Wednesday, August 28, 2013

“Look At Me!”: Gaining Attention



Photo source: www.johnrobison.com


*Recommended Reading: The Off Task Learner


For anyone providing ABA instruction to a child (teacher, parent, therapist) knowing how to get, and then keep, learner attention will be critical. Just because you start a session with a compliant and attentive child does not mean the session will end that way.  Much of ABA instruction can involve quickly delivering specific demands, and if the child is not properly attending then it can be difficult to truly assess learning.

Even outside of an ABA therapy session, getting and keeping the attention of a child with Autism can be challenging. I find that when I observe non-ABA professionals interacting with kiddos with Autism, they end up “throwing away” lots of demands. They may give a demand to a child who is engrossed in a DVD, has his back turned, or is engaging in vocal stims. When this happens, I really can’t blame the child for not complying with the demand. How can the child comply with a demand to “Come eat dinner” when all he heard was “-inner”?

What most adults determine to be indicators of paying attention (sustained eye contact, immediate responding) can actually be pretty difficult behaviors for a child with Autism. Self-stimulatory behaviors can make paying attention difficult, as can auditory processing issues. For example, if I am at a kids play center with a client and I am trying to give him a demand, I may have to compete with the sounds of kids laughing and screaming, the whoosh of the air conditioner, and the dings coming from a nearby video game. My client might have difficulty tuning all of that out to focus on what I am saying.  
Socialization deficits can also make paying attention difficult for a child with Autism. Looking directly into my eyes may be very aversive to the child, so if forced to “Look at me” they may now be so uncomfortable they can’t really focus on what I’m saying. Or standing in close proximity to me could be a very uncomfortable situation, which makes attending to what I am saying more difficult. All of these factors must be considered when trying to get and keep the attention of a child with Autism.

 I think this is common knowledge, but if not let me share: Just because an individual with Autism is not looking into your eyes, does not mean they’re not listening. I know especially for teachers it can come off like disrespect if a child stares at the floor while you are talking to them, but for a child with Autism they may look away in order to put all their focus into listening.

Here are some suggestions for gaining attention:


Avoid:
  • Using the child’s name – I mention this briefly in my Stimming  post, but you really want to avoid using a child’s name to get their attention in an ABA session. You could end up saying the child’s name literally hundreds of times in a 2 hour session, and you are also teaching the child to pair their name with a demand. I will give a very clear example of how unpleasant this is from the child’s point of view. Lets say that every time you are at work, your boss calls out your name (“Tameika!”) and then follows it by giving you more work to do. How long would it take you to start feeling dread and annoyance when your boss says your name? Not very long. So it’s really important not to pair the child’s name with work (“Aidan, touch cup”…..”Aidan, give me yellow”…..”Aidan, how old are you”).
  • Touching/moving the child’s face – Beyond not being a true indicator of attention (the child may orient their face to you, but not their eyes), this can also be pretty aversive. Would you want me to yank your chin towards me because you aren’t paying attention to my story about my vacation? I doubt it. The child may have temporarily forgotten about your presence while they are engaging in stimming, so to abruptly touch their face or chin can be very jarring.
  • “Look at me!” –  Understand that saying “look at me” is not the same as asking the child to pay attention. Also, ple-e-ease do not shout at the child "Look at me!". That is not the way you want to gain attention. Use a natural tone of voice and an interesting facial expression, and say something like "Are you looking?" or (while gesturing to materials) "Look right here".
  • Using rigid reminders or cues – I have used visual cues to get the attention of a child at the table, particularly very young children. However, it can sometimes be hard to generalize or fade these cues. This could be something like a sign that says “Hands quiet, Feet still, Mouth closed, Ready to Learn”. What I would suggest is not relying on cues or reminders such as these so much that the child isn’t actually learning to attend, they are really just learning to be prompt dependent.

Try:

  • Use behavioral momentum – Behavioral momentum basically means to allow the individual to contact success first before presenting a demand or task. So if you are conducting an ABA session and the child is not paying attention, give them a few mastered tasks such as “Clap hands……stand up”. Then put out your cards/materials and start teaching. Be sure to reinforce the mastered tasks. This way the child has a behavioral cycle of {easy(reinforcer)+easy(reinforcer)} before you move to harder tasks, which can make it more likely they will attend.
  • Be fun and engaging – The best ways to gain attention will always be child specific. However I can say that for past clients, we would have goofy things we did at the start of a session such as countdowns, arm/hand squeezes, racing to the work table, etc. For older or more high functioning children, you can offer choices (“Should we do Matching or play the Numbers Game first?”). This way the child is involved in the structure of the session, and you now have their attention.
  • Capture or Contrive M.O. – Capturing the motivation of the child will always lead you into gaining their attention. If I want $5, and you walk up to me holding $5, I’m probably going to pay attention to what you’re saying to me. Wouldn’t you? So start the session by conducting a Reinforcer Preference Assessment, to see what will motivate the individual/client. Gaining and keeping attention should always be a byproduct of consistent Differential Reinforcement, capturing motivation, and approaching the individual with powerful reinforcers.

*Quick Tip:

Attending should not be a skill that is assumed upon. Maybe the individual/client does not know how to attend. In that case, you can use ABA strategies to teach the skill. Here are a few suggested skill acquisition programs to target attending:

Imitation
Receptive Language
Responding to Name
Attend to an Object  (track object with eye gaze)


Wednesday, August 21, 2013

Quote of The Day

“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” 

Maya Angelou, Poet and Author

 

I love this quote from the wonderful Ms Angelou because it so relates to what I do for families and children as an ABA provider. 

To other ABA professionals I would say: Leave an impression with how you treat people, because whether good or bad that is what will be remembered. Don't focus so much on the technical aspects of the job that you leave your "bedside manner" at home.

 

Wednesday, August 14, 2013

ABA Interview!



Its time for another ABA interview!

If you work in the field of ABA and would like to share your story and experiences feel free to contact me directly. I'd love to hear from you.




In the 2nd post from my Interview Series, is a young lady doing ABA in a very interesting location: Malaysia. She was kind enough to share her story:



Interview

  • If you would like to, state your name.  Anonymous

  • State your job title. ABA Therapist

  • Where do you work (location)? Malaysia

  • Do you work independently or for a company/agency? Independent

  • How long have you been an ABA therapist? 2 years

  • Did you receive initial training for your current position? Yes

  • Do you receive on the job training in your current position? Yes

  • How confident are you in your capabilities as an ABA therapist ( rate from 0-100%)? 70%

  • How much do you make per hour ( USD amount)? After deducting gas, reinforcers, supplies, etc., do you feel your hourly rate is high enough? USD $9 -10/hr. I came into this field to gain experience and learn about ABA or anything relating to Autism/Dyslexia/Learning difficulties and etc. It is also my passion to be involved with these children/adults and their families thus I am not very concerned about the rates. But if I were to deduct gas, and all the other stuff, the rate is not high enough.

  • Do you feel more confident with skill acquisition or behavior management? I enjoy doing both but I am not 100% confident in them as I am still in the process of learning and gaining experience. Both give me the same satisfaction.

  • Describe some of the problem behaviors you deal with.
1) Tantrums – from mild to severe such as hitting head, scratching therapist, rolling on the floor, hitting therapist, whining, crying, kicking,
2) Task avoidance – half way doing the work and the child will try to escape, going to the washroom frequently, wetting pants
(These are some of the examples of problem behaviors that the child displays but they do not happen all the time.)

  • What ages do you work with? 6-10 years old

  • What populations do you work with? (Autism, ADHD, etc) Autism.

  • Explain how you got started in ABA. I got involved with some Christian works dealing with people with Autism and my passion for them slowly grew. Later I took up a course specializing in learning disabilities and I was introduced to ABA.

  • Before you started working in this field, what did you know about ABA?
As from my answer in the previous question, I only got to know about ABA when I attended the course. I had not heard of ABA prior to that. Studying and actually executing the ABA work is quite different. As all children/adults with Autism are different, thus what I studied might not be applicable to child A but effective on child B. Thus I find ABA very interesting and effective as we make changes to suit them individually.
But the concept of managing and changing problem behavior is the ultimate goal for them to have a better lifestyle in the future and to help them to learn.

  • Describe a typical work day. (How long is your day, how many clients do you see, how much driving is involved, etc) I work with one or two clients a week (3-4 times a week for each client, 2 hrs each time). I attend meetings monthly. It involves quite a fair bit of driving especially if the sessions are in the evening (6.30pm-8.30pm).

  • What is the BEST part of your job?
1) When the child /children improves (even if it is just one of the tasks).
2) Their smiles and laughter
3) When the child/children enjoys the session
4) Parents/families appreciate my time, work and effort

  • How many times a week do you feel stressed, overwhelmed, or discouraged at your job?
2-3 times a week. Sometimes it could be everyday for a few weeks and then it gets better :-)

  • How do you deal with the stresses of the job? Read up on more articles, books or talking with others in the same field to gain knowledge.

  • Do you prefer working: in home, in the school, in the community? Why? If time permits, I would like to try all as different setting /working environments allow for more improvement on my side (gaining experiences). Children /teenagers with autism will also react differently in different setting thus it would be a good opportunity to see how they behave overall.

  • Do you receive support and active involvement from the families of the clients you serve? Do you wish you received more?
Although the families do put pressures and stress on the therapist, so far I do receive support and active involvement from them. I would really appreciate if the families/parents understand that improvements do not happen overnight. Sometimes the child might reach a plateau or certain behavior might return and that is not the faults of the therapists. It is also not because ABA is not working/effective. Parents should give us the time to look into the problems and then come up with a different approach. And even with a new approach, it might not work immediately.

  • What have been your best and worst experiences with a family/parent?
BEST Experience – Families and therapists getting along, laughing and joking together. Everyone is united with the same goal of helping the child improves.
WORST Experience – Families/parents putting unnecessary stress and pressure on the therapist such as urging the therapists to do better or improve. Not appreciative of the therapist effort and time.

  • Do you plan to pursue BCBA certification? Why or why not? Not at the moment as time is really not on my side :-)

  • Name 2 things you wish you could change about your job.
1) I wish families/parents are more understanding and supportive instead of putting pressures and stress
2) I wish I do not have to work on public holidays.

  • Name 3 things you wish more parents knew about ABA therapists.
1) That ABA therapists take their jobs seriously and work hard for the improvement of the child.
2) That ABA therapists are filled with love and compassion for both the child and the families.
3) That ABA therapists are mere human beings who have their flaws as well. They make mistakes too. Although they are professional in their jobs, there could be some limit to certain things that they can do. Moreover, some therapists might need some time to learn up a certain method in dealing/teaching the child thus parents should be understanding instead of comparing one therapist to the other.

  • Anything you want to add? Being an ABA therapist is really a joy. Although it is stressful (at times since I am still new to the field and also the occasional stress by the families) I derive a lot of satisfaction and fulfillment from it. I enjoy learning ways and methods to help the child. I like to know what constitute to a certain        behavior in the child and then brainstorming with the team to come up with solutions/methods to address the problem. There are no blogs, platforms or support groups for ABA therapists or   teachers/caregivers so it would be great to have one where we could come  together to share our thoughts and experiences and at the same time  encourage and motivate one another.





Saturday, August 3, 2013

FCT: Functional Communication Training







Resource: Carr, E., & Durand, M. (1985). Reducing Behavior Problems through Functional Communication Training. Journal of Applied Behavior Analysis, 18, 111-126


Functional Communication Training is one of those ABA teaching methodologies that everyone should know about, whether you are a parent or professional. Parents and teachers sometimes naturally implement FCT without realizing they are using an ABA strategy. I find that to be true with many things teachers or parents of children with Autism do.

FCT is used to teach and establish replacement behaviors for inappropriate or harmful behaviors such as aggression, escape/elopement, non-compliance, etc. When a child is regularly engaging in disruptive, challenging behaviors that is ALWAYS a form of communication. Even for a verbal child, but particularly for a non verbal child, behavior is a way of communicating wants and needs. My non verbal kiddos are usually the most aggressive kiddos, because they have learned that hits, kicks, and pinches get people moving. They get people doing what you want them to do.

The way FCT works, is it is a strategy used within a comprehensive ABA program. The target behavior is selected and defined, and then through careful observation and data collection a communication deficit is discovered. Then a hypothesis is created in order to select more socially acceptable and appropriate ways for the child to communicate that will also contact naturally occurring reinforcement.

I know that just sounded super technical, so here is a real life example to help explain this a bit.

I had a client a few years ago, lets call her Tiffany. Tiffany was 2 years old, nonverbal, and had some aggressive behaviors. Tiffany communicated mainly through tantrums, leading, or hitting. If Tiffany wanted to eat, she would scream and hit the refrigerator with her fists. If she was tired, she would bang her head on the floor.  Get the picture? After conducting a FBA, and observing the dynamic between Tiffany and her family, I determined that the function of her behaviors was primarily Positive Reinforcement (access to something she wanted).  What I also made very clear to the family was that without a reliable system to communicate her wants and needs, Tiffany had created her own system. The family and I may think the system isn’t acceptable, or label it “maladaptive” but it’s really not. Tiffany’s system was quick, relatively low effort, and it got the job done. People would come running from all over the house once Tiffany started head banging, and when she pummeled the refrigerator a snack would magically appear in about 10 seconds. So how did we teach Tiffany to stop engaging in these challenging and harmful behaviors? With FCT. We taught Tiffany to communicate her wants and needs and then --and here’s the critical part-- we made sure that language contacted reinforcement and behaviors did not. So Tiffany learned that if she slammed her head into Mom’s stomach, Mom would just block the behavior and ignore her. However if Tiffany signed to be picked up, Mom would immediately pick her up and lavish her with attention. That’s FCT in a nutshell: replacing problem behaviors with communication.


When implementing FCT it is important to decide on a communication system that works for the child, and that caregivers will accept. This could include vocal language, PECS, sign language, or a speech generating device. It just depends on the child. Once a communication method has been determined, it is very important to no longer reinforce the problem behaviors. To do so would only undermine the effectiveness of FCT.

Reinforcement and Prompting will be key in teaching the new behavior, as well as keeping the child successful.
The problem behavior must be put on Extinction  so that the child learns that only communication gets needs and wants met. Depending on the child, this can be done with Antecedent interventions or Consequent interventions. Antecedent just means before, so this would focus on preventing the behavior from even occurring. Consequence just means after, so this focuses more on what to do when the behavior occurs.  No one wants to engage in a behavior that doesn’t contact reinforcement-- thats  Operant Conditioning 101.

The last thing I want to emphasize about FCT is it’s important to select reinforcement that is most likely to occur across environments, and in various social settings. In the Carr & Durand article, the researchers taught the children to say the phrase “I don’t understand” to replace problem behaviors during difficult tasks, such as academic work. I love that! Multiple people, whether they are familiar with the child or not, would know how to respond to this phrase. 
What I see happen much more commonly, is the therapist will teach the child to say “Help me”. Here’s my problem with “help me”: the child doesn’t normally receive help, instead the adult does the task for them. I see this all the time, and I have been guilty of this as well. A child who only has a few words walks up to you with their pants half zipped and says “Help me”. Usually, you are so excited that they are talking that you happily reinforce the language and then zip up their pants all the way. The problem with this is that over time, the child is learning that “If I say "help me", then somebody will do this for me”. Whoa, see what happened there? That is not what you want to teach. We want to teach the child to request assistance, not to get out of the task.

I am not saying to stop teaching your child to say “help me”. Just be sure to provide partial help, and not allow the child to escape the task completely.


**More Reading on FCT:

Fisher, W.W., Thompson, R.H., Bowman, L.G., Hagopian, L.P., & Krug, A. (1999).  Facilitating tolerance of delayed reinforcement during functional communication training. Behavior Modification.

Shirley, M. J., Iwata, B. A., Kahng, S., Mazaleski, J. L., & Lerman, D. C. (1997). Does functional communication training compete with ongoing contingencies of reinforcement? An analysis during response acquisition and maintenance. Journal of Applied Behavior Analysis, 30, 93-104.

Carr, E.G., & Carlson, J.I. (1993).  Reduction of severe behavior problems in the community using a multicomponent treatment approach.   Journal of Applied Behavior Analysis, 26, 157-172.