*Recommended Post: "HOW Much Therapy?/Intensity"

Consistency may be the #1 word I use most often when speaking with staff or with consumers/families. It would be quicker if I just made a sign that said "Be Consistent" and held it up in front of my face at work. Quicker, but also super odd.

Why is consistency so important when it comes to ABA?

Let's step away from Autism, therapy, and teaching for just a sec and talk about behavior change in general. If you've ever tried to change your own behavior, then you know that you get out what you put in. That New Years resolution you made back in January...how's that going? If it's not going so well, it may be because your initial commitment to changing your behavior has lessened or waned over the past few months.
For me personally, I am one of those weird people who actually enjoys exercise. Am I a gym rat? Good grief, no. I hate gyms. Do I run a mile every morning? Ummm, no. If you ever see me running, something is wrong and you should go get help. But I do have specific types of exercise that I enjoy, especially if its outdoors. I also regularly will drop my exercise routine for weeks, or months at a time for various reasons. In other words, I am not consistent. Despite this, I get health benefits from my "sometimes" exercise. If I were more consistent, the results would be much more dramatic. However, I am pleased with exercising for enjoyment and for health, and not necessarily to be a size whatever.

And that in a nutshell is why your BCBA keeps blabbing on and on about Consistency: The behaviors in your child that you want to see dramatically change, will require dramatic consistency. 

I get it, I really do. You have other things going in your life besides implementing interventions. There's laundry to do, and jobs to maintain, and other children to raise. There's also just being tired. Being a parent is tiring. I'm tired right now.

But this is why a quality BCBA won't give you 50 hard things to do at once. This is why a quality BCBA will break down large behavior change processes into manageable chunks. This is why when parents say things to me like "I want him to be able to play independently", or "I want her to be able to tell me about her day at school", I explain how far away we are from that goal. I then explain the specific steps that lead up to that goal, and lastly what that would realistically look like:

-It looks like running a behavior protocol even when you have family staying over at your house.
-It looks like taking your child to a birthday party/family event for only as long as they can tolerate being there. 
-It looks like filling out data sheets as you simultaneously cook dinner and help your other children with their homework.
-It looks like embedding (translation: creating) opportunities in the day to play with your child, or to run language trials.
-It looks like following the behavior plan when you are tired, sick, or your spouse is out of town for 2 weeks and you have no help.

The beauty of consistency (and its saving grace) is that it will look different from one family to the next. I hope your BCBA told you that as well.
Consistency in my house means that we bust our butts all week to get a fun day Friday. I really don't care what you do on fun day Friday, but I need a break so that means you get a break. Just don't burn the house down.

In your house, consistency may mean hiring a part time nanny/asking your friend to come over every Tuesday because you need an extra pair of hands. Or it may mean only collecting data weekly because every day is impossible. Or it may mean you only observe 1 therapy session a week because you work from home and can't do more than that. Whatever sacrifices must be made in order for consistency to happen, it is SO important that this is communicated to the BCBA. We cannot help you overcome barriers that we do not know you have.

Anytime I go over a new behavior plan with a family or with the direct staff, there's always the part where I put the plan down and say "Okay, now is the time where you ask me all your REAL questions". See, there are the polite, typical, questions, and then there are the REAL questions that basically get at: "When I haven't slept/the child is sick/when this gets really hard/during the Extinction Burst/when we are in the community, how are we supposed to follow this??".

Consistency is very, very important. Especially if you are tackling significant areas of behavior change, such as teaching a child to communicate or extinguishing aggressive behavior. But consistency does not mean 100% perfect. No one is 100% perfect. It just means that as much as possible, even when it's hard to do so, you

Related post: Hiring ABA Staff: You're Hired!

There are few things I hate about my job (thankfully for me), but right near the top of the list is when I encounter a parent who tells me about a really bad experience with ABA staff/an ABA company.
Some of the stories I hear are bad or unprofessional, and some are just shocking. And hugely disappointing.

I think that if more parents were aware of how to evaluate the quality of therapists/technicians, many of these situations could be avoided. Speaking of: wouldn't it be helpful if I made a checklist for parents to evaluate the quality of ABA staff? Yup, I already did that. Check out my free resources section ;-)

When a parent realizes the "professionals" working with their child leave much to be desired, I usually see 1 of 2 responses:

Response #1: "I don't want to rock the boat/make a fuss/complain, so I'll just deal with it and hope this gets better"
Response #2: "This person/company is horrible, so I will make no complaint and just move to a new company blindly trusting that they will be better"

The recurring word in each response is "Better". I talk to many parents who have unmet desires that their ABA team will get "better". If quality, ethical, and professional treatment is not just expected but demanded, then parents wouldn't need to silently hope for "better". "Better" basically means that whatever is happening right now is not great, but maybe....somehow....all on it's own...the situation will improve. I don't usually see that happen, and I wouldn't advise a parent to follow that kind of cross- your- fingers- and -wish- for- better approach.

Instead, I would urge parents to be aware of what ethical treatment should look like (here, read this) and to remain an informed consumer. I would also urge parents to please speak up if you are dissatisfied with your ABA team. The provider cannot correct an issue they are unaware of, nor can any staff disciplinary measures be enacted if the company is unaware of problems.

What I usually see whether the parent gives response #1 or response #2, is they say nothing about their issues with the staff. Instead, they just hope it improves or they simply move on to a new company.
Looking at it from the staff's perspective, how does that help them improve their skillset?
Looking at it from the company's perspective, how does that help them weed out the weak links from their employee pool?
And most importantly, looking at this issue from the child/client's perspective: how much valuable learning time is wasted hoping staff improves or bouncing from one company to the next?
No matter which perspective you use to look at this issue, it's imperative to maintain clear and open lines of communication between the parent and the ABA team. No one can meet unspoken expectations.

Clear and open communication is not complaining, it isn't rude, and the provider should not take offense. Speaking for myself,  I would much rather a parent tell me plainly they don't like something I am doing, than just silently dislike me. The beauty of ABA treatment is we can always hit "reset" and modify what we are doing. Parents: do not feel like you can't openly communicate with the team because they may retaliate, become passive-aggressive toward you, or even openly hostile toward you. If this is a valid concern for you, then you are not dealing with professionals.

When is clear and open communication of grievances necessary? Well, that will depend on your expectations as a parent. While I can't answer that for you, I CAN name several common parent grievances that should always be addressed with the staff directly, and if necessary with the company management/owner:

  • Staff seems under-qualified for their position, visibly lacks confidence, or openly tells you they are "new" - Would you fly on a plane if the pilot walked out and told all the passengers that while he has attended a 2 -hour pilot training, this is his first time flying a plane and he's a bit nervous? No right? No is the right answer to this question. But I talk to parents all the time who can visibly see that the staff is nervous, scared of their child's behaviors, or even asking the parent for tips! **YES, I have seen scenarios where the staff asks the parent what they should do**  If you are experiencing this issue with your ABA team, address it immediately.
  • Staff either rejects parent input or politely listens to the input and then does the opposite - This is the technology age, where parents can do a quick internet search and find out massive amounts of information about ABA. Parents suggest specific strategies, programs, or goals to me all the time, that they read about or saw online. It is my job to incorporate their input when I can, and explain the reasons against it when I cannot. What is NOT my job is to flat out refuse. Or to nod and smile and then completely disregard what the parent said. Address this issue immediately.
  • Showing up for work seems optional - Probably the #1 reason I see ABA staff get fired off  a case is because they just don't show up for work. They are habitually late or habitually cancel, often with short or no notice at all. Not only is this completely unprofessional behavior, it is detrimental to treatment. If you have a headache and the bottle of aspirin says to take 2 pills, and you take 1/8 of 1 pill, don't expect to feel better. In the same manner, if your ABA treatment plan states that your child needs 20 hours of therapy each week, then they need 20 hours of therapy each week. Address this issue immediately.
  • Issues with billing/payment/co-pays - Many parents tell me that they were shocked to receive a bill from the ABA provider because they thought insurance covered everything. Or they didn't understand how the BCBA could bill for services if she was not at the home. Or the staff was asking them to sign timesheets for hours that weren't actually worked. The HR/Billing department of the company should have thoroughly and clearly explained the intricacies of billing and payment to you before services ever began. If you have a parent co-pay you should know that in advance, and if the staff are billing in codes only (e.g. code B912) then you should know what kind of service that code stands for. Receiving an invoice for thousands of dollars should not come as a nasty surprise. Address this issue immediately.
  • It's more Babysitting than actual Therapy - I know, I wish I didn't have to state this either. It seems fairly obvious. But I hear it often enough from multiple parents that I know it's happening. ABA therapy sessions can look probably 100 different ways just depending on what skills are being targeted. I think that very flexibility is what can make it difficult for a parent to know if any treatment is going on. Will every session be at a small table with flashcards? No, that's a big myth. Can sessions that appear to be just play actually target multiple goals? Yes, they sure can. However there is a large difference between playful yet intentional interaction, and the therapist sitting with your child and watching cartoons. Or texting on their cell phone as your child plays alone in a corner. Or taking your child to the park for 2 hours each session and never working in front of you. Or working with your child for a few minutes and then taking a 20 minute smoke break. And no, I am not making these examples up. Unfortunately, I have seen this and worse. The ABA staff should be able to explain to you their goals for the session (their "session plan"), which programs they will teach, and which parts of the session you can participate in. Yes, you should be able to participate in at least some parts of the session. If it is not clear to you as a parent when "therapy" is happening, and when the staff is just hanging out with your child: Address this issue immediately.

If clear and open communication does not result in concrete improvements or resolution (not just vague promises), or if it directly results in staff retaliation, anger, or hostility, then it's time to move on. As a parent you have every right to expect to deal with mature professionals who will put your child first before their preferences or ego.
The ABA provider is there to help you and your child, so if that help comes attached with unethical behavior, poor attitudes, and habitual tardiness, well that's not really any help at all is it?

**Recommended Reading: Signs of a Bad ABA Therapist

*Recommended Post: Normalization

Iowa man sits at a messy table while holding paint covered pencil and brush

If you are implementing ABA treatment (regardless of the diagnosis, or lack of diagnosis, your client has) with the #1 goal of making the individual "normal", then you are doing it wrong.

"From cradle to grave, the pressure is on: Be normal." 
Gordon MacKenzie

'Teaching Loosely' is a concept I intentionally aim for when designing treatment, and it can include things like varying stimuli as much as possible (and using common items found in the home rather than purchased materials), having loose criteria for what is an "acceptable response" to any SD, moving away from formal SD's as soon as possible, and embedding multiple skills into one target. For example, instead of writing up distinct and specific targets to work on during a Play Imitation program, the goal may be to embed novel motor behaviors into play for the child to imitate (shake the doll, feed the doll, burp the doll, tickle the doll, etc.).

Why is this so important? Because creativity is where unique, God- given personality and character cause you to stand out from others.
Yes, as my clients are all somewhere on the ASD continuum they do have things in common: a strong desire for sameness, sensory issues, feeding issues or sensitivities, motor/coordination difficulties, etc. But they are also as different from one another as a zebra is from an elephant. Saying all my clients are the same would make about as much sense as me saying "I saw an animal the other day, it was either a zebra or an elephant. Whatever.....they're both animals". That's a crazy statement considering how much those 2 animals differ.
In the same way, it's crazy to plan treatment in such a way that ALL your clients learn "Familiar People ID" in the same way, or learn to tact colors in the same way, or spend the same amount of time on DTT drills.

Creativity is often given a bad rap, especially among us ABA peeps, because it takes us off-script. Before I'm seen as bashing the ABA peeps, this happens in classrooms as well. Think of the kid who has to hum as he does his work, or the kid who dances/wiggles while standing in line, or the kid who draws pictures of robots on his homework assignments. The script would say "this kid is inattentive...this kid is non compliant....this kid is disruptive". Instead of looking it at that way, what if the kid is creative? Or unique? Or has a vivid imagination?

I don't mean to make it sound easy as pie to consider the unique personality of the client when designing ABA treatment. It's not. It takes more time, assessment takes longer, program writing takes longer, and more constant revisions to programs are necessary. Something I like to do often is look at specific programs that aren't going well, and ask myself "How important is this??". Like any BCBA, I use specific assessments and curriculums to design treatment and consider typical developmental goals. But I also look at the specific client, their learning environment, and their overall learner profile. Is using a flat knife to spread really important for this child? What about neat handwriting? Or learning to ask a friend to play? For some of my clients, these are pretty important skills for them to learn. And for other clients, not so much. It depends.

I also don't mean to make it sound like everyone will just love a treatment plan that embraces creativity. Expect some push back. From who? Well, from the program implementers as well as the parents/stakeholders:

It's easier to assume what the child should learn, rather than teach what they are interested in learning.
It's easier to assume lack of competence in the child when a program isn't progressing, rather than think of ways to make the skill more functional.
It's easier to adjust the child to the learning environment/classroom, than it is to modify the learning environment/classroom to the child.
It's easier to demand the child change to meet your expectations, than to change your expectations to meet the child.
It's easier to use purchased materials or flashcards than it is to create teaching materials for the purpose of generalization, or just based on learner interest (e.g. Shrek themed emotion cards).
It's easier to teach the way you have always taught than to constantly change your teaching based on how the learner is responding.

That last point is my favorite.

If the session is flatlining quickly (learner is trying to escape, learner has shut down and isn't responding, learner is screaming and crying), don't just plod through a 3- hour session like that. Stop and assess: what's going on here? ---> Are you approaching the learner with powerful reinforcement? Have you made it clear the behaviors that reinforcement is contingent upon? Are your materials boring? Are you maintaining your energy and an animated affect? Is the learner getting to make frequent choices? When did the learner last have a break/creative time? (I like calling it creative time rather than just a break, because that makes it clear to staff that the learner decides what happens on breaks. Not the staff)

None of us typically enjoy working with non-creative people....they can take the fun out of projects or assignments, and suck the energy out of meetings. If that's the case, why do some of us work so hard to kill the creativity in our clients?
Kids are some of the most creative people I know, so I'd rather spend my time helping them hold onto that as they grow up, rather than killing it.

Photo source: www.newcap.org

A novel, based on the life of an 18th century peasant girl who marries into nobility...

I am totally kidding.

My newest book, "Everything You Ever Wanted to Know about ABA" is now available for purchase on www.Amazon.com.
I'm just going to say it: It's my best book so far.
(If you are unfamiliar with my previous books, just go to Amazon and type 'Tameika Meadows' into the search bar).

I stand by that huge claim. If you buy the book and hate it, let me know and I'll give you a cookie or something.

This is my BEST book yet because I combined all the ABA horror stories I hear from families, all the questions parents ask me when I first meet them, all of my kind-but-honest responses to those scared parents, cold hard data, but also warm, soft hope.
The book also includes 2 *bonus* Parent Checklists with over 50 suggested questions to ask potential ABA providers. I talk to so many parents with newly diagnosed children and tell them "You should be asking more questions", and they respond with "But I don't know what to ask!". Well.. now you will.

My hope is that any parent who finds themselves nervously facing their computer screen trying to process and digest everything about ABA to make a decision for their child, can instead just get this book and have all their innermost questions and fears addressed in clear, simple language.
If you have visited my blog for longer than 10 seconds then you should know by now that clear and simple language is how I roll.

Specifically, this book will honestly and plainly tackle the following common parent questions or concerns:

  • If ABA is so great, why does it get SO much hate? (I did not mean to rhyme right there)
  • How do I know if I'm getting quality ABA treatment?
  • How much should I be paying the ABA provider?/Why is this so expensive?
  • What will ABA therapy cost my marriage, or my family?
  • Do all children with Autism NEED ABA therapy?
  • Who can provide ABA therapy? What training do they need?
  • What setting for ABA therapy (home, school, center) is the BEST?
  • How much therapy is enough therapy?
  • I have NO idea how to read these assessment results from the BCBA. Help.
  • Can older kids or adults benefit from ABA therapy?
  • Isn't the goal of ABA therapy to force Autistics to be "Normal"?
  • What is the role of the parent in ABA treatment and why is parent training so crucial?
  • What the heck is a FBA (Functional Behavior Assessment)?
  • How quickly will my child progress/improve with ABA therapy?
  • Why doesn't my BCBA provide direct therapy to my child?
  • What is the difference between Non-verbal and Non-vocal?
  • Is ABA therapy the right choice for my child, and for my family? 
  • What will my child be like after years of ABA therapy? What should I expect?
  • Why are ABA providers so judgmental about sensory diets/sensory integration?
  • Why can it be so difficult to obtain ABA treatment for older kids/teens?
  • Why can't ABA sessions be 30-45 minutes long, like so many other therapies?
  • Can ABA ever truly "not work"?
  • Why does ABA force compliance?
  • Does ABA today still use aversives and punishers?
  • What questions should I ask this new ABA provider we just started with?
  • How can I determine if an ABA provider is practicing ethically or not?

And many, many more!

Order your copy today, all the cool kids are doing it: Click here to go to Amazon.

So much to say on this topic, far more than anyone would actually want to read.

Does ABA therapy require/demand/force individuals into a narrow and specific box titled "NORMAL"?
(Well, it shouldn't anyway)

But the myth persists.

I mean this in the best way, but many of the children I work with just are not going to fit into that "normal" box, no matter how much someone tries to push or squeeze them into it... it ain't happening.

And that's a cause for celebration!

The very thing I love about working with such a diverse group of kids, is that they are all different, yet all interesting. I work with some super fascinating small people, who constantly show me how dumb I am. And I thank them for it, because how can you grow if you already think you know everything? You can't.

As a provider, of course I know the research on the effectiveness of ABA therapy. I also know the many success stories I have seen with my own eyes, of children I directly worked with. But success story does not equal "...and then the child was totally normal!".

A couple of reasons why my job is not to drive families in my car to a fantasy location called "normal":
1) Each client/family I work with usually has their own idea of what "normal" means. If you have been in this field more than 10 minutes, you know this to be true. This client over here may live in a home where no one really cares what time they go to bed, as long as they stay in their room and are quiet. But that client over there, may live in a home where all the parents want most in the world is for that child to get their 7.5 hours of sleep every night.
2) Even when a family can explain to me what "normal" means for them, it quickly changes! Again, if you have been in this field more than 10 minutes you know this is true. Sometimes parents tell me they want desperately for their child to talk, but what they really mean is they want their child to communicate. Or, a parent may tell me they want desperately for their child to go to "normal" school with their big sister, but next thing you know that parent has decided to homeschool. Expectations change, as perspective changes.

So if ABA therapy is not about hitting a child over the head with your magical "normal" baseball bat, then how exactly is it decided what the goals of treatment will be? I'm so glad you asked.

If you are working with a quality ABA provider, the goal selection process will look something like this:

"I need to evaluate/assess your child to collect baseline data" – This just means data is collected at the onset of services to create a starting point. Over time, that starting point data will be reviewed again and again to make sure the child is progressing. If therapy has been happening week after week after week, but the child has not progressed past that starting point, then something is seriously wrong. This is why it’s important to collect that initial data, so over time you can compare the child’s current learning to their previous learning.

"What are your goals for therapy? Tell me the reasons why you initiated services." – The people who asked the ABA team to show up clearly had reasons for doing so, and we need to know what those reasons are. We cannot fully help if we don’t know what issues are happening. Treatment planning should always be a team effort, with the family/client working together with the BCBA to create goals.

"What are the highest priority areas of concern in the home? At school? In the community?" – What this question is really getting at is “where do you want to start?”. It isn’t unusual that families want to work on…oh, 85 behaviors or so when you first meet them. Unless I can get a good idea of the priority level of those 85 things, the treatment plan will be a chaotic mess. Prioritizing treatment helps focus in on the areas of deficit that are impacting the client the most.

"Describe your household: rules, routine, disciplinary procedures commonly used, etc." – This question gets at Culture. Households form a sort of culture, or a way things are done. Stepping into a household/family dynamic and imposing completely opposing culture onto it, is not a great idea. It will likely lead to aggressive resistance. What is more helpful, is to teach the family strategies and techniques that line up with the way their household functions.

"Can you finish this sentence: In 5 years, I want my child to be able to....." – This question is really getting at long-term goals. Professionals need to know long-term goals, because every long-term goal is really made up of hundreds of baby steps. Gradually introducing those baby steps leaves less work to do down the road and increases the likelihood of successful skill acquisition.

"Your child scored low on (insert skill domain here). Do you care about that??" – One of my fave questions to ask. I have learned to ask this, because I used to do quite a bit of assuming. Things like “Of course, you guys want him to write his name, right?” or “Of course, you guys want her to stop eating with her hands, right?”. Maybe not. If I see an area of concern, I will bring it up. If the parent isn’t as concerned as I am or wants to stick a pin in that issue until a later time, then it’s really important that I know that.

My normal is not your normal, and vice versa. What's considered "normal" in your household might not fly in my household, and what's "normal" in your marriage could be unbearable for another couple. That's why normal is such a useless word to throw around, because it has too many meanings to actually mean anything significant. 

One of my pet peeves is when a parent says to me during an intake, "I just want him/her to be normal!". Ummm, and that means what?? :-) Seriously, I need details over here. I do not have an intervention for "normal" behavior, nor do I know how to program for that.

Does ABA therapy seek to change individuals? Yes! Behavior change is the entire point of this therapy, either increasing appropriate behaviors or decreasing inappropriate behaviors. But if you think that the only change ABA therapy values is when a child can be fully "normal", you are:

“The two most important days in your life are the day you are born and the day you find out why.” 
Mark Twain

This is a topic that is really, really, important to me because I have really, really, experienced the lack of it a time or two....or 50.

Goodness-of-fit (let's just call that GOF) is a bit of a buzzword people like to throw around to describe that ideal match between employer and employee. Employers want (or should want) happy, productive employees, and employees want to not hate their employer. So it would seem logical and in everyone's best interest to aim for GOF. Then why is it sometimes so lacking?

GOF is more than just the employee/employer dynamic. I have observed or directly experienced a lack of GOF when it comes to: working privately with consultation clients, being assigned cases at an ABA company, families/parents being assigned ABA staff, and supervisors/BCBA's being assigned direct level staff or supervisees.

In each of those areas, it is crucial for overall success that team cohesiveness, compatibility, and mutual respect occur. But in each of those areas, I have seen it not occur. The consequences of a lack of GOF are weighty, and unfortunately can lead to preventable fallout such as staff burnout or client termination (initiated by the parent).
If you are an ABA peep working in this field, you likely can think of an example when you were paired up with a co-worker, supervisee, or supervisor and GOF was lacking.
If you are a parent receiving ABA services, I'm sure a few examples come to your mind of a therapist or two that just lacked GOF with your family.

This is an issue that affects all of us, because ABA therapy/consultation always requires a team. That team could be the BCBA and RBT, it could be the parent and the BCBA, it could be the employer and their employees, but each of those teams can quickly fall apart when GOF is not considered.
For example:

RBT's/Direct staff - Do the other RBT's on the team work collaboratively with you towards client success? Do they respond to your notes/questions/emails/texts? Are schedule/hours changes discussed as a team, and agreed upon by everyone? Are the other therapists open to you observing them as a learning opportunity and vice-versa? Does the BCBA/supervisor on the team support you and make you feel valued?

BCBA's/Supervisors - Are the other BCBA's you work with a helpful place to brainstorm or safely vent? Do your supervisees respond appropriately to feedback and demonstrate appreciation for the time and energy you pour into them? Do you feel that your caseload resides in that sweet spot between where your expertise lies and areas where you need to grow and stretch? Do the people you supervise, teach, or train, support you and make you feel valued?

Parents/Families - Does the ABA team welcome your input and suggestions regarding treatment? Does the ABA team respond promptly to your notes/emails/voicemails? Are you not only allowed, but encouraged, to regularly join therapy sessions as a learning opportunity? Do you feel comfortable addressing conflict or disagreement with the ABA team, and having respectful communication? Does the ABA team seem to have the goal of supporting and valuing your child?

Employees (ABA peeps in general) - Do you know the mission statement and vision of the ABA company/organization you work for? Is there potential for growth at your current employer, either promotions, new responsibilities, or areas of professional development? How many of your colleagues regularly experience burnout, and how does your employer respond to that? Does the work culture at the organization stifle or embrace individuality? Does your employer support you and make you feel valued?

One of my favorite quotes at the moment is "Employees join companies, but leave managers". Yup, accurate.
Personally, I've been that unhappy employee who loves the job but hates the management/ownership.....which over time will turn you into an employee who hates the job.

Lack of GOF is often blamed on the individual and not the situation. Like the alpha dog BCBA who keeps clashing with the alpha dog parent. Or the micromanaging employer who keeps clashing with the autonomous employee. Or the naturally inquisitive RBT who keeps clashing with the BCBA who receives questions as criticism.

Continuing to shove a square peg into a round hole may eventually work (if you shove hard enough), but I doubt that square peg will be very productive or useful to anyone in that position.

Photo source: www.theartofautism.com

Photo source: www.linkedin.com

The Discriminative Stimulus is defined as a stimulus in the presence of which a particular response will be reinforced (Malott, 2007, Principles of Behavior).

SD is just ABA speak for the demand, instruction, or the event/stimulus that serves as a signal to someone that there is something they need to respond to. Now, that response can also include a non-response. Not responding is always a possible choice, that comes with its own possible consequences.

For example, if my cell phone rings and it is someone I do not want to talk to I have choices:
-answer the phone
-don't answer the phone

The phone ringing is a SD because when it rings, there is a specific response that in the past has led me to contact different consequences. Some pleasant, and some not so pleasant.
When my cell phone rings, I am not confused about what I should do. I know what my choices are, and depending on who is calling (or if I recognize who is calling) I then make a choice based on my history of reinforcement with that person.

SD's can vary in how they are delivered, the specific reinforcement that they make available, as well as the specific expected response.

In ABA therapy sessions, sometimes hundreds of SD's can be delivered throughout the session, and each one of those SD's has a specific expected response, as well as specific consequences available for each possible response.

The SD has an authority based on the history of consequences being delivered.
I'll say that another way: Let's say I state the SD "give me blue" to a child, and I then provide a consequence of playing on an iPad if the child gives me yellow. Assuming playing on the iPad is a reinforcer, over time I am going to see the child consistently respond to my SD by giving me yellow. Is yellow in this example actually correct? No. But it does not matter: I gave my SD, I followed the child's response with a reinforcer, and I have superglued this particular response to the SD.

And this explains why your kids don't listen.

Reinforcement is like the most powerful superglue on the market. It binds things together, as can be seen in the example below:
(SD) "Clean up the toys" ----> (Response) child cleans up the toys ---> (Consequence) "Thanks so much, you can go outside now"

Assuming in the above example that going outside is a reinforcer, over time the child will learn the expected response to the SD of "clean up the toys", AND they will learn that good things happen after they demonstrate the expected response. In other words, you just taught your child that when they clean up their toys, they might get to go outside.

If I flip this scenario on its head, I can show you how SD's (and their absolute authority) can sometimes cause you to teach things you did not mean to teach:
(SD) "Clean up your toys" ---> (Response) child cries/child screams "no!"/child does not respond to the SD ---> (Consequence) "Ugh! Fine, I'll clean the toys up. Just go outside while I clean up this mess"

Assuming in the above example that going outside is a reinforcer, over time what will the child learn? A few things actually:

-child will learn that problem behavior or not responding is a response
-child will learn that escape/avoidance behaviors work
-child will learn that cleaning up the toys is not a requirement to be able to go outside

Did you mean to teach that? I am nearly positive you did not. Unfortunately, the absolute authority of the SD remains unmoved by the fact that you didn't intend to teach new ways to avoid a demand.

Don't freak out, there is a way to avoid this trap.

First, understand what Instructional Control is and how it can help you. I promise, it isn't as scary as it sounds.

Second, see below for some common characteristics of successful SD's. A successful SD helps your child learn in an effective manner WHAT to do, and WHY to do it (because good things might happen). Let the absolute authority of the SD work for you, and not against you.

Characteristics of Successful SD's

  • The SD is precise: A precise SD includes only the language necessary for the individual to know what to do. Extra details, threats, or reminders are best left off the SD, particularly if the individual has communication deficits or is very young. Good example - "Get down". Not-so-good-example - "Michael Benjamin Clark, you get down off that railing right now before you fall and break your neck".

  • The SD is stated, not asked: Unless you are cool with the individual tossing you a "No/I don't feel like it/I don't want to", then do not present the SD as a question. A question gives the option of refusal. 

  • The SD allows for a brief time to begin to respond: Brief as in, a few seconds. I have been in this field a long time, and I have developed an internal countdown timer that kicks in when I give a SD. To help yourself learn this skill, when you give your child a demand silently count to 3. Or, you could subtly tap a finger against the inside of your palm 3 times. If you get to 3 and the individual has not at least started to respond, it is time to provide a consequence. Another completely personal reason why I like this "internal countdown" is because it helps parents not flood the child with SD's. If you are busy counting in your head, you can't rattle off 4 more demands, when the child hasn't even responded to demand #1.

  • The SD is consistent: Especially if the child has communication deficits or is very young, avoid changing up the SD rapidly. This can possibly be confusing, and impede learning. Once your child is demonstrating they know how to respond to the SD, that is the point where you can start to change the language used, or not use language at all (such as pointing at a book on the floor to indicate the child needs to put the book away).

  • The SD consequence is consistent: The most critical point about understanding SD's is that what follows the response equals learning. You are teaching your child how to respond to you based on what happens when they respond correctly, and what happens when they respond incorrectly. If you decide that the SD "Make your bed" means fluffing all the pillows, then the bed being made with 1 pillow fluffed, or the bed being made with some of the pillows fluffed, are both incorrect responses. No exceptions. You would then prompt the correct response so the child knows they made an error.

  • Attention is gained before the SD is given: If you observe the ABA team work with your child you will get to see possibly hundreds of SD's delivered during a therapy session. You may also note that the team works to gain the child's attention before stating the SD, to make sure it is heard. This could look like approaching the child, bending/squatting down to look in the child's face, waiting for a break in crying/screaming, or making a statement such as "Are you ready?", to verify the child is attending.

  • The SD is not repeated over and over again, nor is it screamed, or shouted: SD's are bosses. SD's are in charge. SD's call the shots. They do not need to beg, bargain, plead, scream, or lose their cool. Remember, your child only has a short time to respond correctly. If they do not respond correctly, you just deliver a consequence (such as a prompt). It will be very tempting to state the SD over and over again, but don't give in to that temptation. Over time, this will actually teach your child they do not need to listen to you the first time, and that ignoring you is an effective way to avoid a demand.

This post will focus on making sure your child is therapy ready before an ABA session, and what exactly that means.

When the ABA professional asks you to please have your child "therapy ready" when therapy sessions start, what do they mean?
  • If the child is ill or experiencing unusual circumstances (e.g. child slept only 2 hours the night before) the therapist should be notified before arriving to the home
  • The child has been fed, or offered food recently
  • The child's diaper is dry, or they've been taken to the bathroom recently
  • The child is awake (therapist should not have to wake a sleeping child)
  • Preferably, the child is not engaged with their most preferred items or toys

The point of these guidelines is to make sure the therapist does not arrive to the home to work with a child who is hungry, crying, wet/soiled, tired, or fixated on a specific toy or item. Any of these scenarios is likely to start off the session on a bad note.

For the therapy sessions to be most beneficial, the child should be in an attentive learning state, calm, and ready to contact reinforcement (if they are already contacting valuable reinforcement, they may be less motivated to work with the therapist). 

Throughout the session the therapist will present multiple demands and lead the child through frequent transitions, often at a quick pace. Many parents want to know what to expect of a therapy session, especially if they are new to ABA. I could walk into 1,000 homes and see ABA sessions happen in 1,000 ways. So a very general example of how a therapy session could look is detailed below:

Therapist arrival: Greet client and family, take time to set up for session
Transition: Therapist transitions client to work area, takes time to build rapport and engage with established reinforcers
Transition: Reinforcers are put away, and demands are presented/specific goals are targeted. Contingent upon performance and correct responding, breaks or reinforcement are intermittently delivered
Transition: Outside play time, or more adaptive teaching opportunities are embedded into the session such as a snack, playing basketball outside, sibling interaction/family games, or going for a short walk
Therapist departure: Therapist informs the client and family the session is complete, takes time to clean up work area, collect data, and record session note

It is easy to see from this brief session outline that if the child is sick, tired, hungry, etc., the session could quickly grind to a halt and dissolve into extended problem behavior. Most of the time (not always, but very frequently) if my staff contacts me to after a session to discuss how horrible the session went, after some digging I find out that the session started on a very bad note....and probably should have been rescheduled.
If sessions are consistently starting off on a bad note, that means goals are consistently not being targeted intensively, which means data scores are consistently dipping or decreasing, which means ultimately = the child will not progress as they should. So this issue of "therapy ready" is actually quite serious.

It's important to plan to set your child up for success before therapy sessions, so that in the long term they are regularly contacting success during sessions and progressing through treatment plan goals. I usually give my clients several tips to help them set their child up for success, I will include a few below:

  • Using language or a visual, inform the child that it is almost time for a therapy session. It may be helpful to show them a picture of which therapist is coming (e.g. "Look, Ms. Nicole will be here soon"). It should not be a shock to your child when the front door opens and the therapist is standing there.
  • Set aside the most valuable reinforcement (and let your child see you do this) and explain that they can have it when the therapist arrives. As a BCBA, I do this all the time during supervision sessions by arriving with valuable reinforcers, and then telling the child "I'm going to give this to Ms. Nicole", to increase motivation to work with the therapist.
  • Have your child engage with a neutral activity shortly before therapy starts (example: coloring, Play Dough, etc.). The activity should not be overly stimulating or too reinforcing, but should help the child get into a calm, on task, and alert state before therapy begins. It may be helpful to have them engage in this activity in the same area the therapist will work with them. Often, therapists arrive for a session and the child is having free play, or unstructured time spent running, jumping, climbing things, etc. In a situation like that, the child is very unlikely to be motivated to come over to the therapist and sit and work. 
  • If problem behavior begins to happen right before the therapist arrives, this can be an amazing opportunity for learning. Don't feel the need to quickly calm or soothe your child, but instead use the therapist's arrival as an opportunity to ask for help. Example: "He fell out on the floor right as you were pulling up, now in this situation what should I do??"

*Tip: More information about what typically happens during an ABA therapy session.
It's that time again!

Over the holidays I'll be traveling and very much anti-working (pajamas... Netflix... pie) so I will be taking a break from the blog until after the new year.

In my absence, I leave you with one of my fave holiday things: LIGHTS

Every year my munchkin and I make our rounds at local light displays. I could lie and say I do this to create lovely memories, but no....dazzling Christmas lights just make me giddy :-)

To all my visitors, either brand new or the regulars-- have a Blessed & Merry Christmas, and Happy 2018 in advance.

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