Family involvement

We always say that when parents and other caregivers get involved in the interventions, their children show the most gains and progress. Parents become the therapist and thus, the intervention is in place 24-7.

The question is what it means to be involved. Here are my recommendations regarding the necessary steps of family involvement:

Phase 1: Look, listen, and learn

·       This is the introductory phase where the parent observes the behaviorist working one to one with the child. The parent will observe different segments in a variety of domains including independent living skills, functional communication, play, and behavior. Verbal instruction as well as modeling will be used throughout this phase to familiarize the family with common strategies and techniques.  

·       20 - 25% of the session will be devoted to observation. 

Phase 2: Working together

·       The parent has now observed all of the segments and is given a choice of what segment they would like to work on. During this step the parent and provider are both actively involved in the segment. The parent begins to give instructions, redirect inappropriate behavior, and use reinforcement contingencies.

·       The behaviorist is collecting data on the consumer’s interactions with the parent as well as with herself/himself.

·       20 – 25% of the session the parent and behaviorist will work together on achieving the consumer’s goals.

Phase 3: Parent lead

·       The parent is now leading the segment with the support of the provider. Instructions, redirections, and opportunities are all directed by the parent.

·       The behaviorist is taking data on the interaction and is only stepping in when necessary to give feedback to the parent.

·       25 – 30% of the session will be parent lead.

Phase 4: Independence

·       In the fourth and final step the parent is working with the consumer one to one and the provider has been completely faded. The parent is responsible for handling difficult behaviors, following through with demands, and employing environmental modifications.

·       The parent and behaviorist are both taking data that will be compared during the debriefing session to check for reliability.

·       25 – 30% of the session will include parent participation.

 

All this take and investment in terms of work and commitment. But it is worth it because you are investing in your family quality of life.

 

 

Daniel Adatto, BCBA

cadatto@tesidea.com

The First 3 Months of Early Intervention

Numerous research studies show that the earlier the better when it comes to early intervention using applied behavior analysis in the treatment of autism.  What is not so often written about, is how exactly to begin an early intervention program and what are the critical first steps to take when a Behavior Analyst begins working with a child with autism.

At a recent ABAI conference an expert from Poland held a session on why the first 3 months of an early intervention ABA program are so critical. The presentation focused on quality of services and building a strong foundation, reminding us not to jump ahead too quickly, not to target all deficits but to prioritize deficits and skills to ensure quality. The presenter emphasized how important it was to develop a positive relationship with the client in the first month in order to obtain optimum results. This information probably seems intuitive to most Behavior Analysts yet so many of us go about our first treatment sessions the wrong way.

When a typical ABA program begins, a Behavior Analyst will gather information on problematic behavior and details surround that behavior - the frequency, where it occurs, when it occurs, etc. The Behavior Analyst will meet with important people in your child's life, such as friends, babysitters, teachers, and relatives to get an understanding of how they behave within a variety of relationships. Also, they will schedule a time to observe your child to personally witness the problematic behavior. Once they have gathered enough information, the Behavior Analyst will complete an entire behavioral assessment on your child's behavior and then begin to implement the plan in your child’s natural setting such as the home or classroom. A Behavior Therapist will typically show up with a bag of tricks (toys, games, motivators) and get to work. This is where, according to the presenter, some of us may be going wrong.

What she recommended was to use the first month to build motivation in the child by establishing a playful rapport. Do whatever it takes to win him over – jump on the couch, do fun activities or just be silly.  If a child knows that every time his therapist comes he/she will need to work, then a feeling of dread comes over the child when the therapist arrives. But if the first month is used to establish a positive foundation, the child will look forward to the arrival of his therapist and be more motivated to work.

Another recommendation was to take a step back in the beginning to identify the motivating factors that are already in the child’s home. If all the therapist uses to motivate the child are his special toys in the bag of tricks, it will be very difficult for the parents to replicate once the therapist leaves. If there are things in the household that motivate the child – special  DVD’s, one-on-one attention, preferred games – use these motivators rather than the toys that come and go with the therapist.      

And as we always say, consistency in the implementation of the treatment plan across people and time is paramount in the success of the intervention.

We at Total Education Solutions are committed to being at the forefront of the behavioral health services industry. We strive to keep up to date with all the latest research and trends in the industry. It is always our pleasure to pass along to our readers and clients the valuable information we learn.

Daniel Adatto

cadatto@tesidea.com

Unsuccessful Behavior Management: Common Causes

We often see behavior management programs fail. Even when implemented by professionals. So let’s take a look at possible causes:

 

- Not looking at the “big picture”:

Many interventions focus on extinguishing the viewed behavior without thoroughly evaluating their cause. Identifying the cause is critically important to be able to find a solution. Even though causes are not immediately observable, they relate significantly to the immediate behavior.

 

- Failure to determine the true cause of the problem:

In children with developmental disabilities, there are usually three interwoven factors into a large percentage of behavior difficulties: the inability to understand effectively, expressive communication problems, and sensory issues. To be successful, an assessment of behavior problems has to consider what need the behavior is trying to meet. 

 

- Trying to deal with too many things at once:

When children have lots of problems in lots of areas, it can be overwhelming. When the parents try to correct too many things simultaneously, both adults and kids become frustrated.

 

- Focusing on extinguishing behaviors rather than teaching skills:

Telling the children what not to do is sometimes helpful, but it is even more important to teach them what they should do instead. One of the most effective ways of reducing/eliminating inappropriate behavior is to teach the child a more effective and appropriate way to get his needs met.

 

- Presuming the child understands:

A child’s difficulty in understanding is frequently a significant source of behavior problems. Presuming the child understands directions and rules can be misleading.

 

- Failing to teach functional communication skills:

For most behavior difficulties, communication emerges as part of the problem and is an essential part of the solution. If the behavior problem is related to the child’s communication needs, then teaching more effective communication skills needs to be a major part of the solution.

 

- Bombarding the child with too much verbal & sensory input:

When children are having difficulty, it is tempting for the adults to do more...talk more, get closer, or any other reaction that only intensifies the situation. Taking a break and backing off is often times the way to go.

 

- Making the whole process too complicated:

 Too many directions, lecturing, bringing the past, complaining, usually makes things too complicated, thus worsening the problem. Be simple and matter-of-fact. Stating the problem (“your room is messy,” “is time to go to sleep,” etc.) is much more effective than lecturing (“I told you one million times”, “you have to be responsible and clean your room”, “I’m not your servant”, “every day the same thing”, etc.). Offering choices rather than giving directions is often times a good idea (i.e. “Do you want to do your homework before or after dinner?” rather than “Do your homework.”)    

 

- Reacting to difficult behaviors inconsistently:

Children get confused easily. The more inconsistent the adults are in managing behavior situations, the longer it will take to observe positive changes in the child’s behavior.

- Not getting the right amount of help:
Dealing with behavior problems can be an overwhelming and exhausting task. Evaluating yourself as part of the situation is difficult. Different people will evaluate situations from different points of view. Teaming together with others will help the whole situation is perspective.

- Not defining success:
Taking into consideration their disability, are we trying to make kids perfect or are we trying to make them behave appropriately? Success is not perfection. Think of success as appropriate participation and interaction with others.

- Forgetting that kids are kids:

Just by their nature, children are going to have their ups and downs. Everything a child does is not a major problem. Take time to sort out the things that children do just because they are kids from the behaviors that are the real problem.

 - Forgetting to have fun:  

Dealing with behavior problems is serious business. It is easy to focus exclusively on behavior problems instead of the good times. Don’t forget to enjoy your child when things are going well.

Remember, learn how to behave so your kids will too.

 

Daniel Adatto, BCBA
cadatto@tesidea.com 

Happiness starts at the top

After attending an IEP two days ago I received this email from the student’s dad yesterday:

“Hello Daniel,

I want to thank you for your advice yesterday with Sam's (not real name) IEP. The main reason I think he does not like German class is the way he is treated by the teacher. At the beginning of the year she was dealing with Sam in a rude and dismissive manner, and I think that her behavior and treatment of my son is the reason for his problematic behavior in her class. I thought that it was insightful when you pointed out that Sam, like most children, responds better when treated with respect rather than in a dismissive manner. Thank you”

When I said that I thought it was common sense rather that especially “insightful,” as this father points out. 

And today, what a coincidence, I came across this article from Aubrey Daniels International (http://www.talentmgt.com/blogs/5/post/7090-happiness-starts-at-the-top?utm):

 Keeping employees happy and engaged can be a challenge for many organizations. Our latest newsfeed offers resources and tips for how to reinforce employees and create a happier

Happiness Starts At The To

In today’s workplace a lot of emphasis is put on making employees happy, but many companies mistakenly do so through added perks. Dr. Aubrey Daniels explains that being happy at work is less about what employees are given and more about how they are treated. This blog explains why companies should focus on recognizing employee contributions and achievements in order to b"In reading The Pursuit of Happiness, a recent article in Talent Management magazine about the job of “chief happiness officer,” my first reaction is that a company that appoints one needs one. Increasing perks, and even income, won’t cause people to be happy. If it did, how would you explain why many who are rich are also seemingly unhappy?

Happiness comes from how employees are treated as they work, not as something you give them to make them happy. An important factor to keep in mind is that because happiness is perishable, recognition of accomplishments, contribution and progress needs to be very frequent.  Measures of happiness can only be made by looking at accomplishments. Attendance, effort, productivity, quality and safety are all lagging measures. It is difficult to be happy when the company is not performing well. If you are not treated well, it is also difficult to be happy, regardless of the economic health of the organization. In other words, happiness starts at the top and is reflected not in what the CEO says but in how those words are reflected in policy, processes and management behaviors. If the CHO can bring about those changes, there is a viable and important job. If not, there will be little happiness and lots of wasted time and money.”

How true this is when it comes to parenting and teaching, especially kids with special needs that present behavior challenges! If the approach is “rude and dismissive,” as Sam’s dad pointed out in his email, how can we expect the kids to behave nicely and respectfully? Why we demand the children to behave when the adults that deal with them don’t?

Yes, kids, like most of us, respond better when treated with respect and dignity, regardless of their special needs, challenges and deficits. Something to think about.

Daniel Adatto, BCBA

cadatto@tesidea.com

 

Peering into the mind of Temple Grandin

I had the chance to watch the HBO movie Temple Grandin. If you haven’t seen it, you should.  It’s been said that Temple Grandin is the most recognized person in the world with autism and has done great things for the autism community.  She is also a well-known animal behaviorist and became world-famous for designing humane slaughterhouses. The inventive HBO film paints a picture of Temple’s perseverance and determination while struggling with the isolating challenges of autism at a time when very little was known about autism spectrum disorder.  The movie takes place in the 1950’s when psychiatrists considered autism a mental disorder caused by cold, withholding “refrigerator mothers”.  Grandin’s mother was anything but cold and so much of Temple’s success can be attributed to her mother’s nurturing support. One of my favorite lines from the movie was when her mother declares “I’m supposed to have done this, well then, I can undo it”.  The film follows Temple from her early school years, completion of her Masters and emergence as a woman with a keen self-awareness and an innate sensitivity and understanding of animal behavior.  With the help of her mother, a woman who insisted that people treat her daughter as “different, but not less”, a farsighted teacher who helped Temple unlock her talents,  as well as Temple’s own relentless determination, Temple Grandin paved her way to a successful career as an author, lecturer and pioneering advocate for autism.    

What I loved most about the film was the insight into Grandin’s world, taking the audience inside her mind and the way she visualizes things by using a series of snapshot images that pop onto the screen the same way that they pop into her mind.  A great example of this is when she attempts to enter a supermarket with automatic sliding glass doors. Images of a guillotine keep popping into her head, preventing her for entering the store and forcing her to instead shop at a small mini-market across the street. In one scene she gets off a plane and the sounds and sights are heightened, the screeching whirr of the propeller, loud greetings, the blazing desert heat, all to capture how overwhelming and unbearable simple daily activities can be to someone with autism. But Temple never let these roadblocks stop her.  Very noteworthy is the way in which she deals with her panic and anxiety with the invention of a contraption she designs to apply pressure by squeezing her when she goes into sensory overload, so typical of autism. What is so admirable about Temple Grandin, and is conveyed brilliantly in the movie, is how unapologetic she is about her disorder as she plows through life. She credits autism for her achievements, arguing that her hypersensitivity and the unique way in which she sees things is what allowed her to be so in tune to animal sensibilities.

Overall it is an inspiring story that is dramatic but at the same time charming and offers a wonderful glimpse into the mind of someone with autism. So much in line with Temple Grandin herself, this movie sends a great message about autism. You ought to watch it.

 

Daniel Adatto, BCBA

cadatto@tesidea.com

Want to Get to “No Man’s Land”? Here’s a Map

I often find myself mulling over how this very circumstance happens a lot in education and parenting. You find yourself in an impossible mess, where every available choice seems wrong. You’re in No Man’s Land. It’s a horrible feeling of helplessness.

But the hard truth is that often we have only ourselves to blame for ending up stranded in the middle of the desert. Let me share with you a situation that illustrates how we get into these dilemmas.

Getting Lost
It was at a school site filling in for the therapist who was on her break when my student decided to throw a tantrum. Bad decision #1 was to tell her to stop and to try to bring her to her desk. I should have just paused and waited for Anny to calm down or try to help her deescalate and choose a better coping strategy, or both. Bad decision #2 was to get upset. If one is determined to manage such behaviors effectively, it is best to stay calm and in control of your own emotions. Every decision later on is made easier by remaining calm.

The student in question became louder and physical (i.e. hitting, pushing, throwing objects at people, etc.). She raised her bet. Everybody, including the teacher, stepped back leaving me alone with the problem and feeling judged by them. I should have joined them and stepped back too. Instead, I called, which in this case means “I’m going to show her who’s the boss.” Bad decision #3. I was now doing what I always advise against: Engaging in a power struggle. Yeah, not smart.

And just like that, I was in “No Man’s Land.”

Fortunately, Anny gave off tell-tales that tipped the balance of my decision when she screamed she wanted the computer. On that basis, I finally found my way out. “First let’s go to your desk to finish your work and then you can play in the computer.” She complied. The magic “First…then…” Or Grandma’s Rule: First you eat your vegetables and then you can have ice-cream. I was saved by her overacting. If not for that, I honestly don’t know what I would have done because I had let myself lose control of the situation from all my bad decisions.

I got lucky to have been shown a way out of the wilderness. That’s not going to happen every time. Usually we just have to make a guess as to which way to go. It’s much, much better to avoid getting lost in the first place.

The Way to No Man’s Land
If you want to get yourself into uncharted territory deep in a behavior management hand, with no idea how to find your way back to safety, I can tell you exactly how to do it. Start by getting upset and losing your cool. Proceed up Bad Position Avenue. Take a left on overreacting and trying to show you are the boss, which quickly turns into Power Struggle Road. Keep going past the flashing yellow warning lights, without pausing to consider what they’re warning you about.

When you get where you were headed, don’t stop, but instead veer off in a new direction, maybe taking Forcing Street or Reckless Boulevard. Keep going past the edge of town, until your car is bogged down by deep desert sand, with no guideposts in sight.

But when you get there, don’t call me asking for directions. I don’t know how to get you out of No Man’s Land. I’m only an expert at how to get there.

 

Daniel Adatto, BCBA

cadatto@tesidea.com

 

 

 

 

 

 

Autism and Special Diets

A report released in an issue of Pediatrics states that there is no proof that special diets help or don’t help children with autism.  The study was conducted by a panel of 28 experts made up of professionals from 12 scientific disciplines, including child psychiatry, pediatric allergy, pediatric gastroenterology, and pediatric nutrition. The panel evaluated scientific evidence regarding gastrointestinal disorders in all forms of autism across the spectrum and concluded that there is no evidence that digestive problems are more common in children with autism compared with other children, or that special diets help alleviate some of the behavioral problems associated with autism.

Like any research released about children with autism, the report sparked some intense debate.  One reason for the controversy is that many parents say that restrictive diets have helped their children by combating symptoms and behavior problems of autistic children. What’s important to note however, is that the panel did acknowledge in their report that many parents and medical professionals have reported improvements in autistic behaviors after dietary treatment, but that these observations aren't based on controlled, scientific studies. In other words, they are anecdotal. Many parents try the restrictive diets after hearing anecdotes from other parents but this is not proof enough for scientists and doctors. Additionally, usually these children are receiving other treatments (i.e. special education, speech therapy, behavior intervention, etc.) which only confounds the conclusion that the diets are the sole responsible, or responsible at all for the improvements.

Based on the research, the panel concluded that there is still no proof that special diets help or don't help autistic kids -- or that food allergies, food sensitivities, or gut problems cause autism. Harvard's Timothy Buie, MD and chair of the panel noted "Anecdotal reports that restricted diets may ameliorate symptoms of ASDs in some children have not been supported or refuted in the scientific literature, but these data do not address the possibility that there exists a subgroup of individuals who may respond to such diets."

Bottom line? Because of the anecdotal evidence, a parent with a child with autism may be inclined to try a special diet. But as with any alternative treatment, we strongly recommended that a child following a restricted diet be carefully monitored by a nutritionist and a medical professional.

 

 

Daniel Adatto, BCBA

cadatto@tesidea.com