Building Variability Into The Routine

Several years ago, I was working with a 6-year-old boy we’ll call Terrence. Terrence was diagnosed with autism. He was a very playful child who was generally good-tempered, enjoyed playing with trains and watching TV, and posed few difficult behavior issues for his parents…until the day there was construction on their walk from the grocery store to their apartment and they decided to take a different route home. What happened next is what most people would call a full-blown meltdown: Terrence dropped to the ground, screaming and crying, and refused to move.

Building Variability Into The Routine

Many of the parents I work with have a similar story when it comes to their child with autism and an unexpected change in the routine. The change varies: the favorite flavor of fruit snacks is out of stock at the store or the babysitter greeted the child at the bus instead of the parent or they grew out of the coat they wore the past two winters… In fact, it can be difficult to anticipate exactly what specific routine may be a trigger for your learner. This is precisely why building variability into the routine can be helpful.

Here are a few things to consider:

  • First, think about the routines that are the most likely to be interrupted. Make a list of these so you can begin thinking about how to address those issues.
  • Second, work with your team (whether that means family or practitioners that work with your learner) to select 2-3 routines to focus on first.
  • Discuss how those routines would most likely be interrupted. For instance, a favorite TV show may be interrupted during election season or you may have a family function when the TV show is aired. In teaching your learner to be flexible with changes in routine, you will contrive changes that are likely to occur to give your learner quality practice.
  • Plan to vary the routine. Essentially, you are setting up the change in routine, but you will be prepared in advance to help your learner behave appropriately. (You’re much more likely to experience some success in this scenario than you would be if a change in routine occurs unexpectedly and/or last minute.)
  • Give your learner a vocabulary for what is happening. I teach many of my students the term “flexible.” I might say, “I appreciate how you’re being flexible right now” or “Sometimes when plans change we have to be flexible. This means…”
  • Reinforce appropriate behaviors related to flexibility! You want to be clear when they’ve made an appropriate, flexible response. In the planning phase, you can discuss what appropriate reinforcers might be for the routines you are targeting.

If you build in variations in routine and teach your learner some strategies for being flexible, you and your learner are much more likely to be successful in navigating unexpected changes.

WRITTEN BY SAM BLANCO, MSED, BCBA

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

Regulating Sleep in Children with Autism

With the new school year in session, it’s especially important to regulate sleep in students. In this month’s ASAT feature, Lauren Schnell, MA, BCBA, offers insight on a variety of approaches parents can take to address sleep disturbances in their kids with autism. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!


I am a home program coordinator who works with a six-year old child diagnosed with autism. The parents are concerned because their child struggles at bedtime and will often wake up in the middle of the night to come into their room. The parents want their child to stay asleep and have tried everything to get him to stay in bed all night. What can I suggest they do to treat their child’s sleep behavior?

Answered by Lauren Schnell, MA, BCBA

Sleep disturbances in children with autism are a common concern for many parents. It has been estimated that approximately 25% of typical children between the ages of one and four struggle with nighttime wakings (Lozoff, Wolf, & Davis, 1985). For children with special needs, the number increases dramatically with upwards of 80% experiencing some type of sleep problems (Lamberg, 1994). Of those who frequently wake at night, the majority end up sleeping in their parent’s bed and the sleep problems often persist over time.

Regulating Sleep in Children with Autism

The good news is there are a variety of behavior analytic approaches found to be effective in addressing sleep disturbances in children with autism. An underlying premise of these approaches is that poor sleep patterns are learned, and, as such, can be unlearned.

Prior to implementing a behavioral sleep program, it is important to first rule out any medical reasons for the sleep disturbance, such as physical discomfort related to an illness. Discussions with a pediatrician should help to determine if the sleep issues may be associated with an underlying medical issue and if further testing or evaluation is warranted.

If the sleep issues are thought to be behavioral, the first step is to complete a sleep log to determine the extent of the problem and potential environmental factors that may be adversely affecting the child’s sleep. A sleep log outlines the time the individual is put into bed, the actual time he/she falls asleep, frequency of night wakings, and the duration of those awakenings. Additional information may be collected on any other behaviors which are observed during bedtime, such as tantrums during the bedtime routine or disruptive behavior during the night. Baseline data collection should continue until a consistent pattern of sleep (or lack thereof) or challenging behavior is apparent. This information can later be used to assess the effectiveness of the sleep intervention.

Some questions which may be helpful for parents in completing the sleep log are:

  • What time does the child go to bed?
  • What does the child do leading up to bedtime?
  • What else is going on in the home while the child is in bed which could be influencing his/her sleep?
  • What activities does the child engage in prior to falling asleep?
  • What time does the child awaken during the night as well as in the morning?
  • Does the child take naps during the day?

Based upon the results of the baseline data collected in the sleep log, a number of interventions may be considered. Below are several practical strategies which may be helpful to improve the sleep behavior of the child with autism.

Bedtime Routines
A bedtime routine can be helpful for the child, as it creates predictability in the sequence of activities leading up to bedtime. A written or visual schedule may be helpful in ensuring the routine is consistently followed. The schedule should outline activities preceding bedtime; for example, brushing teeth, changing into pajamas, saying goodnight to loved ones, and reading a bedtime story. The routine should begin at least 30-60 minutes prior to bed time. It is also recommended that parents eliminate all foods and drinks containing caffeine at least six hours prior to bed, and avoid rigorous activities during the later evening hours.

Initially, the child may need a high rate of positive reinforcement for following the routine. Eventually, the parent may consider providing the child with positive reinforcement the following morning if he/she successfully follows the nighttime activity schedule and remains in bed throughout the night. Such reinforcement might include earning access to a favorite breakfast cereal, a toy, or getting a sticker to put on a special chart upon waking (Mindell & Durand, 1993). Continue reading

Tip of the Week: How to Avoid Prompt Dependence in Teaching Students with Autism

“She won’t say hi unless I say ‘Say Hello.’” “He will only wash his hands if I put his hand on the knob to turn on the water.” “He won’t use his fork until I put it in his hand.”

I hear statements like this all the time from both parents and providers working with learners what autism. What they are describing is “prompt dependence,” which is when a learner requires a prompt from a teacher or parent in order to complete a task. So how do you avoid prompt dependence with your own learners?

Let’s start with the prompt itself. There are many different ways to prompt which can be divided into levels by how intrusive the prompt is. Below is a sample of a prompt hierarchy, with the least intrusive prompt at the top and the most intrusive prompt at the bottom. Your goal is to quickly move through the prompt levels to move your learner to independence.

Now let’s look at two different examples to show these prompt levels. In the first example, the goal is for the learner to greet a person who walks into the room. In the second example, the goal is for the learner to pull up his/her pants after using the bathroom as a part of a toileting routine.

Research shows that least-to-most prompting increases potential for errors and slows down rate of acquisition for new skills. Therefore, most-to-least prompting is preferred for teaching new skills. This means that you would start at a full physical prompt and then move your way up the prompt hierarchy until your learner achieves independence with the task.

In the past, when working with discrete trials, it has been common practice to have a learner master a skill at a certain prompt level, then move to a less intrusive prompt and have the learner master the skill at that prompt level, steadily moving towards independence. This can actually encourage prompt dependence because the learner remains on the same prompt level for too long.

Instead, you should try to quickly move up the prompt hierarchy in a way that makes sense for the skill you are trying to teach. Below are some tips to help you help your learners achieve independence.

  • Follow the rule of three: Whether you are teaching with discrete trials or in the natural environment, once your learner has successfully responded to a demand three times consecutively, move to a less intrusive prompt.
  • If you are taking data, make a notation of what prompt level you are using at each step. (And remember, that only independent responses should be counted towards the learner’s percentage of correct responses.)
  • At the end of a session or group of trials, note what prompt level you were at by the end of the session. Then start at that level during the next session.
  • If your learner does not respond correctly when you move to a less intrusive prompt, then move back to the most recent prompt level. Once they respond again correctly at that prompt level three times consecutively, move again to a less restrictive prompt.
  • Remember that verbal prompts are very difficult to fade. Though they are less intrusive, you should avoid using them when possible.
  • You can pair prompts and then fade out the more intrusive prompts. For example, with the sample of pulling up pants described above, you can pair a visual prompt with a gestural prompt by showing the symbol for pulling up pants while pointing at the pants. Over time, you stop using the symbol and just use the gestural prompt. The gestural prompt can be faded by moving your point further and further away from the pants.
  • Write down what the prompt levels will look like for the specific task you are teaching. This way you will be fully prepared to quickly move your learner towards independence.
  • Differentiate your reinforcement! If you move to a less intrusive prompt and the learner responds correctly, then you should immediately provide a stronger reinforcer than you did for previous responses. If a learner spontaneously responds without a prompt, you should do what I call “throwing them a party” by combining reinforcers (such as tickles and high fives) or providing a highly desirable reinforcer.

Prompting can be very difficult to do well, but following these tips should help set your learner on the path to independence.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently pursuing her PhD in Applied Behavior Analysis at Endicott College.

Autism Awareness Month Interview Series: Getting the Services Your Child with Autism is Legally Entitled To with Gary S. Mayerson, JD

This week, our exclusive interview series with BCBA Sam Blanco features the renowned Gary Mayerson, JD, founder of Mayerson & Associates, the very first civil rights law firm in the nation dedicated to representing individuals with autism and related developmental disorders. In this interview, he reveals valuable advice for parents and caregivers on how to find and obtain the services their children are entitled to.


Getting the Services Your Child with Autism is Legally Entitled To
with Gary S. Mayerson, JD

SAM BLANCO: Can you address any common misconceptions related to IDEA or LRE?

GARY MAYERSON: The federal IDEA statute is governed primarily by what is “appropriate” for the student, as opposed to what is “best” or “optimal.” Unfortunately, the IDEA statute does not define the word “appropriate” and that confusion accounts for many of the conflicts that will arise between parents and school districts, who are obligated to provide a FAPE (a “free and appropriate public education”). On the other hand, LRE, otherwise known as “least restrictive environment,” is one of the few “maximizing” provisions in the IDEA statute. LRE is Congress’ mandate that students with disabilities be educated with their non-disabled peers to the “maximum extent appropriate,” even if doing so requires supplemental aids and services. The LRE mandate requires school districts to consider what is known as “the full continuum” and not rely upon “one size fits all” special education classrooms.

SB: What is the most important piece of advice you can give to parents as they begin the process of finding an appropriate school placement for their child?

GM: The best advice I could give parents who are just getting started is to seek out the best possible baseline of assessments and evaluations to tease out the strengths and challenges, identify and address any interfering behaviors, and hopefully get a good sense as to how their child learns, i.e., what kinds of programs are likely to be effective or not. Without the benefit of solid evaluations, the discussion at the IEP meeting will likely be relegated to “this is what the parents want.” When parents are able to provide quality evaluations, the discussion is elevated to “this is what professionals are recommending.” School districts are far more likely to take action based on the recommendation(s) of experts. Early intervention is always best. Accordingly, once evaluations and assessments are available to guide intervention, services should start ASAP. Parents of children diagnosed on the autism spectrum who are just getting started will find very useful information at www.autismspeaks.org. Autism Speaks offers an online “100 Days Kit” to help parents wade through the initial time frame following a diagnosis.

SB: Many parents struggle with the costs associated with autism. What advice do you have for them to alleviate some of the expenses?

GM: This is a thorny topic because even families with significant financial resources will struggle to pay for the daunting cost of effective programming where autism is the core disability. Today, most states (including New York) have enacted insurance reform, which means that many intervention services will be covered by private insurance, typically limited to an annual cap of approximately $40,000 or so. Parents should also consider obtaining home and community based services by filing for a “Medicaid waiver.” In addition to accessing insurance benefits and applying for a Medicaid waiver, families should register with early intervention (“birth to three”) and later, with their Committee on Preschool Education (3-5) and later, with their Committee on Special Education (5-21) to secure a public program. If, however, the public program is not appropriate or adequate, with timely advance notice, parents can file for a hearing to seek to obtain reimbursement or other funding for services and programming that is appropriate. Even short of a lawsuit, if parents are unhappy with the school district’s evaluation, they can request an “independent (private) evaluation” at the expense of the school district.

SB: Do you have recommendations for how parents keep track of records for legal purposes?

GM: Good record keeping is absolutely essential for parents. A great low tech, low cost method every parent should employ– keeping a $.99 notebook “log” of all your conversations with evaluators, school district personnel and providers. Everything important needs to be confirmed and documented in writing. This, however, does not mean sending a letter by certified mail. Faxes are just fine (but be sure to keep the fax transmittal confirmation), as are emails. Make sure to save every notice, letter and communication. For the IEP meeting, parents should either take good notes or, in situations where distrust has arisen, consider tape recording the meeting. Parents who observe schools that are being recommended by the school district also should record their observations, both good and bad.

SB: What resources do you recommend for parents to educate themselves about their legal rights?

GM: While there often is no substitute for seeking the assistance of an experienced attorney or other advocate, there actually are a number of good resources for parents to turn to in order to become better informed as to their child’s rights and entitlements. Parents, for example, will find useful information at www.wrightslaw.com and at www.mayerslaw.com. Our law firm invites parents to sign up for the firm’s quarterly informational newsletter. In addition, parents should carefully review the “parental rights” booklet that all school districts are required to provide in the context of the IEP process. Parents can also contact their local SEPTA or PTA. Finally, each state’s department of education will post, online, valuable information that parents can access free of charge, 24/7.

SB: Do you discuss estate planning for parents of children with special needs? When do you advise parents to begin making those plans?

GM: Parents of special needs children live with constant worry, knowing that they will not be able to live and protect their child forever. All parents–even those without any financial resources–should have a will that addresses estate planning issues, and the question of who will take over the parental role when the parent is no longer around to do so. Parents with financial resources, or who expect to come into money in the future, need to engage counsel to set up a “special needs trust” for their child—so as to allow the child to receive Medicaid and Social Security benefits without endangering the estate when such benefits are accessed. It is never too early to discuss estate planning issues, and too many parents overlook estate planning issues until it is too late. Parents also should timely commence guardianship proceedings well before the child reaches the age of majority (18 in most jurisdictions). Otherwise, a child who reaches the age of majority without a guardianship order may leave the jurisdiction and put themselves in danger with parents being left with little, if any, legal recourse. This is not to say, however, that obtaining guardianship is a given. Obtaining guardianship requires a showing, deemed acceptable to the court, that the child is incapable of making their own decisions.

SB: Can you describe legal considerations across the lifespan? For instance, what should the preschooler’s parents be considering as opposed to the teenager’s parent?

GM: The perspective and legal considerations when a child is a preschooler are different than when a child reaches his or her teens. While learning can and will continue into adulthood, most scientists and educators are in agreement that the same effort will produce greater learning, with a greater “rate of acquisition,” when the same child is younger. For this reason, judges and hearing officers are most comfortable “investing” significant public resources in the younger child. Because of the value of “early intervention,” parents need to obtain a diagnosis and classification as soon as possible. This means obtaining quality assessments that come with specific recommendations. Parents of children at the preschool age should thus timely receive the services and service levels that are being recommended by professionals. When the child enters his or her teens, that child still may require intensive services. However, as mandated by federal and state law, when a child is about to turn 16 (15 in New York), the IEP is supposed to shift into high gear with “transition” assessments, vocational training, and post-secondary outcomes. At all stages, parents should make sure that educators and service providers are promoting “generalization,” and that increased independence and self –sufficiency is the constant beacon on the horizon.

ABOUT GARY S. MAYERSON, JD

Gary Mayerson is a graduate of the Georgetown University Law Center and the S.I. Newhouse School of Public Communications at Syracuse University. In early 2000, Gary founded Mayerson & Associates as the very first civil rights law firm in the nation dedicated to representing individuals with autism and related developmental disorders.

Gary speaks regularly at national conferences and major universities and has testified before Congress on the subject of the federal Individuals with Disabilities Education Improvement Act (“IDEIA”). At the invitation of the United Nations, Gary spoke on the subject of facilitating inclusive education. Gary is well published in the field and is the author of How To Compromise With Your School District Without Compromising Your Child (DRL Books 2005), the “Legal Considerations” chapter appearing in the Second Edition of Dr. Donna Geffner’s book, Auditory Processing Disorders (2013), and the “Autism in the Courtroom” chapter appearing in the Fourth Edition of Dr. Fred R. Volkmar’s seminal treatise, Autism and Pervasive Developmental Disorders (2014).

Gary has been interviewed by the Today Show (NBC), Dan Rather (HDNet), Katie Couric, CNN, HLN, ABC, NPR, New York Magazine, the Wall Street Journal, Congressional Quarterly Researcher and the New York Times, among other media. In 2014, after being peer-nominated and vetted across 12 factors by an attorney led research team, Gary was named by Super Lawyers Magazine as one of the top attorneys in the New York metropolitan area.

In addition to the U.S. Supreme Court, Gary is admitted to the Second Circuit Court of Appeals, the Third Circuit Court of Appeals, the Fifth Circuit Court of Appeals, the Sixth Circuit Court of Appeals, the Seventh Circuit Court of Appeals, the Tenth Circuit Court of Appeals, and the Eleventh Circuit Court of Appeals.

Gary is responsible for more than sixty reported federal court decisions, including Deal v. Hamilton County, the very first autism case to ever reach the U.S. Supreme Court. Gary’s work also was instrumental in T.K. v. NYCDOE (bullying recognized as a “FAPE” deprivation), R.E. v. NYCDOE and C.F. v. NYCDOE (cases rejecting school district’s attempts to rely upon “impermissible retrospective evidence” at trial), T.M. v. Cornwall (least restrictive environment mandate as applied to ESY), L.B. v. Nebo School District (pertaining to “supported inclusion” and Congress’ “least restrictive environment” mandate), V.S. v. NYCDOE (parents have a procedural right to evaluate the school assignment) and Starego v. NJSIAA, a federal court settlement affording Anthony Starego, a 19-year-old high school placekicker with autism, an unprecedented fifth season of interscholastic competition (incredibly, that additional season had a storybook ending, with Anthony and his team going on to win the 2013 State Championship 26-15 after Anthony contributed points from two successful field goals!).

Gary has served on the national board of Autism Speaks since its inception in 2005 and founded its Federal Legal Appeals Project, a pro bono initiative at the federal level. In addition, Gary serves on the Boards of JobPath, a not-for-profit based in Manhattan that is dedicated to securing and supporting meaningful employment opportunities for adults with autism, and ALUT, Israel’s largest autism not-for-profit. Gary also serves on the Professional Advisory Board of the New England Center for Children (NECC), a residential school for students with autism located in Southborough, Massachusetts.

Gary testified before the New York City Council in support of “Avonte’s Law,” a safety enhancement measure introduced by Councilmember Rob Cornegy that, once fully implemented, will provide an additional layer of protection for students with autism who have a propensity to wander. Most recently, Gary and attorneys Maria McGinley and Jacqueline DeVore worked behind the scenes to help secure a conditional pardon from the Governor of Virginia for “Neli” Latson, a young man with autism, previously placed in solitary confinement, who is now receiving the therapeutic treatment that he needs.

Guest Article: “Seamless Separation: Transitioning to School” by Bridge Kids of New York

As our kids and students prepare to go back to school, we thought it was the perfect time to share this wonderful guest post on transitioning into a new school or classroom, submitted to us by Bridge Kids of New York. Read on below for exclusive tips on how to best help you and your child have a smooth transition back to school.

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Seamless Separation: Transitioning to School
by Bridge Kids of New York, LLC

When your young child enters into a school or daycare setting for the first time, the transition can be challenging for both you and your child!  This may be the first time your child has had to navigate a new environment without your support and it may be the first time you have had to entrust your little one to someone else.  Of course this has the potential to be stressful for everyone involved!

Here are a few proactive tips to help both you and your child have a smooth transition:

  • Try to meet with your child’s teacher prior to the first day of class.  Discuss your concerns, goals, and values.  Share important information about your child and ask the teacher to fill you in on any key information you should know about the classroom and/or the teacher’s approach. This conversation may help to ease your anxiety and build trust between you and your child’s new teacher.
  • Establish a communication system.  Talk to the teacher and/or the school’s administration to determine the best means of exchanging important information and find out how frequently you can expect communication.  This will help to establish trust, create consistency between home and school, and keep you informed as to all of your child’s triumphs!
  • Have a game plan for the first week of school.  Although we certainly hope you and your child will transition to school without any difficulties, we always advise that you be prepared just in case!  Expect that the separation may initially be challenging for your child.  Talk to the teacher and school administration ahead of time and develop a plan for how you can help your child to be successful.  Rather than waiting for a difficult and emotionally-charged situation to arise and then reacting to it, we suggest that you take proactive measures and develop a plan when both you and your child are calm.  We highly recommend that you consult with a Board Certified Behavior Analyst when developing this plan to ensure its integrity as well as the safety of all involved.
  • Try to remain calm and confident for your child.  Children are often very good at reading our moods, emotions, and energy.  If you enter into the school transition with outward uncertainty and nervousness, you may send your child the message that he should feel the same way.  Instead, try to remain calm and positive about the change—model the behavior you want to see.
  • Prepare your child for the transition to school.  Discuss this new chapter in a way that expresses excitement and positivity.  Provide your child with clear information on what to expect.  Surprises or confusion can make this process more challenging for your child so do your best to help him understand what will happen.
  • Create a “Going to School” storybook.  Consider creating a fun storybook to help your child get ready for this new transition.  Your storybook can include both text and pictures of the school, your child’s teacher, your family, and even some of his classmates (with consent from those parents, of course).  You will want to provide your child with a step-by-step guide for what to expect.  Using actual photographs may help your child to feel familiar with the school environment before the first day.  We suggest reading this storybook to your child for at least 1-2 weeks prior to starting school, in the morning before school, and again after school until he/she is adjusted.  You may even send the storybook to school with him.  These types of books help to provide important information and also serve as a cue to remind us to talk about it!
  • Do a dry run.  Ask the school for permission to bring your child for a visit before school starts.  Allowing your child to see the classroom and meet the school staff may help him to feel more comfortable on the first day.  You may even consider taking pictures of your child in the school building or with her teacher to post in her bedroom or to include in your storybook.  If school is in session and the administration gives you permission, you may even consider trying to walk out of the room for a few minutes during the visit to assess how your child will adapt to you leaving later on.  (As a pointer, try not to make a huge production out of leaving!  A dramatic exit may lead to a dramatic response!)
  • Practice separating from your child in familiar environments.  If separation is very challenging for your child, you may want to consider practicing this separation in a familiar environment.  It may be overwhelming for your child to adjust to separation from you and the introduction of a new environment and new people all at the same time.  In preparation for school, try separating from your child in environments where she already feels safe and secure (e.g. in your home).  Provide your child with lots of praise and reinforcement for separating from you calmly and successfully!
  • Gradually increase the length of separation.  Some children benefit from gradual and systematic separation.  You may initially just try walking out of the room for 10 seconds, then 30 seconds, then 1 minute, and gradually increase from there.
  • Try to engage your child in a favorite activity before separating.  By doing this, you are pairing the separation with something your child enjoys, which may make the separation itself less aversive.  It may also serve as somewhat of a distraction, so your child is less likely to focus on your absence.  Remember to do this proactively, not in response to problematic behavior.

Important Note:  The tips outlined in this post are proactive measures only.  We hope that applying this advice will help to prevent or reduce interfering behavior and set your child up for success.  However, despite these proactive measures, some children may engage in interfering behavior that is dangerous to themselves and/or to others.  We do not recommend implementing a procedure that may result in an unsafe situation.  For this reason, we highly suggest you consult with a Board Certified Behavior Analyst (BCBA) prior to implementing intervention procedures.  A properly trained professional can assist you in keeping the situation safe while helping your child to be successful.

We hope these pointers will help to make the school transition smooth for both you and your child!  Of course this list of tips is not comprehensive and our behavior team is full of other suggestions, so feel free to contact us for support!  You may find our upcoming Seamless Separation Workshop to be helpful!  Click here to register for this FREE workshop.  We understand that every child and family is unique and that successful transitioning may need to be individualized based on your unique needs.  We are always here to help!

For more information about Bridge Kids of New York, please email info@bridgekidsny.com or visit www.bridgekidsny.com.

Tip of the Week: Minimize Tantrums with High and Low-Quality Attention

Recently I began working with a family who has a six year old boy with autism named Austin (all names and identifying details have been changed to protect confidentiality). His mother was describing Austin’s behaviors when he couldn’t have something he wanted. She told me about him hitting his parents and younger brother, sweeping all materials off tables and shelves, and throwing himself on the floor. She was worried that he might hurt himself or hurt someone else. She told me that when he started this behavior, they would say, “Stop hitting.” They had been doing this for months, but his behavior had not improved.

Later that week, she sent me a video of Austin having one of his “mega-tantrums.” It was exactly as she described, though there was one important detail she had missed. Austin consistently sought out eye contact and physical contact with both of his parents. If they were moving around to pick up an item, he would move his body and face to maintain eye contact. If one of them sat down, he would quickly clamber into their lap while screaming and pounding their arms or the furniture. If one parent walked out of the room, he would immediately run to the other parent. This behavior was clearly maintained by attention. In order to decrease the behavior, his parents had the very difficult task of ignoring it ahead of them.

The next week I went out to their house to help them practice ignoring the behavior. We put in place a three-pronged plan:

  • When Austin wanted something he was not allowed to have, he would be given a choice of options. The options should be for preferred activities. For example, if he wants to watch TV but isn’t allowed to right now, the parent can say, “Austin, you can play with trains or you can do a puzzle.”
  • Once Austin starts hitting or screaming, he does not receive any attention. This includes eye contact, physical contact, and verbal prompts/reminders from his parents.
  • The parents can start one of the motivating activities in another location. For this family, the parents sat with the younger brother at the dining room table and the mother read a book out loud.

As I had forewarned the parents, Austin’s behavior initially intensified as he realized he was getting zero attention. He took a box of toys, turned it upside down, and dumped it all over the floor. His mother kept reading to his brother. He ran over to his father and hit his legs while screaming, the father got up and walked away. Then, Austin did something he had never done before. He climbed up onto the table and started walking around on the edge of it.

His mother looked at me and said, “How do I avoid giving him attention for that?” This is when it’s important to consider high-quality attention and low-quality attention. In order to keep him safe, his mother needed to be more proximal. She walked near where he was on the table, but did not pick him up, did not make eye contact, and did not speak to him. (I let her know that if she felt he was very unsafe, she could pick him up and remove him from the table but quickly letting him go, and withholding eye contact and verbal interaction.) She stayed nearby to catch him if he fell, but she did not provide attention for this dangerous behavior. Her proximity (or if she had chosen to pick him up off the table without eye contact or verbal interaction) constitutes low-quality attention. High-quality attention is only saved for appropriate behavior.

Think about what high-quality attention means for a young child: big facial expressions, expressive tones of voice, big movements, and physical contact. Prior to our intervention, Austin was getting all of those types of high-quality attention for inappropriate behaviors. But now he wasn’t getting any of that type of attention.

However, Austin had been engaging in inappropriate behaviors for attention for 2-3 years now, so changing this behavior takes a little time. For our first day of the intervention, Austin continued to yell and throw items for 40 minutes before he finally went over to where his mom was sitting and reading aloud the story (actually, the third story in a row). When he was near and quiet, his mom started reading in a wonderfully expressive tone, adding voices to the characters. Austin came closer. When a funny part of the story happened, Austin laughed. And then Austin’s mother encouraged him and his brother to imitate the characters in another part of the story. After he imitated the characters, he sat next to his mom and she put her arm around him. All of these high-quality forms of attention were now being given for appropriate interaction.

Sometimes you have to provide some attention in order to keep a child safe, but think to yourself what is high-quality attention for your learner: it may be tickles, silly faces, expressive speaking, or physical contact. Reserve those things for appropriate behaviors.

A few final notes about this intervention: (1) Austin’s inappropriate behaviors will probably still continue for a little bit longer. I’m certain that he will test it out a few more times, and his parents will have to stick to the intervention in order to completely get rid of what they had deemed as “mega-tantrums”; (2) This intervention only works for behaviors maintained by attention. If you’re uncertain about the function of a behavior, confer with a BCBA or an ABA provider for help; and (3) If you’re not certain you can follow through if the behavior persists for a long time (such as 40 minutes in Austin’s case) then give in the first time the learner asks. For more information on this, look back at my tip on Choosing When to Battle.

Pick of the Week: Early Intervention Resources

It’s a fact that Early Intervention leads to positive outcomes for our children. Understand the key principles of Early Intervention approaches with our two newest additions to our early intervention books, The Early Intervention Workbook and Early Intervention Every Day! These reference books cover evidence-based intervention approaches, as well as the best practices on implementation.  Buy one or both of them this week only and save 15%* by using our promo code DRLEI15 at check out.

The Early Intervention Workbook: Essential Practices for Quality Services was written for current and future early intervention providers of all disciplines who are looking to maximize their efficacy. The entire early intervention process is broken down into seven key principles with detailed tips, activities, and strategies on both what to do and how to do it. The workbook covers referral, initial visits with the family, evaluation and assessment, IFSP development and implementation, and supporting a smooth transition out of EI. The authors strive to empower professionals to make positive change happen on both a personal and systemic level by identifying and focusing on successful evidence-based intervention approaches and providing guidance on actual implementation. This is a comprehensive book for group training or independent work, and a great reference.

Effective early intervention doesn’t stop when the provider leaves a family’s home. For parents and caregivers, Early Intervention Every Day! is a practical sourcebook packed with research-based strategies that demonstrate how take a consistent, active role in supporting young children’s development. Targeting 80 skills in six key developmental domains for children birth to 3, this guide also gives professionals loads of ready-to-use ideas for helping families embed learning opportunities into their everyday routines. The guide empowers families to work on IFSP goals during recurring activities, such as grocery shopping or riding in the car, and to give children opportunities to practice and reinforce new skills throughout the day, along with many other strategies for helping children with developmental delays participate more fully in family life.

Remember – this week only, you can save 15%* on your order of either or both The Early Intervention Workbook or Early Intervention Every Day! by using promo code DRLEI15 when you check out online!

*Offer expires at 11:59pm ET on April 15, 2014.  Not valid on past orders or with any other promotions and offers.  Be sure there are no spaces or dashes in your code at check out!

Pick of the Week: Visual Schedules

schoolSummer is winding down and for most it’s time to get back to a routine. For many of our students and children that means getting a handle on a busy new schedule of self-care, school, therapy sessions, extra-curricular activities, play dates and special occasions. A visual schedule or an activity schedule can help pull all of the parts of a hectic day together for a child and increase independence, build organizational skills as well as improve comprehension skills. A visual schedule provides clear expectations, utilizes a child’s visual learning strengths, can reduce anxiety or difficulty with transitions, and can increase flexibility.

This week, we’re offering a 15% discount on some of our favorite products to help you get a visual schedule up and running. Just enter the Promo Code BLOGVS13 to redeem your savings and get organized.

DRP_928_Clear_Schedule_Token_StripClear Schedule with Token Strip: This is an option that is easy and portable for those who want to customize and create their own schedule pictures. There is a token economy that runs alongside which is great for learners who require a thick schedule of reinforcement and need to earn a token for each step of the schedule and can be used for any age.

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On Track! Responsibility & Behavior System: This product is a great tool for children 8 and up. It is a wonderful resource for keeping the whole family on track across multiple daily routines and behavioral objectives. The detailed instructional guide walks you through the implementation and execution of the system is an added bonus.
DRP_916_EasyDaysies_Magnetic_Schedule

 

 

EasyDaysies Magnetic Schedule for Kids: The simplicity of this is fantastic. The Magnetic Fold & Go schedule board travels with you easily and can adhere directly to any metal surface. The imagery is very clear and easy to understand and the To Do and Done Columns are intuitive and easy for even the youngest child to use. The starter kit includes 18 magnets that cover all the basics in your learner’s daily routine but as proficiency increases there are supplemental packs are available to include more specific magnets covering Chores & Special Times, Family & Extracurricular Activities, and Get Dressed & Bathroom routines.

*This offer expires on September 24, 2013 at 11:59 pm EST. Not compatible with any other offer. Be sure there are no spaces in the promo code at check out!

Pick of the Week: Reactivity – Teach Social Skills Through Play

Reactivity CoverThis deck of beautifully illustrated cards uses science-based social skills treatment for children with autism to deliver simple, objective and measurable results. Reactivity allows both parents and professionals to establish the foundations for social skills through a series of cards that introduce children to a wonderful world of playful interactions, designed to develop their interest in relating to people as well as their awareness of the world around them. This week only, take 15% off your purchase of the Reactivity: Teach Social Skills Through Play cards by applying the promotional code BLOGRTVY6 at checkout.

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Reactivity is a wonderful amalgamation of the worlds of play and therapy that is simple and fun to implement while providing short-term observable results. The cards can be used by parents and families, caregivers, behavior analysts, special education teachers, speech pathologists, occupational therapists, psychologists and others.

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Remember, this week only, save 15% on your order of Reactivity: Teach Social Skills Through Play by using our promo code BLOGRTVY6 at checkout!*

 

 

*This promotional code expires on September 17, 2013 at 11:59 pm EST. Not compatible with any other offer. Be sure there are no spaces in the promo code at check out!