When parents get involved in ABA the results are amazing!

There is so much research on the benefits of early intervention for children on the autism spectrum that we often forget that parents are really the first line of defense in the uphill battle. Parents can be the strongest influence in modifying a child's behavior when they understand the principles of behavior modification and implement them consistently. Extensive research shows that home-based therapies may be more beneficial to children with autism if therapists also provide parent support and parent training. Many parents reported that learning to use the ABA techniques not only helps their children but it helps them and the rest of the family.

But there are difficulties. As therapists that work with children with special needs we face the challenge of motivating parents and caregivers to implement the therapeutic advice we offer.  Learning the techniques and following through consistently takes a significant commitment on the part of parents, many of whom are already stressed and stretched to the limits. It helps if the therapist approaches the challenge of training parents with compassion and understanding while at the same time treating them professionally, as if they are the client, not just their child. Take into consideration that the same ABA principles and techniques we use in behavior plans for children work with parents also – rewarding desirable behaviors, consistency and persistency, effective instruction and environmental manipulations. 

Some tips on how to implement a parent-training program:

·       Parents need to be motivated. Praising them for their efforts and commitment is crucial. It helps to say “Good Job, mom”, or “You are doing a great job in taking care of your child and advocating on his behalf”. Keep in mind that we reinforce successive approximations towards the goal. We want to reward direction, not perfection.

·       Make it simple. Break complex concepts and techniques into small, more reachable units, and teach each unit until mastered. Provide sufficient modeling, examples and opportunities for turning the theory into practice. If necessary, go to the grocery store and show mom how to handle her child’s behaviors. Provide parents with audiovisual materials, such as research, articles, books, and videos. One thing is to understand the theory. It is another thing is to be able to apply that theory to real-life situations.

·       Consistency and Persistency: People do not learn overnight. Be patient. You will need to repeat the lesson several times. Do not get frustrated when parents reject your ideas and advice. They might need time to assimilate the new strategies. 

·       Environmental Manipulations: Parents are not able to implement a behavior plan if they have a full work schedule; if they are currently dealing with an emergency or a crisis, such as an illness or a divorce; if their lives are cluttered; or if they are extremely stressed. Helping them with time/stress management could be crucial in ensuring the success of the program. In some cases, we may need to suggest seeking professional help, taking time off work, changing jobs, getting help and support from family members and/or community sources.

When parents get “on board” the results are amazing. After all, what can be better than 24/7 therapy.

 

Daniel Adatto, BCBA

 

 

Behavior consultants: Who are they and how to find the right one?

There is confusion about this strange breed of professionals known as Behavior Consultants. They are not psychologists, but deal with behavior problems. They are not teachers, but teach socially significant and functional behaviors. They are not Speech Therapists, but teach communication. They are not Occupational Therapists, but deal with sensory deficits and excesses.

So, who are they? 

The California Association for Behavior Analysis presents an interesting article about this on its website: http://calaba.org/AAMR-BehConsultantsFlyer.pdf

The article was developed by representatives of three major professional organizations: the psychology division of the American Association on Mental Retardation, the MR/DD Division (Division 33) of the American Psychological Association, and the Association for Behavior Analysis.

As the article explains, board certified behavior consultants, or analysts (BCBA’s) are “professionals with documented graduate training and supervised, hands-on experience in Applied Behavior Analysis (ABA), and have passed a special examination in this area.” This program is managed by the Behavior Analyst Certification Board (please, see www.bacb.com for more information, including a Certificant Registry).  

I especially like the following paragraph from the article:

“We suggest you do not use a behavior consultant who focused mainly and solely on reacting to the problem behavior unless a crisis or other particular circumstances warrant this focus. Focusing only on reacting to the problem behavior will not prevent it from happening in the future and does not represent current best practices. In crisis situations or in the case of an escalating behavior problem that requires immediate action, treatment should address both immediate concerns and preventing strategies, such as changing the environment and teaching appropriate alternative skills. In most other cases the main focus of behavior consultation should be on skills development.”   

Because of a shortage in trained and experienced behavior consultants, I recommend you look for programs directly supervised by BCBA’s. We will assess the meaning (function) of the problematic behavior and be able to determine an appropriate course of action. In other words, an experienced behavior consultant will be able to determine what the individual is telling us through his/her behaviors, what she/he needs. We will measure the current status (baseline) of the problem in quantifiable terms (numbers) and set goals accordingly. We will teach desired replacement behaviors so the individual can communicate his/her needs appropriately. We will measure each step of the process and compare it with the baseline and the goals in order to monitor the effectiveness of the program. We will make changes if those measurements show lack of progress. We will recommend consultations with other professionals when the problem goes beyond our scope of practice. And we will go to the natural environments and train all caregivers (parents, teachers, etc.) in the process so behavioral gains can be generalized across settings and maintained across time, even though when we are not there anymore. 

In summary, we are trained in behavior management and best practices on how to implement these programs. And we are ready to help you.

Daniel Adatto, BCBA

Preparing for back-to-school

Is it back-to-school time already? Where did the summer go? Anyway, let’s get ready for back to school.

Children in general, but especially those with autism spectrum disorders, generally have a difficult time with transitions. It stems from the fact that they have trouble shifting attention from one activity to the next and tend to have a greater need for predictability. As any parent of a child with autism knows, preparation strategies are crucial. These next few days are the perfect time to begin preparing your child for the back-to-school routine. By using this time to slowly transition into the routine, it will help avoid the meltdowns and behavior issues that can occur when a child is not adequately prepared for a new situation. Here are some tips:

·       If your child has trouble waking up in the morning, start putting him to bed earlier, using 15-minute increments to get the time earlier each night. Once he is used to waking up at the expected hour, waking up on the big day will be much easier.

·       Next, you need to establish a consistent morning routine. Using a visual schedule is a great way to show to a child the sequence of events that make up this routine. You can prepare the schedule together with your child using pictures or drawings of familiar activities such as going to the potty, brushing teeth, getting dressed and eating breakfast. The visual schedule will give your child a sense of control and allow him to understand which activity follows which. To help avoid power struggles, it is helpful to have a desired activity follow an undesired activity. For example, if TV is part of your morning routine, make sure that more difficult tasks such as getting dressed come first and TV time can serve as a reward.

·       Give your child a 5 or 10-minute warning before he is expected to move onto the next activity. Never whisk him away from a preferred activity and demand that he gets in the car when it is time to leave. When giving warnings try to make the instructions as clear as possible by breaking them down into simple steps. Sometimes a seemingly simple statement such as “we’re leaving in 5 minutes” can be too difficult for a child to understand. Instead you can say “in 5 minutes we have to walk out the door and get into the car”. 

·       If power struggles over food or clothing are an issue, be sure to offer choices, as in “you can have cereal or oatmeal”. You can even have your child choose his clothe the night before. Choice making will give the child a sense of control and reduce the power struggles.

·       Needless to say, choose your battles. Give up on combing his hair to perfection, for example.

Once you have established your routine stick to it consistently. Having a predictable and consistent daily schedule builds confidence in a child, decreases anxiety, and encourages cooperation. Preparation and consistency are keys to success in back-to-school. Remember, it is not about “begging” or “forcing”; or “hoping” your child will be OK. It is about manipulating environmental variables (routines, visual schedules, rewarding positive behaviors, providing choices instead of directives, etc.) to prevent meltdowns and facilitate desired behaviors, such as compliance. You can be in control, and you should.

Daniel Adatto,
Board Certified Behavior Analyst

Spanking Again?

I can’t believe it. Another article about spanking? This time the title is “Study fuels spanking debate” (http://www.latimes.com/news/local/la-me-banks-spanking-20120714,0,6374260.column)

How is it that spanking is still a topic of debate?

“If you spank your children, even occasionally, you’re setting them up for a lifetime of mental and emotional distress,” the article reads. There was a study from two Canadian universities published in the journal of the American Academy of Pediatrics and led by Tracie O. Afifi who defines “spanking” as “hitting”. What’s the novelty of this, I asked myself, it IS hitting.

No so fast, Mr. Behaviorist. “I think there is an important distinction”, writes Sandy Banks, the author of the LA Times article, “Hitting, slapping, shoving, grabbing are not the same thing, to my mind, as a parental smack to the behind.”

I don’t agree with that. But I agree with her when she says “The conflict between what we do and what we believe is never tested more than in parenting.” Yes, but that does not make hitting, excuse me, spanking OK. Or yelling, or threatening. Parenting is very rewarding and fulfilling, but it can be very challenging as well, no doubt, and it confronts us with unknown territories of ourselves.

“The point of spanking, after all, is to get kids to behave”, we read in the article. My question is how can we expect them to behave when we don’t? Being able to control ourselves before we request our kids to control themselves is paramount. After all our main job as parents is to teach, not to police. What we teach with hitting? Maybe, just maybe, we teach that conflicts are resolved with violence and aggression, don’t we?

The author of the article finally confessed. “While I would never have called it “hitting”, as Afifi insists, I probably whacked a few backsides when my children were young.” She goes further when she says “Looking back now, I think the spankings of my youth taught me things than lectures and time-outs couldn’t: that my mother’s indulgence had limits. That pain can be a powerful deterrent. That bad choices have bad consequences.”

Seriously?  Are you saying that spanking is the way of teaching all that?

How would you like, Ms. Banks, if someone much bigger than you spanks you every time you do something wrong? What would you say if you know that the teacher spanks your kids? And what if the police officer spanks you for speeding? Problem solved, let’s just spank each other every time we misbehave.

Spanking is not OK under any circumstances. It reflects “parenting ignorance” because there are other ways. Spanking comes out of frustration, anger and lack of resources. If you find yourselves spanking, first apologize to your kids and then ask for help. There are other tools of discipline that build positive behavior repertoires, that teach limits and respect, responsibility and self-control. But through love. Let’s set our kids for success by respecting them at least in the same way we like to be respected.

Daniel Adatto.

Board Certified Behavior Analyst.

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