Oh my(!), .....you all have lots of questions :-)

I say this often to my staff, but I always feel like if 1 or 2 people are asking me something, its likely tons of people want to ask but just haven't yet for some reason. It's like being in a group training and no one wants to raise their hand first and say "I don't understand".

This massive, super- sized post will compile ALL of my FAQ posts and hopefully serve as a one stop shop. If you can't find your question answered here, then something is wrong with you (I'm totally kidding).

The FAQ posts below include great questions I receive from both parents and professionals. Let these FAQ posts help clear up some of those burning ABA related questions that you have pondered over, but never actually asked anyone about. OR, unfortunately you did ask someone but just didn't receive an adequate answer.

Dig in, I hope its helpful!

FAQ Parts I, II, and III
FAQ: Common Questions Parents Ask when Initiating ABA Therapy
FAQ: Massive Super Hero Post (questions about entering this field)
FAQ: Post - BCBA Supervisor Tips
FAQ: Tips for the BACB exam
FAQ: What IS ABA, After the Diagnosis...Now What?

Photo source: www.pinterest.com, https://www.yorktheatreroyal.co.uk    

Therapy sessions "on the moon" will mean something different based on where you regularly work.
For me, my bread and butter is in- home services. I feel like I have been doing that since the Roaring 20's. 😉

So for ME, what pushes me outside of my comfort zone and makes me feel overwhelmed is when I go into community or school settings to work with my learners, because its a wildly different environment than what I am used to. But this could easily be a vice versa situation for someone else, if they have never worked in home.
Real life example- I have lots of hilarious conversations like this with direct staff all the time:

Therapist: "Tameika, I have a problem! I showed up for the therapy session today and the entire extended family was in town visiting and the therapy materials were scattered all over the house, they got a new dog and it peed on my shoe, and there were workmen repairing the roof and I could barely hear myself talk"

My response: "Okay...so whats the problem?"

Due to my experiences, I have in my mind what is typical of working inside peoples homes and over the years I have learned how to think on my feet, and throw out plan A and grab desperately at Plan B. I do it on auto-pilot at this point. However, if you plop me down inside a chaotic daycare, or a circus-like grade 2 classroom, or an outing with my client to a crowded Six Flags, I may not be quite so cool and collected.

It's all about perspective, really.

To properly prepare staff for their role, its important to consider what their idea of "normal" is. If they are coming from a center based background, their first school based client will be a very interesting experience. Or if they have only ever worked in residential settings with adults, teaching Color ID to a tantrumming 3 year old will be kind of like...Therapy on the Moon. It will be so far outside their comfort zone and practical knowledge base as to make them feel overwhelmed, inept, and a nervous wreck.

I work with many direct staff who have an extensive background of doing one kind of thing. So while they may be amazing at doing X, if you just throw them into Y without prior preparation, it likely won't go well.

What's that you asked? How can we better equip staff to perform their job with excellence across settings?
Well I will tell you!

  1. Discuss the setting in advance, and review potential land-mines: Step 1 will definitely involve knowing the setting (which may require reconnaissance in advance by the BCBA), so the staff can get a quick rundown of what to expect from the setting. If its a classroom, how many teachers are there? How many students? Whats the daily schedule? Can we use classroom supplies or do we need to bring our own? Can we deliver tangible reinforcers inside the classroom? Can we pull the learner out for 1:1 time? How does the school feel about us going in? Do they understand how we will manage problem behavior (typically *but not always* this means we will NOT remove our client from the room just because they escalate/kick off a tantrum).
  2. Help the staff find similarities, as well as critical differences: How will data collection differ because of the environment? How will DTT time differ because of the environment? If the parents will not be present in this setting, how will the direct staff include them in treatment goals/progress? BUT, what is still the same regardless of the environment? Something I really like to drill into my staff is to finish (or return to) a teaching trial, no matter what. So if the fire alarm goes off, finish the trial. If a younger sibling runs off with your data sheet, finish the trial. If Big Bird walks in and starts passing out cookies....you know what to do.
  3. Set up the environment for success (as best you can): This will take pre-planning, and collaboration with the powers- that- be at the new environment. If a classroom, is it ok for you to store therapy materials? Or do you need to bring those with you every day? If in home, do the parents know you need a set aside area to keep the program binder, flashcards, etc.? If a community setting, have you thought about a discreet way to carry reinforcers around? Where is the nearest bathroom located? What about distracting room features (like a huge window that looks onto the playground)?
  4. Promote and Praise creative thinkers: The reality is, the direct staff will spend more time in this setting by themselves than they will with their supervisor. So its critical that they have the freedom to think through problems as they pop up, disregard non ideal options, and choose an action step. Praise, and heavily model this creative thinking process for the staff. Teach them that yes, there is an action plan, but sometimes for unforeseen reasons that plan will need to be discarded. And then what? Well, then you quickly think on your feet based on your clinical knowledge, and what treatment goals are being targeted.
  5. Play Nicely: The last tip is to approach the powers -that- be with an attitude of respect and collaboration. They may not have the ABA knowledge you have, they may not fully understand your role, and they also could have different goals for the learner than you have. Maybe you are targeting problem behavior, but their main focus is on language. Or vice versa. Your role in this new environment is also part ambassador. Be sure to carry yourself professionally and ethically, and to let it be clear you are always available to offer assistance or strategies, but you also are not there to step on any toes. Its a delicate dance, and a fine line to walk, but it does get easier with practice.
Photo source: www.thethingswesay.com

So many times in this ABA universe when we talk about CHOICE, we always talk about the individual receiving treatment. The student, client, child, etc.
What about our choices? How much in a typical day do you think about the impact your choices have on the behavior of the consumers you treat, or the children you are raising?

When I first meet new families, a common misconception I enjoy correcting is the idea that the child is completely "out of control". I hear statements like, "Well he can't help it, he has Autism", or "We know it will probably always be like this, but do you think there is any hope she might get better?". Statements like that come from a belief that problem behaviors don't involve choice, which leads to the next belief that as caregivers or treatment providers we are powerless to change behavior. Well clearly that can't be true, or there would be a lot of ABA practitioners standing on street corners with "Will write Behavior Plan for food" signs. ;-)

When you understand that your choices impact your child's choices, or your choices impact your client's choices, it opens up a dizzying amount of possibilities and potential outcomes. So make wise choices today, that will benefit you tomorrow.

*Recommended Reading: The Burden of Choice

Photo source : www.thirtyhandmadedays.com, www.journeyofmylifendestiny.blogspot.com 

*Recommended post-- Writing ABA Programs

My last post on programming was really for professionals, but this one should help parents/caregivers understand the "why" and "how" of teaching new skills.

Typically with ABA treatment, intake/assessment is followed by treatment planning, which is followed by creating individualized programs, which is followed by teaching those selected programs. What's a program you ask? Basically, a program is what is being taught to the learner. If your child is receiving ABA services, they probably work on multiple programs every single therapy session.

I find that most parents/caregivers have a very vague understanding of what their child is working on and why, and how skills connect to each other. Due to this lack of understanding, some common problems that can arise include:
  • Expecting the ABA team to teach your child everything, all at the same time
  • Expecting skills to be taught in a matter of days
  • Parent gives little to no input on treatment planning/can't think of anything they want to work on
  • Confusing a "Program" with a "Target"
These are the main problems I see, although there are many more that can pop up when parents don't understand how the teaching part of ABA therapy works (yes, ABA is far more than behavior reduction!).

I always recommend to parents to ask questions, observe therapy sessions, utilize the BCBA, and review/look at the data regularly. These components are like the blueprint of the building, or anatomy of the cells of your child's treatment. If you are confused about the services your child receives, I would ask: how regularly are you viewing that blueprint? How involved are you with the anatomy of it? It took the staff and BCBA on the case extensive training, years of experience, and college coursework to have a solid understanding of what they are doing. How much harder do you think it will be for YOU to understand what they are doing?

I love to remove confusion (just call me Confusion Off) so let's address each of the common problems I see, one at a time:

  • Expecting the ABA team to teach your child everything, all at the same time - Definitely the biggest misconception I see. Intake/assessment is usually the point where the BCBA discusses goals for treatment with you. From the assessment results and this conversation, the BCBA will prioritize goals based on a variety of factors such as: goals that can replace current problem behavior, goals that are needed for daily functioning, goals that address the most pervasive developmental delays, etc. What this means in plain English is we cannot teach everything, all at the same time. It's just not possible. Plus your child would hate that. The reality is other non- clinical factors must be considered too, such as how available is the child for therapy, how many hours of therapy a week can the family afford, how many hours of therapy a week can the ABA therapist provide, etc.. When you add up all these factors and weigh the highest priority goals, this does mean that some skills may not be targeted right away. Your suggestions to keep adding new goals are not being ignored, it's likely that the things you want to add are not priority, the child already has the maximum number of goals for the moment, or new goals won't be added until performance improves.
  • Expecting skills to be taught in a matter of days - When you start climbing a ladder, do you put your foot on the 5th rung? No, right? Teaching is very similar to that. When teaching a new skill, there is this thing called a "pre-requisite skill". This means there is something the child needs to be able to do before they can move on to more complex or advanced skills. For example, many play skills require the ability to imitate. Why? Well, if I am trying to teach a young child to play with a Barbie doll I am going to do this by sitting down with them.....and playing with a Barbie doll. I know, this is complicated stuff :-) But what happens if while I am enthusiastically playing, the child just stares up at the ceiling and drops their doll? The child needs to be able to watch my play and imitate it, in order for me to teach them to play on their own. So before I can tackle play skills, I first need to work on teaching imitation. Much of ABA treatment involves these kind of careful ladder steps. We have to work our way up that ladder, which depending on the learner can take days, weeks, or even months. But its super unrealistic to assume the learner will just fly through learning new skills. Expect it to take time.
  • Parent gives little to no input on treatment planning/can't think of anything they want to work on - This may sound like it would never happen, but it absolutely does. A parent initiates ABA services, and during the intake makes statements like "I just want him to be normal", "I'm fine with whatever you think we should focus on", or "I just want her to be happy". Unfortunately, I don't have any curriculum for teaching "normal" or "happy". So in these kinds of situations what can happen is the ABA team puts together a treatment plan that is not functional for the learner. For example, the BCBA may decide the child should work on manners to improve their social skills. However the family isn't big on manners, and this is not an important goal to them. So when the ABA team is not around, who is practicing manners with the child and reinforcing this skill? Likely nobody. Which means the skill won't progress, and it probably won't  generalize. Think of the ABA team like a group of painters showing up to your home. We have our coveralls on, our paint, and our paintbrushes. But...what exactly do you want us to paint??
  • Confusing a "Program" with a "Target" - "I told you I wanted him to learn his body parts, why is he just playing with a Mr Potato Head toy?". If I did not have the knowledge I have, I would find much of what the ABA team does highly confusing.  It looks like we teach random flashcards, meaningless games, and senseless activities over and over again, that have nothing to do with the reasons parents initiated therapy. This could not be more inaccurate. Every "program" is like a menu at a restaurant. You open the menu because you want something to eat or drink. But you can't tell the waitress "I want to eat". You need to be more specific. So you read over the menu and see the hamburger section. But you can't tell the waitress "I want a hamburger". You need to be more specific. So you choose the exact hamburger, and the exact toppings and tell the waitress "I want a hamburger-well done- with no onions and extra cheese". Make sense? Bringing it back to ABA treatment: menu= overall objective, hamburger= program, specific hamburger= target. When a parent says to me "I want him to play with his brother". What I hear is "I want him to improve his social skills", which means breaking that down to improving and reducing behaviors, which means breaking that down to first learning to play with me, then learning to play with me and a peer, then learning to play with just a peer. Whew. Designing treatment is not quick, or simple. Rest assured, the issues you initially discussed with the BCBA are being worked toward, but we have to break the skill apart in order to teach it.

With any child, there will be skills that come easy and skills they struggle to learn. There will be things they should be able to do but cannot, and other things they do super early or super easily. Thats just part of being a human. It will drive you crazy if you look at your child with Autism as a collection of deficits and "not there yet's", and it will also cause you to overlook all the progress they are making right now.
Take time to appreciate those baby steps, sometimes baby steps are all we have.

*Free Resource: This simple handout helps explains common program names many BCBA's use (what the program is supposed to teach).

Photo source: www.giphy.com

*Recommended Post- The Basics: Operant Conditioning

Much of what I do does not involve teaching complicated, advanced level behavior analytic concepts to families/caregivers or educators. No, most of what I spend my time doing is simply explaining "basic" concepts over and over again. I say these concepts are "basic", because if they really were so basic would so many people not know them??? Hmmm, I think not.

One of these basic concepts is the idea of RESPONDING vs. REACTING.
Most of the common errors I see across clients, happen when a teacher or a parent quickly react to something my client is doing instead of going into robot-mode to properly respond.

What's robot-mode? I'll tell you: it's that moment where time seems to freeze and outwardly the ABA practitioner goes stone faced, stops talking, quiets their body language, gets near or away from the client (depending on what is happening), and appears to be not a tiny ounce affected by what the client is doing. The pros make it look easy, don't they?

Well, inwardly, that practitioner is thinking hard and fast. They are scanning the room to weigh potential dangers, they are automatically thinking of what they will do if the behavior escalates, they are reminding themselves what the last demand was (so they can return to it as soon as feasible), they are doing a mini-FBA to think about what led to this behavior, etc. And watching the practitioner work, it probably looks like none of this is happening. I've actually had parents comment on that before, something close to "I can't do what you all do, I can't just SIT THERE while my child is tantrumming". Oh believe me, we are not just "sitting there".

That's why I call it robot-mode....the outside is objective and mechanical and the inside is a  computer clicking along at high speed. It took me time+ time+ time to get to the point where I could do this as quickly as those amazing supervisors who were teaching me to do this. Especially if the client has a good handful of your hair, or skin, or clothes.

To put it simply, when we react to something we are usually going in emotions-first. When we respond to something we are usually going in logic- first. I have tested this theory out a bit by asking parents in the moment "Ok, now why did you just do that?" and they usually say something like "...I don't know/I wanted him/her to stop". *see note on this below
 If you ask the ABA practitioner (which I recommend) why they are doing what they are doing, there is a technique or strategy they can describe to you, with the overall goal always being to teach. This could be teaching replacement behaviors, teaching communication, teaching the child problem behavior does not = escape, etc. Responding is a thoughtful process where you generate ideas, evaluate your idea, consider the consequence of your idea, and then act.

*Note: I explained this in my Punishment post, but when people tend to emotionally react to problem behavior it is often in a highly punitive manner, or with the goal to just stop the behavior. Little thought may be given to teaching new behavior. Just another reason it is so important to be intentional about behavior change, and manage your own behavior before you try to intervene on your child's behavior. If your child gets frustrated and yells, so then YOU get frustrated and yell....what did they just learn?

Photo source: www.myuntangledlife.com, www.cultureofyes.com, www.cozylittlehouse.com

In a typical day as a BCBA working in the field, multitasking will be a very close friend. I you don't possess the skill of being able to supervise staff, carry on a conversation with a parent, write up a progress note, and open a container of blocks for the client all at the same time...then you should probably work on getting there.

It doesn't happen overnight, but with practice, diligence, and lots of organization----> you CAN be perfect.
Okay, not really :-) You won't be perfect, but you will be able to get an amazing amount of things done in short periods of time. And if there's one thing BCBA's have in limited commodity, it's time.

Over the years, I have learned this skillset the easy way and the hard way. I have watched and learned from other BCBA's that I admire, and definitely had some trial and error situations that didn't go so well.

Below are some of my top tips or strategies I regularly use to maintain my sanity, starting off with my absolute must haves: The Top 3.


* Know your limits and set your boundaries, or other people will constantly test your limits and push your boundaries
*Set working hours (I am including all the work you do at home for free) and stick to them
*Delegate whenever you can, to appropriately qualified individuals. You won't get a glittery cape for trying to be Superman/Superwoman, just a tension headache

  • Calendar/Scheduling: Keep a copy of your schedule in whatever format is easiest for you. I use an oversized wall calendar, but I also store my schedule electronically in case I need to update it on the fly. As much as you can, schedule things in advance. I usually schedule out a month at a time and I block out certain days each month as "catch up" days. This is where I turn off the phone and focus on paperwork, or if I need to schedule something out of the ordinary (like meeting a client's new speech therapist), then I always have free spots to do so.
  • Traveling Office: Formerly known as your car. Make sure when you head out for the work day that you have your car loaded up with any odds and ends you or your staff may need, such as extra pens, extra data sheets, supervision notes, clipboards, etc. I also carry a large therapy bag, which is loaded with my clipboard and feedback forms, pens, post its, highlighters, etc. 
  • Make a Supervision Binder: This is one of those tips I had to get from trial and error. It changed everything once I put it in place. Make a binder where you store all client information and important documents, such as: a map of the area (I found this most helpful when I was working in new states), client contact information, each client's schedule, recent notes for each case, To Do list for yourself, client school/daycare calendars, progress report due dates, etc. Put your supervision binder in your huge therapy bag, and carry it with you from one client to the next.
  • The To Do List: I make To Do lists of things to add to my To Do list. That is how much I love having a checklist. Before heading out for supervision sessions, make a To Do list for each client. This will help keep you on track once you are there with the client, the parent, and the staff. New things will pop up (of course), but get in the habit of saying "We can talk about that in just a second, but first let me run through this checklist". This was one of the best timesavers for me, and it helps me fully optimize my face to face time with the client when everyone is pulling me in 10 different directions.
  • Get a Nice Clipboard & Make Your Own Data Sheets: This one is the most helpful for going into schools or in the community. Places where you can't drag your huge therapy bag behind you. What I used to do is write copious notes on 50 little pieces of paper, carry that around with me, and then have the fun task of wading through that when I got home. What I do NOW, is I have a clipboard that I can store things inside. Especially when visiting a new school, always bring your ID/employee badge just in case they ask for it (stick that inside the clipboard, along with your keys and a few pens/pencils). Make simple data sheets instead of using large amounts of paper. This keeps your hands relatively free, keeps you from awkwardly asking where you can put your purse/bag, and when you don't need to take notes just tuck your clipboard under your arm, have a seat, and observe your client.
  • The Home Office: Your home work space needs to be neat, free of clutter, and use a storage system that makes sense for you. For me, I keep all my learning resources together, I keep my client files together, I keep my assessment kits together, etc. Everything has its own tub, and is labeled by category. Then inside each tub, items are stored in baggies and documents are stored in file folders. I use a similar system for my computer files, everything is divided up by category. I have categories for general resources, for insurance/billing, for employer required forms/data sheets, and each client has their own file system with identical subfolders. This way when I move quickly in between various clients, each folder is set up the same way (saves lots of time when I need to find something quickly). I also insanely love templates. So I have Client Master File templates, Supervision Feedback Form templates, Parent Training Handout templates, ABC Data sheet templates....I will stop there because we'd be here all day. When I need something, I just open up a template and edit it depending on who it is for. Saves an amazing amount of time.
  • Give Up 1-2 Hours Each Night: This tip may not be as helpful for you, depending on your schedule and how many clients you see in a day. For me, I don't see more than a few clients a day. What that usually means is I work a few hours and then I am done. Once I get home, I pull out my supervision binder, flip to each client's section, and I am looking for: program changes I need to make, reminders/emails I need to send to the team, data I need to transfer to my computer, materials that need to be purchased or made, etc. I plan this time into my schedule, and do not consider my work day done until this is completed. By adding this step, I avoid getting to the middle of my work week and staying up all night catching up on things I didn't get done earlier in the week. Or worse, spending all weekend furiously updating programs or revising data sheets before I go see the client again the next week. This was such a timesaver for me! I don't work in an office setting, but this is the equivalent of not leaving the office for the day until your desk is clear ;-)

 As your work experience and confidence grow, you will learn how you work best and what level of organization you need to stay sane. More than just the stress that comes from chaos though, its important that you as the BCBA are on top of things because ....well, everyone else on the team is expecting you to be! You are the one who is expected to remember everything, always have copies with you, and update everyone of important treatment changes. It helps to fulfill that role when you develop a system, and stick to the system.

**Resource: Some nice ideas (complete with decorative photos) for staying organized as an ABA practitioner.

Photo source: ww.giphy.com, www.turning-point.org

“Well, the parents on this case are a bit….high maintenance
“You definitely need thick skin to work with this mother”
“You have experience dealing with…very involved parents right?”

If you're an ABA professional, then you probably know what I mean by the phrase “That Parent”. You have been warned about those kinds of families in hushed tones, or directly felt their wrath somewhere in your career experience.

Who loves honesty? Yup, me too. So let’s honestly describe what is meant by the hushed and frantic whispers about THAT parent. 

The parents are/A parent is:

  •  Difficult to please and/or very picky
  •  Quick to complain, criticize, belittle, or insult 
  • SUPER vocal, opinionated, and in-your-face assertive
  •  Overly involved in the therapy process
  •  Frequently talks over you, or talks for so long you forget the point you were going to make
  •  Demanding (if you don’t respond to their email fast enough they start texting you)
  •  Slow with praise or compliments
  •  If there is a chain of command, they never follow it. Any small grievance gets immediately reported to the top of the company 
  •  Habitually speaks in an agitated or annoyed tone of voice (always seems upset)

Is this description ringing any bells?  

Over the years, I’ve had multiple experiences dealing with THAT parent. Some experiences were very brief, usually because the parents abruptly stopped services. Other experiences seemed to stretch out like stars against the night sky, and every day with them felt like 1,000 years.

Back in the day I used to approach these types of parents with a queasy stomach, sweaty palms, and a lovely tension headache whenever I was in their presence. They made me nervous, made me stammer over my words, or worse, left me angrily rehearsing unspoken conversations in my head of what I should have said, or how I should have responded. And of course, nothing like THAT parent to make you feel wholly incompetent and like a disgrace to your field.

Fast forward to today as I have a few things I didn’t have back then: perspective, increased maturity, and a munchkin of my own. As a munchkin wrangler, do I now understand what it’s like to be a 24-7 advocate for a child with Autism? No. Do I know what it’s like to navigate IEP’s, special education laws, inclusion classrooms, and the like? No. Have I nearly gone into bankruptcy trying to get my little one all the therapies she needs that insurance *coincidentally* won’t cover? Nope. BUT, I can only imagine what going through all of that might do to my awesome, bubbly personality. ;-)

And now we have reached my point: There is nothing wrong with being THAT parent. Not only is there nothing wrong with it, we ALL have the potential to be That parent when it comes to our children.

Even the most sweet, gentle, Happy Happy-Joy Joy parents that I work with have stories to tell me about that “one time” they acted like THAT parent. They ashamedly, or with clearly false bravado, tell me about the time they yelled at their child’s teacher, said the F word in an IEP meeting, or made the ABA therapist cry. 

For the most part, THAT parent doesn’t enjoy behaving the way they sometimes behave. They are not out to get you, and do not actually despise you. They are not intentionally trying to make your job harder, trying to get you fired, or trying to make you look bad. Actually it’s the opposite: they are more concerned about their child than about you.
 If fighting for what their child needs means you get yanked off a case, or receive regular 2 a.m. emails from them, or you have to spend 4 hours rewriting the behavior plan they didn’t like, then so be it. 

When dealing with THAT parent, it’s helpful to take a step back and switch out THAT for This:

  • This parent did not ask to be in the position they are in
  •  This parent may lack a strong support system that also gives them honest feedback on their behavior 
  •  This parent may be having marriage problems
  •  This parent may be dealing with emotional or mental health issues
  •  This parent may still be carrying guilt about previous experiences where they did NOT speak up
  • This parent may feel resentful that you can help their child in ways that they can’t
  • This parent may not have slept in days because they stay up nights worrying about their child’s future

My advice for navigating the choppy waters around THAT parent is to choose empathy over offense, to tackle problems/conflict head on and respectfully, and to know when to back off. By “back off”, I mean know when to say “Well then I can’t help you”. 

Part of being an ethical professional is being able to assess when you are not adding value to someone’s situation. If the working relationship has become more about misunderstandings and heated conversations, then how is that helping the individual receiving services? It really has nothing to do with someone being THAT parent: if what you bring to the table is not seen as valuable to the parents/family, then get out of the way for someone else who could potentially be a better fit.

Photo source: http://cogop.org, http://www.babasouk.ca

So excited to introduce a new resource, this one is targeted specifically to parents pursuing ABA therapy for their child.

I regularly talk with people who are seeking ABA therapists, have questions about what ABA therapy entails, or have been waiting and waiting for therapy services to begin and are curious if they should be doing something while waiting (the answer to that is always yes).

Since I am so incredibly brilliant, it only took a few hundred times of this happening before it occurred to me that perhaps creating a parent resource aimed at answering the most common questions would be helpful? Yes. I think it will be quite helpful.

If you are a parent currently in some stage of pursuing ABA therapy, this resource will help you:
  • Finally get a straight and simple answer about what ABA therapy is
  • Learn what to do about problem behavior, right now
  • Learn how to help your child catch up developmentally, right now
  • Identify (and avoid) the low quality or unethical therapy providers out there
  • Increase your understanding of ABA & "ABA speak", in preparation for working with a team of ABA professionals

However, this resource won't just help parents. For my fellow ABA professionals, this resource can help you:
  • Design/implement a parent training or parent resource to give to families currently on your waiting list
  • Identify the top questions or concerns most parents have when initiating ABA therapy
  • Clearly and plainly teach parents about Behavior Management, and Skill Acquisition

Click here to visit my Shop and purchase this new resource!

Photo source: www.peacefulplaygrounds.com, www.speechbuddy.com

 Here is a scenario I encounter on a regular basis with the clients I serve:
After receiving a diagnosis of ASD the parents receive a list of recommendations about what to do next. Things like speech therapy, occupational therapy, special needs school settings, and early intervention/ABA therapy are almost always on that list.

Invariably, there is a small problem. Due to the intensive nature of ABA therapy (especially if its provided in an early intervention context) the parent soon realizes they have to make a choice. Should the child be enrolled in a local preschool? Or should the child receive several hours of therapy per day? Which one is “best”?

I see so many parents facing this dilemma, without the needed information to make a decision. Obviously no matter what they choose there will be pros and cons, but I like to help people make informed decisions as much as possible. So if you were my client, what follows is what I would typically say :-)

  1. Is it really Either/Or? – I have worked with families who were able to enroll their child into a part time preschool setting, which allowed for plenty of time each week for therapy. I have also seen many scenarios where the preschool/daycare allowed the therapists to enter the classroom, to fully maximize therapy hours. So before moving straight to making a choice, find out if a compromise is possible.
  2. Pros of preschool/daycare option- The main benefit of placing a child with a developmental delay in a setting with their peers, is socio-emotional development. The child is learning to socialize with peers, seeing how typically developing children play/talk/behave, and learning to receive instruction from adults other than mom and dad. For many of my clients, the daycare/preschool setting is also their first experience with following a schedule/having routine in their day. However, the biggest issue I see is the appropriateness of the preschool setting. If the setting is not conducive to catching the child up developmentally, then it’s pretty similar to just sticking a plant in a room full of toddlers.
  3. Pros of intensive therapy option- The main benefit of pursuing intensive therapy  (intensive usually means 20 hours per week or more) is overall development and skill acquisition. Pursuing a rigorous therapy schedule means that the core deficits the child is exhibiting will be clinically evaluated and treated, as well as reducing or replacing problem behaviors that impede learning. Also, part of intensive therapy is parent training, which is priceless for most families. Having a team of professionals help you learn how to better engage, teach, or correct the behavior of your child can be life- changing. However, working with a therapist 1:1 cannot compare with the social opportunities provided in a classroom. While social opportunities can be embedded into treatment, often it’s not as varied or frequent as what the child would get at school. Add to that, many of my clients just feel very strongly that they want their child to have the same option of a school experience as any other child.

Clearly, this isn’t a decision to make lightly. 
With different clients, I give different recommendations about which option would be “best”. There is no way to make a blanket statement about what all young children with Autism need the most, as far as treatment.

Making this decision should involve the child’s treatment team, include observation of the classroom the child would be placed in, as well as careful review of the yearly learning objectives for that classroom. 
By the end of the year, what skills will the child have gained? How will skills be taught? Does the classroom teacher have experience/training on ASD or behavior management? What is the school policy on addressing challenging behavior? These are just a few examples of the kind of questions the preschool/daycare should be able to answer.

*Free Resource: This simple handout can be very helpful to evaluate your local preschool options and decide if they can offer the support your child needs. Unfortunately, you may find that your local options are severely lacking or inadequate. In that case, intensive therapy may need to be pursued. Placing a developmentally delayed child in a school setting that cannot appropriately support them could waste precious time, or possibly worsen/create challenging behaviors.

Photo source: www.pinterest.com, http://blog.kevineikenberry.com

*Recommended Post: 3 Step Prompting

This post is really about 2 issues, but I almost always see them done at the same time: stating instructions over and over, and delivering utterly non-concise instructions.

There is almost a quizzical cause and effect thing going on, where the more times the parent delivers the instruction to the child the more and more unclear the instruction becomes. I’ll give you an example:
(parent is trying to get child to touch a flashcard)-->“Okay Nicholas, touch the frog…..Come on, touch the frog….Hey—are you looking? Nicholas……Nicholas?....Nicholas!.....Nicholas, touch the frog…..Look, the green FROG right here……Just touch it…..” etc., etc.

I promise I am not exaggerating, I saw an exchange very similar to this just this week. These 2 issues that I will really boil down to 1 issue (stating non-concise instructions over and over), are extremely non- helpful whether your child has Autism or not.
An individual with communication delays (receptive or expressive) is not likely to respond well when instructions come at them too quickly, in a jumble of other words, or without any prompting to help them understand what they are supposed to do. Children with communication delays or impairments can struggle to comprehend language spoken to them, understand abstract words/terms, make inferences, read facial expressions, and respond appropriately to spoken language.

Since most of my client base consists of children with pervasive communication deficits, one of the first things I work on teaching parents is how to deliver a concise instruction. This seems like something that should be common knowledge, right? I disagree. I think most of what ABA professionals do is not common knowledge to the average parent, so it’s important to take the time to explain these concepts and strategies that we love to implement.

There are a few common objections that I almost always hear from a parent when we start working on this issue:
Objection #1- “But what if s/he didn’t hear me the first time?”
Objection #2-“But I KNOW s/he can do this, so I just keep asking”
Objection #3- “S/he doesn’t respond unless I yell/get “firm”.

My lovely rebuttals to these objections:
Rebuttal #1- Many of the families I work with tell me during our first meeting that they actually had their child’s hearing evaluated, because it truly seemed that the child had hearing loss. Definitely, make sure your child’s hearing is working normally. But lots of my clients can ignore people so well that it seems like something must be wrong with their ears (their ears are fine).
Rebuttal #2- How do I know what you know? By what you show me. If you show me inconsistent behavior, then I cannot say with certainty what you know. In the absence of consistency, I have to treat the behavior like an unlearned skill.
Rebuttal #3- I usually respond to this by reminding the parent that I don’t have to yell, get aggressive, or anything else like that to get their child to comply (and if I did, they should fire me immediately!). Do you think the child’s teacher has to yell? What about their nanny? What about their speech therapist? I hope not, because that’s a lot of yelling :-)  What this objection is actually saying, is that the child has been conditioned over time to know that mom/dad are not serious, and do not mean business unless they get angry and threatening. The goal is for the child to know you mean business wayyy before that point.

Now that you thoroughly understand how NOT to give instructions, let’s jump into what I mean by Show & Not Tell.

A little trick I like to teach to parents is that when they give an instruction, start a mental countdown clock. Example: “Tameika, go brush your teeth (1….2….3)”. Once the clock in your head has counted to 3, this means it’s time to move from Telling to Showing. Does that sound radical, impatient, or worse? How long do you think teachers give your child to respond? Or a friend on the playground? You don’t want to unrealistically teach your child that its ok to respond to a question the 4th or 5th time the person asks it.

Let me back up just a bit, and repeat the original instruction: “Tameika, go brush your teeth”. This is a concise instruction. It tells the child what to do using simple and clear words. Now that a full concise instruction has been given, there is no need to repeat it. That’s right, once you have given the concise instruction you want to only use less language. Why? You want to make it clear to the child that you do not have to repeat yourself, you know they heard you, and that ignoring instructions does not gain more of your attention. I know parents don’t intend to do this, but amping up your reaction after your child starts ignoring you is actually giving them WAY more attention for ignoring you, than for listening to you.

The next (and shorter) instruction should be combined with some type of prompt. Remember, inconsistently correct behavior is still inconsistent behavior. Show the child what they need to do, and don’t assume they already know.
You may have noticed something else about the Show & Not Tell: it’s faster. Have you ever used a timer or stopwatch to see how much of your day you spend telling your child to do something over and over? Well, I have. I do it at work all the time :-)  Most parents don’t realize how much time is wasted when each instruction is given 5 or 6 times before the child responds. Buckets and buckets of time. Do you have buckets and buckets of time to waste? I doubt it.

Want a handy -dandy example of all of this in motion? Here you go:

“Tameika, clean up these blocks”
Clear, simple language. Use the fewest words necessary for the child to understand. Gain their attention before you give the instruction. Once you say the instruction, start your mental clock.
(Approach the child and use some level of prompting to SHOW them what to do) “Clean up”
Remain cool and calm. Use less words than you did the first time. Move in quickly to provide assistance/a prompt. Assistance does not equal completely allowing the child to get out of following the instruction.
(Move quickly through the prompting to get the task completed. Make a brief and neutral statement at the end) “You cleaned up/This is cleaning up/All done with blocks”
Continue to remain cool and calm. Avoid lectures or reprimands about how the child does not listen. Use short, simple words. IF the child had complied right away they would have received praise and/or reinforcement, so at this point provide neither.


Kennedy Krieger Institute article about teaching ASD children
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