By Maithri Sivaraman, BCBA

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

What are the barriers?

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

Do we hold stereotypes?

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

Are we aware of cultural norms?

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

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

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

Cultural analysis

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

Empathy grows as we learn

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

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

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

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

References

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

About The Author

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

Previously published on Different Roads to Learning on November 14, 2019.

Imagine telling your students to sit down at the table for math. You finally get 4 students seated, but then you turn your back for two seconds to grab the materials for your lesson, and in the meantime, two kids pop up and run back to their preferred activities.

Scenarios like these make me want to pull my hair out. I hate downtime. My students struggle with it, which makes my life as a teacher so much harder.

So one way I have found to eliminate as much downtime as possible (besides packing my day full of activities) is to create routines in every part of my day. This way, students know what is expected and can independently get going with an activity even when I have to run and grab some materials, deal with a challenging behavior, etc. It makes my students (and me) more productive! In today’s post, I want to share some helpful tips and activities I have found to reduce downtime in the classroom.

Visual Schedules

One helpful way to do this is to post a visual schedule of your routine. In the beginning, you will need to teach this to your students on a very consistent basis. Over time, they will get into the swing of things and they’ll be ready to get started without you! For my morning group, by the end of the year, I put each kid in charge of a different activity (their names were written on a clothespin and clipped onto the activity) which gave me time to do attendance, get the lunch count, check backpacks, etc. while still monitoring the group as needed.

Binders

Binders can be another helpful way to create routines. Students can grab their binders and begin working on activities in order. If you need students to stop and pause between activities for more instruction, use dividers to split the binder into sections along with a “stop and wait” visual. (Check out this post for more info on my morning work binders or this post for 8 ways to use binders in your classroom).

I often find it is the beginning of the lesson that is the hardest…like I said before, teachers need time to get set up, materials gathered, smart board turned on, etc. In general ed, teachers often have a “do now” or “warm up” activity where their students do a review activity, practice problem, or introduction activity for the lesson that will follow. I find this extremely helpful in my classroom as well. Here are a couple activities I have used to fill the downtime in the beginning of a lesson.

Correcting Sentences

To start my advanced morning group, I had my students start with a daily correcting sentence worksheet. We would review as a group, then move onto other literacy activities (click here to see a blog post detailing what we did in this group).

Fluency Timings

I have utilized a few different versions of fluency timings in my classroom and they can be extremely helpful as a beginning “warm up” activity. (My little soapbox on fluency… fluency is speed + accuracy. Our students can sometimes learn skills, but they are too slow with that skill to make it actually functional. Fluency activities help students practice a skill and increase their speed.) With my beginner students, we use these fluency timings where students label as many pictures/numbers/letters/etc. out loud in one minute. With my advanced students, we did written fluency timings. We had kids assigned to be in charge of these as well (yellow cards were student initials who were in charge). These helped my kiddos increase their ability to generate ideas when given a topic, speed of writing, and made writing into a fun activity. And of course, including some visual directions for the activity increased student independence!

Check-in/out 

I helped a teacher create this check-in for students who came into her room when they needed a break from their general ed classroom. To help them not disrupt her other groups and get to their break as quickly/independently as possible, she came up with the idea to have them check-in, select their break activity, set a timer, and check out when they were finished. I have also seen some great social skills groups start and end with a check-in/out worksheet. Here is a sample from do2learn which provides these FREE.

Predictable Worksheets

I like these worksheets for practicing letters/numbers as they involve minimal writing, but more coloring, tracing, and circling.  Most of my kiddos could complete these with minimal assistance, and with so many worksheets, we could use them throughout the year to begin a group.

File folders, puzzles, or adapted books

Have a bin of these at the ready to either set at each student’s spot or have them make a choice from the bin as the beginning activity before starting your lesson. I love using my “All About Me” books which each student has to practice targeting personal information.

About The Author

This piece was originally published on Autism Tank.

My name is Hailey and I have been a special education teacher for students with autism for over 10 years.  I taught students in 1-8th grade.  My class size has ranged from 4-13 students over my career and I have had between 1-4 paraprofessionals full time in my classroom. I currently work in a school district as an autism specialist and help teachers in all disability areas to implement evidence-based interventions for their students. I have had several family members with disabilities, which initially made me interested in the special education field.  I took an intro to special education course in college, where I absolutely fell in love.  As a course requirement, we had to volunteer every week in a classroom, and it became the highlight of my week!  

Previously published on Different Roads to Learning on February 6, 2020.

By: Randy Horowitz, M.S. Ed., S.A.S.

Children with autism often engage in problem behavior when asked to participate in activities to which they are infrequently exposed (e.g., doctor/dental exams, haircuts, etc.). In many cases, the problem behavior serves as a means to avoid an unpleasant situation or to communicate a need.

Why are dental visits problematic?

Infrequent exposure, combined with fears associated with dentists, sensory issues related to dental implements and changes in schedules (going to the dentist when you should be in school) prevents some children with autism from learning the appropriate skills and behaviors needed to be successful at the dentist.

Because of these challenges, parents and teachers tend to avoid dental exams, when in reality, they need to do the opposite. Create many opportunities to practice. Build skills. Practice appropriate behavior. Come into contact with reinforcement. Do so under the best circumstances (e.g., in the absence of a tooth ache or painful dental issue).

Prepping for success

• Prepare the dentist/hygienist/receptionist in advance. Talk to the dentist prior to your scheduled appointment. Explain your child’s preferences and aversions (e.g., one person speaks at a time, noises, etc.) 
• Visit the dental office without having an actual exam. Take a tour. Provide reinforcement for appropriate skills and behavior (e.g. labeling objects in the environment, walking nicely etc.). Leave on a good note. Consider repeating this across several visits.
• Introduce pictures (e.g., the dentists’ office, waiting room, exam room, etc.) during structured teaching sessions
• Use visual schedules to indicate when the appointment will be
• Consider using social stories, peer models or video modeling procedures during regular teaching sessions

In some cases, the above strategies may not be effective, or your child’s rate of acquisition may be slower than the timeframe you have. In these cases, you may have to create a lot of opportunities for direct instruction. Practice a dental exam several times a day with the actual dental implements.

Some Prerequisite Skills (Mastery of these skills may create the occasion for more success during a dental exam)

• Sits in chair (also lays back/tolerates the reclined position)
• Imitates adult movements (e.g., opens mouth)
• Follows simple directions (e.g., “say ah”, “open wide” etc.)
• Tolerates toothbrushing. Use many different types of toothbrushes and toothpastes during teaching sessions at home. Programming for generalization across materials may help your child accept what the dentist offers.

Strategies for waiting

• Strategically schedule the appointment for times that are less crowded. Ask the office if the first appointment of the day is less wait time than the end of the day.
• Use a timer
• Bring things to do (but avoid a situation where terminating a preferred activity or relinquishing a preferred object may cause problem behavior)
• Wait in the car, take a walk around the block and ask the receptionist to call or text when the dentist is ready

Strategies for during the appointment

• Begin with mastered skills. Ask the dentist to do a few trials of general direction following. This builds momentum and also provides an opportunity for the child to access reinforcement for correct responses
• Pair the exam with reinforcement (e.g., preferred music, TV, etc.)
• Give breaks out of the chair
• End on a positive note. Even if the entire exam is not complete, if the child has tolerated many steps for longer periods of time, terminate the exam and schedule follow up.

Through systematic teaching and gradual exposure, children with autism can learn needed skills and behaviors to be successful during a dental exam. The rate of acquisition of these skills and behaviors varies across children. In some cases, mastery may take weeks or even months. In the meantime, remember to celebrate each successful step along the way!

About the Author

Randy Horowitz, M.S. Ed., S.A.S.

Randy has a Master of Science in Education from Queens College and a Certificate of School Administration and Supervision from the College of New Rochelle. Randy is currently a doctoral candidate in the educational leadership program at Concordia University. Randy started her career as a special education teacher in public school in Nassau County and then spent close to 30 years in senior leadership positions at nonprofit organizations serving children and adults with autism in NYC and Long Island. Randy has presented at local, national and international conferences on topics relating to educating individuals with autism. Her particular areas of interest include preparing and supporting individuals with autism for integration into community activities.

In addition to her many work responsibilities, Randy is also a seasoned runner and has participated in countless road races and marathons, including our Blazing Trails Run/Walk, raising well over $65,000 in the past 15 years to benefit the autism community.

This week’s post comes to us from Stephanny Freeman, PhD and Kristen Hayashida, MEd, BCBA, our partners on the Play Idea Cards app. Play Idea Cards is a full curriculum on teaching play – right in the palm of your hand! Check it out on the Apple App Store! 

Everyone just loves the holidays!

Lots of emotions!  Excitement, joy, love, anxiety, anticipation, stress, and relaxation…

Lots of activities! Giving gifts, eating holiday food, traveling to see family and friends…

Lots of people!  Big groups, little groups, friends, family, loved-ones, and strangers too!

But the holidays are also a FANASTIC time to help your children continue their COGnitive development! 

You can target executive functioning (EF) during these special activities, which is not only a great opportunity to foster skills, but also helps you as a caregiver have a successful and joyous holiday season! Here are some of our tips to build EF during the holidays:

Consider EF Skills when Choosing Gifts for Your Children

Rather than impulsively buying the newest screen toys… plan, problem solve, and control those holiday emotions!! Use your EF skills to buy enriching toys and plan fabulous activities! Deck the Halls with Cogs of EF – fa la la la la, la la la la!

• Working Memory – look for memory-based board games and the copying pattern games.
• Planning – consider activities where children can make something (e.g., manipulatives such as blocks or magnetic tiles, arts and crafts, dough).
• Cognitive Flexibility – give a track set and challenge the child to vary the path or move a vehicle through obstacles. You may also consider any “flexible” toys (e.g., magnetic sets, wax sticks, slime) to talk about how you can change the shape of the object.
• Task Initiation – outdoor equipment would be great for this skill (think: balls, hoops, chalk, ropes, cones/domes), or cleaning and gardening supplies.
• Emotional Control and Inhibition – use a gift that challenges your child to inhibit impulsive responses and regulate through frustration/excitement. We think of dress up clothes (for peer play, turn taking), advent calendars, surprise toys, bubbles, foam shooters, noisy electronic infant toys.
• Organization – find toys that contain lots of pieces and can be sorted and used by category such as figures, furniture, vehicles, houses/garages/buildings with all the associated pieces, doctors/vet kits, cooking/kitchen/ice-cream stand/restaurant.
• Problem Solving – STEM kits, puzzles, brain teasers all naturally present the child with problems to solve, but you can use these activities as opportunities to solve problems that may naturally occur (e.g., if chemicals don’t react, liquid spills from the beaker).

Embed EF practice in your holiday preparation!

Everyone is so busy making their lists and checking in twice! Involve your child during your holiday preparations to help build EF skills:

• Shopping!  Make a store plan by the layout, develop a list, check it off as you go, make sure to consider other things if something is not available, don’t buy things not on the list!
• Baking and Cooking!  Talk about the order, what’s in a recipe, have them retrieve the items (more than one at a time), try to remember the measurements, plan out the decorations (draw first, gather the colors, etc.)
• Decorating the house/tree!  Sort decorations by room, place items on the tree by tree zone, and compromise and delegate roles and responsibilities.  Include how to be careful with delicate objects, how things are meaningful to others, and fix broken items.
• Wrapping and giving presents!  Notice how people respond to gifts given.  Work on fixing ripped paper/ribbons that don’t cooperate, and glitter that gets everywhere.  Be sure to label and organize the gifts.  Solving any problems related to gift giving (oops, we forgot cousin Milt!)
• Family Gatherings!  Organizing some family activity, planning where people are going to sit, getting along with family members and discussing how to behave in other people’s homes.

From our family here at KidsConnect to yours… Happy Holidays to the wonderful, thoughtful, executive functioning-using, caregivers! 

About the Authors

Dr. Stephanny Freeman is a clinical professor at UCLA, a licensed clinical psychologist, and Co-Directs the Early Childhood Partial Hospitalization Program (ECPHP).  For 20 years, she has educated children with ASD and other exceptionalities as a teacher, studied interventions for social emotional development, and designed curriculum and behavior plans in school and clinic settings.

Kristen Hayashida is a Board Certified Behavior Analyst at the UCLA Early Childhood Partial Hospitalization Program (ECPHP).  For the last 10 years she has served as a therapist, researcher and educator of children and families living with autism spectrum disorder through the treatment of problem behavior.

By Sam Blanco, BCBA

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

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

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

Keep It Simple

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

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

About The Author

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges and the Senior Clinical Strategist at Encore Support Services. You can read more of Sam’s posts for Different Roads To Learning when you click here!

This post was originally published with Different Roads to Learning on December 19, 2019.

In this podcast, Drs. Jill Dardig and William L. Heward discuss their new book, Let’s Make a Contract. Contracts are particularly useful for children on the autism spectrum, who benefit from understanding clear expectations and receiving positive feedback and rewards.

In their interview, they discuss key elements of a behavior contract:

• What a behavior contract is
• How long a behavior contract should last
• Common mistakes made with behavior contracts, and how to avoid negativity when mistakes are made
• How contracts can benefit children, parents, families, school settings, and self goals

For more information regarding this interview, and for a full transcript of the episode, visit https://marybarbera.com/behavior-change-contract-bill-heward/

This month’s ASAT feature comes to us from Mary Jane Weiss, PhD, BCBA-D and Nicole Pearson, PsyD, BCBA-D, Association for Science in Autism Treatment. 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 mother of three children, one of whom has autism and requires a tremendous amount of time and care. I worry about how this is impacting my other children, both of whom are a few years older and are very aware of how our family has changed because of their sibling’s diagnosis. Do you have any advice on how to best address this with them?

Answered by: Mary Jane Weiss, PhD, BCBA-D and Nicole Pearson, PsyD, BCBA-D, Association for Science in Autism Treatment

Having a child with autism spectrum disorder inevitably impacts the entire family, from the stress and anxiety that accompanies the initial diagnosis to the time-intensive nature of navigating treatment options and providers. It can also present challenges for siblings.

While children of younger ages may not be fully aware of their sibling’s disability, they likely detect parental stress, perceive inequities in the amount of time and attention given, and struggle with a sense of disruption in overall family life (Feiges & Weiss, 2004; Smith & Elder, 2010). Adjustment difficulties are influenced by such factors as sibling age and gender as well as family size. Siblings closer in age to the child with autism, and those who are younger and have not yet developed effective coping strategies can be more affected. However, as a parent, there are many strategies you can take to support sibling coping and adjustment.

Foster a supportive environment at home

Siblings may feel many emotions, including love, joy, fear, anger, embarrassment, resentment, and guilt, among others. Encouraging an environment of open communication allows the sibling to safely express all emotions. Doing so helps with positive coping and establishes a foundation for good familial communication and problem-solving.

Further, as siblings become aware of such differences, they will likely look to their parents and family members for guidance. Thus, parent coping and adjustment play an important role in sibling adjustment. As such, it is important for parents to be cognizant of the impact their actions, behaviors, and decisions will have on all their children.

Ensure your child understands what autism is

Parents sometimes overestimate their typical child’s understanding of autism as the child may be able to explain what it is without fully comprehending it. Making sure that siblings have developmentally appropriate information will help reduce their fears and misconceptions (Glasberg, 2000; Harris & Glasberg, 2003).

When speaking with children under age nine, parents should keep explanations brief and frame the sibling with autism’s deficits in the context of having not yet learned or mastered particular skills, such as playing with others or communicating in ways that other children do. For example, saying, “Your sister learns a bit differently than you and me, so she needs extra help,” or “Your brother may not be able to talk but we are teaching him other ways to show us what he wants to say.”

As children age, explanations can be more involved. Behavioral escalations can be disruptive for typical siblings, so providing them with clear explanations can help alleviate some of these feelings. Regardless of the children’s age, parents should offer reassurance and convey love and acceptance of everyone in the family. There are several free online resource guides available:

• Autism Speaks offers a “Siblings Guide to Autism” toolkit designed for siblings ages 6-12 that parents and siblings can read together to learn more about autism and facilitate conversation about it
• Organization for Autism Research’s “Kit for Kids” offers an illustrated booklet for elementary and middle school students, called “What’s up with Nick?” and “Autism, my sibling, and me”

Promote meaningful relationships between siblings

Creating opportunities for younger children to play together or helping older siblings to find common interests, even if it’s as simple as doing a puzzle together or playing a video game, can go a long way in increasing the quality and quantity of interactions and ultimately building sibling bonds.

Being mentors to one another can be very fulfilling for siblings and can promote bidirectional feelings of self-efficacy and nurturing. Prior to starting, make sure that the preferences of both children are understood, and start with easy tasks to ensure success. Perhaps the autistic sibling is great at puzzles, while the typically developing sibling is great at following recipes to bake.

Whenever possible, involving the individual with autism in the discussion of autism is preferred.  If it is possible to share information about autism openly and in their presence, it may be helpful to do so. For children who do not yet understand much about their autism, it is important to be as respectful as possible when explaining it to others, discussing it, or otherwise referring to it.

Build one-on-one time for each sibling and foster individuality 

While inequities exist in all families, they are intensified in a family who has a child with autism. And if typical siblings feel dissatisfied with these inequities, their relationship with their sibling with autism is negatively impacted (Rivers & Stoneman, 2008). To help minimize the impact of these inequities, it’s important to make time for one-on-one interaction with each sibling. Carving out even a small amount of time where you’re giving your child your undivided attention can go a long way. Let them know that even though they may not always get as much attention as their sibling, they’re loved and cared for equally.

Encourage siblings to get involved in sports, clubs, or other community activities where they can develop relationships with peers and just have fun. Doing so allows them the time and space to be their own person and establish a sense of individuality (OAR, 2014).

Consider additional sources of support

Finally, sibling groups can be a helpful source of support. They provide siblings the chance to meet and speak with others with similar experiences and can give them accurate and age-appropriate information about autism. If a support group isn’t readily available within your children’s school or your community, consider looking at some of the following resources for more information:

• Sibling Support Project: Offers more than 475 community support programs, called SibShops, for younger siblings of children with special needs.
• Online resources: There are several online communities for siblings, both teens and adults:
  • SibTeen, an online Facebook group for teen siblings: https://siblingsupport.org/connect/sibteen/
  • SibNet online forum for adults: https://siblingsupport.org/connect/sibnet/

The Organization for Autism Research (OAR) has also developed the “Autism Sibling Support Initiative” offering helpful resource guides for young children, teens, and parents.

While much is often said about the challenges faced by siblings of people with autism, there are also substantial positive outcomes. Most siblings who reflect on the experience in adulthood attribute their high levels of compassion, tolerance, patience, and concern for others to having had a sibling with special needs. Furthermore, many of them develop a sense of mission and enter helping professions.

There is no universal description of the ways in which this role changes the lives of siblings of children with autism. Parents can help their typically developing children by creating an environment of transparency and openness about autism. They can help siblings find effective and rewarding ways to interact with their brother or sister with autism. Parents can also ensure that every child in the family gets needed attention and permission to pursue their own dreams. Finally, they can remember that most siblings of children with autism end up being compassionate human beings who treasure and admire their siblings, and who note both the struggles and joys that the family experienced because of being touched by autism.

Note: This submission was adapted from Drs. Weiss and Pearson’s book chapter, “Working effectively with families of children with autism spectrum disorders: Understanding family experience and teaching skills that make a difference” which appeared in “School success for kids with autism.”

References:

Feiges, L. S., & Weiss, M. J. (2004). Sibling stories: Growing up with a brother or sister on the autism spectrum. Shawnee Mission, KS: Autism Asperger Publishing Company

Glasberg, B. A. (2000). The development of siblings’ understanding of autism and related disorders. Journal of Autism and Developmental Disorders, 30, 143-156.

Harris, S. L., & Glasberg, B. A. (2003). Siblings of children with autism. Bethesda, MD: Woodbine House.

Organization for Autism Research (OAR). (2014). Brothers, sisters and autism: A parent’s guide to supporting siblings. Retrieved from: http://www.researchautism.org/family/familysupport/documents/OAR_SiblingResource_Parents_2015.pdf

Rivers, J. W., & Stoneman, Z. (2008). Child temperaments, differential parenting, and the sibling relationships of children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 1740-1750.

Smith, L. O., & Elder, J. H. (2010). Siblings and family environments of persons with autism spectrum disorder: A review of the literature. Journal of Child and Adolescent Psychiatry Nursing, 23, 189-195.

Weiss, M. J., & Pearson, N. K. (2012). Working effectively with families of children with autism spectrum disorders: Understanding family experience and teaching skills that make a difference. A. L. Egel, K. C. Holman, & C. H. Barthold (Eds.). School success for kids with autism. Waco, TX: Prufrock Press.

Citation for this article

Weiss, M. J., & Pearson, N. (2016). Clinical Corner: How to manage the impact of child with autism on siblings. Science in Autism Treatment, 13(2), 22-26.

About the Authors

Dr. Mary Jane Weiss, Ph.D., BCBA-D, LABA, is the Dean of the Institute for Applied Behavioral Science, the Director of the Ph.D. Program in ABA, and a Professor at Endicott College, where she has been for 11 years. Dr. Weiss also does research with the team at Melmark. She has worked in the field of ABA and autism for over 38 years. She received her Ph.D. in Clinical Psychology from Rutgers University in 1990 and she
became a Board Certified Behavior Analyst in 2000. She previously worked for 16 years at the Douglass Developmental Disabilities Center at Rutgers University. Her clinical and research interests center on defining best practice ABA techniques, exploring ways to enhance the ethical conduct of practitioners, and training staff to be collaborative, compassionate, and culturally responsive.  She is on the board of ASAT.

Dr. Nicole Pearson, PsyD, BCBA-D, is a Licensed Psychologist and Board Certified Behavior Analyst (BCBA-D) who has been working in the field of autism and developmental disabilities for more than13 years. Passionate about serving children with complex medical, behavioral and mental health needs, Dr. Pearson has worked across a number of settings including hospitals, clinics, homes and schools. Most recently, she served in a dual role as Program Director and Director of Psychological Services at The Joshua School. Dr. Pearson provides consultation and training to schools and families through her private practice, West Side Behavioral Associates. She has also volunteered with autism programs internationally in Kenya and the Maldives. Dr. Pearson holds Master’s and Doctoral degrees in Psychology from Fairleigh Dickinson University and a Bachelor’s degree in Business from Villanova University. She currently serves on the Board of Directors for We are the Village Ltd. and A Global Voice for Autism.

By: Tameika Meadows, BCBA from I Love ABA

“Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:

1. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).”

www.CDC.gov

It is part of the diagnostic criteria for Autism to struggle with Rigidity.

What is Rigidity? It is an inflexibility, an inability to tolerate change or unexpected events, to varying levels of difficulty.

This is something many of my clients struggle with, and it can be quite life impacting in negative ways. Issues around rigidity can affect the school day, relationships/social ties, life at home, transitions, community integration, and vocation/employment success (for older clients).

Some examples can include:

• Difficulty tolerating a change in teacher
• Difficulty staying calm if something breaks, loses power, or the battery dies
• Difficulty staying calm if mom or dad drive past Wal-Mart but we don’t go inside 
• Insistence on the same routine every day, Monday-Sunday
• Refusal to change eating habits, clothing choices, etc., from one day to the next
• Difficulty sleeping if traveling, away from home, or the bedtime routine is different

As rigidity is a core characteristic of Autism, treating or intervening on it must be approached carefully. The goal should not be to turn an inflexible person into a flexible person. The goal should be to help the learner adapt to an ever-changing world that will NOT stay constant, and increase the learners coping skills to accept what they cannot control. 

To a degree, most of us are creatures of habit. We buy a certain brand of makeup, we brush our teeth a certain way, we park in the same place when we go to work, we always sit in the 2nd row for our college lectures, etc. It isn’t inherently a problem to like sameness and predictability in your life.

But.

This does become a problem when the reaction to the routine being disrupted, is explosion, aggression, self-harming, etc. For example, I have specific restaurants where I order the same thing every time I go. If I went one day and that item wasn’t available, I’d be disappointed, annoyed… I might even leave and go eat somewhere else. But I would not become a danger to myself or others, and I would not perseverate on that annoyance for hours or days.

So how do we help our clients, students, and loved ones calmly accept life’s inevitable changes?

ABA provides many, many strategies to teach flexibility and tolerance to change. Let’s discuss a few:

1. What are we teaching instead? This should be priority #1, it is truly that important. We cannot just rip away established patterns and rituals, we have to first identify the replacement behavior(s). This could include teaching the ability to request (“I wanted the red cup”), to wait (“We will go to Wal-Mart, but I’m stopping at Wendy’s FIRST”), to self-manage anger and disappointment (“I can see you are angry. Let’s do our deep breaths, okay?”), and/or to problem solve (“Oh no, your tablet’s battery died. How do we fix that?”).
2. Do we have rule out for underlying issues? It is not uncommon that Autism co-occurs with other diagnoses. Is the learner just “rigid”, or are they OCD? Or struggling with an undiagnosed Anxiety disorder? 
3. Intentionally, and systematically, introduce change. I work with so many families who try to skirt this issue by avoiding changing things in their child’s environment, giving in to the rituals, even driving out of the way in the community to avoid passing places that will trigger the child. I know this seems like the easy way to manage this problem, but in reality it will make things worse. It is almost presenting a lie to the learner to act as if nothing in their environment need ever change. That just isn’t real life. We need to help the learner by introducing small, intentional changes (start super small) and then helping them tolerate that change. Speaking of tolerate….
4. Help the learner develop a “plan of action” when they are triggered. This will be highly specific to the individual learner, so I cannot give a recipe for this. What is most important is to utilize function based intervention to teach a strategy to the child for de-escalation. For example: When there will be a substitute teacher at school, inform the learner. (If possible) Talk about how they feel about this change. Empathize with their distress, and do not minimize it. Engage in action steps such as pacing, squeezing a stress ball, humming, and deep breathing with closed eyes. Remind the learner of the things they can control/the things that are unchanged. For example: “I know you’re angry that Mr. Walker is not here today. That’s disappointing. We can go in the hallway and take a break, and when we come back in you let me know if we’re doing our writing journal or sight word folder first. Okay?”.
5. In Step # 4 I referenced “Empathy”. I know it can be frustrating and stressful when your client/child/student explodes over a moved seat, a different bowl at breakfast, or a broken toy. You might think “WHAT IS THE BIG DEAL?!”. Well, do you like change? If we’re honest, most of us do not like unexpected, unrequested change. It makes us angry, and we feel annoyed. So even if you can’t fully relate to the size of the explosion, you can relate to the feeling, right? That “relating” is empathy. Put yourself in the learners shoes, and treat them the way you would want to be treated if you were that upset and agitated.

Additional Resources

• Rigid Eating Habits
• Food Selectivity
• Inflexible Thinking
• Use Inflexibility to Teach Flexibility
• SuperFlex Curriculum
• Intentionally Changing Routines
• Poljac E, Hoofs V, Princen MM, Poljac E. Understanding Behavioural Rigidity in Autism Spectrum Conditions: The Role of Intentional Control. J Autism Dev Disord. 2017 Mar;47(3):714-727. 

This piece originally appeared at www.iloveaba.com.

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 month’s ASAT feature comes to us from Dr. Karen Parenti, MS, PsyD CEO/Executive Director at Special Friends Foundation. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

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

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

Police officers consistently and expertly respond to a large number and variety of emergency situations daily. Each emergency has its own unique characteristics, and so do the individuals involved in that crisis. First responders and police receive standard and rigorous training on how to respond to emergencies compassionately and effectively. This training, while appropriate and efficient for most situations, is not necessarily the best way to respond to a child or adult who is diagnosed with ASD. Unfortunately, this may lead to a tragic outcome such as injury or death.

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

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

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

A Child or an Adult Diagnosed with an Autism Spectrum Disorder May:

• Avoid eye contact.
• Walk away from family residence or group home to stores, shopping centers, local pools, or other places they enjoy. They may wander into traffic, not understanding environmental dangers.
• Be overstimulated and not comply appropriately to police or first responders’ instructions. For example, they may not respond to directives such as “come here”, “get out of the street” or “let me see your hands.”
• Become preoccupied with certain objects or interests, such as planes, trains, fire trucks, or movies.
• Repeat or echo phrases, words, or actions.
• Not know how to relate, talk, or play with others.
• Have sensory sensitivity, manifested by stereotypical behaviors which may include covering their ears, flapping their hands, spinning, toe walking, or making unusual noises among others.
• Become agitated due to the disruption in their routine.
• Have unusual reactions to the way things in the environment look, feel, smell, sound, or taste.
• Not speak at all or may not be able to communicate their wants or needs effectively.
• If verbal, may have difficulty understanding questions or may respond noncontextually. For example, they may simply script from a movie, speak about their special interests, or provide answers that appear to be evading the questions posed.
• Be unable to communicate that they are in pain.

A first responder will be able to interact more appropriately with a person with autism if he or she is able to recognize that the person may have ASD. It may also be helpful if the first responder becomes familiar with the following crisis response and intervention safety habits.

Crisis Response and Safety Habits:

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

Awareness is Essential

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

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

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

Additional Information and Resources

The following resources provide additional information related to first responders:

• Living with Autism – Autism Information for Law Enforcement and other First Responders
• Training for Indiana’s First Responders: Recognizing and Responding Appropriately to Individuals with Autism Spectrum Disorders
• POAC Autism Services –First Responders Training
• First Responder Autism Certification (ibcces.org)

About the Author

Dr. Karen Parenti works as the CEO/Executive Director of Special Friends Foundation.  She has extensive experience in ABA and in developing and overseeing group homes, day services, and rehabilitative programs for individuals with intellectual and developmental disabilities and autism. She also serves as the treasurer of the MAX association’s board where she continues to advocate for the needs of the individuals she serves. Karen earned her Bachelor’s degree in psychology from York College of PA, her Master’s Degree in Human Services Administration from Springfield College in Wilmington, DE and her Doctorate Degree in Clinical Psychology from Immaculata University.

This article has been republished with permission from https://asatonline.org/research-treatment/clinical-corner/first-responders/

By Sam Blanco, BCBA

Assessment is the cornerstone of creating appropriate and effective interventions. Two common assessments used for youngsters with autism are the Assessment of Basic Language and Learning Skills-Revised (ABLLS-R) and the Verbal Behavior – Milestones Assessment and Placement Program (VB-MAPP). You’ve likely heard of both the ABLLS-R and the VB-MAPP. While these two assessments are similar in many ways, there are also some big differences that might make one more appropriate for you than the other.

ABLLS-R

The ABLLS-R is made up of two components: the ABLLS™-R  Protocol and the ABLLS™-R Guide. The protocol is comprised of a skill-tracking system, assessing items ranging from listening and language skills to academic and ADL skills. The scoring system is simple, in that each specific skill is broken down into 2-4 levels. You simply mark the level that matches your client’s current skill. The simple organization allows for you to easily track your learner’s progress.

It is important to recognize that the ABLLS-R is more than just the protocol. It also includes the ABLLS-R Guide, which provides instructions for scoring as well as strategies for using the information to develop appropriate goals. Over the years, I have seen many practitioners simply using the protocol without referring to the guide. This is an error that should be corrected, as the guide is a useful resource for parents, teachers, and practitioners. Finally, the ABLLS-R assessed skills that typically develop between approximately ages 2-6.

VB-MAPP

The VB-MAPP is composed of five components.

The Milestones Assessment is comprised of 170 measurable milestones, all based in B.F. Skinner’s analysis of verbal behavior. It focuses primarily on language and social skills, but does include some skills related to academics.

The Barriers Assessment provides a way to assess and measure common barriers to learning experienced by children with language delays. These include barriers such as prompt dependence, impaired social skills, and failure to generalize.

The Transition Assessment provides a way to assess and measure progress towards the child’s ability to move to a less restrictive environment. This portion of the VB-MAPP includes items such as the rate of acquisition for new skills, adaptability to change, and ability to learn from the natural environment.

The fourth component of the VB-MAPP is the Task Analysis and Supporting Skills. This portion goes hand-in-hand with the Milestones Assessment. It is comprised of hundreds of skills that are often directly related to the milestones. It shows the skills that should be taught prior to each milestone and can provide additional information into the child’s current skill level.

The final portion is the VB-MAPP Placement and IEP Goals. This is an in-depth guide for developing IEP goals and identifying interventions based on the results of the other portions of the assessments.  As with the ABLLS-R, I’ve seen many practitioners utilizing the VB-MAPP without referring to the Placement and IEP Goals in the VB-MAPP Guide. This is an error that should be corrected to best use the assessment. The VB-MAPP assesses language skills that typically develop by age 48 months.

VB-MAPP or ABLLS-R?

It is valuable to receive training in both of these assessments. They are important tools for assessment, especially if you are working with young children.

No matter what assessment you choose, we’ve got you covered! Head to our website and check out our full line of ABLLS-R and VB-MAPP supports, including our exclusive full assessment kits!

About The Author

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges and the Senior Clinical Strategist at Encore Support Services. You can read more of Sam’s posts for Different Roads To Learning when you click here!