I Love ABA!

Welcome to my blog all about Applied Behavior Analysis!

This blog is about my experiences, thoughts, and opinions on ABA. My career as an ABA provider is definitely a passion and a joy, and I love what I do.

This is a personal blog: The views and opinions expressed here represent my own and not those of the people, institutions, or organizations that I may be affiliated with.

Thursday, March 19, 2015

Slow & Steady


 
Photo source: policyexchange.org.uk, queenbeeberta.blogspot.com


*Recommended reading: Progress IS Success


I will generalize a good bit in this post, because if I listed all the different types of learners and their possible rates of learning this post would be 60 pages long, and none of you would read it. :-)

When working with whats often referred to as Early Learners, usually those “learning how to learn” skills are being taught: eye contact, following directions, problem behavior reduction, adaptability to change, etc. Early learners are often those individuals who may be nonverbal/nonvocal, engage in near constant self-stimulatory behaviors, have minimal self -help skills (feeding, dressing, toileting, etc.), and learn at a slow pace.

With these learners, progress is often subtle and slow.
Like, pouring out molasses slow.

For professionals who choose to focus on early intervention, it can often be because we LOVE the quick progress and seeing new skills emerge so rapidly (I know that’s why I love early intervention).
It’s extremely reinforcing to a professional to teach a client 5 new words in 1 week. For parents, its extremely gratifying and exciting to see the results of quality, intensive early intervention.

So when a learner doesn’t have that quick pace of skill acquisition, they don’t generalize skills well, and they don’t maintain learned skills easily, what impact does that have on parents and professionals? Well, I would say the impact is pretty similar: discouragement, self-doubt (“Am I doing the right thing?”), and frustration. 

I notice that my early learner clients often frustrate and confuse the direct staff much more than other clients do. Staff come out of a session with an early learner sweaty, tired, possibly with a few bruises or scratches, and feeling incompetent.
Staff burnout can occur more frequently with early learners, and from a professional’s perspective it can be harder to get parents on board with treatment when the child is an early learner. The parents don’t see rapid progress, so they think the ABA is ineffective or the BCBA doesn’t know what he/she is doing.

Not that you asked, but I simply love working with early learners. I think because my first few clients when I joined this field were the typical moderate to severe early learner, something tugs at my heart when I meet an early learner client. I just want to jump in and get to work and help that family, even though I know it will be difficult and slow going. Another reason I love working with this population is that I have learned over the years to look at progress through a unique lens. Yes, I have those clients with mild Autism who are working on advanced skills like cognition, self-care, problem solving, conflict resolution, academics, etc. I also have those early intervention clients who quickly move from babble, to Echoics, to spontaneous Tacting, in a nice little progression that makes you feel like you are the most amazing BCBA ever! (who says BCBA’s don’t need immediate gratification?)

But I have learned not to let my slow learners frustrate me and cause me to doubt my abilities. So my gift to you today, whether you are a parent or a professional, is to let you borrow my unique lens so you can view early learners the way I do.
Print this post out and put it up on your refrigerator, and read it to yourself whenever you have been painstakingly teaching a skill for week after week…..after week, and feel completely without hope.


Tips for Teaching Early Learners

  • Have you remembered ICEL? When a learner is not making progress or has plateaued, we don’t first blame the learner. Look at your teaching first (Are you moving through targets too quickly? Are you over prompting?), the curriculum next (are your programs flawed or poorly written?), the environment next (is the reinforcement schedule dense enough?), and the learner LAST.
  • Are you looking at the BIG picture? When you collect quality data, you will be able to see gains and progress that may be invisible on the surface. To put it another way, the direct staff who work with the client day after day may feel like no progress is being made. This is because they are too close to the situation. As the supervisor who comes in monthly, I can look at the data as a whole and see that tantrums are decreasing from 10 minutes a day, to 8 minutes a day, to 6 minutes a day, etc. I stay focused on the small and the big picture, so I know that we are making progress.
  • Are you focused only on the programs you run? This is a big error I see direct staff make. Yes, the programs you teach day after day are important and it can be highly frustrating to see slow progress with those programs….but therapy is more than just the goals we target. Therapy is also teaching learners that interacting with people brings about good things, and learning can be fun. My early learners may make slow progress with their programs, but often their eye contact improves like crazy, or their ability to stay calm if a peer starts tantrumming next to them, or their ability to stay dry and have minimal accidents each day, or their willingness to try new foods. I see these changes and improvements, and I know that what we are doing IS benefiting that child.
  • Are your expectations too high? Do you know what I expect from my clients? That they learn. That’s it. I know that some learners will progress very rapidly, and some won’t. Some learners will be very impacted by their Autism, and others will be only minimally impacted. As long as learning is occurring, thats what matters. This isn’t a race, and constantly comparing your child/ client to others will only lead to disappointment. You may need to adjust your expectations so you can appreciate the baby steps.
  • Lastly, are you sure you’re doing ABA? Seem like a silly question? It’s not. I consult with schools or families all the time who proudly show me their “ABA” program that I have to explain to them is not actually ABA. ABA requires ongoing data collection. ABA requires training and oversight to implement correctly. ABA modifies the environment to make certain behaviors more likely to occur. ABA is rooted in reinforcement and motivation, not punishment and coercion. ABA is the application of evidence supported strategies, not pulling from a bag of tricks. If you are experiencing persistent slow, or no, progress with your learner, maybe you need to check out the 7 Dimensions of ABA  to make sure you haven’t missed the mark.






Sunday, March 8, 2015

Effective Classroom Facilitation






Photo source: www.learn2learnclinic.org, www.specialeducationguide.com



Recommended posts:


A classroom facilitator, or “shadow”, is someone who goes into the school setting with their client to help them benefit from the educational environment. There could be multiple reasons why classroom facilitation is necessary: problem behaviors, difficulty with group instruction, child is not toilet trained, social skill impairments, or to help the child function appropriately in the least restrictive environment. Sometimes a school setting may be unfamiliar with ASD and require a 1:1 aide not necessarily because the child needs it, but so the teacher can learn from the aide the most effective ways to work with the child.

A sad conundrum I see many families go through is their child is placed in a general education classroom where they struggle to keep up academically or stigmatize peers with their behaviors, OR they are placed in a special education classroom where they are bored, not being cognitively challenged, and learn lots of new problem behaviors. These choices pretty accurately fit the saying “stuck between a rock and a hard place”. When it comes to school placements, there may always be some degree of dissatisfaction but it’s important to consider the difference classroom facilitation could have on a child’s ability to meet the demands of a classroom setting.

It’s important to understand what a great shadow does and does not do, before attempting to start facilitation with a client. When I first started seeing clients at school, I wasn’t given much information about my role. It was described to me as “helping my client be a part of the class”. Looking back on those experiences, I misunderstood my role to be prompting the child all day long  from a very close proximity. What can happen if you cause your client to depend on you too much as their shadow is the classroom kind of melts away and you and your client become an island. Your client will only respond to you, the teacher will tend to move around you/your client (treat you like your own class), and the other students will completely ignore you and your client. All of these are indicators that you aren’t facilitating properly, and don’t understand your role.

Photo source: www.barnesandnoble.com

Think of this like Goldilocks and the Three Bears. You can be a shadow who is too HOT, too COLD, or just right:

  •        Too HOT – You hover over your client, and use physical prompting throughout most of the day. You adapt every task your client is given, and constantly make separate assignments just for them: if the class is drawing a picture of their family, you take your client to the library to read books. You miss some opportunities to encourage social interaction because you and your client were too busy playing with each other, instead of your client playing with peers. You rarely ask the teacher questions or give her any input/strategies because you are too busy tying your clients shoes, wiping their nose, or correcting their worksheets. Step back!
  •  Too COLD – You stand or sit in the back of the room, and occasionally look up to check on your client and see what they are doing. Mainly you collect data, or record notes on your clipboard. You miss some opportunities to prompt or to encourage social interaction because you have to dig in your bag to find your clicker, or because you were graphing the frequency of vocal outbursts.  You often step out of the classroom to call your Supervisor or to send long text messages about your ideas for classroom modifications. When the teacher asks for your  help because the client is exhibiting problem behaviors, you tell the teacher you are just observing and don't want to interfere. Step up!
  •  Just right- Based on the needs of your client, you move in close when you need to but stay a good distance away when they are doing fine. You rotate around the room instead of permanently standing right next to your client or at the back of the room. If prompting is needed, it is the least intrusive necessary. You interact with the whole classroom, not just your client, to build rapport with the teacher and students. You collect data and notes during breaks or when your client is engaged with a task. Otherwise, you keep your eyes and ears alert for social opportunities, triggers/antecedents to problem behavior, or learning scaffolding opportunities. You encourage independence in your client and only modify classroom tasks when necessary, and after speaking to the teacher. You walk a delicate line between supporting the teacher and fading into the background so the teacher can learn how to teach your client. Keep up the good work!


When working as a school shadow, think of yourself as an excellent paraprofessional. Great parapro’s do not hover over the children, and they also don’t sit down in the back of the room all day long. They assist as needed, they discreetly steer away a student who is attempting to swat at a peer, they bend down to tell a student quietly to have a seat at their desk, and they are there to support the teacher in managing the classroom and teaching the curriculum.
A great shadow is not the teacher’s best buddy, but you also aren’t there to be the teacher’s enemy. As an ABA professional, you possess knowledge and training the teacher may not have. Part of your job is to eventually fade yourself out of the classroom, at which point the teacher should be prepared to use ABA strategies to prompt your client, reinforce your client, and keep your client on task.

Working with a client in a classroom is SO different than the typical in-home session. That intensive 1:1 attention needs to be kept at a minimum, and the client needs to be able to receive instruction from multiple adults or peers, as well as work for a delayed system of reinforcement (Don’t pop Skittles in your clients mouth every time they perform a task. Yes, I have actually seen that happen). 

The ideal role of a school shadow is to make sure that the client is equipped to meet classroom expectations which can include specific behavioral, emotional, social, and academic criteria: Can the client raise his hand to answer a question? Can the client manage conflict with peers without becoming aggressive? Can the student easily transition from one task to the next, or from one room to the next? Can the client join an ongoing conversation and stay on topic? Can the client independently use the restroom, including first requesting the restroom (if appropriate)? Can the client sit and wait appropriately if they finish work early? Can the client differentiate between when to imitate peer behavior and when not to imitate peer behavior? These are just a few of the many specific skills that children are expected to perform in a classroom setting, every single day.


For more helpful hints about classroom facilitation, check out this training handout.

Monday, March 2, 2015

Quote of The Day


Everytime you work with your clients, you can choose to believe the worst or the best about those individuals.
You can choose to see their strengths, or their deficits.
You can choose to see their failures, or their progress.

Decide today, that "wonderful" is right around the corner.

Tuesday, February 24, 2015

Sensory or Behavior?





He squeals loudly and lets all of his body weight collapse to the floor (“flopping”), as he covers his face with his hands and hums to himself. He is still for several seconds, making quiet humming sounds. Then he suddenly stands up, looks around the room and darts toward the front door. A parent quickly runs over to keep him from trying to leave the home, and steers him back to the living room by his shoulders telling him “We’re staying in here”. Once back in the living room, within a span of several minutes he repeatedly tries to jump on the couch, eat lint from the carpet, and stand on the coffee table. All of these attempts are interrupted or blocked by a parent. Throughout the entire observation, he makes continuous vocal sounds, some sound like “eeeeee-eeee” and others are short, high - pitched squeals or shouts (“Ahh!”).


This is a brief scenario describing a kiddo I observed recently during an intake, but really these descriptors could describe multiple children I work with…bounces, climbs, puts items in mouth, quick and sudden movements, crawling or laying on the floor, vocal self-stimulatory behaviors, etc. These are often referred to as “sensory issues”, “unmet sensory needs”, “sensory seeking/avoiding”, or “stims”.

If you are new to words like “sensory issues” or “stims” and not quite sure what I’m talking about, then check out this visual aid:  



I think what people mean when they say “Is it sensory or behavior” is really “Does this individual have something in their body that feels too high or low right now, OR are they just acting up”. There is an assumption that “sensory issues” mean the child needs to do something active or calming, but “behavior” is just about pushing buttons. The misuse of both of these terms must be quite confusing for a layperson to understand.

There are a few things that are important to understand about sensory issues from an ABA perspective …..which if you are here, you must want an ABA perspective :-)

  • We focus on behavior. Saying the word “sensory” can mean many different things to different people, so to keep it clear and simple we focus on what we can see and measure.
  • So if we label something a “behavior” and not a “sensory issue”, then what does that mean? It means we view behaviors as gaining or avoiding something. If I pull out my phone to play Farm Heroes Saga anytime I have to wait in a line (which I do, by the way), I’m bored, and me going for a video game is a way to alleviate that boredom. What if I didn’t have my phone? Well, I might twirl my hair, bite at my nails, or tap my foot. Depending on my options, my behavior may look very different. However the reason for my behavior is the same.
  • Speaking of function, if we don’t consider sensory issues to be separate from behaviors then what are they? We ABA people would call them Automatic Reinforcement maintained behaviors. 
  • The intervention needs to be clinically sound. Blanket, or general, interventions like "Just put on her weighted vest when she gets hyper" aren't going to cut it. The intervention needs to be valid and tied to the function of the behavior, as well as empirically supported.
  • Vague or poorly defined words like “sensory issues”, “overly stimmy”, “sensory diet”, “sensory protocol”, etc., are pretty hard to implement. If I tell you “Everytime Dominic starts acting stimmy, let him do sensory exercises”, would you know what that meant? Most likely not, which is why ABA people use clear and objective language to define our interventions.

Are you now wondering then what in the world CAN you  do about these self-stimulatory, automatic reinforcement maintained behaviors? Well, wonder no more:

Select and define the behavior you want to target---be specific (“climbing furniture” not “hyperactivity”)
Conduct a FBA  to determine the function(s)
Now that you know the function, select a replacement behavior (what the child will do instead of climbing furniture, mouthing items, standing on the kitchen counter, etc.). The replacement behavior needs to provide the same function payoff, and if possible should be topographically similar
Decide how to teach the replacement behavior, and block/redirect the target behavior
Make sure all relevant caregivers and staff know how to implement your intervention, and what to do both before and after the target behavior occurs
Evaluate your plan, review the data, and if necessary make changes


Lastly, there are 2 super-duper important things to understand as it relates to automatic reinforcement maintained behaviors:
  1. Never deliver the specified treatment/stimuli contingent upon problem behavior. You want to teach your clients to request, or initiate, appropriate ways to meet their automatic reinforcement needs, not teach them that “bored during session” + ”start mouthing all the flashcards”= “now I am in the hallway sucking on a lollipop”.
  2. I don’t advise aiming to completely eliminate self-stimulatory behavior. For one, everyone does it. For two, I will let you read about how a teen with Autism describes her need to engage in “stims”.


References/Recommended Reading:

Morrison, Heather; Roscoe, Eileen M; Atwell, Amy. (2001). An Evaluation of Antecedent Exercise on Behavior Maintained by Automatic Reinforcement using a Three Component Multiple Schedule. Journal of Applied Behavior Analysis. 42. 523-41.


Roberts-Gwinn, Michelle M; Luiten, LeAnn; Derby, K Mark; Johnson, Tania A; Weber, Kimberly. (2001) Identification of competing reinforcers for behavior maintained by automatic reinforcement. Journal of Positive Behavior Interventions.3.2. 83.


Piazza, Cathleen C.; Fisher, Wayne W.; Hanley, Gregory P.; LeBlanc, Linda A.; Worsdell, April S.(1998) Treatment of Pica through Multiple Analyses of its Reinforcing Functions. Journal of Applied Behavior Analysis.31.2. 165-189


Goh. H., Iwata. B.A., Shore, B.A., DeLeon, I.G.. Lerman. D.C., Ulrich. S.M., &
Smith. R.G. (1995). An analysis of the reinforcing properties of hand mouthing. Journal
of Applied Behavior Analysis. 28. 269-283



Lang, R., O’Reilly, M., Healy, O., Rispoli, M., Lydon, H., Streusand, W., Davis, T., Kang, S., Sigafoos, J., Lancioni, G., Didden, R., & Giesbers (2012). Sensory integration therapy for autism spectrum disorders: A Systematic review. Research in Autism Spectrum Disorders, 6, 1004-1018