Common misconceptions about Applied Behavior Analysis

I would like to draw attention to some very common misconceptions about Applied Behavior Analysis (ABA). For example, that ABA is only relevant to the treatment of autism, or that it is synonymous with Discrete Trial Training (DTT). Discrete Trial Training is a teaching procedure that is based on the fundamental principles of Applied Behavior Analysis, but it is only one of the many aspects of ABA.

ABA is a systematic approach to understand and change behaviors and thus, much more than any one particular teaching procedure or intervention. It is based on many years of research into behavior, its causes, and strategies for changing behavior and building functional behavioral repertoires. ABA can be applied in any situation where a behavior change is desired. Other teaching methods included in an Applied Behavior Analytic approach include Incidental Teaching, Pivotal Response Training, Verbal Behavior Training (VB), Behavior Management, and others.

DTT (sometimes referred to as the Lovaas method) is an intensive treatment designed to assist individuals who have developmental disabilities such as autism.  It involves systematically and intensively teaching a variety of skills those individuals with disabilities may not pick up naturally. Because these individuals do not learn the way we teach, we should teach the way they learn.

Programs designed for individuals on the autism spectrum initially teach pre-learning skills (sitting, attending, looking at the therapist, imitation, etc.), social skills, self-help skills, communication skills, safety skills and basic concepts (colors, letters, numbers, etc.).  After these basic skills are mastered, higher-level skills are taught. DTT is conducted using intensive drills of selected materials.  Complex behaviors are broken down into small, reachable components, and taught until mastery before moving to a higher level. A specific behavior is prompted or guided, and the client receives a reward (reinforcement) for proper responses in order to increase motivation. 

Adversaries sometimes suggest that DTT promotes robotic responses in children, but that argument only demonstrates lack of knowledge on ABA. Programs start in very contrived, intensive and repetitive fashion. As progress is achieved, the intervention moves to incidental teaching conducted in natural environments and including all caregivers, thus achieving generalization of gains across settings and maintenance across time. Research has demonstrated a 50% recovery rate for autistic children who participated in discrete trial training 40 hours per week, including parent education, and began treatment during the preschool years. But like any therapeutic program, DTT, as well as ABA, needs to be tailored to meet the needs of the individual client because no two cases are alike. A good behavior analyst will know how to adapt a program to fit the child’s needs because, as all of us working in the field of autism know, “when you know one person with autism, you know one person with autism”.

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.  Everybody who jumps in the ABA waters seriously gets hooked. Don’t you wonder why? 

Daniel Adatto, BCBA

Discipline

When considered by parents, teachers and other caregivers as a punitive measure, discipline will, by definition, wrongly include an emotional component and carry with it the stigma of retribution or the need to “get even” for someone doing something “wrong.” It usually involves reacting out of frustration instead of responding with the goal of teaching. This approach provides with few benefits and has a number of limitations. In this context, discipline is equated with punishment and is not consistent with our mission. At all times, this mindset is to be avoided. Punitive behavior management strategies become an invitation to find ways to “get even” rather than an invitation to understand the framework for positive behavior.  As a corrective tool, discipline can be used to clarify the potential consequences for “bad behaviors.” By applying the concept of natural and logical consequences, the emotional element normally found in punitive disciplinary actions becomes neutral.

Natural consequences are those which allow children to learn from the physical order of things. Example: “If you spill your juice on yourself, you will be wet until we can get home and you can change.”

Logical consequences are those which permit children to learn from the reality of the social order. Example: the child’s clothes are all over his bedroom floor and he refuses to put them away. He wants to play video games. So the logical consequence would be: putting away the clothes is required before playing. 

 Natural and logical consequences require the child to be responsible for his own behaviors. As a father I want to motivate my kids to make responsible decisions, not to force them to submission.

 Here are some tips:

1. Be both firm and kind. Firmness refers to your follow through behavior. Kindness refers to the manner in which you present the choice. In other words, firm with the problem, nice with your child. But always give the child a chance to choose so that he can have control: “Would you like to your shower now or after dinner?” “Do you want to do homework before or after playing in the computer?”

2. Talk less; act more.

3. Avoid fights; they indicate lack of respect for the other person. Do not give in; that indicates lack of respect for yourself.

4. Motivate instead of obligate. Example: “if you eat your food you can have dessert.”

And don’t forget to play and have fun with your kids. You not only enjoy them but you deposit “money in the bank for rainy times” (when you have to direct them to non-preferred activities). Love and fun are the most powerful tools of discipline.

Daniel Adatto, BCBA

Finding outlets to your child’s endless energy

I recently heard about a karate studio that began a new program that is being offered for children with autistic spectrum disorders. The idea for offering a specific program for a broad spectrum of Autistic children came from one of the parents that trains with the owner and Sensei (instructor). 

"One day my student dropped by my school with her son and she walked around the studio with him," commented the instructor, "he was very excited and interested in the mirrors and the pictures. We asked him to do a couple of basic kicks and he did really well. The next time she brought him to the studio, she had him put on a karate uniform, and he was laughing and couldn't wait to get into the car and come to the studio. This is when the idea hit us; why couldn't we tailor a program of martial art's for kids with Autism?"

After a few visits, the boy's ABA Board Certified therapist started coming to the studio, rather than the boy’s house, to help develop a curriculum and structure for him.

"The goal of this program," commented the Sensei, "is to help these children find an outlet for their pent up energy. I know some parents are going to be concerned about their child learning how to kick or punch, therefore think they will be more aggressive, but we believe giving the child an opportunity to exercise, will actually help them to relax. Just like any normal child, these kids have a lot of energy and they don't have a way to use it. In addition, the martial art's is all about learning self-discipline, focus and concentration. Lastly, we hope that these classes will provide a social setting for these children to meet and have fun with other children."

"The goal of this new program is to tailor the curriculum to each child and target the areas they need the most help with," stated the instructor, "I also understand that I will need to be flexible with each child and work with the parents to make this a successful program!"

Initially, one of the requirements will be each child will need a "shadow" with them during their class. This can be a parent, an adult sibling or therapist.

What a great idea. And it can be any sport activity. I recommend group sports so there is social interaction. Many kids spend their long after school hours inside their homes, sometimes with little or no space for physical outlets and no social interaction, which is a recipe for disaster. They accumulate energy and if we do not direct them to appropriate activities, they find their own activities with known results. Change the dynamic of your household by enrolling your kids in sport classes. And when you are there, try it yourself. Trust me, it is worth it.

Daniel Adatto, BCBA

Obesity II

In my previous blog “Overweight Children” I shared the case of one of my students and presented my opinion that parents ought to take action on this issue.

My blog was so timely that a few days later, the L.A. Times published the article “It's time to serve up some big incentives to curb obesity” (To read the full article go to http://www.latimes.com/business/la-fi-lazarus-20120515,0,1949780.column)

Here are some quotations from the article:

“To combat the alarming obesity rate, the Institute of Medicine says the U.S. needs to overhaul everything from farm policies to zoning laws. Clearly, doing nothing isn't an option. Americans eat too damn much. And we all pay a rising cost for this gluttony in the form of higher insurance premiums and lost productivity. A study last year by the Society of Actuaries calculated the total economic cost of an overweight and obese population in the United States and Canada at about $300 billion a year (with 90% of that figure attributable to America's dietary issues).”

“We need to acknowledge that much of what we put in our mouths is very bad for us and accept new rules intended to foster healthful behavior and discourage the endless noshing that's turning us into a herd of porkers.”

David Lazarus, the author of the article, proposes some ideas. For example:

“First, we should limit the marketing of fast food and junk food to kids. Young people are just not in a position to make wise choices when it comes to sweets and treats. It's foolish to believe otherwise. Just as parents were outraged by the idea of a Joe Camel trying to make cigarettes look cool to youngsters, they should be equally upset with all manner of colorful characters hawking everything from sugary breakfast cereals to corn-syrup-sweetened sodas.”

He goes further and proposes a cigarette-style tax on such foods and beverages, with the proceeds going toward obesity research and wellness programs. And higher insurance rates for overweight people.

I think these are fantastic ideas.

Here is my crazy idea: a parenting license. After all, for almost everything else you need a license or a certification, from driving a car to being a nurse, from getting married to being a contractor. Even baristas at Starbucks and “hamburgeristas” at McDonalds need to go through a specific training.  

Why is it that the most difficult job on earth requires no training, zero, none, nada?

Part of the license process can be training on healthy nutrition. For those “non-licensed” parents, higher taxes to pay for all the mistakes they will make and all the fixing that will have to be done, with tax-payers money, of course.

So, get a license, or get a pet.

What do you think?

Daniel Adatto, Licensed Parent # 00-0000-01

Overweight Children

Mary (not real name for confidentiality purposes) is overweight. She is one of my students and I’m concerned about it. I noticed that the snacks and lunch she brings from home are croissants/salami sandwiches, several desserts every day (cookies, brownies, candies, etc.), pizza, pasta, etc. In short, not very healthy choices. I felt it was concerning enough that it warranted a conversation with the child’s mother. The conversation went something like this:

Me: “I noticed that Mary is a little overweight”.

Mother: “Yes, I know, but what can I do?”

Me: “Well, I noticed that the food she brings from home is not very healthy”.

Mother: “I know, but she wouldn’t eat anything else”.

So, I discussed the issue with the BII (one-on-one behaviorist that works with her from our company) and she agreed to be sure Mary eats the food if mother sends her healthier choices.

Since two weeks ago, her lunch and snacks consist of carrots, broccoli, celery with a small portion of peanut butter, whole wheat pita bread sandwiches, apples, etc. She still has a hard time with chicken, tuna or turkey, for example. She prefers foods that are crunchy. So for now we honor her preferences and proteins are a work in progress, but we’ll get there.

I went to school this week and I swear I noticed that Mary had lost some weight. I thought it was my perception, you know, my eyes seeing what I want to see. But the BII said that not only she, but the PE teacher noticed it too.

The next step is talking to her mother again. I’m planning to praise her for sending healthy food and encourage her to feed Mary the same food at home. I know she will say she can’t do it, so I’m going to invite her to school at lunch time so she can see with her own eyes what the BII does, and how Mary eats her food willingly.

I share this story because I want to make one point very clear: it is about your behavior, mom, 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. If cheeseburgers and fries, donuts, pizza, pasta and candies are available, they will eat that. Who can blame them, right? We are all tempted by these delicious but unhealthy foods on a daily basis.

Obesity is an epidemic. The effects of it on our health and wellbeing are endless and very well documented. We all should be concerned. Feeding your child only with cheeseburgers, donuts, pizza, pasta and candies is poisoning him. Would you let your child smoke cigarettes, drink beer, or eat paper for that matter? I know your answer is “NO”. Unhealthy “junk” food when your child is already overweight is the same. I know it can be hard because your child will fight for junk food. But this is definitely a fight we have to fight. And win.*

When my wife was pregnant with our daughter she was vomiting all the time and wanted some medication. My wife called the doctor and the doctor said “No medication. It’s not good for your baby. This will be the first of many sacrifices you make for your child”.

And no more monkeys jumping on the bed.

Daniel Adatto, BCBA

*Important: Always consult with a doctor when implementing a weight management plan.

Applied Behavior Analysis in every day parenting

Many kids are picky eaters. Picky eating is one of those parenting challenges almost every parent faces. And while picky eating is not unique to autism, it can be exacerbated by it because of the heightened sensitivity to texture and taste that many children with special needs experience.

 In previous blogs I talked about some of the applications of Applied Behavior Analysis (ABA) and its use with autism. But I also tried to emphasize that ABA is not synonymous with treatment for autism. In fact, ABA can be applied in any situation where a behavior change is desired. And of course, the principles and strategies can be applied in every day parenting. Picky eating is a great example of this.  The same systematic techniques combined with positive reinforcement used to teach any skill can be used to address picky eating. If your child has a severe aversion to a food, start with baby steps, breaking down each task into very small reachable goals. For example, you can start by just having the undesired food on the table. Get the child used to having it there next to his other food and seeing other people eat it. Once he accepts the food on the table, you can move on to having him smell it, bringing it closer to his mouth. Remember that every successful step needs to be rewarded with, for example, a bite of a food that the child likes. Possible next steps can be to have the child lick the food, getting him used to the taste. After that, move on to taking a bite. He may not even chew or swallow the food, just take a bite and spit it out. Remember, we are breaking this down into tiny achievable steps. After the child agrees to take a bite, you can move on to swallowing and so on and so forth until the child agrees to eat the new food.

 The same principles and strategies can be implemented with problems such as brushing teeth, sleep in own bed, toilet training, etc.  

 These baby steps may not be necessary with a typically developing child. Most of the smaller steps can be bypassed and the idea is simply to convey to the child that he at least needs to try the food before saying he doesn’t like it. If the child tries and does not like it, he can have a reward of something else to eat, then slowly move up towards eating more than one bite of the food the child refuses to eat. Eventually, you will be able to say to your child “you can’t have your dessert until you eat dinner” and the child will get the point.  Most children will usually give in to eating something over going hungry.

Always keep in mind that some food aversions can be related to allergies and should be checked with a doctor. Also, even adults have food preferences so if your child really does not like a certain vegetable there is no reason to ever force a food on a child. Be realistic with your expectations and relax.

 Good parenting almost always involves offering choices and a loving approach that focuses on “the good” rather than “the bad”. Love is the most powerful tool of discipline.    

Daniel Adatto, BCBA

Can a child be “a little” autistic?

Parents often ask us if their child can be “a little” autistic. The truth is there really is not a clear answer. There are many terms used for children who do not have a full-blown diagnosis of autism. Some examples of these are autistic-like, on the autism spectrum, displaying autistic-like symptoms. These often refer to children who may exhibit some of the symptoms on the autism checklist but not all. Displaying one or two autism symptoms is not always cause for concern but does raise a red flag and should be checked by a professional.
One can infer that for every kid who receives an actual autism diagnosis, there is another who has autistic traits - including repetitive behaviors and communication problems – but is not found to have autism spectrum disorder. For a diagnosis to be made, a child must exhibit a certain number and severity-level of these characteristics. In other words, not every child with social impairment can be characterized as autistic. But on the flip side, many children can suffer from autistic traits on a level that is in fact impairing even though they may not meet the full criteria. The good news is that Applied Behavior Analysis treatment, which is proven to be the most effective intervention for children with autism spectrum disorder, can also be used to effectively treat any behavior disorder as well as to teach critical skills that a child may be lacking.

A parent’s gut feeling is often the best indication. Parents should follow their instincts and talk to a professional if they have trouble in any of the following symptoms:

·        Impaired social interaction or difficulty forming relationships

·        Trouble responding to social cues

·        Inability to understand give and take activities like sharing

·        Shows extreme distress over minor changes in routine

·        Problems with verbal and non-verbal communication

·        Failure to respond to name

·        Avoidance of eye contact with other people

·        Repetitive movements such as rocking, hands flapping or twirling

·        Self-abusive behavior such as biting or head-banging

 Applied Behavior Analysis is a scientific system of principles and techniques aimed at understanding and changing behavior. Any behavior: eating disorders, addictions, outbursts, domestic violence, relationship problems, crime, stress, etc., etc.

Also, and probably more important, is a system to teach skills. Any skill: learning skills, social interactions, stress management, anger management, productivity and motivation in the work place, etc., etc.

Challenging behaviors are means of communication: your son is telling you something when he throws a tantrum. By understanding what he needs, we teach functional skills (replacement behaviors) that are socially appropriate, thus eliminating the need for crying and screaming.

If you mom or dad are concerned about your child’s behaviors, we can help. We know how. There is a light at the end of the tunnel, even though you may not be able to see it now.

Daniel Adatto, BCBA