California to again cover autism therapy

“…This is something that is going to make a lot of difference for a lot of families in California,” says Norman Williams, the Department of Health Care Services spokesman in a recent article in the Los Angeles Times. He is talking about Applied Behavior Analysis (ABA). Children in California enrolled in public healthcare are to regain access to this form of therapy for children with autism after September 15, 2014 when the state became the first in the country to comply with the new federal guidelines issued in July 2014.  

“It can be the difference from a child who can’t communicate at all to being able to say ‘I’m hungry.’ Or ‘I’m tired,’” said Kristin Jacobson, president of Autism Deserves Equal Coverage, an advocacy group.

An article like this should be on the front page of the newspaper. If you are not affected by autism in your family, you might not understand why I’m saying this. The syndrome involves several areas of deficit, including challenging and antisocial behaviors that not only segregates these children, but have a strong effect on their families and cost a great deal of money to the taxpayers. If these children do not receive the help they need they could end up being a heavy burden on society as adults. They might need assistance for life and some of them will never become productive members of society.

ABA therapy involves working closely and intensively with these children to improve their behaviors and develop functional skills. It can cost tens of thousands of dollars per year, which makes it inaccessible for a majority of families. While private insurance companies must cover the therapy under California law as of a few years ago, it has been left out of Medi-Cal, the sate version of Medicaid.

“This important milestone will ensure that all children in California, regardless of their economic status, will have access to life-changing treatment for autism spectrum disorders,” Senate President Darrell Steinberg said.   

As a proud professional dedicated and committed to implementing ABA therapy with people with special needs, I couldn’t agree more. I see firsthand on a daily basis the burden this spectrum can cause to families. I share in their happiness when their child finally speaks, plays with other kids in the playground instead of standing aside flapping hands or asks for help to complete their work independently. One of the therapists I supervise showed me a few days ago how our student is now able to do one-digit additions by himself. It made my day.  Another student is finally asking for water and to go to the bathroom independently. These may seem like minor steps. Believe me, it is huge for these children.

This is why this article is definitely worthy of the front page news.

 

Daniel Adatto, BCBA

cadatto@tesidea.com

What a school can do when it wants to

This was the title of the email that caught the attention of the author of the editorial of the September 30^th Los Angeles Times edition.

The story you will read of what this school district did for Eunice might seem routine. Sadly it’s not. But today we will focus on the positive. “What the school has done for my daughter, you won’t even believe it,” says Sari Weiner.

Eunice, a 14-year old girl, spent most of her life in foster care before moving in with Sari Weiner two years ago. “The district spotted the talent in this bright but neglected girl and nurtured her so she can reach her potential.”
You may wonder, is that so exceptional? Isn’t that what a finely tuned educational system should do?
Eunice had attended 15 different schools by the time she was 12. Her elementary school record was full of failures and emotional outbursts. She was then placed in a special education class for disabled students. Last year she made the transition to general education. This year she’s enrolled in honors English, history and science classes. “The staff at Hale, a charter school, tutored, challenged, listened and encouraged Eunice in class and out,” Ms. Weiner says. “They learned to tolerate her moods and taught her to trust them. They know when to ease up the pressure and when to give her a nudge.”

Eunice’s teachers had apparently focused on her strengths and devoted a great deal of time, energy and patience to understanding rather than blaming and scolding her. A failure turned into success. Can you imagine what would happen if all teachers were like that? How many kids trapped in the gridlock of mediocrity and disdain could be saved from a permanent state of punishment and turned into productive and happy members of society?

I once heard the phrase “every child has strengths.” Visiting special education classes on a daily basis I can see firsthand how many children go through the system without anybody ever discovering their strengths. Some classes look more like daycare centers than special education.

I feel it is our mission to help these students triumph like Eunice, to become success stories. Passion and compassion have to be part of the recipe. Knowledge and experience are crucial too. Education has to be encouraging and motivating. Instruction for special needs kids has to be individualized. Lunch and recess have to be opportunities for learning self-help and social skills, and not break time for teachers and aides. Music, arts, audiovisual technology have to be the rule because these kids need an extra dose of motivation. We don’t have the luxury of losing them because of boredom.

Like water in California these days, every moment is precious, there is no time to waste.

 

Daniel Adatto, BCBA

cadatto@tesidea.com

Behavior Detectives

The behaviorist was observing the student when the teacher said “We’ve tried everything, nothing works with him.” The behaviorist response was “There is something, we haven’t found it yet.”

B. F. Skinner (1904- 1990) is considered the father of Behavior Analysis, the environmental approach that revolutionized the understanding and treatment of behaviors. Throughout the years I’ve been gathering some of his assertions regarding the field of behaviorism. Here are some jewels, in my opinion.

“One can picture a good life by analyzing one’s feelings, but one can achieve it only by arranging environment contingencies.” 1

“The subject is always right.” 2

“Control the environment and you will see order in behavior.” 3

“Responses in relation to environments were precisely the objects of study for those psychologists who called themselves behaviorists, and Skinner counted himself among them. For Skinner, behavior was worthy of study in its own right, not as a symptom to be used as a window on physiological processes.” ₄

“The task of a behavior analyst is to discover all the variables of which probability of response is a function. It is not an easy assignment, but it is at least an explicit one.” 5

This is what the behaviorist meant when she said “We haven’t found it yet.” A good behaviorist does not rest on the assumption that there is nothing to do because the child is “broken” or “there is something wrong with him.”

It’s detective work. Understanding the variables that elicit the behaviors involves searching the environment for evidence: tight routines and structure, or lack of; physical setting, such as furniture, lighting, ventilation, space, big or small groups, etc.; and last but not least the behaviors of the people who interact with that child. How is the parent/teacher giving directions? Are caregivers frustrated and reacting violently to the child (yelling, threatening, punishing)? Are the curriculum, materials and demands appropriate for this child? Are the tasks the child is expected to complete too difficult, long and/or boring?

I worked with this family a few years ago. We eventually discovered the main problem was homework. It used to take hours for this child to complete his work, and a great deal of nagging and yelling from his mom. When I asked him why he did not want to do homework, he responded without hesitation “Because it’s boring.” And it was. Basically, it was “paper-pencil” work. After consulting with the teacher the student was allowed to do homework using the computer, a preferred activity of his. The problem was reduced by about 75% overnight.

Of course it is not always overnight, but oftentimes simple environmental changes suffice. For more information, see our blog “Behaviors and Environment” at http://totaleducationsolutions.blogspot.com/search?q=Behaviors+and+the+environment

Ask the detectives, become one yourself. And stay away from the excuse “nothing works.” Something works. You just haven’t found it yet. Your child and your family will thank you.

 

Daniel Adatto, BCBA

cadatto@tesidea.com

 

References

1.     Skinner, Notebooks, p.127 1983

2.     Skinner, 1948, p 240

3.     Skinner, 1967, p. 399

4.      J.E.A.B- Nov 1999, 72–461 NUMBER 3. CHARLES CATANIA AND VICTOR G. LATIES

5.      J.E.A.B.- VOLUME 9, MAY, 1966- B. F. SKINNER

 

The challenge of raising a child with special needs

Raising a developmentally different child is a challenge for parents. The challenge begins when parents first learn that their child is not “normal”, something has gone wrong. When this happens there is a natural period of mourning and sadness in them and their family members. This is important because the people who are their support system are affected too, they are dealing with their own pain. Therefore, they have a difficult time responding to the grieving parents.

In other cases parents have a “typical” baby for several months before suddenly problems begin to occur- the child does not respond to situations in a typical manner, has developed unusual mannerisms and/or has lost previously acquired language- these are some of the losses of functioning that commonly occur in autism.  

In any case, there may be some issues that interfere in their ability to cope with the unexpected reality. Some of these issues include the loss of the “perfect child” they fantasized about and all the expectations from “I wanted my daughter to be a ballerina,” or “I hoped my child would be a doctor” to college, marriage and procreation. Suddenly parents are faced with the possibility that their child may be dependent on them for their entire life.

Parents are overwhelmed with having to learn about a disability they had only vaguely heard of and how to navigate the cumbersome route of doctors, diagnoses, school systems, therapies, and funding sources of services. All of these while they are grieving.     

Therefore, it is important for parents to deal with their own emotions, a frequently overlooked side of the situation. The burden of having a child with special needs involves a level of stress that often affects relationships and health, adding wood to the fire. So my advice is first TAKE CARE OF YOURSELF. As the flight attendants instruct us before a flight, place the mask on you before helping others. Because if you can’t breathe, how can you help? Remind yourself that it is not your fault and seek professional help if necessary.

My next advice is take the time to observe your child. It is important to remind yourself that although your child is not responding in the “normal” way, she still is responding. Be a detective to get clues and solutions to the problems that parents of typically developed children don’t have to deal with. Your child will “tell” you the answers. What gives her pleasure? How to adapt to her changing moods? What turns your child off? How to deal with her challenging behaviors? How to set the environment to avoid problems and trigger the desired responses?  Your child have special needs and is different from other children, but he is also special in his own way, and it is your job to figure out how. Capitalize on opportunities to let him experience his special-ness. For example, if he loves numbers, engage in activities where he can be the “smart” one. If he can’t stay still and jumps all the time rather than telling him to stop get a trampoline, a bouncing ball, and other equipment that will help him express himself. 

Be ready to change your priorities. A dad in one of my classes once said to me “I understood that I’m here to help my son, not the other way around.” There will be sacrifices, accept them. One of the most difficult things you may have to learn to do is to keep a check on your expectations and learn when to push for more and when to place your child’s self-esteem in the first place.  

And know that you are not alone. You are surrounded by professionals and specialist that devoted their careers to understand children like yours. Use them as much as you can, and FOLLOW THEIR ADVICE. It is not enough to ask for help, be ready to do the work.

 

Daniel Adatto, BCBA

cadatto@tesidea.com

 

 

 

Self-Management

I was reading Applied Behavior Analysis, 2^nd edition, Cooper, Heron & Heward, and some concepts in the chapter about “Self-Management” caught my attention. Here are some passages I would like to share with you.
“The ultimate goal of behavior management is to develop independent, self-directed people capable of behaving appropriately without the supervision of others.”
“Self-management is an ultimate goal of education.”
In 1974 Skinner wrote about self-control: “When a man free to do whatever he wants controls himself and chooses the right course of action, he is behaving”.
“Self-management is simply behavior that a person emits to influence another behavior. It is the personal application of behavior change tactics to produce a desired change in behavior.”
“Self-management can help a person be more effective in his daily life, replace bad habits with good ones and achieve personal goals.”
“People with self-management skills are more likely to fulfill their potential and make greater contributions to society.” 

As we teach our kids effective life skills, they become more responsible, develop independence, and learn how to solve problems.  Have this in mind when you are working on managing behaviors. Rather than reacting out of frustration yelling, punishing, focusing your energy on “the bad” you want to teach children what to do instead, reward good behaviors, build behavior repertoires your children will be able to use in the future in order to be be successful.

The way you manage the hassles of life sets the best example for kids. Children will do as you DO, not as you SAY. For example, of you throw a tantrum when something doesn’t go your way, do not be surprised if your little ones react in the same way. You can teach them that lying is not OK but then if you lie (“tell them I’m not home,”) or don’t fulfill a promise (“I know I told you we are going to Disneyland today, but I’m so tired. Let’s leave it for another weekend”) that is what they learn.

Providing children with choices and the opportunity to make decisions, when appropriate, is another good idea when teaching self-control. Tell them the difference between right and wrong and then let them decide. Again, model the decision making process by sharing with them why you made this or that decision. You can also read books to them or tell them stories of real life people who make the right choice.    

Self-management should be your ultimate goal.

 “The goal of parents is not to control their children but to teach their children to control themselves while building their self-esteem.”

                                                                                         - Janet Hackleman

Daniel Adatto, BCBA

cadatto@tesidea.com

Yes, We Can!

Recently I have been thinking about the influence this positive phrase can have and the power of “Yes” as it applies to all aspects of our lives. This is particularly relevant when it comes to parenting. 

As discussed in a previous blog (see “Parenting Five Common Mistakes” at http://totaleducationsolutions.blogspot.com/2012/11/the-five-most-common-parenting-mistakes.html ), “we say no 100 times a day and I can almost guarantee that 75% of those NO’s could be YES’s.”

“Don’t jump on the couch”, “No, you can’t have ice cream”, “No more TV, it is time to go to bed”, “No more cookies.” And the list goes on and on.

Who likes to be told “No”? Being told “No” frustrates your child and can instigate bad behaviors, such as crying, screaming, hitting, throwing things, etc., which can be very problematic, especially when in public. Have you ever seen a child throwing a tantrum in the grocery store or at church? Children don’t need to read blogs to know how to make our lives difficult. If we rephrase our response to a more positive alternative and redirect the child instead of just saying “No”, we can reduce the child’s frustration and prevent “behavior disasters.”

Instead of saying just NO, what he CAN’T do, tell the child what he CAN do. Some examples can be:

“Can I have a cookie mom?” Instead of immediately saying no, you can say “Yes, you can have a cookie when you finish your dinner”.

“I want to play outside.” Try “It’s too cold right now but we CAN play blocks or dance inside”. It is very effective to offer two “Yes” for every “No.”       

“It seems you want to jump, let’s go to the trampoline.”

By the way, when you say “NO” to your child, you are teaching him/her to say “NO” to you when you place a request on him/her. So, save the NO’s for when it is necessary. If you child is running to the street or playing with a knife, that’s a NO.

Making positive behavioral changes is crucial to behavior management. Try the “Yes We Can” approach and see what a difference it will make in your child’s behavior. 

 Learn how to behave so your child will too.

 

Daniel Adatto, BCBA

cadatto@tesidea.com

 

 

 

 

My daughter is right

My daughter likes to ask me about my job and sometimes she “helps” me find solutions for my clients’ behavior problems when I present her with hypothetical situations. One of our “case analyses” was about a student who is placed in a regular classroom in middle school because the only autism class is not suitable for his academic level. The problem is that the pace and curriculum of regular education is way over his head, causing this student a great deal of frustration. This in turn leads to frequent outbursts: crying, screaming, throwing objects, dropping to the ground and refusing to move. All this is very disruptive to the classes he attends and leads to countless meetings to try to fix what is broken. And I’m not talking about the student, but about the system.     

My daughter said he needs something in between the low autism and the challenging typical education class. I think she is right. The problem is no such thing exists in the public school system, at least not in the student’s area.

In previous blogs I talked about NBC television show “Parenthood” because one of the families in the show has a child on the autism spectrum. They faced the same problem, no classes that can fit their bright but behaviorally and socially challenged son.  In one of the last season episodes, fed up with being called to school endless times because of behavior problems, the parents decided to create their own school despite all the hardship it involves.

The point is that we don’t have to accept a reality that precludes these children from accessing a learning environment that will allow them to be successful, which in turn condemns them to a state of recurrent punishment (angry school staff, frustrated parents, exclusion from the social life of school, etc.). As stated by Don Baer (1970), “Not to rescue a person from an unhappy organization of his behaviors is to punish him.” Let’s commit to rescuing these kids. We can create a different reality.

I think we all can agree that being “special” is not the fault of these children. They need help the same way a blind or a deaf child needs. With the right assistance, most of these kids can have a happy and successful school experience, which for sure will be crucial in developing productive members of society. The benefits of this are enormous and probably a good topic for future blogs.

So, what can be done? At this point I have to admit I don’t have all the answers.

I don’t accept the argument that there is no money. I’ll submit that the resources spent (wasted?) in managing the problems that the current situation involves could be redirected to create appropriate classrooms and curriculums for these precious children. I’m talking about money spent on all kinds of ineffective therapies, all the time spent in useless meetings, all the frustration, etc. There are also non-profit organizations that receive money from foundations dedicated to this population which could be an additional resource.

In my opinion it is a question of will and commitment to a solution. Let’s stop the laziness and let’s put our minds together to find solutions rather than managing a broken system.

My daughter is 11. What would it take for us, grownups, to arrive at the same conclusion she did?

 

Daniel Adatto, MA, BCBA

cadatto@tesidea.com