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

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.