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.

Sunday, July 20, 2014

The Easy Way vs. The Hard Way





I will often explain ABA to new clients/families by saying ABA therapy isn’t easy to do, but it doesn’t have to be difficult. What I am very careful not to say is that ABA isn’t hard.
It is hard.
 It can be very hard.

Many strategies and techniques we use as ABA professionals have taken us graduate level coursework, years of experience, and a super thick skin to implement correctly. The average busy and multitasking parent isn’t quite ready for what ABA can fully entail, and the changes that will be necessary for their whole household.

When I say ABA doesn’t have to be difficult, I mean that an experienced and quality BCBA/Consultant/Supervisor will have the skills to present complicated concepts to a parent or teacher in a lively way, thoroughly define and explain strategies, and reinforce effort to promote learning. The right professional should make you feel supported and encouraged, and when they need to correct or modify your behavior they do so tactfully with a great deal of patience.

When I say ABA isn’t easy, I mean just that. ABA is often the opposite of “taking the easy road”. Many times as you are on the ABA therapy journey you will have the choice to do what feels easy or “right” or to do what feels difficult or “wrong”.
As a professional I face that same choice.  Am I going to roll up my sleeves and do the work necessary to help my client be successful, or am I going to shrug and say “Well, that’s close enough”.

I think much of discipline or behavior change in general requires changing your mind about what you as the parent or teacher are capable of, what the child is capable of, what behaviors you are willing to accept, and what behaviors you are NOT willing to accept. What can initially seem like a fairly easy way out of a tricky behavioral situation, can cost you much more effort, pain, or frustration in the long run.  It’s similar to eating fast food: in the moment it’s cheap, quick, and easy. But over time, it has an impact on your health and your waistline.

So the next time you are facing behavioral challenges in your child and have various choices of how to respond running through your head, pay attention to the ones that seem the most challenging, time consuming, or difficult. Those choices are likely what an ABA professional would recommend you do. Think about it like this: Autism is not simple or easy, so why would the treatment be simple or easy?

Here are a few examples I see fairly often, of being faced with that Hard or Easy Choice.

BEHAVIOR
EASY CHOICE
HARD CHOICE
Child is screaming at you that they hate you and calling you names
Firmly tell the child to be quiet and that they can’t talk to you that way
Once the child is calm, talk to them about why they feel that way
Child is refusing to stay seated at the dinner table
Promise the child they can have the Ipad if they will come back and sit down
Shorten the length of mealtime and hugely reinforce every 30-60 seconds of appropriate sitting
On a long car trip, the child is engaging in repetitive “junk” talk about boobs and butts
Crank the radio up super loud to drown out the “junk” talk
Pay no attention to the inappropriate conversation, and give high fives to the other children who are talking nicely
At a family function your toddler begins to cry and tantrum. You aren’t sure how best to respond, but people are beginning to stare.
Quickly jump into action to stop the disapproving looks, and get your child under control
Wait. If you don’t know how to respond then do nothing. Quietly wait for calm, as you decide how best to intervene





Friday, July 11, 2014

Quote of the Day

"The rat is always right" B.F. Skinner 
(Father of Operant Conditioning, Author, Researcher, and just all around amazing person)


"The rat is always right" is a classic Skinner saying that alllll ABA people should have stitched onto a pillow somewhere in their home.

What Skinner meant with this statement is that if something is not going right with your experiment, the rat is not to blame. The rat isn't being lazy, stupid, or stubborn. The rat is doing what you have trained the rat to do. Rats can only be rats.

I'm sure you see where I'm going with this.......

When your client just "isn't getting it" after intensive teaching, switching up reinforcement, and changing your materials/stimuli, do you blame the client? Do you assume they cant learn, or are just being noncompliant? 

For parents, when the team of therapists leave your home and all of a sudden the child stops manding and problem behaviors begin, do you think the ABA just "isn't working"? Do you blame the therapists or supervisor that you cant get your child to complete tasks?

To put it simply: the child will do what you have the environment set up for them to do. So blame the environment, not the child.



Tuesday, July 1, 2014

Behavior Plans Made E-Z




Suggested Reading: Creating a Behavior Plan


I have mentioned before on my blog that the extensive behavior plans/interventions ABA professionals create are typically handed to someone else to implement. That may be a parent, teacher, ST, OT, etc. It can be difficult getting someone else to follow your recommendations, and to commit to sticking with the behavior plan especially if an Extinction Burst initially occurs.

I have seen some wonderfully bright and talented BCBAs falter in this area. I like to look at it as Knowing your Audience. A typical busy parent of 2 children really doesn’t want me to hand them a 4 page document with Behavior Plan typed on the first page. That wasn’t what they had in mind when they asked for help with behavioral issues. 


However as a professional, that’s all some us have been taught…..how to conduct FBAs, how to generate hypotheses, and how to form a plan based on results of evaluation.
 What about taking all of this amazing knowledge and expertise, and transforming it into something that’s easy to digest? Now that takes skill! :-)
 

Something I like to do with my clients is create “Cheat Sheets” for behavior plans, that I strongly recommend the family post in visible locations. That could be on the fridge, on the child’s bedroom wall, and making a laminated card to carry out in public. In order for a family to implement my behavior plan, they must know what it says.
 Simply reading and reviewing the plan with a family may not be that helpful. Often after reviewing a 5 page intensive behavior plan, the parents are too intimidated to ask any questions. Or they are in a daze, or feeling extremely overwhelmed (I actually had a parent start crying once in the middle of a treatment plan meeting. That’s not the reaction you want the client to have!)

Creating a small, portable cheat sheet does a few things: it makes the behavior plan seem less scary and unattainable, it serves as a visual prompt for what to do in the moment, it is helpful for family members who work outside of the home and maybe aren’t always available during supervision sessions, and as we all know out of sight, out of mind….simply having the cheat sheet posted in the house helps everyone in the family stay alert to how they are managing problem behavior, or how they may be contributing to problem behavior. Putting my photo on the cheat sheet can be helpful for that too (I’m so joking).



A few tips for making a great cheat sheet for your clients:

  • Leave the jargon at the door:  It’s great that you can easily use terms like “Schedules of Reinforcement” and “Partial Interval Data Collection”, but the cheat sheet is supposed to be NON- intimidating. So use simple, everyday language.
  • Visuals can be helpful!:  Picture icons can be added to the schedule for ease of use, they catch the eye, and if there are siblings in the home adding photos to the cheat sheet makes it more kid friendly.  Use of bright colors, highlighters, stickers, etc., is also suggested. We want little sister or big brother to know how to implement the behavior plan too.
  • Use positive language that is non-judgmental: Keep statements like “Don’t do this”, or “Stop saying this” minimal, and focus on what you want the family to DO or SAY to manage problem behaviors.
  • Provide practice or role play opportunities for the family: Sometimes during supervision sessions my clients experience what I like to call Mechanic Syndrome. Similar to how when you take your car to the mechanic because it is making a noise, and then the mechanic swears they don’t hear anything. Then as you drive away, you immediately hear the noise again. Sometimes even with triggers present, my kiddos won’t engage in the problem behavior when I’m at the home. So I do a role play with Mom or Dad. Using the cheat sheet as our guide, I have them pretend to be their child engaging in a problem behavior. Then I pretend to be them, and show them how they would react. This can be a SUPER helpful exercise because inevitably when I give parents a behavior plan they will say “But Tameika what about when he_______”, “What about if she does _______”, “This plan doesn’t cover if he suddenly ________”. So role play scenarios are good for troubleshooting all those What If situations.


*Resource: Here is an example of a Behavior Plan Cheat Sheet

Monday, June 23, 2014

Quote of The Day



Retro Flashback!

It’s good to look back at history for the purposes of retrospection and learning. Staying future focused can sometimes cause us to minimize what the people who came before us discovered or learned.
Viewing these wonderfully retro Lovaas ABA videos (circa mid 70's) makes me feel many emotions: pride for my field, compassion for children dealing with Autism or related disorders, and motivation to keep doing what I’m doing. 


ABA has evolved, shifted, and matured over the years, and the services provided keep getting better and better as a result. We know things now that Lovaas and his students didn’t know back then. What’s that saying though? The more things change, the more they stay the same?

So as you watch these classic videos of the work of the great Dr Lovaas, keep in mind what looking back to the past can teach us today about ABA:

  • Autism is not a death sentence. Early intervention changes lives.
  • The earlier and the more intensive services can begin, the better.
  • “Stopping” services can have disastrous effects. If you must halt therapy, consider becoming a Parent Therapist.
  • Kisses, affection, & love have long been popular reinforcers.
  • Not every child with Autism will make huge, significant gains through ABA therapy. However, progress is always possible.
  • Parents. Must. Be. Involved. In. Treatment.
  • Behaviors that are not reinforced die out. So stop feeding those tantrums :-)
  • “Fixations”, “obsessions”, and “rituals” in children with Autism can be shaped into hobbies, leisure skills, or even jobs.
  • Adaptive/Life Skills  cannot be left by the wayside. Can the child mail a letter? Cut meat? Set a table? Play sports? No? Then teach them.
  • When looking at my young clients with Autism, I have no idea what the future holds for them. And neither does anyone else. Dream big.


 
Watch the Videos:

Video 1 Behavioral Treatment of Autistic Children: Ivar Lovaas (1988) Part I

Video 2 Part II

Video 3 Part III

Early Lovaas Videos


 


Saturday, June 14, 2014

Behavioral Momentum




Behavioral Momentum - The use of a series of high-probability requests to increase compliance with lower-probability requests (Ray, Skinner & Watson, 1999).

Behavioral Momentum is one of those cool ABA terms that sounds exactly like what it is. Behavioral Momentum basically means to build up momentum to what you really want the child to do, by tossing out easy, or “throw away” demands, that they are super likely to do first. Or to put it another way, you approach the child not with what YOU want in mind but with what they are most likely to want to do.

This seems like one of those simple, obvious things that everyone knows to do, right? Wrong.

 I see staff or parents make this error all the time: They approach the child and fire off a series of demands, all of which are non-preferred activities. The child then refuses to comply (either vocally or non vocally), and then a power struggle begins, tantrumming comes next, etc. There is a way to prevent this frustrating little cycle of behaviors from happening in the first place.



Taking a few seconds to prepare yourself to use Behavioral Momentum can save so much effort and frustration in the long run, especially if you are dealing with a non-compliant or defiant child, or even a typical “I’m-going-to-test-you-just-because” 4 year old.

Firstly, do you know how to give a demand? If not here is a quick review:
  1. Demands are stated, not asked.
  2. Get in close proximity to the child and gain eye contact, if possible.
  3. Wait until you have the child’s attention.
  4. Using clear language, present your demand (“Its time for bed” and not “Come on, lets get ready for bed, and I don’t want to hear all of that crying and whining tonight ok? When I say bedtime I mean bedtime”).

Think of what you want the child to do as your real goal. Cover that goal with 1-3 layers, before presenting it. So if I want Andrea to clean up her toys, I may walk over to her and say:

“Hi Andrea!” (Andrea looks up at me) “Nice looking! Give me a high five” (Andrea gives me a high five) “Awesome! Clean up your toys”

I initially presented to Andrea a few demands that are easy for her to comply with, and that I know have been successful in the past. For example, every child is not compliant with eye contact. So if I know Andrea struggles with eye contact, I would have used a different task, such as waving or maybe giving me a hug. This is a child-specific technique. What is a super easy behavior for one child may be challenging for another child.

This technique works especially well with more defiant children, who brace themselves as soon as they see an adult approaching. They automatically think you are walking over to them to stop them from doing something fun. For kiddos like that, I may approach them and say:

“Should we play outside or stay in the living room?” (child chooses outside) “Great, we’ll go play outside. Hey, where are you shoes?” (child says shoes are in his room) “Okay, we can go get those right after you turn the video game off”

In that scenario what I really wanted was the video game off. So instead of just walking into the room and saying (as I often hear many parents say) “Turn it off now”, I present simple demands/ask easy questions, and only then present my true demand.

Following the High probability--> High probability--> Low probability sequence is a successful strategy when dealing with non compliant children, or children who do not transition well.

It’s important to provide praise for the easy demands, just like you would for the difficult demand. Remember, you are building a momentum chain. You want the child feeling good and pleased with themselves by the time you present your real demand.

Lastly, using Behavioral Momentum will also minimize you becoming an Aversive Stimulus. An aversive stimulus is something that we learn to avoid or escape from over time, as it is associated with unpleasantness. Kind of the way for some people, going to the dentist is an Aversive Stimulus. If your child knows that every time you approach them and squat down to their level it is to give a demand, it won’t be long before they start running/ walking off when you approach. By using Behavioral Momentum, your approach gets associated with good things, compliments, praise, high fives, tickles, etc.

*Quick Tip: Wondering how to implement Behavioral Momentum with a lower functioning kiddo who doesn’t have many tasks they can easily complete? Try something like this:

  • “Carlos, give me 5!” (Hold your hand up very close to the child so they know what to do)
  • “Thanks! Tickle attack!” (Tickle the childs stomach or under the neck)
  • “Yea! Stomp feet!” (Stand directly in front of the child and stomp your feet)
  • “You are amazing! Time to go potty now, lets go!”



** Here are some great resources on Behavioral Momentum:





Tuesday, June 3, 2014

Autism & Worship





I referenced this briefly in my “Moving From Awareness to Action” post, but for sooo many of my clients, attending regular church services and having a child on the Spectrum mix about as well as oil and water. What is so unfortunate about that is for so many families their faith is what energizes them, and gives them the strength, peace, and sanity to raise a child with special needs. So to be deprived of the opportunity to participate in worship activities can be particularly distressing.

For the ABA professionals, think about a few of the clients you work with. Now picture them sitting through a church service that may be 2-3 hours long, in a crowded room where the sound bounces and echoes, there may be bright lights, lots of people, unexpected transitions, and they are supposed to be still and quiet throughout much of the process. How do you think your client would do?? 
For most of my current and previous clients, the answer is definitely “Not so well”. Looking at things from the child’s point of view, they may not understand why they have been brought to this big, loud place with all these different smells and unknown people.

For parents of children with Autism (particularly as their child ages), going out into the community can become more and more of a restricted activity. Certain restaurants may be avoided, movie theaters are out, and a spontaneous trip to the mall could lead to a meltdown. It isn’t unusual for a family to ask the ABA professional for help/advice/suggestions when it comes to handling their child at church, and how to help their child enjoy the experience. 


~ Helping Your Clients Attend Church ~

The following are some suggestions or tips I would give to a client; feel free to share these tips with the families you serve:

  • Be flexible about where you worship – Is your current church meeting your needs? Church services vary greatly. Some services are quiet with lots of sitting, and other services are loud and everyone is up and moving around. At some churches children are welcome in the main sanctuary, and for other churches children have to go to separate classroom areas. Determine what type of church setting would best meet the needs of the child, and then honestly ask yourself if your church can provide that. Be open to looking at other church settings that may have a very different kind of service than your current church.
  • Are there simple modifications that may help your child?- Is the choir at your church really loud? How about letting your child wear headphones until the choir is done singing. Does your church have hard pews to sit on? How about bringing a cushion or folded blanket for your child to sit on. Does your child have a hard time attending? How about arriving halfway through the service, to limit the amount of time your child has to sit. Does your child consistently struggle in their children’s classroom every week? How about asking to move down to a younger classroom with a looser schedule. Sometimes simple changes can make the whole church experience easier on your child.
  • Take a helper or a buddy with you - The ABA therapist or possibly the Supervisor can attend church with you. You could also ask a nanny or babysitter, as long as they have been trained in behavior management. If a behavioral episode occurs, they can walk you through what to do and how to handle it while keeping everyone safe. Particularly if your family has multiple children, I highly recommend bringing a helper with you to church.
  • Prepare your child in advance- Days before church, talk to your child (in language they can understand, using visuals if necessary) about what church is, what to expect, and why they are going. I highly suggest showing them actual photos or video of the church service, and pointing things out to them (e.g. “See, that’s Pastor Michael right there”). This way when your child arrives at church it will seem somewhat familiar. This “prepping phase” may need to continue for weeks, or even months to help your child know what to expect from church service.
  • Help raise awareness at your church- I can’t give a list of recommendations for families without addressing this. What is the environment like at your church as far as special needs? Are children with special needs made to feel welcome? Is there a greeter or staff person who helps families make accommodations (such as special wheelchair accessible seating)? Is there a special needs room or area? If possible, start a committee or volunteer group that assists families in the church who have children with special needs. There could be many other families who feel the same way you do, and wish they had someone to help them navigate through the church service. Advocate for your child, and speak to leadership about ways the church can make your family feel more welcome. If your child goes into a children’s classroom, prepare and hand out a simple 1-2 page document describing your child, how he/she communicates, problem behaviors, what they love to do, etc. This will be immensely helpful for the volunteers who will spend time with your child, especially since these volunteers often change rapidly.
  • Church should be a fun experience- Remember, from your child’s point of view they may not understand why they keep being brought to this loud, crowded place called “church”. Use Pairing  to your advantage. This is easy to do, just pair fun/awesome/exciting things with attending church. If possible, let your child wear their favorite clothing to church. Yes, that may mean they choose to rock a lime green t -shirt and cowboy boots. Do a highly preferred activity before and after church, bring a “goodie bag” to church with you of super fun toys and fidgets, or save up the biggest reinforcer (e.g. the Ipad) for after church. Does your child favor one parent? Then definitely let them sit next to that parent during church, and maybe even ride alone with that parent to church (the rest of the family can follow separately). This way church becomes connected with  cherished alone time with Mom or Dad, which will make church more exciting for the child.


** Awesome resource for how churches can make special needs children feel welcome: Rachelwojo.com  

Monday, May 26, 2014

Quote of The Day


The power of the spoken word:

"Affirming words from Moms and Dads are like light switches. Speak a word of affirmation at the right moment in a child’s life and it’s like lighting up a whole roomful of possibilities", Gary Smalley

Monday, May 19, 2014

The "Why" of Selecting Goals for Intervention




Reference: “Balancing the right to habilitation with the right to personal liberties: The rights of people with Developmental Disabilities to eat too many doughnuts and take a nap”, D. J. Bannerman, J. B. Sheldon, J. A. Sherman, and A. E. Harchik (1990)

Just the other day a direct therapist asked me how do BCBA’s decide on what targets to teach, what skills to improve on, and in what order to teach skills. It’s a very loaded question.  There are multiple factors to consider when determining what to work on with a client: funding source (how much time do we have to teach the child), wishes of the family/caregivers, are severe behaviors present, are barriers to learning present, is the child in school or not, etc. It’s a heavy crown of responsibility. Selecting goals for intervention is made simpler with the use of assessment tools, such as the VB-MAPP or ABLLS-R, or through a proper intake process where caregivers are carefully interviewed.

Beyond just deciding “What am I going to teach this individual”, much consideration and thought needs to go into “Why am I selecting these goals?”. ABA is a powerful method of implementing behavior change. It’s like glue; when you apply it to something, it will stick. If you accidentally apply it to the wrong area, or you put too much glue in one spot, glue still sticks.

Who gets to decide what an individual receiving treatment needs to work on? If the individual is over the age of 18 and mentally capable, they can just tell you. When working with cognitively capable adults (or even adolescents), they are involved with their own treatment. Their consent, or assent, must be obtained before treating them. 
However, what about those kiddos who are either young, or not mentally capable of saying “Tameika, you’re right. I should decrease the frequency of my tantrums”.

These are important things to think about as a professional. Why should a child’s stimming behaviors be reduced? Why should an introverted, shy child be required to socially interact? Why should a child have their hyperactive behaviors decreased, or extinguished?  What about client choice?

There will be times when as the professional, you do not agree with the goals the caregivers or teacher want to work on. I think many of us have been in the situation of working with a teacher who wants your client to “calm down and be still” during class. Well, there is a difference between using ABA as a magic wand to create perfect children, and utilizing ABA to intervene on socially significant behaviors that interfere with learning. Sometimes as professionals, we have to explain that difference to people. 


 Some of the things you see as “problem behaviors”, the parents will not. The parent may have no issue with their child jumping off furniture at home, or talking back to adults. Creating a treatment plan must involve the primary caregivers, and as much as possible the individual receiving treatment. Client preferences, personality, family culture, and client choice must be considered.

As professionals designing interventions we yield a lot of control over what the client will learn and what behaviors will be reduced. It’s critical to avoid a heavy hand with that control, and to provide multiple opportunities for client choice. Avoid cookie-cutter programming that has Program A for hyperactivity, Program B for social deficits, etc., as these types of treatment act as if all the clients are the same.

Ask yourself does the target behavior cause harm to the child or others, does it interfere with learning, or does it cause (harmful) social stigma. I emphasize harmful social stigma, because all of us experience social stigma to some degree, at some point in our lives.

Think about some of the behaviors you have: Do you get angry at your spouse and furiously stew in your anger for days instead of talking it out? Do you have difficulty sharing your belongings? Do you sometimes fail to eat all your vegetables?  Do you leave dirty dishes in the sink when you go to bed? What if someone decided these behaviors were “maladaptive”, and implemented an intervention to modify your behavior? I bet if someone were writing your behavior plan, you'd definitely want to give your input.


*Recommended Reading: “Burden of Choice
 

Thursday, May 1, 2014

D.I.Y. ABA






Since the birth of my blog, I have consistently received emails from parents and caregivers all over the world who do not have access to an energetic team of ABA professionals, don’t have ABA agencies/schools in their area, or can’t afford to pay for ABA therapy. These parents inevitably want to know “How can I do this ABA thing??”
.

As I have stated on my blog before, research clearly and consistently demonstrates that in the best case scenarios about ½ of the kiddos with Autism who receive quality ABA from an early age will go on to achieve typical functioning across adaptive, play, social, and academic domains. Even for that other 50% who do not achieve typical functioning, they make large, substantial gains compared to the kiddos who receive no ABA.

What does ABA look like in the best case scenario? Well, here is a free resource  describing what an excellent quality ABA program looks like. To briefly summarize, a quality ABA intervention program should:

 Involve the parents and family, be individualized to the client, cover a wide array of targets/skills, include a combination of skill acquisition and behavior management, have consistency across environments, have a trained and knowledgeable supervisor, have energetic and effectively trained direct staff, and be provided at a high enough intensity for learning to occur.

The sad truth is not every child has realistic access to quality ABA programs, for a variety of reasons. That doesn’t mean the child doesn’t NEED ABA, or wouldn’t benefit greatly from ABA, it just means they don’t receive it.

So to those parents and caregivers, my advice is to DIY: Do It Yourself.
Empower yourself and help your child at the same time. Would it be great if everyone had quality ABA treatment options? Of course! But if that isn’t a reality for you, please don’t feel as if all hope is lost. I dont think a systematic and intensive treatment method like DTT is realistic for a parent to implement (with no professional help) but methodologies like Incidental Teaching could easily be incorporated into the day of a busy parent.

Here are my brief guidelines for how parents can work with their own kiddos:

  1. Do your research:  Become knowledgeable about Autism, Behavior Management, and ABA strategies (such as Prompting & Task Analysis). The more you learn through trainings, webinars, books, or research articles, the better you will be able to help your child. Much of the information available to professionals is not restricted, anyone can access it.
  2. Learn how to collect ABC data: Antecedent-Behavior-Consequence data is very helpful for intervening on behaviors. Problem behaviors impede learning. In order to teach your child skills, it is critical to decrease maladaptive behaviors. In the absence of a professional, a fundamental knowledge of the functions of behavior, and reinforcement  & punishment  will empower a caregiver to confidently handle problem behaviors.
  3. Focus on teachable opportunities: Look for moments throughout each day where your child spontaneously communicates with you, gives eye contact, approaches a peer, etc. Work on capturing and expanding upon those moments, to teach a variety of skills such as imitation, language, turntaking, etc.  I do this all the time by narrating the action and treating babble as conversation.  When my nonverbal kiddos give me eye contact, I smile, wave and greet them. When they babble around me, I respond back while describing what they are doing “Oh, I see you are playing with blocks. Look, you have a red one, and a blue one….”. Throughout the day look for these moments and picture them as a piece of bubble gum that you want to stre-t-t-t-tch out as long as you possibly can.
  4. Embed learning into your child’s day: The opposite of capturing those teachable moments is knowing how to contrive an opportunity to teach. Most parents don’t realize just how many little moments in the day can be turned into an opportunity to teach. When giving your child breakfast, work on self help skills (pouring the milk), language (“I want cereal”), or fine motor skills (independently using a spoon), just in one 20 minute meal.
  5. At a minimum, understand Differential Reinforcement of Alternative Behavior: I like to tell parents “When in doubt, act like you didn’t see it”. When new behaviors pop up and you don’t quite know what to do or why it’s happening, a good rule of thumb is to starve the behavior you don’t want and feed the behavior you do want. That may look like turning your head and ignoring your child when they start throwing peas at the dinner table, and providing immediate attention and eye contact when they eat their garlic stick. DRA is a quick and easy strategy to implement for busy parents, especially if you have other children to attend to as well. Save your attention, words, and eye contact for the behaviors you want to see increase. Then think about a replacement behavior. For example, when your child goes to throw peas, remind them they can sign “All done” if they are done eating.

*Recommend Resources:





Thursday, April 24, 2014

Preventing Burnout





That dreaded word: Burnout

Burnout is very real in this field, and is common among social service occupations in general.
The work that we do, while extremely rewarding, can also be challenging, frustrating, disappointing, and sometimes dangerous (such as with aggressive clients). Since we are all only human, we are not immune to burnout.

Staff who are experiencing burnout are sloppy at their work, they make careless mistakes, they “go through the motions” without actually trying to connect with their clients, or they are snippy and irritable where they should be patient and persistent.

Sometimes you can’t tell when you are burned out on a client, or on a job, and may think you are just temporarily tired, overwhelmed, or stressed. It’s important to regularly monitor and assess your emotional state, because you won’t be an effective professional when you are experiencing burnout and you also won’t draw satisfaction and joy from your work. Ideally, management/supervisors will be monitoring staff for signs and indications of burnout, and/or creating systems intended to minimize burnout (such as small caseloads). However, I recommend assessing yourself on a regular basis to be sure you aren't experiencing burnout.

I have learned over the years to monitor my own emotional state to make sure I am far away from reaching burnout levels. I know when to decline clients or refer out, I know when to seek out help or feedback from my colleagues, and I know how to maintain a healthy life/work balance…..but I didn’t start out in this field knowing all of that.

So what are some classic signs of Burnout?

  • Not wanting to go to work, constantly calling in or arriving late
  • Feeling constantly overwhelmed and/or chaotic at work
  • Feeling ill-equipped to perform your job, feeling like you don’t know what you are doing
  • Feeling that you aren’t making a difference….your job doesn’t “matter”
  • Being constantly annoyed or aggravated by your clients/co-workers
  • Productivity decreases…it takes you several minutes to start a task or you find it difficult to stay on task

Knowing yourself and your own preferences or needs as a professional will help you carve out a niche that works for you. Being mismatched in your career is an almost guaranteed way to rapidly slide into burnout. Let’s say I love working with adults in residential settings, but then I take a position working in a K-2 Autism classroom. See what a mismatch that is? I’m not doing what my preference is, I am not working within my skill set, and I may not enjoy my work. I would feel a lack of professional autonomy, or that I am not in control of my career and doing what I want to do. Over time, I may begin to feel that I hate my job……I dislike my clients……or what I do doesn’t matter anyway. These are all classic signs of burnout.

So what can be done to prevent the dreaded Burnout? Lots of things!

  1. Active parental involvement- I will continue to say this over and over on my blog, because it is so critical. When staff are working hard to bring about lasting behavior change in a client, only to have successes derailed or see gains disappear due to no parental carry over, that can be an extremely frustrating feeling. Staff can quickly grow to feel as if they are building sand castles on the shore, if after their session is over no one else is requiring the child to talk, to use the bathroom, to share with their siblings, etc.
  2. Supervision & Support- All ABA professionals need support, including BCBA’s. Having a few colleagues you can go to for venting purposes or to pick their brains is so important. Lack of quality and regular supervision is one of the biggest indicators I see that leads to staff burnout. ABA direct staff absolutely needs an experienced supervisor working with them to make sure they have the support and resources they need to do their job effectively.
  3. Effective training- This is probably the 2nd biggest issue I see that leads to staff burnout. When staff are quickly hired, thrown into the field, and given minimal ongoing supervision, they have no confidence in their abilities/skills. Lack of confidence leads to low job satisfaction, because no one wants to feel like they are bad at their job. Effective training is empowering. It makes people feel better equipped to do their job.
  4. Recognize your area(s) of expertise- This is something I definitely grew to learn over time, but knowing your ideal work setting and ideal client will increase job satisfaction. Not everyone enjoys working with small children. Not everyone enjoys working with high functioning teens. Working within your area of expertise doesn’t just help you to provide the best quality of service; it keeps you enjoying your work.
  5. Low pay- Ask for the level of pay that you need to support yourself, and your family. I see so many new ABA therapists accepting pay rates that are far below what they need, for fear of not being able to find something better. You have to know how to sell yourself in an interview and demonstrate competency in your work, which can often lead management to agree to higher pay rates. ABA therapy can be a physically and emotionally draining job. If on top of that you also can’t pay your bills… that’s a sure recipe for burnout.
  6. Toxic work environment- A toxic or negative work environment will severely impact how much you enjoy your work. I have had past experiences of working with verbally abusive families, or egotistical supervisors, and it really made me dislike my job. I had to be mature enough to realize that I can’t function properly in a toxic environment. If there is consistent dysfunction in your work place, it may be time to leave.
  7. Inconsistent management expectations/client expectations- When the supervisor or family you are working with are constantly demanding more and more of you, yet never satisfied with the work you are putting out, that’s a quick way to slide into burnout. It’s frustrating and defeating to feel that you can’t please someone no matter what you do.
  8. Poor or NO data collection- Some therapists don’t realize this, but consistent data collection can actually serve as positive reinforcement. You may FEEL like the child is not improving, or that what you are doing is not effective but when you can see on a data sheet or graph that small successes are happening, that can be a huge source of motivation. If your client used to scream for 11 minutes and now they scream for 9 minutes, that is progress. Clearly something that you are doing is working, and is having an impact on the problem behavior. I also personally recommend collecting data when dealing with resistant or uninvolved parents. This has helped me immensely in the past. If a parent who used to only respond to my emails 25% of the time now starts responding to my emails 45% of the time that could really make me feel increased job satisfaction. Sometimes little successes are all you have, and they can keep you from feeling defeated.


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