Thursday, June 28, 2012

Gone Fishin'...





Hi Readers,


I will be traveling for a bit on business so posting will slow down. This is where Im headed:





If you are in need of a Quote of the Day or some words of inspiration, just take a look at those photos...you can almost smell the ocean. Well, not really. :-)

See you soon!
Friday, June 22, 2012

Program: IFFC



IFFC, which stands for Intraverbal Function, Feature, & Class, is an Intraverbal program. 

Intraverbals are some of the most difficult programs to write and to teach, and are typically reserved for the ABLLS-R  advanced learners. An early learner or a nonverbal child wouldn’t be ready for the complexity of an intraverbal program.
"Intraverbal" is a VB term, and it refers to questions or statements that require a verbal response and have no stimuli --such as flashcards--present. An example of an intraverbal is responding “29” when someone asks “How old are you”? It’s very common that children in ABA programs start showing disruptive behaviors when intraverbal programs begin such as elopement, aggression, or noncompliance. The difficulty of the task is what’s causing the disruptive behaviors.

Intraverbals can be difficult to teach because they are difficult to learn. Much of ABA early learner skills require rote memorization. As a child progresses through ABA and moves being from an early, to intermediate, to advanced learner, the skill difficulty increases and the goal moves away from rote memorization to recall of information.

Intraverbals are the building blocks of language. If you pay attention to the language of most 3-5 year olds, it’s predominantly intraverbals: requesting information, describing things, talking about favorite objects or TV shows, etc. If a child with Autism does not have a strong intraverbal vocabulary they will be at a huge disadvantage when communicating with peers. Most young children immediately start conversations with intraverbals. Its interesting that as therapists we tend to teach our clients to greet others by saying “Hello”, yet most young children greet each other with questions, such as “What’s your name”. Intraverbal knowledge also leads to more extended social interactions. If a child with Autism can only answer simple “Yes” or “No” questions then their mean length of responses will be pretty short:

Therapist: “Are you hungry?”
Child: “Yes.”

Therapist: “Do you want to swing?”
Child: “No.”

I have successfully held 5-10 minute conversations with clients by just asking them about different IFFC mastered goals. It’s very easy to turn “Tell me something about a car” into a full conversation. First the child tells me about a car, then we talk about the color of my car, we point to cars in magazines, write the word car, draw pictures of cars, all while talking about what a car does and does not have. Intraverbals help an Autistic mind to make connections between things that are similar or dissimilar, which leads to the ability to jump topics in conversation and elaborate on topics…just like typically developing children do.


Intraverbals can be quite complex and are often  taught incorrectly. If you are an ABA therapist, you may need special training to learn how to teach intraverbals. If intraverbals are taught in the wrong order or without teaching  prerequisite skills first, then it’s very confusing to the learner. A great resource for understanding intraverbals better is the "Verbal Behavior Approach" by Mary Barbera. It’s an easy to understand book that breaks down all of the VB teaching operants.

I typically write IFFC programs for clients who have already mastered some intraverbal programs, can easily mand and tact items, have a good amount of spontaneous language, and have mastered the necessary prerequisite skills.

So what exactly does the IFFC program teach?

Function- understanding what things are used for, such as the function of a towel is to dry off.
Feature- understanding adjectives or how to describe something, such as a car has wheels.
Class - understanding categorization, such as both watermelon and pasta are in the class of food.
The IFFC program ties all 3 of these skills together, so the child must know how to receptively and expressively identify features, functions, and classes of items before you can begin teaching IFFC. Those prerequisites are necessary. IFFC can be taught receptively (RFFC) or expressively, just depending on what is easier for the child. The goal of the program is that the child will be able to describe an item/object to you, after you name the object. The SD would be “Tell me something about a ___”. The child should respond by stating a feature, function, and class of the item you named.  Here is what a successful teaching trial would look like:

Therapist: “Tell me something about a car”.
Child: “A car has 4 wheels, you drive it, and it’s a vehicle”.



Here are a few of the most common questions therapists ask me about IFFC programs:

  1. “The child states the feature and function, but not the class”- Try using a verbal prompt, such as “What else” or “Tell me the class”. Be sure not to provide reinforcement until the child has correctly named all 3. If you reinforce after the child has said the feature and function, then over time they will think they don’t need to state the class.
  2. “The child just repeats my SD and doesn’t say anything else”- First make sure the child has the prerequisites needed to learn this program. Be sure you aren’t asking the child to do far more than they are capable of. If they do have the prerequisites then use visual prompts. If your SD is “Tell me about a house” then have a photo of a house ready to be used as a prompt.
  3. “The child gets very upset when we do intraverbal programs or tries to leave the table”- This isn’t unusual, and it happens a lot. Intraverbals are hard.  Magnify the reinforcement you use for intraverbal programs: use a bigger reinforcer or give the child more of it. Make sure you are prompting the child if they take more than 3 seconds to respond to you.
  4. “The child does well with this program at the table but away from the table they don’t seem like they get it”- They probably don’t. Generalization must be incorporated into an ABA program…it doesn’t magically happen. Let’s say you are teaching the child to describe a cat in an IFFC program. Take the child to a pet store, or flip through a picture book together and when you see a cat stop and say “Look! It’s a cat. Tell me something about a cat”.
  5. “The child will master an IFFC goal, but when we move on to the next goal they are still giving the responses for the old one”- Sometimes therapists push forward through this problem, and just expect that the child will take several weeks to learn each new IFFC target. It’s important not to just push through this error. It isn’t normal that for each new IFFC goal the child struggles, and continues to give you the wrong answer. What this is revealing is difficulty with discrimination. The child hears you say “Tell me something about a ____”, and they just toss out the last response they gave that was reinforced. If you see this happening, learning is not going on. Rote responding is going on.

Don’t be intimidated by teaching intraverbals! Some intraverbal programs can be very simple, such as Animal Sounds. IFFC is a bit more difficult to teach and understand, but the payoff is huge when you see how much easier it is for the child to socially interact and engage in meaningful conversation. If you have a Consultant or BCBA leading your ABA program I highly suggest you request additional training on how to teach intraverbals and how to correct common student errors. Even if you don’t have a regular Consultant, you can hire one part time or as needed to help you teach this difficult skill.


**Quick Tip: Many parents have a tendency to try and teach intraverbal responses to a child who is extremely unprepared for the task. Instead of the child making varied and appropriate responses they are taught 1 or 2 rote responses, which do little to help the child socially. I’ll give you an example: Teaching a child to respond “Fine” when Mom or Dad asks “How was school today?” Was school really fine today? Or is that just what the child has been taught to say? If the child got sick at school and threw up their lunch, will they still say their day was “Fine”? If so, that is completely missing the point of the question. When I ask parents why they taught their child to say “Fine”, they usually tell me they wanted the child to be able to have a social interaction about their day. Well, if that is your goal then write an intraverbal program where the child is taught to describe their day, who they played with, what they had for lunch, etc. Don’t settle for a robotic, rote response of “Fine” when what you really want is an actual conversation.
Monday, June 18, 2012

Quote of The Day








"A Good teacher Explains ... A Superior teacher Demonstrates ... A GREAT teacher Inspires".
William Arthur Ward, Inspirational Author
Friday, June 15, 2012

Demand & A Promise





 Yes, it’s just like that…except not quite.


The goal of rapport building and pairing during ABA therapy is to develop a trusting, close relationship with the child so they are compliant and find you reinforcing. Not the toy you have or the bubble machine you just turned on, but you. This goal isn’t always easy to accomplish and there will be times when even after you accomplish this goal you have to start over again. Like after the child has been on vacation and hasn’t seen you in a month, or if the child is feeling ill or on medication.

A great technique for getting a child to comply during a therapy session is called “Demand and a Promise”. This technique can be used in the home or out in public, and it’s very easy to learn. I’ll also include another bonus tip at the end of this post for getting a child to comply.

Quick Note: This technique is more helpful for a child who is overall compliant but may be having a bad day, going through a regression of behavior, or your pairing relationship may have weakened recently. If you are working with a client who is very defiant and noncompliant on a regular basis, I wouldn’t recommend using this technique. Instead I’d recommend you use 3 Step Prompting for noncompliant children, and use Demand and a Promise for noncompliant situations. Make sense? Great.


The idea behind this technique is very simple: When you present a demand to the child you are “promising” them a reward in advance, for their compliance. 
 The demand and a promise technique makes your demand more exciting and interesting because of the promise attached to it. I typically use this technique to get a crying, overstimulated,  frustrated, or tired child to the therapy table.




(You don't need to use an index card, that's just for illustrative purposes)


Here’s what the technique looks like:


Procedure:
1. Approach the child as he or she is engaged in a preferred activity, such as on break. Present a simple demand to do something else, like “Come sit down”. Make sure that you are within 1-2 feet of the child when you place the demand as you will be providing prompts/guidance if necessary.
2. As you deliver the demand show the child an open palm holding a highly preferred reinforcer.
3. If the child begins to comply with the demand and does not engage in problem behaviors give them the reinforcer. If the child does not begin to comply or begins engaging in problem behaviors, close your hand around the reinforcer and use prompting to finish out the demand.


Notice the wording “begins to comply”. With this technique you provide reinforcement before the full demand is actually completed. If you told the child to come sit down, then once they stand up and start walking to the therapy table you give them the reinforcer. If the child says “no”, walks away from you, or ignores the demand, you guide or physically prompt them to go sit down and they lose the reinforcer.

A very common question I get from therapists about this technique is “What do I do if the child takes the reinforcer, and then runs off and goes back to play?” Yes, this may happen. These kiddos are quite smart.

  1. Once you get the child to the table, do not immediately apply demands. Praise the child for sitting down (“Nice sitting down, Tia!”). Turn on music or a DVD and give the child a few seconds of break while you gather your materials and get your data sheets together. Over time, this teaches the child that they get something good for complying, and compliance doesn’t mean immediate work. Doing this consistently will save you from dealing with a lot of escape behaviors.
  2.  Before implementing demand and a promise get in super close proximity so if the child bolts  after taking the reinforcer you are able to immediately block escape and prompt.

**Bonus Tip: Another strategy I use with kiddos who are sometimes noncompliant is I remove the task from my demand. 
Instead of saying a task statement like “Go clean up the toys”, I say something like “Come with me” or “Follow me” (again, this wont be as successful with a child who is highly defiant or non compliant so use 3 step prompting instead). Once the child follows you to where the toys are instead of saying “Pick those up”, say “Sit down”. Or you can just sit down yourself and say “Do this”, so the child will imitate you and sit down.  Depending on how strong the child’s imitation skills are you can start picking up toys and see if they copy you, or you can present the demand like a question. Such as “Where does this go?” as you hold up a toy. If needed, prompt the child to put the toy away. Continue until all the toys have been put away. This technique is a way to sneak in your demands without making them sound like work. Especially if you are in a session with a crying or whiny child who just wants you to leave them alone, you definitely don’t want to be giving lots of demands that they probably won’t do. That just makes your job harder, and who needs that? Saying “Come with me” doesn’t even sound like a demand, it sounds like a request or invitation.






Friday, June 8, 2012

ABA Haters




Oh, the irony. An ABA fan writing about ABA haters.

Clearly from the title and content of my blog, I respect and believe in ABA as a science. I started in this field working as an in-home therapy provider to 2 kids. I knew absolutely nothing about Autism or ABA at the time. Gradually, my knowledge grew, I received training, my experience grew, and so did my passion. I found the kids I worked with to be so smart and so capable, once you figured out how to teach them.  I quickly caught the ABA bug and became hooked on the Lightbulb Moment. What's the lightbulb moment? I'm glad you asked.

The lightbulb moment is when you have been painstakingly trying to teach a skill to a child for days or even weeks, and then one day out of the blue something clicks and the child just gets it. The clouds part, angels sing, and you scare the child a little when you yell "That's RIGHT!" Its an amazing moment.

The more I learned about Autism  the more I wanted to learn. I probably drove my first few clients insane, because long after my therapy sessions were over I would still be in their home asking question after question about Autism. There was just so much to learn: sensory needs, supplements, advocacy, IEP's, funding for therapy, etc. Thankfully those parents were patient with me and my constant questions.


As my love affair with ABA grew, our love bubble burst as I started to become aware that there are people out there who don’t like ABA. 



Really? Yes, really.


There are even professionals, educators, and individuals who hate ABA. 



Hate it? Really? Yes, really.


Many of these people are adults with Autism, some who experienced ABA as children and some who did not. Their opinions about the detriments of ABA are just as strong and vocal as mine about the benefits of ABA. These individuals state that there's nothing wrong with being neurologically different and they don't need to be "fixed" or made normal by some ABA person.

My blog isn’t about bashing or putting down other therapy methods, or attacking people who don't agree with me. That's just not necessary.


I think the best decisions are informed decisions. Don’t become an ABA hater based on outdated or distorted information you read on the internet. There’s a lot of misinformation out there, and many untruths about what ABA is -- far too many for me to address here. So I will tackle a few.

Reasons Why People Hate ABA

History of ABA- I referenced this briefly in my post on Punishment, but ABA had an ominous start. If you read the research on how ABA was originally done it was punishment heavy. Children who didn’t respond correctly were slapped, spanked, yelled at, or received electric shocks. As the field advanced, professionals realized that reinforcement is much more effective than punishment. ABA as a field became reinforcement based, and created rigorous ethical standards for ABA professionals. Some ABA haters incorrectly believe that ABA therapy still looks the way it did decades ago, which is just not accurate. 

Think ABA is Just Discrete Trial Teaching- I have had new clients say to me they don’t want their child to be drilled 50 times to say “banana”, because cousin so-and-so told them that’s what ABA is. ABA is a broad term that covers a wide range of therapeutic approaches. Depending on the needs and learning style of the child, there are many ways to implement ABA therapy:  Verbal Behavior, Natural Environment Teaching, Incidental Teaching, Pivotal Response Training, etc. Every one of these methods is unique, and has advantages and disadvantages depending on the specific treatment goals. If you don't want your child to be intensively drilled in a very structured manner, then don't use a discrete trial approach. I love discrete trial; its extremely effective...but it is not appropriate for every client.

"I just hate the idea of behavior therapy/ABA Therapy is an unnatural treatment!"- So here is the problem with this criticism: the science of ABA is all around you, all the time, whether you sign up for therapy or not. Behavior contingencies explain how you learned to answer a ringing telephone, why you say sorry when you offend someone, and why you reduce your speed when you drive past a police car. ABA is based in conditioning, which to put it simply is the fact that we learn what to do/what not to do by what consequences follow our behavior. All ABA therapy does is apply this science and research to create individualized strategies, that are taught in a precise way. So unless you plan to completely stop behaving (hint: that's impossible), then every single day you are adjusting your own behavior based on the consequences to your behavior.

Frauds/Shysters Exploit Families- Another criticism is that the field of ABA is full of amateurs claiming be experts. The national certification for ABA professionals has been around since 1998. Before that time, anyone who could convince people of it could label themselves an Autism Expert or Consultant. Accountability was very low. The ABA field established board certification specifically to protect the public from amateurs calling themselves experts, and to raise the requirements of working in this field. The BCBA certification process is difficult and lengthy, and in some states licensure is required on top of certification. My response to this criticism would be to look for credentialed and experienced professionals, and be very leery of programs with "pseudo-ABA" (e.g.  "Behavior Tech", "Autism Consultant")  staff and not a single certified individual supervising them.


ABA Creates Robots- You've probably heard this criticism before: ABA creates robotic children incapable of spontaneous thought who can only spit out memorized responses like a trained seal. Sound harsh? ABA haters make much harsher statements than that, and actually believe them to be true.  Some ABA programs do start off with rote memorization. That’s how many of us initially learned skills. How did you learn the multiplication tables? It was likely by memorizing it. At some point someone helped you move from memorizing to actually learning. That’s what a quality ABA program does. When I teach a child to vocally imitate, initially they will sound slightly robotic and I reinforce them every single time they emit a sound. Over time they begin to learn more naturally, I provide less reinforcement, and I teach them to use a natural speaking tone. If your child has a stilted/artificial way of speaking and can only respond to a question if it is asked in a precise way, then they may be in a poor quality ABA program. This resource should help you evaluate if you are receiving quality intervention or not.

Autism is a Medical Disorder and Should be Treated Medically – There is some truth to this criticism. I do believe that Autism affects the body and brain in many ways. The child can have toxic yeast, allergies, comorbidity (such as Autism & ADHD), etc. Each of those issues may require a separate treatment. I’m not an OT, so I wouldn’t try and design an OT program. I work in the domain of behavior. It’s better to think of Autism treatment as a package deal. Depending on your child your treatment package may be “Speech Therapy-Social Group-Private School”. Or your package may include “ABA therapy-Counseling-Homeschooling”. It will vary depending on the child and their needs. The reason why so many treatment packages include ABA is that ABA as a treatment covers many skill domains at once, and it focuses intensively on behavior. Many parents really need that behavioral help.

ABA Therapy is TOO intensive/A 3 year old Should be Outside Playing! – The problem with this criticism is this is a decision for the parents. "Parent shaming" is not ok, as families struggle to make the best choices for their children that they can. Some parents want to start therapy as intensively as possible while the child is young. Other parents feel they want their child to enjoy being a child and not just shuffle from one therapy session to the next. I don’t make parenting decisions, I make clinical programming decisions. I must add that for anyone who thinks children should be outside playing instead of receiving needed intervention, did you know that some of these children don’t play? When I first meet a new client they often spend their days engaging in problem behavior, trying to escape the home, or harming themselves or others. For those children, I'd say their parents are much more interested in teaching critical life skills than being told their child is getting too much therapy.


ABA is about Erasing Autistic Traits and Forcing "Normal" Traits- This is a  super common ABA myth. I definitely believe that neuro -diversity should be appreciated, after all some individuals with Autism have become great authors, speakers, or inventors due in part to their Autistic traits.The goal of a quality ABA program is not to erase the Autism and make the child “Normal”. If any so-called professional tells you that is the goal of treatment, then you are not dealing with an ethical professional. Normal is a relative term that can mean many things to many people. The goal of treatment should be to teach critical life skills, and remove barriers to instruction....that's it.  ABA therapy is about causing beneficial changes to help improve quality of life. For example: Talking. Using a toilet. Attending to a Teacher. Accepting changes to the daily schedule.



Many of these criticisms are likely true for poor quality ABA programs, or programs lacking BCBA supervision.
 It’s unfortunate, but some people have bad experiences with an agency, company, or therapist and they blame the entire field of ABA for it.  Believe me, I understand. I have had bad experiences as an employee of some agencies or companies. That didn't dissuade me from the passion I have for this field. It actually propelled me further, to be the change I wanted to see. If you come across an ill -mannered and rude doctor, do you then hate the entire field of medicine? Do you stop seeking needed medical treatment??

Please don’t confuse the methods of an unethical or unprofessional ABA practitioner with the vast science of ABA.





Thursday, June 7, 2012

Quote of The Day


Take some time today to look for strengths in your child, student, or client with Autism.

“A disability is usually defined in terms of what is missing. … But Autism … is as much about what is abundant as what is missing.”

Paul Collins, Author of Not Even Wrong, Adventures in Autism



Sunday, June 3, 2012

Visual Preferences- Video Post




Do you have a preference for receiving information visually? 

Do you:

  • Always look at the recipe when cooking?
  • Always need to write a grocery list, or you'll forget something?
  • Write daily To Do lists or checklists?
  • Have Post It notes stuck on walls all over your house?
  • Leave things by the front door so you don't forget them in the morning?
  • Learn better by observing the task rather than hearing about it?
  • Love charts or diagrams? Love highlighting, underlining, or color coding?
  • Find that people ask your help with organizing or planning?
  •  Have to use notes or index cards if you are going to speak in front of people?
  • Remember how to spell a word by closing your eyes and visualizing the word?

Did you answer yes to most of these questions? :-)

 


So what did you win? Well, nothing. Except a future filled with making lists.

I definitely have a strong preference for receiving/learning information visually (some people might use the term "visual learner", however the idea of learning styles has been debunked and is not empirically validated) so I can relate to my kiddos who often need visual supports to feel calm and in control of their environment.
 I write To Do lists, and then I write checklists for completing my To Do lists (not kidding). If you write instructions for me on how to do something...I might understand. If you verbally tell me how to do something...I'll probably get it. But if you show me visually how to do something, I've got it!

I understand how stressful and chaotic it can feel when organization and order aren't embedded in my environment.

For many of my clients with Autism they struggle daily to navigate through what people expect them to do, when to do it, when to stop doing it, and what to do next. I am basically describing a sequence of daily activities.

 A visual schedule is a visual representation of a sequence or activity. Individuals with Autism tend to be concrete learners who benefit greatly from visual schedules. Due to impairments in focus, rote memory, and generalization individuals with Autism often have difficulty adjusting to their environment. Visual schedules also help provide routine, organization, and structure, which many kids crave. If the child has a visual schedule to look at each day--even if the schedule changes--then it helps lower the child's anxiety about what is coming up next.

How do you know if your child or client could benefit from a visual schedule? Here are a few red flags:

  • The child asks for items or activities over and over again ("I want outside....I want outside.....I want outside")
  • The child always needs prompts to transition, to start an activity, or to stop an activity
  • The child has regular tantrums at specific times of day, such as they tantrum everyday when its Circle Time
  • The child completes steps out of order or skips steps
  • The child has difficulty waiting to do an activity, such as waiting for their reinforcer at the therapy table
  • You repeatedly have to state a demand more than 3 times
  • The child forgets things frequently
  • The child completes very few activities independently

If you answered yes to most of those questions, then you are dealing with a child who could absolutely use some visual supports. Visual supports are more than just visual schedules. They could include transition signs, labels, visual directions, reminders, conversation cues, reinforcement token boards, checklists, "First/Then" cards, waiting prompts, etc.

Visual schedules do not have to be purchased from a specialty store or Autism website. They are very easy to make and affordable. I would suggest at a minimum creating a daily schedule for both home and school, and if the child is school-age a separate morning routine schedule.
I meet SO many parents who have consistent difficulties with the morning routine: getting their child out of bed, dressed, fed, and off to school. The morning is usually a stressful, crazed, loud, frustrating part of the parents day. All of that can be changed by creating a visual representation of what the ideal routine looks like, and then teaching the child to consistently follow the routine. Visual supports help bring order to chaos.

I made a video explaining how to make a visual schedule, some tips for teaching it to the child, and how to modify it for older children.



Autism Speaks has a  Visual Supports Tool Kit on their website that is full of helpful information about how to create visual schedules.


Friday, June 1, 2012

Quote of the Day


This is pretty much an endorsement for motivation-based teaching, from one of the great philosophers:

"Do not train children to learning by force and harshness, but direct them to it by what amuses their minds".

Plato, Greek Philosopher