Pivotal Behaviors

Individuals with developmental disabilities present a myriad of challenging behaviors. Addressing each one of them separately can be a daunting task for parents, staff and the clients themselves. Successfully addressing multiple behaviors with one intervention is often necessary. PRT (Pivotal Response Training- Koegel, O’Dell and Koegel, 1987) focuses on critical behaviors that are central to many areas of functioning, such as communication and social skills. PRT is built on the premise that improvement in these key pivotal behaviors opens the door to improvement in other areas as well. In other words, teaching pivotal behaviors produces widespread positive effects on other behaviors.  

This is a positive, naturalistic behavior intervention based on Applied Behavior Analysis principles that focus on teaching specific behaviors in the natural settings and is used successfully to help children with ASD and other developmental disabilities. Key pivotal behaviors addressed include motivation and responsivity to multiple cues. 

Motivation: Children with developmental disabilities are frequently viewed as lacking motivation to initiate and respond appropriately to stimuli, to learn new tasks or engage in their social environments. They demonstrate this lack of motivation by engaging in non-compliance, tantrums or other challenging behaviors to escape tasks and social interactions. They may not initiate conversations or ask and answer questions. These children are so difficult to motivate perhaps because since they often fail, they have learned not to try.

Thus, motivation is a key component of a behavior modification program. Lack of motivation constitutes a barrier to teaching appropriate behaviors. A motivated child is interested in learning. Research indicates that increase motivation has a dramatic positive effect on children’s learning (Koegel, O’Dell, & Dunlap).

I like the phrase “We can not teach if we cannot motivate” because it summarizes the importance of focusing on motivation.

Responsivity: Children with developmental disabilities are characterized by “stimulus overselectivity”, and attention deficit in which they select or focus on only one part of the environment or an object. A child may focus only on round part of an object such as the wheels on a car. Increasing children’s responsivity to multiple cues is an important pivotal behavior that may help them to learn more from typical educational strategies and naturally occurring situations, which ultimately leads to engage more in desirable and functional social behaviors.

Parents and professional should focus and take advantage of naturalistic child and family-centered situations. Here are some tips:

1. Implement teaching sessions around objects, activities or topics that the child prefers in order to increase motivation. For example, if your child is “crazy” about cars, engage in playing with him the way he plays with cars (start imitating what he does), and slowly include and model social interactions, such as “the red car asks the blue car to play”, or “all the cars are having a playdate” and they take turns while playing games, share toys, collaborate in building with Legos, etc.

2. Take advantage of natural situations to teach. For example, having dinner, taking a bath or doing groceries are great opportunities to model behaviors and increase motivation.  

3. Parent, teacher, make sure that the child is attending to you by getting down to his level, calling his name or asking “Are you ready?”, and then presents the child with a question or instruction that is directly related to the setting, task and material available. In our example, playing with cars.

4. Very Important: All attempts to respond appropriately (even if the response is not perfect) are rewarded. Ample time is allowed so the child can try to respond without stress. Prompt (model, guide) appropriate responses to end always on a positive note, the reward. This allows the child to experience success, which increases motivation.

5. Use rewards directly related to the task and the natural environment. If you are playing cars, the child receives another car, or gets access to his favorite car, for example.  

In sum, teaching pivotal behaviors is a child-centered intervention that can be implemented across settings (school, home and the community) and across caregivers. Once parents learn how to do it, they become the therapists and thus, the intervention is in place 24/7.  

This intervention has been most successful in improving social and communicational behaviors of children with developmental disabilities in the areas of language, play and social interaction.

Another example of an effective way we can help to improve the quality of live of individuals with developmental disabilities and their families.

 

 

Daniel Adatto, BCBA

 

The Power of Structure and Routines

Try to imagine your life “unstructured”: you don’t know when you are going to have food again, or where it’s coming from; you don’t know at what time you’re going to be home, or if you are going home at all today; you don’t know when you are going to be done with a non-preferred activity, how long it’s going to last; and you don’t know when you are going to be able to rest, have fun with you preferred activity or see your loved ones again. In sum, your life is unpredictable, uncertain, chaotic.

 

I don’t know about you, but I’m “freaking out” just by thinking about that possibility.

 

Your child might be living in that state of confusion and anxiety all the time. So, let’s structure. 

 

What does "Structure" mean?

 

A predictable and consistent daily schedule (time-space-people in charge). Lack of predictability increases anxiety, which leads to problematic behaviors. Yes, I’m talking about your kids. Are you with me?

 

Predictability is what your children need, and something you can implement at home. You don’t need complicated IEPs, or your insurance to approve services, balanced state/federal budgets or lawmakers to pass bills.    

 

Benefits of "Structure":

 

q  Builds Confidence

 

q  Decreases Anxiety and Fears

 

q  Develops Positive Expectations

 

q  Encourages Cooperation and Compliance

 

q  Increases Predictability

 

q  Increases Motivation (when desired activities follow undesired activities)

 

q  Increases sense of Control

 

q  Increases Independence

 

q  Anticipates future events

  

Sounds good? Well, it is.

I can hear your question, How to Structure Activities?

--Keep times, places and people in charge as consistent as possible. Start with the “must do”: meals, bed time, etc.

--Adjust the environment to focus on the activity. For example, turn off the TV when it is bed time.

--Present scheduled activities in a positive manner. Do not be overly rigid. Some flexibility is necessary.

--Include free and play time: children need it.

--It is very important to allow time for transitions between activities. For example, when your child comes from school he/she typically will need some free, unstructured time. Or when transitioning between activities. Prepare the child ahead of time. For example: "It is almost dinner time, so you will need to come in soon. Be ready to put your toys away".

--Have preferred activities follow non- preferred activities. In order to be able to do the desired activity, the child has to finish the undesired activity. For example, "homework first, then play"; or "bath first, then video".

Children may not have independent play skills. You may have to set aside time to play with your child.

Choices can be built into the schedule by allowing the child to choose between 2 activities, such as "bath or shower", or "going to the park or to the store", or "video or TV".

In sum, structure and routines do not mean “militaristic”. They mean “predictable”.

Very cost-effective: easy to implement, excellent benefits. Sometimes, the solution is simple.

 

Daniel Adatto, MA, BCBA

 

 

Parents with Special Needs

Are you a parent of a child with special needs? If so, you know how challenging it can be. You are a parent with special needs.

Children with special needs are, first and foremost, children, and thus, they share kids’ basic needs: love, acceptance, care, and support and guidance to overcome challenges. Parenting is arguably the most difficult job on earth. However, the emotional toll you pay due to your child’s deficits and excesses can drain you, making it more challenging than raising a non-special needs child. 

But you are not alone. The state health department, social services agencies, parents support groups, schools and health insurers are there to support you.

When parents learn for the first time that their child has special needs, strong emotions such as denial, anger, fear and/or guilt take over. This is common and understandable. Parents feel alone and worry that their child will have an unhappy life. However, you need to learn to manage your emotions. Some helpful recommendations are:

- Communicating with others about how you feel.

- Seeking help from family, friends and other parents who have kids with special needs. Do not hide. Do not feel ashamed. Your worst mistake could be isolating and pretending that nothing is going on.

 - Learning about children with special needs, effective treatments, and educational and legal rights.

- Taking care of yourself (see previous blogs about Stress Management). It is difficult to help your family and your child if you are stressed, depressed and out of energy. Remember to rest, exercise, eat healthy and relax.

- Seeking counseling if your emotions and responsibilities are overwhelming.

And don’t forget to spend quality time with your child. Be sure to have fun!

Yes, having a child with special needs is challenging. Would you believe me if I tell you it can be rewarding too?

Daniel Adatto, BCBA

Anger Management

In my everyday practice, I see a lot of parents who struggle with anger. I don’t blame them. Having a child with special needs is very challenging, stressful and frustrating. But reacting out of anger only leads to more anger. Thus, this made me think about anger management.

We know that anger is a common emotion. Everybody feels angry from time to time. Different situations or people can make us angry. Even when we may not be able to change that situation or person, we can control our behaviors so we respond to the situation instead of reacting out of anger. The goal is to control and express anger in a positive, safe, appropriate and constructive way. Avoiding anger may not be realistic. Managing anger is the solution. 

In order to manage our anger it is important to know what situations make us angry, where the anger comes from, as well as recognize when the emotion is taking over.

Anger can be expressed in a destructive and hurtful way. Relations can be damaged or destroyed.  Jobs can be lost. Lives can be ruined. This is why it is necessary to develop effective anger management skills in order to promote peaceful and healthy environments and teach our children how to manage their anger too.

Identifying “anger triggers” for us and our child allows us to be equipped to respond in a positive manner. Common triggers are:

For us 
- Children's behavior
- Unexpected events
- Traffic jam
- Relationship problems
- Stress at work
- Health problems
- Financial problems

For children
 - Conflict with other kids
 - Peers rejection
 - Not getting their way
- Delaying gratification
- Waiting
- Being scolded or punished
- Being ignored

By paying attention to our body’s signs, we can “cool down” before losing control. Some signs are:
- Rapid heartbeat
- Tense muscles
- Sweaty palms
- Feeling warm
- Destructive thoughts
- Snapping at people

Children need help to understand and recognize their feelings of anger. Some signs are:
- Yelling or crying
- Throwing things
- Pulling out own hair
- Tightening fists and muscles
- Hitting self or others

I would like to share with you some ideas for “cooling down” in healthy ways:

For us:
- Exercising
- Taking deep breaths
- Time-outs: Removing ourselves from the person or situation that makes us angry
- Writing about feelings
- Going for a walk
- Sleeping/resting
- Talking to a friend or a professional

For our kids:
- Talking to an adult about their feeling: Instead of asking them to stop with the behaviors, open the door to talking, so they can learn a way to vent feelings appropriately
- Playing outside
- Removing them from the person or the environment
- Writing about their feelings
- Time-outs as a way of calming down (not as a punishment)

Anger can be expressed with words. Not communicating anger does not make it go away. It might build up and lead to an “explosion” later.

As we teach our kids effective anger management skills, they become more responsible, develop independence, and learn how to solve problems. 

Remember that our children learn by watching us coping with anger. They learn what they see, not what we tell them to do.

Good parenting involves modeling good behaviors. We have to know how to behave, so our kids will too.

 

Daniel Adatto, BCBA

 

 

Autism Screening Quiz

There are many early warning signs and symptoms of autism that can present in babies, some say as early as 6 months to one year old, though most children get diagnosed with autism-like symptoms closer to the age of 18 months when the signs become more apparent. Some of the early warning signs include:

 

 

• Impaired social interaction


• Problems with verbal and non-verbal communication


• Failure to respond to name


• Avoidance of eye contact with other people


• Repetitive movements such as rocking or twirling


• Self-abusive behavior such as biting or head-banging

 

 

With autism numbers on the rise (a CDC study shows that as many as 1 in 100 children have autism), it is only natural that paranoia may set in when it comes to signs of this baffling disorder whose cause is so unknown. How many of us haven’t felt that twinge of fear when your baby doesn’t respond to his name, or doesn’t say any words by the age of 12 months? How many parents have woken up panicked in the middle of the night and gone to the computer to Google the signs of autism? If you’ve ever worried that your baby may have autism but did not want to ask your pediatrician for fear of sounding like an over-worried parent, now there is a quiz you can take that will help you know if you really should ask a professional to evaluate your child.  According to the National Institute of Child Health and Human Development, there are a number of things that parents, teachers, and others who care for children can look for to determine if a child needs to be evaluated for autism. This autism quiz asks about 'red flags' that could be a sign that a Pediatrician or other health professional should evaluate a child for autism or a related communication disorder.

 

 

But before you panic, keep in mind that other conditions can also cause these symptoms, that you have to consider what your child can do in an age appropriate manner (for example, a 6 month old likely won't respond to his name), and that normal children can have some of these symptoms and behaviors (like being independent, walking on her toes, or preferring to play alone).

Having one or more of these signs, symptoms, and behaviors should prompt a discussion with your Pediatrician to see if further evaluation needs to be done. If you have any doubt, you should never fear asking a professional for help. Countless scientific studies show that when caught at a young age, early intervention using the treatment methods of applied behavior analysis (ABA) are extremely effective at helping a child with autism lead a more typical life.

To start the quiz, click on the link:

http://pediatrics.about.com/od/autism/l/bl_autism.htm

 

Daniel Adatto, BCBA

Limits and Consequences

In today’s pursuit of having confident children who believe they can achieve whatever they want, many parents overlook their responsibility to set limits for their children. Ironically, children who don’t learn limits may not develop the sense of security and self-esteem they need to achieve important life goals. One of the most challenging but fundamentally important principles of parenting is the ability to set limits for children and follow through with consequences when the boundaries have been crossed. Limits and boundaries provide children with a feeling of safety and love. Confidence develops when children know that their parents are looking out for them.

Limits and consequences are also a vital tool in behavior management. Limits are set to help your child to understand respect for himself and the world around him. The purpose of using consequences is to motivate children to make responsible decisions, not to force their submission. Consequences are effective only if you avoid having hidden motives of winning and controlling your child. Try not to establish rules solely for your convenience and always make sure you have realistic expectations. A child must have the cognitive capacity to understand the rules and the consequences for breaking the rules before the consequence is given. For example, an 18-month old child does not understand that he can get burnt from touching the stove. If he does not understand, he can’t be held responsible and should not receive a consequence. Instead, a parent can use distraction techniques or can arrange the environment to secure safety, such as putting up a safety gate when the stove is hot.

Consistency and follow-through are crucial when using limits and consequences to change a problematic behavior. If a limit has been established and been broken, a parent needs to follow through with a consequence. Any flexibility will teach the child what he can get away with in the future. In other words, mean what you say.

It will help you to set reasonable limits if you remember that your child needs freedom to explore, to learn and to discover. The right of children to play freely and to learn by doing things themselves must be acknowledged.

Here are some important guidelines when setting limits and consequences:

• The person whose rules were broken is responsible for enforcing and administering the consequence whenever possible. For example, school rules should be enforced at school by the teacher.
• One consequence per violation should be enforced.
• Be both firm and kind. Firmness refers to your follow through with the limit and consequence. Kindness refers to the manner in which you present the choice. A consequence should not be perceived as a punishment if it is to deter the behavior in the future. Be firm with the problem; be kind with your child.
• Consequences should be over as quickly as possible so a positive family atmosphere can be reestablished.
• Whenever possible, offer you child the chance for a do-over before enforcing a consequence. Give the child another chance to practice an appropriate behavior and be successful.
• Follow through with consequences as soon after the violation as possible so the child connects the consequence with his/her action.
• Be in control of yourself when administering or enforcing consequences. Any show of anger and frustration, such as yelling, name calling, criticizing or rage by the parent, cancels the effect of the consequence. Remember: it is you AND your child against the problem, not you against your child.
• Be patient. It will take time for the consequences to be effective.
• If you make the child feel bad, he’ll hold on to the behavior as part of his arsenal against the parent and this will not foster a parent-child alliance against the problem behavior.
• Consequences must be planned in advance. You should be prepared with a list of consequences you can call upon when the situation arises. Both parents should agree in advance what is an appropriate consequence.
• Choose consequences related to the violation, whenever possible. For example, if your child exhibits antisocial behavior, sending him to his room is a logical consequence (not as a punishment). If he’s disrupting the rest of the family, logically he needs to leave the room so as not to disturb the rest.
• Make sure the consequences you choose do not negatively affect you or the rest of the family more so than the child receiving the consequence. For example, limiting TV or cancelling a weekend outing may affect you and other siblings.

In sum, do not react to the behavior out of frustration and anger. When you implement consequences to manage challenging behaviors, think of it as helping your child to get back in control and teaching him important life skills such as patience, respect for others, and respect for himself.

After all, our kids are not our enemies. They don’t wake up in the morning thinking how to make us miserable. They are children, our son, our daughter, they are the most important thing in our lives, by far, and our love for them should be unconditional.

 

Daniel Adatto, BCBA

Understanding Applied Behavior Analysis

Behavior disorders in children are common and could be the result of a variety of causes. We, Applied Behavior Analysts, sort those causes and develop individualized treatment plans. We will evaluate your situation and work with you to develop a treatment plan. We believe that every child is unique and deserves an in-depth look into their particular situation. Each treatment plan we develop is tailored to meet the needs of each individual child.  Not all challenging behaviors in children are cause for concern but if you have any doubt, it is always best to have a professional assess your child.

The process starts with a comprehensive evaluation: The Functional Behavior Assessment. 

Functional Behavior Assessment is a process for gathering information to understand problem behaviors and develop effective behavior intervention plans. Functional Behavior Assessment is a set of methods for defining the environmental factors that contribute to, reliably predict, and maintain challenging behaviors. Understanding why a behavior occurs directly leads to how it can be changed. “By determining the contingencies that maintain problem behavior, functional analyses allow the development of effective function-based treatments.” (Iwata et al.,1994).

According to E. Cipani and K. Schock, “a function-based diagnostic does not presume that challenging behaviors are driven by characteristics inherent in the person, which is a sharp contrast with the traditional psychiatric approach to diagnosing clients’ behaviors (e.g. DSM-IV-R).” “In a function-based diagnostic, the form of the behavior (how the behavior looks like) does not dictate the function.”  This has significant implications in designing effective behavior interventions. If behaviors are identified according to their form, each and every behavior would require a different plan. When behaviors are assessed according their function, one intervention could be prescribed for different behaviors that serve the same function. As an example, a child that engages in hitting, kicking, throwing objects, crying, and screaming in order to avoid non-preferred activities (negative reinforcement function), would be prescribed with one intervention rather that five (one for each behavior).

Therefore, when trying to understand problematic behaviors in children it is important to consider the many different variables that could be playing a role in the behavior.  Every child throws tantrums. But each situation is different and there are countless motivating factors that could be causing the tantrum. Evaluating the environment in which the tantrum occurs, understanding the child's motivations, and assessing how the adults and caregivers in the child’s life react to the behavior are all factors that help us develop a strategy to treat the behavior disorder.  To give us the complete picture, we look at all the possible reasons why a child is behaving a certain way. We include interviews with the family as well as all those who interact with the child, such as a teacher or relative, to give us a more in-depth look at the child’s life.

We observe the child in different situations, including when and where the behaviors are less likely to occur, because those situations give us an insight of what works for this child. We analyze the variables that contribute to the occurrence and non-occurrence of the challenging behaviors, and develop hypotheses about their functions, the why this child engage in these behaviors? What is the child trying to obtain or avoid?

We manipulate those variables to prevent undesired behaviors and trigger desired ones, thus confirming or ruling out our hypotheses.

And we develop behavioral plans that match the functions of the behaviors.

In sum, by taking an individualized approach, we maximize the chance of success of the treatment plan.

Daniel Adatto, MA, BCBA