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CBO Baby

15 Apr

Sometimes the best way to address a behavior is to prevent it from happening in the first place. Antecedent strategies work by adjusting the circumstances or environment in such a way to reduce the likelihood of a problem behavior occurring. For example: to prevent your child from breaking your favorite vase you move it up to a higher shelf out of reach.

I recently came across an antecedent intervention that helps with:

  • Reducing diaper smearing behaviors
  • Minimizing inappropriate touching
  • Preventing undressing behaviors

CBO Baby is a company that creates large size onesies and bodysuits that cater to the autistic community. These are particularly helpful for older kids since typically onesies are not made in their size. CBO Baby sells a variety of different styles and colors ranging from size 2T up to 7.

I have personally used a onesie strategy with a client to help reduce inappropriate touching behaviors and have seen how effective it can be. While antecedent strategies work best as part of a comprehensive approach, this particular intervention can make life a whole lot easier for stressed out parents.

If you visit CBO Baby use my promo code “ONION” to get free shipping or $6.99 off your purchase.

CBO

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Creating versus complaining…

24 Mar

A month or so ago I attended a behavior analysis conference for work. It was a 2 day event with presentations from various researchers, students, professors, scientists, and ABA providers. But my favorite presentation of the whole conference was one by Jodi and Jonathan Murphy of Geek Club Books. Jonathan is an adult with Aspergers who has a successful voice-over career and his mother, Jodi, created Geek Club Books as a way for Jonathan to share his stories. Their presentation focused on employment opportunities for adults with special needs.

What stood out to me about their presentation was their willingness to share their struggles without blaming their hardship on the rest of the world. There is a huge need for more employers to embrace special needs adults and provide well-paying opportunities to them. However, Jodi and Jonathan didn’t focus on the victimization of special needs adults. Rather, they focused on what to do about it. Jodi recognized a talent and a passion her son had and found a way to help make it a career for him.

So many people live with bitterness and resentment towards the world, claiming we “neuro-typicals” need to stop trying to help special needs people fit our mold and instead change our mold to fit them. While the ideals of accommodation and acceptance are perfectly reasonable and fair, I don’t find it realistic or appropriate to suggest a complete adaptation with blind tolerance. There are certain things that will never be acceptable, special needs or not. Aggression, indecent exposure, extremely disruptive or dangerous behavior…. just to name a few.

 

Instead of fighting so hard against “neuro-typicals” to demand complete and utter acceptance, without the intent to “change” people, why not collaborate on ways to make life easier and more pleasurable for those with special needs? The fact of the matter remains, to secure and maintain a job in this culture a person must have certain skills and must be able to refrain from certain behaviors. So I just can’t understand how someone helping a person gain those skills and reduce those behaviors (to help them get a job someday where they can earn a fair living and contribute their gifts to the world) is a bad thing.

And that’s what I loved about Jodi and Jonathan’s presentation. There was a clear recognition that although opportunities are limited, it is not beneficial to point the finger in anger, but rather to examine what can be done about it. Let’s focus on how we can strengthen skills, cultivate passions, and create opportunities, instead of just marinating on an “us” versus “them” mentality.

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Learning through play…

12 Oct

Children learn through play. This fact is well researched and supported across multiple disciplines (psychology, education, behavior analysis, etc). With that in mind, it stands to reason that a child’s development can be largely affected by their environment and what items or toys they have available to them. Disclaimer- this isn’t always the case. There are definitely children with access to every toy ever made and they still have significant delays in several areas. And there are also those kids who have next-to-nothing but develop perfectly fine.

But, what I find in my work as a developmental evaluator is that the children I assess often lack skills due to lack of opportunity. They don’t know how to use toys according to their function, they don’t know how to manipulate items, they don’t know how to pretend, they don’t sing along or copy dance motions… because they’ve never been given the chance to. Given exposure to various toys and interactions, many of these kids would easily acquire the skills. Enriching a child’s environment, through toys and through meaningful interactions, gives them the opportunity to learn. The skills they develop early on will have a significant impact on their functioning in other areas as they grow and mature. For example, a child’s ability to match colors helps them later to sort which leads to being able to organize things in their environment (groceries, laundry, dishes, work files, etc). A child being able to imitate simple motor movements leads to being able to imitate sounds and words, and later being able to monitor their social behavior depending on their environment (professional at work, relaxed at home, friendly at church, etc). Point being, there are a million ways that little toddler tasks are actually linked to higher-level thinking and daily living skills.

Here are some toys and activities I recommend to cultivate learning opportunities for little ones, pre-school age or younger.

Toys

  • Shape sorters
  • Ring stackers
  • Large piece board puzzles with shapes, animals, etc.
  • Cause and effects toys that light up, make music, or have ball ramps
  • Train sets or car ramps
  • Pretend kitchen, tool bench, vanity, etc.
  • Baby doll sets
  • Colorful picture books with pictures of everyday items
  • Blocks
  • Markers and crayons

Once you have the tools to promote learning, it’s also important to have a relationship that creates learning opportunities. Sadly, many kids rely on technology for entertainment and companionship, spending hours on end without any real social interaction. Television, iPads, and cell phones are one-sided and don’t allow children to truly interact with their environment or those around them. While cartoons or apps might be an easy distractor, they are generally empty and rob children of true learning opportunities. Parents have an important role in making sure their children engage with their environment. Here are some ways I recommend parents can stimulate their children through meaningful interactions.

  • Read books together– ask your child to point to various pictures, label items you see in the book, have him or her turn the pages
  • Play with toys together– demonstrate how to use toys, take turns, build things, act out daily life routines using pretend items
  • Sing songs together– do hand motions or facial expressions, let your child fill in some of the words (Wheels on the bus, Itsy-bitsy-spider, Head-Shoulders-Knees and Toes)

Combining the right materials with the right interactions sets children up for success. Access to age-appropriate toys and a parent’s ability to engage with their child are the key factors in maximizing a child’s learning opportunities and fostering healthy development. So take these tools and help your child learn though play.

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7 years

18 Sep

This past September 11th marked my 7th year working in behavior analysis. 7 years ago I got a job as a behavior therapist, as a part-time gig. I started with just 9 hours a week, school shadowing a little guy in a Jewish Temple. Then my client list grew, and so did my passion for the job.

And here I am now….certified, and in a Supervisory role overseeing teams of interventionists and dozens of clients. My company recently published my bio on their website, and it seems fitting to share it, as I celebrate my 7th anniversary in ABA.

BioPic

I didn’t set out to make this my life-long career. It started as something I could do that would help me learn more about the kind of therapy my brother was receiving. Then it blossomed into much more. It became my purpose to learn all I could in order to help my brother, and kids like him.

So, here’s to another 7 years, and hoping I learn even more to help those around me.

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Myth #2

5 Aug

Another theme I keep reading about from those who hate ABA is that it produces overly compliant people who are subject to all kinds of victimization because they have not been taught to say “no”. It “strips” people of their voice by insisting on compliance.

First, I’d like to say that where I work it is almost 100% guaranteed that my learners will have a refusal language goal. (The main exception to this is when the child already has a refusal language repertoire). In other words, one of the first things we work on with most of our learners is saying “no” or “stop” or “all done”. And when first targeting this goal, these requests are put on a Fixed Ratio 1 schedule of reinforcement (ie: they are reinforced every time).

Now, once this skill emerges we shift the reinforcement to something more variable. The child no longer gets to be “all done” every time they ask for it. Maybe instead they have to do 1 more task, then all done. And after that maybe they have to complete 2 more tasks, then all done, etc etc. The idea being that yes, it is important for a person to know they have a right to refuse things, especially the older they get. But, it is also important for them to know that sometimes you don’t get your way…and that’s okay.

I’ve read a lot of posts with people arguing that kids in ABA should ALWAYS have the right to refuse something.

saywhat

Now, before you start getting riled up that I’m opposing this idea…hear me out…

Do I think all people (autistic or not) deserve the right to refuse things that harm them? Absolutely.  And do I believe that some people have genuinely been injured (emotionally, physically, sexually) as a result of over-compliance? Absolutely.

But, do I think that kids in ABA should be able to say “no” to something just because they don’t like it, and it should be reinforced every time? No. I’m sorry, but no.

Typical kids don’t get to refuse things they don’t like, why would autistic kids have it any different?

Typical kids go to school, sit in their chairs, do their math worksheet, line up when the bell rings, etc. Typical kids have to make their bed,  wash their hands before dinner, eat their vegetables, share with their siblings, put away their toys, etc. They follow rules and when they choose not to, they face the repercussions.

That’s how the world works for adults, too…We all have to do things we don’t want to do! And, when we make the choice to NOT do those things, we face the ramifications.

If we taught autistic kids that saying “no” or “all done” ALWAYS got them what they wanted…would that really be beneficial to them? I challenge you to really ponder this.

I would say NO. A loud, resounding, NO! This is actually extremely detrimental to them.

If we instill the belief that THEY make all the rules, that they call all the shots, these kids will be in for a rude awakening when they enter a society where teachers, bosses, law enforcement, and government officials actually make the rules. Sure, the autistic person can always choose not to follow the rules…they can choose to refuse the rules…but they will face consequences.

Just think about how far-reaching this is.

Their diets, their self-hygiene, their education, their lifestyle, their housing, their ability to earn a living, their ability to form relationships.

What if they refuse to eat? What if they refuse to wait for the cross walk sign to change before walking into the street? What if they refuse to leave a place at closing time? What if they refuse to pay for something before walking out of the store with it? What if they refuse to keep their hands to themselves? What if they refuse to wear clothes? I could go on and on with examples!!

There are REAL LIFE consequences for refusing to comply… incarceration, financial penalties, health issues, and even death!

Teaching people to say “No” is an important skill and is vital for ensuring one’s self-defense and dignity. BUT, teaching people to comply with things they don’t necessarily like is equally vital. The balance is teaching when it’s okay to refuse and when the consequences of refusing outweigh the benefit. When I hear parents  say that being forced to do something the kid doesn’t want to do (ie: finish a task) is “abusive” and “strips” the child’s dignity or ability to be heard….I have to disagree. Teaching a child to do things he or she doesn’t want to do (ie: completing a task) is imperative for success in all aspects of life. While we want to make sure we are not creating blind compliance that may lead to being abused or taken advantage of, we also want to make sure our kids are prepared for a world that doesn’t revolve around them and their every desire. Teaching a person to accept this reality is one of the most loving things I can think of, because it sets realistic expectations and helps them navigate through this world we live in; a world with rules and regulations.

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Myth #1

4 Aug

Like I mentioned in my last post, I want to try to dispel some misconceptions people have about ABA.

One thing I keep reading, by parents who hate ABA and also those with autism who hate ABA, is this idea that ABA is for “autistic people”, and it treats them like machines, or like animals.

No, no, no. This could not be further from the truth. ABA is all around us! The principles of behavior are what make ALL of us operate.

If you have ever scratched an itch- you just employed negative reinforcement.

If you have ever been paid to do a job- you just received positive reinforcement.

If you have ever stretched your muscles- that was automatic reinforcement.

If you have ever gotten a speeding ticket- that’s positive punishment.

If you have ever been grounded or put on time out- that’s negative punishment.

Do you see what I mean?? The principles of behavior are constantly around us. All of our behavior is shaped by our environment. Everybody’s is!

When you’re driving in the rain, you turn the windshield wipers on.

When it’s hot and sunny, you put sunscreen on.

When it’s too loud, you cover your ears.

When you don’t feel well, you take medicine.

When you want to go on the internet, you turn your computer on.

Our behavior is a direct result of our environment. And, our environment includes our bodies as well.

The difference between what I’m talking about here and what people with autism experience is just a matter of intensity and structure. Okay, so not all of us have 2 hour sessions, 5 days a week, specifically carved out for ABA. But, the principles are the same. We are operating under the same concepts, constantly.

ABA is not something robotic or mechanical; at least it shouldn’t be. ABA sessions should be utilizing the person’s natural environment to have them come into contact with new contingencies. (ie: If I ask for “more”, I will get more cookie. If I scream and cry for more, I will not get more cookie). It can also be contriving their environment in order to come into contact with new contingencies. (ie: If the cookie jar is too high up I can ask for “help” and get help. If I bang on the cabinets over and over, I will not get help).

For those that hate the principles of behavior analysis….I challenge you to live a day without them. (Spoiler alert: It can’t be done.)

Perhaps it’s the just methods of a particular practitioner that you hate, in which case, I suggest you find a provider who better meets your needs. There are good clinicians out there. As Priority ABA says on their website, “When done correctly, ABA will maximize a child’s ability to express their own personality and preferences by teaching them the skills they need to communicate, play, and otherwise enjoy life.”

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Reality check….

2 Aug

This past week I was browsing around online….stumbled onto a blog (which will remain nameless)…and got a slap-in-the-face style reality check.

This blog, which is fairly popular, has an anti-ABA tone throughout it’s posts. The writer, a mother of an autistic boy, posts about how detrimental she thinks ABA can be. She believes ABA shames it’s learners, it is by nature a “dangerous” treatment and is harmful to those who receive it; she believes it damages a child’s ability to form relationships, it takes away their voice, it’s overall a very limited practice which ruins a parent’s view of their child, and it over-pathologizes children.

Wow.

What struck me most was that in all of her rants about how terrible ABA is, she didn’t at all express the benefits of ABA or the years of research showing it to be the most effective treatment for individuals with autism. No, she didn’t shed light on any of that. Instead, she put out messages of skepticism and fear, encouraging others to stay away from so-called experts and to question everyone and everything.

Call me naive, but I had no idea parents out there so hated what I do for a  living. I had no idea parents out there call my work dangerous, damaging, and harmful. It really took me down a notch to hear that not everyone thinks what I do is as great as I know it is. Sure, I have worked with plenty of parents who don’t think ABA works; who don’t think ABA is valid or something they’d like to commit to. But I have NEVER met a parent who flat out loathed ABA the way this parent does. People out there think my work is emotionally injuring their child? People out there believe my work is taking away their child’s voice? It’s ruining their perception of their child? What????!!!!!????

It’s really sad to me that any parent would choose to focus on the work of a few bad practitioners and thereby discredit the entire field altogether. Would any parent hold doctors to the same standard? If a doctor misdiagnosed, or couldn’t cure a disease, or gave the wrong prescription to his patients…would that mean that ALL doctors are bad? The entire medical profession is tainted? I don’t think so. So I wonder why this is the case with behavior analysis.

It’s also really sad to me because I know the kind of work I do. I know the way I think about and feel about my learners, and I know the ways I have helped them and their families. I know that I use ethical practices that ensure my client’s dignity. I know that I genuinely care, and that I see my clients as people, not as diagnoses.  It’s just a shame that some parents out there are so let-down by some people practicing ABA that they decide the whole science is destructive.

How can I change these parents’ minds? Why do I even feel like I need to? It’s funny, because I’m normally more of a “live and let live” type of girl. Opposing views don’t threaten me; I’m secure in my beliefs and don’t care if people disagree with me. I have no interest in debating people online, and can’t stand when bloggers pick fights that they’re “right” and someone else is “wrong”.  But right now, I find myself feeling very protective of my field. And, I guess I know why. Because I believe in ABA. I believe in it’s power to change lives. So, I feel responsible to untangle the myths and misconceptions about ABA. It’s interesting that this has stirred up in me a desire to defend my position, when I would normally let it roll right off my back. And, while I still respect that everyone has their own values and beliefs, and I would never pick fights or sling mud to be heard, I feel the need to spread the word about the incredible value of ABA. So… that’s my plan.  Stay tuned! I’m on a mission! 🙂

StayTuned

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1 in 50

21 Mar

Yep, you heard right. The CDC announced yesterday it’s new findings that show 1 in 50 school-age children have autism.

Naturally, articles instantly popped up about how this doesn’t really mean anything, the numbers are the same as they’ve always been. We’re just more “aware”. This article was my favorite: (<— sarcasm)

“You will probably see a lot of headlines about the 1 in 50. Some organizations might even try to use those numbers to scare people, to talk about an “epidemic” or a “tsunami.” But if you look at the numbers and the report itself, you’ll see that overall, the numbers of people born with autism aren’t necessarily increasing dramatically. It’s just that we’re getting better and better at counting them.”- Forbes.com

“We’re betting better and better at counting them”…??? Seriously!?

Are we as a society more “aware”. Of course. Are there probably some percentage of kids who are misdiagnosed and don’t actually have autism? Sure, the same is true of ANY diagnosis. But does that account for the ever-increasing autistic population? ABSOLUTELY NOT!

People LOVE to deny an increase and tell us we’re overreacting to these numbers. If the numbers aren’t increasing…prove it. Show me 1 in 50 sixty-year-old adults with autism.  You can’t! Because they don’t exist!

THAT is the research I’d love to see. If people are so sure that we’re just getting better at recognizing autism, then let’s look at the adults around us and see how many of them currently qualify for an autism diagnosis. How many ADULTS (ages 30, 40, 50, 60+) have autism? Let’s compare those numbers to the numbers we see today.

And for those parents out there who say they agree with this Forbes article, and don’t think there’s a real increase in autism…ask yourself these 2 simple questions:

How many autistic kids do I know?  How many autistic adults (ages 30+) do I know?

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Fluency

27 Feb

One of the presentations I attended last week was on the topic of Social Significance. Dr. Mary Jane Weiss, BCBA-D, discussed how we as behavior analysts need to make sure our goals are producing socially significant results. We should not teach skills for the sake of teaching them, but rather we need to be sure what we are teaching will be functional.

An interesting aspect of teaching skills of social significance is FLUENCY.

Fluency can be defined as a, “combination of accuracy plus speed […] that enables competent individuals to function efficiently and effectively in their natural environment.” (Binder, 1996)

Fluency is the true mastery of a skill. It is something retained, and that can be done in the face of distraction.

Think about it this way… when you’re riding a bike, you don’t have to focus on what step comes next to perform the skill. After practicing for a while, bike riding became a natural. You no longer needed to plan when to press down on the left pedal, when to press on the right pedal, how hard to turn the handle-bars. No, none of that requirs intense concentration. You can ride your bike while listening to music, talking with a friend, and watching for cars. It’s just fluid and natural.

So how does this relate to autism?

Imagine you have taught your son or daughter how to greet peers. They go to school, peer #1 says, “Hi Johnny!” 1 second….2 seconds….3 seconds….4 seconds….5 seconds… then your child responds, “Hi, Tommy!” A delay in greetings like that can be very detrimental to forming relationships, especially for young children! The child greeted back, so yes, it looks like they have mastered that skill. But the extended delay between the peer’s greeting and your child’s response was so long that by the time they did reply, the peer was already off saying hi to another child.

I have actually seen the above scenario play out many times. And, I have also seen what longer-term effects it has. The delayed child becomes labeled as “slow” or, “he doesn’t answer when I talk to him”. Peers lose interest if there is not immediate feedback. It can damage or even preclude friendships. And this is just one example of how fluency would be very important.

Imagine the skill of counting money to pay at a cash register, or getting your credit card out and swiping it…. or preparing a snack or meal…. how about showering or getting dressed…. washing your hands…. ordering off a menu…. coming over to someone when called…. All of these things are done relatively quickly and naturally for most of us. But the fluency of these skills has to be taught to many people with autism.

Mary Jane Weiss listed the following as Consequences of Dysfluency:

– missed social opportunities

– inability to keep up with the group

– difficulty being competitive in a job environment

So, I encourage everyone (parent or practitioner) to consider the importance of making kids FLUENT in their skills (as opposed to just “mastering” skills) so that they might have more, and better, social interactions and opportunities to thrive in future.

How do we do this? Same way you learned to ride a bike… practice. Give the child lots of opportunities to practice the skill. And as always, reinforcement is key to teaching any new behavior.

Premack Principle

9 Feb

I’m working with a mom who’s young son was recently diagnosed with autism. In helping her think of ways to help him eat protein, I mentioned the Premack Principle (based on David Premack’s research). I did my best to explain it to her, but I wanted to provide her with some type of handout on this strategy; a little cheat sheet perhaps. I searched online and found nothing of the sort. Some definitions and Wiki pages, sure. But no quick-guide to give to parents. So, I created one. Feel free to share with anyone you know who might find this helpful.  The awesome thing about this is that it can be used with people of all ages and abilities! (Click to enlarge)

PremackHANDOUT

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