Help with Feeding

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, we have a question in from Melany who writes:

“I would like to create a program for a young boy who has difficulties with some specific textures. I thought about a fading procedure but there is maybe a better one?”

Before recommending anything specific for this child, it will be important for you to assess and have others assess the child thoroughly. We have learned that children with food allergies/sensitivities often have oral sensory issues. We have also learned that children who have oral motor deficits may have difficulties with certain textures. However, some children are simply scared of textures. Thus, a good assessment of the child’s medical and oral motor condition is important before commencing treatment for this child.

A substantial amount of research has proven a texture fading model to be effective. In a texture fading model, clinicians move from puree to table food by slowing increasing the texture. You will see this if you examine any commercially produced baby food in puree to stage 3 foods.

Finally, please do not try this at home. Just because you have learned how to use a fading protocol in your coursework, it does not mean that you can or should implement a fading protocol in feeding. Appropriate training and supervised clinical experiences are essential prior to addressing feeding issues. Additionally, other clinicians may be needed to assist you. These include physicians, occupational therapists, speech and language therapists, and/or nutritionists or dietitians.

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

Read Full Post »

Requesting an IEE for an FBA

Hi and welcome to Ask Missy Mondays where I take questions from readers. Today’s question comes from Judy who writes,

“Hi Dr. Olive, my child’s school BCBA recently completed a Functional Behavior Assessment (FBA) for my child. The report seemed to be very detailed. However, I disagreed with the report because the BCBA did not include an assessment of my son’s scripting. The BCBA did not interview me as part of the FBA because it was a “school FBA”. I told the school that I wanted an Independent Educational Evaluation (IEE)/FBA at the school expense. Now they are telling me that they don’t have to give me an IEE because they think their FBA is good enough. Do I have any options?“

Hi Judy, and thanks for writing. This is a great question and so very similar to some of the things I’ve seen happening in recent months. For example, one of my relatives requested an IEE for their child’s initial evaluation and the district filed due process against them! You can imagine how scary it is to be told that your school district is filing AGAINST  you!

I have a couple of points to address regarding your question. For my readers who are lost with all this terminology, you may read about an FBA here, learn about what to expect from an FBA here, and finally, learn the difference between an FBA and a functional analysis here.

Right to an IEE

First, if your child has an IEP, you have the right to request an IEE as long as the school completed their FBA within the past 12 months and you disagree with it. You don’t have to say why you disagree; just merely indicate you disagree.

The school does have a right to refuse the IEE by stating that their FBA is appropriate. At that point, you would have to file due process against them. I don’t recommend taking that step unless you have legal representation. Should you file due process against the school, you will need to prove why their FBA is insufficient.

I have heard of 3 different cases in Connecticut (I’m sure there are more) where the school refused to provide the IEE and so the family proceeded with a due process. In all 3 cases, the school district settled the case after the family spent precious time and resources gathering data, experts, and attorneys.

Parent Involvement in the FBA

My second point to your question is that the BCBA has a duty to involve you, the parent in the FBA. The reasons for this are twofold. First, the BACB Guidelines for Responsible Conduct require written parent permission to assess (see Guideline #3). Second, the BACB Guideline #4 requires client or guardian involvement during individual behavior change program planning.

“The behavior analyst (a) designs programs that are based on behavior analytic principles, including assessments of effects of other intervention methods, (b) involves the client or the client-surrogate in the planning of such programs, (c) obtains the consent of the client, and (d) respects the right of the client to terminate services at any time.”

If the parent disagrees with the FBA, how could the parent possibly be involved in the planning of the program? The BCBA should minimally involve the parent/guardian throughout the FBA and the BIP.

Research on Family Involvement

My third point to your question is to highlight the research on the importance of family involvement during the assessment and intervention process. For starters, including families in the process will serve to help educate parents on the assessment and intervention process. This education may then go on to reduce parenting stress (c.f., Bristol, et al., 1993; Gallagher, 1991; and Koegel et al., 1996). Second, professionals should be conducting assessments and development interventions utilizing a multicultural lens (c.f., Harris, 1996; Heller et al., 1994). Without parent involvement, cultural competence cannot be achieved.

In summary, if your child’s BCBA, behaviorist, behavior specialist, or similar completes an FBA on your child and you disagree with it, be sure to ask your team for an independent educational evaluation (IEE).

References

Bristol, M.M., J.J.Gallagher, and K.D.Holt 1993 Maternal depressive symptoms in autism: Response to psycho-educational intervention. Rehabilitation Psychology 38:3–9.

Gallagher, J.J. 1991 The family as a focus for intervention. In Handbook of Early Childhood Interventions, S.Meisels and J.Shonkoff, eds. Cambridge MA: Cambridge University Press.

Harris, S.L. 1983 Families of the Developmentally Disabled: A Guide to Behavioral Intervention. Elmsford, NY: Pergamon Press.

Heller, T., R.Markwardt, L.Rowitz, and B.Farber 1994 Adaptation of Hispanic families to a member with mental retardation. American Journal on Mental Retardation 99:289–300.

Koegel, R.L., A.Bimbela, and L.Schreibman 1996 Collateral effects of parent training on family interactions. Journal of Autism and Developmental Disorders 26:347–359.

Read Full Post »

Does ABA Work?

“A child with autism (three years old) pointing to the fish in an aquarium.” The photo demonstrates a controlled randomized test by Kasari, Stephanny Freeman and Tanya Paparella to determine whether intensive training in sharing attention (in this case, pointing at fish) and pretend playing can lay the groundwork for the acquisition of language skills and subsequent normal development. (Photo credit: Wikipedia)

Hi and welcome to Ask Missy Mondays where I answer a question from a reader. Today’s question comes from a mom with a newly diagnosed child on the autism spectrum. She is searching for answers at all hours of the night. Marie says,

“Hi Missy, I am very new to this autism thing. I have heard that children with autism can get better–even lose the diagnosis completely. Is this true or is this some quackery to get me to buy something I cannot afford? Where can I read more about this treatment and how do I know if it’s real?”

Hi Marie and thanks for stopping by the blog. You are not being sold “quackery”. The truth is that children with autism CAN recover–even lose the diagnosis. I have written about this before (here, here, and here), which is probably how you found this blog.

Applied Behavior Analysis (ABA) therapy is the only treatment that has been proven to help children recover from autism. Dr. Lovaas is best known for his study describing the improvements of almost half the children who received the treatment. Other scientists have replicated his research with similar outcomes. Unfortunately, scientists do not yet know which children will recover, only that some recover.

We do know that intervention must start early, it must be intense (40 hours of therapy per week), and that it must last for 2 years or more. We also know that therapy must address all areas of development including speech and language, social and emotional skills, gross and fine motor, self-help and adaptive skills, as well as academic skills.

ABA is an appropriate treatment for children with autism. In fact, 32 states have legislation requiring certain types of insurance to cover ABA therapy. Check

out this resource to see if your state is included.

You may also find some of the work by Dr. Fein helpful. She has no association with ABA whatsoever and she has published several papers on this topic as well.

Finally, we know that many children on the autism spectrum are sick. The illnesses include GI disease, food allergies, mitochondrial disorders, and other things. Thus, in addition to using ABA to teach your child, you will need to include medical support to address any underlying medical condition that your child may have.

I am sorry that your child has been diagnosed but I hope that you will pursue active treatment as soon as you possibly can.

If you have a question email askmissy at applied behavioral strategies dot com.

Related articles

• Autism treatment can be expensive, but benefits can be dramatic, Hope Network leader says (Guest column) (mlive.com)
• Parents say son is cured of Autism thanks to extensive behavior training (fox59.com)
• What is recovery (centerforautism.com)
• Recovery from autism
  (phys.org)

Read Full Post »

Show Me The Data!–or not

Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question was posted on a list serve for parents and family members of individuals with autism. The mom wrote,

“As far as data collection, I hear about the BCBA doing it but I have never seen it nor heard specific results. I requested the data and the BCBA told me that as an outside consultant she is not allowed to provide it.“

Having taught a course on Ethics and Professional Issues for behavior analysts, and in addition to offering on-going coursework related to ethical issues for Board Certified Behavior Analysts, hearing things like this really upsets me.

Guideline 2.0 Responsibility to Client

The Behavior Analyst Certifying Board (BACB) has developed a set of Guidelines that BCBAs and BCaBAs must follow. These guidelines are called the Guidelines for Responsible Conduct and they may be viewed here. One of the guidelines states that “the behavior analyst has the responsibility to operate in the best interest of the client“. When the client is a minor or incapacitated (i.e., unable to make decisions for him/her self), the client’s parents or guardians become the client.

In the case above, the BCBA is claiming that her responsibility lies with the school district who is paying her salary. Unfortunately, the school district is a third-party payer. While the BCBA has responsibilities to her employer, those responsibilities cannot override her primary responsibility to the client. In fact, the guidelines address this issues.

Guideline 2.05 Third Party Requests for Services

This guideline has two parts. First the guideline states that “When a behavior analyst agrees to provide services to a person or entity at the request of a third-party, the behavior analyst clarifies to the extent feasible, at the outset of the service, the nature of the relationship with each party. This clarification includes the role of the behavior analyst (such as therapist, organizational consultant, or expert witness), the probable uses of the services provided or the information obtained, and the fact that there may be limits to confidentiality.”

The guidelines go on to state that “If there is a foreseeable risk of the behavior analyst being called upon to perform conflicting roles because of the involvement of a third party, the behavior analyst clarifies the nature and direction of his or her responsibilities, keeps all parties appropriately informed as matters develop, and resolves the situation in accordance with these Guidelines.”

So, while the district is paying for the services, the client is the child and his/her guardian. When he client requests their data, the behavior analyst must make those data available.

Related articles

• A Behavior Analyst’s New Year Resolutions (appliedbehavioralstrategies.wordpress.com)
• The ethics of mobile data collection (matt-welsh.blogspot.com)
• My Supervisor Told Me To Do It (appliedbehavioralstrategies.wordpress.com)

Read Full Post »

What Should I Tell My Child?

Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question is in response to the horrific events that took place on Friday in Newtown, Connecticut.

Words cannot express the horror that we all have about the event. As teachers, educators, behavior analysts, and parents, we are all hurting, confused, and want to know what we can do to prevent this from happening again.

A long-time reader wrote:

“Missy, what should I tell my child? How can I explain something to my child that I do not understand myself?”

If you have been reading this blog for any length of time, you know that not one answer is not appropriate for every child. Each parent needs to examine the needs of each child separately and determine what is appropriate to tell each one.

Children with ASD

If your child has ASD, it may not be necessary to tell him/her what has happened. Several parents on my case load have already made the decision not to tell their children. This will require that you shield them from the news, social media, and the internet. This is not an easy task. Norm and I chose to tell the girls but we have prevented them from viewing news and social media. However, just yesterday we were watching football and the news broke in to show a church being evacuated.

Children of All Ages with Anxiety

This group of children will be really vulnerable to this incident. They may worry if it will happen to them. They may spend inordinate amounts of time trying to find images or they may be visualizing the imagery in their heads. This group of children will need extra parental support and reassurance. These kids need to know that they are safe.

1. Continue to give them the verbal, emotional, and physical support that they need.
2. Limit access to television and social media as one way of preventing them from seeing things that they will “run wild with” in their minds.
3. Be sure to answer their questions; but do not let them perseverate on the topic.
4. If you notice that your child is quiet, sullen, or withdrawn, be sure to work through exercises designed to prevent children from worrying too much.

Young Children

If your child is under the age of 8, you may also choose to keep this horrific incident from them. Again, you will need to shield them from all media sources. As mentioned previously, you will have to make sure that their peers do not know about the incident.

We told our children not to discuss it with other children. We also asked them to tell their friends that they are going to discuss the matter with their parents only.

Children 8-14

This group of children is in a different place developmentally and psychologically. They think they are grown up. However, their cognitive level is not as advanced and that limits their ability to fully comprehend. This group of children will most likely want to discuss the events. Unfortunately, this is all the group that is more likely to believe exaggerated stories. Additionally, this group is also more likely to be connected to social media where strange images have already started to circulate (e.g., the letter written by the kindergarten student while he was in lockdown).

1. Provide only the basic and necessary facts.
2. Limit access to media as much as possible during the first couple of weeks.
3. Answer questions honestly and factually.
4. Reassure the child that he/she is safe.
5. Be on the lookout for any behaviors that suggest the child may need additional supports.

Children 14+

This group of children are almost self-sufficient. However, despite their confidence and independence, they will need additional support from adults. Unfortunately, they will not want to admit that they need this support. Thus, adults will need to be on the lookout for signals that indicate the children need assistance.

1. Provide information when asked.
2. Ask the child if he/she needs any additional information or support.
3. Teach the child how to digest television and social media sources.
4. Review strategies for remaining safe during similar incidents (e.g., where to go if it happens in the mall; what to do if it happens at school)
5. Be on the lookout for any behaviors that suggest the child may need additional support.

This is surely a difficult time for everyone. I ask that you all keep the families of all those affected in your thoughts and prayers.

Related articles

• The Horror In Newtown, Ctd (andrewsullivan.thedailybeast.com)
• How to Talk to Your Kids About the Shooting in Connecticut (wired.com)
• Helping Anxious Students Cope with the Sandy Hook Shooting (fearless-learning.com)

Read Full Post »

Autism and Behavioral Medication

Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question comes from Andrea who asks,

“I have a 4-year-old who was diagnosed with autism within the last 6 months. He is extremely hyperactive and inattentive. What medication do you find to be most helpful?”

Hi Andrea, and thanks for taking the time to write. I am sorry to hear about your child being diagnosed with autism but he is young so there is ample time to get appropriate intervention to help him.

Please know that as a behavior analyst and special educator, I am not licensed to practice medicine. So, making recommendations about medication is out of my preview.

However, as behavior analysts, we are trained to address all types of behaviors, including hyperactive and inattentive behaviors.

Assessment

Before we address any behaviors, we first complete assessments to better understand why the behaviors are happening. The assessment includes record reviews, interviews, and asking those who know the child to complete rating scales. The assessments also include observations of the child to better understand when the behaviors are good versus when the behaviors are bad. Finally, we may even conduct analyses to determine which environmental conditions directly affect the behavior.

Intervention

Once the assessments have been completed, the behavior analyst will help design interventions to address the behaviors of concern. Behavioral interventions can be designed to address attentive behaviors, impulsive behaviors, and skills related to following instructions.

Health Interventions

In addition to behavioral intervention, parents should also consider whole body interventions that address the overall health of the child. Children need daily physical activity and I am not talking about using their fingers to control the remote or the iPad. Children need full body physical activity every single day.

Children also need a healthy diet. If your child eats mostly processed foods full of sugars, fake color, and other artificial ingredients, then you should change the diet before considering the use of medication to treat behaviors that may very well be caused by foods.

Finally, children need far more sleep than they are getting. Children need at least 10 hours of sleep each night. Children (nor adults) can make up for lost sleep so make sure that your child goes to bed early and sleeps as late as possible.

When All Else Fails

If you have followed all of the other advice above (consistently) and your child continues to have behavioral issues, then consider seeing a behavioral pediatrician to assist you in determining if medication is the right thing for your child. Medication should not be your first stop, it should be your last.

If you have a behavioral question for me, email askmissy at applied behavioral strategies dot com.

Related articles

• I’m Pregnant, Should I Get a Flu Vaccine? (appliedbehavioralstrategies.wordpress.com)
• No, Our Son Doesn’t Have Leukemia (lifeandink.com)
• ADHD and Autism: Is It in the Genes? (everydayhealth.com)
• ADHD & Parenting: 4 Mindfulness Techniques to Curb Stress (psychcentral.com)
• Sleep Training Solutions Supports New Study on Sleep and School Behavior (prweb.com)

Read Full Post »

Does My Child Need to Learn Cursive Handwriting?

Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question comes from Angela who is the mother of a 3rd grader with a diagnosis of autism. Angela asks,

“Hi Missy, I have been reading your blog for a while. Thanks for all the help and advice you provide to us as parents. I’m writing now because I have come to a crossroad for my child. Chris has responded brilliantly to ABA and is doing very well in many areas. He is reading on grade level, he is doing math on grade level, and he is above grade level in science. He continues to struggle with fine motor skills which is common among children in this population. As you probably know, in third grade, children learn to write in cursive. Chris tried this for the first two days but it is going to take him a long time to master the entire alphabet. Who knows how long it will take him to put letters together to form words? What do you think about this? Should we keep working on this even if it means he may fall behind in reading and math? Thanks in advance for your help on this.”

Hi Angela, and thanks for writing. It is ironic that you emailed with this question. One of my current clients went through this exact issue just a few weeks ago. As a supervisor, I always take the family preferences in to consideration.

Parent Input

Right away, the first thing I would do is ask the parent (in this case, it is you), “How important is it for you for your child to learn to write in cursive?”

Socially Stigmatizing

The next question I ask is, “If your child does not learn to do this skill, will it be socially stigmatizing for him?” In this same area, I have to also ask, “Is it going to be socially stigmatizing for him to learn how to do this skill? Will his friends laugh at him if he doesn’t learn it as fast as they do?”

Essential Life Skill

The next question I ask is, “Is this skill essential for your child to do in order to be independent?”. Some skills are absolutely necessary. Handwriting is not one of those essential skills. I cannot tell you the last time I wrote in cursive. Even my signature is a scribble more than a signature. So, your child will need to learn to sign his name but he is allowed some creativity in doing this. I honestly don’t think the majority of people use proper D’Nealian when signing important documents.

I hope this helped to answer your question, Angela. I also want to point you to some other blogs on this same topic (listed below) as you may find them helpful too.

If you have a behavioral question for me email me directly at askmissy at applied behavioral strategies dot com. Thanks!

Related articles

• Is Cursive Handwriting Dead? (robincoyle.wordpress.com)
• State Board of Education will debate role of cursive handwriting on curriculums (kansascity.com)
• Mass. Among States To Still Require Cursive In Schools (boston.cbslocal.com)

 

Read Full Post »

I’m Pregnant, Should I Get a Flu Vaccine?

Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question comes from a frightened pregnant reader who has heard a popular news item”flu during pregnancy leads to autism“. Janet writes,

“Hi Missy, I’ve been a huge fan of your blog. As a teacher, I started reading for resources. My husband and I recently found out that we are expecting a baby. And now I’ve heard this news that if I get the flu while pregnant, it increases the likelihood that my baby will get autism. I thought that the flu vaccine itself was linked to autism. What should I do? Should I get the vaccine? I’m torn!”

Hi Janet. I’m so thrilled that you are a regular reader of the blog. Thanks! And congratulations on your pregnancy news! I can certainly understand your concern after hearing all of this on the news. It is an awful lot to make sense of.

Unfortunately, as a behavior analyst and special educator, I am not in a position to give you medical advice. I suggest that you speak with an appropriately trained health care practitioner to discuss your concerns. Also, please check back on Thursday when the Denmark study on pregnancy and the flu will be reviewed in detail.

P.S. frequent hand washing is recommended by all healthcare practitioners.

If you have a behavioral question for me email me directly at askmissy at applied behavioral strategies dot com. Thanks!

 
 

Read Full Post »

Social Stories and Visual Supports

Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s post is in response to multiple requests and questions about social stories and visual supports. Common questions include:

1. I thought the story had to be written in first person? (e.g., “I like” versus “Charlie likes”)
2. I thought the story had to be just like Dr. Gray says (A specifically defined style and format: sharing accurate social information and affirming something positive about the child)
3. Is there any research to support social stories or visual supports?
4. We do ABA.  Social stories aren’t behavioral.
5. My child cannot read so why should we have a story?

Overview

Social stories and visual supports serve a specific purpose of providing visual information to individuals so that they can be successful in difficult situations. Some examples of difficult situations include:

• Non-preferred but required activities (e.g., shopping, haircuts, blood draws)
• Changes to routine (schedule is disrupted, substitute teacher, different bus route, school cancellations)
• Novel situations (first time to hospital, first time on an airplane, first time to a play or show, storms)
• Special but routine situations (dr. appointments, dentist appointments, hair cuts)

 

Individualized

Social stories and visual supports should be individualized to the user. While it may  not be convenient for a teacher to create 12-15 stories/visual supports, what works for one person may not be appropriate for another. When developing stories and visual supports keep the following considerations in mind:

• age of the individual (resources must be age appropriate for the user)
• reading ability (adjust the text of the visual depending on the reading level)
• visual acuity (content should be selected based on the individual’s vision and ability, 3D versus 2D, color versus black and white)
• attention span (the length and detail of the story or visual support)

Content

While Dr. Gray has created a trademark, there are many options beyond what she describes. Because social stories and visual supports should be individualized, the content should be determined based on the individual’s needs. For example, a mom here in CT created a social story for her child regarding Hurricane Sandy. The story included information about the storm, how it would affect trees and power, and how power could be restored. The story was developed for her son because the issue of losing power is important for him. He becomes upset if he cannot turn on lights or play on computers. However, another child may be scared of the wind or scared of the heavy rain. That child would need a story that focuses on the wind and the rain and how to make the noise go away. And then another child may not fully understand why she cannot go to school. Because she cannot read, her story may show a picture of wind and rain and a picture saying “no school”. The story would end with a picture of the little girl at home working with her ABA therapist.

Research

We have written about visual supports before: here, here, and here. We recommend only evidence-based strategies for our readers. So obviously there is ample research to support social stories and visual supports. A research group has developed a list of evidence-based practices for individuals with autism. Social narratives and visual supports are both on the list. For additional information on those practices and to read the research visit here.

ABA and Social Stories and Visual Supports

ABA, applied behavioral analysis, is simply the application of behavioral principles, to everyday situations, that will, over time, increase or decrease targeted behaviors. For additional information on ABA, visit our website. Thus, the use of visual supports and social stories does not preclude someone from doing ABA. Similarly, implementing ABA does not preclude someone from using visual supports and social stories.

I hope this helps to answer the many questions about social stories and visual supports. If you have a behavioral question for me email me directly at askmissy at applied behavioral strategies dot com. Thanks!

 

Read Full Post »

Adult Picky Eaters

I came across this news piece over the weekend.

adult-picky-eater-will-only-consume-three-kinds-of-food.html

While no one asked me for my opinion, I’m certainly going to provide it.

Medical Assessment

First, this woman needs a complete medical work up. I would be willing to bet that she has anemia and bone density issues. Having low cholesterol is simply not good enough.

GI Workup

The TV journalist did not mention this but I would also want to know this woman’s GI habits. Is she constipated? Does she have diarrhea? Are there bouts of these? Additionally, does she experience acid reflux? If not now, did she as a child?

Nutritional Evaluation

Marla needs to see a nutritionist or dietician. Chances are, Marla is also deficient in important minerals like zinc. Research has shown that zinc deficiencies can result in altered taste and smells.

Does Marla have any food allergies? or Food sensitivities? I would be willing to bet she is sensitive to Gluten and Dairy (and possibly potato). This should be evaluated.

Treatment

Once the assessments have been completed, Marla needs to start some good behavior therapy. She needs to learn to associate good things with all the foods that she is currently scared to eat. We currently use the iPad with various applications, games, and movies. However, she may need something a little more powerful.

All of the foods that she is currently eating need to be stopped immediately and completely. The foods she is eating cause cravings which prevent her from wanting other foods. When she stops eating those foods, she will be able to tolerate and appreciate new foods.

Withdrawals

However, when Marla stops eating those same 3 foods, she is more than likely going to experience extreme withdrawal symptoms (much like those experienced by drug addicted individuals). We have written about this before and we have experienced it with several of our client.s

I wish  the best to Marla and her counselor and I hope that they get these issues resolved for her.

Read Full Post »