Regulating Sleep in Children with Autism

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


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

Answered by Lauren Schnell, MA, BCBA

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

 

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

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

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

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

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

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

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

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

Tip of the Week: Using Economy of Language in Your Teaching

Sometimes our learners don’t comply with instructions simply because they don’t fully understand what we are asking of them. At times, I find myself making the error of using too many words when I give directions, especially if I’m in a rush during a transition. For instance, I might say “Grab your shoes, put them on, and meet me by the door.” A few seconds later my learner meets me at the door, but with no shoes.

I may feel frustrated or irritated, but ultimately I realize my instructions are provided in a poor manner. I am at fault! It would have been more effective to point towards the shoes and say “Shoes on.” In his book Teach Like A Champion, Doug Lemov refers to this as Economy of Language, a phrase that essentially means the fewer words you use, the clearer your message. (It should be noted here that Teach Like A Champion is written for ALL teachers, not just special education teachers. This is a strategy that works across the board!) This is especially true when working with learners who struggle with listening comprehension, attention, or multi-step directions.

Here are a few suggestions to help you with economy of language:

Plan ahead. I actually write out instructions that I will be providing often and plan precisely how I will be giving them. I might plan a few variations, but, especially when working with young learners with autism, I want to provide lots of opportunities for success, then build to more complex instructions.
Consider hand signals. I often pair a hand signal with an instruction. For instance, one of my current students often sticks his fingers in his nose during instruction. I pair “Hands down” with a hand motion in which I move my hand from about shoulder-height to my lap (down). This is helpful because the learner also comprehends the signal, and I can begin providing the signal without the vocal statement. This allows me to provide instructions without interrupting the lesson.
One step at a time. Be aware of your learner’s listening comprehension and attending skills. If you notice that your learner is often only completing the first or the last thing you asked, this is a good indication that you provided too many instructions at the same time.
Avoid lengthy explanations. Sometimes I’ll hear an adult say something like “You need to hurry up and put your shoes on because your father is going to be here in a moment and we need to meet him outside and get in the car quickly so you’re not late for swim practice.” This is an easy trap to fall into, especially if vocalizing the explanation is helping you remember everything you need to do during a transition, but it may result in inaction from your learner.
Take a deep breath. If your learner is not responding correctly to instructions you’ve provided, step back, take a deep breath, and think about how to simplify the instruction.

WRITTEN BY SAM BLANCO, MSED, BCBA

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

Pick of the Week: Self Management Planners – 20% OFF!

Find a better way to manage your time and check more things off your to-do list this school year!  Created with ABA principles by Dan Sundberg, PhD, the Self Management Planner is perfect for those who have busy and frequently changing schedules and want something that will do more than schedule time in the day. This week, you can save 20%* on the Self Management Planners and get a head start on organizing your schedule for the school year! (Use promo code MANAGE at check-out!)

Self Management Planners

Not only is this planner perfect for effective time management and organizing your activities, but it also allows to set and track your goals (it even includes graph paper so you can watch your progress!).

The Self Management Planner includes:

  • Full 18.5-hour days and 7-day weeks
  • Tutorial on using the planner, appointment book, and measuring your success
  • Guide to setting long term goals and figuring out ways to accomplish those goals
  • System of selecting and tracking daily activities. (People have used this section to track a huge variety of important things like spending, hours billed, driving mileage, activity goals, and more.)
  • Graphs for visualizing and tracking progress on goal
  • Lined note paper
  • Blank date periods
  • Weekly and daily to-do lists
  • Space to make note of all day events

Available in two sizes: Full (11.5″ x 8.5″) and Compact (8.5″ x 5.5″).

*Promotion is valid for one-time use through September 6, 2016. Offer cannot be applied to previous purchases, combined with any other offers, transferred, refunded, or redeemed and/or exchanged for cash or credit. Different Roads to Learning reserves the right to change or cancel this promotion at any time. To redeem offer at differentroads.com, enter promo code MANAGE at checkout.

Tip of the Week: Measure Group Behavior in the Classroom

Many classroom teachers are required to take data on the behavior of their students. However, this can feel like a daunting task given the many things teachers are trying to do simultaneously throughout the day! PLACHECK is a simple way to measure group behavior in the classroom for engagement or attention.

PLACHECK is short for Planned Activity Check. Let’s say that Ms. Esterman is using a partner activity for a math lesson for the first time in her fourth grade classroom. She wants to see if the kids remain engaged with the content during the partner activity. Here is how she can implement PLACHECK to collect data on engagement.

  1. Measure Group Behavior in the ClassroomSet a MotivAider for a predetermined interval (learn more about the MotivAider). The partner activity Ms. Esterman has organized will take a total of ten minutes. She decides to set the MotivAider for 2 minute intervals.
  2. At the start of the lesson, set the MotivAider to run and clip it to your waistband. For Ms. Esterman, the MotivAider will vibrate every two minutes to signal her to observe her students.
  3. When the MotivAider vibrates, collect tally data. Ms. Esterman feels the MotivAider vibrate, then quickly counts the number of students who are engaged in the partner activity.
  4. Continue to do this for each interval.
  5. Graph your data.

Ms. Esterman’s graph looks like this for her 24 students:

PLACHECK Graph 1

The next day, Ms. Esterman does a similar activity with her students, but uses an independent activity instead of a partner activity. She uses the same 5 steps to use PLACHECK to measure student engagement in the independent activity. Now she can easily compare engagement between the two types of activities. You can see both days graphed below:

PLACHECK Graph 2

When she compares the two days, she finds these results, and it allows her to make better decisions about what types of activities might work best for the individuals in her classroom. Here, it is clear that between these two activities, her students were more likely to be on task during partner work. However, Ms. Esterman would attain better results by taking more data.

PLACHECK is simple to implement. Ms. Esterman is able to collect this data in less than two minutes each day and can learn a lot from just that brief time.

WRITTEN BY SAM BLANCO, MSED, BCBA

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

Pick of the Week: The NEW ABA Program Companion — Take 20% Off!

New ABA Program Companion Cover.inddJ. Tyler Fovel, MA, BCBA’s essential manual for creating professional and effective ABA programs blends clear explanations of scientifically-based concepts and methodology, clinical examples and advice, and suggested implementation strategies. This revised edition presents information on:

  • qualities of an effective ABA program
  • transdisciplinary teamwork
  • curriculum selection and development
  • program writing and revision
  • strategies for attention and engagement
  • prompts
  • error- correction
  • reinforcement
  • progress evaluation
  • data-based decision-making

TAKE 20% OFF The NEW ABA Program Companion this week with our promo code NEWABA at check-out, and get a head start on designing an efficient ABA program for your students this year.

The NEW ABA Program Companion also comes with training packages for implementers, forms, and a 6-month subscription to the online program development and management software, ABA Program Companion 3.0.

Productive Meetings in Home ABA Programs

Creating effective meetings with your child’s BCBA and other service providers can be difficult. In this month’s ASAT feature, Preeti Chojar, Board Member of the Association for Science in Autism Treatment (ASAT), shares some valuable tips about how parents can make the most out of these meetings. 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 who has a home-based ABA program.  We have monthly meetings with all of the providers that work with my child.  I am looking for some ideas on how to make the most of these meetings.  Any suggestions?
 

Answered by Preeti Chojar, Mother and ASAT Board Member

It is terrific that your team meets monthly! Collaboration and consistency amongst members of the professional team is the hallmark of a successful home program. I have found that a great way to build teamwork is to have regular meetings to keep the whole team on the same page. Here are some suggestions to help you use this time effectively and efficiently. In our particular case, we meet monthly, but keep in mind that some teams may need to meet more frequently (depending on the composition of the team, level of oversight required, and needs of the child).

Meeting composition
Ideally, a time should be scheduled when the entire team can be present. A supervisor like a behavior consultant (e.g., BCBA) or a family trainer should be present as well. It could also include any related service providers, such as the speech pathologist, occupational therapist, or physical therapist. Assembling the entire team can be difficult but try your best, as the benefits will make it worthwhile.

Develop the agenda
Always create an agenda well before a team meeting. Please note that this agenda should not side-step any other communication that should be occurring (e.g., the consultant may want to know right away if a new skill-acquisition program is not going well).

  • Start by writing down any new behaviors, both positive and negative. Also note if there is evidence of lost skills or discrepancies in skill levels across settings, situations or people.
  • Any data taken by instructors should be summarized and analyzed before the meeting.
  • Add anything that the supervisor or the collective wisdom of the group could help resolve.
  • One of the agenda items should always be to review last month’s meeting notes paying close attention to any open or unfinished items.
  • If the child is also receiving services in a school or center-based environment, it is beneficial to seek input from those providers as well. Any observations made by people in the community that highlight some skill or skill deficit which had gone unnoticed can be brought to the table too.
  • Finally, make sure the agenda is well balanced and addresses everyone’s concerns. Prioritize agenda items and if necessary suggest some time limits.

Circulate the agenda

  • Make sure to circulate the agenda to everyone attending the meeting, ideally a few days before the meeting.
  • Ask all team members to notify you ahead of time of any other agenda items they might have that were not added yet.

Continue reading

Tip of the Week: Considerations for Parents on Grounding Kids

Many parents choose to “ground” their kids when they make poor decisions. Maybe they lose access to video games for a week, or can’t watch TV for a month. Grounding in and of itself is not necessarily a bad thing. Here are a few considerations:

  • If you keep grounding your kid for the same behavior, then grounding is not changing the behavior. Sometimes grounding your child is a default response, but if it’s not working, you might want to consider some other options. You can take a look back at our series on
    differential reinforcement
    or our post on noncontingent reinforcement.
  • When possible, the consequence should be connected to the behavior. If your child throws a controller, then not having access to video games makes great sense. However if video games are taken away for any infraction, it may not be the most logical punishment and over time, it may even backfire. If the child is losing video games for everything, then he/she might stop trying to earn video games at all.

Continue reading

Pick of the Week: Token Boards + 10-Packs, now available!

Token boards are a part of every ABA program. They give teachers a positive way to reinforce good behavior and monitor success. Our lightweight, laminated Token Boards are now available in 10-packs – and even better – you can save 15% on any of our token boards and their 10-packs this week! Just use our promo code TOKENS when you check out online or over the phone with us.

Once the student receives 1 to 5 stars on their token boards, they receive a reward – a favorite activity, a toy, or something good to eat! There is also a 2″ box at the end of the row, so the instructor can place an image of the reward.

Each token board comes with 8 reusable reward stars. The chart measures approximately 5″ x 9″.

View more token boards here.

*Code is valid for one-time use through August 9, 2016 at 11:59pm. Offer cannot be applied to previous purchases, combined with any other offers, transferred, refunded, or redeemed and/or exchanged for cash or credit. Different Roads to Learning reserves the right to change or cancel this promotion at any time. To redeem offer at differentroads.com, enter promo code TOKENS at checkout.

Tip of the Week: Things You Should Know About BCBAs

Maybe you’ve never heard of Board Certified Behavior Analysts (BCBAs), or you’ve heard of them frequently but never been provided an explanation of how a BCBA differs from an ABA therapist. Here are a few things you should know:

  • BCBAs are required to take extensive coursework in applied behavior analysis and complete 1500 hours of supervised work. Furthermore, they are required to take a difficult comprehensive exam at the end of their coursework and supervision hours. Once they have completed the hours and passed the exam, they are officially a BCBA.
  • BCBAs must complete 32 units of continuing education every two years. There is a requirement that some of these hours pertain to ethics, but the rest can be focused on skills such as addressing verbal behavior, feeding issues, aggressive behaviors, and more.
  • BCBAs are required to utilize evidence-based practice. A BCBA should be aware of current research in the field and should be able to easily reference the literature when encountering a difficult problem or working on an intervention.
  • One of my favorite parts of the ethical code for BCBAs is that “clients have a right to effective treatment.” Your BCBA should be taking data and implementing interventions that are effective in creating behavior change for clients. If an intervention is not working, then adjustments should be made.

The goal of Behavior Analyst Certification Board is to ensure appropriate training and accountability for behavior analysts.

WRITTEN BY SAM BLANCO, MSED, BCBA

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

Tip of the Week: How to Maintain a Fast Pace of Instruction

There is a common misconception that individuals with special needs require a slower pace of instruction. While they may require a slower pace through a curriculum, this does not mean that individual lessons should be taught at a slower pace. In fact, slowing the pace of instruction not only wastes precious instructional time, it may increase the occurrence of problem behaviors.

Higbee (2009) writes that “appropriately paced instruction helps students to maintain attention to the instructor and instructional materials. Though student attention can be lost when instruction is happening too rapidly, it is most often lost when the pace of instruction is not rapid enough” (p. 20).

So how can you maintain a fast pace of instruction that is appropriate for your student? Here are some things to consider:

  1. Prepare! Set out your materials in such a way that they are easy to access quickly. I keep all the mastered skills on index cards so I can easily add maintenance questions into instruction. Organization is often the simplest way to increase efficiency in your session.
  2. Take data. You want to increase attention and decrease problem behaviors. Try different paces of instruction and measure the behaviors you are wanting to change. For instance, if I have a student who is often grabbing for my shirt during a session, I may try a pace of instruction that includes 15 questions each minute, then try a pace of 20 questions per minute, another of 25 per minute. Next, I will compare the rates of grabbing for my shirt with each pace of instruction. Remember, these aren’t 15 questions for the target skill; some mastered skills will be intermixed.
  3. Record a session. By taking video of yourself working with a child, you may see opportunities for increasing efficiency on your own. You may also observe specific times at which problem behaviors tend to increase, then be able to target those specifically. For instance, perhaps problem behaviors occur when you turn to write data in a binder, but didn’t recognize that pattern until you watched a recording later.
  4. Use reinforcement effectively. Usually, pace of instruction in and of itself will not change behavior. Instead, pair it with reinforcement and be systematic with how you implement reinforcement. We’ve talked about reinforcement here on the blog a lot, so you can read about that in more detail here.
  5. If possible, get input from supervisors or the individual you are working with. Supervisors may be able to observe your session and provide insight on how to increase your pace of instruction. And the individual you are working with may be communicating that they are bored through misbehavior, stating “I’m bored,” or nonvocal behaviors such as yawning. This may be an indication that you need to provide more challenging material or increase the pace of instruction.

REFERENCES

Higbee, T. (2009). Establishing the prerequisites for normal language. In R. A. Rehfeldt, Y. Barnes-Holmes, & S.C. Hayes (Eds.), Derived relational responding applications for learners with autism and other developmental disabilities: A progressive guide to change (7-24). Oakland, CA: New Harbinger Publications, Inc.

WRITTEN BY SAM BLANCO, MSED, BCBA

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