Autism Early Intervention and Joint Attention

By: Rose Griffin, SLP, BCBA

There is a strong bond between joint attention and both receptive and expressive language skills. When we work on joint attention, we are showing that our learners’ communication is powerful! I am sharing a few tips and ideas that I use to build connection before communication while working on joint attention goals.

These activities involve shared activities through playing with toys, singing songs, and reading books. It is okay if your student isn’t ready to fully engage when you introduce these activities, note their baseline data and move forward with goals. You will be amazed to see the transformation and excitement over these simple activities.

Toys:

Playing with toys in therapy is all about creating an interaction in a semi-structured environment. Remember to use simple language and allow for natural curiosity and play and not bombard with questions. 

Examples of toys I love to use:

  • Car and car track
  • Mini Objects
  • Farm Set

Literacy:

Build excitement around the book, use books with repetition, and if your kids like it try an animated voice which can be really fun.

A few books I love to keep in my therapy bag that are a great success for joint attention are, Pete the Cat and his White Shoes, Brown Bear, The Very Hungry Caterpillar, and Chicka Chicka Boom Boom.

Music:

Students love songs, they are familiar, and create engagement. I also love to use visuals that can be just laminated pictures or little toys that match the activity of the song. It can also be engaging to sing songs that have motions for the words.

Songs I love:

  • Old Macdonald
  • Wheels on the Bus
  • Head, Shoulders, Knees, and Toes

It can be difficult to keep data and set goals around these abstract ideas, be sure to check out my goal bank on ABA speech. I hope you love these ideas and get use out of them in your next therapy session! 


Rose Griffin, SLP, BCBA is dedicated to helping SLPs and other professionals provide systematic language instruction with ease. Working with students with autism and other complex communication disorders can be challenging. Rose has dedicated herself to helping by providing professional development and real life examples of what she does in her daily practice. See her podcast, blog, and collaboration opportunities at www.abaspeech.org

Posted in ABA

Spotlight: Responsible & Responsive Parenting in Autism: Between Now and Dreams

By: Shahla Ala’i-Rosales and Peggy Heinkel-Wolfe

At one time there were very few avenues available to the increasing number of families receiving autism diagnoses for their children. In the 1960s experimental psychologists took a new direction to improve the quality of life for people on the autism spectrum and their families.  Their work in behavior intervention began as a treatment for people society had neglected.  Little did they know that it created a market.

Their success resulted in a new way of approaching autism that can bring lasting change when services are delivered with intention, skill, effort, and love. Today, autism services are widely available. These services have also become a multi-billion-dollar industry, where a child’s disability risks becoming a business opportunity.

But we can minimize that risk. First, we can ground ourselves in ethical principles and the science of learning. Then, we can remember the power that families have had all along: love. Responsible and Responsive Parenting in Autism: Between Now and Dreams offers timeless guidance as it answers three essential questions: What do you need to know? Who will help you? How can love be your compass?

Prior to the publication of this book, the authors have been friends, colleagues, and allies for 30 years. Shahla’s expertise as an applied behavior analyst and years of clinical work inform this book. Peggy is the author of See Sam Run: a mother’s memoir of autism, winner of a Mayborn Nonfiction Prize.

Together, they have collected meaningful stories from their own experiences and from others on the journey. The stories focus on how family members can understand the scientific principles behind autism services, how parents and professionals can best help and respond to their child and each other, and how they can bring meaning to all of their interactions.

All parents have a responsibility to raise their children with autism as best they can. Parents cannot sidestep this journey. This work is part of how we all develop as humans—nurturing children in ways that honor their humanity and invite full, rich lives. Between Now and Dreams provides the roadmap for a joyful and sustainable journey. The essence of this journey relies on three powers; learning, connecting, and loving. Each power informs the other. Each amplifies the other. And each power is essential for meaningful and courageous parenting.


Shahla Ala’i-Rosales is an Associate Professor int he Department of Behavior Analysis at the University of North Texas. She has taught courses on ethics, early autism intervention, parent training, behavioral systems, applied research methods, technology transfer, and behavior change techniques. She has served on several boards and disciplinary committees and has published and presented research on social justice, ethics in early intervention, play and social skills, family harmony, and supervision and mentoring. Shahla has more than four decades of experience working with families and has trained hundreds of behavior analysts. She has received awards for her teaching, her work with families, and for her work in the community.

Peggy Heinkel-Wofle‘s first book, See Sam Run, a mother’s story of autism, was originally published in 2008 by the University of North Texas Press. The book’s manuscript won the Mayborn Prize for Literacy Nonfiction in 2005. For more than a decade, she has been exploring themes in autism parenting and self-determination on her blog, peggyheinkelwolfe.com. An award-winning writer and journalist, Peggy holds a master’s degree in journalism from the University of North Texas and a master’s degree in music performance from the Eastman School of Music.

Posted in ABA

Building Partnerships

Written By: Dana Reinecke, PhD, BCBA-D

Two people examine some graphs together.  They discuss the trends and variability in one graph, and troubleshoot ways to improve the pattern so that the child engages in a higher rate of mands (requests for desired items), with the expectation that this will reduce distress and improve independence and participation in family and school activities.  A child scoots by (literally, on a scooter), through the kitchen, giggling while another child jogs behind, also giggling.  The two adults stop to watch the kids for a moment, and exchange a smile and then return to their discussion.

Would it be surprising to know that one of the adults is a BCBA?  Probably not. The graphs and discussion kind of give it away.  Who is the other adult?  An RBT?  A consulting BCBA?  A trainee who is engaging in some unrestricted supervision activities?  Any of these make sense, but in this scenario, the other adult is the parent of both children, one of whom is receiving ABA services to increase manding.

This scene is a common one for BCBAs working with children, who regularly and comfortably consult with a parent or caregiver of each client regarding many components of programming (for the purposes of this article, the term “caregiver” will be used to include parents and anyone else who may take on the roles described here).  These components include type and results of assessment; goal selection; choice and definitions of behavior targeted for increase or decrease; strategies used for effecting behavior change; and as described above, data analysis and outcomes.  Ideally, there is also the opportunity to share celebrations of accomplishments, discuss the impact of treatment on the whole family, and address any other areas that may overlap with the BCBA’s role in the family.  This regular sharing of information can be approached as a partnership, entered into by people who care about the child, in the best interests of that child.

Partnership is a two-way street, requiring both the professional and the caregiver to prioritize and facilitate the relationship.  Depending on the funding source, there may be a third party impacting time and availability of resources for this relationship.  Even with limited formal “hours” for working with caregivers, however, the development of a partnership is a necessary and rewarding piece of any effective behavioral programming.  As in any partnership, negotiations must occur to arrive at the ideal situation for both parties.  Let’s take a look at some areas of consideration.

  • Scheduling is an obvious important piece of the partnership.  The caregiver and the behavior analyst should establish a mutually agreeable, regular time for connection, with clear boundaries that will help to maintain professionalism and manage both parties’ expectations.  Caregivers might not be able to connect during their work day, and BCBAs might have families of their own to spend time with after hours. Working together to identify times when caregivers are able to speak with the behavior analyst without work or other family demands helps to reduce missed opportunities to work effectively together.  Similarly, the professional party should be clear about when they are and are not available, so that caregivers can plan accordingly to be available and ready with questions and points for discussion.
  • In addition to when to meet, the place for meetings might be negotiable.  If telehealth (video or phone conferencing) is possible given the funding structure, this may add a layer of flexibility that can be beneficial to both caregiver and provider.  If telehealth is not available, it might be appropriate to think creatively about where meetings happen.  For example, the caregiver might welcome the opportunity to meet outside the home, so that they can freely discuss concerns without their child hearing.  Alternatively, if the professional can meet in the home, that might allow for better participation of more members of the family. 
  • Means of communication is another important area to consider.  HIPAA-compliant email or texting services may be more efficient and helpful for some caregivers, or may present a burden for those who are not as comfortable with technology.  Both parties may be comfortable with phone calls, but there should be some guidelines around when phone calls might not be answered or if it is preferable to schedule phone calls at mutually agreeable times rather than “cold calling.”
  • The areas around which partnership occurs should also be a topic of discussion, especially at the beginning of the working relationship.  The caregiver rightly should expect the BCBA to be the “expert,” but only in the area of behavior analysis.  The caregiver is actually the expert in their child, so they should expect to have a big role at every stage of assessment and intervention.  The professional’s role is to provide guidance and advice, based on their prior experience, education, and the published best practices in the field.  It is up to the caregiver, however, to provide sufficient information, guidance, and input to the professional so that programming is tailored to best meet the needs of the child and the family.  It is also often up to the caregiver to carry out interventions and provide generalization opportunities to complement formal sessions.

With mutual respect, partnership occurs easily and naturally.  One way to facilitate partnership is to approach each other with curiosity and humility.  The caregiver should assume that the behavior analyst has valuable information to offer, and the behavior analyst should assume the same about the caregiver.  Another important way to build partnership is to communicate openly and honestly.  If the behavior analyst proposes goals or interventions that are not comfortable or possible for the family, the caregiver should freely express their reservations.  The behavior analyst needs to make space for this feedback, and be receptive to it.  The caregiver should also be receptive to the behavior analyst, and assume that recommendations are based on best practices and in the best interest of the child and family.  Finally, even the best partnership needs to be nurtured.  Providers and caregivers should create opportunities to check in with each other about their relationship, and to make adjustments as needed regarding expectations and needs.

The provider and the caregiver will be much more helpful to the child they both care about together, than apart.  The little kid scooting around his house is lucky to have a team of people working together to help him live happily, safely, and independently, and the team is lucky to have each other in this important work.


About The Author

Dana Reinecke, Ph.D., BCBA-D is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA).   Dana is a Core Faculty member in the Applied Behavior Analysis department at Capella University.  She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum, forms, and hours tracking.  Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities. She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism.  Current areas of research include use of technology to support students with and without disabilities, self-management training of college students with disabilities, and online teaching strategies for effective college and graduate education.  Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA).

Posted in ABA

ASD Learners and Sexuality


By: Randy Horowitz, M.S. Ed., S.A.S. and Joanne Capuano Sgambati, Ph.D., BCBA-D, LBA

Sexuality is part of normal human development for every man, woman and child. It is a basic need and an integral part of life. Sexuality is not just physical maturity and sexual intercourse; it is diverse and personal. It’s about relationships, intimacy, and thoughts and feelings about other people. Individuals with ASD follow the same physiological sexual development and interests as their typically developing peers; About 75% of individuals on the spectrum desire and engage in some form of sexual behavior. (A comparable percentage to the neuro-typical population). Behaviors range from masturbation to intercourse and many steps along the way. Individuals with ASD have the same sexual interests, needs, and rights as anyone else, they just may not have the same ways to express themselves and share their feelings.

So what else is unique about individuals with ASD in relation to sex education?

  • Poor social competence and limited peer relationships lead to few opportunities to obtain sexual information, have sexual relationships, and fulfill their desire to have a healthy romantic and sexual life.
  • Cognitive differences (difficulty with inferencing, perspective taking, and theory of mind) can impact their understanding, generalization, and application of sexual information.
  • Language and communication challenges as well as social skills deficits can get in the way of initiating and maintaining relationships.
  • Societal barriers which interfere with learning necessary sexual information that can prevent intimate relationships from taking place. 

It is a natural instinct for parents and teachers to want to protect their children; however, by avoiding speaking about sexuality and sex education, they may be suggesting that sexuality is unimportant or shameful and they may be leaving their children even more vulnerable to frustration, problematic behaviors, social isolation, anxiety, depression, low self-esteem and even victimization.

So, how can we best educate learners with ASD about sexuality?

Start early: Children with ASD may have a hard time with change and take longer to learn concepts. Start very early; and present positively in a calm and clear manner:

  • Body part ID
  • Using appropriate words and language to identify genitals.
  • Private vs. public (e.g., places, behaviors, hygiene, and eventually conversations and on-line activities etc.)

Remember what is cute as a child (like hugging teachers), may be inappropriate in middle school. So, teach appropriate social boundaries early on. Do not wait until puberty to discuss body changes as it can be alarming to teens with ASD who resist change (pubic hair, private time for masturbation, shaving, bras, maxi pads, etc.).

Use appropriate teaching strategies: You can teach sexuality skills the same way you teach other skills to those with ASD. Some ideas are use of visuals, schedules, task analysis, functional communication training, and video modeling. Remember that sexual behavior is still behavior and adheres to the laws of applied behavior analysis. If there is a behavior to increase, decrease, or maintain it is important to know the function of that behavior in order to modify it.

Remember while teaching make sure you are aware of issues regarding consent, legalities in your state, wishes of the parents, policies of your agencies and how your intervention will look to others.

Teach independence: It is natural for parents to want to protect their child with ASD but to avoid sex education and relationship development may actually make the individual vulnerable to dependency. Teach independence on skills that are transferable to sex education:

  • personal hygiene
  • dressing
  • toileting
  • use of a cell phone
  • who and how to call in an emergency

Don’t do anything for them that they can do for themselves. This will help the child be less dependent on others for “help” and able to make their own decisions.

Teach safety skills: . Children with ASD are typically taught compliance, They may not know how to self-advocate and say “No” because they have been rewarded for compliance and listening to people who are “in charge”.

  • Teach them to say “NO” when asked to do something they do not want to do (i.e. “No thank you, I do not want a hug”).
  • Teach them that “Your body belongs to you” and rules for touching (appropriate vs inappropriate touches). They need to know they have rights over their bodies and how to “report” any inappropriate sexual behaviors or abuse.

Teach the obvious: Most children learn from a variety of sources: family, peers, TV, movies, internet etc. Those on the spectrum may not pick up on all this information. They may need things spelled out for them in a concrete literal fashion. “You cannot date women younger than 18”. Avoid or explain confusing language. “A “hook-up” is slang for meeting someone for sex and not a relationship.”

Teach about relationships: Explain the variety of relationships that people have (friendship vs love vs intimacy) and (close family and friends vs professionals, acquaintances, and strangers). Help them be social, learn social communication skills, and make friendships. Best friendships form from common interests (e.g., video games, “Anime”, trains etc.). The internet can help you find special interest groups and meet ups. There are also speed dating and singles groups for those with ASD.

Teach them about themselves: They need to develop self-esteem and a healthy self-concept. Understanding their diagnosis, strengths and weaknesses will help them be better advocates for themselves. Being a better self-advocate will also help protect their sexual well-being.


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.

Joanne Capuano Sgambati, Ph.D., BCBA-D, LBA

Dr. Sgambati serves as the Director of Psychological Services for Eden II’s Genesis Programs on LI.  She specializes in consulting, counseling, evaluations, and behavior management of individuals with autism spectrum disorder (ASD).  For the past 30 years, she has been dedicated to using positive behavior approaches, applied behavior analysis (ABA), for enhancing the lives of students in special education and adults on the autism spectrum.  Dr. Sgambati is an active participant in Eden II’s Genesis Outreach Department conducting live presentations and webinars on a variety of topics at organizations, conferences, schools, and universities. She also conducts training seminars for local schools and various parent organizations.  Dr. Sgambati specializes in ABA interventions for families of children and adults with special needs who demonstrate challenging behaviors. She is also the proud parent of two young adults on the Autism Spectrum.


Resources:

https://researchautism.org/sex-ed-guide/

https://www.autismspeaks.org/sites/default/files/2018-08/Puberty%20and%20Adolescence%20Resource.pdf

https://www.autismspeaks.org/recognizing-and-preventing-sexual-abuse

Ames, H. & Samowitz, P. (1995). Inclusionary standards for determining sexual consent for individuals with developmental disabilities. Mental Retardation, 4, 264-268.

Davies, C., Dubie, M. (2012). Intimate Relationships  & and Sexual Health: A Curriculum for Teaching Adolescents/Adults with High Functioning Autism Spectrum Disorders and Other Social Challenges.

Griffiths, D. (1999) Sexuality and developmental disabilities: Mythconceptions and facts. In I. Brown and M. Percy, (Eds.). Developmental Disabilities in Ontario (pp. 443-451). Toronto: Front Porch Publishing.

Griffiths, D.M., Richards, D. , Fedoroff, P., & Watson, S.L. (Eds.) 2002. Ethical dilemmas: Sexuality and developmental disabilities.  NADD Press: Kingston, NY

Hanault, I. (2006). Asperger’s Syndrome and Sexuality: from Adolescence through Adulthood. (information and lessons for students on the less cognitively impaired end of the spectrum)

McLaughlin, K., Topper, K., & Lindert, J. (2010). Sexuality Education for Adults with Developmental Disabilities, Second Edition. (structured group model) Schwier, K.M., & Hingsberger, D. (2000). Sexuality: Your sons and daughters with intellectual disabilities. Baltimore: Paul H. Brookes Publishing

By: Nicole Gorden, M.S., BCBA, LBA 

This blog post is part 2 of 2. Read part 1 HERE


Autism spectrum disorder occurs in individuals from many different cultures and backgrounds. Therefore, cultural competency and sensitivity is imperative for effective delivery of services. To work with autistic learners, is to respect that they are the product of many environments that have shaped them and will continue to shape them throughout their life.

As stated in the most updated ethical code from the BACB, behavior analysts are responsible for incorporating and addressing diversity in practice. For example, the BACB ethical code states that behavior analysts must practice within our scope of competence, maintain competence including cultural responsiveness and diversity. Specifically, providers must “evaluate their own biases and ability to address the needs of individuals with diverse needs/backgrounds” (Ethical Code, 2022, 1.07).

However, what are the practical implementations to culturally sensitive treatment? What does this actually look like in practice? As providers, we are obligated to offer exceptional service delivery with individualized treatment goals. Considering our learner’s cultural background and the impact of their community’s beliefs and attitudes is essential to effective treatment. The following will provide guidance on how providers can apply cultural sensitivity to their clinical decisions in treatment.

Priorities in Treatment Goals

Overlooking the cultural impact can also create conflict and disparity within the stakeholders’ involvement and commitment to treatment. In contrast, “when these values and expectations align with those of the family receiving the intervention, positive outcomes are likely, including high levels of participation and response to treatment” (Dubay, Watson, & Zhang, 2018). Thus, we must also consider how we prioritize goals for culturally sensitive treatment.

For instance, I recently worked on a sleep intervention to desensitize my client to sleeping in his own bed. When discussing the intervention, and more importantly, when to introduce the treatment goal, the cultural sleeping norms had a significant impact. In some urban and minority cultures, co-sleeping is common. Yet, if a provider may think it is significant for the client to start sleeping in their own bed by the age of six, but it is common in the culture to continue co-sleeping even until the child is ten, culturally sensitive conversations can play an important role.

In another example, Filipino cultures find it respectful for younger family members to “bless” elder members by bowing towards the hand of the elder family member and placing their forehead on their hand. Thus, although the provider may find it significant for the client to learn to wave to greet others, by prioritizing cultural norms, it may have a greater influence on the client receiving natural reinforcers by working on blessing their family members, first.

The contradiction between parents following therapy targets that will be supported by their community compared to the skills that might benefit their child in the long term may prove to be challenging and demanding on the family (Dubay, Watson, & Zhang, 2018). Thus, culturally sensitive treatment is prioritizing treatment goals with the best outcome and secures family commitment.

Interdisciplinary Collaboration

By creating culturally sensitive treatments, providers will build better relationships with stakeholders and in turn, reduce the social stress that may come from raising and teaching an autistic child within various cultures. This idea does not only apply to parents, but even extends to the interdisciplinary team that could be influenced by the learner’s culture.

Within Russian communities, it is common to eat soup for lunch. When I provided services in a primarily Russian daycare, I had to consider my client’s aversion to eating these traditional meals as well as the importance of this target behavior to the daycare providers. Rather than dismiss this potential goal, despite my own perspective on the client’s needs, I modified my treatment goals to effectively collaborate with the daycare providers. By understanding the cultural impact and importance of certain behaviors to any stakeholder, the provider can often address unmet needs, gain support for treatment, and keep open communication if other issues arise (Fong et. al, 2017). We must be culturally sensitive towards the beliefs and attitudes that are different than those in the US, and not assume that the learner’s culture does not affect how they or their community respond to treatment.

Educate Ourselves. Stay Cultured. It is not required to culturally match your clients to provide adequate care and treatment. However, providers should strive to acquire knowledge and skills related to cultural responsiveness and diversity. Although we may be the experts in our particular discipline, remember that the parents are the experts on your learner. Culturally sensitive providers should strive to learn about the cultural norms of their diverse clientele. Constant dialogue, keeping an open perspective, and asking questions about cultural norms can make all the difference.


About the Author: 

Nicole Gorden, M.S., BCBA, LBA has over 14 years of experience implementing Applied Behavior Analysis principles with the Autism Population. She currently works for Comprehensive Behavior Supports in Brooklyn, NY.


References:

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. Littleton, CO: Author.

DuBay, M., Watson, L. R., & Zhang, W. (2018). In Search of Culturally Appropriate Autism Interventions: Perspectives of Latino Caregivers. Journal of autism and developmental disorders48(5), 1623–1639.

Fong, E. H., Catagnus, R. M., Brodhead, M. T., Quigley, S., & Field, S. (2016). Developing the Cultural Awareness Skills of Behavior Analysts. Behavior analysis in practice9(1), 84–94.

Fong, E. H., Ficklin, S., & Lee, H. Y. (2017). Increasing cultural understanding and diversity in applied behavior analysis. Behavior Analysis: Research and Practice, 17(2), 103-113.

Patton, S. (2017, April). Corporal punishment in black communities: Not an intrinsic cultural tradition but racial trauma. CYF News. http://www.apa.org/pi/families/resources/newsletter/2017/04/racial-trauma

Practical Applications to Culturally Sensitive Treatment – Part I

By: Nicole Gorden, M.S., BCBA, LBA 


Autism spectrum disorder occurs in individuals from many different cultures and backgrounds. Therefore, cultural competency and sensitivity is imperative for effective delivery of services. To work with autistic learners, is to respect that they are the product of many environments that have shaped them and will continue to shape them throughout their life.

As stated in the most updated ethical code from the BACB, behavior analysts are responsible for incorporating and addressing diversity in practice. For example, the BACB ethical code states that behavior analysts must practice within our scope of competence, maintain competence including cultural responsiveness and diversity. Specifically, providers must “evaluate their own biases and ability to address the needs of individuals with diverse needs/backgrounds” (Ethical Code, 2022, 1.07).

However, what are the practical implementations to culturally sensitive treatment? What does this actually look like in practice? As providers, we are obligated to offer exceptional service delivery with individualized treatment goals. Considering our learner’s cultural background and the impact of their community’s beliefs and attitudes is essential to effective treatment. The following will provide guidance on how providers can apply cultural sensitivity to their clinical decisions in treatment.

Awareness of Own Cultural Biases

Cultural awareness is the first step to providing culturally ethical treatment. Providers should concurrently and habitually engage in practices in which they remain aware of their own predetermined perceptions and acknowledge their own limitations to cultural competency. As mentioned in Fong et. al (2016), “cultural awareness may be important because behavioral patterns that are viewed as problematic in our own culture may be the norm in other cultures”. Due to limitations in diversity within most helping professions, a learner’s provider is often from a different cultural background.

Thus, it is essential to understand the traditions of that culture. As an example, physical punishment may be common practice in some black communities which has been perceived to be deeply rooted in racial trauma (Patton, 2017). It would be insensitive for a provider from a different cultural background to ignore that this practice is a cultural tradition, and thus blame or stigmatize black parents for their choices. Rather, “professionals can offer information about why the practice is harmful but have been told it is necessary, and offer healthier alternatives that produce better outcomes for children, families and communities” (Patton, 2017). Cultural sensitivity is facilitating the development of our programs by checking our own biases and how they may affect our choices in treatment.

Selection of Target Behaviors and Programmatic Materials

A few years ago, a client from Asian descent was transferred to me from another behavior analyst. When assessing the barriers to treatment, my client made minimal progress when asked to identify a fork. Believing that an object, rather than a picture might help, I asked the client’s parents for a fork. When obtaining the fork, the parents expressed that they do not use forks to eat. In their culture, hands and chopsticks are typical eating utensils. Thus, when considering cultural sensitivity, this includes selecting programmatic targets that are common in the client’s environment and the cultural norms.

The teaching materials should be as individualized as the treatment plan too. We should rely on diverse representation in the resources we use in treatment. Providers should use materials that represent the individual’s environment, which is typically a blend of many different ethnicities. When providing resources like visual schedules, do your cartoons or pictures represent the racial identity of your learner? If you are teaching body parts on a doll, do you provide toys that look like your learner? To be a culturally sensitive professional, one should give precedence to ethnic representation to allow the learner to feel validated and treat them with dignity.

The cultural assessment process should be used to inform treatment, specifically when designing the program for validity and selecting targets for skill acquisition (Fong et. al, 2016). When beginning a new lesson or treatment program, it is essential that providers select socially meaningful and significant target goals. However, in selecting these goals for treatment, professionals must consider the cultural norms and needs of the client.


About the Author: 

Nicole Gorden, M.S., BCBA, LBA has over 14 years of experience implementing Applied Behavior Analysis principles with the Autism Population. She currently works for Comprehensive Behavior Supports in Brooklyn, NY.


References:

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. Littleton, CO: Author.

DuBay, M., Watson, L. R., & Zhang, W. (2018). In Search of Culturally Appropriate Autism Interventions: Perspectives of Latino Caregivers. Journal of autism and developmental disorders48(5), 1623–1639.

Fong, E. H., Catagnus, R. M., Brodhead, M. T., Quigley, S., & Field, S. (2016). Developing the Cultural Awareness Skills of Behavior Analysts. Behavior analysis in practice9(1), 84–94.

Fong, E. H., Ficklin, S., & Lee, H. Y. (2017). Increasing cultural understanding and diversity in applied behavior analysis. Behavior Analysis: Research and Practice, 17(2), 103-113.

Patton, S. (2017, April). Corporal punishment in black communities: Not an intrinsic cultural tradition but racial trauma. CYF News. http://www.apa.org/pi/families/resources/newsletter/2017/04/racial-trauma

Do You Want to be the Bringer of the Grins or the Bringer of the Power Struggles?

This week’s blog comes from Parenting with ABA by Leanne Page.

Do you know what one of my favorite parenting tools is?

You guessed positive reinforcement, didn’t you? Close- but today I’m going with HUMOR!

When things are tense- can we help ourselves and our kids to crack a smile to defuse the situation?

When my kids are in a bad mood, it’s easy for me to slip into traditional kneejerk parenting reactions. It’s easy to become overly firm and frustrated. This is when voices rise. Tempers rise. Power struggles begin. Who exactly is winning here? I’m not happy with my own behavior following a tense interaction let alone my kids’ behavior.

What if instead of getting firm we got silly? Can we salvage the situation, the morning, the day? I say HECK YES!Mornings can be hard for so many families- mine included. Getting up on time to get out the door by 7:30am for elementary school is not easy for my oldest. After a few rough days of trying all kinds of different things to just get my girl out of her funk, I hit the jackpot. Instead of being firm in the form of “You do it or I’ll help you do it” through the morning routine, I opted for humor. My girl was grunting and moaning and making all kinds of unpleasant noises instead of doing her morning routine. I asked our smart home thingie “Hey google, can you translate cave man talk?” and “What does (insert grunting noises here) mean in English?” I communicated back to my daughter in cave man grunting noises. She cracked a smile. I turned up the silly drama with noises and gestures to communicate to her what she needed to do next in her morning routine. And guess what! It worked! Not only did it work that day but as soon as I started pantomiming things or making silly noises the next day- a grin! Mornings got smoother for several weeks without me even needing to help her do her routine. Then one day, she had a hard time again. Instead of kneejerk over firm parenting tactics, I tried humor. And it worked like a charm!

When else have you heard me sharing about being silly? In getting our kids’ attention before giving an instruction. Try talking in a silly voice, singing, whispering, or rapping. Try silly faces and hand gestures to act out what you need them to do. Get their attention before giving an instruction but also get a smile as you are interacting with your kids!

Get that grin and helping your kids follow through is a million times easier!

And the best part of all- laughing together helps that highly desired true connection with your kids. Not only does it defuse a situation or help them follow instructions- it strengthens your relationship. It helps your kids to feel safe and secure with you- you are the bringer of the smiles, not the bringer of the threats of punishment or the bringer of rasied voices and power struggles.Next time you feel your own temperature rising because your child is not listening, pause. Try hard to use some humor. The first time or two it really is HARD because your instincts are to be firm and stand your ground no matter what. But breathe and consider the big picture. Do you want your kids to think of you as the bringer of the smiles or the power struggles. Be silly. Get the smiles. Then the instruction following is easier. Save the situation and also strengthen your relationship.

Embrace the silly!


Leanne Page, MEd, BCBA, is the author of Parenting with Science: Behavior Analysis Saves Mom’s Sanity. As a Behavior Analyst and a mom of two little girls, she wanted to share behavior analysis with a population who could really use it- parents!

Leanne’s writing can be found in Parenting with Science and Parenting with ABA as well as a few other sites. She is a monthly contributor to bSci21.com, guest host for the Dr. Kim Live show, and has contributed to other websites as well.

Leanne has worked with children with disabilities for over 10 years. She earned both her Bachelor’s and Master’s degrees from Texas A&M University. She also completed ABA coursework through the University of North Texas before earning her BCBA certification in 2011. Leanne has worked as a special educator of both elementary and high school self-contained, inclusion, general education, and resource settings.

Leanne also has managed a center providing ABA services to children in 1:1 and small group settings. She has extensive experience in school and teacher training, therapist training, parent training, and providing direct services to children and families in a center-based or in-home therapy setting.

Leanne is now located in Dallas, Texas and is available for: distance BCBA and BCaBA supervision, parent training, speaking opportunities, and consultation. She can be reached via Facebook or at Lpagebcba@gmail.com.

A Spotlight On: “Executive Function in the Early Childhood Classroom”

By: Stephanny Freeman, PhD and Kristen Hayashida, MEd, BCBA. Their new book: “Executive Function in the Early Childhood Classroom” can be purchased HERE

When kindergarten teachers are asked what skills they would like their students to have the beginning of the year, their answers might be surprising!  Parents and caregivers are often concerned with making sure their children can say their ABC’s, count to 10, and know their colors. Some may believe that their children should be reading by the time they start kindergarten.  However, kindergarten teachers often have a different set of priorities, and instead are looking for skills such as:

  • The ability to listen to and follow directions
  • Follow classroom routines
  • Control impulses
  • Resolve a conflict or solve a problem calmly with another child

Kindergarten teachers value these skills because they are critical for school readiness, paving the way for children to be academically and socially successful.  Moreover, children who are behind in these skills can require disproportionate amounts of teachers’ attention, derail classroom activities and routines, and interfere with other children’s learning.

Underlying these school readiness skills are a set of higher order thinking skills collectively referred to as Executive Functions (EFs). EFs are the cognitive control functions that help us inhibit our initial impulses and think before acting.

But while most teachers agree that EF skills are very important, they are not explicitly taught in most early education settings (or at any point in most children’s educational experiences).

What skills are part of executive functioning?

Three key skills are generally agreed upon as the core of EF:

  1. Working memory: holding information in mind to manipulate, work with, or act on at a later time.
  2. Inhibitory control: the ability to regulate one’s attention, behavior, thinking, and emotion particularly in response to distractions or temptations.
  3. Cognitive flexibility: the capacity to shift one’s thinking, such as changing one’s approach to solving a problem if the previous approach is not working or recognizing and responding when the demands of that task have changed.

Seven additional skills are also considered to fall under the umbrella of EF, often relying and building on the three foundational EF skills:

  1. Initiation: the ability to begin a task or activity or to generate ideas independently in order to answer questions, solve problems, or respond to environmental demands.
  2. Fluency: how fluidly one can access and use relevant knowledge or skills.
  3. Planning: the ability to identify and sequence all the different steps needed to achieve a specific goal.
  4. Organization: the capacity to prioritize and make decisions about which tasks to undertake, and the needed resources to complete those tasks.
  5. Problem solving: carrying out the steps to achieve a desired goal, while monitoring progress making necessary adjustments.
  6. Time awareness: part of the broader skill of Time Management, which includes to the ability to anticipate how long tasks might take, to be aware of time constraints, track one’s progress, and adjust one’s behavior in order to complete tasks efficiently.
  7. Emotion regulation: skills including identifying one’s own emotion states and responding appropriately to emotional experiences.

Why do executive function skills matter?

Executive function skills predict a host of short-term and long-term outcomes!

  • They are a stronger predictor of school readiness than IQ.
  • They are also associated with higher achievement in both reading and math throughout children’s schooling.
  • EF skills, when tested in early childhood predict outcomes later in childhood and adolescence, including psychological and physical health.

Because EF skills are so predictive of later outcomes, they are being increasingly recognized as a critically important focus of intervention. 


“Early EF training is … an excellent candidate for leveling the playing field and reducing the achievement gap between more- and less-advantaged children.”

Diamond and Lee (2011, p. 6)


Can executive function skills improve?

Yes! All young children (typically developing and those with difficulties) can benefit greatly from instruction in EF!  Frequent practice of these skills and gradually raising the difficulty benefits children most in generalization and increasing gains. Practitioners and parents should consider:

  • Providing focused instruction in EF skills.
  • Combining explicit targeted instruction in EF skills with other activities in which they can then apply and practice those skills.
  • Building targeted EF skills into daily routines.
  • Providing multiple opportunities every day, particularly for children with disabilities, to test out and practice EF skills.

“Most experts consider the development of self-regulation skills, of which executive functions are the crown jewel, to be the most important objective of high quality preschool—to help children focus attention, be emotionally expressive, not be impulsive, and to engage in purposeful and meaningful interactions with caregivers and other children”  

Blair (2017, p.4)


 


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.

Working on the Front Lines of Autism Care

By: Stephanie Tafone, M.A., P.D., Behavior Intervention Specialist at Eden II Programs 

Working on the front lines of Autism care in a residential facility is both rewarding and, at times, challenging. Although our residents depend on us in many ways to teach them how to complete day-to-day tasks, it is important for all staff to recognize and respect that our residents each have their own preferences and interests. Therefore, we always strive to let our residents make as many choices as possible (provided they are healthy choices that do not cause harm to anyone). Just because we as staff might complete a particular task a certain way does not mean it is the “right” or only way to do so. Recognizing and respecting residents’ choices can help avoid negative behaviors or frustration for our residents. Our goal is always to teach and foster independence and self-direction. 

It is always important to build good rapport with our residents so we are in tune with their wants and needs, while also enabling them to better trust us, work with us, and learn from us. Unfortunately, with current staffing crises and funding cuts in residential care settings, one challenge we face is securing long-term, seasoned staff. This type of setting often suffers from a high turnover rate, which this is a matter that needs more global attention, as hardworking, dedicated, and experienced/trained staff are crucial for our population. 

One of the biggest considerations we have on a daily basis, particularly during the global COVID-19 pandemic, is finding creative and entertaining recreational and leisure activities to keep our residents happy and actively engaged. Anyone can become restless and bored with nothing to do, and those with Autism are no different, which is why active engagement is one of our top priorities in a group home setting. When selecting activities, we strive to ensure that each resident’s preferences are considered and incorporated. This includes a combination of both community outings and in-house events/activities. Going into the community on outings can be challenging at times when unpredictable factors (e.g. noise, crowds, etc.) may trigger negative behaviors. However, we do our best to avoid triggering situations by researching and/or visiting the activity or location before our residents experience it in order to help determine if there are any barriers that will prevent it from being an enjoyable and successful outing for all. We also do our best to go prepared on each community outing with preferred items that can be used as a source of redirection and comfort if needed. For example, headphones to drown out noise if it gets too noisy, as well as preferred snacks or drinks if our residents get hungry or thirsty. In the residence, we also strive to think of creative leisure activities, such as dance or karaoke parties, Bingo nights, movie nights, baking, and arts and crafts. Having an enthusiastic and supportive approach, as well as using preferred reinforcers, helps to engage our residents in these activities and increase their interest level. 

In addition to recreational and leisure activities for entertainment and socialization, day-to-day life in the residence is also a learning experience for our residents, as they work on a variety of individualized goals with their assigned staff. Examples of goals may include activities such as participating in a consistent exercise regimen, learning how to independently cook rice or make tea, learning how to independently count money and make purchases, and learning how to independently vacuum or clean one’s room. The selection of a participant’s goals is a collaborative process that involves input from parents/caregivers, input from the participant(s) if possible, and input from the management team at the residence. We strive to ensure that selected goals not only address a skill deficit, but are also aligned with the participant’s interests and will help the participant become more independent in daily living skills. Similarly, participants learn increased independence by participating in various chores around the house, such as setting the table for lunch and dinner, loading and emptying the dishwasher, and doing one’s laundry. Teaching many of these goals and chores can be accomplished through the use of a visual task analysis that breaks the task down into smaller components (i.e. individual steps), which are each depicted in visual images. Visuals are a very helpful teaching technique for those with Autism, who often struggle significantly with understanding verbal language and oral directions. It is also helpful for learning, especially in the initial stages, to use a preferred reinforcer to reward correct completion of steps. In the beginning of learning a new goal or chore, one step may need to be taught for a number of consecutive days until it is mastered and the next step can be taught. 

Overall, working in a residential setting has been a great learning experience and we know that our work has had, and continues to have, a significant influence on our residents’ lives, which is very rewarding for all staff. 

About the Author: 

Stephanie Tafone, M.A., P.D. earned her B.A. in Psychology from St. John’s University before going on to earn her M.A. and Professional Diploma in School Psychology from Kean University. She is currently in the process of completing the requirements to obtain an Advanced Certificate in Applied Behavior Analysis as she pursues national certification. For the past ten years, she has been working with both children and adults with disabilities. She currently works as a behavior intervention specialist at a residential facility serving adults who have been diagnosed with Autism Spectrum Disorder. She also works as a school psychologist serving children with various diagnoses and disabilities, as well as an adjunct professor for courses pertaining to Applied Behavior Analysis, Autism, and Intellectual Disability. 

A Parent’s Guide to ABA Facilities

When a child first gets diagnosed with Autism, parents are often overwhelmed. A good doctor will give a prescription for ABA therapy as well as other necessary therapies such as Speech, OT,  PT, Feeding, etc. However, of those therapies, the one that is usually not familiar is ABA. A simple Google search or, even worse, joining a Facebook group is going to lead a parent down a path full of controversy, fear mongering, and misinformation. This will often leave parents very leery of any ABA facility they meet with, or completely turned off from the best medically-proved therapy for young Autistic children.

So I created a list of questions for parents to ask potential ABA facilities to find the best match for their family. After all, they’re entrusting you with their child for hours upon hours. The child is often non-verbal and unable to tell you how their day was. So a parent must trust the facility completely. In writing this list, I also kept in mind the warnings/worries of abuse touted by certain internet groups, in hopes to appease them should they come across this list. Parents can use this list in their ABA search and clinics can have this list on hand for parents, and their potential answers ready.

1) Do you force eye contact or stop unharmful stims? This is one of the top citations of “abuse” from certain internet groups. Some parents don’t want to force eye contact and view their child’s non-harmful, non-disruptive stims as a beautiful part of their personality.

2) How do you avoid meltdowns? Knowing that you are going to avoid meltdowns will help parents feel far more comfortable about sending their child.

3) Do you ever withhold food? Even neurotypical kids are picky. Us “Autism Parents” are usually self-conscious about the fact that our kids survive on pretzels and Pediasure. Telling a child “No chicken nuggets until you’ve finished your green beans” will probably mean a hungry child, and an unhappy parent.

4) How do you handle naps? With the diagnostic age of Autism getting increasingly lower, children are starting ABA before they are ready to phase out of naps. Having a plan in place for nap time will make a parent know their child is getting their needs met.

5) What are your parent training session requirements? ABA is a fantastic therapy, but without the parents upholding it at home, it’s pretty hard to fully instill the methodology and give the child all the help they deserve Parent training lets parents feel more involved in their child’s therapy which is essential!

6) What are the requirements of your staff? Parents researching ABA are shocked to hear you only need a high school diploma to be an RBT. If you have a higher standard for your staff of any sort, parents will feel more comfortable sending their children to your facility.

7) What will my child’s daily schedule look like? Knowing what a child does throughout the day helps a parent make the decision for what works best for their child.

8) How do you incorporate academics? Many parents are choosing between ABA and Preschool. Being able to tell parents your ABA facilitates some sort of Academics (We focus on writing, the alphabet, etc) will make the decision far easier!

9) How do you prevent harmful stims? Parents recoil at the thought of their child being restrained. What are your rules around touching kids? How do you keep our child from harming themselves, or anyone else?

10) How do you communicate with me? My child can’t tell me about his day. So I need his therapists to do so. What are you doing to tell me about his day? What he ate? Did he name? Diaper changes? Injuries? The more communication, the better!

This list isn’t comprehensive. It won’t work for every facility. However, these are the questions I have found most parents want the answers to in order to find the best facility for their kids. And to feel they aren’t sending their children to an “abusive” environment.

About the Author:

Cassie Hauschildt is the mother of her Autistic son, Percival, who was diagnosed at 20 months old. Since his diagnosis, she has become an advocate for autistic children. She dedicates her time to mentoring parents of autistic kids through the tough first few months post-diagnosis. She also is trying to get rid of the negativity surrounding ABA therapy. She does this through humor, while using real talk, on her TikTok @AnotherAutismMom. She also runs “The Dino and Nuggets Corner” Facebook Group.

Posted in ABA