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