I Love ABA!

Welcome to my Blog!

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.

Wednesday, April 9, 2014

Program: Emotional Intelligence

Emotional Intelligence is defined as the ability to identify and manage your own emotions and the emotions of others. This includes emotional self-regulation, problem solving, and modifying your own behavior to impact the emotions of someone else (source: Psychology Today.com).

My Recognizing & Labeling Emotions post was about teaching individuals with Autism to receptively and expressively identify the basic human emotions.

So what about taking a step beyond just identifying a “happy” facial expression to associating events related to emotions, processing ones own emotions, thinking about how your own actions impacts what others feel, or moving into more complex/multifaceted emotions like  worry, guilt, disgust, jealousy, rage, contentment, suspicion, or courage?

As I said in my last emotions post, teaching emotions can get pretty complex!

This post is about programs I may write for my more higher functioning, Aspie kiddos, who often struggle mightily in the area of emotional intelligence. These kids are usually very bright, so (sadly) they are aware that they don’t get called for sleepovers, get picked first for teams at recess, or get invited to birthday parties. They just don’t understand the why.

Unfortunately, I often see higher functioning or older kiddos go without services or treatment because on paper, they seem fine. They don’t need to be toilet trained, they’re making straight A’s, they use Intraverbals all day long…their vocabulary is more expansive than mine! However, when social functioning is assessed that is typically where the deficits emerge.

What’s that? You’d like some examples? Sure, no problem :-)

  1. Therapist gives David a math worksheet to complete. David reaches a difficult problem, and promptly bursts into tears and shouts “I’m so stupid”, before ripping the paper in half.
  2. Therapist is at the park playing a game with Kayla when another child walks up to join their play. Kayla covers her nose with her hands and says “Wow, you smell”. The other child starts crying and walks off.
  3. Christopher is standing in the lunch line at school when a student accidentally bumps into him. The other child says “I’m sorry”. Christopher pushes the child to the floor. When the teacher later asks Christopher why he did that, he says “That kid picked a fight with me”.

Here are some suggested strategies for teaching emotional intelligence, with a resource at the bottom for teaching self-regulation:

(I would present large, color photographs to my kiddo and ask them questions about the photo. I would also work on generating discussion not just about the photo, but about the child’s recent experiences, so we can gently step into discussing THEIR emotions/feelings.)

What are these children doing? What games do you like to play with your friends?

Is that boy paying attention in class? How can you tell he isn’t? How do you think that makes the teacher feel?

How does this boy feel? How do you know that? Tell me about a time you felt sad/lonely. If you saw him what could you say to make him feel better?

What are they doing? How would you feel if some kids did that to you? Whats a good way to handle that?

How does the girl in the middle feel? What do you think the other two girls are saying? Tell me about a time you felt left out from the group. How did you handle it?

*Resource: The Incredible 5 Point Scale by Kari Buron & Mitzi Curtis is an amazing, super easy to read resource that uses a behavioral thermometer system to teach: how to recognize your emotional state, how to determine an appropriate reaction, how to identify triggers, and how to problem solve appropriate solutions to deescalate once you have been triggered. It has tons of visuals, and I have used it as a framework to write programs.

Monday, March 31, 2014

Quote of The Day

"The Burden of Choice"

As I discussed in my ABA Haters post, ABA (arguably the most well known Autism treatment option) often gets a bad rap and is painted with a very ugly paintbrush. There are many who feel that Autism is not a sickness, disease, or something to be "fixed" or scrubbed out of an individual. On the other side of that belief, are people who feel that Autism robs families and individuals of dreams, hopes, peace, etc. Many families feel that if they can do anything to help their child with Autism improve, they will.
Not that you asked, but heres my stand on this issue: For many of my kiddos, they are not capable of communicating to someone that they WANT therapy. They are not able to ask for help or assistance with their self help skills, toileting, feeding, or play skills. That means the caregiver or Mom and Dad are left with the burden of choosing for their child. I have met parents on both side of the ABA debate who feel they are making the wrong choice....they worry that they are doing too much therapy...they worry that they chose not to do therapy. 

For parents in the position of having to choose for their child: you have the right to your choices. You have the right to fully embrace your childs Autism, or to fully jump into therapies and treatments. No one should make you feel like a horrible parent for making either choice. 
As a professional, I help kiddos everyday improve and function to higher degrees, so I do feel that if a family comes to me seeking treatment I am absolutely here to help. BUT, it is not my role to attack the people who choose not to come to me seeking treatment.

Dr Bobby Newman, in his prologue for the book "Behaviorask" (I looove that book) eloquently explains this concept of "choice":

"The basic argument comes down to this: if I dont have a skill, I dont have a choice.  Once I have been taught how to interact with others and how to function in mainstream environments, then I have a choice as to whether to do so or not. If I have never learned these skills, however, then I have no choice. I will wind up with a lifetime of supervised care......Suppose you were the individual who, without treatment, was destined to be standing alone in a corner of an institution, dependent on everyone around you to take care of even your most basic needs, rocking your body perseveratively and eliminating in your clothing....Would you like someone who could speak and could interact in the everyday world speaking on your behalf?

Thursday, March 20, 2014

Getting The Most Bang For Your Buck!

I had a post on Client Intake a while back, where I briefly summarized how I conduct intakes on new clients. A proper assessment and intake is necessary when beginning to work with any client. Typically the supervisor on the case conducts the intake, although sometimes the direct staff may be responsible for this task.

When I am conducting an intake, in addition to assessment, interview, record review, going over the contract, and observation, I also like to do my own brief version of  “ABA 101”. I like to review the program book, answer any questions, and discuss tips for getting the most out of ABA therapy.
The parent or family you are sitting across from during an intake initiated services for a variety of reasons. They expect to see change. They expect to learn from you. They expect their lives to improve. They expect to have their hopes met, and their fears diminished. For these reasons, its important to help families understand what they can do to get the MOST out of ABA therapy.

Just because a family has requested ABA services does not mean they understand what ABA can do, or what its all about.  Parents might ask you things like “How long do we have to do this?”, “Is he going to cry/tantrum every day?”, “Am I supposed to participate or stay out of the way?”, “Should we go buy some Skittles/M&M’s?”, “How soon until she starts talking?”, “Isn’t my child too young/old for this?”, etc.
You may be able to tell from the questions tossed your way the ABA knowledge level of your new client, or you may need to do a bit digging and get them talking to know for sure. You can also try using some ABA terms and see if the family is familiar with them. For example, “Can you describe systems of reinforcement you have used in the past to help with homework completion?”

There are multiple reasons why its helpful to know if your new client is an ABA expert, novice, or somewhere in between:

  1. Helps with composing parent training – I typically can gather enough information from my first few meetings with a new client to start creating parent training documents. Through observation or interview I will learn about the issues the parents are struggling with: Compliance, Bedtime routine, Transitions, Feeding, Toileting, Sibling interaction, etc. Or, basic behavior concepts like Reinforcement. Knowing the ABA knowledge base of your client will help you to individualize your approach to parent training (which will make the information more effective, if they can actually…..you know….understand it).
  2. Helps with designing behavior plans – The behavior plan basically states how all caregivers will react to a specific behavior, and what new behavior will be taught and reinforced. I can write very simple behavior plans, or pretty complex ones. Some behavior plans I hand to a staff member, and sometimes there is no staff which means the parent gets the behavior plan. Its important as an ABA professional to know how to modify what you come up with to fit the audience. You WANT the family involved, so be sure you aren’t overwhelming or frustrating them with the documents you create.
  3. Helps with selecting best teaching methodology – The teaching methodology used should encompass what is best for the learner, the family’s preferences, the expertise/training of staff, etc. Some households are better suited for DTT, while in other households NET/Incidental Teaching may be a better choice. Also, some parents may have negative views about certain methodologies, such as being very against DTT. If so, a different teaching methodology can be utilized that has more parent “buy-in”.
  4. Paves the way for active parent involvement – Similar to having a contract to review, explaining ABA effectiveness strategies sends the message that you are a professional who takes your job seriously, and it makes it very clear that you will not be doing the “heavy lifting” alone. I like to explain this to parents by saying that I will work hard, they will work hard, and the kiddo will work hard…..we all have a part to play.
  5. Provides information for your Shaping  process- Much of what ABA professionals do with new clients involves shaping. Most of us know how to use shaping to teach the kiddos we work with, but much of the work we do with the family also utilizes shaping. If I have just started to work with a parent who is new to ABA, I can’t walk in and hand her an Automatic Stimulus Pairing procedure  and expect 100% follow through. That’s completely unrealistic. I have to start slowly, meet the parent where he/she is, and gradually raise my expectations over time. If I don’t know how knowledgeable the parents are about ABA, then shaping becomes much more difficult.

Below is the handout I give to new clients to provide concrete strategies that will help them get the most out of ABA therapy. I find that families who incorporate these strategies often report the most satisfaction, or see the most gains from therapy. The reason why is simple: ABA therapy is meant to be intensive and to generalize across individuals and settings. The more the family is doing what I am doing, the more effective treatment will be.

Thursday, March 13, 2014

Lemon Treatments

Lemon” -  Any product with flaws too great or severe to serve its intended purpose. Often used to refer to cars that seem perfectly fine on the exterior, but quickly break down once you start driving them.

I mentioned in my last QOTD a great podcast series created by JJ Carolan. One of my fave episodes from her podcast is called "Identifying Fad Science". It’s all about the responsibility of BCBAs to help teach families/caregivers how to test unproven therapies, and how to be a critical consumer.
(I will mainly refer to BCBA’s in this post, but all ABA professionals have a responsibility to help our clients distinguish between true science and junk science. More than an ethical requirement, I believe we are morally bound to do this).

I have learned the hard and awkward way, that no matter how nicely & professionally you explain to a family that you are NOT a doctor and are not qualified to answer questions outside your expertise, you may still get very difficult, emotion packed questions tossed your way.

I don’t meet many families who are only doing ABA therapy. Some of the other treatment choices families choose are supported by research, and some are not. As a Behavior Analyst, it is your responsibility to have knowledge of available treatments and which ones are effective. If you come across a treatment you are unfamiliar with, it is your responsibility to conduct a literature review and gather information. BCBAs cannot administer or promote interventions that are not empirically supported.
 If you’re not a BCBA and think this topic doesn’t apply to you, then think again. Even if ABA is a part time job to you, you’re signing up to provide treatment to an individual who needs help. Would you want your dentist sprinkling fairy dust on your broken tooth? Would you want your doctor to tell you to jump 2 times to fix a broken arm? Well, your clients also expect to receive effective treatment.

So if you can’t endorse or support unproven treatments, then what can you do when these issues arise?

1) Always defer to expert opinion, such as a Doctor or an Occupational Therapist. Clearly state your qualifications and training, and explain why you are not the appropriate person to ask. Be firm and clear, without being rude or judgmental. Please don’t be allergic to saying “I don’t know”. Say to the parent “I haven’t heard of that, but I can look into it for you and bring back some information that we can review”.

2) Give the family the tools to be a critical consumer. Help your clients learn to collect and track data, in order to measure the effectiveness of treatments. I understand why most families do not want to dig through research journals. Research isn’t always exciting, but it does save wasted time spent pursuing lemon treatments.  

Below are characteristics of Pseudo science, aka Junk Science, aka “Lemon Treatments”. These should be in your mental arsenal, ready at a moments notice to help explain to a family why you cannot endorse or support the treatment they are so excited about. Lemon treatments may not just waste money or time, they could also be potentially harmful or dangerous.

5 Characteristics of Pseudo Science

1. Promise of lightning fast results- Overnight or rapid changes are promised, along with just a few easy steps to follow.

2. Requires little experience to administer- Just reading a pamphlet or attending a seminar is enough to learn how to administer the treatment. Also, beware of treatments lacking sufficient supervision or oversight by a qualified professional.

3. Emotionally appealing slogans- “Choosy moms choose Jif”…so I guess moms who choose Skippy should be jailed?? Beware of emotional words like “cure”, “miracle”, or “life –saving”, these treatments are trying to pull on the heart strings.

4. Lack of peer reviewed evidence – Where is the data? Is there any? How is progress measured? Has the treatment been replicated in various studies?

5. Exact procedure is vague or secretive- Not too long ago, a parent asked me my opinion about a new treatment they were pursuing. I hadn’t heard of the treatment, so I started asking questions about how it worked, what was it supposed to do, etc. The parent could not answer my questions, and commented that I was asking too many. My response was “Well, if I were paying for this expecting it to help my child I would want to know exactly how it works”. Beware of treatments where you have to pay a membership fee, attend a lecture, or buy the product before anyone will explain it in depth.


Monday, March 10, 2014

Quote of The Day

Todays QOTD is less a quote, and more a helpful resource.

Like most BCBAs/ABA therapists, most of my time is spent in my car. It is my office during working hours. Recently I have begun taking advantage of all that drive time by subscribing to ABA related podcasts, so I can learn while I drive.
I have recently found two podcast series that I realllllly enjoy, and wanted to share with my blog readers. I think these are great for busy parents or professionals on the go who want to stay on top of special needs strategies and research in a way that is easy to digest (translation = without all the jargon). What I like about these podcasts is that even though its super up to date information, you dont need years of experience or advanced degrees to understand the information being presented. Anyone could easily listen and learn.

Special Parents Confidential is a resource website for parents of children with special needs. They cover a variety of special needs other than Autism, such as Downs Syndrome or Hearing Impairments. Their podcast covers lots of "need to know" topics, such as Medication Management, School System/IEP's, and living trusts/wills. I particularly recommend their podcast episode on ABA, I thought it was very through while also being presented in a clear, easy to understand way. Here is a link to their podcast: https://itunes.apple.com/us/podcast/special-parents-confidential/id624628417?mt=2

*For ABA professionals, I recommend a podcast series done by JJ from BeABetterBCBA.com. Very informative, but also fun to listen to. Here is a link to the podcast:  https://itunes.apple.com/us/podcast/behavioral-bytes/id562794063?mt=2

Saturday, March 1, 2014

The "Costs" of ABA Therapy

The benefits of ABA therapy are well documented and cover varying functioning levels, ages, and methodologies, with supporting research that spans decades. Don’t quite believe that yet? Have a look here, here, here, or here. The “pros” of ABA are numerous.

If you have come across information online about ABA haters, or the “cons” of ABA, they tend to be categorized into bad experiences with a company or person, inaccurate or outdated information, or people who feel ABA is wrong because it tries to “normalize” individuals with Autism. I’ve already addressed those criticisms of ABA on my blog, so no need to do that again.  

So am I saying there are only advantages, or benefits to ABA therapy? Is it all great, ALL the time?

Well, since the name of this blog is “I Love ABA”, clearly my opinion of ABA is positive. :-) 
However, what I think many families do not fully consider  are the “costs” of ABA therapy.

You may have heard before that its always recommended to weigh the costs and commitment required to do something before agreeing to take it on (Luke 14:28 NLT). This is very good advice. Beginning something without fully understanding what it will cost you can lead to disappointments or frustrations.

Think of starting a New Year exercise plan. Many people join gyms, buy workout clothing, alter their diet, etc. However after a few mornings waking up to stiff and sore muscles, or eyeing the doughnut box at work, many people abruptly discard these exercise plans. Why is that? Because the full costs weren’t considered.  While we all know the benefits of regular exercise, living that kind of lifestyle will also cost you something.

Similarly, making a decision to begin ABA therapy for your child can be quite different from actually living out that decision everyday.

As much as I support and believe in what ABA can do, I also meet and work with countless families who don’t really understand the commitment that ABA therapy is. The potential benefits of ABA therapy are so numerous I can’t even list them all here, but every day will not be peaches and sunshine.

The following advice is to help parents on the ABA fence make an informed decision. I’m definitely not putting ABA down (have you seen the name of this blog??), but please, know what you are signing up for:

  •       $$$$$$$$$$- While talking about the “costs” of ABA, the literal cost must be mentioned. ABA therapy is expensive. Why is that? Well, it’s administered by highly trained professionals (more on that later), it’s intended to be intensive, it requires rapidly changing supplies and materials, and the funding sources have not quite caught up to the diagnosis rates. High demand and low supply combined with a credentialing process that takes years to achieve = a not so affordable therapy option. 
  •      Time- ABA therapy could cost you time, spontaneity, and control of your life. Professionals will come into your home multiple times a week, and expect you to participate in the sessions, collect data, practice behavior management strategies, etc. Some of my clients have rearranged family vacations, anniversary trips, doctor’s appointments, even moving, based on what works best for the therapy schedule. ABA takes a lot of time; time that the professionals give to your child and time that you give to the professionals.
  •       Standards/Expectations- So how could ABA therapy cost you your standards? Well, ABA is a unique field. The people who are the most experienced, seasoned, and qualified in this field are typically not the ones who will work directly with your child. Unfortunate, but true. ABA therapists have varying experience levels, and are the ones who work with the child 1:1 to teach skills. The BCBA or Consultant is the one who designs and writes up what the therapist is supposed to teach. So you may pursue ABA therapy thinking you only want the best, most degreed professionals working with your daughter. Then you realize in your area, no one pays for ABA,  the  best companies have 3 year long waiting lists, and that one Consultant you found can only offer 1 session a week. So now what? I hate explaining this reality to new clients, but unfortunately the people in this field with great experience and expertise are in super high demand. They either charge very high hourly rates, or their schedules are completely booked.
  •      A little thing called privacy- So-0-0, no one talks about this part, but it’s true. You may need to develop a new definition of the word “privacy”. The ABA team will see your house messy. They will see you answer the door in curlers and a torn pink robe. They will see you hit the peak of frustration when dealing with your child, as well as explode with joy when your child shows amazing progress. They may see or hear things about you and your family that even your closest friends don’t know, such as how often you argue with your spouse. Speaking of…….
  •       Marital Stress- It can be quite stressful on a family to have a special needs child who is not getting proper services. However it can also be stressful on a family to adjust to a commitment to ABA. Everything becomes scheduled and regimented, and making a simple decision such as “Should I take my spouse on a Florida vacation this summer?” has to be discussed with a team of people. In the course of doing my job, it isnt unsusual for me to have parent meetings that dissolve into heated hubby/wife arguments, sit and observe a family eating dinner,  or be put in the middle of tense or awkward family dynamics. It gets even more awkward in situations where one parent is on board with treatment, and the other parent is not.
  •      Pride- This could be a big one, just depending on the type of person you are. Not to toot my own horn, but I look pretty young. I also don’t have any kids. So imagine me giving parenting tips to a parent who is twice my age, and has 4 children. Definitely a situation that can be a hit to the ol’ ego. Many ABA therapists are 20-something college students, and many BCBA’s are also pretty young. This just tends to be a young field….I think its all the energy we need to do this :-) Regardless, as a parent it can be painfully humbling to have a little whippersnapper explain to you exactly what you should be doing differently with your child, and then darn her, actually be right!
  •       Remember your other kids??- As an ABA therapist, I used to show up to my clients homes with toys, gadgets, edibles, DVD’s, you name it. I would work 1:1 with my client, clapping and shouting and blowing bubbles as reinforcers….while my clients siblings would look on in amazement, not understanding why no one showed up to play with them for 3 hours. This can be really tough, but as a parent ABA may definitely cost you some interaction time with your other kids. It’s almost like your child with Autism is now lead singer of a pop group, and your other children are the back up singers. ABA is very time intensive and labor intensive, and many parents tell me that after a day of collecting data, managing behavior, or meeting with the Consultant, they are just too exhausted to meaningfully interact with their other children.
  •      Social life- Lastly, ABA may cost you a social life. Beyond the time commitments, lack of spontaneity, and financial crunch ABA may cause, you may find yourself interacting and spending more time with the ABA team and Consultant than with your best friends. You may find yourself using “ABA speak” like mands, target behavior, trip training, or prompt dependency, which your friends may find just downright odd. It’s hard to answer simple questions from your friends such as “So, how’s that ABA going?”, yet when the Consultant asks you for a progress update you are bursting with news to share. Your friends may think it’s weird if you call them at 9 am because your son just independently pooped in the potty, but the ABA team will clap and cheer with you! It can be difficult to have a social life, when so much of your social interaction is with a team of behavior geeks.

Friday, February 21, 2014

Moving from Awareness to Action

Photo Source: http://www.momnivores-dilemma.com

I recently had a conversation with one of my clients (see below for information about her company) about Autism Awareness month. While its not quite April yet, during the month of April it is common to see banners, commercial spots, print ads, blue light-bulbs, parades, etc., all focused on spreading awareness of Autism. Across communities, parents, educators, professionals, and regular Joe’s  join together to help spread the word about Autism. If you’re reading this blog you likely have some connection to Autism, so you’ve probably worn a t-shirt or marched at a rally during Autism Awareness month, or maybe even dyed your hair blue :-)

My client asked me a question about Autism Awareness month that struck a chord with me, and prompted me to write this post.

“When do we move past awareness, and into action?”

Awareness and information are important…absolutely. Awareness of the impact Autism can have on an entire family, not just the individual who actually has Autism, is a necessary 1st step. But after that 1st step, then what? Did you spend last April making your church, co-workers, or neighbors aware of Autism? What impact did that have on your life once the month of April was over?

What I would love to see, is a focus on action in the month of April. So many of the families I work with are super non-impressed with the Autism walks, telethons, and celebrity endorsements of various Autism therapies. They tell me “Tameika I’d love to go downtown and wear a t-shirt for the Autism march, but I’m too busy raising my child with Autism”.

So my small part to add to this conversation is a list of simple action strategies that anyone can implement to improve the life of a family living with Autism.  Maybe you feel you don’t know where to start, or this is too big of an issue for you to tackle. Okay, so then do something that helps 1 family.

Ready for the action strategies? Here they are:

  • Greet individuals with Autism out in the community: I know, you can’t know for certain who has Autism and who does not. But if you are a parent or professional and you see the tell-tale tip-toe walking, hand flapping, or echolalia being exhibited by a child in front of you at the grocery store, take some time to greet that child. Smile or wave, whether the individual responds or not. Make eye contact with the parents and ask a simple question such as “How old is she?” or “What’s this little guys name?”. Parents of children with special needs often experience no attention in public, as people politely avert their gaze and look down, or they experience excessive attention, as everyone turns to stare at their child’s odd behaviors. Just a simple smile and a “How are you guys today?” could go a long way.
  • Offer free services to a family living with Autism: Offer to babysit the kids for an evening, so mom and dad can catch a movie….or offer to cut their lawn…..or do their laundry……or cook dinner…….or (and here’s a big one) invite the individual with Autism out without the parents present. Do you know for some families, no one ever invites their child with Autism out to do things? Yes, some parents may feel uncomfortable letting their child go to a movie or to Six Flags without them present. But some parents would LOVE if a family friend or relative invited their child somewhere, and mom and dad are not implicitly expected to go and play chaperone.
  • If you own a business, pursue Diversity Training on special needs: Whether you own an ice cream parlor, shoe store, or a pet cleaning business, does your staff know how to respect the dignity of individuals with special needs? If a parent walked into your business with a withdrawn and quiet teen who suddenly bounced on his heels and shrieked loudly, would that parent be asked to leave? Would the staff make that family feel welcome? Or whisper and stare at that family? Most of the families I work with are incredibly loyal to the businesses in their neighborhood that “get it”….the dry cleaner who lets their daughter spin in circles until she is dizzy, or the Burger King where the manager puts the ketchup in a cup, because that’s how their daughter likes it. Don’t let your business be a place where families living with Autism feel disrespected or unwanted.
  • Instead of lighting something up blue, consider supporting a cause: It’s great to show your support of Autism Awareness month, but once April is over, families will still need quality treatment for their kiddos. Consider making a donation to an Autism research facility, or start locally: call a school in your city and ask what donation you can make to the Special Education department. You can also donate your time. Volunteer at a respite facility, or visit group homes and play your guitar for the individuals who live there. And speaking of volunteering…….
  • Volunteer to serve in the special needs ministry at your church: If you work with kiddos with Autism, think of a few of the kids you help. Now picture them sitting through a church service. How do you think their parents handle it? Well, in many cases they don’t. Often the child has behavioral issues that make attending church difficult, so the family just doesn’t go. Or the volunteers, even in the special needs room, can’t handle their child so the family feels too embarrassed to take their child to church. If you work with children with Autism for a living, you are full of knowledge and information that many of the other volunteers might not have. Helping the church implement structure, visuals, and reinforcement into the special needs ministry could make all the difference in the world.

*Resource: If you are located in the West Indies and need information, resources, or training related to Applied Behavior Analysis, feel free to check out the Dawn Autism Program.

Sunday, February 9, 2014

Teaching Leisure Skills

Recommended posts: Task Completion, Toy play

A few weeks ago, in my Top 10 post I discussed recommendations I make to families over and over again regarding common issues new clients present with.
A common concern I hear from parents is “my child stims all day long”, “he just wanders around the house putting things in his mouth”, “she just sits in the living room and stares out the window”. What these issues are all describing is a lack of leisure skills.

Leisure skills are those skills, interests, and hobbies, most of us have that serve the function of unwinding, relaxation, or simple enjoyment. This is an important life skill. In an ABA program it can sometimes be easy to focus on skill acquisition and filling in gaps in development and miss the big picture. Why does a 3 year old need to know how to entertain themselves without adult involvement or engagement? Because one day he will be 19. What will he do then when he is bored, or mom and dad are busy? Spin in circles? Stand on the kitchen counter? Or, will he be able to go to the game closet, pull out the Scrabble game, and make sentences using the letter tiles?
For me, my main “go -to” leisure skills are cooking, video games, or chatting with friends online. If I am alone, bored, frustrated, agitated, or finish an activity, I don’t need someone to give me something to do or pull me out of my funk. I have the ability to think of an activity, engage in that activity, and independently complete the activity.

So question time: Can you say the same for your child with Autism? When your child is bored, what do they do? When you are not able to give your child attention, can they entertain themselves? When your child finishes one activity, can they independently start another?

Another reason I often recommend teaching leisure skills is for kiddos who spend their time engaging in repetitive behaviors all day long, such as pacing, running up and down the stairs, spinning in chairs, lining up toys, chewing on their fingers, etc. I recently completed an observation of a new client who spent my entire 2 hour observation completing laps around the family dining room table. She would circle the table on her tiptoes, stop and look at me, jump a few times, and repeat. Her parents stated if left unattended she would engage in this ritual all day long. I look at a situation like that, and to me it’s like a huge neon blinking sign that reads “Teach me leisure skills!

So before we jump into exactly how to teach leisure skills, allow me to clear up a few misconceptions. Firstly, just because you think a game/activity/toy will be enjoyable for your child does not mean they will agree. Understand that leisure skills will likely need to be repetitively taught and reinforced before you see your child begin to spontaneously and independently select a game or toy to interact with. Secondly, the inappropriate behaviors need to be placed on Extinction or a DRA in order to teach the child leisure skills. Do not try to compete with the handflapping, toewalking, or pacing behaviors and get your child to play Monopoly with you—you will lose. Instead, reinforce what you want them to do (sit down and play the game) and ignore, block, or redirect what you don’t want them to do (pace up and down the hallway). Lastly, systematic prompting is your friend. If I am working with a child who is used to spending her days playing in the kitchen sink and humming, I cant expect her to immediately be able to play a 30 minute game of Apples to Apples with me. That’s completely unrealistic. Start at a level of expectation where your child can experience some success. Perhaps bring out the Apples to Apples game, reinforce sitting and a quiet mouth, and then set a timer for 5-10 seconds. Prompt the child to play the game with you and when the timer goes off, they are all done. Gradually increase the amount of time the child must engage with the game, and gradually reduce the prompts you provide.

Here are some strategies to teach appropriate leisure skills to replace inappropriate problem behaviors:

        -Begin teaching this concept by using simple Work Boxes, or “Busy Boxes” consisting of easy or mastered targets. For example, have a busy box filled with crayons and cut outs of shapes. Set a timer and prompt the child to color the shapes. When the timer goes off, put the busy box away. Gradually increase the length of time, and introduce new or unknown tasks. Eventually it will be helpful to set up an area in your home where your child can sit and engage with leisure activities, such as books, puzzles, bubbles, board games, card games, etc.

       - Use a First/Then visual to help the child understand that they must complete the non-preferred task to access the preferred item/ task. Or, “First you sit down and  color, then you can go play”. Once the child understands the concept of first/ then, create a visual schedule of preferred and non -preferred activities. For example: “Eat snack. Leisure Time, 2 minutes. Play Outside. Leisure Time, 4 minutes. Play on Ipad.”

       - Teach independence with this skill from the very start. Reduce your prompting and involvement as soon as you can. Try to prompt through silent gestures only, or prompt standing behind the child. Remember that eventually you want the child to complete these leisure activities independently.

     -   Use a visual choice board to allow the child to select what activity they want to complete. Particularly for non compliant children, embedding choice into leisure time activities will make the process go much smoother.

       - Provide excessive reinforcement for engagement in appropriate leisure skill activities, such as looking at a book or completing a puzzle. Provide no attention combined with redirection when the child engages in self stimulatory or repetitive  behaviors.

    -    Provide multiple opportunities per hour for the child to select a leisure activity, and modify the environment if you need to. If your childs favorite activity is the Ipad, then now access to the Ipad is restricted until they complete 2 leisure activities. Put the Ipad away or lock it with a password, and use visuals to help the child understand when they can have the Ipad. (e.g. “First, Leisure Time. Then, Ipad).

*Tip- Resources for creating visual schedules:

Saturday, February 1, 2014

Quote of The Day

"It is not what you do for your children, but what you have taught them to do for themselves, that will make them successful human beings." 
 Ann Landers

Friday, January 24, 2014

Top 10 Reasons Why Kids With Autism Deserve ABA

I recently did a post with my own Letterman-esque “Top 10 List” of essential strategies that should be in every home that has a child with Autism. So when a friend sent me this article: Top 10 Reasons Why kids with Autism deserve ABA by Mary Beth Walsh, I immediately loved it!

I love the practical advice and humor in the article, as well as the basis of the argument for ABA: these kiddos deserve quality, effective treatment. These kiddos deserve the opportunity to improve and to learn.
 As an ABA enthusiast, I don’t  try to sell people on ABA like I’m some used car salesman in a bad suit. I know what ABA can do. I know that even with environmental barriers, weak staff, and resistant parents, kiddos can still make progress. I know that there are still  kiddos with Autism out there receiving ineffective "fad" treatments, or no treatment at all...their lives could change with the implementation of quality ABA.

Instead of feeling like I need to push ABA on people, I help families understand that ABA strategies are really just effective parenting. That’s it. 
Much of what I explain to families consists of techniques and strategies the families have already tried, or at a minimum have heard of.  The problem usually lies in the implementation, the consistency, or the intensity, which is where I come in to help.

Below is the Top 10 List from Mary Beth Walsh, with my own comments added:

Children with Autism deserve ABA because……..

  1. There is more scientific evidence demonstrating ABA works than there is for any other intervention or treatment – Still don’t believe ABA therapy is effective? Read this. Or this. Or this. Or this.
  2. Because they are human -  I agree with the author that the pendulum of public perception toward Autism used to be firmly set in the area of mentally retarded, incapable of learning, hopeless, etc. Now that pendulum has swung towards viewing  Autism as no big deal, just a little “unique”, or socially awkward. Neither assumptions are respectful of the vast and varied ways that Autism can present in children, and how Autism impacts the life of not just the child, but the whole family.
  3. Because it will help their parents be the best parents they can be for them – Lots of the strategies I recommend to parents can sound counter-intuitive. It may sound illogical, or downright odd to not pick up and comfort a crying child. I get that. But here's whats important to understand: normal parenting strategies may NOT be effective with children with Autism. What your parents did with you, or what you do with your other children, may be ineffective or potentially worsen the behavior of your child with Autism.
  4. It will help teach them how to sleep through the night and use the bathroom – The skills that parents learn from active involvement in their child's ABA therapy can generalize to countless other important skills. You learn how to shape behavior. You learn how to create interventions. You learn how to assess if a treatment method is working or not. Or to put it simply, you learn the best methods to help your child use the toilet or sleep through the night :-)
  5. It is the best defense against the tyranny of low expectations – Low expectations can come from the school, the family, or other professionals. Unfortunately I have had several experiences of interacting with people in my clients’ life who basically told me the child would never talk…never improve…..never stop engaging in aggression. Low expectations for kiddos with Autism steals them of a future they could achieve, and does a disservice to the child.
  6. Because it can teach them the skills necessary to make friends – Yes, teaching communication is important. Yes, teaching toileting skills is important. And so is helping kiddos with Autism smile at peers, play with toys, date, have sleepovers, and enjoy being a child. Everyone deserves to have companionship and friendship.
  7. Because it enables their parents and teachers to capitalize on their strengths and preferences – We all have our carrot tied to the stick that keeps us doing the things that we do. There is a reason why you answer your phone, kiss your spouse, lecture your children, etc. ABA helps parents understand that for every skill they want to teach their child, step #1 is to ask yourself: “What motivation does he/she have to do what  I want him/her to do?”
  8. Because it can teach parents how to respond in the moment – There is no way that I can spend every minute of the day working with my clients. They see me a few hours each week, and when I am not there I need the parents to generalize skills, implement strategies, and be consistent. Quality ABA programs teach parents what to do when the ABA therapists and supervisors wave goodbye and drive off after each session.
  9. Because some day their parents are going to die – It’s what no parent wants to think about, and especially the parent of a child with Autism. Parents  learn over time how to modify the environment to make things easier for their child. It’s a natural process of parenting that gets heightened when the child has special needs. But eventually the child will grow up and become an adult who must interact with society. As part of any quality ABA program, the long term benefit of behavior change must be discussed and planned for…..as unpleasant as that conversation may be.
  10. Because it can prepare them to be their own best advocates – You may wonder how to teach self-advocacy skills to a child with Autism. It isn’t that difficult. Self advocacy is really just about teaching someone how to stand up for what they want, and decline what they don’t want. Self advocacy gives power to kiddos with Autism, and how often do you think individuals with disabilities get to feel powerful?