Related Posts: NET, Program: Toy Play


A great program for teaching or increasing appropriate play skills would be: Play Stations.

I usually teach this during NET portions of the session, and the specific way it is implemented will vary according to client age, current play ability, and the setting. So what follows should really be considered a template that will need to be individualized to your specific client(s).

Teaching play stations would be ideal for a client with play deficits, to teach independence/leisure activities, or for pre-school age clients struggling in that setting.
Many of my young clients spend their time at pre-school/daycare wandering aimlessly around the room, or engaging in problem behavior. In that type of setting there's often less of a strict schedule of activities, and more "free play" time with multiple choices around the room. So the client would be at a disadvantage if they are unable/unwilling to interact with the play choices.

A play station is just an all-contained area for play with a related group of toys. For example: clay/Play Dough area, play kitchen area, water play area (I like to include sensory play as well), blocks/Lego area, etc. Think of a typical pre-school classroom. The room usually will have specific play areas sectioned off, in what teachers often call "centers". Toys stay in the specific designated area, and there are many choices available for the children to rotate through.
A play station could also include one themed toy, such as a carwash toy, a marble maze toy, or a railroad set. The options are endless.

I like to label the play areas, this can be done textually or visually, and also include teaching prompts for both the therapist team and the parents/caregivers. A huge benefit of this program for me, is that it's often so easy to generalize to the parents/outside of therapy sessions.

Teaching prompts for the therapist team could include current targets that can be embedded into the play. For example, at an art play station the therapist could embed color ID, tracing/writing, imitation, one step instruction, sharing or turntaking, and multiple fine motor targets ("open the ______","pick up the _______, "use the scissors to cut", etc.).  Mastered targets could also be embedded as a maintenance skill or to target generalization across stimuli.

Teaching prompts for the parents or family could include suggested ways to interact/engage the child with the play, as well as a handful of teaching examples (that have been modeled for the parent during therapy sessions). For example, at a water play station the parent could start an imitation game of pouring out water, implement manding trials to have the child request, or redirect the child to a play station activity when the parent needs to take a phone call, do laundry, etc.

For older clients or as appropriate, play scripts could also be used to teach this skill. For example, a play station with dress up clothing could be made with the following script used as a prompt:

Characters: Civilian (C), Firefighter (F)
Props: Firefighter's hat, empty spray bottle, crayon drawings of fire

  1. C: "Oh no! There's a fire."
  2. F: "Don't worry, I'm on the way to help."
    (Make fire engine sounds and drive a pretend fire truck over to client)
  3. C: "Help, there's a fire"
    (points to crayon drawing of fire)
  4. F: "I'll save you!"
    (squirts crayon drawing with empty squirt bottle)
  5. C: "Help, there's another fire!"
    (points to another crayon drawing)
  6. F: "I'll save you again"
    (squirts second crayon drawing)
    --Continue until all fires are out--
  7. C: "Thank you Mr./Ms. Firefighter."
  8. F: "You're welcome!"
Over time this script prompt can be faded, the acting roles can be alternated, and the language used can vary for spontaneity.  For example, the firefighter can pretend to be unable to put the fire out to see how the civilian will respond.


Keep in mind that this program is aimed at teaching play skills, meaning it should be FUN!
If the client isn't enjoying interacting with the play stations then reinforcement needs to be examined, perhaps the time interval is too high, perhaps the adult isn't all that fun to play with, or maybe the play choices available just aren't that interesting.
Does the client love straws? Iron Man? Beads? My Little Pony? Insert their interests/likes into the play stations, and remember to bring along lots of creativity when designing their play choices.

Below are some examples of varied play stations. All images found on www.pinterest.com:


Repurposed sink into an outside play station for kids! Love this! #diywoodprojectsforkids #woodworkingforkids


May Morning Work Stations. 43 Tubs to keep your students engaged in hands-on learning.

Here are a couple flower color sorting activities that you can make with a Hawaiian lei. Kids can work on color sorting, number sense, and patterning with these cute activity ideas. Perfect for your flowers theme, plant theme, spring theme, summer theme units and lesson plans. For your tot school, pre-k, and preschool class math centers or math work stations. teach colors, color sorting, color matching, flower activity ideas

teaching children with autism how to do imaginary play using visuals

Teaching How To Play -Autism

Speech Universe: Mr. Potato Head

Considerate Classroom: Early Childhood Special Education Edition: Tour Our Classroom's Independent Work Area


*Resource:

Ideas for Teaching Play Skills

*Read the 1st part of this topic:  Preventing Burnout


Burnout is quite real, and goes farther than just having some workplace stress. 

If you think of Time as your biggest commodity (psst....it is), and your talent, energy, effort, intellect, as your "Tool Kit", then what we all want is to spend our Time investing or using our tools in ways that are satisfying and fulfilling. Right?
Right.

Burnout is the process of spending too much Time doing things that don't properly utilize your unique Tool Kit. 

There are parts of my job that are AMAZING, and then there are parts that are stressful and not-so-great.
Constantly changing employer expectations are not so great. Seeing clients severely reduce, or completely discontinue, needed therapy services due to funding issues is not so great. Working for/under incompetent people is not so great. Striving to meet unrealistic funding source requirements is not so great.

But stressors will come and go, and in an ideal scenario: the impact of this stress does not exceed the enjoyment and satisfaction the job provides.

When those scales tip out of balance (stress/fatigue/frustration has exceeded any benefit of the job), THIS is when you have entered burnout territory. And it's critical not just to recognize you have entered into burnout, but to do something about it.

Come on, we're behavior people. Action steps are just what we do. :-) 

According to the my brain (aka in my opinion), there are 2 main culprits for why burnout not only happens but may even go unnoticed for weeks..months..years. I see both as systemic issues that contribute to the rapid turnover common to this field:


Issue #1: You - Yup, you. Did you fall into the harmful way of thinking that once you became certified, you now wear an invisible cape and can solve all problems? Or, did you enter this field thinking you could be ALL things to ALL people? Both assumptions are incorrect, and inevitably harmful because of the let down that will occur when you realize that you actually are not without flaw. Like many other caring/serving professions, such as teachers, social workers, etc., ABA professionals often place unrealistic expectations on themselves to be perfect, to know everything, and to be able to help everyone. That just isn't possible, and placing impossible to acquire expectations on yourself just sets you up for failure. It is crucial to know/establish your professional identity, and discover how you can best use your unique gifts in this field. ~ If you have no idea what I mean by professional identity, this training video may be helpful~  Do you work best with younger or older clients? Which parts of the day are you most productive? What type of staff personalities do you mesh well with, and which types are like combining oil and water?? As providers/practitioners, we are all different, with varying strengths and weak areas, and sometimes what feels like professional burnout can really be the result of a client that needs to be referred out, a lack of support or training for your role, or a company that doesn't need/is unwilling to recognize what you have to offer.

Issue #2: Your Employer - Many, not all of course, but many, ABA employers have systems and procedures in place that actually can encourage professional burnout. When employees feel isolated from colleagues and distant from ownership/management, or when unrealistic caseload expectations are presented as being non-optional, staff will try to rely on their smarts and training to get them through these challenges. But sometimes, it isn't the staff that needs to change, it's the system that needs to change. How well does your employer evaluate staff for signs of professional burnout? Are boundaries or guardrails put in place so that staff are not experiencing excessive driving, highly variable scheduling, regularly dealing with resistant or uninvolved client families, or working 12 hour days 6-7 days a week? Does the work culture intentionally promote cooperation, teamwork, and open communication? How much time is spent getting to know each individual staff so that cases can be matched based on expertise and experience level, not just based on availability? Can staff (no matter their position) directly access management to voice complaints, or even just vent? How are interpersonal conflicts addressed? If at all?? Or, do direct staff know that complaining about people higher up than them will lead to swift retaliation? All of these issues can lead to staff who feel devalued and unappreciated on a regular basis, and how effective can that person be in their position if they think what they do doesn't matter to anyone?



I see burnout as a symptom of a larger issue (think of how your body uses pain to signal to you that something is wrong), and that issue is usually a lack of Goodness-of-Fit. There are people perfectly content to wash dishes for a living, and there are people in high paying corporate jobs who are miserable. So this issue has to be about more than just what you do for a living.

Once you know what to look for, it is easy to see traits in yourself (or systems your employer has in place) that contribute to a perpetual state of job dissatisfaction and discontentment. 
The question at that point would be: what to do about it.


Suggested Resources:








Lately I've been getting lots of inquiries and questions from people new to the field who aren't quite sure what BCBA's do all day.

It's not an unusual question, I don't even know if the families I work with know what I do all day. Obviously they see me in action during a session, but once I leave I don't think they have a good grasp of the typical BCBA workload.

So this post could actually be helpful for ABA peeps and families/parents.

**Upfront disclaimer: I could not possibly detail what every BCBA on earth does on a day-to-day basis. For one, I don't know every BCBA on earth. For two, many BCBA's work in unique settings or with unique populations outside of the developmental disabilities domain. For those non-typical work settings, I'm sure the day-to-day responsibilities are very different from what I do everyday. Possibly more exciting, but possibly more stressful too. Either way, individuals in those kinds of settings would be the best person to talk to if you do NOT plan to enter the developmental disabilities domain.  


The main question I keep getting from people is some variation of:
"Once I'm a BCBA, does that mean I will be stuck behind a desk/a supervisor only/can't work 1:1 with clients/students anymore?"

It's a great question.

It isn't a question I had pre-certification because I knew pretty early in my career that I wanted to be the one designing treatment and being a strong support system for the staff and family. Yes, I LOVED working day after day with the kids and seeing them learn and grow, and watching them gain more independence right in front of my eyes. But the person who fascinated me even more than my client was always the Consultant/Supervisor. I wanted to know how they knew what they knew. How did they know what skills to teach next? How did they know how to reduce challenging behaviors? When they looked at the raw data, how did they know what decisions to make next?
I saw that in the typical ABA therapist position, no one was interested in having me help with those kinds of duties. So I knew I needed to pursue certification if I wanted to do more than implement a treatment plan.


As far as the typical day in the life of a BCBA, on an average day my responsibilities could include the following:

  • On-site supervision of staff/program implementers, which typically includes parent meetings (if in-home), administrative contact or follow up (if at a school), or consultation with your direct supervisor (if in a clinic)
  • Ongoing and on-the-job training and support for program implementers, which often necessitates treatment plan revision, program writing, and/or creating staff training materials
  • Research/Literature review/Colleague or Mentor contact to generate treatment planning ideas, problem solve, or create potential hypotheses about client issues 
  • Data collection, data review, data analysis, data based decision making, pulling out your hair because they "forgot" to collect data, crying because you pulled out your hair, etc....
  • Creating and/or purchasing therapy materials, helping teach program implementers how to appropriately select therapy materials and reinforcers
  • Carefully assessing the overall quality of the ABA program (Is the learner progressing? Are the staff energetic in their role and receiving enough support? Is everyone practicing ethically? Are the parents involved and participating? Do related providers know what is being targeted in ABA therapy? Could any current systems be revised, edited, or tweaked to be more effective or more efficient?)
  • Maintaining compliance with various company policies and procedures, client confidentiality, funding source requirements, etc.
  • Be available for contact by program implementers/parents/stakeholders who may have questions, request meetings, ask for you to attend IEP's, ask for copies of documents/reports, report new behavioral issues, report new skill regressions, etc. All of the above can necessitate treatment plan revision, program writing/revision, creating training materials, updating/revising the progress report, etc.

Yup. All in a day's work.


After reading the typical responsibilities of a BCBA, it may already be apparent that there are a few barriers to being able to work 1:1 with clients. Such as? Glad you asked:
  • Umm, time. Did you see that list above?? When exactly did you plan to have time for seeing clients 1:1?? In a typical BCBA position, you will have a full caseload of clients that could be served at settings spread all over town (at school, in the community, in-home), and there will be a team attached to each client. That team will depend on you and regularly need your assistance or support outside of work hours. This particular barrier is why many BCBA's choose not to accept full-time positions (that often come with billable hour requirements), and instead to contract their services or work independently.
  • $$$. If you are working for a company, they often would prefer to staff a case with non-BCBA's because it is cheaper. The BCBA hours allowed by insurance are often far less than what we need to do our jobs. So money plays a big role in where your employer decides to use you, as your hourly rate is much higher than what direct staff get paid. If you work directly for a consumer, it's not uncommon for parents to contact BCBA's because they want the most credentialed person to work with their child directly. However, these parents are often unprepared for the higher hourly rate a BCBA charges. Which means consumers may not be able to afford to hire you as direct staff.
  • Opportunities available. In this field, a tiered-delivery model is super common. What this means is unlike other therapy models, with ABA treatment there are 2 main roles: program implementer and program supervisor. Many funding sources set up their ABA therapy reimbursement based on this delivery model, which means many organizations and employers hire staff based on this delivery model. If you do a quick search for BCBA positions in your area, you will probably find that most of them are hiring at the supervisor or director level. I rarely see BCBA job postings that mention providing direct services.


Am I saying that no BCBA does any direct, and you have to kiss this dream goodbye in order to pursue certification? Of course not. 
As a BCBA you will be a trained and competent professional, in a high-demand role. Go do what you want!

However, just know that there may be barriers to continuing to do direct/work 1:1, and it can be difficult to locate an employer who wants that/can afford that.


*Recommended Posts:







Today's QOTD isn't quite a direct inspirational quote, it's more of a helpful -and important- resource.

From Dr. Mary Barbera, here is a short and sweet vlog on teaching non-vocal individuals to communicate distress due to pain:




For parents and professionals alike, this hits home. I have worked with many kids who had recurrent medical issues or problems, such as frequent colds (which can bring an unpleasant head fog and nose irritation), bowel/indigestion issues, acid reflux, ear infections with painful blockage, etc.

Can you imagine for a sec, experiencing some kind of painful event and not having the means to communicate that to anyone? Especially if you are a child, and cannot just run to CVS and pick up some medication to make yourself feel better. And we wonder why some of our clients get so frustrated or angry??

Taking this beyond physical pain for just a sec, in my own life when I am in a funk/sad, furious, or anxious about something, it can manifest in my body as physical symptoms. Ever heard of "butterflies in your stomach"? Or "a stress -anger headache"? WOO, I've definitely had more than a few of those.
But unlike many of my clients, I have the ability to communicate I feel like being left alone. Or, I can obtain and then ingest medicine. Or, I can choose to postpone tasks until I feel better (i.e. "Guess I'll be finishing up that report tomorrow...").


The ability to communicate not just thoughts & wants, but private events (feelings, moods, sensations, etc.) is SO critical, regardless of age or ability. I consider it a life skill.


You will never achieve a coveted Boring Award without working really hard to have the most dull therapy sessions possible.


I believe you can do it, and I have observed multiple therapists over the years strive and stay consistent and next thing you know-- they earned a Boring Award. Believing is achieving.


So what do you do? What are the action steps? What can you change right now, TODAY, in order to kill any enthusiasm, energy, or fun in your therapy sessions?
I'd be happy to tell you some action steps towards being a totally boring ABA therapist:


  • Cookie-cutter is your friend - Did you learn a specific strategy several years ago? Be sure to apply it on all your clients, whether it seems to be effective or not. For example, everyone knows all early intervention clients lover to work for Skittles. So just keep a huge bag of Skittles in your car and use that as reinforcement across your entire caseload. Have a client who tosses the Skittle on the floor or gives it back to you? That's fine, just keep giving it to them anyway. You know what motivates the client better than they do, of course.

  • Research, what research?? - It's best to try strategies and techniques based on what seems to be the easiest option, doesn't require reaching out to your supervisor/BCBA, or that won't eat up too much session time. You do have a datasheet to get through, after all. Be sure to stay out-of-date with current ABA research, especially in the areas of motivation and incidental teaching, or your sessions might accidentally start to get pretty fun.

  • Stay as still as possible - As much as you can, plop down in one place at the start of the session and then just stay there. Work in one room of the home, or at one table of the center, or in one tiny corner of the classroom. Another advantage of this strategy is it's easier to keep up with your materials because of the lack of moving around. Who needs to be bothered with all that multitasking and carrying around datasheets in the natural environment? 

  • Avoid or reject feedback - Don't reach out to your supervisor/BCBA to ask for recommendations to embed more fun and energy into your sessions, and take any feedback from them in this area as a personal attack. You can't be expected to show up for a session, run trials, collect data, AND authentically engage the client all at the same time. Again, that multitasking stuff is nonsense. It's not like feedback is meant to improve and sharpen your skillset, so it's best to ignore it.

  • Tunnel vision for the WIN - Lastly, the best way to earn yourself a fancy Boring Award is to make up your mind at the top of the session to never deviate from your plan. Does the client keep asking to go outside? Or are the parents requesting additional parent training? Does the client seem bored to tears when you pull out those same animal flashcards?? None of that should impact the plan you already decided on. Spontaneous changes, mixing up materials, and embedding the family into the therapy session would just slow you down, and require more effort on your part....and who needs that? It's far easier to show up for each session, do the same things, in the same order, and then go home. Autopilot ABA sessions are for winners.



It's important to remember that being a boring ABA therapist takes effort and resolve! No one is that boring on accident, it's a choice.
It's a choice to say "Hey client, I know what we should do today: We should have a dull therapy session that has nothing to do with what you're motivated to do, your interests, your unique personality, and your current M.O.'s. The best way to teach you is to implement a variety of strategies and techniques that I would never want used on me, and that have little connection (if any) to the vast ocean of ABA research. No, it's best if I just plod through this datasheet and pull out the same tired reinforcers session, after session, after session. That would be what's easiest for me, and not what's best for you. Yes, let's do that".



(This entire post is sarcasm: do the opposite)

And there absolutely is an art to it.

I will include TONS of links at the bottom of this post, because it's important to understand this post won't be a paint-by-numbers kind of thing. Teaching a new skill or behavior is not as simple as "Do this-Do this-Do that-Done".

If you took 3 BCBA's and asked them to teach a child to ride a bike, you could end up with 3 different ways to teach that skill. And that's okay.
The expertise, related experiences, and unique professional identity of each BCBA will impact how they design treatment, and how they teach skills. As long as the end result is the child independently riding their bike, then the skill acquisition was a success. The exact path to the finish line is allowed to vary.


Parents and ABA professionals reach out to me fairly frequently to ask "How do I teach my child/client to (fill in any behavior here)". My answer is usually some form of "I'm not going to be able to answer that for you in a brief email". Teaching skills, aka programming, aka skill acquisition, requires thinking/intentional planning by someone with knowledge of the learners individual skillset, deficits, and strengths (professionals refer to this as "assessment").
If you want shortcuts and don't want to think, or you want to rush over planning, or you don't know the learner very well, then you have no business designing treatment for them.

If you are a parent reading this and you work with an ABA team, ask for training in skill acquisition. If you are a parent who does NOT have the help of an ABA team, my first piece of advice is to get that help if you can. Even if you consult remotely with a BCBA for a few hours a month, that would be far more helpful than trying to implement skill acquisition on your own.
Trust me, the BCBA had to learn this skill via graduate level coursework, supervised work experience, and hands-on training with multiple learners. Translation being: skill acquisition is not as simple as it looks.


So to wrap up, if you are a parent needing help teaching your child a new behavior (making a bed, putting shoes on, completing a puzzle, putting toys away, etc.):


  1. Get as much professional assistance as you can afford. Emphasize your need for parent training to that professional
  2. Expect to put time into learning about skill acquisition. One meeting with a BCBA will likely  not be enough
  3. Have a solid understanding of the following: what is the terminal goal (how do you define the skill as being "learned"), how far away is your child from the terminal goal (baseline data), what steps will your child need to have in order to learn the skill (pre-requisite skills), and what concepts do YOU need to know in order to teach the skill (do you know how to prompt? do you know how to reinforce? do you understand motivation?)





*Links: (recommended for further learning and understanding)

Heflin, J., & Alaimo, D. F. (2007). Students with autism spectrum disorders: Effective instructional practices. Upper Saddle River, NJ: Pearson/Merrill Prentice Hall.

Crockett, J. L., Fleming, R. K., Doepke, K. J., & Stevens, J. S. (2007). Parent training: Acquisition and generalization of discrete trials teaching skills with parents of children with autism. Research in developmental disabilities28(1), 23-36.



https://www.iidc.indiana.edu/pages/a-brief-explanation-of-discrete-trial-training

Leaf, J. B., Oppenheim-Leaf, M. L., Call, N. A., Sheldon, J. B., Sherman, J. A., Taubman, M., … Leaf, R. (2012). COMPARING THE TEACHING INTERACTION PROCEDURE TO SOCIAL STORIES FOR PEOPLE WITH AUTISM. Journal of Applied Behavior Analysis45(2), 281–298. http://doi.org/10.1901/jaba.2012.45-281



https://www.aare.edu.au/publications-database.php/1200/Teaching-functional-skills-to-autistic-children-in-natural-settings:-Skill-acquisition,-maintenance-and-generalisation

Using a Task Analysis for Instruction


  •     Luiselli, J. K. (2008). Effective practices for children with autism: Educational and behavioral support interventions that work. New York: Oxford University Press.

Teaching Tips for Children and Adults with Autism

https://www.letstalksls.com/resource-library/autism/dos-and-donts-teaching-children-autism

Secan KE, Egel AL, Tilley CS. Acquisition, generalization, and maintenance of question-answering skills in autistic children. Journal of Applied Behavior Analysis. 1989;22(2):181-196. doi:10.1901/jaba.1989.22-181.


AndersonS. R.TarasM., & O'Malley CannonB. (1996). Teaching new skills to young children with autism. In C. MauriceG. Green, & S. C. Luce (Eds.), Behavioral intervention for young children with autism: A manual for parents and professionals (pp. 181-194). Austin, TX: Pro-ed.

Sundberg, M. L., & Partington, J.W. (1998). Teaching language to  children with autism or other developmental disabilities.  Danville, CA: Behavior Analysts, Inc. 

Writing ABA Programs

Skill Acquisition: Programming Sequence

Everything You Ever Wanted to Know About ABA





Activity schedules are amazing tools that can benefit a household in many different ways:


  1. Ease transitions
  2. Promote independence/Self-management/Leisure skills
  3. Teach play skills (particularly independent play)
  4. Prompt behavior without a therapist/adult being present
  5. Decrease unsupervised "free time", which is often filled with problem behaviors
  6. Teach following a schedule/teach routines
  7. Signifies when reinforcement is available
  8. Teach choice making

I love, love, love activity schedules. A common recommendation in my behavior plans is to "keep the child engaged". Most of my clients exhibit their worst problem behaviors outside of therapy sessions and school. Why is that? 
It's often because the home environment does not provide the same level of routine and structure as school and therapy sessions. For most of my clients, down time is not their friend. Down time is usually filled with behaviors that Mom or Dad do not want to see increase, like eating carpet lint, dumping out the dog's food bowl, or sitting on top of the refrigerator.

If you are working with an ABA team, ask them if this is something your child could benefit from. If you don't have the support of a team, then keep reading and I'll explain how you can make one yourself.


Firstly, parents often say to me "Is this really necessary? Will he/she always need to have a photo schedule to follow? Won't this be inappropriate when he/she is a teen or adult?". My response to that question is to inquire if the parent ever uses some type of planner (including digital ones) to organize or structure their days. Roughly 80% of the time they tell me they do. I then explain that a planner is a glorified activity schedule. Don't believe me? Okay:

Activity schedule with photos----->Written schedule with no photos----->To Do list----->Organizer/Planner/Scheduling app



Now that you know even adults use a version of an activity schedule, how do you know if your household could benefit from one? If any of these scenarios ring true for you, consider implementing activity schedules:
  1. Afterschool/on the weekends/after therapy sessions the child's problem behavior skyrockets
  2. Breaks from school/3 day holiday weekends are just the WORST, and your child seems to amp up their problem behaviors day by day
  3. The child must be constantly supervised or they will break, climb, or destroy something in the home
  4. The child has no leisure skills, and lacks the ability to just "go play" (these words mean nothing to them)
  5. Telling the child "stay in here" also means nothing, and they tend to just wander all over the house
  6. Mom or Dad cannot do laundry, take a phone call, respond to emails, have company over, or cook dinner unless someone else is home to keep the child entertained/busy
  7. Toys sit around gathering dust, because your child only interacts with them for a few seconds before losing interest
  8. Other children in the home rarely get their share of parent attention or time 
  9. The child will only sit and attend to electronics (TV, iPod, tablet, etc.). Books, toys, puzzles....nope.


Are you starting to love the idea of an activity schedule yet? :-)


Now for the fun part: Making one! *Puh-lease do not buy an activity schedule online. For one, it will not be individualized to your child. For two, it's super easy to make

Decide which part of the day you want to introduce this visual support 
(I suggest picking the part of the day that is currently the MOST difficult to keep your child entertained)

Decide what you want the child to do instead of wandering around, being glued to an electronic, or engaging in problem behavior 
(Puzzle? Read? String beads? Sensory tub?)

Create a visual display of each step. The schedule can show one activity or multiple activities (On a piece of cardboard or thick paper, tape a photo of each separate activity in the order they should be completed)

Consider the use of a timer and reinforcement 
(Timers help ease transitions, and reinforcement is behavior superglue)
Prepare the area
(Have all materials organized and nearby, tape the schedule to the wall)

Teach your child to follow the schedule 
(You will need to prompt and reinforce)






* More information:

Book: Activity Schedules for Children with Autism-Teaching Independent Behavior 

Research: Use of activity schedule to promote independent performance of individuals with Autism and other Intellectual Disabilities

Free Activity Schedule PPT




*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 neglect my exercise routine 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.

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 only for 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 work hard all week to get a fun day Friday. Fridays are for relaxing, eating ice cream, and kickstarting the weekend.

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
stick.
to.
the.
plan.






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.





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