Sunday, January 8, 2017

Being a Big Meanie to Promote Language Acquisition





Photo source: www.quotesgram.com, www.toptenz.net

Yes, I admit it: I am a huge meanie who spends lots of time forcing small people to communicate. Yup, guilty.

When I am starting a new early intervention case, something I like to do is give my staff an “Early Learner Protocol”. Over the years I realized there are  so many important skills to teach and not enough hours in the day, so I wanted my staff to have a tangible understanding of the focus of intervention for the little ones. To summarize: reducing problem behavior and increasing imitation skills, play/socialization skills, and LANGUAGE are usually the main things we are intensively targeting with young clients.
I try to get staff and parents to understand that everything involved with working with early learners is all about Pushing. If you can grasp the concept of pushing, then you will do just fine as an ABA therapist for any young child.

Pushing could look like, “He manded for a sip of juice, lets try having him mand for a bite of cookie”, “She labeled 2 toys in the bath last night, lets push for 3 tonight”, “He waited 10 seconds before I opened up the pretzels, now I’ll push for 12 seconds”. See, push.


I remember the mother of the first client I ever worked with telling me that her son was perfectly content to allow me to do everything for him, if that is what I chose to do. I didn’t really believe her at the time, and thought to myself she was just too hard on him (she was just being a meanie). So what if he needed help putting his shoes on…every day. My job was to help him, right? Then there was the day I observed him with another ABA therapist and it went a bit like this:
Therapist- “Put your shoes on”
 Child- (promptly put his shoes on)

Imagine my shock :-)  After the shock faded then I just felt like a chump. I had been putting this child’s shoes on for weeks, and the entire time he was fully capable of doing it himself. Lesson learned!

To parents and new ABA staff, I know it feels like helping but it can actually be harmful if you neglect to push the child to learn new skills, dress themselves, talk, display manners, etc. It’s kind of like saying “Since this child has special needs, I’ll just lower my expectations”. You would never say that out of your mouth, right? Well then don’t say it with your actions.

When it comes to teaching/expanding on language, motivation is KEY. What motivates you and I to communicate with others may not at all be motivating for your child/client with Autism. Or let me put it like this, have you ever considered why the child should communicate? What do they get out of it? If they don’t communicate, is anything different? Does communicating make their life better somehow?

Here are some practical ways you can start to push more, to increase language, build independence, and teach skills. Many of these are things I do on a weekly basis across my clients.

  • When the child wants something (a toy, to watch a TV show, etc.) place a demand on getting it. Connect some form of communication to accessing the most preferred items, instead of giving them away for free.
  • Embed language trials into daily activities, such as eating breakfast, walking to the park, or getting dressed. As your child is getting dressed say , “Pick up the SHIRT/Give me your SHOES/Pull your shorts UP”. Repetition and prompting are how you get the child to respond to your language. I embed language into almost everything I do with an early learner.
  • Mimic and imitate the child’s sounds. This is also a great way to get spontaneous eye contact (my clients usually stare at me like I’m crazy), and this can become a fun social interaction. Sit or lay down near the child and make the same sounds they are making, including pitch, intonations, etc.
  • Look and sound like someone worth talking to. With my early learners, I smile big and keep animation in my facial expressions. Everything is a bit exaggerated. Talk a bit louder than usual, and lay the praise on super thick. If interacting with you is fun and exciting, the child will approach you more which just gives you more opportunities to push.
  • Don’t give up too fast on manding trials. This is a mistake I see all the time. The child wants something, so you withhold it and try to get a mand. Then the child cries, walks off, or stares blankly at you. This is totally normal, and doesn’t mean the child is confused. It could mean they don’t want to mand, or they just don’t want the item anymore. What it definitely should not mean, is you give up on the manding trial and just give them the item. If problem behaviors occur, just silently withhold the item. If the child leaves or walks off, let them. If they really want the item they will come back. When they do, just restart the manding trial.
  • Sing songs to the child, or with the child. Music can work wonders for teaching or expanding on language. I’ve had many clients who would sing or hum far-r-r before they ever said words. Don’t just play music though, remember this is about pushing. Sit down with the child and sing songs that have movements, such as Itsy Bitsy Spider. Remember to be fun and animated, with lots of praise. Or, dance/hop around while singing together and then stop and look intently at the child. They might keep singing (we call this “fill ins”), or tug/pull at you as a way to request more singing. I also like to do songs that include suspense or surprise, such as “….we all fall (pause and freeze dramatically) DOWN! (lightly pull child to the floor and tickle them)”. After you do this a few times, the child may start requesting more of this game such as tugging or pulling at you to do it again. That is when you add a demand, such as the child saying or signing “more”.
  • Receptive language is language too! “Receptive” just means an action is required and not a vocal response. I rarely see parents think to work on receptive language with their children, but it’s a very important part of language development. Get some flashcards or pictures and have the child match them as you label the item (“Tree”), or line up cards and then point to each one and label it. Lots of my clients like to line things up, so pushing would mean embedding language into that activity. If the child likes to sit and look at cards or photos (many of my clients do) then sit with them and say the names of the items on the cards. A way to expand this further, would be to require the child imitate your label before they pull out another card. This means if you say “car” they also have to say “car” before you let them pull out another picture.

*Recommended Post: Teaching Communication to Non-Verbal Children
Friday, December 23, 2016

Christmastime is Here!

Its that time again, blog readers. :-)



I'm off to enjoy my holiday break, which will include lots of pie and lounging around watching A Christmas Story. I won't be posting until well after the new year, so in advance:

Have a BLESSED and wonderful Christmas, enjoy your New Years celebration, and Happy 2017!!
Monday, December 19, 2016

Grocery Store Nightmares


Photo source: www.demeterclarc.com, www.psychologytoday.com


*Suggested Reading: Count & Mand, Community Outings

Despite the title of this post, this information is not entirely limited to grocery store settings. Yes, almost every single client I have ever had needed help with being appropriate at the grocery store, and yes, most parents have dealt with a child flinging themselves down to the floor inside of a Wal Mart. But I hope this information will also be helpful to you if your child has outbursts at Denny's, or the car wash, or inside of malls, etc.

Unfortunately, there's quite a bit of easy to find info online about grocery store meltdowns/ tantrums (go ahead and do a quick search to see ... I'll wait). I say "unfortunately" because much of this information has 2 main flaws:
  • Geared towards toddlers, with the underlying assumption that only very small children act out inside grocery stores
  • NO explanation of the need to determine the function of the behavior
As you really, really should know by now (unless you are new here, which if you are....Hi) all behavior serves a function. To start throwing strategies at a behavior when you have no idea why the child is doing it, is to potentially toss gasoline onto a flame. Its just not smart, and is best avoided.

Before I go into what parents CAN do about grocery store tantrums, I want to get things to avoid out of the way first. Its actually a pretty short list. Ready?

  • DON"T think you are the only one dealing with this. You're not. Autism or not, toddler age child or not, nonverbal child or not, this is an issue most of those other people at the grocery store can relate to. Its important to keep this in mind because when the behaviors kick off and people start to stare, whisper, or even make rude comments, it will feel like you are the only parent in the world with this problem. That feeling is not the truth.
  • DON'T avoid that particular grocery store, DON'T abruptly leave the grocery store (see exceptions below), and definitely DON'T never enter a grocery store again and start buying all your food online. :-) I'm kidding, but also kind of serious. I do know of families who haven't gone to a particular community setting in 6 years...and their child is 7. See the connection there?? Avoiding the location where the behavior happened will not teach your child how to make better choices next time. That will only stick a band aid on the problem.
Now let's jump into what you're really here for, what to do about tantrums/outbursts inside the grocery store.

Handling those Grocery Store Nightmares 

  1. Have a PLAN. Do you just decide to run to Publix, grab your wallet, and put your child in the car? Silly rabbit! That is likely going to be a fail. Before leaving the house you need to work with your child to make a plan for the trip. How you do this will depend on your child's age, and their ability to communicate/understand your communication. This could include making a quick visual, writing out a grocery list, bringing tangible reinforcers with you, getting an extra adult in case you need assistance physically, etc. You need to clearly outline and explain to your child where you are going, what you expect of their behavior, what their job will be (see tip #2), and what they can earn for meeting your expectations. I suggest taking the plan with you to refer to inside the grocery store as needed (use it as a prompt).
  2. Give the child a J-o-b. Do you plop your child inside the shopping cart and expect them to be still and quiet while you shop for 45 minutes? Silly rabbit again! That likely won't last 5 minutes. Instead of making your child observe you shop, get them involved. Also, you want to create reasons to reinforce their behavior. Let your child get items off the shelf, push the cart, hold the coupons, etc. Again, this will vary depending on your child's age and their ability to find or locate things. With my clients I often embed skills into grocery shopping, such as labeling items ("What's this?"), colors/counting ("I need the yellow box of rice/I need 3 apples"), or answering questions ("Which kind of coffee does Daddy like?"). Heavily praise your child for participating, and connect following instructions to contacting reinforcement. 
  3. Choose wisely when to go. By "go", I don't mean when to leave the store. I mean when to go grocery shopping. Its wise to consider how many people will be at the store, as well as which store to visit. If the grocery store across town is usually pretty deserted, its worth it to travel out of your way to go there. As you and your child learn how to better handle the behavior outbursts, gradually start visiting bigger or more crowded stores. I like to ease clients into community outings by going during dead times like right when the store opens, or in the middle of the week. Avoid weekends or evenings. 
  4. It's all about the F word. FUNCTION. This is the "why" of your child's problem behavior. Do they always tantrum when you won't buy them a cookie? Do they scream everytime you tell them they can't sit in the cart? Do they consistently kick off their shoes in the middle of the aisle? Does waiting in the checkout line more than 10 seconds always lead to tears? Each of those scenarios give valuable clues about what is motivating your child to have an outburst. I find that when parents really start to look for these clues, they quickly realize they have been there all along. As in "Wait a minute.....last week he cried until I put him in the shopping cart too. Do you think that's what this is about?". Once you have determined the motivation that precedes problem behavior, then all you need to do is some tweaking. That can look about 1,000 different ways, so here are a handful of examples:
 -If the motivation is getting a highly preferred item (like M&M's), it would be appropriate to only give the M&M's for calmly walking through the store. If calm walking does not happen, it would be appropriate to get NO M&M's, and promptly leave the store.
-If the motivation is relieving boredom, it would be appropriate to give the child a task or job and have them participate in the grocery shopping experience.
-If the motivation is the child always kicks off a tantrum when you go grocery shopping around 11:30am, maybe this is too close to their lunchtime (and now they are surrounded by food). Try feeding them right before grocery shopping, or letting them have a snack in the car on the way to the grocery store.



*Quick Tip: Here is a free download of a simple visual I used with a former client, who was learning how to participate at the grocery store.
For him, he had big issues staying with mom (he would wander off) and he also expected to get some candy anytime he walked into a grocery store. So to tweak that, what we did was teach him to use a grocery list to shop. This gave him something to do instead of wandering off from mom, and it also earned him lots of praise plus a big reward at the end. We also taught him to ASK for things he wanted instead of just grabbing them, which his asking only received a response if he had completed his grocery list. In other words, no participation = no candy.


Tuesday, December 6, 2016

The Massive, Super-Sized, Super Hero Post.


Photo source: www.climbthesearch.com, www.metv.com, www.marketplace.secondlife.com, www.forum.isatrance.com

I get lots of questions and emails from people curious about the field of ABA, and how to become an ABA provider.

Like, a lot of questions.

A lot, LOT, of questions.


After probably question #999,999, it finally dawned on me that maybe a handy dandy resource would be helpful for people. So with this post I present that handout to you!
Oh stop, no applause is necessary.




Okay, if you insist.






Below you will find a massive list of links that will lead you to specific posts that should answer your burning questions about entering the field of ABA. At the very bottom of this post, you can download a FREE (we like that word around here)  handout that goes into great detail about how to enter this field and kick off a rewarding career.

I tried to be as thorough as possible, but of course, I can't possibly answer questions about every possible scenario. So if you live in Alaska and want to know how to open the first Verbal- Behavior  -intervention -clinic- for -left -handed -girls- with- Autism- who- wear -glasses ... yeah I can't help you.

Everyone else, please peruse the information below. I hope its helpful!

**Remember, sharing is caring so if you know someone who could use this information feel free to pass it along.

LINKS:

Why being an ABA provider is so amazing
This is what a great ABA therapist looks like
This is what a horrible ABA therapist looks like
ABA provider dress code
Why I love my job 
Selecting a quality ABA employer
Getting ready for your first few interviews for ABA jobs Part I and II
Common ABA work settings
So you want to be a Superhero?
That lo-o-o-ng road to the BCBA
Finding work post BCBA certification
What to expect after being hired for an ABA position
You should be checking this website out on a regular basis: Behavior Analyst Certification Board


Free handout: Why ABA Wants YOU!
Monday, November 21, 2016

Dress for Success




Photo source: www.mgt.buffalo.edu, www.pinterest.com, www.strongsuitblog.wordpress.com


If dress/appearance has never come up as an issue for you, or any of your ABA supervisees, then gold star for you. For my experiences though, I have been on both sides of this sometimes awkward coin. I have been the ABA therapist showing up for work in questionable attire, and I have been the supervisor having to talk to a therapist about his or her choice of clothing.
Some employers will hire you and just expect that you KNOW how to present yourself professionally. Then there are employers who will make dress expectations clear, such as with an employee dress code. But what if you work independently? Or what if the supervisor over you is just too uncomfortable to bring this up? What if the parent disapproves of your wardrobe, but never says anything?

What can make this topic tricky is that as an ABA professional, you don’t have a “9-5”. Yes, you may literally work a schedule from 9am to 5 pm but you know what I mean. Your work setting could be extremely casual (as in parents opening the door in their pajamas kind of casual), your colleagues or clients may never say anything about your appearance, and you may or may not have received professionalism training during your supervision process. OR, maybe no one has brought this up with you because you’re the boss. Yes, I have had a few situations where my boss was the one who dressed inappropriately. How do you tell your boss to iron their shirt??

If this whole topic of presenting yourself professionally was never discussed with you, allow me to give you a few helpful pointers. If you can, I recommend incorporating this information into the company dress code policy.


Cons of too formal – As the clinical supervisor, I often am dressed a bit more formally than my staff. I don’t work 1:1 with clients, and when I visit homes I may be coming from a meeting, a child’s school, etc., so it’s rare for me to be in jeans. However, when first meeting a client or a new supervisee, or with certain types of families, it can come across as cold or intimidating if you consistently show up perfectly coiffed. You may find that your staff have a hard time speaking openly with you during a session, or avoid asking you to model techniques if your dress is a bit too fancy. Definitely something to consider, since building rapport with the family and staff is an important part of your job.

Cons of too casual – On the flip side of showing up to supervise a session wearing a business suit, is showing up a bit too relaxed. Flip flops? No. Caps or baseball hats? No. Strapless shirts or spaghetti straps? No. I work with a lot of staff who are 20-something college kids, and I really emphasize with them the importance of treating their job like …. a job. I know you play with awesome kids all day, but you are still at work. If you could easily go from a therapy session to the beach or a nightclub, I suggest rethinking your work attire.

Who is your client/What is the work setting – It’s important to think about the problem behaviors your clients exhibit when you are selecting work attire. To put it simply, once you have a client tug your earrings out of your ear you learn not to wear your flashy jewelry to work. :-)   Depending on your work setting, your attire may need to be more business (like at an ABA clinic) or more casual (like if you see clients in home). You want to mimic the attire of the people around you. If everyone at the clinic wears closed toe shoes, then you should too. Or if the family never wears shoes in their home, odds are they don’t want you walking all over their carpets with shoes on either. If you occasionally accompany your client into the community (e.g. church), then your attire may need to change just on those days.

Do you work 1:1 with clients? – If your role as an ABA professional includes working directly with the clients, then you have to evaluate if your work attire is appropriate for: bending down, bending over, climbing, squatting, jumping, running (can you catch an eloping child in those wedge sandals?), sitting in child size chairs, etc. Try these different activities before leaving the house, and if any of these movements are uncomfortable or reveal too much skin then you need to rethink your attire.

Scrubs/Yoga pants – The main problem with scrubs is some parents don’t like it. I have had parents say to me that it made them feel like the staff viewed their child as a “patient”, and not a “client”. But, I get it. ABA staff wear scrubs or yoga pants/workout clothing because its comfortable, and they don’t want to get saliva, blood, urine, or mucous, on their nice clothes. However, if your yoga pants are so snug that your underwear is visible, or if you consistently wear a sports bra to work, be aware that this could be deemed inappropriate depending on the setting.

Perfume/cologne/scented lotions – I love my perfume, so this is a tip I share from personal experience. The family or your client may dislike whatever fragrance you choose to wear, and if your client cannot communicate they may have no way of telling you this other than problem behavior. My advice is to skip the scents when you are working with sensory sensitive individuals, especially if they can’t tell you “Your cologne is giving me a headache”.


Time to get super real for my last tip: the way you present yourself can cost you work

You may think that's unfair or judgmental, but it’s true. Very recently I saw this happen with one of my staff, where the family requested a different therapist because they strongly disliked her work attire. I have also seen fellow BCBA’s get passed over for opportunities, because they don’t present themselves well-- they come across as disheveled, or messy.
Your appearance does play a part in how clients perceive your level of professionalism. If you feel that you perform your job well and have solid clinical knowledge, then why would you let your wardrobe take you out of the game? If you follow the tips I have in this post, you should have no issues with being incorrectly perceived as unprofessional.

**Resource: Here is a general and very basic dress code I have used in the past.