Social Skills and Autism

Going to the movies, hanging out with friends, chatting on the phone – these are simple rituals most individuals take for granted. For a person with autism, these experiences are few and far between. A lack of social skills and the inability to relate to people, are two seminal characteristics of autism. But the mistake most people make is to assume that someone with autism does not want to have social interactions.  In reality, it isn’t that they don’t want to interact socially, it’s that they can’t.

An inability to anticipate how people think and feel in social situations is a hallmark feature of autism.  Individuals with autism might want to enter a conversation, but they don’t know how. As a child gets older, this can be devastating and cause the individual to further withdraw.

The problem is compounded when children with mild autism are mainstreamed in school with typical developing kids and forced into an environment where they feel different. The same thing happens when attending a birthday party or a family gathering. This often causes families to isolate in order to avoid meltdowns in public.

Therefore, a big chunk of our efforts should be devoted to teaching social skills. Social interaction is a must in a child’s environment since this is a skill they will need throughout life. A child’s struggle with social skills can neither be concealed nor overcompensated by any other skill. Most children learn social skills through imitation but children who have a harder time learning these skills need to be taught. Children who do not develop appropriate social skills will suffer loneliness and isolation. This can create difficulties with communication and result in behavior problems.

To help your child be successful in social situations and learn the social skills fundamental to his or her development, it is necessary to prepare your child for the social situation and prepare the social situation for your child. Here is a list of recommendations that will help children thrive in social situations:

• Prepare your child before entering a social situation by giving precise instructions and expectations.
• Make sure the social situation is appropriate for your child.
• Have a “Plan B” in case things go wrong when planning to attend a social event.
• Teach your child through role-playing games using dolls and toys, reading stories, singing songs etc.
• Teach them to share, take turns, and follow rules.
• Make use of natural situations to teach them: set examples of desired social behaviors in your everyday life; comment on what you see in videos and TV shows.
• Reward positive social behavior.
• Use photos and videos to introduce your child to different people.
• Help build your child’s self-esteem by assigning them leadership roles within the family.
• Encourage your child to help and take part in daily household chores.
• Use mistakes as opportunities to teach appropriate social behavior instead of punishing them.
• Encourage and increase opportunities for successful social experiences and offer praise.
• Avoid and minimize social failure as much as possible.

And include your child in every family interaction possible, as long as it is child appropriate. Talk about emotions so you child learns the words to express what he is feeling.

It is a battle worth to fight.

 

Daniel Adatto, BCBA

 

Behaviors and the Environment

One of the core principles of Applied Behavior Analysis is that behaviors are related to the environment in which they occur. And no, we are not talking about global warming nor are we going to tell you to “go green”. When we talk about the environment, we are referring to (a) the physical setting in which a behavior occurs and (b) the behaviors of the people who interact with the child.

a.     Physical Setting: This means the places where he/she spends the most time, home, school etc.  Lack or abundance of sensory stimuli such as lighting, temperature, noises, clutter, activities, curriculum, demanding routines (or lack thereof) are some examples.

b.     But behaviors are also affected by other factors in the environment such as the people and how they behave. “You change child behaviors by changing the behaviors of the adults who deal with that child. Pure and simple” (Cipani and Schock- 2011)

When attempting to change a behavior, a behaviorist’s first step is to assess environmental factors that trigger behaviors. Something either IS in the environment or IS NOT in the environment, which is causing the occurrence of the behavior.  One example (discussed in a previous blog, “Tantrums in Public”) of this is meltdowns that commonly occur at large retail stores like Target or supermarkets.

Another example is when parents tell us that their child behaves well at school but not at home or vice versa. When analyzing the situation one easily concludes that since the child is capable of handling himself at school, there must be something in the environment or something missing from the environment at home (or vice versa) that is causing the problematic behaviors. 

If you are experiencing problems with your child’s behaviors, take a look at some of the environmental factors that could be contributing to the problem. A few examples include:

-        Lack of structure and consistency, or too demanding routines, which can increase anxiety and/or boredom, some of the top causes of acting out in children.

-        Physical environments that don’t fit the child’s sensory needs (like the one described at Target).

-        Lack of opportunities to release energy appropriately, such as when a child is expected to sit still for too long at the dinner table or restaurant.

-        Unrealistic expectations: too many “No’s” and “Must Do’s”.

-        Lack of following through with instructions, giving in to challenging behaviors.

-        Others’ undesired behaviors that the child imitates.

-        Adults’ stress.  

If parents pay attention to the environmental factors and become aware of the cues that a meltdown is about to occur, it can go a long way in prevention.

 

Daniel Adatto, Board Certified Behavior Analyst

Hey, kids, it’s not fair!

Have you ever wonder how your kids get away with so much? I’m pretty sure they didn’t attend a “Kids Training on Behavior Management Class” before they were born and yet, they know how to push our buttons and get what they want. One thing is for sure, in all fairness: they don’t play by the rules; and we as parents have to. Kids, it seems, are allowed to scream, cry, hit, runaway, etc.

How are they getting away with it? Let’s take a closer look:

-        They ignore us. They do not follow our directions. And when they follow the directions, they do it slow or wrong or half way so we come to the conclusion that next time we should do it.

-        When they want something they can’t get, they cry and scream very loud. And I mean LOUD. If this doesn’t work, they throw things. If it’s still not working, they pinch, scratch, hit and kick.

-        Eventually we give in just to stop their behaviors. Now is the time when they are quiet and behave like angels, thus rewarding us, which increases the likelihood of us giving in the next time.

-        They do not brush their teeth. This is an easy one; we are so tired at that time of the day that we give up pretty quickly. If we insist, they distract us by running away, asking for water or fighting with their brother. Or they say they have a stomach ache. This never fails.

-        Usually, moms and dads do not agree on what to do. So our kids play us against each other, they go to daddy when mommy says “No”, or vice versa. And we argue between us and forget about them.

Do you see where I’m going with this? All these behaviors make us give in and get them what they want.

It’s not fair, they manipulate us. So, we should be able to manipulate them. So let’s learn from their behaviors and see how we can turn the tables in our favor:

-        Learn to ignore their crying and whining. This does not mean you ignore them. It means you do not give them what they want because of their behaviors. It doesn’t matter how tired you are or how little time you have. Every time you give in, you are making your life more difficult. The “I’ll deal with these behaviors when I have time” mentality does not work, you’ll never have time. It is NOW.

-        Do not give up when they ignore you or do it wrong. It’s OK to choose your battles, so if you don’t have time or energy, do not ask them to do it. Because if you do, you’d better follow through. Brushing teeth is a great example. Be sure that when you ask them to brush their teeth, you can follow through.

-        Do not argue with your spouse in front of them. Talk about behavior management strategies when there are not present. Reach an agreement and be consistent. And if your spouse told them something, support him/her in front of the kids. You need to present a united front.

We parents can feel like complete failures sometimes but we are not bad people. We love our kids. The problem is that we never imagined that being a parent and managing behaviors would be so difficult. Education and knowledge is the key. It’s up to us to get the best of them and help them become the children we want.  Or at least go down fighting.

 

Daniel Adatto, BCBA

LA Times article uncovers risks of alternative treatments for autism

“Autism: Kids Put at Risk” is the name of an article that appeared in the LA Times Health Section (http://www.latimes.com/features/health/la-he-autism-main7-2009dec07,0,5807576.story ).  The article is in essence an expose of biomedical treatments for autism being promoted by a select group of physicians.  The piece follows another investigation conducted by the Chicago Tribune and states that “after reviewing thousands of pages of court documents and scientific studies and interviewing top researchers in the field, an investigation by the Chicago Tribune found that many of these treatments amount to uncontrolled experiments on vulnerable children. The therapies often go beyond harmless New Age folly. Many are unproven and risky, based on flawed, preliminary or misconstrued scientific research. Lab tests used to justify therapies are often misleading and misinterpreted. And though some parents fervently believe their children have benefited, the investigation found a trail of disappointing results from the few clinical trials conducted to evaluate the treatments objectively.”

Some of the more questionable approaches include Chelation, a treatment where the patient is given a drug that binds to heavy metals to be excreted in urine. The theory is that it will rid the body of heavy metals but it carries significant risks including death. According to court records, a 5-year old boy with autism died in 2005 after experiencing a heart attack while being intravenously chelated at his doctor’s office.

Hyperbaric oxygen therapy (HBOT) is another highly risky treatment purported to help treat autism by reducing inflammation. Patients are sealed in pressurized chambers which are enriched with extra oxygen. It carries a risk of oxygen toxicity.  Last month, the Center for Autism & Related Disorders (CARD) published the results of a randomized double-blind placebo-controlled trial stating that researchers found no differences between HBOT and placebo groups across any of the outcome measures. The present study demonstrates that HBOT does not result in a clinically significant improvement in the symptoms of Autistic Disorder.

With such high risk and questionable results, why would a parent be willing to expose their child to such dangerous therapies? The article contends that many of the parents are desperate.  Until someone has spent a day in the shoes of a parent dealing with autism, it would be unapprised to pass judgment. But the real reason probably has to do with lack of treatment recommendations by the medical community.  If a desperate parent attends a conference and hears stories of improvement that offer hope from other parents and physicians, that is far more persuasive than a pediatrician who is going to spout off statistical studies.  But parents need to know that the results of these therapies may have more developmental explanations. With early intervention, children with autism often show natural improvement at the age of 3 or 4 and by age 5, many make so much progress they can be indistinguishable from their typical peers. This happens regardless of whether the child is undergoing alternative therapies.

To prevent a parent from agreeing to these risky alternative therapies, the medical community needs to offer a more streamlined response in terms of treatment recommendations, resources, and ongoing support.

To date, Applied Behavior Analysis (ABA) is the only safe and effective method of autism treatment backed by evidence-based scientific research. It is considered the gold standard in autism treatment and has been endorsed by the U.S. Surgeon General. But ABA requires commitment, support and can be quite costly.

Information is paramount for parents. The more you learn, the better you can help your child with special needs. The road ahead is challenging, but it can also be very rewarding.

 

Daniel Adatto, MA, BCBA 

I admire your courage!

To the parents of a child with autism or other developmental disorder, I admire your courage to advocate and seek help for your child. Having a special needs child changes everything about your life, from whether you get enough sleep at night to enduring everyday challenges like buttoning your child's pants during a tantrum. The demands of raising a child with a developmental disorder are great and families frequently experience tremendous stress coping with daily life.

Being a parent myself, I know the love you have for your child and your deep desire to provide him/her with the best possible future. My hope is that these blogs will provide guidance of which treatment to pursue and reassurance that your child's behavior will change for the better.  Believe in your child's potential. The desired results might not always develop at the speed you expect, but have faith your child will achieve the goal.

If you feel your child may be in need of behavioral services, I strongly urge you to seek help immediately. Research and clinical practice has repeatedly demonstrated that early intervention is linked with positive treatment outcomes. I am confident that in seeking effective and research-based treatment for autism, you are on the right path.

I believe the key to a successful treatment program is a plan that is specifically tailored to your child's behavior needs. Each child is an individual with his/her own unique feelings and needs.

As Behavior Analysts, it is at the core of our science to track and measure your child's progress through the treatment plan. Our greatest reward is identifying when and why a treatment plan is not working and making the necessary changes that bring success and effectiveness.

Whether you are a parent in need of services for your child or a professional dedicated to improving the lives of children diagnosed with autism, we look forward to meeting you!

 

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