Showing posts with label behavior. Show all posts
Showing posts with label behavior. Show all posts

 



“She’s/He’s just a bad kid”

 

Dig deeper.

 

Have you considered:

Maybe you just don’t know how to teach him?

Maybe he has a trauma experience you know nothing about?

Maybe he’s misdiagnosed?

Maybe he’s undiagnosed?

Maybe he’s undermedicated?

Maybe he’s overmedicated?

Maybe he has mental health issues?

Maybe she can’t focus in this environment?

Maybe your low expectations are impacting her performance?

Maybe you just aren’t that reinforcing?

Maybe this material is beneath her ability level?

Maybe this material is far too challenging?

 


“Bad” is a lazy word meant to signal a conclusion, where further data, analysis, assessment, and modification of strategy is clearly needed.





 Birthday parties. Let's talk about it.


Parties, gatherings, events, picnics, etc., where there will be lots of people, noise/music, activity, chatter/laughing, and hidden, unspoken rules for "appropriate" behavior.

The event may even be outdoors, which brings a whole host of safety concerns.

Or, the event could be near a body of water (pool party), which definitely adds even more safety concerns.


For parents with Autistic children, or another disability, do you just not go??? Is that the way to do this? How do you get a child through elementary school without ever attending a birthday party?? These days, kids have to invite the whole class. So in an average school year, your child may receive several birthday invitations, to loud, active, parties full of running, screaming kids, hopped up on sugar and soda.

Before we jump into what to do, let's back up a bit and describe the challenges: Why are birthday parties sometimes so not fun, and so very hard

Birthday parties/large gatherings are (often) loud, full of junk food/ice cream/candy/cake, full of people, tantalizing presents, music or entertainment, and the expectation to socialize ("You kids go play"). All of this can combine for quite the sensory nightmare.

Your Autistic child may find the event overstimulating, scary, uncomfortable, or painful (overstimulation that one cannot leave can be painful). Your child also may be unable to tell you any of that, which leaves demonstrating the discomfort through their behavior.

I have seen this up close many times, both "on the clock" and off the clock. I've been at kids birthday parties and seen that girl or boy seriously struggling and having an awful time, or attended birthday events with clients to provide support during the party. 

I think its critical to reset expectations and have a clear understanding of just how scary parties can be for Autistic children or adolescents (I'm not mentioning adults because, typically, adults with disabilities are not forced to attend events they seem not to enjoy, the way small children are).


The questions below should be carefully considered based on your child's age, temperament, sensory profile, and support needs, with strategies in place in case the party experience goes badly. Have a plan, then have a backup plan, and don't go it alone. Bring at least 1 other adult with you, or if you are hosting the event, assign helpers among family ands friends who know what to do and will quickly jump in if your child is having a hard time.


Things to Consider:

Do you have to attend/throw the party? No really, think about that. What would happen if you just...didn't go? Or what would happen if your child didn't have a 4th birthday party? I'm pretty sure the earth would still keep spinning. Sometimes, the level of support that would be needed as well as the needed accommodations aren't feasible. In that case, is it better to force your child through something they are unlikely to enjoy, or to just skip it? I'm not saying forever, and this could even be a case by case decision. Small party at a neighbor's home? Sure. Huge community pool party with 6 clowns, a DJ, and group party games? Maybe not.


- Don't try to stay the whole time, instead play it by ear. For some children, they aren't excited about the cake (feeding issues are common with Autism). They don't care about the social games or group activities. They don't yet have the ability to wait, so they won't understand why they can't start ripping into set aside food or activities (and may not understand why they can't open someone else's gifts). What will YOUR child do at the party that they find fun, entertaining, and is safe? Think about that, before you take them to a 2 hour birthday party.

- Understand that vigilant supervision may be needed. This does mean dropping your child off may not be a safe option (as the party host will be super busy), and if you stay with your child, you may need to keep them in eyesight at all times. It isn't unusual for my clients to 100% "veer off from the group" during parties, only to be found sometime later upstairs in a closet, or trying to access YouTube on the family laptop, or casually digging through someone's refrigerator. These can be very embarrassing moments, that could easily be prevented by keeping a close eye on your child, especially if the party or event will be held outdoors.

- Speaking of embarrassing, there is nothing embarrassing about accommodations or supports. If you are taking your child to a party or event where they can't wear their noise canceling headphones, or freely STIM (family members, sadly, can be very judgmental about stimmy kids at birthday parties)  without being treated poorly, that may not be the kind of event you want to attend. Again, parties are overstimulating for many Autistics. So it makes sense that they will do MORE of what helps them calm or regulate in response to being at the party. In other words, if most of the kids are quietly playing Candyland, but your child is in a separate room happily squealing and jumping, while chewing on a straw, will this be a problem for other people at the party? If so, I don't think your child is the problem.

- Take preferred foods, toys, and leisure items with you. Please do not expect that your child who eats 3 foods at home, will magically attend a birthday party and chow down on Cheetos, cake, and pizza. If they won't eat it at home, they likely won't eat it at the party. Also, don't withhold stim items or comfort toys because the child is in public, and other people will see. Those favored items may help keep your child calm and comfortable, in a chaotic and loud setting. On that note, it can be helpful to bring items your child may grab, snatch, or steal, if they see it in public. For example, I worked with a boy once who loved to suck on pencils. If he was out somewhere and saw a pencil, he would try to grab it and put it in his mouth. So in that situation, I'd recommend bringing oral sensory items with you so the child doesn't need to hunt throughout someone else's home for something to satisfy that chewing desire. Think about things like this in advance, and plan accordingly.

- The biggest tip, and the one I see cause parents the most pain and distress, is this: Please don't expect your child to be a different person socially, just because you're at a birthday party. If your child is not very social at home, they likely won't be very social with 23 other kids present. In fact, they may exhibit new behaviors you usually don't see at home (such as pushing, swatting at, or running off to get away from the other kids). This can be very hard for parents to watch. So can bullying and stigma, such as if your child DOES want to join the play, and the other kids are being mean or cruel to your child. Remember that earlier tip about close supervision? It's very important to watch how your child interacts with the other children, so you can stop any bullying or rudeness in its tracks, and so you can monitor when your child's social battery is "full". Most of my clients fill up that social battery very fast.....maybe 15-25 minutes of social interaction, and they're done. And that is OKAY. Not all children want to "Go play" with their peers for hours and hours. Observe your child, redirect them to solo play or maybe a calming activity as needed, and when they seem to be all done with being around so many people, its time to head for the door so the event can end on a high note. Don't be ashamed or embarrassed to say "S/He's ready to go now. Thanks for inviting us, bye guys!". 



I hope the largest theme coming across in this post is that large events/birthday parties aren't necessarily about you, as the parent. They aren't about the party host, the games, the clown, catching up with friends, hanging out, etc. They are about helping your child be successful, in what is likely a highly overstimulating scenario.

It is important to provide your child with the support and tools they need to engage with the event, to endure the event (again, consider if it would be best not to go if they seem to just be "enduring" parties), or to excel at the event. Whether the bar is set at engagement, endurance, or excelling, will depend on your child. 
And don't lose hope and feel defeated if right now, you are at an endurance level. That doesn't mean things will always be that way! As your child grows and matures, and most importantly as they develop more skills and abilities, they may begin to enjoy parties. Maybe even, to have fun at parties.
Give it time, and be patient. Both with your child, and with yourself.





*Recommended Resources & Resources:




Ghanouni, P., & Quirke, S. (2022). Resilience and Coping Strategies in Adults with Autism Spectrum Disorder. Journal of autism and developmental disorders, 1–12. 






 



When it comes to the treatment or reduction of challenging, disruptive, dangerous problem behaviors, regardless of the setting or populations served, this will often be referred to as “Crisis Intervention”.

This concept is far broader than ABA, as many institutions and facilities will create, monitor, and implement crisis interventions whether anyone on site has received ABA training, credentialing, or licensure, or not (examples: police, schools, daycares, residential settings, prisons, etc.).

Being such a broad topic, that can look about 10,000 different ways depending on the setting and availability of highly trained specialists, it should come as no surprise that crisis behavior scenarios frequently result in injury or even death. If you do some online searches for news stories related to seclusion and restraint, regardless of the setting, you will see what I mean.

This issue is also larger than disability.

Yes, most of the horror stories we see on the news where someone was seriously injured during a restraint DO involve people with disabilities (whether it was known at the time, or not). But in the absence of disability or mental health issues, crisis management can still lead to serious injury or death. That could be for the person(s) responding to the crisis, or to the person(s) having the crisis.

This is a very weighty and complex topic, and I can’t possibly cover everything anyone should know about crisis intervention. However, due to the seriousness of crisis scenarios and the increased risk of harm (again, for the person intervening, the person or having a crisis, or even both of those people), I very much want to share some resources and information about managing behavioral crises.


First, some terms. Here is my favorite definition of a crisis:

A time of intense difficulty, trouble, or danger; a time when a difficult or important decision must be made.

 

During a behavioral crisis, the individual is having intense difficulty or trouble. They are having a hard time (not giving you a hard time). Decisions must be made, not just regarding what to do RIGHT NOW, but in the future, in case this happens again. Which, without the proper supports in place, the crisis event is highly likely to happen again.

Viewing a crisis through this lens takes the responsibility off of the individual having the crisis, and onto the supports in place (or lack thereof). When a crisis event occurs, ask yourself these questions:

1.       1. Does this individual know how to safely de-escalate during a crisis event?

2.       2. If yes, then why are they not using that tool?


Truly individualized and effective de-escalation tools are best understood as the means by which an individual in a crisis state can identify they are approaching a crisis state, select a de-escalation method, implement the method, and lastly evaluate how well the method worked once they are calm again.

Depending on the setting, availability of support help, and the understanding of de-escalation (or lack thereof), this “returning to neutral” process can take minutes, hours, days, or may not occur at all. It may involve a team of people, a caregiver or support person, or happen independently. When it doesn’t occur at all, that typically results in emergency room visits or admittance into an inpatient facility.

I do not know your work setting, the populations you serve, or your job title, but if you are reading this post I have to assume you have either experienced a crisis event with a client/student/etc. or want to be equipped if it should happen.

Right here I have to point out a very common myth, that can be quite dangerous when people believe it: In the field of ABA, clients who exhibit (or have a history of exhibiting) highly violent or dangerous problem behaviors may be classified as exhibiting “severe behavior”. It is a myth that only severe behavior clients can have crisis events. That is not true at all. Clients with non-violent or less disruptive problem behaviors, under the right set of combined circumstances, could have a behavioral crisis. For example, what if their home routine is significantly disrupted, they are ill, dealing with a change of medication, and also recently started puberty? These setting events when combined, could trigger a crisis event. For this reason, it is important for professionals and practitioners to be properly trained and equipped for crisis conditions, far before they are needed.

Now I want to speak specifically to ABA implementers (RBT’s, paraprofessionals, etc.) who work directly with clients: If you are working with clients where you are regularly responding to crisis events or working with clients with a known history of crisis events, you should be following the policies of the physical management training you received. If you have not received any physical management training, then you should not be working with those clients. It is dangerous for you, and dangerous for them.


Again, crisis events could potentially happen at any time, with any client/student/etc. It would be unwise to think “Oh I don’t work with severe behavior individuals, so this doesn’t apply to me”. For ANY of us (disabled or not, mental health issues or not) the right set of circumstances could trigger a crisis event.

If you were in the midst of a crisis event, who would you want helping you? Someone reacting on impulse or instinct, or someone who has been thoroughly and properly trained on safe de-escalation?


So what can be done? Glad you asked.

 There are many, many crisis intervention and de-escalation resources readily available. If you are not in the position to set policy or choose employee trainings, you can still request additional training from your employer and send them recommendations of evidence-based methodologies. You can also always communicate when you feel ill-equipped or prepared to work with a specific student/client/etc. or feel unsafe.

Research shows that in the absence of individualized, evidence- based crisis interventions, individuals will contact injury to self and others (Burke, Hagan-Burke, & Sugai, 2003), receipt of medications with serious side-effects that rarely correct the causes of the behaviors (Frazier et al, 2011), receipt of intrusive, ineffective interventions that are punishment-led (Brown et al, 2008), and increased negative interactions (Lawson & O’Brien, 1994).

 In ‘Effects of Function-Based Crisis Intervention on theSevere Challenging Behavior of Students with Autism ‘, the following procedures are recommended for crisis intervention planning-

Be cognizant of crisis needs and function when designing a behavior plan for students with crisis behaviors, and operationally describe steps to be taken for each phase of escalation. When describing these steps, be aware of the behavioral function. Change the quality of reinforcement delivered between appropriate and inappropriate behavior, and prompt appropriate behavior before providing access to calming activities. Train staff to competence on the intervention strategies (which most often includes role play scenarios during training, not just discussion/lecture). 

 

 


*Recommended Resources (please share!):

 

~Find the number for the mental health crisis/emergency support services in your state, and save it in your cell phone

~For caregivers, if your child is on medication the Physician/Psychiatrist will likely have an after-hours or emergency help desk. Save that number in your cell phone


https://crisisintervention.com/

https://www.pcmasolutions.com/

https://www.marcus.org/autism-training/crisis-prevention-program

https://qbs.com/safety-care/

Crisis Intervention Strategies

Prevention of Crisis Behavior

Crisis Help in Georgia

ASD & Crisis Behaviors

Handbook of Crisis Intervention and Developmental Disabilities

ASD & De-Escalation 

Crisis Prevention Institute 

ASD & Stages of Behavioral Escalation

Nationally Certified Crisis Training Providers

 


Source: www.PatrickMulick.com


Punishment- A consequence that happens after a behavior that serves to reduce the likelihood of that behavior happening again.  


Teaching - The process of attending to people’s needs, experiences and feelings, and intervening so that they learn particular things.


Got it?

Good.

 "You are not Superman, and you are not Superwoman. Take off the cape."

Tameika Meadows 


Today's QOTD is from an amazing podcast I had the privilege to join: "Shifting Perspectives", hosted by Yolande Robinson.


During the insanity that has been 2020, parents of Autistic children, teens, and adults, have had to repeatedly pivot and navigate new situations when it comes to lack of supports, no access to community providers, increased unemployment, schools or colleges shut down, homeschooling nightmares, increased anxiety, increased depression, and on and on. 

We have all been impacted by this pandemic and global turmoil, but for families raising special needs children there are unique issues and factors that come with the territory. 

What is needed now is encouragement, support, practical strategies, and a reminder that no one should be trying to "do it all" right now. That just isn't possible. Focus on what can be changed and improved, and learn to adapt to what cannot.


Podcast episode link:  Episode 19  "Take off the Cape"









Question: What are you creating??


I hear statements all the time from teachers, parents, supervisees, etc., that will sound something like "S/he is getting SO aggressive", or "These behaviors came out of nowhere!".

There can be a disconnect in the language used to make it sound as if suddenly, on its own, for some random reason, problem behaviors are rapidly escalating.


Can that happen? Hmmmm, possibly.

*Self-harmful behaviors can have an underlying and undetected medical cause.
*A significant life disruption (change of school, death of a parent) can lead to what most people call "acting out" behaviors, in a child who previously had no history of aggression.
*Sometimes very old behaviors can make a resurgence, for reasons that are not always clear.

However, upon close analysis, systematic manipulation of the environment (controlling variables), thorough caregiver interview, and direct observation, the culprit in these scenarios is often: CREATION.
To be more specific, someone/some variable has created a scenario that is reinforcing problem behaviors. Pretty much 100% of the time no one intended to create the problem behavior, but regardless, the problem behavior is now here. Fully created.


I talk a lot on my blog about how to intervene upon problem behavior, or how to decrease the intensity of problem behavior, but what many people need to know is "What does it look like to actually create problem behavior?" (so one can do the opposite, of course!).

1. Lack of consistency - Want to create some problem behaviors right here, right now? Your 1st step is to be as inconsistent as possible. Inconsistent rules, expectations, consequences, and hearing one thing from mom and a different thing from dad, can all cause problem behavior to rapidly increase. Think of consistent consequences and problem behavior as being like oil & water.

2. Lack of "pay off" for appropriate behaviors - On a different note, let's take the focus off the problem behavior for a moment. When the individual does NOT tantrum, spit, throw things, or kick, what happens?? Do they receive the same (or higher) amount of adult attention when they are quiet, calm, and on task? No? Then that is why problem behavior is going sky high.

3. Response effort is too high - Response effort is a fancy way of describing what I have to do to get what I want. Would you wash my car for $10? Maybe. But I doubt you would wash it for $.10. A dime is likely not valuable enough for you to do the work of washing a dirty car. From the perspective of your child/client, is what you are offering them WORTH what you are asking them to do?

4. Foundational skills are neglected or skipped - Sometimes what looks like problem behavior can actually be a skill-deficit. What in the world am I talking about?? Skill Acquisition. That's what. When your child/client/student does not have the ability to perform a skill, instead of saying "I don't know how to do that, can you help me?", they may be much more likely to break a pencil, run out of the classroom, bite, etc.

5. Function-based treatment, what's that?? - Treatment that is designed based on opinions, non-evidence based interventions, therapist/teacher preferences, etc., is not likely to work. Function-based intervention seeks to understand the "why" behind problem behavior, and then provides the learner/child/client with a more appropriate way to get that "why" met.

6. Wait, and wait, and wait to intervene - I see this one a lot. Maybe the most. Here is a scenario: David is 3 years old. He hates going to Kroger with his parents. If they take him, he will yell, refuse to sit in the cart, and hit his head. Fast forward to David at age 10. He is bigger and stronger now. He still hates going to Kroger, but now he also hates going to Publix or Wal-Mart. If a parent takes him anyway, he falls to the ground and slams his head against the floor. See what happened there? The problem behavior grew and expanded over time, as David learned more effective ways to get what he wanted (to leave the store). It is vitally important to intervene on problem behaviors early, and effectively. The sooner you can address the barriers of problem behaviors, the sooner you can teach new skills and better ways to communicate with others, across settings, and as the individual ages.




*More Resources:

ABA & Reducing Problem Behaviors

Autism & Problem Behavior

Functions of Behavior

Reducing Problem Behaviors

"No More Meltdowns" by Jed Baker









"Early intervention" usually brings up images of toddlers or pre-schoolers completing puzzles, learning to put on a jacket, or labeling photos. In its truest sense, early intervention is better described as "intervening early". When thought of that way, the concept (and corresponding strategies) can be applied at any age to intervene on challenges or issues that are preventing your child from being as successful as they could be.


I often get questions from parents or caregivers about behavior issues, such as sleep routine ("How do I get him to sleep in his own bed?"), feeding challenges ("How do I get her to eat more than creamed corn?"), or issues with rigidity ("If he can't sit in the red chair, he screams"). The best response to these questions, is not to allow the problem behavior to get embedded in the first place. It's probably the least helpful response, but arguably the most accurate response.
 As soon as you see a problem behavior has been established, seek help or further education right then and there. ~Don't wait.~
 I repeat, don't wait and think the behavior will just go away magically on it's own. The same recommendation is true for skill deficits. If there is a particular skill your child is struggling with, seek help or further education to help them learn the skill. Don't wait and think the skill will magically appear in it's own time. 

Just ask any ABA professional and they will tell you that untangling a behavior knot that has been in place for weeks, months, or even years, is difficult. It may seem like problem behaviors pop up overnight, but they rarely leave overnight. Meaning that it typically takes hard work and effort to reduce or replace challenging behaviors.

The hard truth for many families is quality treatment just isn't accessible. It could be a funding issue, there could be a lack of local providers, or maybe other environmental barriers to accessing available treatment are in place. I meet families of older children all the time who haven't even heard of ABA treatment. You can't request a therapy you don't know exists.

Yes, accessing intensive and quality treatment is always going to be the ideal option. But for those who cannot, it's helpful to know that there are still options available to you and your child. What is most important is to have expectations for your child, set realistic goals (such as teaching your child to use a spoon), and then work diligently toward each goal. Don't overload both you and the child by tackling multiple things at once, as this is a marathon and not a sprint.


See below for other tips:


  1. Look into funding sources in your local area, and see what your insurance will cover. The local school system typically has resources available through special education that most families just don't know about. Ask if there is a parent advocate/liaison to help you navigate all the treatment options.
  2. Consider pursuing intensive treatment or consultation, and then following through on your own. Nowadays, many parents attend ABA conferences, enroll in behavior analytic coursework, or even pursue the RBT credential just to learn about the science. You can also pursue free training events that may be offered at local colleges, ABA clinics, or research institutions. The more you can learn about Autism, behavior, and ABA, the better equipped you will be to handle challenging behaviors. You can also work intensively (and briefly if needed) with a BCBA and then follow through with their recommendations on your own.
  3. Learn as much as you can from your child's teachers. Special education teachers have so much knowledge and experience creating accommodations and breaking down instructional material for children who learn in unique ways. I would suggest regularly reaching out to the teacher to ask questions about issues at home, to pick their brain for ideas, and actually observing in the classroom to get ideas about what can be replicated at home. For example: nearly all my clients follow a daily schedule in the school setting, but not at home. Why?? The same benefits that are achieved at school from having a consistent daily routine, can easily be achieved at home by using the same technique.
  4. Look for activities/groups/classes that welcome children with disabilities. I cannot emphasize enough the importance of peer models, and making sure your child spends time around typically developing peers. There are many fun kid activities like karate, gymnastics, or swim, that do offer accommodations so individuals with special needs can participate. Beyond the actual skill that is being taught, your child is learning to learn within a group, to follow an authority figure, to socialize/be appropriate around other kids, and most importantly they are integrating into their local community.
  5. Avoid the establishment of strict rituals or routines. Now this one is easier said than done, but it's super important. Most of the older clients I work with have particular challenging behaviors that have been allowed to persist for years and years. The longer a behavior is embedded, often the more difficult the intervention will be. So how do you know the difference between a simple preference ("I like to sit in the green chair at dinner") vs. a rigid ritual ("I MUST sit in the green chair at dinner")? Look at what happens when the ritual is interrupted, or cannot occur....does intense problem behavior follow? If so, then just close your eyes and imagine what the behavior will look like in 5 years, 10 years, and 15 years. If you're not okay with how the behavior will likely grow over time, then it's time to intervene.
  6. Intentionally set aside time for active engagement with your child. If you're wondering what in the world "active engagement" means, it basically means to focus on extending an interaction for as long as you can. Get down on the child's level, and read a book to your child, paint together, bounce them on a huge yoga ball, or line up cars together. The actual activity doesn't matter much, what is more important is that both you and the child are socializing, and not you socializing with the child and receiving no socialization in return. Talking is teaching! By talking to your child, engaging them in an activity, and socializing with them 1:1, you are teaching many skills at once. Point to objects together, play with a toy, sing songs and dance, laugh and make eye contact, tickle the child, model language use ("c-u-p"), etc.
  7. Have household rules. Schools have rules, right? So does any workplace, the library, the grocery store, even the slide at the playground has rules concerning how to use it. But does your child have rules at home? Are there certain things they cannot do? Do they know what the rules are? You will help your child grow into independence and maturity immensely, if you set expectations of their behavior and follow through with consequences when those expectations are not met.




*More resources below for ways to intervene early, and help your child be as successful as they can as they age. Remember, just because a resource may state "ages 0-3" that does NOT mean you can't use the same general strategy with your older child. The point is to intervene early as much as you can, teaching important life skills and reducing problem behaviors as soon as they appear. 














Today's QOTD isn't quite a direct inspirational quote, it's more of a helpful -and important- resource.

From Dr. Mary Barbera, here is a short and sweet vlog on teaching non-vocal individuals to communicate distress due to pain:




For parents and professionals alike, this hits home. I have worked with many kids who had recurrent medical issues or problems, such as frequent colds (which can bring an unpleasant head fog and nose irritation), bowel/indigestion issues, acid reflux, ear infections with painful blockage, etc.

Can you imagine for a sec, experiencing some kind of painful event and not having the means to communicate that to anyone? Especially if you are a child, and cannot just run to CVS and pick up some medication to make yourself feel better. And we wonder why some of our clients get so frustrated or angry??

Taking this beyond physical pain for just a sec, in my own life when I am in a funk/sad, furious, or anxious about something, it can manifest in my body as physical symptoms. Ever heard of "butterflies in your stomach"? Or "a stress -anger headache"? WOO, I've definitely had more than a few of those.
But unlike many of my clients, I have the ability to communicate I feel like being left alone. Or, I can obtain and then ingest medicine. Or, I can choose to postpone tasks until I feel better (i.e. "Guess I'll be finishing up that report tomorrow...").


The ability to communicate not just thoughts & wants, but private events (feelings, moods, sensations, etc.) is SO critical, regardless of age or ability. I consider it a life skill.

*Recommended Post: "HOW Much Therapy?/Intensity"


Consistency may be the #1 word I use most often when speaking with staff or with consumers/families. It would be quicker if I just made a sign that said "Be Consistent" and held it up in front of my face at work. Quicker, but also super odd.

Why is consistency so important when it comes to ABA?

Let's step away from Autism, therapy, and teaching for just a sec and talk about behavior change in general. If you've ever tried to change your own behavior, then you know that you get out what you put in. That New Years resolution you made back in January...how's that going? If it's not going so well, it may be because your initial commitment to changing your behavior has lessened or waned over the past few months.
For me personally, I am one of those weird people who actually enjoys exercise. Am I a gym rat? Good grief, no. I hate gyms. Do I run a mile every morning? Ummm, no. If you ever see me running, something is wrong and you should go get help. But I do have specific types of exercise that I enjoy, especially if its outdoors. I also regularly will neglect my exercise routine for various reasons. In other words, I am not consistent. Despite this, I get health benefits from my "sometimes" exercise. If I were more consistent, the results would be much more dramatic. However, I am pleased with exercising for enjoyment and for health, and not necessarily to be a size whatever.

And that in a nutshell is why your BCBA keeps blabbing on and on about Consistency: The behaviors in your child that you want to see dramatically change, will require dramatic consistency. 

I get it, I really do. You have other things going in your life besides implementing interventions. There's laundry to do, and jobs to maintain, and other children to raise. There's also just being tired. Being a parent is tiring.

But this is why a quality BCBA won't give you 50 hard things to do at once. This is why a quality BCBA will break down large behavior change processes into manageable chunks. This is why when parents say things to me like "I want him to be able to play independently", or "I want her to be able to tell me about her day at school", I explain how far away we are from that goal. I then explain the specific steps that lead up to that goal, and lastly what that would realistically look like:

-It looks like running a behavior protocol even when you have family staying over at your house.
-It looks like taking your child to a birthday party/family event only for as long as they can tolerate being there. 
-It looks like filling out data sheets as you simultaneously cook dinner and help your other children with their homework.
-It looks like embedding (translation: creating) opportunities in the day to play with your child, or to run language trials.
-It looks like following the behavior plan when you are tired, sick, or your spouse is out of town for 2 weeks and you have no help.


The beauty of consistency (and its saving grace) is that it will look different from one family to the next. I hope your BCBA told you that as well.
Consistency in my house means that we work hard all week to get a fun day Friday. Fridays are for relaxing, eating ice cream, and kickstarting the weekend.

In your house, consistency may mean hiring a part time nanny/asking your friend to come over every Tuesday because you need an extra pair of hands. Or it may mean only collecting data weekly because every day is impossible. Or it may mean you only observe 1 therapy session a week because you work from home and can't do more than that. Whatever sacrifices must be made in order for consistency to happen, it is SO important that this is communicated to the BCBA. We cannot help you overcome barriers that we do not know you have.

Anytime I go over a new behavior plan with a family or with the direct staff, there's always the part where I put the plan down and say "Okay, now is the time where you ask me all your REAL questions". See, there are the polite, typical, questions, and then there are the REAL questions that basically get at: "When I haven't slept/the child is sick/when this gets really hard/during the Extinction Burst/when we are in the community, how are we supposed to follow this??".


Consistency is very, very important. Especially if you are tackling significant areas of behavior change, such as teaching a child to communicate or extinguishing aggressive behavior. But consistency does not mean 100% perfect. No one is 100% perfect. It just means that as much as possible, even when it's hard to do so, you
stick.
to.
the.
plan.






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The Discriminative Stimulus is defined as a stimulus in the presence of which a particular response will be reinforced (Malott, 2007, Principles of Behavior).


SD is just ABA speak for the demand, instruction, or the event/stimulus that serves as a signal to someone that there is something they need to respond to. Now, that response can also include a non-response. Not responding is always a possible choice, that comes with its own possible consequences.

For example, if my cell phone rings and it is someone I do not want to talk to I have choices:
-answer the phone
-don't answer the phone

The phone ringing is a SD because when it rings, there is a specific response that in the past has led me to contact different consequences. Some pleasant, and some not so pleasant.
When my cell phone rings, I am not confused about what I should do. I know what my choices are, and depending on who is calling (or if I recognize who is calling) I then make a choice based on my history of reinforcement with that person.

SD's can vary in how they are delivered, the specific reinforcement that they make available, as well as the specific expected response.

In ABA therapy sessions, sometimes hundreds of SD's can be delivered throughout the session, and each one of those SD's has a specific expected response, as well as specific consequences available for each possible response.

The SD has an authority based on the history of consequences being delivered.
I'll say that another way: Let's say I state the SD "give me blue" to a child, and I then provide a consequence of playing on an iPad if the child gives me yellow. Assuming playing on the iPad is a reinforcer, over time I am going to see the child consistently respond to my SD by giving me yellow. Is yellow in this example actually correct? No. But it does not matter: I gave my SD, I followed the child's response with a reinforcer, and I have superglued this particular response to the SD.

And this explains why your kids don't listen.


Reinforcement is like the most powerful superglue on the market. It binds things together, as can be seen in the example below:
(SD) "Clean up the toys" ----> (Response) child cleans up the toys ---> (Consequence) "Thanks so much, you can go outside now"

Assuming in the above example that going outside is a reinforcer, over time the child will learn the expected response to the SD of "clean up the toys", AND they will learn that good things happen after they demonstrate the expected response. In other words, you just taught your child that when they clean up their toys, they might get to go outside.


If I flip this scenario on its head, I can show you how SD's (and their absolute authority) can sometimes cause you to teach things you did not mean to teach:
(SD) "Clean up your toys" ---> (Response) child cries/child screams "no!"/child does not respond to the SD ---> (Consequence) "Ugh! Fine, I'll clean the toys up. Just go outside while I clean up this mess"

Assuming in the above example that going outside is a reinforcer, over time what will the child learn? A few things actually:

-child will learn that problem behavior or not responding is a response
-child will learn that escape/avoidance behaviors work
-child will learn that cleaning up the toys is not a requirement to be able to go outside


Did you mean to teach that? I am nearly positive you did not. Unfortunately, the absolute authority of the SD remains unmoved by the fact that you didn't intend to teach new ways to avoid a demand.


Don't freak out, there is a way to avoid this trap.

First, understand what Instructional Control is and how it can help you. I promise, it isn't as scary as it sounds.

Second, see below for some common characteristics of successful SD's. A successful SD helps your child learn in an effective manner WHAT to do, and WHY to do it (because good things might happen). Let the absolute authority of the SD work for you, and not against you.


Characteristics of Successful SD's

  • The SD is precise: A precise SD includes only the language necessary for the individual to know what to do. Extra details, threats, or reminders are best left off the SD, particularly if the individual has communication deficits or is very young. Good example - "Get down". Not-so-good-example - "Michael Benjamin Clark, you get down off that railing right now before you fall and break your neck".

  • The SD is stated, not asked: Unless you are cool with the individual tossing you a "No/I don't feel like it/I don't want to", then do not present the SD as a question. A question gives the option of refusal. 

  • The SD allows for a brief time to begin to respond: Brief as in, a few seconds. I have been in this field a long time, and I have developed an internal countdown timer that kicks in when I give a SD. To help yourself learn this skill, when you give your child a demand silently count to 3. Or, you could subtly tap a finger against the inside of your palm 3 times. If you get to 3 and the individual has not at least started to respond, it is time to provide a consequence. Another completely personal reason why I like this "internal countdown" is because it helps parents not flood the child with SD's. If you are busy counting in your head, you can't rattle off 4 more demands, when the child hasn't even responded to demand #1.

  • The SD is consistent: Especially if the child has communication deficits or is very young, avoid changing up the SD rapidly. This can possibly be confusing, and impede learning. Once your child is demonstrating they know how to respond to the SD, that is the point where you can start to change the language used, or not use language at all (such as pointing at a book on the floor to indicate the child needs to put the book away).

  • The SD consequence is consistent: The most critical point about understanding SD's is that what follows the response equals learning. You are teaching your child how to respond to you based on what happens when they respond correctly, and what happens when they respond incorrectly. If you decide that the SD "Make your bed" means fluffing all the pillows, then the bed being made with 1 pillow fluffed, or the bed being made with some of the pillows fluffed, are both incorrect responses. No exceptions. You would then prompt the correct response so the child knows they made an error.

  • Attention is gained before the SD is given: If you observe the ABA team work with your child you will get to see possibly hundreds of SD's delivered during a therapy session. You may also note that the team works to gain the child's attention before stating the SD, to make sure it is heard. This could look like approaching the child, bending/squatting down to look in the child's face, waiting for a break in crying/screaming, or making a statement such as "Are you ready?", to verify the child is attending.

  • The SD is not repeated over and over again, nor is it screamed, or shouted: SD's are bosses. SD's are in charge. SD's call the shots. They do not need to beg, bargain, plead, scream, or lose their cool. Remember, your child only has a short time to respond correctly. If they do not respond correctly, you just deliver a consequence (such as a prompt). It will be very tempting to state the SD over and over again, but don't give in to that temptation. Over time, this will actually teach your child they do not need to listen to you the first time, and that ignoring you is an effective way to avoid a demand.




Disclaimer: The information in this post is intended to be a general guide to composing a behavior intervention plan. Behavior plans must be an individualized, needs-specific process. As a parent or professional, please avoid “paint -by -number” guides to writing behavior plans. Various funding sources or employers may have different requirements for behavior plans, so trying to stick too closely to a formula definitely wont help you. 

I didn't intend for my first post on Behavior Plans to be a 2-parter, but recently I have become aware that many people could use assistance with writing up plans for how to intervene on behaviors. Including newly certified BCBA's :-)

I also know that BCBA's are not the only people writing these things. If you are an Educator, Program Director, Counselor, Mental health professional, etc., and you came here looking for some tips for behavior plans then I hope to be helpful.

Before I can be helpful though, let's just clear up a few things:


  • A behavior plan is not what you think it is. During your first step of selecting target behaviors and determining function (if that was not your first step, start over), you should have come up with some hypotheses of what's maintaining the problem behavior. In other words, what is the function? So think of the behavior plan as just a written Function Based Intervention. Truly, that's all it is. People get intimidated or lost in embedding graphs, language style, sections, headers, etc., when what is most important is connecting function --->to---> treatment. The skills of selecting target behaviors, measuring behavior, analyzing data, and creating specific strategies are required in order to write up an effective behavior plan. So if you do not possess these skills or any behavior analytic knowledge, or have no access to a BCBA who can consult with you, then you likely are not the ideal person to be writing up a behavior plan. And here's my next point-----
  • Everyone who has responsibility for creating behavior plans, is not necessarily a BCBA. If a non- BCBA is in the position of creating a behavior plan they can still choose to do so in an ethical manner, with evidence based recommendations, and under the close guidance of a BCBA when needed.  I  recommend consulting with a BCBA/seeking out assistance before trying to go it on your own. As explained in the previous tip, simply writing something down on paper does not a behavior plan make. If the goal is to reduce or modify behaviors with long lasting effects, then its imperative the author of the behavior plan has behavior analytic knowledge/access to a BCBA.
  • The behavior plan is not for you. As a Supervisor and Consultant, I spend a good amount of time critiquing and editing other people's behavior plans. A common mistake I notice is writing a "limousine" level plan, that will be handed off to "bicycle" level staff. By that I mean if you are working with entry level staff who received minimal training, you cannot/should not write some 12 page and highly technical intervention for them to follow. Particularly if the funding source does not allow for you to follow up with the staff to supervise, train, and support them. Don't set the staff up for failure.

With those tips out of the way, consider the following a helpful cheat sheet for any professional who has anxiety about creating behavior plans. Like any other behavior analytic strategy, behavior plan writing is a skill that will take time to learn and enhance. Between this post and the Part I, you should be good to go.


 Be patient with yourself, and when in doubt always review the literature (Behavior Analytic journals, that is). Reading what others tried and found effective, will help you develop a knowledge base of how to approach problem behaviors. Good luck!


First Things First: Summarize the Functional Behavior Assessment or Functional Analysis results (those beautiful graphs), describe the client, and identify the plan author. This will vary depending on where you work, but usually there will be some table or chart at the top of the plan that covers most of this information. Below that, there will be some type of summative data of the selected behaviors (baseline data), and possibly a brief summary of how the behaviors were measured.
What’s the Problem?: Don't forget to clearly and objectively define each behavior selected for intervention, aka this is where the Operational Definition goes. Common mistakes I see in this section are an entire list of problem behaviors (which will lead to a bulky and highly challenging behavior plan), vague descriptions of the behavior, and subjective terminology. For example: "Sally has tantrums whenever she gets mad at someone". Who is someone? What does "get mad" look like? What does "get mad" NOT include? If a stranger could not read your plan and know what the problem behavior looks like, then the definition is not clear enough. 
Get to the WHY: Function is the name of the game. If you have written up behavior plans that make no mention of why the problem behavior occurs, you have absolutely missed the mark. All recommended interventions should be based on the function, so without identifying the function there is no behavior plan. Again, language used in this section should be clear, objective, concise, and behavior analytic. If you don’t know how to write using behavior analytic terms, then you should be consulting with a BCBA as you create the plan.
Set Goals: Is the behavior going to decrease in frequency? Duration? Severity? Is it going to be replaced completely? Clearly spell out the expected goals for the problem behavior, in order to modify the plan over time. Behavior plans are not intended to be in place for eternity. As problem behaviors reduce/improve, the plan should be regularly updated based on mastery of behavioral goals.
Get to the HOW: This is the section where you connect function to treatment. Example, “Mickey Mouse’s aggression is maintained by escape/avoidance, therefore here is how to a) teach other methods to request escape, and b) no longer reinforce escaping tasks”. The how section includes both before and after strategies (Antecedent & Consequent strategies), and if necessary: the Crisis Plan.
DANGER: Crisis Plan time---Are any of the behaviors dangerous, intense, or potentially harmful? Keep in mind, even mild level dangerous behaviors (like breath holding for 5 seconds) could possibly worsen due to the Extinction Burst. A crisis plan should be included if problem behaviors are, or could become, harmful to the individual, property, or another person. Ethically, the staff/parent must be trained on the crisis plan and the crisis plan should include evidence based strategies.
Remember the Audience: If the behavior plan will be handed off to a parent, a layperson, or minimally trained staff/non-ABA staff, then this should set the tone of the plan. Avoid jargon, give clear examples, and be prepared to train the staff on implementation of the plan. Even highly trained or credentialed ABA staff often need assistance with implementing behavior plans, so your job is not done once you put a plan in writing. Writing the intervention down does not mean people will magically follow it.
Copy & Paste = Bad: Behavior plans (like skill acquisition programs, prompt levels, etc.) should be individualized to the learner/client, as well as follow the procedures outlined by the employer or funding source. This means that if you work at ABC school in Texas, you should not be copying behavior plans from the XYZ school in Virginia. That just isn’t how this works. Behavior change is highly specific, and also the people implementing the plan will influence how the plan is written. Doing a quick internet search will yield many results of sample behavior plans, but do remember that a sample is only a starting point. The hard work of literature review, reading over the ethical guidelines, discussing possible interventions with appropriate stakeholders, and considering the needs of the individual, all need to happen in a systematic manner.





Maladaptive - Incomplete, inadequate, or faulty adaptation; unsuitably adapted or adapting poorly


I had a colleague once who brought to my attention that our supervisees seemed to love to throw around the word "maladaptive" in their reports. It had almost become like a buzzword for saying "inappropriate". Like, "maladaptive tantrum behavior" or "maladaptive social functioning". My colleague's response to this was genius, IMO, and changed the way I view this word: Maladaptive to who?? 
As in, the client's tantrums are maladaptive...to who? The client's toy throwing is maladaptive...to who??? Certainly not the client.

See, the word maladaptive implies that there is something defective, or wrong, about the behavior. However, to the person engaging in the behavior it is very much serving a purpose and meeting a need.

So if I am 4- year- old little Tara and I cannot readily communicate, I now have to come up with some other way to get what I want. Oh I know, how about screaming? If screaming leads to adult attention, followed by accessing things I want, then how exactly is my screaming maladaptive?

Before throwing around buzz words, or using overly technical language to sound impressive, try thinking through what you really mean to say when describing behavior.

The irony is I think it's extremely "adaptive" to come up with a method to be understood. ;-)
Kids are so much smarter than we give them credit for, whether or not we like what they choose to do.


Clearly, when I think of "reinforcing" I think of doughnuts. :-)

Positive reinforcement has lots of precise definitions, but a very simple way of understanding it is: why you do it again.

After buying your wife roses once, why do it again?
After visiting an exclusive spa, why do it again?
After having 1 bite of delicious ice cream, why do it again?

We do something again, because of reinforcement. Something reinforced, or strengthened, our behavior to drive us to repeat the behavior seeking to contact that same reinforcement.

Whether you came to this blog as a parent or professional, we all should a common goal of seeking to build upon or expand reinforcers.


Reinforcement is the reason why my clients learn what words like "Come here", "Give me the ____", or "Stop" mean. It's why they choose to use language rather than hit me when I upset them. It's also why you got up and went to work today, and why you answer a ringing telephone.

For most of the kids I work with, when I first meet them they have minimal reinforcers. They often spend their time wandering around the home, making noises or sounds, engaging in repetitive or challenging behaviors, and being heavily dependent upon other people to make fun things happen. By the way, this is also why many early ABA programs use edible reinforcement. I see that critiqued quite often, but it is very common that pre-intervention young children do not have a massive list of reinforcers to choose from. For this reason, edibles must be used initially with the goal being to move to tangible and social reinforcement as soon as possible.

Through intervention combined with valuable systems of reinforcement, individual clients learn to:

- request desired items or activities, instead of angrily crying until someone figures out what they want
-replace harmful or disruptive behaviors with hobbies, skills, or leisure activities
-let someone know when an activity is boring, or when they just don't want to do it anymore
-get another person to engage with them, play with them, or talk to them


It's very easy to focus solely on teaching skills or reducing problem behaviors. These things are important. Highly important. But a life is not built upon performing skills, or keeping a calm body.

If someone went to your home and removed every activity or object you find reinforcing (cell phone, coffee, laptop, a good book, etc.), you probably would not want to live in that home anymore. It might start to feel more like a prison or jail, than a home. Okay....so think about how a child with special needs may feel when they have so few reinforcers that they are allowed to contact, or know how to request. Sounds like a pretty dull life, doesn't it?

Intervention should be about more than just fixating on deficits, it should also look to improve overall life functioning. I know for my life, my reinforcers are pretty darn important to my overall satisfaction, mood, and temperament. I'm guessing it's the same for your life.

Building a history of reinforcement, builds an enriched life. As you are working on teaching your child, student, or client to tie their shoes, say "please", or complete math problems, I'd also suggest systematically working to increase their reinforcers, which improves quality of life.







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What causes some problem behaviors to rapidly escalate in regards to severity/intensity, duration, or frequency? What is pumping these behaviors up?

I usually don't meet potential clients when problem behaviors are mild, occur sometimes, or are of low intensity. I don't hear a lot of statements like "She rarely tantrums, it's not that big of a deal.....We'd appreciate some help though. When you get around to it". Nope.

Far more often when people reach out for help it is because that annoying or frustrating problem behavior that started off small, has now pumped up into this Goliath -size problem that may or may not be occurring across settings. The behavior has become such a challenge, that it's clear professional help is needed.
The child used to tantrum, and now they tantrum AND bite. Or the child used to refuse to eat peas, now they won't eat anything green OR round in shape. Etc., etc.

So what happened? Most likely 1 of 2 things. Or 2 things (Just one can happen, or both can happen):

#1 The problem behavior was fed, and/or #2 Nothing else was.



Want me to elaborate? Well, I'm going to anyway.


Thing #1 - Problem behaviors grow or stick around based on what maintains them, or the available reinforcement . So giggling when your toddler throws a spoon during dinner, or buying your son a candy bar at the store because he started screaming....these things likely do not seem like reinforcement at the time, but if the behavior begins to increase then reinforcement is doing its magic. Here is a particularly unpleasant little chain of events I see often: The child cries when told to clean up toys, and mom or dad ignore and keep the demand on. The child flops to the ground and screams when told to clean up toys, and mom or dad ignore and keep the demand on. The child punches mom or dad in the legs when told to clean up toys, and mom or dad.....yell "No! Don't you hit me" and lecture the child and forget to keep that demand on. Uh-oh. What usually happens next in that scenario is the child has now learned that the quickest and most efficient way to get out of that dreaded clean up task is to punch mom or dad pretty hard. THIS is how super intense problem behavior can seem to appear overnight. I know its hard, but you have to be careful not to give a big reaction when your child suddenly increases the intensity of their problem behavior. We professionals see this from time to time in our therapy sessions, but we know if we "ride that wave" and just hold on, the new problem behavior likely won't stick around.

Thing #2 -  Persistent problem behaviors are trying to tell you something. It can require some detective work , but it will so be worth the effort to get to the root of the problem. Is your child trying to gain your attention? Are they hoping to avoid a challenging task? What about wanting you to give them something in a public place? This might help you when addressing problem behavior: remind yourself that underneath the behavior is a valid need. Buried underneath the tantrum, or spitting, or ear-splitting screams, your child is expressing or requesting something. The tricky part is determining what the heck that is! When problem behaviors suddenly seem to pump it up out of nowhere, think of that as your child saying, "Wow, what do I have to DO to get this need met??!". Here is another unpleasant little chain of events I see often: Mom or Dad successfully get rid of problem behavior A, and then the child begins problem behavior B. Mom or Dad successfully get rid of problem behavior B, and then the child begins problem behavior C. Mom or Dad....... are you seeing the pattern? The child keeps pulling out new variations of the problem behavior because the underlying root of the problem has not been addressed. And if it hasn't been addressed, then how can be it strengthened/reinforced so it will stick around? Learning new skills goes hand in hand with behavior reduction, because you don't just want to teach the child what to stop. You also want to teach him/her what to start.


Being careful to address thing #1 & thing #2 when evaluating problem behavior makes its far less likely you will end up in a situation where the behavior balloons up to a huge issue, seemingly overnight.
When in doubt, reach out for professional help. A qualified professional can work with you to reveal how multiple small steps along the way worked like multiple strings tying up into a huge knot, and then help create a plan to untangle that knot.




*Recommend Resource: ABA Inside Track discuss Functional Communication Training, which is a great tool for reducing problem behaviors
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