Teaching Your Child/Adult to Tolerate Wearing a Mask

Read time: 5 minutes

For some of our children/adults, clothing in general may present discomfort. With the pandemic we are facing today, it may be necessary for your child or adult to wear a mask while out in public. In this article we will teach you 5 steps to help your child/adult tolerate wearing a mask while out in public. 

1. Allow the child/adult to become familiar with the mask by playing with it, modeling how it is used on a favorite stuffed animal or on yourself. We want our child/adult to know that there is nothing scary about the mask! 

2. As part of the teaching process, we can use a social story if the child/adult understands the concept. We would not solely suggest this as the only method but it may be helpful if the child/adult understands the information being provided. A link to a social story about wearing masks can be found here: Wearing a Mask Social Story

3. When the child/adult has become more familiar with the mask, begin requiring that the child/adult wear the mask and time how long they are able to tolerate it. This will be our starting point! If the child/adult takes it off after 1 minute, we may need to start at 45 seconds and provide praise and lots of reinforcement once you hit 45 seconds when you practice. 

4. We will then start increasing the time required to wear the mask. If we had 3 successful times of tolerating the mask at 45 seconds, we can then move onto 1 minute, then 3 minutes, then 5 minutes, then 10 minutes and so on while doing other things at the same time (i.e. reading a book, playing with blocks, going for a walk). Our mission is to increase the time gradually and successfully while making the process for the child/adult less aversive. This is a procedure we call shaping. Think of it as creating the shape of a clay bowl: we must work on the small steps over and over again until we can achieve our biggest goal.  

5. The next step will be to test in the natural environment. Take your child/adult to a place where a mask may be required (i.e. grocery store). Remind the child/adult of the expectations before arriving and remind them of what was practiced at home. If the child/adult does not tolerate the mask in a public place, we may need to take a few steps back and test again to see where we need to work on and try again. 

Additional COVID-19 social stories: Autism Little Learners

We hope these steps are useful to you in these times! If you have any questions, please email me at amarilys@amabehavioralconsulting.com

Preparing for a Visit to the Dentist

Read time: 5 minutes

Who likes going to dentist? The dentist for me up is not my favorite place to be. When one of our parents asked for tips on how to make this process a bit easier for our learner, I immediately jumped into action. Here are some of the things we did to get ready for our big trip:

1. Created a social story on the steps that would take place for our visit. I contacted the dentist office and asked about each step and the expectations of the child. I took pictures from their page and created a social story with visuals of what the office and equipment the child would come in contact with would look like.  See the video of our social story below!

2. Practice! During our sessions we practiced by playing with similar items so that the child could become familiar with some of the steps. We used Play-Doh dentist set as well as took our own set of X-Rays using the X-Ray Scanner Teeth App to portray the steps that needed to be taken in a visit. 

3. Last but not least, during our one on one direct therapy sessions, we practiced different instructions like “Open your mouth” “Stick your tongue out” and even “Stand as still as a soldier” to prepare the child with some of the instructions they may hear as well as the expected behaviors. If the child did not know what behavior was expected, I showed him how to do it and we practiced together! 

4. During these steps, our learner was provided with lots of praise and positive experiences so that the transition to the actual office would be as flawless as possible. 

Playdoh Dentist Set

Although our learner had difficulty with some of the steps in the actual office visit, he was able to complete the cleaning and we are calling it a success! The visual schedule truly helped with the process of knowing what was coming next and he was able to see the tools we played with in real life. I would love to thank the staff at Happy Family Dental Group in Brandon, Florida for their patience, understanding and their willingness to provide materials and information before our visit! 

Top 10 Questions to ask your ABA Provider…. ANSWERED!!

1. What kind of oversight will the direct staff have? All direct care staff (RBT’s, BCaBA’s and BCBA’s) will be overseen on a weekly basis to ensure treatment fidelity of programming and continued learner success.

2. Do you have team meetings? Yes, we have monthly team meetings in which we review our learners successes and difficulties, learn new concepts/review research in the field and work on team building activities! 

3. How is data collected and graphed? Our data is collected and graphed on a daily basis via our online platform: Central Reach. The lead analyst reviews this data on a weekly basis to ensure that our learners do not need additional modifications and continue to make significant progress. 

4. What kind of parent support is offered? What will this look like? Parent support is an extremely important portion of our therapy! We believe that all skills worked on should be generalized to the natural environment and with the caregivers involved with our learners. Parent support is offered with the lead analyst and usually follows the behavior skills training model: Instructions are presented, the analyst performs the skill, the analyst and caregiver rehearse the skill and then the caregiver receives feedback implementing the skill. Instructions are modified per family structure. We will always make accommodations on what works best for your family! 

5. Can we do community outings? ABSOLUTELY! We go where you may need us the most. Community outings lets us put the skills we are working on to the test in the natural environment. 

6. Do you coordinate with other service providers (e.g., school, OT, speech)? Collaboration is KEY! We love to collaborate with other service providers to incorporate whatever skills they want us to incorporate and vice versa. 

7. What kind of teaching will be involved in my child’s program? We incorporate both Discrete Trial Instruction and Natural Environment Teaching. Click on the links for additional information. 

8. How are the goals developed? Goals are developed using various methods. We will conduct an initial assessment to test the learner’s skillset, observe them in the natural environment and conduct a series of interviews with caregivers. Based on these results, we will develop goals for our learners to meet in the next 6 months. We will review with caregivers to ensure they are in accordance with these goals. 

9. What will be in my child’s behavior intervention plan? We will include antecedent manipulations, consequences and replacement behaviors for maladaptive behaviors. 

10. What services are available to my child? We offer one-on-one direct intervention, parent support services, school consultation, behavior based feeding therapy, and toilet training. 

11. Ok so there was 11: Do you have social skills groups? At the moment, we do not. BUT stay tuned for future planning!

Teaching Your Child To Be More Independent

Read Time: 5 minutes

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

Behavior: The Good, The Bad, and the Ugly

Read Time: 5 Minutes

As described by Cooper, Heron and Heward (2007), behavior is anything an organism does and their effect on their environment. The saying goes “If a dead man can do it, then it is not behavior.”

As adults, we engage in different types of behaviors for different outcomes:

• If I call my doctor’s office →  they will schedule my appointment

• If I pay someone to take a test for me →  I don’t have to study

• If I get a massage → it will make me feel relaxed

• If I continue to call my ex-boyfriend → he will eventually pick up

Kids do the same thing:

• If I ask for a cookie nicely → I will get the cookie

• If I scream →  I won’t have to do my homework

• If I spin quickly →  my head feels funny

• If I scream for my mom when she’s on the phone → she will hang up

What do these scenarios have in common? A behavior usually has 3 things in common: an antecedent (something that happens before the behavior), the behavior itself, and the consequence (what happens after the behavior).

Why do these behaviors occur? Adult or child, usually our behavior occurs for one or combined reasons. The first reason is to get access to attention. This may be positive or negative attention but in the end we classify it all as attention. A child who constantly yells “mom” while she’s on the phone has learned that by calling her name, she will provide the attention he/she desires. The second reason that could be behind a behavior is to escape from a task. In the example above, the child has learned that by screaming, he/she will eventually get out of doing their homework. The third reason a behavior may occur is to gain access to items. We often see this example on the playground. A child may learn that if they push another child, the child will give them their turn or toy. The last reason a behavior may occur is because it simply feels good. My favorite example is of myself! Whenever I begin to get nervous, I begin to twirl my curls with my fingers because it feels calming to me.

Why do these behaviors continue to occur? These behaviors continue to occur if they result in the same desired outcomes. For example, if the mom no longer acknowledges the screaming child when she’s on the phone, he/she will attempt other behaviors to gain her attention. If a child no longer gets his way from pushing his peers, this behavior will decrease.

Our following blog will review how to teach appropriate behaviors while working on decreasing undesired behaviors!  

Resources:
Cooper J.O, Heron T.E, Heward W.L. Applied behavior analysis (2nd ed.) Upper Saddle River, NJ: Pearson; 2007.

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/.

Tips for a Visit to the Eye Doctor

Going to visit a "doctor" of any type, can result in a series of behaviors even for us as adults. Today's blog will review tips on how to best prepare your child for a visit to the eye doctor.

1. Prepare your child for what they will encounter: Showing your child what they are likely to experience before the visit will assist your child in becoming more familiar with the visit (i.e. showing pictures of the doctor's office, the doctor, the tools they may use, etc.). Some offices now have virtual tours so they can view exactly what they will see on the visit!
2. Practice what the doctor will ask of them: The doctor may ask your child to cover one eye and then ask to cover the other. As a parent, we can show our child what this looks like (modeling) and then have the child practice while providing positive feedback.
3. Practice labeling items/compare and contrast: Usually, the doctor will ask that the child label items, letters or numbers. They will also ask the child to compare and contrast when looking through the lens. Using the steps in #2, we can practice doing so with these items. If your child cannot label things such as numbers and letters, inform the doctor as they have various tools to help! 
4. Relax: Sometimes as parents, we are more worried about our child's reaction than they are. Remember to not scare the child by saying everything that can go wrong but by explaining to them why it's important to visit the eye doctor and how fun it will be!

Thanks to Dr. Knighton at Bright Eyes Kids and Dr. Laura Vizzari at Vision Source for your suggestions!