Medication Considerations

Posted on March 16, 2017 by Different Roads to Learning

What do you do when your doctor recommends medication? In this month’s ASAT feature, Megan Atthowe, RN, MSN, BCBA, offers insight on a variety of approaches parents can take when medication is recommended for children exhibiting aggressive behaviors. 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!

My son with autism has developed aggressive behavior, and his doctor is considering whether medication could help. What can I do to prepare for this conversation?
Answered by Megan Atthowe, RN, MSN, BCBA

First, you should know that there is no medication that specifically treats autism. Medications approved by the United States Food and Drug Administration (FDA) for other conditions can be useful only to lessen symptoms. That said, off-label use of pharmaceuticals is by no means unique to autism and is common practice for many health conditions. So while research on the use of particular psychotropic medications in the autistic population is growing, our body of knowledge is still limited. In addition, medications can and do affect every individual differently, and children can respond differently as they develop, so it is likely to take time to find the best medication at the appropriate dose. Medication management, in other words, is a complex and an ongoing process and one that is highly individualized. It is a good idea, then, to be prepared with the right information before every visit to your health care provider.

Do you know how often the aggression actually occurs? Bringing data like this to the visit can be very helpful. You may want to ask your son’s teachers to share any information they have about the aggression with your health care provider, too. (They would need your consent to talk with him/her or to share any confidential information such as behavior data.) If you have not been keeping track of the aggression, now is a good time to start, even if there are only a few days until your visit. An easy way to do this is to use a calendar. Record specifics about when the aggression happens, what the behavior is like, how long it lasts, and whether you have noticed any recent changes. It is difficult for anyone to recall these details accurately, especially if the behaviors happen frequently, so writing them down will help you to share the most meaningful information you can with your health care provider. If your son’s school team is not already collecting data, perhaps they should start as well.

In addition to information about the current levels of the behavior, be prepared to describe how the school and your family are addressing the behavior and how long that plan has been in place. Has your son’s team considered or tried Applied Behavior Analysis (ABA) to treat the behavior? Research supports ABA as an effective intervention for decreasing problem behaviors such as aggression as well as for teaching children with autism new skills. It is important to be sure that a qualified behavior analyst is supervising any ABA interventions, as they must be implemented correctly to be effective. Your health care provider may be able to refer you to a local ABA provider, or you can find a list of board certified behavior analysts at the Behavior Analysis Certification Board’s website.

Before your visit, prepare a list of the names and doses of any medications your son takes, as well as any over-the-counter medications, vitamins, or other supplements. If your son receives other therapies, share what they are with your health care provider. He or she will want to ensure that any new medication is safe to take and will not interact with other medications.

If you and your health care provider decide to start your son on a medication, decide what the goal is. How will you know when the medication has been effective? How will you know if it is ineffective? Be specific and write the goal down. Schedule a date when you will check in with your health care provider on your son’s progress. He or she may have specific suggestions about what type of data to keep.
Finally, there are some important questions that you should have the answers to before you leave. Make sure that you ask any questions you have—a responsible health care provider will want to know that you understand how to use the new medication correctly. If you think of questions later, do not hesitate to call and ask your physician, nurse, or pharmacist.

Key Questions:

What is the name of the medication?
What is the medication used for?
When and how should I give it to my son, and how much do I give?
Should I give this medication with food?
What effects should I expect to see?
What are common side effects?
How long will it be until I notice the desired effects and side effects
What side effects are serious, and what should I do if I notice them?
Will side effects lessen over time?
Is there anything I should avoid giving my son while he is on this medication?
If I decide that I would like to stop giving him the medication, what should I do?
What should I do if I miss a dose?

Please note that there is information about research related to medications elsewhere on the ASAT website.

ABOUT THE AUTHOR

Megan Atthowe, MSN, RN, BCBA, LBA, is a registered nurse and behavior analyst who has worked with people with autism and other special needs in educational, home, and healthcare settings for over 15 years. Currently she consults to educational teams who serve students with autism in public schools.

Building Variability Into The Routine

Posted on October 13, 2016 by Different Roads to Learning

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

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

Here are a few things to consider:

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

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

WRITTEN BY SAM BLANCO, MSED, BCBA

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

Tip of the Week: Common Mistakes in Implementing Reinforcement

Posted on September 22, 2016 by Different Roads to Learning

Over the years, I’ve seen several behavior intervention plans written and implemented. Typically, these plans include reinforcement for the desirable behavior, but I see the same mistakes crop up again and again. Here are a few common mistakes in implementing reinforcement to look out for:

Fail to identify individual reinforcers. Hands down, the most common error I see is identifying specific activities or items as reinforcing. For instance, many people love gummy bears, but they make me want to puke. Presenting me with a gummy bear would not increase my future likelihood of engaging in the appropriate behavior! You must account for individual differences and conduct a preference assessment of your learner, then make a plan based on his or her preferences.

Fade reinforcement too quickly. Let’s say you’re working with a child named Harold who draws on the walls with crayon. You implement a reinforcement plan in which he earns praise and attention from his parent each time he draws on paper. The first few days it’s implemented, Harold’s rate of drawing on the wall greatly decreases. Everyone claims that his behavior is “fixed” and suddenly the plan for reinforcement is removed… and Harold begins drawing on the wall once more. I see this sort of pattern frequently (and have even caught myself doing it from time to time). After all, it can be easy to forget to reinforce positive behavior. To address this issue, make a clear plan for fading reinforcement, and use tools such as the MotivAider to help remind you to provide reinforcement for appropriate behavior.

Inconsistent with reinforcement plan. Harriet is writing consistently in a notebook, to the detriment of her interactions with peers. Her teachers implement a DRO, deciding to provide reinforcement for behavior other than the writing. However, the teachers didn’t notify all the adults working with her of the new plan, so Harriet’s behavior persists in certain environments, such as at recess, allowing her to miss multiple opportunities for more appropriate social interaction. To address this issue, make a clear outline of the environments in which the behavior is occurring and what adults are working in those environments. Ensure that all of the adults on that list are fully aware of the plan and kept abreast of any changes.

Don’t reinforce quickly enough. This one can be quite challenging, depending on the behavior and the environment. Let’s saying you’re working with a boy named Huck who curses often. You and your team devise a plan to reinforce appropriate language. You decide to offer him tokens that add up to free time at the end of the school day. However, sometimes as you are handing him a token for appropriate language, he curses again right before the token lands in his hand. Though it was unintentional, the cursing was actually reinforced here. Remember that reinforcement should be delivered as close to the desired behavior as possible. To address this issue, consider your environment and materials and make a plan to increase the speed of delivery.

Fail to make a plan to transfer to natural reinforcers. Ultimately, you don’t want any of these behaviors to change based solely on contrived reinforcement. Making a plan for reinforcement of appropriate behavior is essential, but your ultimate goal is to have the behavior be maintained by naturally occurring reinforcement. To address this issue, the first thing you need to do is identify what that naturally occurring reinforcement might be. For Harold, it might be having his artwork put up in a special place or sharing it with a show and tell. For Harriet it might be the interactions she has with peers on the playground. Once you have identified those reinforcers, you can create a plan for ensuring that the learner contacts those reinforcers over time. This might include pairing the naturally occurring reinforcers with the contrived reinforcers, then fading out the latter.

Ultimately, it’s important to remember that reinforcement is not as simple as it seems. Taking the time to plan on the front end will help with long-term outcomes.

WRITTEN BY SAM BLANCO, MSED, BCBA

How To Have A Successful School Experience

Posted on September 8, 2016 by Different Roads to Learning

Every parent wants their child to succeed in school. The definition of success may differ from parent to parent, but most would agree that they want their child to get good grades, demonstrate good behavior and make friends. These desires are no different for parents who have children with developmental disabilities. So, how do you know if your child is ready and are there ways to predict how well they will do? Tools like the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP), which is one of the primary assessment tools used at the Behavior Analysis Center for Autism (BACA), can assist parents and professionals alike in assessing their child’s skills and providing them with valuable information as to what areas they can support their child to increase the chances of them doing well in whatever educational setting they may enter.

How To Have A Successful School Experience

General skill deficits will likely determine the educational placement of your child, but may not be the biggest issue at hand.

Behavior problems and problems with instructional control can cause significant barriers to achievement with grades, developing friendships and avoiding expulsion. Learned prompt dependency may make developing independence and responsibility more difficult. Failure to generalize already existing knowledge across multiple examples, people and environments will require more teaching time and may manifest inconsistent performance on tests and classroom work. If your child likes very few things, seemingly peculiar things, or has strong motivation for some things, but is unwilling to work to attain them, it may make it more difficult to motivate them to learn material that is presented. If your child is reliant on getting something for responding every time in order for learning to occur, the teaching process will likely remain a tedious one and decrease the likelihood that they will be able to maintain those responses when those incentives are not provided as frequently. Many children with developmental disabilities will rely on providing themselves with reinforcement in the form of self-stimulation when such dense access to preferred items or activities is not provided.

Overall skill level will undoubtedly increase the odds that your child will be able to manage good grades. However, their ability to acquire new material quickly and then retain that information for later use may play a more critical role in their long term accomplishment. Adapting to change quickly or ‘going with the flow’ will be critical when faced with day to day schedule changes that occur in classrooms or other instructional environments. General independence with functional skills such as toileting, eating and managing their personal items such as backpacks, folders, etc., will decrease the amount of time their teachers may need to focus on teaching these skills and allow more time for teaching other critical skills.

All of these things taken together can seem daunting, even for parents of typically developing children. The good news is that there are things that every parent can do to help. Perfect parenting is unattainable, but valiant and consistent attempts with certain things can go a long way. Allowing your child to experience the consequences of their behavior can be tough, but is central to ensuring that they will behave well when it counts. Having your child try things on their own before helping them and then only helping them as much as needed to get the job done whenever possible will foster independence. Exposing your child to new or different things within fun activities can increase the things they are interested in. Those things can then be used to motivate them to learn. Setting up opportunities for them to experience even small changes, modeling a calm demeanor and praising them for doing the same when unexpected things happen can also help.

Your child’s teacher or other professionals like Board Certified Behavior Analysts can aid you in thinking of other ways to enhance what you are already doing and assist in developing an individualized treatment plan to support you and your child.

WRITTEN BY MELANY SHAMPO, MA, BCBA

Melany Shampo is a clinical director at the Behavior Analysis Center for Autism in Fishers, IN.

This post first appeared on Indy’s Special Child.

Tip of the Week: How to Avoid Over-Pathologizing Behaviors in Kids with Autism

Posted on March 24, 2016 by Different Roads to Learning

A diagnosis of autism can be very challenging for a child and for his or her family. But one of the most difficult aspects of autism is that it is not clear cut what behaviors are related to autism, and what behaviors are related to just being a kid. Every child tantrums sometimes. Every child talks back sometimes. Every child engages in dangerous behavior sometimes.

When I look back on my own childhood, I think of several behaviors I exhibited: in third grade I cut my own hair while my teacher’s back was turned, in fourth grade I got mad at my brother and threw an alarm clock at him, and in seventh grade I loved Agatha Christie books so much that I frequently refused to go outside and sat in my room reading by myself for hours on end. If I had autism, any one of these behaviors may have been pathologized instead of being considered as just a part of growing up.

So how do you parse through all the behaviors your learner is exhibiting and figure out which ones you should actually be worried about? Here are a few questions to ask yourself in determining behaviors to address:

Is the behavior dangerous?
How often and for how long does your learner engage in the behavior?
How different is this behavior from the learner’s same-age peers? For example, does your three year old cry for a couple minutes when told that she can’t have her favorite toy, or does she cry for two hours and refuse to engage with any other toys for the rest of the day?
How is this behavior interfering with the learner’s ability to learn?
How is this behavior interfering with the learner’s ability to engage with peers and family members?
Is the behavior related to a skill? For example, pacing the room and flapping your arms is typically not related to a skill, but building Lego models can be related to a skill. If it is related to a skill, think about ways to provide opportunities for expanding that skill.

The answers to these questions should be able to inform the decisions that you make in intervening with behaviors. And we should remember that above all else, kids with autism are still just kids.

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: The Importance of Identifying the Function of a Behavior

Posted on January 7, 2016 by Different Roads to Learning

By: Chance Agrella / Flickr

As a BCBA, I am often asked to address problematic behaviors. One of the most common errors I see in addressing such behaviors is that the adults working with child have not identified the function (or purpose) of the problematic behavior. Decades of research have shown that there are only four functions for any behavior: attention, escape/avoidance, access to a tangible, and automatic reinforcement (or something that just feels good internally, but cannot be observed by outsiders).

The function of the behavior is whatever happens immediately after the behavior, and increases the likelihood that the behavior will occur again in the future. Here are a few examples of the functions, based on the same behavior:

The therapist tells Lisa it’s time to practice tying shoes. Lisa starts biting her own hand. The therapist look shocked and calls in Lisa’s mother, who rubs her back lightly while Lisa ties her shoes then gives her a lot of verbal praise. This is likely an example of a behavior that functions for attention, because the mother comes in and provides both verbal and physical attention while she ties her shoes. Or it could be an example of a behavior that functions for escape or avoidance, since Lisa did not have to tie her shoes immediately once she began biting her hand.
The therapist tells Lisa it’s time to practice tying shoes. Lisa starts biting her own hand. The therapist gently pushes Lisa’s hand down and then introduces a new task. This is an example of a behavior that functions as escape because Lisa does not have to tie her shoes once she begins biting her hand.
The therapist tells Lisa it’s time to practice tying shoes. Lisa starts biting her own hand. The therapist says, “Oh, don’t stress, we’ll take a sensory break,” and gives Lisa a ball to squeeze. This is an example of a behavior maintained by tangible reinforcement. When Lisa began biting her hand she was immediately given access to a preferred item.

You’ll notice that I left out the automatic reinforcement. This is intentional because often, with a diagnosis of Autism Spectrum Disorder, people assume that a behavior is automatically reinforced instead of exploring these three potential functions described above. One way to recognize if a behavior is automatically reinforced is to note if the behavior happens when the child is alone and/or when no demands have been placed on the child. If it’s only happening around other people or when demands are placed, then it is highly unlikely that the behavior is automatically reinforced. For now, we’ll save automatic reinforcement for another blog post.

Identifying which of these functions is maintaining a problem behavior is essential to putting in an effective intervention. But how do you go about doing this?

The first thing you should do is assess! You can do an informal assessment, such as using the Functional Assessment Screening Tool (FAST) which is comprised of 16 questions that can help you quickly determine the function. If this does not provide conclusive results, you can have a BCBA do a formal functional assessment. Once you have identified the function of the behavior, you can change the environment so that not only does the child no longer receive that reinforcement for a problematic behavior, but there are appropriate replacement behaviors they can engage in to access that reinforcement. For more on that, you can look back at the Importance of Replacement Behaviors.

It may be difficult at first to think in terms of “function of behavior,” rather than assigning a reason for the behavior that is based on the child’s diagnosis or based on something happening internally inside the child’s brain that we can’t see (such as, “she’s just frustrated so she’s biting her hand,” or “she doesn’t know how to control herself”). However, once you try it out and experience some success with addressing the true function of behavior, you’ll likely see the beauty of a simple explanation for why we behave.

WRITTEN BY SAM BLANCO, MSED, BCBA

Tip of the Week: Use a Time-Out Ribbon

Posted on July 23, 2015 by Different Roads to Learning

Time-out can be an effective procedure for addressing behaviors that do not function for escape. However, often it can be difficult to implement, and in some schools is not even allowed. There are valid concerns related to time-out. For example, you may not have the opportunity to supervise a child in a separate location for time-out, or you might want to keep them in the same place so they don’t miss a lesson during class.

The time-out ribbon may be an excellent solution for just those types of instances. When Foxx and Shapiro (1978) first wrote about the time-out ribbon, they referred to it as “nonexclusionary time-out,” meaning the individual does not have to be excluded from an environment or activity to be “in time-out.” In their initial study, all students wore a ribbon on their wrist. When the individual has the time-out ribbon on, they have access to socially-mediated reinforcement. If the time-out ribbon is removed, they do not have access to that reinforcement. (Foxx & Shapiro also note that it does not have to be a ribbon, but could be anything that is easy to wear and easy to remove.) However, by again demonstrating appropriate behavior, the ribbon can be placed again on the individual’s wrist.

In a time where we often focus on new, high tech solutions, such as the use of iPads or SmartBoards to introduce behavior change procedures, it’s important to draw attention to low-tech solutions that are easy to implement. Another aspect of the time-out ribbon that is attractive for our particular population is that it provides a clear visual indication that reinforcement is available.

A possible drawback is that, in a classroom setting, if the ribbon is removed, the student could continue to engage in disruptive behavior. Foxx and Shapiro emphasize the need to pair the ribbon with social reinforcement when first introducing it to the individual. This increases the likelihood that the individual will correct their behavior to earn the ribbon back.

Foxx & Shapiro demonstrated the effectiveness of the time-out ribbon with five boys with developmental disabilities. Since then, two more studies have demonstrated the efficacy of the procedure. We know that time-out can be highly effective from a wealth of research over recent decades, but if it’s not available, you should definitely consider the possible use of the time-out ribbon.

WRITTEN BY SAM BLANCO, MSED, BCBA

Tips on Effective Self-Management with ABA Techniques by Daniel Sundberg

Posted on June 18, 2015 by Different Roads to Learning

Most of us at some point or another have struggled with time management. Whether it is finding more time to spend with your children, or just finding the time to exercise, time management can be a major challenge. But the benefits are potentially huge. When I first started graduate school I had trouble scheduling classes, work, research, exercise, and social activities. Fortunately, I was introduced to some effective techniques, derived from the principles of applied behavior analysis, designed to help people systematically manage their own behavior, known as self-management (Cooper, Heron, & Heward, 2007). The self-management process at its core is about taking data on your own behavior and setting up systems to manage your own performance. Individuals have used self-management to address a wide variety of challenges, from reducing smoking and managing spending, to better utilizing their billable hours and managing medication use. Additionally, self-management techniques have been used by individuals with a wide range of developmental and cognitive abilities (Cooper et al., 2007), and have been shown to be effective in increasing an array of positive behavioral skills in individuals with autism (Lee, Simpson, & Shogren, 2007).

While I find a specific tool like the Self Management Planner useful in coordinating my own efforts at self-management, the components of a good self-management program can be incorporated into many different types of tools or systems. These components are very similar to those that you may see in effective applied behavior analysis or performance management programs (Baer, Wolf, & Risley, 1968; Daniels & Bailey, 2014). At its most basic level this process involves specifically identifying important goals and related behaviors, measuring progress, determining how to affect those behaviors and reach your goals, and evaluating and modifying your program as necessary (Cooper et al., 2007). While Cooper et al. (2007) present a wide range of self-management tactics, here are a few specific suggestions for making your self-management program more effective:

Define your goals and the related behaviors. Creating a goal is a very important part of this process, as specific goals have been repeatedly shown to be more effective than vague goals (Locke & Latham, 2013). By identifying what you ultimately want to accomplish in the future it becomes much easier to identify things you can do today to get you there. Here are some specific tips for setting your goals:
- Set a long term goal in terms of an accomplishment, not an activity (e.g. “save $5,000 for a vacation” rather than “spend less money”).
- Make these long-term goal challenging yet attainable.
- Set many short term goals, and direct these towards behaviors and results.
- Make these short-term goals realistic – err on the side of making them too easy.
- Make both short-term and long-term goals as specific as you possibly can.
- Use your short-term and long-term goals to identify day to day behaviors that will allow you to reach your goal.
- When you are selecting the goals that you want to focus on, pick only a few at any given time. It is reasonable to focus on around 4-6 goals at a time, too many and it becomes easy to lose focus – if everything’s a priority, nothing’s a priority.
Identify measures. Tracking and measuring your progress is critical, and a large part of that involves clearly defining how you will measure the goals and behaviors you identified. For example, if you want to reach a set of parent training goals will you measure it in time spent working on that goal, milestones accomplished, appraisal from a clinical supervisor, or some other means? The more objective and countable, the better.
Change the behavior of interest. There are a number of ways to try and change your behavior. Often times, simply measuring behavior can produce change. If that is not enough, enlist the help of a friend to help you set and track your goals, keep you accountable, and deliver consequences. You can use Facebook or some other social media tool to make a public commitment and regularly post on how you are progressing. Paid programs such as Stickk can help you to track and measure your progress towards a goal. It is also possible to rearrange your environment in a way that makes the desired behavior more likely, B.F. Skinner wrote extensively on this in this in Enjoy Old Age: A Program of Self-Management (Skinner & Vaughan, 1983).
Track and measure. Record data on your progress every day, or at least several times per week. Frequently tracking your performance will also serve as a regular source of feedback, which can by itself change behavior.
Evaluate and modify your program. Taking frequent data will also allow you to make much more informed decisions about the effectiveness of your program. When recording your data spend some time evaluating your self-management program. Determine whether the goals you have set are realistic, you have enough time in your week to accomplish what you want, your environment is set up to help or hinder your progress, etc. This step is a lot easier to do if you are frequently taking data. If you are not making the progress you want (or aren’t even able to track your progress!) that means something needs to change. Reflect on what has been done thus far and consider other changes you could make that will lead to greater success.

Here are a few other points that are not specifically part of the self-management process, but may help you in your efforts:

Before you go to bed, make a list of the things you need to do tomorrow. Keep that list next to your bed, so you can jot down a task you think of in bed, rather than fixating on it.
Consider whether there are tasks that you do better at different times in the day. For example, I find that I do my heavy mental activities best in the morning, and try not to schedule anything too mentally demanding during the post-lunch lull.
Honestly appraise how well you respond to prompts and lists. For some, having a to-do list can control a lot of behavior, for others it is not nearly so effective. If you find that you don’t respond well to to-do lists, no amount of listing and planning is going to change your behavior. You may find that you need to recruit a friend to help in your program.
Schedule in some breaks. Most of us cannot tackle tasks back to back to back all day at the energy level needed. Even if it is 10 or 15 minutes, plan in some time during the day to take a quick break. You may find that this has the effect of making your time on task much more effective.
Avoid multi-tasking with important activities at all costs. The act of shifting your focus from one activity to another can take up more time than you expect, and eliminate any perceived efficiency from doing two things at once.

Self-management is no easy task, but the benefits can make the effort well worth it, not just for you, but for those you work with as well.

WRITTEN BY DANIEL SUNDBERG

Daniel Sundberg is the founder of Self Management Solutions, an organization that operates on the idea of helping people better manage their time. Towards this end, he created the Self Management Planner, which is based on an earlier edition created by Mark Sundberg in the 1970s. Daniel is currently a PhD candidate and continues his work helping individuals and organizations better themselves.

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

Posted on July 31, 2014 by Different Roads to Learning

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.

Prompting Behavior Change: A Guest Post by Steve Levinson, PhD, Inventor of the MotivAider

Posted on March 13, 2014 by Different Roads to Learning

We’re thrilled to bring you this exclusive article written by Steve Levinson, PhD, Inventor of the incredible MotivAider. We’re all familiar with the incredible versatility of the MotivAider in facilitating behavior changes and here, Dr. Levinson explains how behavior modification works. We’re so grateful to Dr. Levinson for this fantastic article. You can find more exclusive articles from leading experts in the field in our new catalog.

Prompting Behavior Change by Steve Levinson, PhD

If you’re a parent or a teacher who’s trying to change a child’s behavior, you’re probably frustrated. It’s not easy to change a child’s behavior. But before you blame the child, consider this: It’s not all that easy to change your own behavior either! Even when you have a good reason to make a particular change, and you’re really serious about doing it, changing your own behavior is rarely a snap.

Why it’s so hard to change behavior So, what makes it so hard to change behavior? If you think it’s simply a matter of motivation, think again. Motivation is certainly important, but many behavior change attempts fail not because of insufficient motivation. They fail because of insufficient focus.

You can’t change your own behavior unless you can keep your attention focused on making the desired change. While it’s easy to do things the old way because the old way is automatic, doing things the new way requires focus.

Unfortunately, whether you’re a parent, a teacher or a child, it’s not easy to stay focused. That’s because, amazingly, the human mind has no built-in mechanism to keep our attention focused on making the changes we want to make. So it’s really no wonder that our good intentions keep getting lost in the shuffle.

If you’re not convinced that (1) focus is an essential ingredient in the recipe for behavior change and (2) we’re not well-equipped to stay focused on the changes we want to make, here’s an example that should help. Suppose you have a bad habit of slouching. You realize that slouching is not only bad for your back, it’s bad for your image. So you promise yourself that from now on that you’ll sit up straight and stand up tall. How hard could that be? Yet soon—very soon—after setting out to improve your posture, you’re right back to slouching.

So, what happened? Did you lose your motivation? No. You lost your focus! You failed to make a change you genuinely wanted to make because you simply couldn’t keep your attention focused on making it.Yes, it’s hard to change behavior because changing behavior requires focus, and none of us—not parents, not teachers and especially not children—are particularly well-equipped to stay focused.

So what can we do to stay more focused on the positive changes we want to make? And what can we do to help our children or our students stay focused on the positive changes they want to make?

Prompting: A simple way to facilitate behavior change One solution is to use “prompting.” Prompting is a simple behavior change method that uses frequently repeated signals to keep your attention focused on making a desired change.

To illustrate how and why prompting works, let’s return to the posture example we used earlier. Only this time, after you promise yourself that you’ll sit up straight and stand up tall from now on, I’m going to follow you around and every few minutes—whether you’re slouching or not—tap you on the shoulder and whisper in your ear, “You’re no slouch.”

With me reminding you frequently, I guarantee that you’ll stay focused on improving your posture. What’s more, soon I’ll be able to stop whispering because just feeling the tap on your shoulder will be all it takes to send you the associated message, “Yes, I’m no slouch.” Sometimes when you feel the tap, you’ll find yourself slouching, and you’ll straighten up right away. Other times when you feel the tap, you’ll notice that your posture is already fine. It doesn’t matter whether you catch yourself slouching or you catch yourself with perfect posture. Either way, you’ll be making progress in replacing your bad posture habit with a good posture habit. Before long, you’ll automatically be sitting up straight and standing up tall.

Fortunately, there’s a more practical and even more effective way to use prompting. Instead of relying on a dedicated person to follow you around and keep tapping you on the shoulder, all you really need to implement basic prompting is a timer or other mechanical or electronic means that’s capable of sending you frequent private signals automatically. The process is simple. First, you devise a brief personal message that urges you to make the change you want to make. Then, you associate the personal message with the signal—the same way we associated “You’re no slouch” with a tap on the shoulder in the example above. The result is that whenever you receive the signal, you’ll focus your attention on making the change you want to make. And by making certain that you receive signals often enough, you’ll stay focused.

Prompting isn’t magic, but it can do amazing things. What’s more, because it allows us to overcome an obstacle that all of us—parents, teachers and children—share, it’s remarkably versatile. The same simple method that can be used to help a young child do a better job of staying on task can also be used to help parents and teachers consistently stick to an effective technique they forget to use when they’re busy or frustrated. The same simple method that can be used to help a child make a constructive keystone change in her social behavior can also be used to help parents and teachers stay cool, calm, collected, and constructive when interacting with a defiant child.

Tag Archives: behavior modification