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Archive for September, 2012

Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s post is a follow-up to a previous post on Supervision where Karen had asked “what are the rules on ABA supervision?

Recently, the Behavior Analysis Certification Board (BACB) issued a document related to practice guidelines. While the practice guidelines are specifically related to the provision of ABA services for individuals with autism, readers are provided with clarity regarding the supervision expectations for clients.

The BACB has this to say about on-going supervision of ABA services:

“Although the amount of supervision for each case must be responsive to individual client needs, 1-2 hours for every 10 hours of direct treatment is the general standard of care. When direct treatment is 10 hours per week or less, a minimum of 2 hours per week of clinical management and case supervision is generally required. Clinical management and case supervision may need to be temporarily increased to meet the needs of individual clients at specific time periods in treatment (e.g., intake, assessment, significant change in response to treatment).

A number of factors increase or decrease clinical management and case supervision needs on a shorter- or longer-term basis. These include:
• treatment dosage/intensity
• client behavior problems (especially if dangerous or destructive)
• the sophistication or complexity of treatment protocols
• the ecology of the family or community environment
• lack of progress or increased rate of progress
• changes in treatment protocols
• transitions with implications for continuity of care

Within the same document, the BACB discusses case loads for BCBAs. Specifically, they suggest:

  • The average caseload for one (1) Behavior Analyst supervising comprehensive treatment without support by a BCaBA is 6 – 12.
  • The average caseload for one (1) Behavior Analyst supervising comprehensive treatment with support by one (1) BCaBA is 12 – 16. Additional BCaBAs permit modest increases in caseloads.
  • The average caseload for one (1) Behavior Analyst supervising focused treatment without support of a BCaBA is 10 – 15.
  • The average caseload for one (1) Behavior Analyst supervising focused treatment with support of one (1) BCaBA is 16 – 24.
  • As stated earlier, even if there is a BCaBA assigned to a case, the Behavior Analyst is ultimately responsible for all aspects of case management and clinical direction. In addition, it is expected that the Behavior Analyst will provide direct supervision 2-4 times per month.

Keep in mind that these recommendations are related to comprehensive programs for children with autism.

We hope this helps to clarify our previous suggestions about supervision of ABA programs. We applaud the BACB for providing these guidelines that will prove helpful to behavior analysts, parents, and school district staff alike.

 

 

 

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Today marks one year for our blog. On September 19th, 2011, we started blogging regularly. The first blog appeared in August of 2011 but we didn’t become regular until September. Of course, we paused for life here and there along the way.

We want to take today to thank all of our readers and followers. We appreciate your support, your criticisms, and your suggestions.

Our all time busiest day so far was April 3, 2012 when we posted about free apps for Autism Awareness

And here are our top 10 posts based on total number of views.

10. Help! My Child Has ADHD

9. Peanut Butter Bread: Battle It Out?

8. My Child Won’t Poop in the Toilet: HELP!

7. Inclusion is an Individualized Decision

6. What Inclusion Teaches Us

5. Updated iPad Application List

4. Homework Habits That Work

3. Autism Awareness Free Apps

2. Using ABA to Teach Math

And the number one post of all time? Do You Use Visual Schedules?

Readers, we love hearing from you. Please let us know if you have any questions to answer about behavior or if you have a topic that you want us to write about. And most importantly, thanks for hanging around.

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Here at Applied Behavioral Strategies, our mission is to improve the quality of life through effective intervention. One way we hope to do that is by reviewing research articles for our readers. Today’s article is titled, Intervention for Food Selectivity in a Specialized School Setting: Teacher Implemented Prompting, Reinforcement, and Demand Fading for an Adolescent Student with Autism (wonder if they could make that a little longer?). A journal called Education and Treatment of Children published the article and Maria Knox, Hanna C. Rue, Leah Wildenger, Kara Lamb, and James K. Luiselli authored it. (If you want to read the entire article, you will find it on www.freelibrary.com)

Background

Many children with autism engage in picky eating or what researchers call “food selectivity“. For example some children live on a white foods diet (chicken nuggets, french fries, and bread) while others remain stuck in pureed foods.

Applied Behavior Analysis (ABA) is one intervention that has been demonstrated repeatedly to be effective at addressing picky eating behavior. However, the intervention often results in challenging behaviors that make it difficult for parents and caregivers to implement on their own. In fact, most of the research to date has been implemented by highly trained therapists.

Purpose of the Study

Thus, authors set out to determine if an intervention could be implemented by school staff in the school setting.

Study Method: Participants

The authors enrolled one child in the study. “Anna” was 16 and had autism. She was verbal and she could follow simple instructions. Anna could feed herself. However, she limited her diet to  a few brand-specific crackers, dry cereal, and apple juice . During the study, Anna’s mother provided new foods including one main food (chicken nuggets, macaroni and cheese, or turkey and cheese sandwich) and two side foods (cheese cubes, vegetable chips, carrots, mandarin oranges, or apples).

The authors implemented all study procedures at the school in Anna’s lunchroom or her classroom. The teacher and the teaching assistants collected all the data for the study.

Study Method: Design

The authors used a changing criteria design which is one type of single subject design. In this design, the expectations are gradually increased across phases. Thus, the teacher required Anna to eat more and more food across the study.

In baseline, the food were presented. If Anna did not eat within 2.5 minutes, the food was removed. After 10 minutes, Anna was allowed to eat her preferred foods.

Study Method: Intervention Technique

The researchers taught the teacher how to implement the intervention prior to the beginning of intervention.

Prespecified Reinforcement (First-Then)

During intervention, the teacher presented the new food on a separate plate and told Anna when she ate the new food (small amount at first), she could have her preferred food.

Reinforcement

Additionally, Anna earned verbal praise and stickers for eating new food. Anna cashed her stickers in for small trinkets.

Prompts

The teaching staff verbally prompted Anna to eat her lunch, if, 30 seconds after swallowing she had not taken her bite.

Demand Fading (Increasing the Volume Slowly)

Gradually, the teaching staff increased the amount of food that Anna needed to eat in order to get her preferred foods.

Results

By the 23rd lunch session, Anna consumed 100% of the new food and she repeated this on the 24th and 25th lunch sessions. The authors came back to assess her eating 2 weeks, 6 weeks, and 7 months later. Anna continued to eat 100% of her new food.

Congrats to Anna and the research team on such a successful intervention. ABA works!

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Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question comes from Gwen who writes:

“My high functioning 7-year-old is in mainstream 1st grade with an aide. Her biggest problem is laughing and saying, “No!” as an attempt to avoid working. She is not disruptive enough to be sent to the resource room, yet she is non-compliant which is not appropriate for general education. Our ABA team has tried token systems and they did not work.They tried PEC cards for “quiet time” and “stop talking” but those strategies did not work.

At home, I simply say in a firm voice,  “It’s time to work” and she does it. She may giggle and say repeatedly, “all done!” but the work is completed and it is usually correct!

Do you have any tips for us? She is simply running over them”

Hi Gwen! thanks for coming back to visit. We are sorry to hear that you are having troubles with your daughter’s behavior. Let’s talk about a few things.

Function of Behavior not Form

First, so many times teachers and other professionals fall in to the trap of treating a behavior based on its form (how it looks–or what behavior analysts call topography of the behavior). However, we should not attend to the form of the behavior as much as we should attend to its function (the result of the behavior).

Functional Behavior Assessment (FBA)

We cannot effectively address a behavior without first knowing it’s function (why is your daughter doing this?). We typically understand the function by taking careful ABC data. We could also do some manipulations if necessary to prove why she is doing the behavior.

Your Daughter

Based on what you’ve told me, it seems that she is getting an awful lot of attention for her behavior (e.g., “no talking” and “quiet time” contingent on the behavior). If that is the case, a simple intervention of attending to her for good behavior (i.e., attending and working) and ignoring the junk behavior (i.e., work refusal and laughing) should be effective. Both techniques should be used in combination to ensure effectiveness of the intervention.

Example:

Seat work time. Your daughter laughs and says, “no”.

The teacher and aide should immediately turn their backs to her and instead give all of their attention to the other kids in class who are working quietly. The adults should say “I like how Johnny is working quietly” and “Suzie, you are doing great quiet work”

When your daughter is quiet and working, the teacher or the aide should immediately turn to her and give her praise for working quietly.

Class-Wide Reinforcement

The teacher may want to consider a class-wide reinforcement system so that all the children can be rewarded for staying on task and completing work

Keep me posted on how things go!!

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Hi! and welcome to What Works Wednesdays where we share a success story from our clinical files. Today’s success story is personal.

If you are a parent, step-parent, nanny, or in-home behavior support person, you know full-well, how difficult the early morning routine can be. I (Missy) have always been an early morning person. Back before I acquired my new status (Bonus Mom), I often arose before 5am to get in my workout before showering and heading to a local coffee shop to write. Oh those were the days……..Oh, sorry! I lost track of my purpose. I started dreaming of Austin and those stress-free mornings.

Now it’s all different. I often wake as early as 5am so that I can write, answer emails, bill for services, grade quizzes for class, and a host of other morning duties. That is all done before the kids get up. We let the kids sleep until they wake up naturally. There are advantages of this (less crabby) and disadvantages (crazy mornings). However, we follow a few simple steps to make sure that our mornings are successful regardless of the waking hour.

Start the Night Before

Yes, I know that after school is just as hectic as before school. However, if you take a few steps the night before, stress the next day is eliminated.

 Lay Out Clothes

Have the kids pick out the clothes for the next day before they go to sleep. This prevents tantrums over what to wear and dilly dallying about finding matching outfits. We require this step to be completed before the kids have night time television. If the clothes are new (or from last year), consider having the child try the clothes on to ensure a proper fit.

Identify breakfast foods

Yes, we plan ahead. We have learned that if we identify the food for breakfast, we have less junk behavior leading up to and during breakfast. And no, we don’t allow changes to the menu (unless we have a serious issue such as the molded cream cheese we had this morning).

Pack lunches

Ok, we totally get that we are over-achievers. But seriously, if the lunch is packed the night before, we have less to do in the morning.  We ask the kids to decide if they are eating school lunch (totally over-fat and over processed) or lunch from home. From there, we ask them to pick their protein, fruit, vegetable, and starch. Our kids get at least one snack in school so we have them pick those as well. If we have time, we have the kids make their own lunch. This is not always feasible given the afternoon and evening schedules.

To bed! ON TIME

We have done this without fail since I moved in to this step-mothering role. In fact, Norm engaged in this practice long before me. But honestly, if I hadn’t read Ado’s blog, I probably would have left this one off the list because it is so engrained in our lives.

 

The Morning

Wake up naturally

Again, there are advantages and disadvantages to this. If we see that the kids are sleeping too long, we will begin to make natural noise (e.g., walking around, talking more loudly, etc).

Work Before Play

My other half likes to allow the kids to wake up slowly by vegging in front of the television. He keeps a strict rule of TV off at 7:30. This goes against the laws of behavior. You see, children will work faster to earn a reinforcer. So, my rule is TV does not go on until breakfast is eaten, teeth are brushed, beds are made, and children are fully clothed. Then I reward all of that hard work with TV time. The beauty here is that the faster the children get ready, the more TV time they earn.

Backpacks Ready

We like to make the children be responsible. How else will they learn to take care of themselves? So, they have to put their lunches and fluids in to their backpacks. Homework folders, permission forms, and the like must also go in the back pack. Again, we prefer to do this the night before but it is good to walk the kids through the process of remembering everything before they leave.

Bus or Drop Off

Our school requests that children ride the bus. First, this is more green. Second, it cuts down on traffic at the school. Finally, the bus comes about 20 minutes before drop-off time. I need all the time I can get. So, I institute another rule: if you miss the bus, no TV time after homework.

How do you get through the morning routine? Do you start the night before like we do? Do you have anything to add to our strategies?

 

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It seems that about every 3 months, we need to update our application list. So here is our latest list. Please let us know if we have overlooked something that your child loves. We enjoy expanding our app list too!

Reading and Reading Readiness

  • Smiley Sight Words
  • Teach Me Toddler
  • Teach Me Kindergarten
  • Teach Me 1st Grade
  • Super Why
  • ABC Match Ups
  • Intro to Letters (by Montessorium)
  • Bob Books
  • Elmo’s ABCs
  • See Touch Learn
  • Zoo Train
  • Feed Me
  • Monkey Preschool Lunchbox
  • Dora ABCs
  • DTT Words
  • ABC Matchups

Spelling Apps

These apps go beyond letter recognition and actually teach the child to spell words.

  • Montessori Cross Words
  • Word Magic
  • Wordball
  • PCS Word Scramble

 

Vocabulary and Language Builders

  • Kindergarten dot com Flash Cards (there are many! actions, alphabet, zoo, fruits, toys, instruments)
  • Speech with Milo (sequencing, verbs, prepositions, adjectives)
  • First Words Deluxe
  • Preschool Animals
  • Story builder
  • Sentence builder
  • Language Builder
  • Question Builder
  • Zombie Grammar Force
  • Grammar App
  • SAT Grammar
  • Little Match Ups
  • PCS Language Flash Cards
  • PCS Vocabulary Flash Cards
  • See Touch Learn by Brain Parade

Speech and Articulation

  • Phono Pix Full
  • Artic Pix
  • Articulation Flip Book
  • Articulation Flash Cards (PCS)

Writing and Story Writing

  • My Story Book Maker
  • Pictello
  • iMovie

 

AAC and Visual Planners

  • Proloquo2go
  • iPrompts
  • Going Places
  • Timer
  • Alarmed
  • Tap to Talk
  • Vu Meter
  • My Choice Board
  • PCS Sign Language Flash Cards

Social Skills

  • QuickCues
  • Stories2Learn
  • What are They Thinking?
  • HiddenCurriculum Kids
  • Stories2Learn
  • Conversation Builder
  • iTopics

Interactive Food Games (Thank you Maverick Software)

  • More Grillin
  • More Cookies
  • More Buffet
  • Cupcakes
  • More Pizza
  • More Salad
  • Little Match Ups Fruits

Interactive Echo Games

  • Talking Gugi
  • Talking Tom
  • Talking Babies
  • Talking Gina
  • Talking John
  • Talking Roby
  • Talking Larry

Interactive Books

  • Misty Island (Thomas the Train complete with puzzles, coloring, and dot to dot)
  • 5 Little Monkeys
  • Green Eggs and Ham
  • Me and Mom Go to the City
  • Toy Story (with reading and painting)
  • On The Farm
  • Ronki
  • Speech with Milo
  • Mickey Mouse Puzzle Book
  • Monster at the End of the Book
  • Another Monster at the End of the Book (with Elmo)

Books

  • Read me Stories (a library with one free book each day)
  • Mee Genius (a library)
  • Reading Bug
  • Food Fight
  • Christmas Tale
  • The Ugly Duckling
  • Three Pigs
  • Sesame Books
  • Elmo’s Birthday

General Knowledge

  • Brain Pop
  • Weet Woo
  • See Touch Learn by Brain Parade

Math

  • Bert’s Bag
  • Intro to Math (by Montessorium)
  • Free Multiplication Tables
  • Grasshopper
  • Ace Math Flash Cards
  • Pattern Recognition
  • Analogies for Kids
  • Analogies Practice
  • Tally Tots
  • Counting Coins
  • Every Day Mathematics
  • Fish School
  • K12 money
  • Math Cards
  • Patterning
  • Sail Through Math
  • Sequencing

Puzzles

  • Children’s Wooden Puzzles
  • Wooden Puzzles (these are not all good but the good ones are great. Sadly, the developers did not advertise on their app so we can’t tell you the exact name or developer)

Strategy and Problem Solving

  • Zentonimo
  • Cogs
  • Scrabble
  • Numulus
  • Logigrid
  • Conquist2
  • TicTacToe
  • Memory Game
  • Checkers Plus
  • Sudoku
  • Dots Free
  • Spider Free
  • Understanding inferences

Scanning

  • Pictureka
  • Waldo
  • I Spy

Adaptive Skills

  • I Love Potty
  • Everyday Skills
  • Potty Time with Elmo

Motor Skills

  • Dexteria (developed by an OT and teaches fine motor skills)

Interactive Games

  • Bowling
  • Mini Cooper Liquid Assets
  • Monkey Flight (by Donut Games)
  • Sunday Lawn (by Donut Games)
  • Skee Ball
  • Flashlight
  • Spin the Coke Bottle
  • Spinning Plates
  • More Cowbell
  • Angry Birds
  • Doodle Jump
  • Cut the Rope
  • Where’s My Water
  • Rat on a Skateboard
  • Trucks (by Duck Duck Moose)
  • Sponge Bob Super Bouncy
  • Sponge Bob Diner Dash

Interactive Songs and Music

  • Wheels on the Bus (Duck Duck Moose developers)
  • Old MacDonald (Duck Duck Moose)
  • Wheels on the Bus (Duck Duck Moose)
  • Itsy Bitsy Spider (Duck Duck Moose)
  • Kid’s Songs
  • Virtuosa Piano
  • Piano Free
  • Music Sparkles

Art Tools

  • Drawing Pad
  • Draw Free
  • Kid Paint
  • Whiteboard
  • Doodle cast
  • Doodle cast for kids

Halloween Applications

  • Carve a Pumpkin (to make the cute Jack-O-Lantern)
  • Pumpkin Lite
  • PumpknXplod
  • Pumpkin Plus
  • Skeleton (interactive and imitative)
  • Halloween Coloring Book
  • Carve It
  • Halloween Heat

Data Collection and Other Tools

  • DT Data
  • ABC Logbook
  • ABC Data Pro
  • Touch Trainer
  • Smart White Board
  • Sticky Notes for iPad
  • Timer
  • Meditation Timer

 Parent Tools

  • IEP Checklist
  • Autism Diagnosis and Treatment
  • Autism Track

 

Websites with Application Reviews

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Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question comes from a parent who is a regular reader (and poster) on our blog. Thanks Karen for your loyalty. Karen asks:

“What are general rules regarding supervision of the individual that provides ABA services?

How much oversight is required?

Is Supervision provided through data collection or intermittent on site visits?

How many students can the BCBA supervise ?

How is supervision validated?”

Thanks for stopping by our blog again! We love having repeat visitors.

BCBA  Supervision Rules

We have different rules for supervision depending on who we are supervising.

Supervising a BCBA in Training

If we are supervising someone who is training to become a BCBA the board requires us to supervise them a minimum of 2 hours every other week. This process is very long and can take up to 2 years. In addition to the on-going supervision we provide to those in training, we have to complete a form each time we supervise the person. Additional information on this type of supervision may be found here.

Supervising a BCaBA in Training

We have strict rules for providing supervision to a student who is trying to become a BCaBA. This process is also lengthy and requires written feedback. Rules for this type of supervision may be found here.

Supervising a certified BCaBA (on-going)

If we are supervising a practicing BCaBA, we have different rules.The board requires only one hour per month of this type of supervision. However, annually, “at least two of these monthly supervision sessions shall be conducted in-person, to include direct observation of actual service provision with individuals”. Additional information may be found here.

Supervision of Non-Certified Implementers

Finally, our organization lacks specific requirements for supervising staff who implement our programs. We have an ethical duty to make sure that programs are being implemented appropriately. Depending on how much ABA a client is receiving, supervision needs would vary. For example, if a child is receiving 40 hours per week of ABA therapy, more supervision would be needed (2-4 hours per week) but if someone is only receiving 10 hours of therapy per week, they may receive only 1-2 hours per week of supervision. For a detailed list of our guidelines for responsible conduct including supervision recommendations click here.

How is Supervision Provided?

Supervision may be provided a number of ways. Obviously, face to face supervision, where the supervisor is watching the implementation, is ideal. However, this is not always possible. Thus, other types of supervision may be provided. Supervisors may watch live video feed, they may watch previously recorded video, they may have sessions over Skype or other similar technology (we use WebEx for privacy purposes).

How Many People Can a BCBA Supervise?

As supervisors, we have to carefully build our caseload so that all of our clients receive appropriate services. Again, there is no minimum number to follow. We have our guidelines for responsible conduct that we should follow. There are only so many hours in the day. While many people burn the candle at both ends, it is difficult to provide supervision while clients are sleeping. Thus, case loads should be reasonable. When I worked for a large provider, it was common for individuals to have 14-15 clients on their caseload.

How is Supervision Validated?

Supervision is validated in a number of ways. We prefer to use the feedback form during formal supervision. However, if the implementers are not seeking certification, it is not uncommon to provide supervision without written documentation. For example, yesterday, I provided supervision to staff for about 30 minutes regarding a client at his school. We did not document the session because neither implementers is seeking certification.

Additional Resources

Supervision is a tricky issue. Your questions are completely appropriate. Please feel free to visit other sources of support.

  1. The Behavior Analysis Certification Board http://www.bacb.com
  2. The Association for Professional Behavior Analysts  http://www.apbahome.net
  3. The Association for Behavior Analysts International http://www.abainternational.org

Concerned?

If you have concerns about the supervision your child receives, be sure to address it with the BCBA who is responsible for your child’s case. In some instances, the supervision may be limited to funding. If you want more supervision than is funded, consider paying for additional supervision. Perhaps additional staff should be brought on to help (e.g., I’m seeking a BCBA to assist me with cases). Finally, if you cannot get the issue resolved, consider asking for a new BCBA or report the individual to the BACB. You will need extensive documentation but it may result in more appropriate supervision for your child.

We hope that helps.  And of course, come back and visit us often!

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