Category Archives: Guest Blog Post

Normalization

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So much to say on this topic, far more than anyone would actually want to read.

Does ABA therapy require/demand/force individuals into a narrow and specific box titled “NORMAL”? No.

(Well, it shouldn’t anyway)

But the myth persists.

I mean this in the best way, but many of the children I work with just are not going to fit into that “normal” box, no matter how much someone tries to push or squeeze them into it… it ain’t happening.

And that’s a cause for celebration!

The very thing I love about working with such a diverse group of kids, is that they are all different, yet all interesting. I work with some super fascinating small people, who constantly show me how dumb I am. And I thank them for it, because how can you grow if you already think you know everything? You can’t.

As a provider, of course I know the research on the effectiveness of ABA therapy. I also know the many success stories I have seen with my own eyes, of children I directly worked with. But success story does not equal “…and then the child was totally normal!”.

A couple of reasons why my job is not to drive families in my car to a fantasy location called “normal”:

1) Each client/family I work with usually has their own idea of what “normal” means. If you have been in this field more than 10 minutes, you know this to be true. This client over here may live in a home where no one really cares what time they go to bed, as long as they stay in their room and are quiet. But that client over there, may live in a home where all the parents want most in the world is for that child to get their 7.5 hours of sleep every night.

2) Even when a family can explain to me what “normal” means for them, it quickly changes! Again, if you have been in this field more than 10 minutes you know this is true. Sometimes parents tell me they want desperately for their child to talk, but what they really mean is they want their child to communicate. Or, a parent may tell me they want desperately for their child to go to “normal” school with their big sister, but next thing you know that parent has decided to homeschool. Expectations change, as perspective changes.

 

So if ABA therapy is not about hitting a child over the head with your magical “normal” baseball bat, then how exactly is it decided what the goals of treatment will be? I’m so glad you asked.

If you are working with a quality ABA provider, the goal selection process will look something like this:

“I need to evaluate/assess your child to collect baseline data” – This just means data is collected at the onset of services to create a starting point. Over time, that starting point data will be reviewed again and again to make sure the child is progressing. If therapy has been happening week after week after week, but the child has not progressed past that starting point, then something is seriously wrong. This is why it’s important to collect that initial data, so over time you can compare the child’s current learning to their previous learning.”

“What are your goals for therapy? Tell me the reasons why you initiated services.” – The people who asked the ABA team to show up clearly had reasons for doing so, and we need to know what those reasons are. We cannot fully help if we don’t know what issues are happening. Treatment planning should always be a team effort, with the family/client working together with the BCBA to create goals.”

“What are the highest priority areas of concern in the home? At school? In the community?” – What this question is really getting at is “where do you want to start?”. It isn’t unusual that families want to work on…oh, 85 behaviors or so when you first meet them. Unless I can get a good idea of the priority level of those 85 things, the treatment plan will be a chaotic mess. Prioritizing treatment helps focus in on the areas of deficit that are impacting the client the most.

“Describe your household: rules, routine, disciplinary procedures commonly used, etc.” – This question gets at Culture. Households form a sort of culture, or a way things are done. Stepping into a household/family dynamic and imposing completely opposing culture onto it, is not a great idea. It will likely lead to aggressive resistance. What is more helpful, is to teach the family strategies and techniques that line up with the way their household functions.

“Can you finish this sentence: In 5 years, I want my child to be able to…..” – This question is really getting at long-term goals. Professionals need to know long-term goals, because every long-term goal is really made up of hundreds of baby steps. Gradually introducing those baby steps leaves less work to do down the road and increases the likelihood of successful skill acquisition.

“Your child scored low on (insert skill domain here). Do you care about that??” – One of my fave questions to ask. I have learned to ask this, because I used to do quite a bit of assuming. Things like “Of course, you guys want him to write his name, right?” or “Of course, you guys want her to stop eating with her hands, right?”. Maybe not. If I see an area of concern, I will bring it up. If the parent isn’t as concerned as I am or wants to stick a pin in that issue until a later time, then it’s really important that I know that.

My normal is not your normal, and vice versa. What’s considered “normal” in your household might not fly in my household, and what’s “normal” in your marriage could be unbearable for another couple. That’s why normal is such a useless word to throw around, because it has too many meanings to actually mean anything significant.

One of my pet peeves is when a parent says to me during an intake, “I just want him/her to be normal!”. Ummm, and that means what?? 🙂 Seriously, I need details over here. I do not have an intervention for “normal” behavior, nor do I know how to program for that.

Does ABA therapy seek to change individuals? Yes! Behavior change is the entire point of this therapy, either increasing appropriate behaviors or decreasing inappropriate behaviors. But if you think that the only change ABA therapy values is when a child can be fully “normal”, you are:
100%,
absolutely,
wrong.

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. 

Qualifications of Practitioners/Consultants who Practice ABA

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This month’s ASAT feature comes to us from Sabrina Freeman, PhD, ASAT’s Consumer Corner Coordinator. 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!

It’s crucial to be a savvy consumer when it comes to one of the most important decisions you will make for your loved one with autism – choosing an ABA treatment provider for your child. Those of us who have already walked in your shoes know that all treatment providers are not the same. To the uninitiated, these professionals all look marvelous. From the slick websites, to the large numbers of associations of which these professionals are members, it is becoming increasingly difficult to differentiate between mediocre and outstanding treatment providers. Furthermore, publication of research in high quality journals is not synonymous with clinical expertise.

Fortunately, in this issue of Consumer Corner, we present a summary of consumer guidelines created by the Autism Special Interest Group (SIG) of the Association of Behavior Analysis International to help you make an informed choice when searching for ABA professionals to design, run and maintain your child’s program. A complete copy of the SIG guidelines are available here: https://3lvvdfmmeol12qpvw2c75ch6-wpengine.netdna-ssl.com/wp-content/uploads/2018/07/Final-Autism-Sig-Guidelines-Parent-Version-May-2018.pdf It is important to remember that your child’s future depends on highly quality consulting. Good luck!

 

  1. Certification:

Treatment professionals must all have advanced degrees, e.g., a Master’s Degree or a Doctorate in a relevant field of study, and be certified either by the Behavior Analyst Certification Board (BACB), or a board that has equal or higher level requirements than the BACB. To look up your consultant, visit: www.bacb.com and click on “Find A Certificant.” If the potential consultant is not on this list, ask where he/she became credentialed, and trained so that you can verify licensure and experience to determine whether it is equal to/or surpasses the standards of the BACB. If this individual responds to your inquiry in a defensive manner, then you may consider looking elsewhere as you are well within your right to seek clarification about certification status.

Find & Contact Certificants

  1. Extensive Hands-On Supervised Training:

Consultants are required to have extensive hands-on training treating children with autism in which they have worked at least one full year (1500 clock independent supervised hours or 1000 hours if taking a university practicum and 750 hours if taking an intensive practicum) under the supervision of a credentialed BCBA Certificant. In addition, they need to prove competency in many areas that cover the design and implementation of both individualized ABA interventions, and comprehensive ABA treatment programs. The partial list below was created by the Autism Special Interest Group (SIG) below. Your consultant should be competent in all the following areas:

  1. a) Design and implement individualized ABA Interventions
  • community living skills
  • functional communication skills (vocal and non-vocal)
  • “learning to learn” skills (e.g., looking, listening, following instructions, imitating)
  • motor skills
  • personal safety skills
  • play and leisure skills
  • pre-academic and academic skills
  • reduction of behaviors that jeopardize health and safety and impede successful functioning (e.g., stereotypic, obsessive, ritualistic, aggressive, self-injurious, disruptive, and other behaviors often described as “challenging”).
  • school readiness skills
  • self-care skills
  • self- management skills
  • social interaction skills
  • vocational
  1. b) Design and implement both comprehensive ABA intervention programs (using multiple ABA procedures to address multiple intervention targets) and focused interventions (using one or more ABA procedures to address a small number of intervention targets).
  2. c) Delivering ABA interventions directly to at least 8 individuals with autism who present with a range of repertoires, levels of functioning, and ages.
  3. d) Implementing the full range of scientifically validated behavior analytic procedures, including but not limited to:
  • reinforcement (including differential reinforcement)
  • extinction
  • discrete-trial procedures
  • modeling (including video modeling)
  • incidental teaching and other “naturalistic” methods
  • activity-embedded intervention
  • task analysis
  • chaining
  • activity schedules
  • scripts and script fading
  • prompting and prompt-fading
  • errorless training
  • error correction
  • motivating operations
  • stimulus control
  • preference assessments
  • choice
  • augmentative and alternative communication training procedures.
  1. Continuing Education:

Not only do behavioral consultants need to be trained as above, in order to maintain their certification, practitioners must also pursue continuing education in a variety of areas that may include, but are not limited to, Applied Behavior Analysis.

Red Flag

These practitioners should not be working collaboratively with professionals who implement an eclectic mix of interventions that are untested, discredited or experimental in nature. If the consultant you use endorses an eclectic approach, understand that this practice is inconsistent with the BACB Guidelines for Responsible Conduct for Behavior Analysis. This red flag is a particularly helpful way to be forewarned about a consultant who is not a good choice to design and maintain your child’s program!

 

Common Mistakes In Implementing Reinforcement

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Over the years, I’ve seen several behavior intervention plans written and implemented. Typically, these plans include reinforcement for the desirable behavior, but I see the same mistakes crop up again and again. Here are a few common mistakes in implementing reinforcement to look out for:

Fail to identify individual reinforcers. Hands down, the most common error I see is identifying specific activities or items as reinforcing. For instance, many people love gummy bears, but they make me want to puke. Presenting me with a gummy bear would not increase my future likelihood of engaging in the appropriate behavior! You must account for individual differences and conduct a preference assessment of your learner, then make a plan based on his or her preferences.

Fade reinforcement too quickly. Let’s say you’re working with a child named Harold who draws on the walls with crayon. You implement a reinforcement plan in which he earns praise and attention from his parent each time he draws on paper. The first few days it’s implemented, Harold’s rate of drawing on the wall greatly decreases. Everyone claims that his behavior is “fixed” and suddenly the plan for reinforcement is removed… and Harold begins drawing on the wall once more. I see this sort of pattern frequently (and have even caught myself doing it from time to time). After all, it can be easy to forget to reinforce positive behavior. To address this issue, make a clear plan for fading reinforcement, and use tools such as the MotivAider to help remind you to provide reinforcement for appropriate behavior.

Inconsistent with reinforcement plan. Harriet is writing consistently in a notebook, to the detriment of her interactions with peers. Her teachers implement a DRO, deciding to provide reinforcement for behavior other than the writing. However, the teachers didn’t notify all the adults working with her of the new plan, so Harriet’s behavior persists in certain environments, such as at recess, allowing her to miss multiple opportunities for more appropriate social interaction. To address this issue, make a clear outline of the environments in which the behavior is occurring and what adults are working in those environments. Ensure that all of the adults on that list are fully aware of the plan and kept abreast of any changes.

Don’t reinforce quickly enough. This one can be quite challenging, depending on the behavior and the environment. Let’s saying you’re working with a boy named Huck who curses often. You and your team devise a plan to reinforce appropriate language. You decide to offer him tokens that add up to free time at the end of the school day. However, sometimes as you are handing him a token for appropriate language, he curses again right before the token lands in his hand. Though it was unintentional, the cursing was actually reinforced here. Remember that reinforcement should be delivered as close to the desired behavior as possible. To address this issue, consider your environment and materials and make a plan to increase the speed of delivery.

Fail to make a plan to transfer to natural reinforcers. Ultimately, you don’t want any of these behaviors to change based solely on contrived reinforcement. Making a plan for reinforcement of appropriate behavior is essential, but your ultimate goal is to have the behavior be maintained by naturally occurring reinforcement. To address this issue, the first thing you need to do is identify what that naturally occurring reinforcement might be. For Harold, it might be having his artwork put up in a special place or sharing it with a show and tell. For Harriet it might be the interactions she has with peers on the playground. Once you have identified those reinforcers, you can create a plan for ensuring that the learner contacts those reinforcers over time. This might include pairing the naturally occurring reinforcers with the contrived reinforcers, then fading out the latter.

Ultimately, it’s important to remember that reinforcement is not as simple as it seems. Taking the time to plan on the front end will help with long-term outcomes.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

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

Running behaviors? Tips for Making Your Class & School Safe

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If you have a runner in your classroom, you don’t need a gym membership and have long ago put away those cute wedges. Every time the door opens you head jerks around to make sure it isn’t your little guy. The starbucks barista has your venti triple shot ready for you every morning before you get there. A lot of us have been there. From our kid’s perspective, running is effective. Whether it’s to get attention, escape a task, or find that keyboard in the music teachers room – it works most of the time. When looking at these behaviors, we of course want to analyze the function (or the why) behind the behavior when developing interventions. Interventions will definitely include teaching some type of replacement behavior. Today let’s also look at what else you can be doing while these interventions start to take shape.

Running is a scary behavior and potentially dangerous behavior because your student could get outside of the school. He could get lost, hit by a car, or walk into a stranger’s home. If your child or student has these types of behaviors, your mind has definitely gone to these worst case scenarios. I remember losing sleep regularly thinking about a student who had high frequency running behavior and stressing like crazy over what would happen if he ever got out of the school.

Keep them in your class. This is really the golden rule when it comes to runners. Do whatever you can to keep them in your room. Once that foot gets one inch outside your door, all bets are off. Once they are outside your room, you are chasing them and they are loving it. You’ve completely reinforced the inappropriate behavior but you had no choice. You had to keep them safe. Some schools may have systems set up with different staff at different spots in the hallway or building so you can avoid that. But unfortunately many of our classrooms don’t have that much staff to do that. The number one goal is keeping them safe, so do whatever you have to do to get them once they leave your room. But the goal is avoiding that. The goal is keeping them in your room where you can be teaching replacement behaviors.

In the effort to keep them in your room, think obstacles. Go through your student’s schedule and make sure that at every single point of the day there is not a direct pathway to the door. When I do behavior consults, the teacher and I literally do this together. We walk around the room and go to every single spot the student will be at. Sometimes you forget about a specific center or time of day when the student is very close to the door. You classroom may look like a maze. That’s okay. That’s actually good. A maze means it will take your student 4 seconds instead of 2 seconds to get to the door and the extra 2 seconds may be enough to prevent that escape. Use furniture and dividers to create zig zag pathways around your room. I know it’s tempting to do something potentially unsafe like put a lock on the door – but it’s majorly breaking fire code so steer clear of that. If you have two doors in your room, block one up completely so you only have to worry about one.

Have a super clear and straightforward schedule of who is in charge of this student at all times of day. Make sure the transition handoff is clear. Clarify with staff what they should do if they need to go to the bathroom or get up to get a pencil when working with this student. Make sure the goal is clear to everyone – keep him in the room.

If they do get out – minimize the attention component. Sometimes we are doing everything right, working on analyzing the function of the behavior, teaching a replacement response, added in loads of preventative interventions keep the student in your classroom – and life happens and you blink and your student is halfway down the hallway. As we talked about, yes you are going to run after him to get him because above everything safety is important. But minimize the attention that goes into this. Picture two scenarios: 1 – Johnny runs down the hallway. Three adults start running after him, one of them yelling. They catch up to him. One adult yells to the other, “got him.” Another adult, starts lecturing Johnny on we he shouldn’t be running. The three adults walk him back together talking amongst themselves about how fast they are getting. They re-enter the classroom and announce to everyone in the room loudly, “he one got to the end of the hallway.” Basically it’s a circus. I see this ALL the time. And it’s unintentional. None of those adults wake up thinking let’s turn Johnny’s behaviors into a parade today, but it happens. We get scared, adrenaline is rushing, and we don’t have a clear plan in place. Let’s rework this scenario. Johnny runs. One adult makes eye contact with another adult in the classroom and says, “I’m on it.” One adult runs after him, another waits in the doorway of the classroom to watch. When the adult gets him, she says nothing and walks him back to the classroom. He goes back to the exact task he was doing before without any eye contact or talking/lecturing. Attention was minimal. Attention may be a function for many of these behaviors so even though we have to give attention by chasing we can minimize the magnitude of the attention. 

Know where all the school exits are. Seems obvious but I worked in a school for ten years and honestly still didn’t know where all of the exits are. Really old buildings have a seemingly endless amount of hidden doors to the outside. I finally had the school engineer walk me around the basement so I could find them all. Once you know where the main exits are, you can divide and conquer with staff. If your student is running the direction of an exit, one staff member can run ahead to that door or go meet him where the door opens outside. #themoreyouknow

Have a plan with the security guards for the worst case scenario. You guys know I’m all about having an emergency plan in place and you likely already have one with your classroom staff (if you don’t – make one!). But take that emergency plan beyond just your classroom staff. Work with your school’s security guards to get them in the loop. If that horrible worst case scenario happens and your student does somehow get out of the building, what is the plan? We tend to avoid making a plan for this because we think it never will happen. Agreed, plan for it never happening. But just in case at the rare, rare, rare chance it does – you will be much better off with a plan in place.

Use Walkie Talkies with key people through the school. Walkie talkies can be your saving grace here. Many schools already have a system of walkie talkies in place and if you aren’t part of – get part of it. If you student has left the classroom, you will be much more efficient getting him back to the class if you can alert 8 people throughout the building of it versus doing it yourself. If you school doesn’t use walkie talkies, approach your admin about getting a set for your classroom staff and a few key people through the building (security guards, secretary, etc.).

This piece was originally posted at The Autism Helper. 

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 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.

Pairing auditory stimuli in your reinforcement

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            Using a consistent, auditory stimulus as part of your reinforcement strategy can be a powerful addition for improving behaviors. It allows for students to be reinforced without necessarily looking at you, which can be great if you are providing reinforcement for remaining on task or independently completing a task. Here are a few examples of auditory stimuli you may consider pairing with your reinforcement.

            Token Towers – If you are using some sort of a token system, the Token Tower might be a great option. As opposed to token systems that require the use of Velcro tokens (such as stars or happy faces) or a written system, the token tower is plastic. When a token is earned, your student hears it hitting the bottom of the tube.

            ClassDojo – There are a lot of great features in ClassDojo. Not only does ClassDojo have a specific sound associated with earning points for various tasks, it also has a different sound for losing a point. You can communicate a lot without interrupting the class, and students understand what is happening simply from a brief auditory stimulus.

            TAGTeach – This is a neutral auditory stimulus that is paired with reinforcement so the student can learn that the stimulus means “you did a great job” or “nice work!” The auditory stimulus can then be used on it’s own as a reinforcer. It allows you to reinforce at the very moment the behavior happens, which is incredibly important because positive behaviors increase when they are reinforced immediately.

            What types of auditory stimuli do you use in your reinforcement strategies?

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

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

Managing a Home-Based ABA Program

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This month’s ASAT feature comes to us from Beverley Sharpe, a founding member and Director of Families for Early Autism Treatment of B.C. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

We have a home-based intervention ABA program for our son. What are some helpful suggestions for managing the steady stream of professionals in our home?

Answered by Beverley Sharpe, parent of a 22- year-old daughter with autism

Opening your home to therapists, behavioral consultants, and other providers is part of effective treatment for your child. However, it can sometimes be difficult to supervise a home that doubles as a work environment and the many opportunities and challenges that come with that arrangement. I am humbled by the high level of energy and dedication my therapy teams, past and present, have demonstrated within my own child’s program. Teamwork and collaboration are crucial elements to make home therapy effective. The following are some helpful tips I’ve learned over the years to help make home team coordination more manageable.

Be a Good Host/Hostess

I have struggled at times to balance being a “boss” and a “hostess” within my home. At the start of a shift, I recommend a five-minute exchange to greet and debrief the provider. No matter what job one has, people deserve to be acknowledged and greeted. I typically put on the tea pot or provide a cold drink, say hello, debrief, then let the provider begin the shift. With a new provider, I allow more time for him or her to set up materials, reinforcers, and data sheets before bringing in my child.

Define Your Expectations of Those Who Work with Your Child

An agency that provides home-based intervention will have a written job description or list of expectations for employees. If you are not working with an agency but are, instead, hiring and training your own team, please take the time to put important expectations in writing. Being on time, completing data sheets, communicating about behaviors observed, being prepared for shifts (including bringing appropriate task and reinforcer materials), and respecting other family members are examples of appropriate expectations.

Get Feedback from Staff

Over time I learned to explain to the team that it is hard for me to be both a boss and a friend. I truly did want to be a good listener, and at the same time a good manager of the team. I enjoyed the one-on-one time at the beginning of a shift with each provider and would ask, “How are you?” and “How are you finding the work with my child?” Their answers inspired me to make changes to the program, address issues with the behavioral consultant, and work on team building during team meetings that became more frequent when my daughter’s inappropriate behaviors became challenging.

When conflicts of any kind arise, talk about it and clear the air so that tensions or misunderstandings do not fester. Speaking about problems factually, face-to-face, with a hot cup of tea or coffee is a strategy that I have used. Also, I would make sure my daughter was engaged in an activity before starting the conversation. Remember, you can control yourself, your communication style, and the environment when you address an issue. Being respectful, honest and kind are great ways to be sure you have done your best to address issues. In my experience, new directions have come from allowing members of the team to share their perspective with you. Your child’s quality of life depends on effective intervention, and a home that is warm and inviting to the hard working providers who share your vision will help your son realize his fullest potential.

Keep in Touch with Former Providers

Email has enabled me to keep in touch with some of the former providers who have worked so hard with my child. One of Allison’s former providers is now professionally trained in hairdressing. Every year before Christmas this provider comes to our home to gift Allison a Christmas haircut! I love the expression, “Friends are like stars, you can’t always see them, but you know they are there.” I think of all past and present providers as being Allison’s stars, not all providers will maintain relationships with the family. The reality of employing people in your home is that some will choose, for reasons of their own, not to stay in touch with you or your child. Don’t take it personally. Life happens to everyone! Also, keep in mind that agencies may have policies forbidding contact outside of the current professional relationship.

Acknowledge Other Siblings in the Household

Shortly after putting together my first therapy team in 1997, I realized I had to address the issue of acknowledging siblings in the household. My daughter, Allison, who was receiving services in the home, was 3 years old at the time. She had a big brother, Jackson, who was 5 years old. Jackson came to think of it as normal that he would have to move from one room to another when Allison’s therapy sessions were in progress. He was always good-natured about this. I wanted to keep big brother Jackson involved with sessions, as appropriate, to help him feel more involved, instead of just frequently displaced. For example, turn-taking was a wonderful way to involve Jackson, as was the “Go Find” program.

I also reminded providers to acknowledge Allison’s brother whenever possible. I reminded them that a simple and genuine greeting will go a long way with his cooperation in the house! This helped to make Jackson’s cooperation more likely when he was asked to move to another room during a therapy session. Also, Jackson was taught to ask a provider, “What can I do to help my sister today?” when a provider started her shift. This simple act facilitated Jackson’s knowledge of his sister’s abilities, and gave him a lot of pride when he was able to tell his friends that he was helping his sister to learn! Big brother Jackson then became a big help during sessions by moving and sharing his play toys, games and puzzles and allowing space for his sister and her therapy team. Always remember, siblings are part of the household that supports the learning of the child!

Recognize That Housekeeping Is Important

Remember, your home is a provider’s work environment. I do my best to clean and tidy the therapy area before tackling any other room in the house on cleaning days. I also do a quick check of the bathroom area before sessions, as everyone appreciates a clean washroom! I make sure therapy notes, bulletins, communiqués are all neatly on their clipboards. I also make sure that my child is clean and presentable for the shift. Finally, I make sure that there is an “outing fund” with money for community activities. If my child worked towards a reward of an outing to the zoo, Dollar Store, or movie theatre, I wouldn’t want the lack of funds to delay the delivery of that reinforcer. Make sure your team knows to keep receipts for outings which are approved by the behavioral consultant and yourself. Also, remember to reimburse bus fare or gas money for a provider. Agencies will likely already have a policy in place for travel expenses as well.

Be a Good Employer, Which Means Advocating for Your Staff

Therapy time does not equate to babysitting. I had to correct a few well-intentioned neighbors who referred to my providers as babysitters. When my child is in the community, grocery shopping, at a gymnasium, or at work experience, these hardworking men and women are providing therapy, not just watching or transporting my child. Providers are important members of your child’s medically necessary treatment team. Correct misconceptions by family and friends along the way. Many family and friends may not be familiar with this type of therapy or treatment and may need some educating about the purpose and format of a home-based intervention based on applied behavior analysis. This education can help preserve the dignity and respect of your child, your team, and the discipline of applied behavior analysis for autism.

Stay in the Home During Therapy Time

For insurance purposes, many agencies require that a provider not be left alone in your home. Providers work in your home and deserve a safe and respectful environment. This means that a parent must remain in the home during a therapy session. This can be helpful for routine questions and support as well as in case of any emergencies.

Set Clear Expectations Around Cell Phone Use

The abundance of cell phones means that providers and families can be in real-time communication for shift or program issues relating to the child. However, they can also be a distraction from active treatment and supervision of my child. This has occasioned another hiring criteria for being on my child’s treatment team: Cell phone use for anything other than communication about the child, on their shift, is not acceptable. Cell phone games, texting, social media, and other social messaging are not acceptable. Even the ten seconds (as stated by one provider) it takes to text back to a friend means you are disengaged, not observing, and not “on” with your client – my child. Cell phone use expectations must be made clear from the very beginning and reiterated as needed.

Gift Giving

Holiday time was always a tough time at my home. In British Columbia, there was zero funding for autism treatment when I started my daughter’s program in 1997. I wanted to give tokens of appreciation to my daughter’s home treatment team for the holiday season. My budget was beyond tight, but homemade cards were always appreciated. One family I knew put together a cookbook of favorite home recipes for their home team; another family made a huge holiday dinner, in conjunction with a team meeting, to thank their team. There is always a way to say thank you to your team that is respectful of one’s budget.

Please note that many agencies and ethical guidelines for behavior analysts have strict policies around gift exchange and it is often not permitted. Check with your agency and your providers if you have any questions around this topic. And please do not be offended if a member of your team is not able to accept a gift.

Use Different Cultures and Celebrations as Learning Opportunities

We took the opportunity to learn about different religious holidays when one of our providers shared that she was Jewish. This was a wonderful learning opportunity for everyone on the team. We even made a card for the start of the Jewish New Year – Rosh Hashanah. Over the years, my daughter’s providers brought the wonderful gifts of sharing their religious holidays, culture, and favorite recipes that have enhanced our lives!

Making birthday cards for therapy team members gave my child the opportunity to use pencil and coloring skills, printing skills, and to sing the “Happy Birthday” song. All of these skills took a long time for acquisition. However, after all the hard work, to see my daughter use her skills to put a smile on her providers’ faces was priceless. To hear my child use her voice (she was non-verbal for the first 6 years of her life), and to hear her sing Happy Birthday – well, it is a win-win situation!

With a therapy team, it is a wonderful opportunity to have a simple celebration for each of the several birthdays throughout the year. My child learned that birthdays are for others as well as for herself. This learning extended to teaching big brother Jackson that every time we celebrate a birthday, he does not always get a present!

As our programs progressed, our behavior consultant added a cooking and baking program to help include both children in all household birthday celebrations for family members and members of the treatment team. The beauty of a cooking program was that skills, such as: counting, measuring, mixing, pouring, baking, decorating with icing, and washing and putting away dishes, were all “taught” in a fun way. This was a very detailed program with the huge reinforcer of getting a tasty item to eat at the end of completing a recipe!

In Summary

Managing an ABA treatment team in your home can be challenging but can be rewarding as well. There are many things you can do to help the team work well together and be effective in providing your child with the services he or she needs and deserves. Remember, it’s a learning process for all!

Please use the following format to cite this article:

Sharpe, B. (2017). Clinical corner: Managing a home-based ABA program. Science in Autism Treatment, 14(3), 17-20.

About The Author 

Beverley Sharpe is a founding member and Director of Families for Early Autism Treatment of B.C. (FEATBC). Bev’s daughter Allison was diagnosed with autism twenty years ago and Bev became an advocate for effective autism treatment. She was a member of the Legal Steering committee for the Canadian landmark decisions (Auton and Hewko) regarding autism treatment. Bev participates in new parent intake, political lobbying, fundraising, and speaks regularly with parents regarding advocacy in the school system. She also helps new parents access funding for autism treatment.

 

 

The ABA Tools Of The Trade Kit!

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While data collection is a cornerstone of ABA, and essential for providing effective interventions, there are many obstacles to collecting accurate data. My colleague Val Demiri and I have focused a lot of time and attention to addressing these obstacles and working to make the data collection process easier.

The new ABA Tools of the Trade Kit includes some of our most-used tools, from low-tech tools such as the abacus bracelet to high-tech such as the GymBoss. The tools included here allow you to take a variety of types of data. Here’s a peek at what’s inside:

Tally counters: This is one of the simplest tools available, but incredibly useful. Put it on a lanyard around your neck or keep it in hands-reach to easily tally the number of instances of a target behavior.

Time Timer: I use this tool all the time with my clients. It provides a great visual for them to see time as it is elapsing. I use it for teaching children to wait for a preferred item/activity and to remain on task while the “red bar” is showing.

GymBoss: This interval timer is one of my favorite and most-used tools. I’ve used it and similar items in a variety of ways, for helping parents and teachers provide more positive reinforcement, teaching clients self-management skills, and keeping track of interval schedules of reinforcement when I’m implementing an intervention.

Audible Timer: While this is a basic tool, having something with an auditory stimulus is invaluable!

Token Tower: Speaking of auditory stimuli, this is one of my favorite token systems simply because the plastic token makes a sound when it drops into the tower. I also love that I can move the ring up and down the tower to indicate how many tokens the client must earn.

Abacus Bracelet: This is one of the best low-tech tools around. It’s especially great for classroom teachers who are trying to count a target behavior while teaching. Simply move a bead from one side of the bracelet to the other, and then at the end of the lesson count how many beads were moved. I love technology, but sometimes you can’t beat simplicity.

ABA Tools of the Trade: The book is also included in the kit, which provides much more information about these and other tools, as well as dozens of examples of real-life scenarios.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

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

Growing Up: Supporting Teens On The Autism Spectrum

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Growing up is exciting and challenging for kids and parents alike.  Teens on the autism spectrum may face difficulties in socializing, planning for their futures, and enjoying independence.  Parents may find it hard to know how to support their children through the rites of passage of adolescence and adulthood, but there are some things to keep in mind to make this time a little easier and more enjoyable for everyone.

First, just like any teen, every teen with autism is an individual and should be treated as such.  There are no one-size-fits all solutions at any age, including adolescence.  Parents and teachers should be aware of the strategies and supports that helped their child in the past as possible sources of information for the present and future.  For example, a child who did really well learning from video models may grow up into a teenager who can learn quite a lot from YouTube videos (under the appropriate supervision, of course).  It’s important to make sure that supports are thoughtfully updated to be age-appropriate, too.  Individuals with autism do not need to be stigmatized by being associated with materials and activities that are typically seen as more child-like.  For example, a teenager with autism who requires a reinforcement system would hopefully be able to use a system that is age-appropriate like actual money, or discreet enough like points awarded in a phone app or on an index card, instead of a colorful token economy with stickers or pennies.  Many children with autism benefit from activity schedules, which can be updated for older children using the same organizational strategies that other teenagers may use, including smartphone-based apps for scheduling, reminders, and to-do lists.

Another important consideration in supporting teenagers with autism is that their goals may need to be updated as they get older.  Hopefully, the “5-year rule” has been observed, in which goals are carefully selected according to what the individual will need to be able to do in the next 5 years.  This means not waiting until the child is in the midst of puberty to teach the self-care routines associated with that time, and not waiting until the child has become an adult who is interested in having a romantic relationship to teach some of the social skills associated with that part of life, in addition to many other examples.  If not, then it’s never too late to work on these skills, but it’s definitely easier and less stressful to address them earlier rather than later.  Keeping this in mind, teens with autism may need to be thinking further ahead than typical teens.  For example, if college is going to be a goal, it’s helpful for parents and school supports to know and be preparing for this from the beginning of high school.  Similarly, if the young person is aiming more towards a career path, the skill set needed for work should be addressed well in advance of the time that he or she is expected to start to work. 

Finally, adolescence is a time to celebrate and enjoy independence.  For teens with autism, independence should be approached as a goal for every area of life, with the careful assessment of safety and readiness.  Independence can be achieved at the right level for each individual, given the appropriate goals and supports.  For example, many teenagers enjoy learning to travel independently, from taking public transportation to eventually driving independently.  If a teen with autism is able to safely navigate these skills, that can be a great achievement.  For teens who may not be ready for this level of independence, alternatives can be focused on, such as learning to map out public transportation routes that will be traveled with a parent or support person, or being responsible for one’s own money when traveling with supports.  For individuals with autism at any age, there are always new levels of independence to strive for.

About The Author

Dana Reinecke, PhD, BCBA-D is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA).   Dana is a Core Faculty member in the Applied Behavior Analysis department at Capella University.  She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum, forms, and hours tracking.  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).

Sticking to Clear Sds and Planning Error Correction Procedures

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Recently I was supervising a session in which the current goal was for the child to identify cards by category. The teacher was placing three cards in a messy array, and asking “Where’s the animal?” or “Point to the food.”

When the child got it right, the teacher did a great job of providing reinforcement. However, if the student didn’t respond correctly, the conversation might look like this:

TEACHER: What is this? (Pointing to zebra)

STUDENT: No response.

TEACHER: Come on. You know this one.

STUDENT: Horse?

TEACHER: No. You know this one. Remember we did a puzzle earlier with this animal.

STUDENT: Animal?

TEACHER: What animal? Remember the puzzle?

While the intention of the teacher is understandable, this is not an evidence-based error correction procedure. We don’t want our student practicing errors. Often, you might see your student is making the same error over and over. This means there has been in error in our teaching, and we need to make adjustments. Many times, the error is in how we correct errors.

The example described above is one that I commonly see when supervising. Many of our students don’t have strong listening comprehension skills, so continuing to give clues isn’t teaching our student to respond to “What is this?” but is actually teaching them to respond to some other stimulus. The very first recommendation I had as this teacher’s supervisor was to be clear with the discriminative stimulus.

But how should we correct the student’s initial error? There are several commonly used, evidence-based error correction procedures, but the most effective procedures vary from individual to individual. It’s valuable to assess the evidence-based procedure that is most effective for you individual student prior to beginning teaching procedures. This will make your teaching more effective and efficient.

There is a lot of research about error correction procedures for individuals with autism. Carroll, Joachim, St. Peter, & Robinson (2015) clearly outline four commonly used procedures and explain how to assess an individual’s response to each procedure. Carroll, Owsiany, & Cheatham (2018) utilized a short assessment for determining which of five commonly used procedures may work best for a specific individual. Starting with these two articles can clarify how to best move forward with your students or clients.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

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

Autism Awareness Month Is Over…Unless You’re A Parent

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Autism Awareness Month is over, but for many parents of children with autism, awareness is a daily battle. You would think that after decades of research, awareness of what autism  would be more prevalent. But I still talk with parents who are struggling with relatives, friends, or strangers on the street being unaware, (and often incredibly rude,) about Autism.

             One parent I work with recently asked me if I had a stock response for such rude responses. The truth is that even after seventeen years of working with people with autism, I am often at a loss for words when I encounter statements such as “I don’t even think your child has autism. This seems like a discipline issue.” OR “Why aren’t you working on _______ since you’re spending so much time on all of these other behaviors.” So, I turned to some of my colleagues for help.

            Below is a list of some “stock responses” to help out in these awkward, and possibly offensive, conversations.

Response to statements like “Autism isn’t a real thing.”

“Autism is a real thing in our house. We’d be happy to have you come over and see first hand what it is and how it effects our family. In many ways, we need to live differently than we expected, but we have all learned to grow in ways we never expected. “

I think the best answer is probably to refer the person to a resource like Autism Speaks or ASAT. “Thanks for expressing an interest in what we’re doing.  Our strategies are based on scientific principles and are supported by trained professionals.  If you’d like to learn more about what it means, here’s a website you can look at.”  

“Autism is a tricky disorder because sometimes people who have it have strengths in some areas but weaknesses in others.  I know my child may seem just like any other kid, but he’s worked hard to get to this point, and he’s still working hard.”

“It may seem to you like my child is crying/tantrumming/etc. because he’s spoiled or just wants to get his way, but his ability to communicate with others is really impaired, so he gets easily frustrated.  Thanks for your concern, but we’re working on helping him to overcome this.”

I think my response would depend on the day and my mood.  On a BAD day, I might tell (yell at) the person to be thankful they are not faced with the same challenges in their children.  On a more level day, I would attempt to use it as a learning experience and provide a logical response that Autism is a genetic disorder recognized by the Surgeon General and defined in the DSM-V.  That it generally impacts the child’s social and communication skills and can often result in stereotypic motor movements like hand-flapping.  I would go on to tell them about ABA and that there is no known cure.

“Autism is a neurological disorder so his brain works differently than other people. I can send you some info through email if you would like.” (Or end it after the 1st sentence and walk away)

“Thank you for your concern. It really takes a supportive community for us to manage each day.  We prefer to not discuss this with people who don’t understand autism as our time is best spend with our child, rather than explaining ASD to others.”

“Autism isn’t a ‘thing’ – Well, it really is, but it’s a wide spectrum so almost every person with autism is different from any other one you’ve met. That’s why it can be hard to diagnose and treat, because of the wide range of the disability and variability across it.”

“Thanks, but I’d rather not discuss this with you” can go a long way, too!

 

Response to statements like “Why aren’t you working on _______ since you’re spending so much time on all of these other behaviors?”

“We are working tirelessly everyday to improve social behavior, we target the most interfering behaviors first and will systematically work through the list. “

“While _________ is important, there are other things that are more important at this time- _________ won’t matter if the child can’t tell you what he wants or needs. We’ll get to it eventually but only once it shows to be important and interfering with other things. “

“Or, we ARE working on it, but it takes a long time to change behaviors.” (maybe even insert a “You could help us by…”  line)

“Yes we are working on that too. We still have work to do. And how is your…”

 

Response to statements like “What’s his problem anyway?”

“He just learns some things differently and a bit slower than others; but you should see how smart he is in (describe an area of strength).”

“There are some things that really get him mad, but he is getting better and is learning to tell us what the problem is.”

 

Responses to “I’m sorry, but I don’t think my kids can be around your kid. I’m worried about them picking up some of his problem behaviors.”

“I’d say that’s too bad, he’s a great kid and really helps other people in ways that he can; he’s never had a problem with anyone.”

“I tried to think of something good and positive, refine to say/write…but you know me…I would give them the middle finger :)”

 

More general advice:

I have worked with a parent who had business cards printed that had 2-3 websites listed on it. When the person started up, the parent handed the card to them and just said something like: “That is a big question that would take too much time to answer here so here are some resources for you to check out.” This allowed them to shut it down but in a way that was not confrontational. 

Remember that you don’t have to say anything, especially when it’s to a stranger. It is perfectly okay not to share personal details about your child’s diagnosis.

So you can see I try to not directly contradict someone saying something; I downplay the concern, reflect back, gently push back, and then stop talking and redirect the conversation if I can.

 

Thank you to Cheryl Davis, Michael Dorsey, Kari Dunlop, Dana Reinecke, Krishna Ruano, Sarah Russell, Erin Stone, and Tom Zane.

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

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