Archive for October, 2011

We try to review a research article each week. Because we were both recently at the Autism Research Institute (ARI) conference, we picked a research article related to one of our presentations: sleep–or the lack thereof. We are not talking about OUR lack of sleep (there is not much sleeping going on out here), we are talking about sleep issues for children with autism.

Missy was lucky enough to present alongside Dr. Rosignol. He presented on the medical aspects of treating sleep and she presented on the behavioral aspects of sleep programs.

Thus, we are going to review his recent article on the use of melatonin to aid with sleep for children with autism. He co-authored the article with Dr. Richard Frye. The article was published in Developmental Medicine and Child Neurology in April, 2011. The authors set out to review the research on the use of melatonin for children with autism. The authors conducted a meta-analysis which is simply analyzing the results from a group of studies to determine if a consistent outcome was observed.

A total of 35 studies were included in the review. However, the meta-analysis (statistical analysis) was performed on five studies which were considered to be highly experimental. Specifically, the five studies included random assignment to treatment groups, the use of double-blind procedures (which means the researchers and the participants were blind to treatment groups), and treatment groups received treatment or a placebo.

The authors reported some very interesting results across the studies. First 9 studies individually reported that melatonin or its metabolites were abnormal for the children with autism in the studies. Seven additional studies reported that the melatonin (or its derivates) levels were below average for participants. Five studies reported gene abnomalities that could have contributed to the decreased melatonin production.

In terms of outcomes following melatonin supplement use, the authors reported that six studies indicated improved daytime behavior following melatonin use. Eighteen studies reported improvements in “sleep duration, sleep onset latency, and night-time awakenings.The authors went on to report large effect sizes (which means that the studies consistently showed positive outcomes) for increases in sleep duration. However, there were no significant findings related to nighttime awakenings. Additionally, side effects were reportedly minimal to none.

In summary, many children with autism present with sleep difficulties including later onset, shorter duration of sleep, and frequent night awakenings. This meta-analysis showed that children with autism may have a lower level of melatonin or they may have an underlying condition that affects melatonin production. However, the use of melatonin as a supplement improved the overall duration of sleep for children. Additional studies are needed to determine how to address frequent awakenings during the night.

We want to know, does your child have sleep issues? What are they? Have you tried melatonin? Was it effective?

If you have a research topic that you would like for us to review, please let us know.

Happy sleeping!

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Hi and welcome to “What Works Wednesdays” where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be.

We are often asked,”At what age should we begin behavioral feeding therapy?” Our reply is a consistent one: sooner is better than later. However, please do not take that to mean that if your child is older, that behavioral feeding therapy will not work for him/her. We have helped several children over the age of 10 learn to eat new foods and overcome their picky eating. So, today, we thought we would highlight the positive outcomes of one such case.

We want you to meet a teenager named “Alex”. Alex was much like any other teen. He wanted to get his driver’s license. He was tall and lanky and he liked typical teen food such as pizza and he also over-salted all of his food. On top of being a teenager, he was also diagnosed with autism spectrum disorder (ASD) and he suffered from a long history of gastrointestinal (GI) disease.

His mother contacted us because she wanted him to learn how to follow the gluten-free, casein-free (GFCF) diet that was prescribed as part of the treatment for his GI condition. We were happy to teach Alex how to eat. It worked to our advantage that Alex was also studying nutrition at school. He was learning about the food groups and how it is important to eat a healthy, balanced diet.

As part of the planning process, we developed a social story for Alex so that he could better understand the importance of learning to eat a healthy, balanced GFCF diet. In the social story, we showed Alex how each type of food helped his body and we tied it back to his lessons in nutrition at school. For example, protein helps build big muscles. We used this image:

We ended the social story by explaining to Alex that learning to eat healthy will also help his brain so that he could study for his driver’s test. And finally, we added the winning argument that girls would more likely be interested in guys that eat right and have healthy brains and bodies.

We would be lying if we said that behavioral feeding therapy is easy. For 90% or more of our clients, the first day or two of therapy is hard. The children are mad because they want to eat the foods they are comfortable with. They are scared of new foods and when they are asked to try new foods, it causes reactions. Most children use their words to explain their feelings while others use their behaviors.

After Alex got over his difficult days, he took off. We attribute much of his success to his mother. She used games on the iPad as an incentive to eating. She told him, “If you eat your _____, I will buy you _______ for your iPad.” Most games on the iPad can be purchased for under $1.00 so this was a cheap incentive. Additionally, this helped associate food with something positive. Before long, Alex was developing new favorite foods such as rice and mixed vegetables.

Teaching teens to make healthy food choices independently is important because we cannot be with them at every meal. If we teach them the skills to choose a food from each food group, we increase the likelihood that they will make good choices. Teaching teens that healthy food also tastes good, is another  important step. It only took 4 days for Alex to learn to try and like new, healthy foods. I wonder how he is doing on that driver’s license test?

Another mom talks about her child’s success here (and we’re not just highlighting this case because she thinks we are awesome–they both did a great job in overcoming this difficult issue).

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We just returned from the ARI conference in Las Vegas hosted by the Autism Research Institute. We were able to meet many people, parents and practitioners alike.

We feel that this conference is must for families who are learning to treat their child’s autism. If you could not make it to Las Vegas, consider attending the spring conference which will be held in Newark, NJ.

Attendees at the conference are able to attend a variety of lectures from experts in nutrition, medicine, and educational programming. In addition to lectures, participants may also drop in on demo room sessions where the experts show you how to do a particular technique. The demo room this year included, among others, tips from us on how to teach your child to swallow pills. Email us if you would like a copy of the brief handout that we provided.

Attendees are also able to visit the booths of many exhibitors including Talk About Curing Autism (TACA) and Kirkman Labs.

Lunch is provided on site allowing participants time to network, mingle, and speak intimately with presenters.

We were also very lucky to meet Alex Plank, Kirsten Lindsmith, and Jack Robison who were filming for Autism Talk TV. These young adults all have a formal diagnosis of autism spectrum disorders (ASD). They participate in the website Wrong Planet and they have proven that individuals with ASD can live a full and productive life.

We always feel renewed after such a great conference experience. We want to hear from you. Did you attend the conference? What was your favorite part?

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Hi and welcome to Ask Missy Mondays where I respond to email questions from parents who are having difficulty with their child’s behavior. Today’s question comes from Angela, who is a college professor.

“Hi, I am a faculty member at a public university and I am being verbally abused (e.g., why are you such an f*ing b%^#) by a student with Asperger’s. Many of these interactions occur in my office when he comes in for office hours. Additionally, there is a past history of this student acting in a threatening manner by getting mad and throwing furniture. I called the University’s hotline and was told that this is normal for someone with Asperger’s. What do you recommend?

Angela, this is a great question! While this post may not apply to everyone reading this blog, parents of young adults with Asperger’s and teachers of high school students with Asperger’s should all pay attention. We have a responsibility to teach this young man (and others like him) that these types of behaviors are simply unacceptable and will not be tolerated in an academic setting. It is inappropriate to behave in this way towards anyone, but especially inappropriate to do so to a professor.
First, I don’t think you should call the University hotline. I think you should go straight to Student Services and report your concern. Every University has an office for students with disabilities. These offices provide support for college students with identified disabilities. The office at your University needs to be informed of this behavior so that it will documented in the student’s file. The staff in that office should be able to help him with his  behavior.
If staff in the office do not know how to help the student with his behavior,  then staff should contact faculty in the University who are also behavior analysts. The faculty may be housed in the Psychology Department, Special Education Department, Curriculum and Instruction Department, or Educational Psychology Department. If there are no faculty on campus to assist, then contact a local behavior analyst (BCBA or BCaBA) in your area. You may find a behavior analyst in your area by visiting the website for the Behavior Analyst Certification Board. Look up a certificant by zip code and contact them directly from the website.
The second thing I would do is contact the student’s advisor directly. You will find the advisor by contacting the Dean’s Office within his home college. When you make your call, be sure to mention previous cases where students threatened people (not just faculty) and then ultimately ended up hurting someone (e.g., Gabby Giffords).
While the student has Asperger’s syndrome, and explosive behavior is common in this population, as a faculty member, you should be concerned. The student should not be allowed to participate in courses if he is not following the University policy.

Thanks Angela, keep me posted.

If you have a behavior or situation that you need assistance on, please email me at askmissy at applied behavioral strategies dot-com.

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I want to start off by saying that I will not write about accidentally changing places with one of the children in this house. But rather, I am writing to say there is nothing more freakish to a behavior analyst that when members of her own family engage in challenging behavior. And since it’s Friday, well, I’ll just call this post Freaky Friday.

Behavior analysts, by nature, change behavior. We tweak variables in the environment and then we watch to see how behavior changes as a result of those tweaks. Another interesting thing about behavior analysts is that we take pride in knowing that our procedures work. We proudly show off our graphs as an indicator of success. There is nothing more geeky than the Annual Convention where thousands of behavior analysts gather to show their data. What we do works.

Well, what we do works most of the time. Sometimes behavior gets worse before it gets better. Sometimes behavior gets better slowly. No matter how good a behavior analyst professes to be, all behavior cannot be controlled. “What!” you scream in surprise, “All behavior cannot be controlled?!?!” Sadly, it is true. I must confess that behavior is influenced by a number of variables that are, at times, out of the behavior analysts’ control. Let’s take the weather as an example. We can teach children to engage in a behavior day after day for many days. However, the weather can come along and change the behavior in an instant. Each day we teach Johnny to tie his shoes. Day after day he gets his sneakers, puts them on, and ties them. What an accomplishment! Then BAM! It’s raining and now Johnny needs to wear different shoes. While we taught Johnny to put his shoes on successfully, we only taught him to do it with one pair of shoes. We should have taught him to put on all types of shoes so that when it is raining, he can put on his rain boots.

The same thing holds true for behaviorists and their our families. While we teach our family members to engage in the right behaviors as often as possible, other things come along and impact the behavior. Lack of sleep, illnesses, medications, and peer reactions also impact behavior. Take all of those things and add them to a family situation simultaneously and you get a chaotic Freaky Friday (or whatever day of the week it happens to be). You see, behavior happens. And more often than not, it happens when we want it least.

  • When you are shopping in Costco and your child is crying because she doesn’t want to wear a long sleeve shirt under her coat this winter
  • When you are trying to park to get to a medical appointment (for which you are already) and there are 10 cars in line to park and the sibling with autism starts screaming because he does not like to sit still in a car
  • When you are at a restaurant and your child is crying because she does not want to eat her vegetables and everyone in the restaurant is looking
  • When you are trying to catch the bus and there is a meltdown about how to wear the hair that day
  • When ________________________________________ (you fill in the blank yourself)

Because behavior happens when you least expect it, here are a few tips to avoid your own Freaky Friday:

  1. Stay calm. No matter how bad the behavior or situation seems, stay calm. If you lose your cool, it could cause the behavior to escalate.
  2. Use a calm voice. Easier said than done but your voice can set the tone for subsequent behaviors. Be cool.
  3. Walk away. Sometimes, it is easier to just walk away from the behavior. You do not have to have the last word. You are the adult, aren’t you?
  4. Take a deep breath. Repeat (as often as necessary).
  5. Laugh when it is over and when your child is out of earshot. Repeat.

Enjoy your weekend! Whatever freaky behavior it may bring.

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We try to review a research article each week. Because we are both in Las Vegas this week for the Autism Research Institute (ARI) conference, we picked a research article related to one of our presentations: sleep–or the lack thereof. We are not talking about OUR lack of sleep (there is not much sleeping going on out here), we are talking about sleep issues for children with autism.

As if having a child with autism isn’t stressful enough, the condition brings along many other issues as well. For example, many children with autism also have gastrointestinal (GI) issues. Many children with autism also have feeding problems. And if those don’t wreak havoc on a family, try having all of that plus a child who won’t sleep.

Sleeping issues may be brought on by a number of variables including medical issues. Before trying any sleeping program with your child, be sure to rule out any underlying medical issue that may be affecting the sleep disorder. For example, some antibiotics cause insomnia. If your child is taking antibiotics, the medication could be causing the sleep issue.

Some environmental factors may be contributing to the sleep dysfunction. And that is the topic of today’s research review. The study we will review is titled, “Does television viewing cause delayed and/or irregular sleep–wake patterns?” The study authors are Asaoka, Fukuda, Tsutsui, and Yamazaki. The study was published in the Journal of Sleep and Biological Rhythms in 2007.

I like this study because they did not focus on participants with disabilities. Instead, they studied people from the random population. Eight participants were college age and the other eight were elderly. The researchers studied the participants for 2 weeks while the participants wore a wrist recorder and they self-recorded notes about their activities. The first week of the study, the researchers asked the participants to behave normally. The second week of the study, the researchers limited television watching to just 30 minutes per day.

The researchers reported that for elderly participants, their sleep-awake patterns did not change. However, for the college-age participants, sleep increased significantly. The researchers noted that while the sleep for elderly participants did not change, the motor movements at 1am decreased when television was limited and the researchers associated that with the decrease in television.

The researchers noted that “previous studies have revealed that exciting video display terminal tasks with a bright display suppresses the concentration of melatonin” which is definitely related to sleep. They also discussed the association with increasing body temperature and increased sleep so they stressed the importance of an evening bath.

In summary, if your child is having difficulty sleeping, we suggest that you cut out television, iPad, and video games at least 2 hours before bed time. Instead, use that time to settle in to a comfortable bedtime routine of bathing, reading, and family time.

Happy Sleeping!


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Hi and welcome to “What Works Wednesdays” where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the client and family. Our intent is to show readers how successful ABA can be.

Recently, we have been sharing success stories from our feeding clinic. Today, we are going to discuss a success story about using ABA to teach toilet training. We want you to meet Christopher. Christopher is an adorable little 2.5 year old. He has curly hair, talks up a storm, and he is ALL boy! He loves to run around the yard, drive his trucks, and wrestle. He does not have a disability of any sort.

His mother approached us in August because it was time to move up in the preschool. Christopher wouldn’t be turning 3 until November but the toddlers were moving up to the three-year old class. Christopher could not move up until he was toilet trained. His mother did not want to hold him back with the toddlers. How was she going to get him toilet trained in less than a month?

“That is easy!” We told her. “You can train him in a weekend.” She did not believe us. So, we sent her the toilet training protocol with instructions on how to teach toileting skills.

For toilet training, we approach it in several steps. First, diapers and pull ups must go. Throw a party and throw them away. Well, do not throw them all away because you will still need them for overnight. Diapers and pull ups keep children dry. Children need to feel wet if they have an accident. The discomfort of being wet is often all that is needed to stop future accidents.

Second, go out and buy fun underwear or panties. Take care to have your child help you pick them out. Christopher loved Transformers so they bought him some great underpants. Celebrate growing up and moving on to “big boy” or “big girl” underpants.

Third, plan the weekend where it will happen. While this can be done in one day, for some children it may take 2-3 days to fully get the routine down. We recommend that families select a holiday weekend to ensure success before going back to work and school.

Fourth, identify a fun reinforcer or reward that will be used ONLY when success is achieved on the toilet. This can be a book, food, movie, or other preferred object. You may also find it helpful to use a sticker chart to show successes.

On the day that toilet training starts, get your child out of bed as soon as she awakens. Take her straight to the bathroom. Do not pass go, do not collect $200….I digress. Have her sit for a few minutes reading fun stories or listening to music. If she urinates on the toilet, cheer wildly. Give her the reinforcer/reward. Put on the big girl panties and do not look back!

If she does not urinate, allow her to get up. Put on her big girl panties and remind her that she must urinate on the toilet or she will get wet. You will need to take her back to the toilet every 15 minutes until she urinates on the toilet.

If your child has an accident, do not get upset. If you can catch it early enough, carry her  to the toilet to finish on the toilet. Have her assist with the clean up. Again, do not make a big deal out of the accident. Simply say, “oops, pee pee goes in the toilet”.

Once your child urinates successfully, be sure to take her back to the toilet about every hour. Over time, your child will learn to tell you that she has to go. However, initially, you will need to remind her. Always watch for the potty dance. We have provided you with an example picture. Just know that it looks slightly different for each child. When you see the potty dance, take your child to the toilet. Do not ask, “do you have to go potty?” as children often say no because they are doing something fun.

A few weeks later, Christopher’s mother emailed to let us know that Christopher was toilet trained and moving up to the Three Year Old class! Congratulations Christopher. You rocked the toilet! And your mom is awesome too!

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