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.

Friday, July 15, 2016

Mand Training




Photo source: www.autismsparks.com, www.pbs.org




When teaching or providing intervention to young children with Autism, communication impairments are often pretty high on the list of priorities. This can include issues such as echolalia, poor articulation, syntax difficulties, or the child may be nonverbal (remember, nonverbal does not mean “no talking”. That would be “non vocal”. Nonverbal would indicate a lack of a consistent means to communicate).

A highly effective method for teaching a child with communication deficits to communicate is: Mand Training. If you read my Verbal Behavior post then you know that “mand” just means request.
Notice I said Mand Training is about teaching an individual to communicate, not “talk”. Communication is far more than being able to speak. I have clients who can talk, but aren’t communicators. I also have clients who communicate all the time, but do not talk. Some of my previous clients never reached a point of producing vocalizations (talking), and that does not mean treatment failed. They made amazing gains, they just developed other means of communicating.
Since Mand Training is far more than just talking, this means that communicating can be taught via sign language, picture communication (photos or iPad), use of an assistive device, etc. While many parents often want to target vocalizations, manding does not have to be vocal.

So WHY teach manding? What is so important about being able to communicate with others?
-A child who cannot request wants and needs, is (very often) a child who will use problem behavior to communicate: aggression, tantrums, property destruction, etc.
-A child who cannot request wants and needs is a child who will bewilder and frustrate caregivers on a regular basis: “What do you want? Are you sick? Are you hungry? Are you tired? Does something hurt?”. I work with many parents who often have to guess if their child is hungry, guess what their child wants to eat, guess when their child is full, etc. It’s a very difficult and challenging way to live. Not just for the parent of course, but for the child as well.
-A child who cannot request wants and needs is a child who may struggle with social interaction. How will the child let other children know they want to play? How will the child let other children know they are tired of playing? For a nonverbal child this can often happen through exhibiting problem behavior (such as pushing a peer down who stands too close, or snatching an interesting looking toy from a peer).

Before learning more about Mand Training my biggest tip would be NOT to read this post and then try to implement a mand training procedure on your own. It’s important to work with a BCBA to accurately design and implement a manding intervention. This is one of those skill areas where you definitely want the assistance of a qualified professional.

Okay, so here is a basic outline of how Mand Training occurs. At the end of the post I will include a clip of some actual mand training (taken from an episode of Supernanny) because I think seeing how the procedures are implemented could really be helpful.

  • Mand Training kicks off with a good amount of highly preferred items/reinforcers. You need to know what the learner is MOST interested in, because those are the mands you will want to teach first. You teach reinforcers first -- before general nouns (“school”), before generalized mands (“more”), and before manners (“please”) --- because motivation is key. If I love my talking Elmo doll more than anything in the world, I will be ridiculously motivated to mand for my talking Elmo doll.
  • Next, you will start requiring a mand in order to access the highly preferred items. No mand= No access. I suggest watching the video clip below to see examples of what this looks like, and what often happens at this part. If you’re a professional you probably already know what I am hinting at: Behavior City. From the perspective of the learner, they are used to getting what they want, when they want it, without having to mand. So once you start to require communication, expect to get some pushback.
  • Be knowledgeable about vocal shaping, if you are targeting vocalizations. When the learner begins to vocally communicate the speech may be unclear, garbled, or otherwise fractured. It is important to work with a professional who understands shaping procedures and how to accept closer and closer approximations to clear speech. This means that initially, “BUH” may be acceptable to request “Bubbles”.
  • Consistency will lead to success. Mand training can take literally hundreds of trials per target, or per item. In a typical therapy session, I can incorporate mand training into nearly every few minutes of work. This repetition can be extremely necessary for some children with Autism. Be prepared to work on mands all throughout the day, across environments, and across caregivers.
  • Mand training gets increasingly more complex. I may start out with a client by having them mand for a reinforcer that is present, and accept any vocalization as a correct response. From there, the item may be hidden from view, the learner may have to accurately state the name of the item, the learner may have to request using a full sentence, etc. Skipping over this step can lead to learners who can only speak in short phrases (“want chips”), can only mand for a few items, or mands for categories and not items (can say "eat", but no one knows what they want to eat). Once the learner can successfully mand for something, increase the response requirement.  


*More information about Mand Training:





Wednesday, July 6, 2016

Supervisor Tips: Good Staff?


Photo source: www.church.calvaryministries.com, www.absmagazine.com.au


Suggested post: ABA Staff training

How is “Good” evaluated? Better than bad? Almost great? Without further definition of the word “good”, valid measurement is pretty impossible.

ABA people are big on defining things. We like to break abstract concepts down, get an operational definition, make sure everyone agrees on the definition (and what the definition excludes), and ONLY then go about measuring the concept. It's super common to hear ABA people say things like “What does that look like?”, “Give me an example”, or “What do you mean by tantrum?”. If we can’t agree on what we are measuring, then how can we accurately measure?

Staff evaluations and staff feedback are two areas where all of these same skills come into play: being able to break concepts down, defining what you want to measure, and then creating a system of measurement. For supervisors, at any given moment we are always shaping the behavior of at least 3 people: the client, the caregivers/parents, and the staff. Everyone wants excellent and well-trained staff, but I have often observed few want to do the work necessary to transform staff from "good enough" to "excellent".

The reality is regardless of experience or education you may find that the direct staff need remediation in various skill competencies in order to perform their role with excellence. Years and years of experience does not mean it was quality experience. Or, months and months working for “prestigious Dr. so- and- so” does not necessarily translate into a great clinician. Sometimes book smarts does not equal bedside manner, and vice versa.

Staff evaluation is basically about making sure the staff are meeting the demands of their role, but it’s also about seeing staff improve over time. Of those two concepts, I have encountered the most staff opposition with the 2nd one. Particularly for highly experienced staff, there can be a bit of a “I know what I’m doing, so there’s nothing I can improve” kind of attitude, which may need to be addressed before accurate evaluation can occur. I’m pretty sure you don’t know any perfect people (because I sure don’t), so that means staff can always improve upon their skillset or knowledge base.

An approach I like to use is to provide overall performance evaluation (long term/every 6 months) combined with more frequent and specific feedback (every supervision session). I like to focus on a combination of content areas, as well as more indirect skills or capabilities that are an important part of this kind of work. What’s that, you’d like to see an example? Sure, I can do that :-)


For the specific staff feedback, it’s good to include specific skillsets that should be demonstrated each session. I suggest starting with the staff job description and building from there when creating your feedback forms. For example, typical direct staff job duties can include implementing the treatment plan, accurate data collection, and appropriately conducting reinforcer preference assessments. For those indirect areas, I like to include areas such as professionalism (e.g. appropriate work attire, cell phone used only for emergencies), initiative (e.g. asking for supervisor help when needed, promptly updating the supervisor on client changes), and personal goals. I like to have the staff select a few goals for themselves that they want to be held accountable for, and that I will assess as part of their feedback forms (e.g. increase fluency with using ABA jargon when describing client progress, teach a parent to collect ABC data, etc.)

For the long term evaluations, this is where I am more interested in improved performance over time. I focus on areas such as Teaching/Instructional Control, Time Management/Organization, Behavior Reduction, Prompting & Prompt Fading, etc. A good tip is to incorporate content areas from the current BACB task list. This will help guide your understanding of what behavior analytic skills and concepts you should be teaching to your staff. I’m big on teaching…probably the #1 thing I do during supervision sessions is on the spot staff training, or teaching.

Lastly, part of helping your staff reach excellence means you need to intentionally hop in the passenger seat and let them drive sometimes. What I mean by that is allowing opportunities for more of a leadership role, such as having the staff create program visuals, help you update the client’s VB-MAPP, co-lead a parent training session with you, or give input on skill acquisition goals. Giving the direct staff opportunities to learn about your role and what you do as the supervisor enhances their skillset, and I have found multiple times it can spark an interest in becoming certified/pursuing a career in this field.



Saturday, June 25, 2016

Community Outings Part II


Photo source: www.madamenoire.com, www.parentingthroughschoolyears.com

 My last post on community outings was aimed at staff/therapists who provide therapy services in the community (at the library, neighborhood pool, a birthday party, etc.). However, there's more to the concept of community instruction than the therapist taking the client into the community. There's also the family/parents being able to participate in their local community.

It is super common that when I start working with a family one of the issues they describe to me is being unable to take their child into various community locations. I hear things like "I have to get a babysitter to go grocery shopping", or "We stopped going to church 2 years ago", or "We USED to go to (insert community location here) but it just got too difficult so we stopped". I hear stories like this on a regular basis where the whole family lives in a shrunken down world of just a few places (i.e. home, school, Grandma's house).

This is always an area I seek to target through intervention, because this is such an unrealistic thing to avoid. Its kind of like failing to teach toileting; this is a life skill that must be addressed.

People live in communities, so to avoid or completely stop taking your child into community settings due to difficulties or challenges is to miss out on a multitude of learning opportunities. I'll say it another way: I learn how to act in a library by going to the library. I learn how to wait in a line at the post office by going to the post office. I learn how to order food in a restaurant by going to a restaurant. Make sense?

Here are some general tips and guidelines for successful community outings:

  1. Go - Yeah.....my first tip is just to go outside. Fear is crippling, and it will lock you in a box. Even if you feel afraid of what may happen or what could go wrong, do not let that stop you from taking your child to community locations. More than being brave, I would emphasize being prepared. Which leads to the next point------ 
  2. Preparation is key - Preparation is one of those things that often gets skipped over. Unfortunately, you don't know how unprepared you are until you are in a rapidly deteriorating scene. So its better to over prepare than to under prepare. If you have ABA staff or are working with a BCBA, schedule outings for when these people will be present. Backup is good. Take your spouse, or a friend with you just in case challenging behaviors occur (also, just having the support is nice). Visuals are your friend. Prep your child in advance by explaining simply where you will go, and what they need to do there. Use a visual to help make your words concrete and clear. Take the visual with you, as well as a few reinforcers your child loves. Connect being in community locations with receiving reinforcement.
  3.  K.I.S.S. - No, not keep it simple stupid: keep it SHORT sweetie. :-)  Especially when you first decide to work on this, I don't suggest taking your child to see a 2 hour movie.....that likely wont go well. Start small. Go walk around the grocery store for 5 minutes, go mail a letter at the post office, go look at fish at a pet store and then walk out. Keep it brief, and leave on a high note (leave before things start to go south). 
  4. Engagement is key - Make sure whatever the setting is, your child has something to do. This is not exclusive to Autism. Kids get bored...they start requesting things....requests get denied...behaviors start. Lets sidestep that whole ugly little chain by going in prepared (see #2). If you're at a grocery store, your child can help put items in the cart and find things on the shelves. If you're at the mall, your child can carry bags. I know some of you may be thinking "My child is not yet at a point where they can follow an instruction or help out at a store". Not a problem. Then bring distractor tasks with you. A distractor task is just something your child can engage with. This could be a kaleidoscope, some headphones to wear, a squishy ball to squeeze, etc.
  5. Stay strong - You knew this was coming, right? Sorry. There's just no getting around it. If behaviors erupt in the community setting what is the last thing you want to do? Leave. Why is that? Well, this will actually serve an escape response which is the last thing you want to do. Over time, your child will start exhibiting behaviors as soon as you drive up to the community setting so that they can leave. I know its hard. I know people stare. I know its embarrassing. I know people will judge your parenting abilities. Here's the good news: over time, as you keep returning to the community setting and following steps 1-4 the behaviors should drop down, and down, and down. Do yourself a favor and go into the community during "dead times": go see a matinee, or arrive to the restaurant 5 minutes after it opens, or go bowling on a Tuesday afternoon. Go out at times when places are more likely to be empty, and all the judgemental people are at work :-)

Lastly, I have to add another huge reason why its so important to take your child out and about in their local community. Earlier I mentioned the dazzling array of learning opportunities available for your child. What about other people in your community? How do people learn to live and interact with people with disabilities if they never encounter people with disabilities? Diversity awareness is not as widespread as some may believe. I encounter the stares, pointing, whispering, or rude comments when I am out with my clients today just as I did years ago as a newbie ABA therapist. When people see you out and about teaching your child skills in the community, they are getting an opportunity to learn and grow as well.

*Resources:

Community Outing social story
Community Outing Teaching Protocol
Going to the Store social story
Going to the Movies visual

Saturday, June 11, 2016

Observing Therapy Sessions


Photo source: www.researchhistory.org, www.goodtherapy.org

I've said it before, and I'll say it again: parent participation is critical to the success of any ABA therapy program.

One way that participation can be accomplished is by having parents/caregivers observe the therapy sessions. Particularly when therapy first begins, it may be too challenging to have the parent join the session. This can be challenging for the child, who may not want mom or dad in their therapy session, and it can also be challenging for the parent who is still learning what ABA entails. So a nice compromise I like to do initially is just have the parents sit and watch the session without joining in.

I have a pretty big dislike for therapy sessions that only go on behind closed doors. I do not think that the therapist should arrive at your home, go into the therapy area, close the door, and then in a few hours you see them again as they leave. How is that helpful for the family who urgently need to learn how to generalize what the therapist is doing? From the child’s perspective, this sends a message that they only need to listen to their therapist. So when the therapist leaves…..things can get very hard for the parents.

I tell my staff that one of my goals of treatment is that the therapist can work with that child all over the home, across various rooms, where family members may or may not be present. In other words, treatment should occur naturally and within the context of the typical environment. This could look like playing games at the kitchen table as mom cooks dinner, or practicing bike riding in the driveway next to some siblings. I love to see therapy sessions that are active, loud, full of laughter, and move freely from room to room. Admittedly it may take time and practice to get to this point, but it definitely should be a goal.

Many parents are unsure of what to do when I ask them to start observing, and for some it can even be an uncomfortable or unenjoyable experience. ESPECIALLY if just the sight of you walking into the therapy area causes your child to erupt in problem behavior. If that happens to you, don’t feel alone. It’s pretty common. This just means your child needs more opportunities to get used to your presence during their therapy session, but it definitely does not mean you should leave/walk away when this happens. That will only serve to strengthen an escape response where your child acts out in the session to get you to leave.

So now that you know not to leave in response to problem behavior, what should you do while observing a therapy session? Glad you asked :-)

1.       Observe the dynamic between the therapist and your child- You know your child better than anyone, so what you are looking for is a healthy respect for who your child is as a person. If your child squirms away from touch, does the therapist keep giving huge bear hugs anyway? Does the therapist speak to your child with respect, or in a degrading tone? Does the therapist seem bored or disinterested while teaching? These are all bad signs.
2.       Observe the reinforcement your child receives – What reinforcement is being used? Is it varied, and delivered frequently? Is praise delivered along with reinforcement, or does the therapist just silently hand your child a toy or edible? What if your child seems bored with the reinforcement, does the therapist pick up on that?
3.       Observe how correction or prompting is given during instruction – When your child gives an incorrect response or stops responding at all, what does the therapist do? How do they react? Do they appear frustrated, flustered, or annoyed? If you can read that in their face, so can your child.
4.       Observe how the behavior plan is implemented – Firstly, if there is a behavior plan you should be familiar with it. Observe how the therapists implement the plan, and if they are following it. Are you seeing the antecedent strategies being used?  If your child becomes aggressive, does the therapist know how to react in a calm and neutral manner?
5.       Observe both professional and ethical behavior – This is probably my #1 reason for recommending parents observe, from the perspective of a parent. When I have on my BCBA hat, I want you to observe to learn the treatment plan and ABA strategies. But when I have on my parent hat, I want you to observe to make sure you are dealing with professionals. If you are unaware of the ethical and professional standards for this field, please become familiar with them. Here is a link to the standards for this field. If you directly observe violations of these standards, that is absolutely a bad sign.
6.       ASK QUESTIONS- This is so important I must say it again: ask questions!  The ABA team are not in your home 24/7. It is super important that when they are there you use that time to bring up concerns, problems, or questions. Ask about behaviors, the treatment plan goals, bring up your concerns about the upcoming school year, etc. The team should answer your questions respectfully and simply, minus a bunch of jargon. I also suggest using therapy session time to practice things that are particularly difficult when the team is not around. For example, if you have a rough time every morning getting your child to brush her teeth, practice that skill with the staff during therapy sessions. That is why they are there after all, is to help you!

Just like any new skill, ABA will be so much easier to learn once you have seen/observed what it should look like.
One of the best ways to truly learn how to implement the treatment plan is to watch the professionals do it, then ask questions about any parts that seem confusing…or ineffective…..or overly punitive. I have had some parents ask me some very probing questions which led to some great moments to teach about the application of ABA.  

*Suggested Reading: The Rights and Wrongs of a Parent Observing Therapy