Autism and Vitamin D

Reading LifeExtension magazine (January 2014- www.lef.org) I learned that there might be a connection between vitamin D deficiency and Autism. Research indicates that vitamin D stimulates factors in the body than could have a beneficial effect on the disorder:

-        Vitamin D has significant anti-inflammatory actions, which are high in autism. For example, it inhibits the actions of pro-inflammatory prostaglandins, elevated in autism.  Some believe that autism is a disease of neuro-inflammation. The article speculates that vitamin D could help autistic children by reducing inflammation.

-        Autoantibodies to the brain have been identified in autistic children. The severity of autism are associated with levels of those antibodies. The article speculates that vitamin D could help autistic children by reducing levels of antibodies.

-        Some proteins induce the survival, development and function of nerve and brain cells. Vitamin D regulates those proteins and thus, it could help autistic children by increasing those proteins and help the brain to develop properly.

Too many coulds, mights, maybes. The author of the article, John Cannell, MD, advises parents to understand that “no evidence, other than theoretical, exists for such effects.” And yet he states “even though there are no studies proving the benefits of the vitamin in autism specifically, the proven benefits on the mechanism underlying autism make vitamin D a smart option for children with autism.”

And goes on to explain complicated procedures of calculating the dosage per pounds ratio, other vitamin and nutrients the child should take, and blood tests that should be obtained every specific amount of months. Something that the lay person would have a hard time to understand, in my opinion.
And he goes further to provide his contact information “for parents who want me to participate in the diagnosis and treatment of their child.”

I can imagine desperate parents raising their hopes and being ready to invest (waste?) efforts, time and money on unproven treatments.

I think making non-scientifically proven claims and raise the expectations of people is a very delicate matter. We should raise our voices against it and explain the danger involved. I understand parents who will do anything to improve their situation. We the professionals in the field ought to safeguard them.

I usually recommend to share with the general public only proven effective treatments based on scientific research. On behalf of distressed and confused parents, I think it is the right thing to do.

 

Daniel Adatto, MA, BCBA
cadatto@tesidea.com

Raising Your Child with Special Needs

A child with special needs requires special care due to emotional, health, intellectual, developmental or physical reasons. It might be challenging, but it is also rewarding.

Research and clinical practice has repeatedly demonstrated that early intervention is linked with positive treatment outcomes. In seeking effective and research-based treatment for autism, you are on the right path.

Parents with kids with special needs often feel alone, as if they were the only ones facing these problems. It is important to know that you are not alone. We the professionals devote our lives to assist you. It is what we do for a living. Obtaining appropriate education and information will lead you to success. The school, the state health department, support groups and other parents are resources for you to learn more.  

Spend quality time with your child and don’t forget to have fun. Above all, a child with special needs is like any other child because all children have essential needs: acceptance, care, support and more than anything, love. The difference is that the child with special needs experiences delays in development which limit him/her from positive life experiences: learning from the environment and from school, enjoying outings, playing, making friends. This leads to frustration which in turn trigger behavior challenges.

Therefore, these children might be exposed to a state of permanent punishment. Although challenging behaviors produce an immediate desired outcome for the child (e.g. not participate in non-preferred activities, obtaining attention, escaping aversive stimuli, obtaining sensory stimulation) those behaviors also produce anger and frustration in the adults who deal with that child, avoidance by others, poor relationships and low self-esteem, loss of learning opportunities, or restraint.

It’s our job as parents, educators and therapist to rescue this child.

In the spirit of the Holidays, make helping your child a priority for the coming year. That would be the best gift.

 

Daniel Adatto, BCBA
cadatto@tesidea.com

Five Parenting Tips to Survive the Holidays

Holiday season is upon us, again. It feels that time flies, right?

A couple of years ago we posted a blog on the topic of helping your special needs child during the holidays:  

http://totaleducationsolutions.blogspot.com/2011/12/holidays-and-autism.html  

For families with a member who has special needs, the holidays can present unique challenges: lack of predictable and familiar routines, overstimulation, being away from home, and the caregiver himself being stressed, to name a few.    

Let’s review our top tips on how to navigate these troubled waters.

1. Keeping routines in place is the best ways to avoid holiday havoc: sleep/meals times, play/outing activities, etc.

2. When changes in routines are foreseeable, prepare your kids in advance. The use of visual aids, such as pictures, timers, schedule boards, can be very helpful when dealing with children with special needs.

3.   Avoid long trips whenever possible. Airports, planes and long car rides can be very stressful.

4.   At family gatherings prepare a quiet space for your child to retreat to when stimulus gets too intense and he/she needs a break.

5.   Don’t force your child to do anything unless it involves a safety concern or an emergency. Motivation by offering a preferred item/activity in exchange for doing something is always a better solution.

As I said in my previous blog, it’s important for you to relax and stay as calm as possible. Your child absorbs your mood and your stress can rub off. Have fun. You are your child’s barometer and if you are stressed out, he/she will be too.

 

Daniel Adatto, BCBA.
cadatto@tesidea.com 

It should be more than reacting

“Billy, stop”; “Billy, quiet mouth”; “Billy, no hitting”; “Billy, sit down”; “Billy, stand in line”; Billy, quiet hands.”
Although this reacting mode (intervening after the behavior to stop it) is part of our repertoire of tools as behavior intervention professionals, it shouldn’t be the only part, or even the larger. As “experts” on behavior management, our larger repertoire of strategies should be teaching appropriate, functional equivalent (serving the same purpose as the challenging behaviors) behavior repertoires. We should be behavior teachers.
Behaviors have a communicative function. The individual is conveying needs and wants. For example, when the student engages in dysfunctional self-stimulatory behaviors (tapping, self-talking, flapping hands, giggling and laughing with no reason, jumping, moving around constantly, getting out of seat, touching others, body rocking, etc.) in the absence of demands, he is telling us that he needs sensory stimulation. Thus, the recommended treatment in this case is (a) Increase/Provide Access to Alternative Sources of Stimulation: Sensory Diet: various sensory-based activities visually scheduled into the child’s daily routines; (b) Teach replacement behaviors: acceptable methods for gaining the same type of stimulation; (c) Interrupt and Redirect Behavior; and (d) Reward the replacement behaviors: use rewards that provide preferred sensations.
Sitting/standing next to student or behind him and telling/modeling him "stop", "quiet hands", "quiet mouth", etc. is not enough and should not be the only intervention.

Different treatments would be recommended if the child engages in the behaviors to escape non-preferred activities, or to obtain attention.

To summarize, the intervention should focus on teaching appropriate, functional replacement behaviors to communicate desired objectives, thus eliminating the need to engage in the problematic behaviors.
As stated in the textbook Applied Behavior Analysis, by John Cooper, Timothy Heron and William Heward, chapter 3, page 60, “A practitioner should never plan to reduce or eliminate a behavior… without (a) determining and adaptive behavior that will take its place and (b) designing the intervention plan to ensure that the replacement behavior is learned. Teachers and other human services professionals should be in the business of building positive, adaptive repertoires, not merely reacting to and eliminating behaviors they find troublesome (Snell & Brown, 2006).”

And this applies also to teachers, parents and every adult who interacts with that child.

For more information and tips, check out our blog “Responding vs. Reacting” at http://totaleducationsolutions.blogspot.com/2013/08/responding-vs-reacting.html 

Be a teacher, a behavior teacher and you will be not only eliminating/reducing problematic behaviors, but you will give that child the tools to be independent in life.

Daniel Adatto, BCBA.
cadatto@tesidea.com

 

It touched a nerve!

I always tell my team that it is important to stay professional, not let the things that people do get to us, not to get upset, and to continue offering our help to the best of our ability. Well, against my own advice this week I got upset.

I entered a session and the mother of our client said “I hope he’s OK today, he didn’t sleep from 1 am to 4:30 am.”

“What did he do from 1 to 4:30?” I asked.

“He played,” she replied with a smile on her face. I guess she thought it was funny.

In my head I was shouting “This is not funny. How is it possible that you let him stay awake that whole time?” It’s a good thing she could not hear my thoughts.

It is simply not OK to let a child stay awake in the middle of the night. If he cries and screams, as difficult as it is, you wait until he’s done and take him back to bed. It may seem easier to avoid the power struggle, but in fact it is not.

Yes I recognize that it was 1:00 AM and the mother did not have the energy to fight with the child. But, in allowing him to get away with this, is she really making things easier? For one, she ended up sleep deprived because she was not able to fall asleep again. Second, her son was now sleep deprived too, which in turn leads to behavior problems, difficulty learning, disrupting the classroom, etc. Lastly, it taught him one more time he can get his way. No wonder this child throws tantrums at school, including aggression, when he doesn’t get what he wants. “Why they don’t let me, at home I get everything I want when I want. Perhaps I have to be more assertive,” is what he is probably thinking.

I’ve been working with this family for over two years, educating this mom on behavior management and best practices when it comes to helping children with special needs. So I guess I must be the worst behaviorist ever. I quit! (Just joking, TES).

Children need to learn that there are rules, routines, laws they have to obey, the same way that you and I do on a daily basis. Letting them play instead of sleeping at night is simply not good parenting. Good parenting is setting rules and limits, and teaching children that they can’t always get their way. They are children so they will always try, and always test the limits. You might think it is “easier” now to give in, because you’re tired and don’t want to fight. But it is not. You are just making your life harder.

If the goal is to avoid tantrums and you want to take what you think is the easy route, then I suggest you let your kids stay home, eat junk and play video games when they don’t want to go to school; do not take them to the dentist when they cry; and allow them to skip the daily shower. Would you describe that as good parenting? I didn’t think so.

We discussed all this in previous blogs:

1. “The Power of Structure and Routines” (http://totaleducationsolutions.blogspot.com/2013/04/the-power-of-structure-and-routines.html ): “Routines: A predictable and consistent daily schedule (time-space-people in charge). Lack of predictability increases anxiety, which leads to problematic behaviors.”

1. “Limits and Consequences” (http://totaleducationsolutions.blogspot.com/2013/02/limits-and-consequences.html ):  “Limits are set to help your child to understand respect for himself and the world around him.”    

Deal with that tantrum now, even if you are tired. Think that it is an emergency, your child got hurt and you have to help him no matter how tired you are.

Good parenting; that is the easier way.

 

Daniel Adatto, BCBA
cadatto@tesidea.com

Autism, there is an app for that!

Developers dive in to create a wealth of autism apps

Parents, therapists and developers are eager to tap into what they view as a powerful tool to reach people with autism (http://articles.latimes.com/2013/apr/30/business/la-fi-apple-autism-20130430).

Andy Shih, senior vice president for scientific affairs at Autism Speaks, a national advocacy organization based in New York, helped organize a "hacking autism" event in San Francisco that drew 135 apps developers. Over the course of 24 hours, teams built prototypes for more than a dozen apps.

Nearly 1,500 autism apps are available in Apple's App Store.

Even as researchers just begin the process of trying to determine how effective such technologies are, parents, therapists and developers are racing ahead in their attempts to tap into what they view as a powerful tool to reach people with autism.

The range of these apps has expanded well beyond the initial focus of helping people with autism communicate and improve social skills to learning about emotions and delivering basic educational lessons in a format that's better suited to autistic learners, Shih said.

Howard Shane, director of the Center for Communication Enhancement and the Autism Language Program at Children's Hospital Boston, said while he's eager to see more studies, his experience with the iPad and autistic children has been so overwhelmingly positive that he's content to push forward with finding new and better ways to use it.

"The clinical evidence is still emerging," Shane said. "But the excitement and interest in these technologies exists because they are working."

Bill Thompson, a school psychologist at the Orange County Department of Education, who wrote some of the first autism apps, said he's trying to find ways to make their use more effective. Many educators and parents, for instance, like the iPad and other mobile gadgets simply because they can be used as a powerful reward to reinforce a desired behavior. Complete a task, get some iPad time.

That's understandable considering that it often can be hard to find rewards that motivate some autistic children. But Thompson said he'd like more of the iPad time used for educational purposes, rather than just getting bonus Angry Birds time. For instance, Thompson has created a system in which a classroom with many kids on the autistic spectrum use iPads that can be beamed onto a large-screen TV using an Apple TV unit to enable them to communicate with each other in ways they might not otherwise.

Finding rewards that motivate autistic children, that’s the challenge, that’s the key. You cannot teach if you cannot motivate. Think about yourself sitting in a boring class, listening to a boring teacher talking about a topic you couldn’t care less about. Your mind will be focused on anything but the class. And you won’t remember anything later. That’s what happens to our kids, in particular those with special needs. And we know that all kind of challenging behaviors emerge when the kids are bored, or worse, when we force them to work on non-preferred activities. That is the challenge and that is the meaning of “special” in “Special Education.”

And it is not only the rewards that motivate. We must find and use powerful tools to reach people with autism. The activity has to be stimulating enough to motivate them. If we know that they can focus and concentrate when they are watching TV or playing video games, we must use the same technology to teach.

There is no time to waste. Every awaking moment in the lives of these kids is precious. They are so behind that it is immoral, I believe, to waste time with ineffective instructional strategies.

Motivate and you’ll get the response you want. McDonalds knows that. Kids TV channels know that. Video games builders know that. When are we, parents, therapists, “special educators” going to know that?

 

Daniel Adatto, BCBA
cadatto@tesidea.com

Healthy Dining

On Friday September 13, 2013, the LA Times published the following article:

“Public Health Dept., restaurants team up for healthier dining

http://www.latimes.com/local/la-health-restaurants-20130913,0,3105477.story

L.A. County restaurants are joining the Public Health Department's campaign to offer patrons smaller portions and healthier children's meals. The Los Angeles County Department of Public Health launched a partnership Thursday with restaurants throughout the region to promote healthier options for customers. To be part of the Choose Health LA Restaurants program, places must offer smaller portion sizes and healthier children's meals with less fried food and more fruits and vegetables.

The program is the latest effort to attack the obesity epidemic in Los Angeles County, where about 23% of residents are obese. The county has also been encouraging residents to eat less and to give up soda and other sugar-sweetened beverages. "Small changes in what we eat every day, at every meal can make a huge difference in terms of not only our weight but our overall health,"

Kudos to the Los Angeles County Department of Public Health officials. I believe these kind of initiatives put us in the right path to a better quality of live. Although far from reaching a critical mass, I think, every little effort counts. The obesity problem, and child obesity in particular, is that serious.

As we discuss in previous blog (See “Overweight Children” and “Obesity II”, May 2012), “…it is about your behavior, mom, dad, not your child’s. You change the child’s behaviors by changing the behaviors of the adults that take care of that child. Plain and simple. No kid starves if there is food available. So it is about what is available.”

We are responsible for our health. But more so for our children’s health. And that is good parenting.

 

Daniel Adatto, BCBA

cadatto@tesidea.com

 

Help for Parents with Children with Autism

If you suspect your child might be autistic, the first step in obtaining treatment is getting him/her diagnosed. Some of the signs of Autism might include impaired social interaction, delays in both verbal and non-verbal communication, failure to respond to name when called, avoidance of eye contact with other people, repetitive movements such as rocking or twirling or self-abusive behavior such as biting or head-banging. If you are unsure or have any doubts, speak to a professional such as your pediatrician or teacher, or call social services agencies in your area to speak with a counselor who can guide you through the process.

Sometimes a language delay is just that, so there is no need to panic. Trust your parental instincts and seek out help. As with any developmental delay, early intervention is crucial so it is better not to wait to see if your child grows out of it.

There are different levels of Autism and different methods for helping Autistic children. Financial help for Autism treatments is available. In California, health insurance companies are mandated to provide behavior intervention services proven effective for individuals with Autism and related disorders. Also, there is a system called the Regional Centers which provide funding for Autism treatments. After your child is officially diagnosed, you will be referred to various service providers that will get you on the path to helping your Autistic child.  

As a parent, receiving the diagnosis that something is “wrong” with your child can be devastating, confusing and overwhelming. Often times, this lead to isolation and shame. However, rest assure that you are not alone. There is help out there, and there are people and organizations that devote energy and resources to assist you in finding solutions to the problem. Reach out with confidence.

As I wrote in a previous blog, even when you don’t see it, there is light at the end of the tunnel.

 

Daniel Adatto, BCBA
cadatto@tesidea.com

The Role of the Behavior Analyst in the IEP Team

When a child receives a diagnosis related to a developmental disability that requires special educational needs, the first step in the process is putting together an Individualized Educational Program (IEP).  The IEP is designed to provide the child with an educational program taking into consideration all areas related to the disability.  The goal of the IEP is to provide the child access to the general education curriculum and to allow the student be successful in the least restrictive environment. The IEP team comprises professionals from a multitude of disciplines, which may include a school psychologist, a speech & language pathologist, an occupational and physical therapist, a behavior analyst and more depending on the child’s needs. 

When a child demonstrates behavioral challenges that prevent him/her from gaining access to educational requirements – this can include both behavioral problems and/or a skills deficit – a Behavior Analyst is requested to participate in the educational planning. Parents have the right to request a Behavior Analyst in the IEP team.

Behavior Analysis is the scientific study of behavior. Behavior Analysts seek answers by looking at the environmental factors that trigger the occurrence of a behavior.  As discussed in previous blogs, Applied Behavior Analysis (ABA) is a scientifically proven method that promotes positive conduct in children while decreasing undesired behaviors. In recent years, ABA has gained the reputation of being the most effective method of treatment for behavior problems that are associated with autism spectrum disorders and pervasive development disorders because it effectively addresses behavioral issues and skills deficits associated with the disorder. ABA is the systematic study of the relationship between behaviors and the environmental factors that trigger and maintain those behaviors.  Behaviors serve a purpose for a child. They allow a child to have a need met and are used as a tool to get something the child wants or escape something the child does not want to do. When we understand the purpose of a behavior we can work to improve behaviors and achieve the best results during therapy sessions.

Possibly the most important aspect of ABA is that it can also be used to build socially appropriate and productive behavioral repertoires by teaching a child an appropriate alternative behavior to replace the undesired behavior. Using a system of positive reinforcement, new skills can be taught by breaking down complex skills into small, achievable components and rewarding each step towards the desired behavior.

It is crucial that any behavior intervention program be carried out across all settings. This means that the procedures must be implemented anywhere the child interacts: school, home, the community. Since Behavior Analysis treats behaviors, in essence any therapist that works with a child becomes an implementer, regardless of the symptom being treated, whether it is speech, occupational or physical. If we understand this, it becomes logical that for any therapeutic program to be effective, all caregivers, educators, parents and therapists must work synergistically to implement the program. The job of the behavior analyst supervising the program is to notify the other therapists on what works to motivate a child and to appropriately coordinate the IEP objectives and learning goals to help the child achieve maximum progress.

Children can realize their greatest potential when teaching techniques are consistent across all settings. Best results are achieved when the therapeutic team works in synergy to implement the program in accordance with behavioral principles.

 

Daniel Adatto, BCBA
cadatto@tesidea.com

Responding vs. Reacting

In my practice, I often see parents and caregivers “reacting” to children’s challenging behaviors instead of “responding”. You react to your children’s behaviors by yelling, spanking, threatening or physically forcing them to comply out of frustration and anger. You target your child rather than the problem. The way you behave is influenced by your current emotion. Often times, you react without thinking and as a consequence, you lose control; you are not making a conscious and rational decision about the outcomes you want from the situation. When you react you can’t choose the best way to reach the outcome you want. Reacting out of frustration and anger causes damage, hurts relationships and creates resentment. Furthermore, it does not make you happy even when you were able to “stop” your child’s misbehavior.  

Responding to your child’s behaviors, on the other hand, means that you take a moment to think before you act, thus keeping your actions under your control. It takes more time and effort because it involves making a conscious and rational decision about what you want from the situation. And what you want is to teach something, to build behavioral repertoires. You want to “respond” as a teacher and not “react” as a police officer enforcing the law. The time that you take (it could be 10 seconds, five minutes or even more) between your child’s misbehavior and you responding to the problem is vital to the relationship between you and your child.

 

Here are some tips:

1. Take a few seconds and a deep breath.

2. Consider all the options before you make a decision with the goal of teaching in mind.

3. Be ready ahead of time for situations that happen often. It is very likely that your child will misbehave again.

4. Be consistent and persistent in your responses.

5. Try to understand why your child is behaving in that way, what is the function of the behavior, what need is the child trying to meet. Target your response to the problem, not the child. It is not you and your child against each other, but the two of you together against the problem.

6. Do not threaten your child with a list of consequences you know you won’t implement. For example, “I’ll call the police”, “No TV today”, “I’ll tell your father”, “No more ice-cream”, etc. Try instead “If you listen, you’ll have ice-cream”, or “If you finish your homework, we go to the park.” And follow through.

Be sure that you are responding to your child’s behavior and be sure your “response” is appropriate, not over-blown, out of proportion. You want to teach, not enforce. Your job as a parent is to teach your child how to achieve self-control. If you do, it gets easier, I promised. And, I’ll buy you an ice-cream.

 

Daniel Adatto, BCBA
cadatto@tesidea.com

 

 

 

Consistency

In my practice, I often see that “consistency” is one of the most misunderstood concepts in behavior management: parents and caregivers discontinuing effective strategies, implementing them seldom, or not practicing what they demand from their kids.  Today, I’ll focus on this misconceptions. 

Consistent parents follow the same principles and practices they expect from their children. For example, if you are teaching your child not to scream and yell, you should not scream or yell at your child (or at anybody, for that matter). If you don’t want them to lie, do not tell them that you are not home when they pick up the phone.

And do not lie to them. Tell them the truth in simple terms and do not go beyond what they ask. It is much better to say less than lying. And always fulfill your promises. Do not think that they have forgotten. You want to teach them that they can trust you. 

At the same time you should be consistent when setting boundaries with your child. If your child goes beyond the limits, deal with him/her in similar ways for similar actions. A child is more likely to behave well if he or she has some idea of what to expect from you.

As children learn how limits work and what happens when they go past those limits, they will trust you to be fair. Your child is also more likely to come to you with questions or problems if he/she knows what to expect. Children need limits. Limits help build their sense of security and in turn build self-confidence.

Consistency between parents/caregivers is also crucial as your child learns about behaviors that work and behaviors that don’t work. Disagreements between parents are normal but it can be harmful and undermine the other parent’s authority in front of a child. Try discussing your differing perspectives when your child is not present, until you achieve a meeting of minds. Then, you present a united front to your child. DO NOT ARGUE IN FRONT OF YOUR CHILDREN. It gives them the wrong message by teaching them an inappropriate way of dealing with conflicts. Keep in mind that children learn more from what they see than from what we tell them.

Consistency leads to predictability, which in turn reduces anxiety and challenging behaviors, and teaches children that the world is truthful.

 

 

Daniel Adatto, Board Certified Behavior Analyst.

 

How to talk so your kids will too

Communication is paramount in the relationship with your children, or any healthy relationship for that matter. A lack of communication or deficits in this area can lead to problematic behaviors. Children face a lot of pressure and many emotions. They don’t always know how to express these emotions but the “pressure” has to come out somehow. If they don’t have the right tools to express themselves, problems can arise and it will start to manifest itself in the form of challenging behaviors.

This is even more so when it comes to children with special needs. If children did not learn the necessary skills, they will resort to methods that worked during the time they were babies: crying, screaming, throwing things, etc. As a child gets older and stronger, this can be incredibly problematic.

For this reason teaching and encouraging functional communication should be a key component of any school and parenting program.

An essential component of effective communication is to listen. This helps to make children feel comfortable and secure: you care about their feelings and needs, you respect their point of view, and you are interested in what they have to say.

As teachers and parents we can take important steps to build healthy communication repertoires. Both ways. I mean, you are talking and listening to them and at the same time you are teaching them how to talk and listen. How many times you felt as if they were not listening to you? Well, they felt the same. Every time you feel the other person is not listening to you is because you are not listening as well. Think about the other person as a mirror that reflects your image. So, the best way to get the other to listen, is to start listening.

Parents, teachers and caregivers can show and teach positive communication skills by:

Listen patiently before disciplining your kids. Instead of asking them to stop, encourage communication, even if they need to scream and cry for a little while. They probably need to vent, let the anger out before they talk about the problem. And do not interrupt or criticize when they are communicating. Keep in mind that communication is not only words. Crying, gestures, facial expressions, breathing patterns are all means of communication as well.  

Do not rush to give solutions or directions, in many cases venting is what the other person needs.

Clarify the situation by paraphrasing what your child is saying. Repeat back to your child what he said. This helps your child feel that you are listening.

Give them the opportunity to solve the problem by themselves, coach them in the right direction so they feel they discover the solution.

Encourage your children to express their opinions by just responding “Yes” or “Really?” Ask them open-ended questions such as “How would you feel if that would happened to you?”, or “What is the right thing to do?” If needed provide them with 2-3 choices.

Speak calmly, especially during stressful situations. This is a skill difficult to achieve, but it can go a long way. When they are stressed they need you to calm them down rather than stress them further.

Do not discuss discipline during stressful situations, such as when your child is hungry, tired, or upset. Deescalate the situation and wait for a good moment to discuss behaviors and solutions.

Use a positive language. Instead of telling your kids what not to do (i.e. “Stop screaming”) tell them what to do (i.e. “If you use your words I can understand you and help you”).

Focus on the behaviors, not the person. For example, instead of saying “You are a bad boy because you don’t want to clean up” try “Your room is messy, please, clean up your toys.”

It is important to teach your children that it is okay to disagree or be upset, as long as they express their opinions and feelings in an appropriate manner. Emotions are always okay, behaviors can be problematic. Validate their feelings by saying “You seem very upset”, or “You are mad, and I understand why”, for example.

Create opportunities to communicate with your children by:

Read to them: ask questions about the story, make comments, and relate the story to real life situations.

Have family outings for the purpose of spending time together.

Make time to play with them, preferably daily.

Have at least one family meal a day and encourage conversations between all family members. Remember, kids learn what they see, not what you told them. Adults conversing can be a strong model for your kids.

Be sure to make eye contact when talking to your children. Giving instructions or asking questions from the other room or while talking on the phone? Not a good idea.

I would like to recommend some good books about this subject:

“How to talk so your kids will listen, and listen so your kids will talk”, Adele Faber & Elaine Mazlish.

‘Raising your spirited child”, Mary Sheedy Kurcinka.

“Everyday opportunities for extraordinary parenting”, Bobbi Conner.

In summary, the best approach to listening and talking is to do so in the way you would like the other person to listen and talk to you. This is the healthiest way.

 

Daniel Adatto, BCBA

Teaching Teachers

Henry D. Schlinger Jr., Director of the Graduate Applied Behavior Analysis Program at Cal State Los Angeles, published a very interesting letter in the June 22, 2013 edition of the Los Angeles Times. His position is that “the main thrust of teacher training programs should be how to teach.” To do so, he proposes that schools of education need to “stop relying on trendy but unscientific “theories” of learning and instead focus on those based on good science, such as behavior analysis.” I can not agree more.

He adds that “when teachers actually teach, behavior problems in the classroom decline.” This is because students need to be active and interactive learners.

So now the question becomes how can behavior analysis accomplish that?

One of the core principles of Applied Behavior Analysis is that behaviors are related to the environment in which they occur. B. F. Skinner, the father of Behavior Analysis, sheds some light:

“The subject is always right” (Skinner, 1948, p 240).

“Control the environment and you will see order in behavior’’ (Skinner, 1967, p. 399)

“The task of a behavior analyst is to discover all the variables of which probability of response is a function.”

Applying this to our subject matter, we can conclude that instead of forcing the kids to fit teachers’ way of teaching, teachers need to be able to change their way of teaching to fit their students’ needs. This couldn’t be more relevant than when talking about special education. Children with special needs do not learn the way we teach, so we need to teach the way they learn. Applied Behavior Analysis is a single-subject design. Each student needs an individualized program. That is the idea of IEP’s (Individual Education Plan).   

As a first step, teachers can have more of an impact by learning the art of motivation and the power of stimulating instructional routines and structure.

The art of motivation: Simply put, this means motivating students to perform non-preferred activities. Good teachers motivate their students when they tell them they can have 10 extra minutes of recess if they finish their work on time, or give them points towards a pizza party or a preferred activity. It is important to note that motivation does not always mean a treat, or a prize. Motivating materials (i.e. arts & crafts, music, computers and tablets loaded with educational software, etc.), topics relevant to kids, and a loving, warm, and passionate approach to teaching are excellent tools. Education does not have to be synonymous with boredom. It should be an amazing experience.

In my opinion it’s time to mainstream the concept that people engage in behaviors because they work, we get or avoid something through our behaviors. When we ask children to do something they don’t want to do, we need to motivate them, so they want to do it. Plain and simple.

So, three words: Motivation, Motivation, Motivation. Let’s get out there and motivate our kids instead of forcing them, or just hoping they will comply.

Under the title “The Power of Structure and Routines”, we published a blog on April 28^th, 2013, where we wrote “Structure and routines mean a stimulating, predictable and consistent daily schedule (time-space-people in charge). Lack of predictability and down time increase anxiety, which leads to problematic behaviors.” Predictability is what children need, and it should be implemented in the classroom setting. Keeping them busy is part of all this.

Skinner also pointed out that his main contribution was the measurement of behaviors. Behavior Analysis is a data-based decision making process. We need to be certain, through constant measurement and experimentation, that the program is working and it will continue to work. Data should be the indicator to make decisions to continue an educational program or change it. Sustaining an ineffective instructional program is like knowingly keeping a patient on medication that is not working. Doctors (scientists in general) analyze data and make changes accordingly. Teachers should do the same.

But more than anything good teachers share a crucial feature: passion. They are passionate about their jobs. They wouldn’t change it for anything else. Thus, the system should reward them. Parents should acknowledge and thank them.

As Henry D. Schlinger Jr. put it at the end of his letter, “It’s not rocket science, but judged on the basis of how rarely it occurs, one would think it is.”

I could not agree more.

 

Daniel Adatto, BCBA

The Lovaas Legacy in Autism Treatment

The autism community continues to mourn the loss of pioneer Dr. Ivar Lovaas. Realizing that Skinner’s systematic approach using reinforcement could be instrumental in teaching functional skills to children with autism , Lovaas was one of the pioneers in the implementation of  Applied Behavior Analysis (ABA) principles and procedures in the treatment of autism, and in doing so helped thousands of children across the globe. The Lovaas Method of ABA starts with "discrete trials therapy” often referred to as DTT. A discrete trial consists of a therapist asking a child to perform a particular behavior. For example, “Timmy, name the animals in this picture.” If the child complies, he is given a "reinforcer" which is usually a desired prize or reward that is meaningful to the child in order to increase motivation, often times an area of deficit in children in the spectrum. The reinforcer could be a food treat, a high five, stickers in a chart towards earning play time, or anything else that has meaning for the child. If the child does not comply, he does not receive the reward, and the trial is repeated. Prompts are added as necessary to ensure the trial ends in success.  Since ABA is a data-based decision making process, data collection and analysis is warranted in order to continue a specific program or make changes.  

It's important to note that ABA interventions are single-subject designs: the specific content of the discrete trials therapy is based on an assessment of the individual child, his needs, and his abilities. So for example a child who is already capable of sorting shapes would not be asked to sort shapes indefinitely for rewards. Instead his therapy would focus on different, more complex functional skills.

As children master specific programs, therapists will start to take them out of the therapy or home setting and into more natural environments, where they can practice their learned skills in the real world. This is the meaning of “Applied” in Applied Behavior Analysis, which differentiates ABA from other therapies that are implemented only in a contrive setting where the therapist has full control over the variables in place. In simple words, we consider that a skill is mastered when the child is fluent in the real world. This often presents a challenge because the therapist does not have control over the environment when at the groceries store, a restaurant or a play-date at the park. However, research shows that this is the only way to achieve generalization of gains across settings and maintenance across time.   

Additionally, ABA therapists are required to keep detailed records on their outcomes. This means that ABA has been extensively researched and replicated. As such, ABA has a reputation for being the most scientifically researched form of successful therapy available for autistic children.                     

As I said in a previous blog (see “Common misconceptions about Applied Behavior Analysis”) I fell in love with ABA when I learned all that. The more I learn, the more passionate I am. ABA gives me the answers I need to do my job effectively.  Everyone who jumps on the ABA bandwagon gets hooked. Have you ever thought about why?

 

 

Daniel Adatto, BCBA

 

Summer Time and Autism

The summer is already here. Having a child with special needs at home all summer is extremely stressful for parents. As we’ve discussed in previous blogs, this kind of stressful environment often leads to behavioral issues.  

Summer should be a time of joy, sharing and spending time with family and friends. However, for those with family members who have special needs, the holidays can present unique challenges because it can often be overwhelming to children. The comfort and predictability of the school time with its routines and schedules is gone and now there is a lot of free time.

As discussed in previous blogs, being sensitive to your child’s needs and keeping familiar routines in place are the best ways to avoid summer havoc. Let’s review some recommendations to help keep parents sane during the summer. 

Prepare your child for the unexpected event: Explain to your child what is going to happen when there are changes in routines ahead of time. Be specific about every detail that might occur in any given situation, such as meal times, preferred and non-preferred activities, time to come back home, etc. New or unexpected situations can be very frightening for a child with autism and being prepared can help him cope.

Prepare the social event for your child: Avoid long trips whenever possible. Airports, planes and long car rides could be very stressful.

Stick to your normal routine as much as possible. Keep sleep and meal/snack times as close to their usual time as possible.

Keep your child busy: Don’t expect that your child will entertain himself independently. Your role here is crucial. I know that finding activities for kids with special needs can be challenging. However, there are some options available. Consult with your Regional Center or your social services agency. Schools and community centers sometimes offer activities for children with special needs. Try to build a schedule of activities similar to the schedule your child follows during the school year. 

 

Know the triggers and read the precursors of challenging behaviors, such as facial expressions, changes in breathing, body movements, etc. Look for the signs that your child may be unraveling and retreat to your safe place. Preventing a meltdown is always easier than managing a tantrum once it begins.

Finally, relax and enjoy. You are your child’s barometer and if you are stressed out, he will be too.

 

Daniel Adatto, BCBA

Pivotal Behaviors

Individuals with developmental disabilities present a myriad of challenging behaviors. Addressing each one of them separately can be a daunting task for parents, staff and the clients themselves. Successfully addressing multiple behaviors with one intervention is often necessary. PRT (Pivotal Response Training- Koegel, O’Dell and Koegel, 1987) focuses on critical behaviors that are central to many areas of functioning, such as communication and social skills. PRT is built on the premise that improvement in these key pivotal behaviors opens the door to improvement in other areas as well. In other words, teaching pivotal behaviors produces widespread positive effects on other behaviors.  

This is a positive, naturalistic behavior intervention based on Applied Behavior Analysis principles that focus on teaching specific behaviors in the natural settings and is used successfully to help children with ASD and other developmental disabilities. Key pivotal behaviors addressed include motivation and responsivity to multiple cues. 

Motivation: Children with developmental disabilities are frequently viewed as lacking motivation to initiate and respond appropriately to stimuli, to learn new tasks or engage in their social environments. They demonstrate this lack of motivation by engaging in non-compliance, tantrums or other challenging behaviors to escape tasks and social interactions. They may not initiate conversations or ask and answer questions. These children are so difficult to motivate perhaps because since they often fail, they have learned not to try.

Thus, motivation is a key component of a behavior modification program. Lack of motivation constitutes a barrier to teaching appropriate behaviors. A motivated child is interested in learning. Research indicates that increase motivation has a dramatic positive effect on children’s learning (Koegel, O’Dell, & Dunlap).

I like the phrase “We can not teach if we cannot motivate” because it summarizes the importance of focusing on motivation.

Responsivity: Children with developmental disabilities are characterized by “stimulus overselectivity”, and attention deficit in which they select or focus on only one part of the environment or an object. A child may focus only on round part of an object such as the wheels on a car. Increasing children’s responsivity to multiple cues is an important pivotal behavior that may help them to learn more from typical educational strategies and naturally occurring situations, which ultimately leads to engage more in desirable and functional social behaviors.

Parents and professional should focus and take advantage of naturalistic child and family-centered situations. Here are some tips:

1. Implement teaching sessions around objects, activities or topics that the child prefers in order to increase motivation. For example, if your child is “crazy” about cars, engage in playing with him the way he plays with cars (start imitating what he does), and slowly include and model social interactions, such as “the red car asks the blue car to play”, or “all the cars are having a playdate” and they take turns while playing games, share toys, collaborate in building with Legos, etc.

2. Take advantage of natural situations to teach. For example, having dinner, taking a bath or doing groceries are great opportunities to model behaviors and increase motivation.  

3. Parent, teacher, make sure that the child is attending to you by getting down to his level, calling his name or asking “Are you ready?”, and then presents the child with a question or instruction that is directly related to the setting, task and material available. In our example, playing with cars.

4. Very Important: All attempts to respond appropriately (even if the response is not perfect) are rewarded. Ample time is allowed so the child can try to respond without stress. Prompt (model, guide) appropriate responses to end always on a positive note, the reward. This allows the child to experience success, which increases motivation.

5. Use rewards directly related to the task and the natural environment. If you are playing cars, the child receives another car, or gets access to his favorite car, for example.  

In sum, teaching pivotal behaviors is a child-centered intervention that can be implemented across settings (school, home and the community) and across caregivers. Once parents learn how to do it, they become the therapists and thus, the intervention is in place 24/7.  

This intervention has been most successful in improving social and communicational behaviors of children with developmental disabilities in the areas of language, play and social interaction.

Another example of an effective way we can help to improve the quality of live of individuals with developmental disabilities and their families.

 

 

Daniel Adatto, BCBA

 

The Power of Structure and Routines

Try to imagine your life “unstructured”: you don’t know when you are going to have food again, or where it’s coming from; you don’t know at what time you’re going to be home, or if you are going home at all today; you don’t know when you are going to be done with a non-preferred activity, how long it’s going to last; and you don’t know when you are going to be able to rest, have fun with you preferred activity or see your loved ones again. In sum, your life is unpredictable, uncertain, chaotic.

 

I don’t know about you, but I’m “freaking out” just by thinking about that possibility.

 

Your child might be living in that state of confusion and anxiety all the time. So, let’s structure. 

 

What does "Structure" mean?

 

A predictable and consistent daily schedule (time-space-people in charge). Lack of predictability increases anxiety, which leads to problematic behaviors. Yes, I’m talking about your kids. Are you with me?

 

Predictability is what your children need, and something you can implement at home. You don’t need complicated IEPs, or your insurance to approve services, balanced state/federal budgets or lawmakers to pass bills.    

 

Benefits of "Structure":

 

q  Builds Confidence

 

q  Decreases Anxiety and Fears

 

q  Develops Positive Expectations

 

q  Encourages Cooperation and Compliance

 

q  Increases Predictability

 

q  Increases Motivation (when desired activities follow undesired activities)

 

q  Increases sense of Control

 

q  Increases Independence

 

q  Anticipates future events

  

Sounds good? Well, it is.

I can hear your question, How to Structure Activities?

--Keep times, places and people in charge as consistent as possible. Start with the “must do”: meals, bed time, etc.

--Adjust the environment to focus on the activity. For example, turn off the TV when it is bed time.

--Present scheduled activities in a positive manner. Do not be overly rigid. Some flexibility is necessary.

--Include free and play time: children need it.

--It is very important to allow time for transitions between activities. For example, when your child comes from school he/she typically will need some free, unstructured time. Or when transitioning between activities. Prepare the child ahead of time. For example: "It is almost dinner time, so you will need to come in soon. Be ready to put your toys away".

--Have preferred activities follow non- preferred activities. In order to be able to do the desired activity, the child has to finish the undesired activity. For example, "homework first, then play"; or "bath first, then video".

Children may not have independent play skills. You may have to set aside time to play with your child.

Choices can be built into the schedule by allowing the child to choose between 2 activities, such as "bath or shower", or "going to the park or to the store", or "video or TV".

In sum, structure and routines do not mean “militaristic”. They mean “predictable”.

Very cost-effective: easy to implement, excellent benefits. Sometimes, the solution is simple.

 

Daniel Adatto, MA, BCBA