ABA is bigger than Autism.

Here are just a few of the many ways ABA professionals help society:

• Clinical settings- Behavior Analysts or Behavior Specialists work in hospitals to provide therapy for medical trauma victims, people with mental or physical diseases, or as counselors to treat addiction and behavioral problems
• Criminal Justice system- Behavior Analysts or Behavior Specialists consult on criminal cases,work inside prisons or juvenile detention centers, or examine ways to reduce recidivism rates
• Community/Family systems- Behavior Analysts or Behavior Specialists help families or individuals with mental health issues, parenting problems, stress management, consult with child welfare agencies, or create behavioral management supports for elderly persons inside care facilities or living in the community
•  Educational settings- Behavior Analysts or Behavior Specialists teach at universities, or work inside/ consult with public and private schools
• Business world- Behavior Analysts or Behavior Specialists help large businesses and companies increase productivity or efficiently train new staff
• Space program (bet you didn't know that!)- In the 1960's behavior analytic research was used to help train astronauts and chimps who were sent into space

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Tameika Meadows, BCBA

Photo source: www.avivaahwerner.com

Disclaimer: Conducting an FBA is a very individualized process that must consider the setting, the learner's environment, and who will carry out the intervention. The following post contains suggestions to guide the process, and is not intended to be applicable for every learner or every situation. It’s also important to note that the usefulness of an FBA extends beyond individuals with Autism.

For my original post explaining how to conduct a FBA, click here: http://www.iloveaba.com/2012/02/everyday-fba.html

This post is for caregivers (parents, teachers, therapists, etc.) who have conducted a FBA to determine the function of a challenging behavior and it is: Negative Reinforcement, commonly known as Escape or Avoidance.

Most people think the term "Negative Reinforcement" refers to using a harsh or mean type of reinforcement to get someone to do something, such as yelling at a child to get them to clean their room.

Nope.

That isn't what negative reinforcement means at all. 

Since you read my blog :-) then you already know that reinforcement is anything that makes a behavior go up, and negative means to remove something. So, negative reinforcement means to remove something and cause a behavior to go up. Make sense? Great.

Negative reinforcement is seen in learners who avoid (will not do at all) or escape (may start, but then stop) tasks, in order to get out of the demand. It is the demand being removed, or avoided completely, that reinforces the inappropriate behavior. Children who engage in challenging behaviors that serve a negative reinforcement function can be some super difficult learners to work with.

 If these kids had a motto, it would be “We’ll get along fine, as long as you do everything my way!”

These are the kiddos that frustrate and exhaust their therapists and teachers. Every day is a battle, and these learners will leave you with battle wounds (scratches, bites, bruises, etc).  The parents of these children can spend their days putting out behavioral fires, and trying to avoid complete meltdowns.

From the perspective of the child engaging in escape or avoidance behaviors, they are willing to do whatever they need to do to make the demand disappear. This is why escape or avoidance maintained behaviors can get pretty aggressive or violent, pretty fast.

These children have learned over time how to quickly get an adult to leave them alone. By the time I meet these learners, they are often at the point where they are running the household…or the classroom.

What do escape/avoidance behaviors look like?

Behaviors that serve the function of negative reinforcement are intended to remove or stop an undesired activity, event, or demand. The motivation for the child is to get out of something. It looks something like this:

Present demand ---> Child tantrums

Remove demand ----> Tantrum stops

Common escape/avoidance behaviors include:  biting, throwing objects, noncompliance, verbal defiance (“No!”), kicking, tantrums, falling to the floor, walking away from adults, head butting, arguing, destroying property, pinching, hitting, screaming, crying, negotiating/bargaining, walking away from the activity, and refusing to participate.

Why do children engage in escape/avoidance behaviors?

Behaviors that serve the function of negative reinforcement have a history of learning behind them. The child has learned that if they bite Mom every time she tries to turn the video game off, Mom will back down. Therefore the behavior of biting gets strengthened more and more over time.

And that’s just the beginning…..these learners are also able to exert less and less effort over time. Eventually all they have to do is whine, or lunge at Mom, and she will back down. So the short answer to “Why do children engage in escape/avoidance behaviors” is because these behaviors work and the demand is removed.

When dealing with escape/avoidance behaviors it’s important to distinguish between “Can’t Do” tasks and “Won’t Do” tasks:

1. Can’t Do: The child does not have the skill necessary to complete the task or demand, and instead of asking for help they engage in behaviors.

2. Wont’ Do: The child is fully capable of completing the task or demand, they just don’t want to.

For both a “Can’t Do” and “Won’t Do”, the behavior may look identical. However, the way you would respond to the behavior would differ.

How do I handle escape/avoidance behaviors?

Once you determine the function of a behavior, you need to do 2 things in order to reduce the behavior: stop reinforcing (feeding) the inappropriate behavior, and teach the child what to do instead. For behaviors with a function of negative reinforcement, that is much easier said than done!

 In order to stop reinforcing the behavior, it is imperative that the demand is not removed. No matter what behavior the child throws at you, don't back down. To do so is to reinforce the inappropriate behavior.

If the task is a “Can’t Do”, then you need to teach the child how to do the skill. Break the task down into smaller parts, lower the difficulty level, provide more assistance to the child, or teach them to hand you a “Help” card.

If the task is a “Won’t Do”, then you are dealing with a compliance issue. Stand firm, do not back down from the demand, and use 3 step prompting to gain full compliance. Also look at the reinforcement embedded in the task and ask yourself if the child is properly motivated to comply. If it’s appropriate to do so, provide choices to the child. Instead of barking at them to “Make your bed!” ask the child if they want to make their bed before or after breakfast. Sometimes offering a simple choice can head off aggressive behavior before it even starts.

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Tameika Meadows, BCBA

Disclaimer: Conducting an FBA is a very individualized  process that must consider the instructional setting, the learner's environment, and who will carry out the intervention. The following post contains suggestions to guide the process, and is not intended to be applicable for every learner or every situation. Its also important to note that the usefulness of an FBA extends beyond individuals with Autism.

For my original post explaining how to conduct a FBA, click here: http://www.iloveaba.com/2012/02/everyday-fba.html

Photo source: easypeasykids.com.au

This post is for caregivers (parents, teachers, therapists, etc.) who have conducted a FBA to determine the function of a challenging behavior and it is: Positive Reinforcement or Attention.

Attention seeking behaviors can be tricky to intervene on, because most attention seeking behaviors really GRAB people’s attention….that’s kind of the point. :-)
 If a child bites your arm, throws a plate of food at you, or yells out curse words in the classroom, you will probably have a reaction to those things. However, your reaction is exactly what the child wants. The good news is you don’t have to ignore these behaviors forever, which is impossible anyway. What you need to do is show the child an easier, more appropriate way to gain the attention they want.

 If I want some cake, I can choose to bake the cake myself or I can just buy a pre-made cake from the store. Either way, I’m still getting what I want. Think of behavior like that; the goal is to teach the child an alternative way to get what they want. It takes much more effort for a child to throw themselves on the floor and tantrum to get Mom’s attention, than it does to hand her a card that says “Play”.

What do attention seeking behaviors look like?

Attention seeking behaviors are going to produce the desired goal of attention. This could be “good” or “bad” attention (I don't use these terms myself, but many do). The student in class who yells out curse words to make his peers laugh is getting “good” attention. After the other kids laugh the teacher may deliver a reprimand and scold the student, which is “bad” attention. However, both sources of attention are feeding the problem behavior. To an attention seeking kid, he/she doesn’t care if you are praising them or scolding them: attention is attention.

Common attention seeking behaviors include:  cursing/potty mouth, talking out in the classroom, crying/whining, lying, off task behaviors, shouting/talking loudly, bothers peers in the classroom, screaming, insults people, out of seat behavior in the classroom, kicks the back of your seat in the car, hits/swats at peers, spits, throws objects, and breaks toys.

Why do children engage in attention seeking behaviors?

Attention seeking behaviors serve unmet needs, and may occur or increase if the child is  unattended, unsupervised, or see others getting attention and they are not. Typically these children either don’t know how to appropriately gain attention, or when they use appropriate methods of gaining attention it isn’t rewarded. You may be thinking “Why wouldn’t someone reward the child if he/she is appropriately trying to gain attention?” That issue is much more common than many people realize. Think about a 4 year old who is grocery shopping with her Dad. She is being quiet, appropriate, and keeping her hands to herself, which her Dad is grateful for so he can focus on shopping. After several minutes in the store, the child begins to make noises and knock things off shelves. Her father scolds her, and gives her a short lecture in the middle of the aisle. Do you see what happened right there? The daughter received no attention for appropriate behavior, and TONS of attention for inappropriate behavior.

How do I handle attention seeking behaviors?

Once you determine the function of a behavior, you need to do 2 things in order to reduce the behavior: stop reinforcing (feeding) the inappropriate behavior, and teach the child what to do instead. If you have other children, or if the setting is a classroom, then it’s important to consider peer attention as well. If you are ignoring your son spitting out food at the dinner table, but your other 3 children laugh and stare, then the behavior is still being reinforced. Smiles, eye contact, and facial expression are all powerful forms of attention. You may need to specifically teach the other children how to react when the inappropriate behavior occurs.

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Tameika Meadows, BCBA

Parent training refers to involving the parents or caregivers in their child’s ABA therapy. All ABA therapists have a responsibility to encourage parent training or parent education. That may mean sharing details of behavioral goals with the parents, videotaping your sessions and evaluating them with the parents, observing the parents implementing compliance training and providing feedback….it could even be as simple as making recommendations to the family about behavioral supports in the home, such as posting a visual schedule.

Parent training doesn’t have to be difficult or time consuming. If you’re an ABA therapist then at the end of each session you could review data and behavioral concerns with the parents. If you’re a supervisor you could schedule weekly meetings or telephone consultations with the families to discuss their child’s programs. When it comes to ABA, parental involvement is key.

Research has consistently shown that when parents are involved in the ABA therapy process, outcomes are more positive. ABA just isn’t as effective without a team approach. If the behaviors that the ABA therapist teaches to the child are not generalized, reinforced, and maintained by the family, then one of two things will happen: the child will lose the skill, OR the child will only display the skill for the therapist. That can look like a client who uses language with you, but leads their Dad by the arm. Or a child who is potty trained for you, but wets their underwear when they are alone with their parents. Partial success only when the therapist is around isn’t real success at all.

The parents or primary caregivers need to know and understand the ABA therapy goals, behavior plans, and strategies so well that in the ABA therapists’ absence they could independently run a therapy session. That is the degree of involvement you are shooting for.

A very popular question I get asked by new therapists is “How can I get resistant or uncooperative parents to participate in parent training?”

First, its important to look at the parents you work with using the correct set of eyes. Take off the judgemental or critical eyes, and put on compassionate eyes:
 It is very hard to let someone into your home who will tell you everything you are doing wrong. It is very hard to trust a stranger to help your child. It is very hard for some families to accept a diagnosis of Autism. It is very hard to step out of paralyzing fear to seek help. It is very hard to admit that as a parent, you don't know what to do with your own child.

Understand that behind the verbal insults, rude demeanor, critical attitude, and apathy a parent displays towards you, could be something much more simple: Fear.

Every client you have will not be interested in receiving parent training. That’s just reality. It is part of our job as ABA professionals to explain to a family why their involvement is critical. Sometimes even after you explain why you need the family on board, they still wont get on board.  What’s important as an ABA professional is to not allow any client to repeatedly decline or avoid parent training. If you work for yourself, you can tell habitually resistant clients that you will have to terminate services if they don’t get on board. If you work for a company, difficult and uncooperative clients usually aren’t tolerated for long. I wouldn’t suggest you work for a company that doesn’t enforce parent training because you will end up in a situation where the family views cooperating with you as optional, and in their eyes you will become a glorified babysitter. That’s not a fun place to be.

I have worked with many families who were either uncooperative with treatment, or sometimes actively worked against me, and there are a few tips I have learned to help the situation:

*        Start your relationship with parents off on the right foot. State from the beginning your expectations of their involvement (I suggest putting it in writing), and make it clear that the success of the therapy will suffer if they aren’t generalizing what you are teaching.

*        Always be mindful of how you are speaking to the parents. Be aware of your tone, your demeanor, and your attitude. No parent will want to cooperate with a professional who makes them feel stupid, lazy, or like a bad parent. We aren’t here to judge parents; we’re here to help them.

*        Give the parents specific feedback, not general disapproval. Tell them what you want them to DO, not what you wish they would stop doing. Use action statements.

*        Require that the parents be in the home during the sessions. It’s very easy for a family to view you as a babysitter if they use your session time to go grocery shopping, or get their car washed. Tell the parents that they need to be home during your sessions so they can observe and learn.

*        Don’t get too involved or too close to parents. When boundaries are crossed and the parents become “your friends” it can be difficult to maintain your professional authority. If a parent views you as their buddy they may start treating your therapy recommendations as optional.

*        Siblings of your client are only to be involved with your session if you need them for a social skill program, or for peer modeling. Again: do not get trapped in the “babysitter” zone. You are a professional providing therapy and you shouldn’t have to run a session while simultaneously entertaining the parents’ other children.

*        Be consistent in your behavior towards the parents. Call the parents when you say you will, be on time for work, etc. Acting inconsistently towards them will cause them to distrust you, and at that point they won’t be interested in listening to anything you have to say.

*        Ask open ended questions. Don’t ask the parents questions that they can quickly say “Yes” or “No” to, because you won’t get much information from that. Instead of asking “Are you following the 3-step prompting procedure?” say “Give me an example from this week of when you needed to use the 3-step prompting procedure.”

*        Use the same strategies to shape behavior with the parents, that you do with their children. If a parent who never complies with collecting data is able to complete even a little bit of data on their own, I will give lots of praise and compliments. I am sure to not only give positive feedback for results, I also give it for effort. Remember: reinforcement strengthens behaviors.  Be consistent with the parents, and provide consequences and reinforcement based on their actions.

** Suggested resources for how to implement parent training:

Dempsey, I. & Dunst, C.J.  (2004). Help giving styles and parent empowerment in families with a young child with a disability.  Journal of Intellectual & Developmental Disability, 29 (1), 40-51.

Hastings, R.P.  (2002). Parental stress and behavior problems of children with developmental disability.  Journal of Intellectual & Developmental Disability, 27(3), 149-160.

Johnson, C.R., et al. (2007). Development of a Parent Training Program for Children with Pervasive Developmental Disorders. Behavioral Interventions, 22(3):201-221.

Perry, A.  (2004). A model of stress in families of children with developmental disabilities: Clinical and research implications.  Journal on Developmental Disabilities, 11(1), 1-16.

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Tameika Meadows, BCBA

Every day approach the learners you work with as if it was Day #1. Yesterday is wiped away, and today could be the day they look into your eyes and truly begin to learn.

“Every day is a new beginning. Treat it that way. Stay away from what might have been, and look at what can be.”

  — Marsha Petrie Sue, Author, Motivational Coach

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Tameika Meadows, BCBA

This post is a continuation in my “Hiring ABA Therapists” series. To read the previous posts, click here:

http://www.iloveaba.com/2011/11/hiring-aba-therapists-interview.html

And here:

http://www.iloveaba.com/2012/03/interview-other-side.html

So you found some experienced ABA therapists in your area (or some super energetic people willing to learn), you conducted interviews, observed the therapist interacting with your child, finalized pay rate, created a weekly schedule, and hired a Consultant to run the program.

Now what??

Now you become the Manager of a really cool corporation called “Your Child’s ABA Therapy Program”.  The Consultant running the program is there as a guide to oversee everything, provide training, and track progress. There are still many tasks left for the parents to do, and it is in your best interest to know what to expect.

To a parent, the relationship between the ABA professional(s) and your family can be a strange one. The therapists are the experts on behavior and motivation… but you are the expert on your child. People you just met a few days ago are now in your home several hours a day… which can be difficult for your other children to understand.  It can be hard to draw a boundary between “The therapist needs to know about our household in order to help my child”, and “The therapist is my best friend/support system and I finally have someone to talk to!”  Particularly if you've never hired in-home staff before, this will be a new and interesting experience for you. Whether you employ 1 therapist or a team of therapists, there are some general tips that will make the process run much more smoothly:

• Missed sessions, no-shows, repeat cancellations, and arriving late to sessions are all to be avoided—that goes for you too, parents. It is unprofessional and rude for the therapist to regularly show up at your home 20 minutes late for a session, and it is unprofessional and rude for you to regularly “forget” scheduled sessions or meetings and leave the therapist waiting outside your home for you to arrive. Make time expectations clear and if either you or the therapist is going to be late or needs to cancel a session, give as much notice as possible.
• The therapist should begin work by doing Pairing only. The therapist should not arrive for their first day of work and start firing demands at your child. Pairing should be fun, noisy, and full of laughs and your child’s favorite activities.
• The therapist should have questions! It doesn’t matter if the therapist is someone with no experience that you found through a friend, or if they have 2 degrees in ABA. They should have questions about your child, behavior, reinforcement, etc., and the therapist should seek feedback from you. The therapist may have years of experience, but it wasn’t with your child. If the therapist has no experience they should be asking you what things mean: What’s a VR? What is a prompt? How do I get the child to do X or Y or Z?
• The therapist should arrive to your home with a goodie bag full of edibles, toys, activities, games, books, or fun items for the child to interact with. This is something that a brand new therapist probably won’t know to do, so you will likely need to tell them. As a new therapist just meeting a child, its unrealistic to expect the child to work for toys they see everyday in their own home. Some therapists believe in working with what is in the child's home only, but I dont. I think reinforcers should be a mix of what is in the home, as well as special things I bring with me. 
• Decide how you want to monitor sessions (because you should be monitoring sessions). Options include a communication log, videotaping sessions, or observing sessions. What you are looking for is a good rapport with your child, adherence to the programs and behavior plan, successful transitions, lots of breaks, and good energy. I have said it before—energy is one of the most important qualities to look for in a great ABA therapist. Even if the therapist has no experience, they should be able to get on the floor with your child and play and have fun. The relationship between therapist and child is just as important as the programs being taught.
• The Consultant should assess your child and provide initial training to you and the therapist. Once therapy begins you will need programs, materials, a program book, and a quiet, distraction free room where therapy sessions are held. Ongoing communication between all team members, as well as training of staff members, typically occurs 1-3x a month.
• Staff turnover is normal. In this field, people come and go. Experienced therapists move out of state for higher paying jobs. Inexperienced therapists realize they don’t like the job and leave the field. Some families may have the same therapist working for their family across several years, but thats really more of the exception than the rule. It can be painful and difficult, but you found one great ABA therapist and you will find another.
• Follow through with what goes on during therapy sessions. The therapist needs your consistency in order to get the best results. If the therapist tells you she is requiring your child use utensils at meals, then you need to require the same from your child. You, the therapist, and the Consultant are a team now. The more you all work together, the better for your child.
• Be prepared for personality differences between therapists. If you have hired a team of therapists, then one therapist may be bossy, another very timid, another messy, another neat, etc. Just because the morning therapist enjoys chatting with you when she arrives doesn’t mean the afternoon therapist will. Respect individual differences, and don’t expect all the therapists to do their job in the same way. Its actually a good thing for your child to learn from differing personality types.

Running your child’s in-home ABA program --even with the help of a Consultant-- is hard work.  The families who handle it best tend to be organized, great communicators, and self- disciplined. It’s important as a parent to educate yourself and become knowledgeable about ABA and behavior. The Consultant and therapists won’t be moving in with you. When all the professionals pack up and leave for the day you need to know what to do about behaviors, or just how to get your child to sit down and eat dinner.

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Tameika Meadows, BCBA