Monday, May 19, 2014

The "Why" of Selecting Goals for Intervention




Reference: “Balancing the right to habilitation with the right to personal liberties: The rights of people with Developmental Disabilities to eat too many doughnuts and take a nap”, D. J. Bannerman, J. B. Sheldon, J. A. Sherman, and A. E. Harchik (1990)

Just the other day a direct therapist asked me how do BCBA’s decide on what targets to teach, what skills to improve on, and in what order to teach skills. It’s a very loaded question.  There are multiple factors to consider when determining what to work on with a client: funding source (how much time do we have to teach the child), wishes of the family/caregivers, are severe behaviors present, are barriers to learning present, is the child in school or not, etc. It’s a heavy crown of responsibility. Selecting goals for intervention is made simpler with the use of assessment tools, such as the VB-MAPP or ABLLS-R, or through a proper intake process where caregivers are carefully interviewed.

Beyond just deciding “What am I going to teach this individual”, much consideration and thought needs to go into “Why am I selecting these goals?”. ABA is a powerful method of implementing behavior change. It’s like glue; when you apply it to something, it will stick. If you accidentally apply it to the wrong area, or you put too much glue in one spot, glue still sticks.

Who gets to decide what an individual receiving treatment needs to work on? If the individual is over the age of 18 and mentally capable, they can just tell you. When working with cognitively capable adults (or even adolescents), they are involved with their own treatment. Their consent, or assent, must be obtained before treating them. 
However, what about those kiddos who are either young, or not mentally capable of saying “Tameika, you’re right. I should decrease the frequency of my tantrums”.

These are important things to think about as a professional. Why should a child’s stimming behaviors be reduced? Why should an introverted, shy child be required to socially interact? Why should a child have their hyperactive behaviors decreased, or extinguished?  What about client choice?

There will be times when as the professional, you do not agree with the goals the caregivers or teacher want to work on. I think many of us have been in the situation of working with a teacher who wants your client to “calm down and be still” during class. Well, there is a difference between using ABA as a magic wand to create perfect children, and utilizing ABA to intervene on socially significant behaviors that interfere with learning. Sometimes as professionals, we have to explain that difference to people. 


 Some of the things you see as “problem behaviors”, the parents will not. The parent may have no issue with their child jumping off furniture at home, or talking back to adults. Creating a treatment plan must involve the primary caregivers, and as much as possible the individual receiving treatment. Client preferences, personality, family culture, and client choice must be considered.

As professionals designing interventions we yield a lot of control over what the client will learn and what behaviors will be reduced. It’s critical to avoid a heavy hand with that control, and to provide multiple opportunities for client choice. Avoid cookie-cutter programming that has Program A for hyperactivity, Program B for social deficits, etc., as these types of treatment act as if all the clients are the same.

Ask yourself does the target behavior cause harm to the child or others, does it interfere with learning, or does it cause (harmful) social stigma. I emphasize harmful social stigma, because all of us experience social stigma to some degree, at some point in our lives.

Think about some of the behaviors you have: Do you get angry at your spouse and furiously stew in your anger for days instead of talking it out? Do you have difficulty sharing your belongings? Do you sometimes fail to eat all your vegetables?  Do you leave dirty dishes in the sink when you go to bed? What if someone decided these behaviors were “maladaptive”, and implemented an intervention to modify your behavior? I bet if someone were writing your behavior plan, you'd definitely want to give your input.


*Recommended Reading: “Burden of Choice
 
Thursday, May 1, 2014

D.I.Y. ABA






Since the birth of my blog, I have consistently received emails from parents and caregivers all over the world who do not have access to an energetic team of ABA professionals, don’t have ABA agencies/schools in their area/country, or can’t afford to pay for ABA therapy. These parents inevitably want to know “How can I do this ABA thing??”
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The truth is not every child who needs it has realistic access to quality ABA programs, for a variety of reasons. So to those parents and caregivers, my advice is to DIY: Do It Yourself.
Empower yourself and help your child at the same time. Would it be great if everyone who needed it had quality ABA treatment options? Of course! But if that isn’t a reality for you, please don’t feel as if all hope is lost.  
Please note: I am NOT saying professional help won't be necessary. ABA is an evidence based treatment method and without clinical oversight and proper data collection you cannot call what you are doing "ABA". If there are no BCBA's in your area, don't fret! Many BCBA's provide remote services or will travel to you. If there are no ABA therapists in your area, hire people you know and trust and get them trained. Go to www.bacb.com to search the directory for credentialed professionals.


Here are my brief guidelines for how parents can work with their own kiddos:

  1. Do your research:  Become knowledgeable about Autism, Behavior Management, and ABA strategies (such as Prompting & Task Analysis). The more you learn through trainings, webinars, books, or research articles, the better you will be able to help your child. Much of the information available to professionals is not restricted, anyone can access it.
  2. Learn how to collect ABC data: Antecedent-Behavior-Consequence data is very helpful for intervening on behaviors. Problem behaviors impede learning. In order to teach your child skills, it is critical to decrease disruptive behaviors. A fundamental knowledge of the functions of behavior, and reinforcement  & punishment  will empower a caregiver to confidently handle problem behaviors.
  3. Focus on teachable opportunities: Look for moments throughout each day where your child spontaneously communicates with you, gives eye contact, approaches a peer, etc. Work on capturing and expanding upon those moments, to teach a variety of skills such as imitation, language, turntaking, etc.  I do this all the time by narrating the action and treating babble as conversation.  When my nonverbal kiddos give me eye contact, I smile, wave and greet them. When they babble around me, I respond back while describing what they are doing “Oh, I see you are playing with blocks. Look, you have a red one, and a blue one….”. Throughout the day look for these moments and picture them as a piece of bubble gum that you want to stre-t-t-t-tch out as long as you possibly can.
  4. Embed learning into your child’s day: The opposite of capturing those teachable moments is knowing how to contrive an opportunity to teach. Most parents don’t realize just how many little moments in the day can be turned into an opportunity to teach. When giving your child breakfast, work on self help skills (pouring the milk), language (“I want cereal”), or fine motor skills (independently using a spoon), just in one 5 minute meal.
  5. At a minimum, understand Differential Reinforcement of Alternative Behavior: I like to tell parents “When in doubt, act like you didn’t see it”. When new behaviors pop up and you don’t quite know what to do or why it’s happening, a good rule of thumb is to starve the behavior you don’t want and feed the behavior you do want. That may look like turning your head and ignoring your child when they start throwing peas at the dinner table, and providing immediate attention and eye contact when they eat their garlic stick. DRA is a quick and easy strategy to implement for busy parents, especially if you have other children to attend to as well. Save your attention, words, and eye contact for the behaviors you want to see increase. Then think about a replacement behavior. For example, when your child goes to throw peas, remind them they can sign “All done” if they are done eating.

*Recommend Resources: