Monday, June 23, 2014

Quote of The Day



Retro Flashback!

It’s good to look back at history for the purposes of retrospection and learning. Staying future focused can sometimes cause us to minimize what the people who came before us discovered or learned.
Viewing these wonderfully retro Lovaas ABA videos (circa mid 70's) makes me feel many emotions: pride for my field, compassion for children dealing with Autism or related disorders, and motivation to keep doing what I’m doing. 


ABA has evolved, shifted, and matured over the years, and the services provided keep getting better and better as a result. We know things now that Lovaas and his students didn’t know back then. What’s that saying though? The more things change, the more they stay the same?

So as you watch these classic videos of the work of the great Dr Lovaas, keep in mind what looking back to the past can teach us today about ABA:

  •  Early intervention changes lives.
  • The earlier and the more intensive services can begin, the better.
  • “Stopping” services can have disastrous effects. If you must halt therapy, consider becoming a Parent Therapist.
  • Kisses, affection, & love have long been popular reinforcers.
  • Not every child with Autism will make huge, significant gains through early & intensive ABA therapy. However, progress is always possible.
  • Parents. Must. Be. Involved. In. Treatment.
  • Behaviors that are not reinforced die out. So stop feeding those tantrums :-)
  • “Fixations”, “obsessions”, and “rituals” in children with Autism can be shaped into hobbies, leisure skills, or even jobs.
  • Adaptive/Life Skills  cannot be left by the wayside. Can the child mail a letter? Cut meat? Set a table? Play sports? No? Then teach them.
  • When looking at my young clients with Autism, I have no idea what the future holds for them. And neither does anyone else. Dream big.


 
Watch the Videos:

Video 1 Behavioral Treatment of Autistic Children: Ivar Lovaas (1988) Part I

Video 2 Part II

Video 3 Part III

Early Lovaas Videos


 


Saturday, June 14, 2014

Behavioral Momentum




Behavioral Momentum - The use of a series of high-probability requests to increase compliance with lower-probability requests (Ray, Skinner & Watson, 1999).

Behavioral Momentum is one of those cool ABA terms that sounds exactly like what it is. Behavioral Momentum basically means to build up momentum to what you really want the child to do, by tossing out easy, or “throw away” demands, that they are super likely to do first. Or to put it another way, you approach the child not with what YOU want in mind but with what they are most likely to want to do.

This seems like one of those simple, obvious things that everyone knows to do, right? Wrong.

 I see staff or parents make this error all the time: They approach the student or client and fire off a series of demands, all of which are non-preferred activities. The child then refuses to comply (either vocally or non vocally), a power struggle begins, tantrumming comes next, etc. There is a way to prevent this frustrating little cycle of behaviors from happening in the first place.



Taking a few seconds to prepare yourself to use Behavioral Momentum can save so much effort and frustration in the long run, especially if you are dealing with a non-compliant or defiant student or client, or even a typical “I’m-going-to-test-you-just-because” 4 year old.

Firstly, do you know how to give a demand? If not here is a quick review:
  1. Demands are stated, not asked.
  2. Get in close proximity and gain eye contact, if possible.
  3. Wait until you have the individual's attention.
  4. Using clear language, present your demand (“Its time for bed” and not “Come on, lets get ready for bed, and I don’t want to hear all of that crying and whining tonight ok? When I say bedtime I mean bedtime”).

Think of what you want the child to do as your real goal. Cover that goal with 1-3 layers, before presenting it. So if I want Andrea to clean up her toys, I may walk over to her and say:

“Hi Andrea!” (Andrea looks up at me) “Nice looking! Give me a high five” (Andrea gives me a high five) “Awesome! Clean up your toys”

I initially presented to Andrea a few demands that are easy for her to comply with, and that I know have been successful in the past. For example, every child is not compliant with eye contact. So if I know Andrea struggles with eye contact, I would have used a different task, such as waving or maybe giving me a hug. This is a child-specific technique. What is a super easy behavior for one child may be challenging for another child.

This technique works especially well with more defiant clients or students, who brace themselves as soon as they see an adult approaching. They automatically think you are walking over to them to stop them from doing something fun.

It’s important to provide praise for the easy demands, just like you would for the difficult demand. Remember, you are building a momentum chain.
On that note, what happens if the beginning of your "momentum chain" breaks down? You toss out some super easy demands, and the child won't comply....now what? You would prompt compliance to those demands, and then you start your chain up again. Think about it like this: if the front of your chain falls off, you now have a broken chain. You can't just keep going, you have to start over.

Lastly, using Behavioral Momentum will also minimize you becoming an Aversive Stimulus. An aversive stimulus is something that we learn to avoid or escape from over time, as it is associated with unpleasantness. Kind of the way for some people, going to the dentist is an Aversive Stimulus. If your child knows that every time you approach them and squat down to their level it is to give a demand, it won’t be long before they start running/ walking off when you approach. By using Behavioral Momentum, your approach gets associated with good things, compliments, praise, high fives, tickles, etc.

*Quick Tip: Wondering how to implement Behavioral Momentum with a lower functioning student or client who doesn’t have many tasks they can easily complete? Try something like this:

  • “Carlos, give me 5!” (Hold your hand up very close to the child so they know what to do)
  • “Thanks! Tickle attack!” (Tickle the childs stomach or under the neck)
  • “Yea! Stomp feet!” (Stand directly in front of the child and stomp your feet)
  • “You are amazing! Time to go potty now, lets go!”



** Here are some great resources on Behavioral Momentum:





Tuesday, June 3, 2014

Autism & Worship





I referenced this briefly in my “Moving From Awareness to Action” post, but for sooo many of my clients, attending regular church services and having a child on the Spectrum mix about as well as oil and water. What is so unfortunate about that is for so many families their faith is what energizes them, and gives them the strength, peace, and sanity to raise a child with special needs. So to be deprived of the opportunity to participate in worship activities can be particularly distressing.

For the ABA professionals, think about a few of the clients you work with. Now picture them sitting through a church service that may be 2-3 hours long, in a crowded room where the sound bounces and echoes, there may be bright lights, lots of people, unexpected transitions, and they are supposed to be still and quiet throughout much of the process. How do you think your client would do?? 
For most of my current and previous clients, the answer is definitely “Not so well”. Looking at things from the child’s point of view, they may not understand why they have been brought to this big, loud place with all these different smells and unknown people.

For parents of children with Autism (particularly as their child ages), going out into the community can become more and more of a restricted activity. Certain restaurants may be avoided, movie theaters are out, and a spontaneous trip to the mall could lead to a meltdown. It isn’t unusual for a family to ask the ABA professional for help/advice/suggestions when it comes to handling their child at church, and how to help their child enjoy the experience. 


~ Helping Your Clients Attend Church ~

The following are some suggestions or tips I would give to a client; feel free to share these tips with the families you serve:

  • Be flexible about where you worship – Is your current church meeting your needs? Church services vary greatly. Some services are quiet with lots of sitting, and other services are loud and everyone is up and moving around. At some churches children are welcome in the main sanctuary, and for other churches children have to go to separate classroom areas. Determine what type of church setting would best meet the needs of the child, and then honestly ask yourself if your church can provide that. Be open to looking at other church settings that may have a very different kind of service than your current church.
  • Are there simple modifications that may help your child?- Is the choir at your church really loud? How about letting your child wear headphones until the choir is done singing. Does your church have hard pews to sit on? How about bringing a cushion or folded blanket for your child to sit on. Does your child have a hard time attending? How about arriving halfway through the service, to limit the amount of time your child has to sit. Does your child consistently struggle in their children’s classroom every week? How about asking to move down to a younger classroom with a looser schedule. Sometimes simple changes can make the whole church experience easier on your child.
  • Take a helper or a buddy with you - The ABA therapist or possibly the Supervisor can attend church with you. You could also ask a nanny or babysitter, as long as they have been trained in behavior management. If a behavioral episode occurs, they can walk you through what to do and how to handle it while keeping everyone safe. Particularly if your family has multiple children, I highly recommend bringing a helper with you to church.
  • Prepare your child in advance- Days before church, talk to your child (in language they can understand, using visuals if necessary) about what church is, what to expect, and why they are going. I highly suggest showing them actual photos or video of the church service, and pointing things out to them (e.g. “See, that’s Pastor Michael right there”). This way when your child arrives at church it will seem somewhat familiar. This “prepping phase” may need to continue for weeks, or even months to help your child know what to expect from church service.
  • Help raise awareness at your church- I can’t give a list of recommendations for families without addressing this. What is the environment like at your church as far as special needs? Are children with special needs made to feel welcome? Is there a greeter or staff person who helps families make accommodations (such as special wheelchair accessible seating)? Is there a special needs room or area? If possible, start a committee or volunteer group that assists families in the church who have children with special needs. There could be many other families who feel the same way you do, and wish they had someone to help them navigate through the church service. Advocate for your child, and speak to leadership about ways the church can make your family feel more welcome. If your child goes into a children’s classroom, prepare and hand out a simple 1-2 page document describing your child, how he/she communicates, problem behaviors, what they love to do, etc. This will be immensely helpful for the volunteers who will spend time with your child, especially since these volunteers often change rapidly.
  • Church should be a fun experience- Remember, from your child’s point of view they may not understand why they keep being brought to this loud, crowded place called “church”. Use Pairing  to your advantage. This is easy to do, just pair fun/awesome/exciting things with attending church. If possible, let your child wear their favorite clothing to church. Yes, that may mean they choose to rock a lime green t -shirt and cowboy boots. Do a highly preferred activity before and after church, bring a “goodie bag” to church with you of super fun toys and fidgets, or save up the biggest reinforcer (e.g. the Ipad) for after church. Does your child favor one parent? Then definitely let them sit next to that parent during church, and maybe even ride alone with that parent to church (the rest of the family can follow separately). This way church becomes connected with  cherished alone time with Mom or Dad, which will make church more exciting for the child.


** Awesome resource for how churches can make special needs children feel welcome: Rachelwojo.com  
* Free resources at the Inclusive Church website