Feeds:
Posts
Comments

Archive for January, 2012

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 Bobby’s mom. In case you are new to our blog, we wrote about Bobby last year. You may read his story here.

Bobby’s mom asked,

“Bobby is over-stuffing his mouth with food and chewing for long periods. He is not swallowing, but adding more food until he can no longer add more. We ask him to swallow and we prevent him from adding more. Then he melts down and soupy, half-eaten food goes everywhere. A simple dinner is now lasting 2 hours and this has been happening for about the last 2 weeks.”

So, if you’ll remember from our previous post, Bobby is one of those kinds of children who like to control. It is important to prevent him from controlling the meals like he has done in the past. On the other hand, because this behavior is fairly new, it tells me one of two things:

  1. Is he sick or having a reaction to something?
  2. Is everyone in all environments following protocol? All it takes is for one person to let him get away with not eating and he will attempt it with everyone.

Assess

Before you start anything new, rule out underlying medical conditions. Is he sick? Does he have any cold symptoms? Has his bowel movements changed suddenly? (e.g., more constipated? looser? more often?) Does he have a rash or other physical sign of a reaction to something?

If all of that is clear and there is no underlying medical condition causing the behavior, then assess the environment. Is there a new teacher? a new assistant teacher? a new behavior therapist? Is everyone on the team following the protocol?

Intervene

Once you have completed your assessment, then it is time to make changes. The fact that he has been doing this for 2 weeks means that you need to intervene quickly so the behavior stops sooner and does not become engrained in his mealtime.

  1. I know it is hard but you (and school staff) will need to sit next to him for a few meals in a row until this behavior is back under control. Make sure that he takes an appropriate size bite. He does not get any more food until he finishes the first bite. Move the plate away from him if you need to.
  2. If he continues to chew slowly, then put on a timer and say, if you chew and swallow within 30 seconds, you can have ________. Then give him the reinforcer when he swallows. Do not give the reinforcer until the food is completely swallowed.
  3. Any food that is expelled must be represented unless it is contaminated. If it is contaminated then you need to replace the bite with an identical clean bite.
  4. Consider using a short picture schedule that shows:
  • small bite
  • chew
  • swallow
  • reinforcer

Fade Reinforcement and Proximity

As Bobby begins to experience reinforcement for appropriate behavior, you will begin to see an increase in appropriate behavior. This should also result in a decrease in the inappropriate behavior, especially when expelling results in an identical bite.

As Bobby is able to eat one bite, then put two bites on the plate and teach him to wait to take the second bite until he swallows the first bite. He will need to put the utensil down on the table while he is chewing. At this time, he will only receive tangible reinforcement when he chews and swallows both bites. Be sure to provide verbal praise when he swallows the first bite.

When he is able to eat two bites, then increase it to 3 bites on the plate. Begin fading the verbal feedback after the first bite and move to verbal feedback after the second bite with tangible reinforcement after the 3rd bite. If he can safely eat 3 bites without assistance and without stuffing, then begin fading the proximity of the helper.

Good luck and please let us know how it goes!

If you have a question about behavior, email Missy at askmissy at appliedbehavioralstrategies dot com.

Read Full Post »

One of the popular topics this week has been the discussion about children outgrowing their autism diagnosis. If you have missed these discussions, you may catch yourself up by visiting here, here, and here.

Before we jump in to the original article on which all of this discussion is based, we would like to point out that we have already discussed how children with autism can recover from autism. If you missed that post, you may read it here.

Ok, so what is all this talk about “outgrowing autism”?

We prefer to go to the original source to make sure people are accurately reporting what was published. Heather A. Close, Li-Ching Lee, Christopher N. Kaufmann, and Andrew W. Zimmerman authored the paper. The journal Pediatrics published the paper which is available online now and will be available in hard copy in February 2012.

Purpose

The authors set out to describe characteristics and co-occurring conditions in young children, children, and adolescents.The authors also stated that they wanted to describe how characteristics and conditions may cause a change in the diagnosis of ASD.

Participants

The authors actually sought participants who either: a) currently had an autism spectrum disorder (ASD) diagnosis; or b) who had an ASD diagnosis in the past but no longer carry such a diagnosis. Interestingly, the authors did not speak to any of the participants directly. Rather, they pulled the data from a database that was collected as part of the 2007 National Survey of Children’s Health.

Method

To complete the study, the authors opened the 2007 database and retrieved answers to two questions.

  1. Has a doctor or other health care provider ever told you that the child had ASD?
  2. Does that child currently have autism or ASD?

Once the authors retrieved the data for parents who responded to the two questions, the authors created two groups with the data. One group with a current diagnosis of ASD and a second group of children who do not have an ASD diagnosis but whose parents were once told that the child had ASD.

The authors then ran a number of statistical analyses with the data based on three age ranges of children.

  1. young children aged 3–5
  2. children aged 6–11
  3. adolescents aged 12–17

The authors also examined the data set to determine if any of the following conditions co-occurred in the children:

  • attention-deficit/hyperactivity disorder
  • learning disability
  • developmental delay
  • speech problems
  • hearing problems
  • anxiety
  • depression
  • behavioral or conduct problems
  • seizures or epilepsy

Results

Finding #1: Young children ages 3-5 with a current diagnosis of ASD were more likely to have a current learning disability. Might we add here that learning disabilities are often not diagnosed until age 8 or 9. Thus, we find it hard to believe that children ages 3-5 were diagnosed with learning disabilities. Perhaps they had developmental delays but the authors did not state that.

Finding 2: Young children ages 3-5 with a current ASD diagnosis were more likely to have current co-occurring conditions than children without a current ASD diagnosis.

Finding 3: Children ages 6-11 with a current diagnosis of ASD were more likely to have a past speech problem and current anxiety.

Finding 4: Adolescents age 12-17 with a current diagnosis of ASD were more likely to have current speech problems and 10 times more likely to have current seizures or epilepsy. Note: We would hope that the children have current speech problems since the definition of ASD diagnosis requires that speech problems be present!

Comments

Honestly, it is surprising that such a low-quality study would find itself in a prestigious peer-reviewed journal such as Pediatrics. It is even more surprising that it would receive subsequent attention from the press. This type of study hardly qualifies as a master’s thesis, let alone a study that is covered in national news.

The authors did not conduct an experiment. The authors did not verify if the children actually had autism. The authors did not review records to determine if a diagnosis existed in the child’s history. The authors based their entire paper on someone else’s data set.

The original data set the authors utilized is also full of issues. The authors noted that the majority of respondents were white, non-Hispanic, and that most of them had health insurance for at least one year. Not to mention that at 61% of the respondents had incomes over 200 times above the poverty level. Thus, the study results are skewed towards white, middle and upper-class families.

Finally, the authors based all of their conclusions and findings on parent report. Please do not think that we do not believe parents. We do. However, a parent may think their child has ADHD or learning problems but that does not mean that an actual diagnosis of ADHD or learning disability exists. Thus, when the authors discuss how other conditions may impact the autism diagnosis, they are merely speculating as their study did not prove, or control for the other conditions.

The bottom line here is that children in this study who had a history of ASD, may or may not have even had an ASD to begin with. The authors failed to verify this information. Moreover, the authors failed to ask if the children received intensive early intervention or biomedical intervention that may have resulted in recovery from autism.

Finally, the authors never stated that children outgrow autism. The authors themselves state that the children who no longer have a diagnosis could have been:

  • misdiagnosed in the first place
  • responsive to early intervention
  • or they may have experienced developmental changes

So, we are asking you to please check the facts before spreading rumors. Children do not outgrow autism.

Read Full Post »

We are pleased to announce our schedule of upcoming webinars for the spring! Please join us for your continuing education needs. Contact us if you have questions: info at appliedbehavioralstrategies dot com.

Additionally, we are pleased to announce a free webinar for parents on using the iPad for communication, language, and academic instruction. The webinar will be on Wednesday February 8th from 7pm-9pm. Please visit our website for additional information. Space is limited and registration is required.

If you have suggested topics for continuing education or parent trainings, please email us with suggestions.

Thank you!

Spring Webinars

Read Full Post »

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 Jillian and J.D. who ask,

“We have 2 children ages 2 and 4. They are driving us batty with their crying, whining, and tantrumming! Seriously, I cannot even get in the shower without one of them having a major meltdown. Please help us before we go crazy!”

I replied to Jillian and J.D. and said,

“I wish I could solve this problem for you but I do need a little bit more information. Tell me more about when these behaviors happen. You mentioned being in the shower. Can you tell me some other times these behaviors happen? Also, tell me how you react when your children engage in these behaviors. What do you say? How do you handle it?”

Jillian and J.D. wrote back almost immediately. They noted:

“The behaviors happen:

  • When Jillian is on the phone
  • When Jillian is cooking
  • When Jillian has a neighbor over
  • When Jillian is doing laundry

They also noted that when one of the kids whines to get something:

  • The child does not get what he wants
  • The child must ask using a “big boy” voice

Jillian and J.D. noted that when the children tantrum:

  • The child is first told “no!” so that they can learn not to do the behavior
  • After Jillian tells them no, she walks away unless someone is hitting
  • The child is put in 2 minute timeout for serious offenses (e.g., hitting brother)
  • When the child is calm, his needs are addressed

Now I have something I can work with! The first pattern that I noticed is that the behaviors seem to happen when mommy is busy (on the phone, cooking, laundry, etc). This means that the children have learned how to successfully divert mommy’s attention away from other important activities. I am certain that, as a mommy, you give your children ample high quality time (e.g., playing together, reading books together, etc). However, your children want even more of your time.

Antecedent Changes

Thus, before you begin one of your busy activities:

  1. Spend time playing with them
  2. Tell them that you are going to be busy for 15 minutes (or however much time you need–I recommend no longer than 30 minutes)
  3. Set the timer so they can have a clear signal when the activity is over
  4. When the activity is over, tell them they can have mommy time and praise them for letting you do your house work so that…..(e.g., we all can eat, or have clean clothes)
  5. If a child interrupts you during the work time, point to the timer but do not give any attention
  6. If a child tantrums, wines, or screams during the work time, do not “rush” in to save him

Consequence Changes

Once you have the antecedents taken care of, then you will need to change some of the ways that you respond to their behaviors.

  1. Refrain from stating “no!” after a behavior that has been reprimanded in the past. The children know they are not supposed to hit, scream, etc.
  2. Refrain from giving the child what he wants immediately after timeout
  3. When the child comes out of timeout, be sure to review what he did wrong and what he could do “next time”
  4. Remind your child that he cannot have X, Y, or Z because he _______ but that he can have it later
  5. If a child whines, remind him to use his big boy voice but do not give him what he wants right away. Set the timer for 2 minutes and when the timer goes off, he can ask using his big boy voice

I know this sounds like a lot and once you practice it a few times, you will get the hang of it. And not matter how much work it is, when those behaviors stops, it will be well-worth it. Please let us know how it goes!

If you have a question about behavior, email Missy at askmissy at appliedbehavioralstrategies dot com.

Read Full Post »

We love sharing funny cartoons about behavior with our readers. This one is hysterical!

Teachers, how many of you have felt like this? Parents, have you ever wish your children came with a manual?

Read Full Post »

Here at Applied Behavioral Strategies, we try to review a research article on a hot topic for our readers. Because a timeout room procedure in Connecticut has received quite a bit of attention lately, it seems timely to review another study about timeout.

Christine Readdick and Paula Chapman authored the article called, Young Children’s Perceptions of Timeout. The Journal of Research in Childhood Education in 2000. If you want to read the article yourself, you may find it here.

Purpose

Because timeout has been such a widely used procedures in both homes and classrooms, and because researchers have never paused to ask children how they felt about being placed in timeout, the authors hoped to learn how children understood timeout. They stated that the specific study purpose was to learn how young children felt about being placed in timeout and if they understood why they were placed in timeout.

Participants

The authors studied 42 young children ages 2, 3, and 4 years old who attended child care centers that were willing to be included in the study. Parents consented in writing for their children to participate in the study.

Methods

Immediately following a timeout, the researchers interviewed the child asking a series of 17 pre-determined questions. These questions included things like:

  • do you like school?
  • when you are in timeout do you feel lonely?
  • when you are in timeout do you feel sad?
  • when you are in timeout do you feel that the teacher disliked you?
  • when you are in timeout do you feel that you dislike timeout?
  • do you think you need to be in timeout?
Results

More children reported feeling alone, yet safe while in timeout. More children also reported that they disliked (rather than liking) timeout. Sadly, more children also reported feeling that their peers did not like them when they were in timeout.

More children than not could identify what they were doing that led to timeout (e.g., I wasn’t playing the right way). More children reported being in timeout “a little” rather than “a lot”. Most children reported that an adult told them why they were in timeout. Interestingly, most children also indicated that they deserved to be in timeout.

Teachers placed most children in timeout for being non-compliant (N=27). Sixteen children were placed in timeout for aggression.

When the authors compared the answers between children who were placed in timeout “a little” to those of children who were placed in timeout “a lot”, the authors noticed that their negative feelings were more intensified (e.g., more alone, more sad, more disliked by friends).

Interestingly, only about 50% of the children correctly identified the reason for being placed in timeout. Observers recorded behaviors prior to timeout and those records were used to verify if children’s responses were correct.

Summary

The authors noted that timeout, in this study, was being used for minor offenses (e.g., non-compliance in most cases) and that timeout should be reserved for the most severe and dangerous behaviors.

We want to hear from readers. For those of you that have verbal children, have they shared their thoughts about timeout? Are your children being placed in timeout for minor offenses?

Read Full Post »

Hi and welcome to “What Works Wednesdays” where we share a success story from one of our clinical cases.

Our intent is to show readers how successful ABA can be. Today’s success story is not about a clinical case but rather a personal case.

As some of our readers may know, Missy has a brother with autism and intellectual disabilities. Mac is also non-verbal which complicates the intervention process.

When Mac was in his early 20s, he moved in to a group home with 5 other men. Mac engaged in inappropriate touching during mealtimes. He touched their plates, he pushed their drinks, and he touched his roommates. When he did this, staff put Mac in timeout until the end of the meal and then Mac was allowed to eat his meal alone.

After several weeks, the staff called Missy to report that the inappropriate mealtime behavior had become a serious problem and that state rules required roommates to eat together. Thus, they needed an intervention so that Mac could eat with his roommates. They had concern that their timeout technique was not working.

Missy provided them with some important background information. When Mac was very young, like many children with autism, he engaged in challenging behaviors during mealtime. To decrease family stress, their mother fed Mac separately from the rest of the family. Thus, Mac had developed a strong preference for eating in isolation with abundant space on either side of him.

Missy explained to them how to develop an appropriate behavior intervention plan: a) modify antecedents to prevent challenging behavior; b) teach appropriate/replacement behaviors; and c1) modify consequences to stop reinforcing challenging behaviors; and c2) begin or increase reinforcement for appropriate behaviors.

Modify Antecedents to Prevent Challenging Behaviors

Staff planned to do a variety of things to prevent Mac from touching his roommates, their food, and their drinks.

  1. At the beginning of the meal, they asked Mac where he would like to sit. He often chose to eat at the bar adjacent to where the rest of the roommates were eating.
  2. Chips (a highly preferred food for Mac) were offered at the table. Mac could only have chips when he sat at the table with everyone else.

Teach Appropriate/Replacement Behaviors

The staff also taught Mac to communicate instead of using challenging behavior to get his needs met.

  1. They taught Mac to ask (using gestures) to sit in a different place.
  2. They taught Mac to ask for additional space (using gestures) when he felt crowded.

Reinforce Appropriate Behaviors

Staff also focused on reinforcing Mac for engaging in good mealtime behaviors.

  1. They provided him with attention (praise and high fives) when he was eating appropriately.
  2. They provided him with chips when he sat at the table with everyone else.

Staff stopped reinforcing Mac’s challenging behaviors.

  1. When Mac touched other people, their food, or their beverages, staff did not allow Mac to eat alone.
  2. Staff did not allow Mac to leave the area when he touched other people or their food and drink.
  3.  Staff only allowed Mac to leave the table when he asked to move or when he asked to sit somewhere else.

Follow-Up

Mac now lives in a home with 2 other roommates. He eats at the table with his roommates. The table is large so that Mac has ample space. When Mac comes to visit Missy and her family, he eats at the table with the children but he asks them to make extra space for him. When Mac eats out in restaurants with Missy and her family, they always ask him where he would like to sit before the meal begins. If the table is large enough, he asks to sit at the end. If the table is small and he feels crowded, he asks to sit at an adjacent table so that he can interact with his family but still have ample space to feel comfortable.

Summary

Staff originally tried to use a timeout procedure to address Mac’s inappropriate mealtime behavior. Staff failed to notice that Mac wanted to eat alone. When they used the timeout procedure it actually had a reinforcing effect: Mac’s inappropriate mealtime behavior increased because they gave him what he wanted when he misbehaved. Additionally, the timeout intervention did not teach Mac any new skills. He still prefers to eat alone or with ample space around him but now he has learned how to communicate his preferences so that he does not have to engage in challenging behavior to get his way.

Thus, when addressing challenging behavior, we must first understand why the behavior is happening. It is then, that an appropriate intervention may be developed to effectively address the behavior.

Read Full Post »

Older Posts »

%d bloggers like this: