Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about behavior. Today’s question comes from Tracy, who asks:
“My child is having his first ABA Assessment soon, what questions should I ask? What should I expect?”
Tracy, thanks for asking! You have been an amazing help to me on Twitter so helping you in this way is the least I could do. You have definitely opened a can of worms with this question but hopefully I can give you some insight.
Your first question to the provider should be, “Do you believe in and work towards recovery from autism?” I realize that this question may offend some readers with autism. Please understand that I would never suggest that any individual who is capable of self-advocating be treated without consent. However, for young children, we know that the symptoms of autism can be successfully treated so that the child can go on to function in school without special education. The child can go on to function in adulthood without supports. The recovery rate is not high (around 48% of treated children). However, even if children do not fully recover, early intervention can lead to great improvements in IQ, adaptive behavior, and communication. “Shoot for the moon. Even if you miss it, you will land among the stars.” -Les Brown.
Reinforcement and Punishment
The second question you should ask is, “What is your philosophy on reinforcement and punishment?” A good ABA team will use a variety of reinforcers to help your child learn. Over reliance on edible reinforcers can be problematic. We have written a little bit about reinforcement here. Check it out. Preference Assessments are a must. Read about them here.
A good ABA team should deflect the question on punishment and talk more specifically about using reinforcement to address challenging behavior. Do not get me wrong. Punishment strategies are important and warranted in many cases. However, in a comprehensive ABA program, the team should be modifying antecedents to prevent challenging behavior, teaching replacement behaviors for challenging behavior, and severing the association between reinforcement and challenging behavior. New, appropriate behaviors should be reinforced and challenging behaviors should not be reinforced.
The third question you should ask is, “What curriculum do you use?” My favorite response to this question is “We use a variety of resources to determine what to teach your child.” Any agency who relies on one tool to drive their programming for your is setting your child up for failure. Your child with autism needs a comprehensive program to address all areas of development including receptive and expressive communication, fine and gross motor, social and emotional skills, pre-academic and academic skills. As your child ages, other skills such as pragmatics, perspective taking, and theory of mind skills will be important.
An exception here is the SKILLS assessment and curriculum. Having worked for CARD for several years, I know that the SKILLS curriculum was developed using multiple resources. CARD also completed several research studies on reliability and validity of the measure. While the curriculum may appear to be one tool, it is actually quite comprehensive.
The fourth question you should ask is, “What is your philosophy on inclusion?” The research on ABA (and on inclusion) supports that children should be educated alongside their typically developing peers as soon as possible. Depending on the severity of your child’s autism, he/she may need initial instruction in a very small, distraction-free environment. Once your child learns how to learn, he/she will be transitioned to a larger room with distractions. Once your child is able to imitate and learn from watching others, he/she needs to start regularly scheduled play dates to practice skills with other children. Finally, your child should be transitioned to a preschool with support. The support should be systematically faded until your child is functioning in general education with no supports.
Finally, your last question should be, “What is your philosophy about assessment?” This is a loaded question but their response will be informative. We have written a little bit about assessment here. The bottom line is that an agency should either refer you to or assist you with a variety of assessments. Obviously, the first is the diagnostic assessment where your child received the autism label. After that, a comprehensive developmental assessment is needed so that your child’s current level of functioning is assessed compared to his/her peers. This assessment should be norm-referenced and it should occur about once per year so that you will see how your child is progressing.
The agency should complete informal preference assessments daily. This will help them better understand how to motivate your child to work. Formal preference assessments may also be needed initially and periodically throughout your child’s program.
The agency should collect on-going data to monitor your child’s progress towards his/her learning objectives. The data should be collected by each therapist for every therapy session. Data should be graphed following each therapy session. The graphs should be examined to ensure that your child is making adequate progress. Changes should be made to your child’s program if he/she is not making adequate progress.
Supervision and Clinical Team Meetings
Your child’s program should be supervised by a BCBA with extensive training and experience in autism. The supervisor should oversee and train all the therapists on your child’s team. The supervisor should hold clinical team meetings at least twice per month and those meetings should include every therapist and both parents. When possible, related therapy providers (SLP, OT, PT), and school staff should be invited to attend.
The supervisor should also conduct visits of your child during regularly scheduled therapy sessions to ensure that the program is being implemented as planned.
I realize that this was a long-winded answer. Hopefully, it will help you prepare for your meeting! I hope it goes well. We can also schedule some Skype time if you want to talk more.
Readers, if you have a question that you need help with, email me at askmissy at appliedbehavioralstrategies dot com.