learning to mand using prompts as earlier goals, and then continuing to mand independently as prompts are faded. 

Finally, each of the smaller goals set for the year should be measured so that progress can be tracked.  Seeing progress is not only motivating and exciting, but can help to guide when to advance to the next set of goals.  Measurement is also important for identifying when progress is not happening as quickly as desired, so that the supports and strategies in place can be updated for better success.

About The Author

Dana Reinecke is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA).   Dana is an Assistant Professor and Department Chair of the Department of Special Education and Literacy at Long Island University Post.  Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities.  She has presented original research and workshops on the treatment of autism and applications of ABA at regional, national, and international conferences.  She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism.  Current areas of research include use of technology to support students with and without disabilities, self-management training of college students with disabilities, and online teaching strategies for effective college and graduate education.  Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA), and is currently serving as President (2017-2018).

Can the principles of ABA be used to toilet train a child with an autism spectrum disorder?

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This month’s ASAT feature comes to us from Dr. Frank Cicero, Ph.D., 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!

Here is the good news…children with autism can be toilet trained through the exact same methods that are used with typically-developing children. And what are these methods? Applied behavior analysis! If you have ever toilet trained a typically-developing child, you probably used a combination of praise and rewards for going on the toilet, explaining your expectations, removing the child‘s diaper, prompting to the toilet on some type of schedule, rushing him or her to the toilet when they seemed like they needed to go, and teaching how to notify you that he or she needs to use the bathroom. You might or might not have added in some form of punishment or verbal reprimand for accidents. Well…here is my advice for toilet training a child on the spectrum…use exactly the strategies that I just described.

So then, why does it seem so much more difficult? One of the biggest obstacles is simply getting started. Because parents think that toilet training will be very difficult, and something so different than anything else they have taught their child in the past, they delay training. Toilet training for a girl typically is recommended to begin at around two years of age. For a boy it is a little later (about two and a half). When it comes to a child with a developmental disability it is difficult to use these age guidelines. Instead, a child is ready to begin training when they can hold urine in the bladder for at least 1 hour, can remain seated on a toilet for at least three minutes, have an awareness of the relationship between following instructions and getting rewarded, and do not have significantly interfering problem behavior. Another challenge with toilet training a child on the spectrum is the absolute need for consistency and intensity of training once you begin. The more intense you implement a plan, the quicker you will see results. For the most intense procedure, I recommended toilet training for at least 6-8 hours per day. I also usually implement the training directly in a bathroom with the child wearing the least amount of clothing possible (usually underwear, shirt and socks). In this way, he or she can easily get to the toilet when needed and also you, as the trainer, can easily and quickly see when they are beginning to have an accident.

Toilet training consists of four main components: prompting to the toilet on a schedule, rewarding success, teaching how to request, and quickly prompting to the toilet at the start of an accident. For the schedule, I usually recommend starting with 30 minutes. The child sits on the toilet and tries to urinate for 1 minute. If the child is successful, immediately provide him/her with a very powerful reward with verbal praise. If the child is not successful, simply prompt him/her to try again in 30 minutes. In order to teach requests, prompt the child to request the bathroom each time you are about to prompt him/her to the toilet. You can use whatever communication system (i.e., verbal speech, picture exchange, signs, etc.) your child is used to and does best with.

Now, what to do with the accidents? Accidents in toilet training are a good thing. In fact, without accidents, you will only be reinforcing prompted trips to the toilet, thereby resulting in a child that is schedule trained instead of independent. You have two choices here, prompting/reinforcement or punishment. I usually recommend the first choice, prompting/reinforcement instead of punishment, at least in the beginning of training. Try encouraging a lot of drinking during training hours. Within the first second of the child having an accident, produce a loud verbal startle such as “HURRY, HURRY, HURRY.” This is not a reprimand but should be stated in a very loud, surprising, urgent tone of voice. The idea is to temporarily produce a startle response in the child so that urination is reflexively held for a brief moment. In that moment, you physically prompt the child to the toilet, where you instruct him or her (now in a very calm voice) to continue their urination. If they continue (which is likely), you reward the behavior with a reward and verbal praise. In this way, you turned an accident into a positive teachable moment. Continue with these strategies until the child begins to show fewer accidents, goes more on the schedule and begins to independently request. Throughout training it is very important to collect data on accidents and successes, so that you can make data-based decisions along the way. Fade the intensity of the schedule, fade out of the bathroom and ultimately fade the tangible rewards. With this intensive treatment program, I have seen complete training in as little as 1 week; however do not get discouraged if your child takes longer. What about training for bowel movements? Good news….you often get bowel training along with urination training without doing any additional procedures. Bad news…this is not always the case. When a child is trained for urination, but continues to have bowel accidents, you need to figure out the reason behind the problem before you can treat it. Is it simply a lack of knowledge? An ingrained ritual or routine? Noncompliance? A medical problem such as constipation? The nature of the accidents will guide your treatment. Very briefly, if the problem is a lack of knowledge, a reinforcement / punishment procedure should work. This procedure is similar to the procedure that I described for urination training, except that it is rarely implemented for 6-8 hours per day. Instead, you bowel train only when the child is likely to need to have a bowel movement. If the problem is more consistent with a ritual or noncompliance, you need a traditional behavior plan more than a toilet training intervention. And finally, if the problem is medical in nature, follow the recommendations of a physician or dietician.

Please use the following format to cite this article:

Cicero, F. (2009). Clinical corner: Toilet training. Science in Autism Treatment, 6(1), 3-4.

About The Author

Dr. Frank Cicero, Ph.D., BCBA, LBA is a New York State licensed psychologist, licensed behavior analyst and board certified behavior analyst with over 20 experience working in the fields of applied behavior analysis and autism spectrum disorders. He received his master’s degree in school psychology from St. John’s University and his doctoral degree in educational psychology from the City University of New York Graduate Center. Dr. Cicero is currently an assistant professor and aba program director for Seton Hall University, New Jersey. Prior to this position, he served as the Director of Psychological Services for the Eden II Programs, an applied behavior analysis agency in the New York City area serving children and adults on the autism spectrum. Dr. Cicero continues a private practice for child/adolescent psychology and aba as well as conducts program consultations in best practice treatment for autism, developmental disabilities and problem behavior. Dr. Cicero frequently conducts workshops and trainings nationally on a variety of topics within his fields of expertise. He also has several publications including peer reviewed articles, book chapters and a training book titled “Toilet Training Success.”

Ten tips to prevent autism-related shopping meltdowns

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This week’s blog comes to us from Lucia Murillo, Autism Speaks’ assistant director of education research. and was originally posted on Autism Speaks as part of their Got Questions? series.

“How can I help my child avoid meltdowns at the store? Everything is okay with him until he gets into the store.”

Thanks so much for your question. You are far from alone in this challenge. For good reason, outings such as shopping can be particularly challenging for families who have children with autism.

The abundance of sights, sounds, crowds and other sensory stimuli can easily trigger challenging behaviors that seem near-impossible to handle in a public place. Unfortunately, this prompts many families to avoid taking children with autism to public places unless absolutely necessary. This, in turn, can contribute to isolation for the whole family.

So I’m so pleased for this opportunity to share a few meltdown-prevention strategies that, when practiced ahead of time, can help promote a calmer shopping experience.

But when I say “ahead of time,” I don’t mean right before you head to the store. These strategies involve time and patience. Ideally, you’ll also have the guidance of a behavioral therapist skilled in working with children who have autism.

#1 Give fair warning
Research and experience tells us that “knowing what to expect” helps children with autism cope with potentially stressful situations. This means resisting the understandable temptation to try to sneak a quick shopping trip into your son’s day. Whenever possible, I strongly recommend letting him know ahead of time where he is going and what he can expect.

#2 Take a virtual tour 
You and your son may be able to take a virtual tour of the store on the store’s website. If that’s not available, consider visiting the store on your own to take pictures and/or a cell-phone video.

This approach is particularly useful for preparing your child to accompany you to a new store. Sit down and look at the pictures and/or watch the video together so your son can become familiar with the new environment.

You might even take a virtual drive to the store using Google Maps.

#3 Practice and build tolerance

When you feel your child is ready to make an actual trip to the store, I suggest starting with a short trip and small purchase. Reward any degree of success with praise and perhaps a small prize or favorite activity.

As you sense your child is getting more comfortable with the short trips, gradually increase the length of time that the two of you are in the store. At this point, try to incorporate these trips into a regular routine – but always with fair warning – so your child can learn to expect them.

Repetition is important. And occasional reversals are likely. So don’t give up!

#4 Prepare a schedule 
Many children – and adults – on the autism spectrum greatly benefit from having a clear schedule for the day ahead. Visual schedules are particularly helpful, and the Autism Speaks visual supports guide can help you make one.

A morning review of the day’s activities can help your child gain a sense of where he’s going and what he’ll be doing. So on the morning of a shopping trip – or even the night before – sit down with your child as you add a shopping trip to the schedule. Or invite him to add it at the specified time.

It can help to schedule one of your child’s favorite activities following the shopping trip and together enter it on the day’s schedule. This can be as simple as time to play with a favorite toy or game with you.

#5 Remember: Rest is best
It can greatly increase your son’s chances of success if you make sure he’s well rested before the outing. In fact, the same goes for you! Being tired tends to shorten everyone’s tolerance.

#6 Identify triggers 
You know your child best. Are there certain sights, sounds or situations that tend to produce to a meltdown? You might try visiting the store without your son with an eye for such triggers. For some people with autism, fluorescent lighting is a trigger. Others are bothered by the loud hum of air conditioners or the blare of clerks calling to each other over the intercom.

#7 Provide personalized “armor”
Identifying triggers enables you to provide personalized support. For example, if loud sounds provoke anxiety in your son, he might be helped by headphones. If overhead lighting is a problem, he might be willing to wear sunglasses or a baseball cap. Many parents find these strategies make a world of difference for their kids.

#8 Getting ready to shop …
Before leaving the house, consider prompting your son with a finer breakdown of what you’re going to do on this shopping trip. For instance:

* We will drive to the store.

* We will park in the lot.

* We will walk into the store.

* We will find the items we want.

* We will pay for them at the register.

* We will walk back to the car.

* We will drive home.

* And we will play a game of Uno.

If, like many people with autism, your child responds best to visual information, try making a personalized story with pictures about the above steps. Autism Speaks has partnered with the University of Washington READI Lab to provide a series of personalized story templates that include Going to the Store. Learn more and download them for free here.

#9 Have a signal
Make sure there’s a way for your child to communicate to you when he begins to feel overwhelmed. We know that children who have autism vary widely in their ability to communicate. So one child might be able to simply say “I need a break.” Another might need to learn a sign – such as hands over ears. Picture communication systems are yet another option. (See the Autism Speaks visual supports guide mentioned above.)

Even if you child can’t reliably communicate when he’s getting overwhelmed, there are often behavioral cues that you can learn to recognize in time to leave the store or otherwise provide support before the meltdown.

#10 Bring “cool down” items
Meltdowns happen. Sometimes, having a favorite comfort item on hand can help ease the crisis.Despite all the best plans, meltdowns happen. You can ease the crisis by bringing an object or activity that you know will soothe. This could be a favorite toy or blanket. It could be a special little song.

All these strategies have the same goal: To provide optimal conditions for your child when taking him into an overly stimulating environment. By preparing ahead of time, you can increase the chances that the shopping trip – or any outing – will be more tolerable for your child and entire family.

 

Annotated Resources: Bullying

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October is National Bullying Prevention Month! In this month’s ASAT feature, Sunbul Rai, MSc, BCBA, Renee Wozniak, PhD, BCBA-D, and Rachel L. Liebert have collected some amazing resources to address the issue of bullying. 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!

Bullying is an unfortunate reality for many individuals with (and without) autism spectrum disorder (ASD). This list of annotated resources has been created to serve as a helpful reference for individuals with ASD, parents, clinicians, and educators alike. Included are resources that provide realistic strategies around both preventing bullying and addressing existing bullying. We hope that this information will support informed decisions and assist you in taking a strong stand against bullying.

 

1.  National Autism Association (2015). A & S bullying: 5 things parents can do – www.autismsafety.org/bullying-tips.php The National Autism Association (NAA, 2015) provides a brief and practical list of five steps parents can take to address and prevent bullying in school, including 1) preparing the team, 2) addressing bullying with specific goals in the Individualized Education Plan (IEP), 3) preparing your child, 4) monitoring your child for signs of being bullied and 5) using the complaint process. At the outset, the authors stress the need to clarify the school district’s policies on bullying as a first step to prepare the team. Next, NAA suggests politely making it clear that you will be involved in helping the team to avoid your child’s victimization, and clearly communicating with teachers, administrators, the school board, and possibly the child’s peers to provide information on the child’s specific strengths and challenges, autism spectrum disorder, and the problem of bullying. In the IEP, NAA suggests addressing bullying by including social skills and self-advocacy goals, applicable accommodations, a familiarization plan, and specific peer support. To prepare your child, it is suggested to talk to him/her about appropriate friendships and about bullying, obtain social skills training if possible, and to help him/her get organized and oriented to the school in advance. Next, NAA suggests monitoring your child consistently for signs of being bullied by visiting the school often and keeping the lines of communication open with your child and teachers. If the complaint process is necessary, be persistent while avoiding being overly emotional; begin with informal written resolutions, moving to filing a complaint if necessary, while keeping in mind your rights under “The Individualized with Disabilities Education Act” (IDEA, 2004). “A & S Bullying: 5 Things Parents Can Do” is a quick read that may help parents take some simple first steps in addressing and preventing bullying issues for their child.

2.  Autism Speaks (2015). Combating bullying – www.autismspeaks.org/family-services/bullying “Combating Bullying” is a compilation of information surrounding bullying of individuals with ASD, incorporating links to a variety of Internet and other resources. Some of the links include the Interactive Autism Network (IAN)’s study on bullying experiences of children on the autism spectrum, a Special Needs Anti-Bullying Toolkit, the trailer for and information on Bully: A Documentary, links to almost 20 books, 10 websites, and to other resources including a DVD and a list of signs to look out for that your child might be being bullied. The compilation addresses bullying of individuals with ASD and Asperger’s Syndrome, and includes information on bullying in schools, cyber bullying, and more. Information may be useful for parents, caregivers, educators, school administrators, individuals with ASD, and peers/friends of individuals with ASD.

3.  Autism Intervention Research Network on Behavioral Health (2013) – Remaking Recess www.airbnetwork.org/remaking.asp The Autism Intervention Research Network on Behavioral Health provides access to a booklet on a social skills intervention called “Remaking Recess” for use in the school setting. The booklet provides a treatment overview (helping children with ASD learn to engage with peers in the school setting) and a brief summary of playground engagement states (solitary, onlooker, parallel, parallel aware, joint engagement, games with rules) followed by specific strategies that can be implemented at recess time. Intervention strategies are included for a variety of situations, including 1) transitioning to an engaging activity and setting up, 2) providing popular developmentally-appropriate games and activities, 3) in-vivo social skills instruction, 4) facilitating peer conversations, 5) playing games, 6) sustaining engagement, 6) fading out of an activity and 7) a quick guide to boosting peer engagement. One of the main purposes of the intervention is to prevent bullying by aiming to improve the social inclusion of elementary-aged children with ASD by means of facilitated interactions with peers. “Remaking Recess” may be useful for individuals in educational settings who wish to take proactive steps to reduce bullying.

4.  Committee for Children (2015). Second step bullying prevention unit – www.cfchildren.org/second-step/research The Committee for Children is a non-profit organization that uses education with the aim of preventing bullying, child abuse and youth violence. The Second Step Bullying Prevention Unit is an initiative through The Committee for Children and is aimed at reducing bullying and peer victimization. The website includes information on the Second Step Bullying Prevention Unit Program as well as program outcomes. It comprises an article on the role of social-emotional learning (SEL) in bullying prevention efforts and highlights the importance of specific social and emotional skills taught in SEL programs, which include 1) empathy, 2) emotion management, 3) social problem solving, and 4) social competence. The website indicates that the implementation of the Second Step Bullying Prevention Unit can help empower schools to prevent and reduce bullying. It may be useful for professionals and parents alike to help them better understand specific skills that need to be taught to children to help prevent bullying.

5.  AbilityPath.org: Support for Parents of Children with Special Needs (2014). Bullying – www.abilitypath.org/areas-of-development/learning–schools/bullying/ AbilityPath.Org provides many bullying resources on its website and one of its highlights is the comprehensive report on bullying which focuses on supporting parents of children with special needs. The report is entitled “Walk a Mile in Their Shoes: Bullying and the Child with Special Needs” and emphasizes the “silent epidemic” of bullying that children with special needs face on a daily basis. It has several sections, which include: an overview of the report, testimonials from parents and children, targets: children with special needs, statistics, signs of being bullied, cyber bullying, teachable moments, the IEP, the law, the experts, the anti-bully program, and the call to action. Furthermore, it has several parent toolkits along with a teacher toolkit to help caregivers identify signs of bullying, and it highlights proactive steps that can be taken to protect a child with special needs. The information is also geared towards cyber bullying, which is bullying that can be conducted through the use of technology and social media sites. For example, one of the parent toolkits stresses the importance of protecting a child with special needs by teaching the child not to reveal personal information online, limiting online time, reviewing security settings on the computer and so forth. “Walk a Mile in Their Shoes: Bullying and the Child with Special Needs” promotes awareness, provides resources on bullying and its impact, and may be useful for parents, caregivers, teachers, administrators and other professionals working with children with special needs.

6.  PBIS: Positive Behavioral Interventions & Supports (2015). Bully prevention in SWPBS – www.pbis.org/school/bully-prevention PBIS: Positive Behavioral Interventions & Supports (2015) provides bully prevention manuals for the elementary, middle, and high school levels. The manuals are meant as a resource for the school setting and aim to provide students with the tools needed to be free of bullying through the use of school-wide positive behavior interventions and supports. The program described in the manual is divided into six lessons and focuses on the “stop/walk/talk procedure” for gossip, inappropriate remarks, and cyber bullying. The stop/walk/talk procedure involves physical and verbal components with examples of when these components can be used appropriately and when they should not be implemented. The manual emphasizes teaching the skill, followed by practice and roleplaying for a variety of scenarios. The lessons are easy to read and are ready for implementation in the classroom setting. PBIS’s bully prevention manuals may be useful for teachers or other educators in school and similar settings.

7.  National School Climate Center. (2015). Educating minds and hearts… because the three R’s are not enough – http://schoolclimate.org/ The National School Climate Center is an organization that utilizes relevant research to establish and distribute guidelines to encourage acceptance and safety in schools. The Center offers professional development programs for educators, parents, and after-school supervisors to better understand and promote children’s social and emotional wellness and communication. Their website offers guidelines to help educators and parents establish and maintain safe, comfortable schools and homes by understanding social and emotional learning. The “Bully Prevention” section of the website includes a toolkit entitled “The Breaking the Bully-Victim-Bystander Cycle Tool Kit.” This resource may be useful for educators who wish to create a positive school climate.

8.  The Bully Project (2015) – http://www.thebullyproject.com/ The Bully Project is a website that aims to take action against bullying. It focuses on a documentary about children who were bullied during the 2009-2010 academic year and how their parents supported them and modeled “upstander” rather than “bystander” behavior. The website invites users to share their own stories and host or organize screenings of the film to raise awareness. The site also includes tools (including DVDs and toolkits that can be purchased) for students, parents, advocates, and educators, with a section devoted to individuals with special needs. The tools for educators are also available in Spanish. The “Roadmap to Building a Caring and Respectful School Community” includes work that was produced with the assistance of the Making Caring Common Initiative at the Harvard Graduate School of Education. The website also provides interested individuals a platform in which they can take action by joining regional anti-bully project teams. This resource may be useful for those looking to increase awareness and to take steps toward reducing bullying.

9.  Pacer’s National Bullying Prevention Center (2015). The end of bullying begins with you – www.pacer.org/bullying/ Pacer’s National Bullying Prevention Center’s website was developed for children and teenagers to be part of a social cause to end bullying. It includes a section dedicated to students with disabilities with legal information and template letters for parents to send to their child’s school to serve as notification of a bullying situation and a written record of having done so. The website also directs children and teenagers to other helpful resources including KidsAgainstBullying.org and TeensAgainstBullying.org. Ample information is provided about National Bullying Prevention Month (October) including a brief history, opportunities to register for events, key points to make should you wish to give a presentation, and directions to request a governor’s proclamation. Educator toolkits are available under the resources tab, and they include classroom toolkits, community toolkits, student-created toolkits, and activities for youth. Additionally, there is a guide for planning school events, and a peer advocacy guide. This website may be useful for children and teenagers who want to make a difference and provides tangible resources to reduce bullying.

10.  U.S. Department of Health & Human Services (2015). Stopbullying.gov – http://stopbullying.gov This government website provides a wealth of resources across a variety of areas, in both English and Spanish. An array of topics is covered with related subtopics and links. General topics and subtopics include:

  • What is Bullying – definition, roles kids play, and related matters (e.g., harassment, teen dating violence, peer conflict and more)
  • Cyber Bullying – what it is, how to prevent it, how to report it, and risk factors
  • Who is at Risk – warning signs, effects, and considerations for specific groups (including bullying and youth with disabilities and special health needs)
  • Preventing Bullying – how to talk about it, prevention at school, working in the community, and a training center which includes videos, reading modules, research and statistics, training manuals, toolkits, user guides and additional resources
  • Responding to Bullying – stopping it on the spot, finding out what happened, supporting the kids involved, and being more than a bystander
  • Get Help Now – includes steps to take to resolve a range of bullying situations

Cite this:
Rai, S., Wozniak, R. & Liebert, R. L. (2015). Annotated resources: Bullying. Science in Autism Treatment, 12(4), 23-27.

Bullying can be complex and the Association for Science in Autism Treatment has other resources available for help with this, as well. Please check out the links below to learn more!

1. Clinical Corner: Preventing and Addressing Bullying, Lori Ernsperger, Ph.D., BCBA-D
https://www.asatonline.org/research-treatment/clinical-corner/bullying/

2. Clinical Corner: Teaching Safety Skills to Adolescents, Shannon Wilkinson, MADS, BCaBA
https://www.asatonline.org/for-parents/education/lifespan/teaching-safety-skills-to-adolescents/

About The Authors 

Sunbul Rai, M.Sc, is a Board Certified Behavior Analyst® with a background in education and psychology.  She has extensive experience working with individuals on the Autism Spectrum in a variety of settings across Canada.  Sunbul serves as the Practicum Consultant for the University of New Brunswick’s Autism Intervention Training Program.  She is also the founder of the ABA Little Tots Program at Autism Services, the first intensive behavioural intervention (IBI) program in Saskatchewan.  She is committed to enhancing the quality of life of individuals with Autism so that they can reach their full and utmost potential.

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 currently serves in the roles of faculty and subject matter expert in Capella University’s Applied Behavior Analysis program. Renée is passionate about helping individuals with autism and their families by supporting and disseminating scientific research in autism treatment.

Rachel Liebert was an extern at ASAT from 2015 to 2016 while she was studying psychology at Barnard College of Columbia University.  She is currently a second-year law student at Fordham University and plans to pursue a career in public policy and child welfare.