Photo source: www.thethingswesay.com

So many times in this ABA universe when we talk about CHOICE, we always talk about the individual receiving treatment. The student, client, child, etc.
What about our choices? How much in a typical day do you think about the impact your choices have on the behavior of the consumers you treat, or the children you are raising?

When I first meet new families, a common misconception I enjoy correcting is the idea that the child is completely "out of control". I hear statements like, "Well he can't help it, he has Autism", or "We know it will probably always be like this, but do you think there is any hope she might get better?". Statements like that come from a belief that problem behaviors don't involve choice, which leads to the next belief that as caregivers or treatment providers we are powerless to change behavior. Well clearly that can't be true, or there would be a lot of ABA practitioners standing on street corners with "Will write Behavior Plan for food" signs. ;-)

When you understand that your choices impact your child's choices, or your choices impact your client's choices, it opens up a dizzying amount of possibilities and potential outcomes. So make wise choices today, that will benefit you tomorrow.

*Recommended Reading: The Burden of Choice

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Tameika Meadows, BCBA, Blog Author

Photo source : www.thirtyhandmadedays.com, www.journeyofmylifendestiny.blogspot.com 

*Recommended post-- Writing ABA Programs


My last post on programming was really for professionals, but this one should help parents/caregivers understand the "why" and "how" of teaching new skills.

Typically with ABA treatment, intake/assessment is followed by treatment planning, which is followed by creating individualized programs, which is followed by teaching those selected programs. What's a program you ask? Basically, a program is what is being taught to the learner. If your child is receiving ABA services, they probably work on multiple programs every single therapy session.

I find that most parents/caregivers have a very vague understanding of what their child is working on and why, and how skills connect to each other. Due to this lack of understanding, some common problems that can arise include:

• Expecting the ABA team to teach your child everything, all at the same time
• Expecting skills to be taught in a matter of days
• Parent gives little to no input on treatment planning/can't think of anything they want to work on
• Confusing a "Program" with a "Target"

These are the main problems I see, although there are many more that can pop up when parents don't understand how the teaching part of ABA therapy works (yes, ABA is far more than behavior reduction!).

I always recommend to parents to ask questions, observe therapy sessions, utilize the BCBA, and review/look at the data regularly. These components are like the blueprint of the building, or anatomy of the cells of your child's treatment. If you are confused about the services your child receives, I would ask: how regularly are you viewing that blueprint? How involved are you with the anatomy of it? It took the staff and BCBA on the case extensive training, years of experience, and college coursework to have a solid understanding of what they are doing. How much harder do you think it will be for YOU to understand what they are doing?

I love to remove confusion (just call me Confusion Off) so let's address each of the common problems I see, one at a time:

• Expecting the ABA team to teach your child everything, all at the same time - Definitely the biggest misconception I see. Intake/assessment is usually the point where the BCBA discusses goals for treatment with you. From the assessment results and this conversation, the BCBA will prioritize goals based on a variety of factors such as: goals that can replace current problem behavior, goals that are needed for daily functioning, goals that address the most pervasive developmental delays, etc. What this means in plain English is we cannot teach everything, all at the same time. It's just not possible. Plus your child would hate that. The reality is other non- clinical factors must be considered too, such as how available is the child for therapy, how many hours of therapy a week can the family afford, how many hours of therapy a week can the ABA therapist provide, etc.. When you add up all these factors and weigh the highest priority goals, this does mean that some skills may not be targeted right away. Your suggestions to keep adding new goals are not being ignored, it's likely that the things you want to add are not priority, the child already has the maximum number of goals for the moment, or new goals won't be added until performance improves.
• Expecting skills to be taught in a matter of days - When you start climbing a ladder, do you put your foot on the 5th rung? No, right? Teaching is very similar to that. When teaching a new skill, there is this thing called a "pre-requisite skill". This means there is something the child needs to be able to do before they can move on to more complex or advanced skills. For example, many play skills require the ability to imitate. Why? Well, if I am trying to teach a young child to play with a Barbie doll I am going to do this by sitting down with them.....and playing with a Barbie doll. I know, this is complicated stuff :-) But what happens if while I am enthusiastically playing, the child just stares up at the ceiling and drops their doll? The child needs to be able to watch my play and imitate it, in order for me to teach them to play on their own. So before I can tackle play skills, I first need to work on teaching imitation. Much of ABA treatment involves these kind of careful ladder steps. We have to work our way up that ladder, which depending on the learner can take days, weeks, or even months. But its super unrealistic to assume the learner will just fly through learning new skills. Expect it to take time.
• Parent gives little to no input on treatment planning/can't think of anything they want to work on - This may sound like it would never happen, but it absolutely does. A parent initiates ABA services, and during the intake makes statements like "I just want him to be normal", "I'm fine with whatever you think we should focus on", or "I just want her to be happy". Unfortunately, I don't have any curriculum for teaching "normal" or "happy". So in these kinds of situations what can happen is the ABA team puts together a treatment plan that is not functional for the learner. For example, the BCBA may decide the child should work on manners to improve their social skills. However the family isn't big on manners, and this is not an important goal to them. So when the ABA team is not around, who is practicing manners with the child and reinforcing this skill? Likely nobody. Which means the skill won't progress, and it probably won't  generalize. Think of the ABA team like a group of painters showing up to your home. We have our coveralls on, our paint, and our paintbrushes. But...what exactly do you want us to paint??
• Confusing a "Program" with a "Target" - "I told you I wanted him to learn his body parts, why is he just playing with a Mr Potato Head toy?". If I did not have the knowledge I have, I would find much of what the ABA team does highly confusing.  It looks like we teach random flashcards, meaningless games, and senseless activities over and over again, that have nothing to do with the reasons parents initiated therapy. This could not be more inaccurate. Every "program" is like a menu at a restaurant. You open the menu because you want something to eat or drink. But you can't tell the waitress "I want to eat". You need to be more specific. So you read over the menu and see the hamburger section. But you can't tell the waitress "I want a hamburger". You need to be more specific. So you choose the exact hamburger, and the exact toppings and tell the waitress "I want a hamburger-well done- with no onions and extra cheese". Make sense? Bringing it back to ABA treatment: menu= overall objective, hamburger= program, specific hamburger= target. When a parent says to me "I want him to play with his brother". What I hear is "I want him to improve his social skills", which means breaking that down to improving and reducing behaviors, which means breaking that down to first learning to play with me, then learning to play with me and a peer, then learning to play with just a peer. Whew. Designing treatment is not quick, or simple. Rest assured, the issues you initially discussed with the BCBA are being worked toward, but we have to break the skill apart in order to teach it.

With any child, there will be skills that come easy and skills they struggle to learn. There will be things they should be able to do but cannot, and other things they do super early or super easily. Thats just part of being a human. It will drive you crazy if you look at your child with Autism as a collection of deficits and "not there yet's", and it will also cause you to overlook all the progress they are making right now.
Take time to appreciate those baby steps, sometimes baby steps are all we have.

*Free Resource: This simple handout helps explains common program names many BCBA's use (what the program is supposed to teach).

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Tameika Meadows, BCBA, Blog Author

Photo source: www.giphy.com

*Recommended Post- The Basics: Operant Conditioning

Much of what I do does not involve teaching complicated, advanced level behavior analytic concepts to families/caregivers or educators. No, most of what I spend my time doing is simply explaining "basic" concepts over and over again. I say these concepts are "basic", because if they really were so basic would so many people not know them??? Hmmm, I think not.

One of these basic concepts is the idea of RESPONDING vs. REACTING.
Most of the common errors I see across clients, happen when a teacher or a parent quickly react to something my client is doing instead of going into robot-mode to properly respond.

What's robot-mode? I'll tell you: it's that moment where time seems to freeze and outwardly the ABA practitioner goes stone faced, stops talking, quiets their body language, gets near or away from the client (depending on what is happening), and appears to be not a tiny ounce affected by what the client is doing. The pros make it look easy, don't they?

Well, inwardly, that practitioner is thinking hard and fast. They are scanning the room to weigh potential dangers, they are automatically thinking of what they will do if the behavior escalates, they are reminding themselves what the last demand was (so they can return to it as soon as feasible), they are doing a mini-FBA to think about what led to this behavior, etc. And watching the practitioner work, it probably looks like none of this is happening. I've actually had parents comment on that before, something close to "I can't do what you all do, I can't just SIT THERE while my child is tantrumming". Oh believe me, we are not just "sitting there".

That's why I call it robot-mode....the outside is objective and mechanical and the inside is a  computer clicking along at high speed. It took me time+ time+ time to get to the point where I could do this as quickly as those amazing supervisors who were teaching me to do this. Especially if the client has a good handful of your hair, or skin, or clothes.

To put it simply, when we react to something we are usually going in emotions-first. When we respond to something we are usually going in logic- first. I have tested this theory out a bit by asking parents in the moment "Ok, now why did you just do that?" and they usually say something like "...I don't know/I wanted him/her to stop". *see note on this below
 If you ask the ABA practitioner (which I recommend) why they are doing what they are doing, there is a technique or strategy they can describe to you, with the overall goal always being to teach. This could be teaching replacement behaviors, teaching communication, teaching the child problem behavior does not = escape, etc. Responding is a thoughtful process where you generate ideas, evaluate your idea, consider the consequence of your idea, and then act.





*Note: I explained this in my Punishment post, but when people tend to emotionally react to problem behavior it is often in a highly punitive manner, or with the goal to just stop the behavior. Little thought may be given to teaching new behavior. Just another reason it is so important to be intentional about behavior change, and manage your own behavior before you try to intervene on your child's behavior. If your child gets frustrated and yells, so then YOU get frustrated and yell....what did they just learn?

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Tameika Meadows, BCBA, Blog Author

Photo source: www.myuntangledlife.com, www.cultureofyes.com, www.cozylittlehouse.com

In a typical day as a BCBA working in the field, multitasking will be a very close friend. I you don't possess the skill of being able to supervise staff, carry on a conversation with a parent, write up a progress note, and open a container of blocks for the client all at the same time...then you should probably work on getting there.

It doesn't happen overnight, but with practice, diligence, and lots of organization----> you CAN be perfect.

Okay, not really :-)
You won't be perfect, but you will be able to get an amazing amount of things done in short periods of time. And if there's one thing BCBA's have in limited commodity, it's time.

Over the years, I have learned this skillset the easy way and the hard way. I have watched and learned from other BCBA's that I admire, and definitely had some trial and error situations that didn't go so well.


Below are some of my top tips or strategies I regularly use to maintain my sanity, starting off with my absolute must haves: The Top 3.

MY TOP 3 TIPS

* Know your limits and set your boundaries, or other people will constantly test your limits and push your boundaries

*Set working hours (I am including all the work you do at home for free) and stick to them

*Delegate whenever you can, to appropriately qualified individuals. You won't get a glittery cape for trying to be Superman/Superwoman, just a tension headache

• Calendar/Scheduling: Keep a copy of your schedule in whatever format is easiest for you. I use an oversized wall calendar, but I also store my schedule electronically in case I need to update it on the fly. As much as you can, schedule things in advance. I usually schedule out a month at a time and I block out certain days each month as "catch up" days. This is where I turn off the phone and focus on paperwork, or if I need to schedule something out of the ordinary (like meeting a client's new speech therapist), then I always have free spots to do so.
• Traveling Office: Formerly known as your car. Make sure when you head out for the work day that you have your car loaded up with any odds and ends you or your staff may need, such as extra pens, extra data sheets, supervision notes, clipboards, etc. I also carry a large therapy bag, which is loaded with my clipboard and feedback forms, pens, post its, highlighters, etc. 
• Make a Supervision Binder: This is one of those tips I had to get from trial and error. It changed everything once I put it in place. Make a binder where you store all client information and important documents, such as: a map of the area (I found this most helpful when I was working in new states), client contact information, each client's schedule, recent notes for each case, To Do list for yourself, client school/daycare calendars, progress report due dates, etc. Put your supervision binder in your huge therapy bag, and carry it with you from one client to the next.
• The To Do List: I make To Do lists of things to add to my To Do list. That is how much I love having a checklist. Before heading out for supervision sessions, make a To Do list for each client. This will help keep you on track once you are there with the client, the parent, and the staff. New things will pop up (of course), but get in the habit of saying "We can talk about that in just a second, but first let me run through this checklist". This was one of the best timesavers for me, and it helps me fully optimize my face to face time with the client when everyone is pulling me in 10 different directions.
• Get a Nice Clipboard & Make Your Own Data Sheets: This one is the most helpful for going into schools or in the community. Places where you can't drag your huge therapy bag behind you. What I used to do is write copious notes on 50 little pieces of paper, carry that around with me, and then have the fun task of wading through that when I got home. What I do NOW, is I have a clipboard that I can store things inside. Especially when visiting a new school, always bring your ID/employee badge just in case they ask for it (stick that inside the clipboard, along with your keys and a few pens/pencils). Make simple data sheets instead of using large amounts of paper. This keeps your hands relatively free, keeps you from awkwardly asking where you can put your purse/bag, and when you don't need to take notes just tuck your clipboard under your arm, have a seat, and observe your client.
• The Home Office: Your home work space needs to be neat, free of clutter, and use a storage system that makes sense for you. For me, I keep all my learning resources together, I keep my client files together, I keep my assessment kits together, etc. Everything has its own tub, and is labeled by category. Then inside each tub, items are stored in baggies and documents are stored in file folders. I use a similar system for my computer files, everything is divided up by category. I have categories for general resources, for insurance/billing, for employer required forms/data sheets, and each client has their own file system with identical subfolders. This way when I move quickly in between various clients, each folder is set up the same way (saves lots of time when I need to find something quickly). I also insanely love templates. So I have Client Master File templates, Supervision Feedback Form templates, Parent Training Handout templates, ABC Data sheet templates....I will stop there because we'd be here all day. When I need something, I just open up a template and edit it depending on who it is for. Saves an amazing amount of time.
• Give Up 1-2 Hours Each Night: This tip may not be as helpful for you, depending on your schedule and how many clients you see in a day. For me, I don't see more than a few clients a day. What that usually means is I work a few hours and then I am done. Once I get home, I pull out my supervision binder, flip to each client's section, and I am looking for: program changes I need to make, reminders/emails I need to send to the team, data I need to transfer to my computer, materials that need to be purchased or made, etc. I plan this time into my schedule, and do not consider my work day done until this is completed. By adding this step, I avoid getting to the middle of my work week and staying up all night catching up on things I didn't get done earlier in the week. Or worse, spending all weekend furiously updating programs or revising data sheets before I go see the client again the next week. This was such a timesaver for me! I don't work in an office setting, but this is the equivalent of not leaving the office for the day until your desk is clear ;-)

 As your work experience and confidence grow, you will learn how you work best and what level of organization you need to stay sane. More than just the stress that comes from chaos though, its important that you as the BCBA are on top of things because ....well, everyone else on the team is expecting you to be! You are the one who is expected to remember everything, always have copies with you, and update everyone of important treatment changes. It helps to fulfill that role when you develop a system, and stick to the system.

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Tameika Meadows, BCBA, Blog Author