Preparing For In Home ABA Therapy

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ABA Therapy hours were approved and you are ready to get started, YEY!! 🎉 You are probably asking yourself what you may need to do to get your home ready for sessions. Below you'll find a simple guide to setting up your home for success with in-home ABA therapy services.

1. House Rules: Let us know what your house rules are so that we may all may follow them (i.e. any cultural practices, no shoes inside the house, noise levels, etc).

   1. Access to your home: Letting your team know any areas that they can have access to. We love to teach in the child's natural environment and sometimes this may look like playing in the room with their favorite doll house, playing with chalk outside and teaching new skills like riding a bike around the neighborhood!

   1. YOU! We love when our parents are a part of our sessions. We love to teach in the moment when implementing any techniques or protocols and want to make sure you feel confident in them when we walk out.

      • Also note: You know your child best! If you notice your child may be doing something different than usual or may be having an "off day" (i.e. may be getting sick, didn't sleep well), let us know so that we may modify our activities for the day to best help them.

   2. Your child's favorite toys: We love incorporating your child's favorite items within our sessions and teach through play (see Natural Environment Teaching)!

   3. Table and chairs: Sometimes we will complete activities that require a table and chair (i.e. homework activities, teaching trials that require a flat surface, messy items like kinetic sand or slime that we'd like to keep in a contained area and not on your floor (you're welcome 😉)) (see Discrete Trial Teaching).

   4. Distracting Items and/or Activities: Blenders, vacuum cleaners, dump trucks, TV's & siblings! We love teaching in the home because we are able to work through some of the most common distractions however, there may be some that are TOO distracting and should be kept to a minimum when our therapist arrives. Our team will review these items with you and how we can work together to minimize or bring these into sessions.

   5. Code of Ethics: All therapists in an ABA therapy team have a Code of Ethics to abide by. We always recommend that our parents review this Code of Ethics and ask any questions to their child's case manager if any areas are violated. Parents are able to report any violations to the Behavior Analyst Certification Board.

      1. RBT Ethics Code

      2. BCaBA/BCBA Ethics Code

We encourage our families to observe our sessions and ask any questions you may have in the moment. Communication and commitment to our families are part of our values at AMA Behavioral Consulting and we want to ensure we share our knowledge in each step of the way.

We hope this list was helpful and if these services seem like a great fit for you, make sure to fill our contact form here.

Preparing for An Initial ABA Therapy Assessment

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An initial assessment is an opportunity for our team to get to know you and your child. There will be several events that take place during this initial session and we want to make sure you know what to expect! Below you'll find the main components of what to expect during an initial ABA Assessment:

Photo credit: B & E Photography

1. Caregiver interview: The very first thing we will do is complete some questionnaires about your family and your child. This will include discussing any family history of diagnosis, developmental milestone progression and delays and learning about any medications or allergies. This will also be a great opportunity to talk about any concerning areas (i.e. Your child is not communicating using vocal words OR does not respond to one-step directions). We also like to use this time to discuss any short or long term goals you have for your child and your family unit to include in our programming.

2. Informal and Direct Observation: While we (Behavior Analyst) are completing this questionnaire with you, we will be observing your child in their natural environment. This is a great opportunity to discreetly observe any behaviors you may have reported, your child's ability to request items or attention while you're busy and also observe the way that they play with their toys!

3. Direct Assessment of Skills: We will then begin testing some skills in the natural environment. Depending on the child's level, we may use a variety of toys (it will look like we are playing but we promise we are testing!). We may also use testing books that have pictures and/or words to assess your child's skill level. Some of the categories we will test for early learners using the VBMAPP as an example will include:

   1. Requesting: Your child's ability to ask for items or actions they want/need.

   2. Labeling: Your child's ability to label items when asked to do so.

   3. Receptive Skills: Your child's ability to follow instructions and selecting items when told do so.

   4. Visual Perceptual/Match-To-Sample Skills: Your child's ability to complete multiple step items like a puzzle, matching and sorting.

   5. Play Skills: During our entire assessment, we will be evaluating how your child plays. Does your child repeatedly play with items a certain way? Do they explore the types of toys we bring in for the session?

   6. Social Skills: Your child's ability to take turns, share their toys and even make eye contact when they want to gain our attention.

   7. Motor Imitation Skills: Your child's ability to imitate the actions we show them through direct or play presentations.

   8. Echoic Skills: Your child's ability to echo words and sounds that we present during the evaluation.

   9. Please note: This is an example of what we would test and does not include additional skills like the child's ability to respond to fill-ins, answer questions, or their ability to create new relations based on direct teaching. For older children, we may use other assessment tools and categories (like these above), to best help them at their developmental level. Our team will review what tools will be used for your child!

4. Assessment Write-Up: Once we are finished with the assessment, we will create an assessment write-up with a summary of your child's skill set, behaviors and goals for the next 6 months. We will also review, based on the assessment results, what we are recommending for hours and what sessions will look like. We will send you a copy and review everything listed to ensure that your goals for your child are in agreement with the goals we have selected.

5. Insurance Approval: The next step involves sending this report to your insurance company for approval. This can take anywhere from 2 weeks to up to a month (time varies by insurance). Once the therapy hours are approved, we will discuss scheduling and get ready to start services. For more information on how to prepare for in home ABA therapy, please read our article here.

We hope you found this article helpful and would love to know if this was helpful in the comments!!

Can ABA Help My Child with ADHD?

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Can ABA help your child with ADHD?

Research shows that ABA therapy is evidence-based therapy that can help other diagnoses including ADHD. Research shows that a combination of ABA therapy and medication can make significant changes in a child’s behavior. 

Oftentimes, we’ve worked with children who engage in behaviors that may seem “impulsive”, “off-task” and “disruptive” to others in their environment. From our experience, some of these behaviors typically have a reasoning as to why they're occurring. Sometimes the learner may be engaging in these behaviors because they cannot communicate their wants and needs. Sometimes these learners cannot concentrate on their tasks because they are distracted by something in their environment. Sometimes these learners don’t realize they are being disruptive with their actions to others around them. 

Step right up Applied Behavior Analysis (ABA)! What do we do in these types of situations? One of our primary goals in ABA is to provide our learners with the tools to help them advocate for themselves. We teach our learners to request for needs and wants appropriately instead of being impulsive and grabbing whatever they may need (be it materials or someone's attention).

We observe the learner in their natural environment and analyze the patterns of their behaviors. We conduct in depth analysis of their environment to determine what could be distracting them in times that they are off-task. We add tools to help them cope in environments that may be overstimulating to them. 

We provide our learners with tools to teach them recognize the behaviors they are engaging in and then help them correct this behavior (should it need to be corrected). One of our learners had a very challenging time completing tasks that involved more than 1 step (i.e. homework). We created a visual support to help with the completion of these steps. We then taught him self-management strategies to keep himself on track and complete these tasks from start to finish. An example of this program can be found below. We also taught this learner to track his “on-task” behavior using a vibrating timer at every 3 minute interval. When the timer went off, he had to evaluate his current actions and label if he was on or off task. Depending on the current action, he would either continue working OR redirect himself to the task he was supposed to be engaging in. This strategy was taken from Finn et al in 2014. 

In summary, ABA can be of immense help in helping your child with ADHD. Board Certified Behavior Analyst will evaluate your child’s current skill set, help create programs to help them develop the skills they need to communicate and teach any replacement or self-management behaviors to help them in the most challenging times of their day. Give us a call to learn more about how we can help! 

Resource: 

Finn, Lisa & Ramasamy, Rangasamy & Dukes, Charles & Scott, John. (2014). Using WatchMinder to Increase the On-Task Behavior of Students with Autism Spectrum Disorder. Journal of autism and developmental disorders. 45. 10.1007/s10803-014-2300-x. 

Therapies that help a child with an Autism Diagnosis...

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Your child has received a diagnosis and you are provided with a list of recommended therapies and acronyms you may have never heard of. Don’t worry! We are here to help! We hope that this blog can help you understand what each of these therapies mean and how they will benefit your child. 

1. Applied Behavior Analysis (ABA Therapy): Your child may have been referred to ABA or Applied Behavior Analysis therapy. Applied Behavior Analysis (ABA) is the application of the principles of learning and motivation from behavior analysis which produce socially significant changes through the analysis, observation, design, implementation and evaluation of past and current environmental events (antecedents and consequences). ABA therapy programs will help your child increase functional communication and language, attention, social skills, memory and academics. There is also an emphasis on decreasing any challenging behaviors that the child may exhibit by teaching the child self regulation or replacement behaviors. ABA therapy can be provided in a variety of settings including home, school, clinic, community and group home settings. ABA therapy is individualized for each child and their family. Opportunities for parent support and collaboration with other professionals who are working with the child are also a part of our treatment plans. - Amarilys Morales, M.S., Board Certified Behavior Analyst

2. Pediatric occupational therapy (OT) is focused on assisting children develop and enhance the skills that they require to grow and function throughout the various stages of development and into adulthood. Developmental delays, neurological impairments, physical impairment, and a host of other areas can hamper a child's ability to perform common tasks or progress at the developmentally expected level through the stages of motor, social, or cognitive development. Focus areas can include fine motor skills, visual motor skills, coordination, sensory integration, self-regulation, and strengthening to assist children with the ability to perform daily tasks and socialize at an age appropriate level. - Kathleen Pici, OTR/L, CAS

3. Pediatric Speech Therapy is specialized in developing and enhancing children’s ability to both express and understand verbal and written language. Various areas of focus include auditory processing, receptive language, expressive language, articulation, pragmatic skills, apraxia, dysfluency, and oral motor strengthening. In addition to communication skills, speech therapists can work on assisting a child that is experiencing feeding difficulties. Developmental delays, neurological impairments, as well as physical impairments can impact a child’s ability to produce language, understand language, and tolerate eating/swallowing age appropriate foods. - Kathleen Pici, OTR/L, CAS

4. Physical Therapy (PT) Children diagnosed with Autism Spectrum Disorder (ASD) exhibit motor impairments that include deficits in visual-motor and bilateral coordination, low tone, motor apraxia, toe walking and/or gross motor delays. Physical activity poses a challenge for those on the spectrum due to poor motor functioning, low motivation, and trouble engaging in a team environment. Children with ASD also have a higher incidence of obesity due to the movement difficulties that they face. Physical therapists have the ability to improve motor delay, increase social participation, and decrease developmental and daily functional obstacles that exist. Physical therapists treat gross motor delay by improving strength, gross motor skills, stability, stretching tight and underdeveloped musculature, and helping the child gain confidence in day-to-day activities and participation in sports. -Karly Zengel, PT, DPT

5. Licensed Psychologist: You may also be referred to a licensed school psychologist. Some licensed school psychologists also complete private psychoeducational evaluations. Psychoeducational assessments are completed for a variety of purposes, including eligibility determination for special education and related services, evaluation of progress, and the development of appropriate behavioral and/or educational interventions. Evaluations may include assessment of domains including, but not limited to: intellectual, academic, cognitive processing, adaptive, and social/emotional development. These results can be shared with the schools to assist in determining the need for a 504 Plan, Individual Education Plan (IEP), or College Board exam accommodation. Some licensed school psychologist may also assess for Learning Disabilities (dyslexia, dysgraphia, dyscalculia), academically gifted program (AGP), Autism Spectrum Disorder (ASD), Attention Deficit/Hyperactivity Disorder (ADHD), and more. Licensed school psychologists help to find a child's strengths and weaknesses so you can walk away with a clear path to what they can do to help your child. The testing will provide concrete strategies and recommendations on what to do next  to help your child become more successful at school and home. -Stacy Zebrick, Licensed School Psychologist

As you can see, each professional and field has skills to help your child be successful in various areas. When providers collaborate with each other, we see the most significant differences in our children. We also always encourage our families to read about evidence-based practices that are available to your child as these will make the most significant differences. A special THANK YOU TO our wonderful community partners for sharing what they do with our readers!

Should you have any questions or would like to receive a copy of our referral list for Hillsborough County, please contact us!

5 Things To Do After Receiving an Autism Diagnosis

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As a parent, receiving the news that your child has been diagnosed with Autism Spectrum comes with a whirlwind of emotions and questions. Depending on the level on which your child was diagnosed, difficulties may follow. As you may have read, there is no “cure” for Autism. However, you are your child’s number 1 advocate and you will be able to fight for what your child needs. What follows are a few recommendations of things to do after your child has received an Autism Spectrum Disorder diagnosis: 

1. Evidence-Based Practices. Researching evidence based practices will be very important to ensure your child’s success. Evidence based practices have been heavily studied, researched and replicated. The National Autism Professional Development Center on Autism Spectrum Disorder provides a great list of evidence based practices you can see here.

2. Therapy Services. Your child may need additional support that your pediatrician/neurologist and/or psychologist may have recommended. Service providers will specialize in areas like speech development and communication, behavioral health, mental health, physical therapy and additional school services. We will be writing a blog post soon to discuss each of these service professionals and the incredible services they provide. 

3. Books. We often learn from other’s experiences. There are several books that we love and recommend to start the journey. Here are some of our favorite books: Parenting with ABA (Leanne Page, BCBA does an incredible job discussing behavioral concepts that you can implement with your child), The Verbal Behavior Approach (Dr. Mary Lynch Barbera discusses Verbal Behavior and how to implement it with your child) and last but not least the book we are currently reading Differently Wired (by Deborah Reber who discusses how to overcome the challenges in raising an neuroatypical child). 

4. Parent/Caregiver Support Groups. We have joined several support groups to help parents and caregivers. In these groups, we often see families come together and help support each other when they need advice, recommendations and support. Some of the groups in Hillsborough County include: Special Needs Community Resources of Pasco County- Florida, Southshore Special Needs Support, Families with Special Needs Kids-Tampa Bay. 

5. Additional Resources. There are several pages that provide additional resources from initial diagnosis to transitioning to adulthood. Some of our favorites are: 

   1. Autism Speaks

   2. Associations for Science in Autism Treatment

   3. First Words Project

   4. National Autism Association

Remember, this is a time where your child needs you at your best. Be open to new techniques that may be suggested by your service providers. The journey will not be easy but your child needs you in their corner to celebrate each milestone and help them reach their full potential. Teach your child that they have a voice and their voice matters regardless of their diagnosis. Your child deserves respect, dignity and deserves to receive what they need to be successful. This is not an easy feat but YOU (mom, dad, grandma, grandpa, foster parent) are here to help your child be the best they can be and we believe in you!

Teaching Your Child To Be More Independent

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Teaching activities of daily living are one of my favorite areas to teach as a behavior analyst. With each daily living skill I teach, I am able to provide each learner with a skill that they will be able to perform for the rest of their lives. We are able to teach a range of daily living skills from riding a bike, to getting dressed, to learning how to dial a caregivers phone number to making food for themselves.

As behavior analyst, we individualize our teaching procedures for each of our learners. We will talk about the three primary ways we teach a long list of steps like teaching activities of daily living. 

Selecting a teaching technique varies greatly by the learner. It is important to consider the following: 

1. How many steps does the learner already know?

2. Will the child need to access to reinforcement quickly (i.e. a break, praise, etc)?

3. How strong are the child’s motor skills (as this will influence how much prompting will be required)?

The first technique is forward chaining. In forward chaining, we teach each learner to complete the very first step of the task and help them through the rest of the steps in the task. Once the first step has been acquired, the second step is taught. When the second step is acquired, the third step is taught and so on. For example, when teaching a child to comb their hair, the first step would be to teach him/her to pick up the hair brush and prompt through the rest of the steps. Once the child has acquired picking up the hair brush on their own, we would then require the learner to pick up the brush (step 1) and place the brush on their head (step 2) and so on until we are able to require them to complete the entire task. 

The second technique is backward chaining. In backward chaining we only require the learner to complete the final step of the task. Similar to forward chaining the learner is taught one step at a time and then required to complete the acquired step and the previous step in the routine. When teaching shoe tying, the learner would be helped through the entire task and then required to complete the last step (i.e. pulling the loops to complete the tie). Once this final step is mastered, the learner would be required to make the loops and also pull the loops to complete the tie. The same sequence would continue until the learner knows all of the steps.

The final technique used is called total task chaining. In this technique the learner is taught the entire task receiving assistance as needed. This technique is great to use if the learner already knows some of the steps and may only need a little assistance. When teaching to make a PB and J sandwich, the learner may know how to gather the ingredients to make the sandwich but may need assistance with spreading the peanut butter and jelly and putting the ingredients away. In this example, the person assisting would refrain from prompting the learner in the areas they know and assist in the steps the learner has not yet acquired. 

Our learner in this video, learned to complete his shoe tying task using forward chaining in which we taught the first steps of the chain and continued to add on to the task as he acquired the steps. In a very short period of time, our lovely guy was asking for the rest of the steps to complete the task on his own! We are so proud of him! You may also be able to hear his brother providing him with positive reinforcement by cheering him on!

Graphed through Central Reach

What is Applied Behavior Analysis (ABA)?

 

What is Applied Behavior Analysis? Applied behavior analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior (Baer, Wolf & Risley, 1968; Sulzer-Azaroff & Mayer, 1991).             

 

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ABA methods are used to support persons with autism in at least six ways:

1. to increase behaviors (eg reinforcement procedures increase on-task behavior, or social interactions);

2. to teach new skills (eg, systematic instruction and reinforcement procedures teach functional life skills, communication skills, or social skills);

3. to maintain behaviors (eg, teaching self control and self-monitoring procedures to maintain and generalize job-related social skills);

4. to generalize or to transfer behavior from one situation or response to another (eg, from completing assignments in the resource room to performing as well in the mainstream classroom);

5. to restrict or narrow conditions under which interfering behaviors occur (eg, modifying the learning environment); and

6. to reduce interfering behaviors (eg, self injury or stereotypy).

Source: Center for Autism and Related Disorders

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Is Applied Behavior Analysis ONLY for children with Autism? Absolutely not! ABA is a science that when implemented correctly is beneficial for all children and adults with or without a diagnosis. Recent research continues to be developed in the areas of health and fitness, organization behavior management, substance abuse and addiction and education.  

Who provides Applied Behavior Analysis services? Services can be provided by a Board Certified Behavior Behavior Analyst-Doctoral (BCBA-D) or a Board Certified Behavior Behavior Analyst (BCBA) : a doctoral or master’s level clinician who has passed the Behavior Analyst Certification Board Exam. Services can also be provided by a Board Certified assistant Behavior Analyst (BCaBA) who is a bachelor’s level clinician often accruing their hours to become a BCBA overseen by a BCBA. A registered behavior technician (RBT) can also provide services while being overseen by a BCBA. Individuals at the RBT level have also passed a certification exam by the Behavior Analyst Certification Board. For more information regarding credentialing requirements, see https://www.bacb.com/.