Tag Archives: ABA

Pick of the Week: “Classifying with Seasons” Fun Deck – Teach time concepts with match-up games and more

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Classifying with SeasonsWinter, Spring, Summer, or Fall… What happens in each season and what do you need for it? With the changing season and cooler days, we thought it was the perfect time to share our newly added Classifying with Seasons Fun Deck as our Pick this week. The Classifying with Seasons Fun Deck contains 13 illustrated cards for each season, depicting holidays, activities, clothing, and weather that might occur. This week, take 15% off* your set of Classifying with Seasons by entering our code CLASSIFY at check out!

Use the Classifying with Seasons Fun Deck to teach time concepts, categorizing, and more. These cards come in a sturdy tin, and make great match-up games, as well as conversation and story starters.

Fall Examples

This week only, don’t forget to save 15%* on your deck of the Classifying with Seasons cards by entering promo code CLASSIFY at check out!

*Offer is valid until 11:59pm EDT on September 30th, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Tip of the Week: Altering the Teaching Environment to Address Problem Behaviors

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A few years ago, I went in to observe an ABA therapist I was supervising. She was working with a ten-year-old girl with Aspergers. One of her goals was to increase eye contact during conversation, but her student wasn’t making much progress in this area. She had consulted the research and was considering a new behavior intervention plan, and wanted my input before doing so.

junior school classroom at the German School in Ham, by 3S Architects. Image shot 2006. Exact date unknown.The first thing I noticed when I walked in to observe was that she did her entire session at a long wooden table, sitting side-by-side with her student. After watching for about ten minutes, I asked if we could change the seating arrangement. We moved her student to the end of the table, then had the therapist sit next to her, but on the perpendicular side. This way, eye contact was much easier as they were able to face each other. The student’s eye contact improved instantly with a small environmental change. (Of course, once we made the environmental change, we worked together to address other changes that could be made to encourage eye contact.)

Environmental changes can be a quick and simple solution to some problem behaviors. Here are some questions to consider in order to alter the environment effectively:

  • Is it possible that a change in furnishings could change the behavior? For example, moving a child’s locker closer to the classroom door may decrease tardiness, putting a child’s desk in the furthest corner from the door may decrease opportunities for elopement, or giving your child a shorter chair that allows them to put their feet on the ground may decrease the amount of times they kick their sibling from across the table. You may also want to consider partitions that allow for personal space, clearly-marked spaces for organizing materials, proximity to students and distractions (such as windows or the hallway).
  • Can you add something to the environment to change the behavior? For example, your student may be able to focus better on independent work if you provide noise-cancelling headphones, line up correctly if a square for him/her to stand is taped to the floor, or your child may be more efficient with completing chores if they’re allowed to listen to their favorite music while doing so.  I’ve also seen some cases in which the teacher wears a microphone that wirelessly links to a student’s headphones, increasing that student’s ability to attend to the teacher’s instruction.
  • Will decreasing access to materials impact the behavior? For example, removing visuals such as posters and student work may increase your student’s ability to attend or locking materials in a closet when not in use may decrease your student’s ability to destroy or damage materials.
  • Will increasing access to materials impact the behavior? For example, making a box of pre-sharpened pencils may decrease the behavior of getting up frequently to sharpen pencils. (I recently visited a classroom in which the teacher put pre-sharpened pencils in a straw dispenser on her desk, and each week one student was assigned the job of sharpening pencils at the end of the day).

Whenever you do make changes to the environment, you may want to consider if the changes require fading. For example, if I make a square on the floor out of tape to teach my student where to stand in the line, I will want to fade that out of over time to increase their independence.

A final consideration is that whatever impact you expect the environmental change to have should be clearly defined and measured. Take data to ensure that the intervention is working so you can make adjustments as necessary.

For more detailed information on modifying environments, there is a great article from the Council for Exceptional Children by Caroline A. Guardino and Elizabeth Fullerton entitled “Changing Behaviors by Changing the Classroom Environment.” Click here for the article.

WRITTEN BY SAM BLANCO, MSED, BCBA

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

States Begin to Include ABA Coverage

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It looks like progress is being made on getting treatments such as ABA covered by insurance. Disability Scoop is reporting that states are finally starting to include coverage of treatments like Applied Behavior Analysis for children with autism under Medicaid. This means that states must cover services consistent with the categories defined by Early and Periodic Screening, Diagnostic and Treatment services (EPSDT). This includes Applied Behavior Analysis, speech and occupational therapies, and other personal care services.

Read the full article here.

Has anyone in CA, NV, and CT had success with getting services like ABA covered?

 

 

 

Pick of the Week: “The Asperkid’s Secret Book of Social Rules” – A teen’s guide to not-so-obvious social codes

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It’s not easy for any teen or tween to fit in, but it can be especially tough for Asperkids. Jennifer O’Toole knows this first-hand, and has written a book she only wishes she had when she was a teen with Asperger Syndrome.

This week only, save 15%* on The Asperkid’s (Secret) Book of Social Rules by entering promo code ASPERKID at check out!

In The Asperkid’s (Secret) Book of Social Rules, O’Toole doesn’t offer advice on what Asperkids should not do, but on what they should do with witty and wise insights into baffling social codes. With helpful tips, practice scenarios, checklists, and quizzes, Asperkids will learn how to:

  • Thank people, apologize, and offer compliments
  • Build and maintain genuine friendships and how to deal with bullying
  • Actively listen and have a meaningful conversation
  • Step back and see the “big picture” instead of focusing on the details
  • Make a correction and let go of the need to be right

With over 30 social rules and logical explanations, this illustrated handbook offers information that tweens and teens can truly digest. And having been there herself, the author shares her experience and points out the potential pitfalls with humor and sensitivity.

Don’t forget to save 15%* on The Asperkid’s (Secret) Book of Social Rules this week by using our promo code ASPERKID at checkout!

*Offer is valid until 11:59pm EDT on September 16th, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Pick of the Week: Audible Time Timers – For Smooth Transitions Back to School

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Transitions back to school can be difficult after a summer of changed routines. When it’s time to go back to school and reset day-to-day routines, a visual timer can make all the difference in timekeeping and easing the stress of structuring activities for your child or student. This week only, we’re taking 15%* off your order of the 3-inch, 8-inch, and 12-inch Audible Time Timers to help you help your learner with their transitions. Just enter promo code TIMETIMER at checkout to redeem your savings!

Recommended by Autism and ADHD experts, the Time Timer is entirely intuitive to use. This visual timer is great at solving time perception problems at all ages and ability levels, and is perfect for easy portability and in one-on-one and group settings.

 

 

 

 

 

 

 

A graphic clock-face gives the child visual understanding of time elapsing. This is ideal for timed activities and for getting ready. When the colored portion elapses, time is up. There is also an optional audible component that you can turn on so that the timer BEEPS when time is up. All Time Timers run on battery-operated quartz movement, and can be free standing or hung on a wall.

Don’t forget to save 15%* on your purchase of the 3-inch, 8-inch, and/or 12-inch Audible Time Timers this week only by using promo code TIMETIMER at checkout!

Read “Time Timer: Time to Build Independence,” an exclusive article by a parent about how she used the Time Timer to help her son challenge himself to get through a timed activity.

*Offer is valid until 11:59pm EDT on September 9th, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Tip of the Week: 6 Ways to Get the Most Out of Your Home ABA Program

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CHILD IN SPEECH THERAPYWhile an ABA professional should be coming in to organize and run your ABA program, as a parent or guardian, there are some simple things you can do to make the time your child spends in a home session more effective. Several tips are here, but it may be unrealistic for you to follow ALL of these tips. Consider your home environment and family’s needs, then implement the tips that are the most feasible for your situation.

Following even one of these tips can make a big difference in your child’s sessions!

1)    Make sure all ABA materials are accessible. It’s important to have a system for storing the materials and the binder the ABA providers use. Some families I work with put everything into a box, a dresser drawer, or on a shelf the child cannot reach which is great. If the child utilizes an iPad for communication or reinforcement, be sure it’s available and charged. If any other items are necessary, such as edibles for reinforcement, make sure those are available at the beginning of the session. One parent I worked with used a craft organizer container with a clear plastic lid to store edibles, so when sessions began she’d set it on the table. All the different snacks were already broken into small pieces and organized in the box, freeing up more time for teaching during the session.

2)    Keep the area for ABA therapy free from distraction. Remove any items that are highly distracting for your student. Shut windows if you live on a noisy street. Make sure your cell phone is with you. This tip is especially challenging for families that live in studio apartments or have loud neighbors.

3)    Limit the number of disruptions from siblings or other family members. As an ABA therapist who is focused on increasing my students’ opportunities for social interaction, I don’t want to discourage the siblings and other family members from coming in. Interruptions should happen from time to time, and it’s important that my students learn to refocus after an interruption. But sometimes it becomes an obstacle to learning when there are consistent interruptions, or if I have to continue to redirect a sibling to other activities.  Instead, it’s better to structure activities with siblings and other family members, perhaps by teaching the learner with autism to request the sibling come play or adding it to the student’s activity schedule.

4)    When possible, reserve one or more highly motivating activities for ABA sessions. If a child has free access to all his/her motivating activities, then those activities are not as valuable when used in a session, and therefore less motivating. Sessions are most effective when the learner is working for something that they’re highly motivated by. It’s important to note here that I don’t want the child to only have access to fun things during sessions. I also don’t want the parents miss out on opportunities to enjoy motivating activities with the learner. The idea is to save a small number of motivating activities for sessions so the child maintains motivation and focuses on learning. This tip is especially challenging for families when the learner with autism is motivated by only one or two activities or items.

5)    Don’t allow the child to engage in their highest motivating activities right before an ABA session. I’ve had more than one case in the past in which I would get to the home and find my student watching his favorite TV show or playing his favorite game on the iPad. What would typically happen is that my student would associate my arrival with the end of his favorite activity, which would lead to crying, refusal to work, and/or attempts to escape. I want my students to be able to watch their favorite shows and play with their favorite games, but our sessions are more effective when those activities don’t take place immediately beforehand.

6)    Ask your provider if there are any changes you can make to improve sessions. Every home is different and every child’s needs are different. Your provider may be able to identify small changes for your specific situation that are not mentioned above. Opening that dialogue can be a powerful way to improve your child’s learning outcomes.  

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

Federal Ruling Ensures that Insurers Must Cover ABA Therapy

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GavelFederal Judge Michael H. Simon in Oregon ruled last week that insurance providers cannot deny coverage of Applied Behavior Analysis (ABA) therapy for children diagnosed on the autism spectrum. The ruling was in response to a lawsuit against Providence Health Plan, an insurance provider that denied coverage of ABA therapy for children diagnosed with autism, while simultaneously granting coverage for children without a diagnosis. ABA therapy, which can cost over $50,000 a year, involves a behavioral interventionist working with a child in the family’s home or in his school to address behavioral deficits for up to forty hours a week.

Oregon State Governor John Kitzhaber also agreed with this ruling and will adjust state health plans to reflect Judge Simon’s decision. The discrepancy between insurance policies and what providers actually cover arises because the medical community views ABA as “a medically necessary treatment of autism,”1 whereas some insurance providers accept it as an educational service that is provided in schools. Since autism is also classified as a “developmental disability,” instead of a mental health disorder, insurers exclude ABA coverage for those with autism, which is also a violation of mental health parity laws.

In some states like California, several warnings have been issued to insurance companies after several denials of ABA coverage had been overturned on appeal. Regional centers now fund ABA therapy by service providers, as well as insurance companies. With President Obama’s signing of Autism CARES last week, the federal ruling will hopefully set a precedent for insurance companies across the country to allow coverage of ABA therapy for families of children diagnosed with autism. ABA therapy is the most influential and widely cited form of therapy for autism, showing the most promise and efficacy in the treatment of autism.

1 https://exm.nr/1oJvnxa

Tip of the Week: How to Implement a Successful Behavioral Intervention

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Creating a successful behavior intervention is more challenging than it first appears. Below, I’ve listed four essential parts for changing maladaptive behaviors and increasing desired behaviors. Most of the time, when a behavior intervention is not working, one or more of these steps has been neglected.

1.  Find a BCBA or ABA provider who can guide you through the process. Getting help from someone with experience in addressing challenging behaviors is an essential first step. They should be a wealth of information about each of the following steps, provide check-ins and troubleshooting during the intervention process, and maintain data on the behavior to insure the intervention is working.

2.  Identify the function of the behavior. There are four reasons that any of us behave: attention, escape/avoidance, access to a tangible (such as chips or a toy train), and automatic reinforcement (meaning physical sensations that are not related to social interactions, including sound, taste, touch, or a response to movement). A BCBA can be especially useful in helping to identify the function of the behavior. They may utilize an ABC chart to determine the function, which means they observe the behavior and note it’s antecedent, what the behavior looks like, and the immediate consequence. If the ABC chart is not helpful, they may perform a more formal Functional Analysis. Before any intervention is put in place, all parties interacting with the child should understand the function (or reason) for the problematic behavior.

3.  Provide a replacement behavior. As a part of the intervention, a replacement behavior should be provided. A BCBA or ABA provider should be able to help you find appropriate replacement behaviors for the problematic behavior. For example, with one student who was chewing his shirt, we introduced a replacement behavior of chewing gum. With another student who was throwing his iPad, we used tape to put an “X” on his desk and taught him to place it on the “X.” The idea is to provide an appropriate behavior that is incompatible with the problematic behavior. But that’s not always possible. For example, one of my former students was banging her head on the table during instruction. We taught her to request a break by touching a picture of a stop sign. Realistically, she was able to bang her head while simultaneously touching the stop sign, but once she learned that she got to escape the activity by touching the stop sign, she stopped banging her head in order to escape. It’s important to note that using the stop sign wouldn’t work for all head-banging behavior, but we had identified the function of the behavior and were able to introduce a replacement behavior that served the same function while meeting the skill level and needs of that individual student.

4.  Provide reinforcement for appropriate behavior. A specific plan for providing reinforcement for use of a replacement behavior and any other desired behaviors is essential. The reinforcement for the appropriate replacement behavior should serve the same function as the problematic behavior. This can sometimes be difficult to achieve, but without this aspect of intervention, you may see slow success, or no success at all.

Again, creating a multi-pronged intervention can be a challenge. It’s important to seek out help, and to take a look at research related to the problem behavior you are trying to address. It is possible to create a strong intervention that has a huge impact on your learner, but it must include the aspects listed above to have the highest potential for success.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

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

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

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

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

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

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

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

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

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

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

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

Tip of the Week: Teaching Language—Focus on the Stage, Not the Age

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Teaching language skills is one of the most frequent needs for children with autism, but also one of the most misunderstood skillsets amongst both parents and practitioners. The desire to hear your learner speak in full sentences can be overwhelming, making it especially difficult to take a step back and consider what it means to communicate and how communication skills develop in neurotypical children. Many times we get hung up on what a child should be capable of communicating at a certain age, rather than focusing on what they are capable of communicating at this stage of development.

Many practitioners and curricula utilize Brown’s Stages of Language Development.* Brown described the first five stages of language development in terms of the child’s “mean length of utterance” (or MLU) as well as the structure of their utterances.


From aacinstitute.org

Sometimes it is necessary to compare a child to his or her same-age peers in order to receive services or measure progress, but it can be detrimental to focus on what a child should be doing at a specific age instead of supporting them and reinforcing them for progress within their current stage.

Research has suggested that teaching beyond the child’s current stage results in errors, lack of comprehension, and difficulty with retention. Here are some common errors you may have witnessed:

  • The child learns the phrase “I want _____ please.” This phrase is fine for “I want juice, please” or “I want Brobee, please,” but it loses meaning when overgeneralized to “I want jump, please” or “I want play, please.” It’s better to allow your learner to acquire hundreds of 1-2 word mands (or requests) before expecting them to speak in simple noun+verb mands.
  • The child learns to imitate only when the word “say” is used. Then the child makes statements such as “say how are you today,” as a greeting or “say I’m sorry,” when they bump into someone accidentally. Here, the child clearly has some understanding of when the phrases should be used without understanding the meanings of the individual words within each phrase.
  • The child learns easily overgeneralized words such as “more.” This is useful at times, but the child can start using it for everything. Instead of saying “cookie” he’ll say “more.” Instead of saying “train,” he’ll say “more.” And he may say “more” when the desired item is not present, leaving the caregiver frustrated as he/she tries to guess what the child is requesting. Moreover, as language begins to develop, he may misuse it by saying things such as “more up, please.”
  • The child learns to say “Hello, how are you today?” upon seeing a person entering a room. A child comes into the classroom and the learner looks up, says “Hello, how are you today?” The child responds, “Great! Look at the cool sticker I got!” Your learner then doesn’t respond at all, or may say “fine,” as he has practiced conversations of greeting.

These are only a few of the common language errors you may see. While you may want your learner to speak in longer sentences, your goal should be to have them communicate effectively. With this goal in mind, it becomes essential to support them at their current stage, which means it’s essential to assess them and understand how to help them make progress.

This is why I always use the VB-MAPP to assess each child and make decisions about language instruction. I need to have a full understanding of how the learner is using language, and then move them through each stage in a clear progression. I may want the child to say “Hello, how are you today?” But when I teach them that, do they understand those individual words? Do they comprehend what today means as opposed to yesterday or tomorrow? Do they generalize the use of “how” to other questions?

As you make treatment decisions for your learner, think about their current stage and talk about how to support your child with both a Speech Language Pathologist and an ABA therapist.

*Brown, R. (1973). A first language: The early stages. London: George Allen & Unwin Ltd.

WRITTEN BY SAM BLANCO, MSEd, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.