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I came across this link on one of my news feeds. It is super cool that the Hartsfield-Jackson Airport in Atlanta in conjunction with Delta Airlines are doing this!

WingsforAutismI have written about travel tips before. If you are interested, you can read them here and here. I have also published a piece on traveling with autism in the Autism File (2012, July).

And obviously this is great news just in time for some spring break and all summer travel plans! Happy traveling!!

To read this story, click here; or to listen to it, press the play button when you reach the news story link.

 

 

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200306160-001After more than a week with my niece and nephews, I have so many funny comments to share that I cannot possibly remember them all. This one stuck out as one of the most memorable.

Aunt Missy (to another adult): “I think I am doing well, considering the fact that I had surgery only 7 weeks ago”

7-year-old nephew: “Aunt Missy, I didn’t know you had surgery. Are you gonna die?”

Aunt Missy (laughing): “Oh no honey! I just had my gall bladder out”

Nephew: “What’s a gall bladder”

Aunt Missy: “Well, it is an organ (body part) that holds bile”

Nephew: “Oh! I have two of them. They are right next to my wiener!”

Readers, did any of you have this much fun on your holiday break? Please share!

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princess KateAll the fuss this week seems to be about Princess “Kate”, her pregnancy, and resulting hyperemesis gravidarum (or extreme morning sickness). I (Missy) can admit that I have been enamored with Princess Kate in the past. She’s beautiful, smart, fit, and independent–all the ingredients for a role model.

When I read that she was hospitalized, my first thought was “what if her child develops autism?”

Don’t get me wrong, I would never wish autism on anyone. Ever. But maybe, if autism introduces itself to celebrity, someone will finally do something about the biggest epidemic facing our world.

Sure, there have been other celebrities with children with autism (Doug Flutie, Sylvester Stallone, Holly Robinson Peete, and Dan Marino). And while some of those individuals have done things to increase autism awareness, none of those individuals have actually stressed finding the cause, cure, or prevention of autism.

Thankfully, the US Committee on Oversight and Reform is interested in finding some answers. Hopefully, they will find the answers soon. Unfortunately, it may be too late for Princess Kate whose child, if it is a boy, has a 1 in 54 chance of developing autism.

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Today is election day in the United States.As you head out to the polls to vote, think about the issues that are important to you:

  • autism
  • disability issues
  • behavior analysis
  • children
  • vulnerable adults
  • special education
  • public education
  • (any others that matter to you and your family)

If we lived in Australia, we would be fined for not voting. In the U.S., people have died fighting for our right to vote. Exercise your right today (if you haven’t already). Just do it. Vote.

 

 

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Many children in the New England area are happy today because schools are cancelled again. Teachers realize that we will be in school until the end of June. And what are parents left to do?

Here are some tips for entertaining your children so that you can work, clean, cook, do laundry, or any one of the other 99 things on your to-do list.

Organize

Anyone who has been following this blog for a while has learned that organization is the key to success.

Get out your whiteboard and markers and make a list of things the children should do before they get to play. Some common chores in our house include:

  • making the bed
  • preparing breakfast
  • cleaning up after breakfast
  • getting dressed

School Work

Yes, school is out but students still need to read every day. If your child is struggling in an area (e.g., math or spelling), then ask your child to complete some extra work in that area. We have written about some great spelling and math games previously. In addition to the chores above, children in our house will find the following:

  • read
  • math
  • spelling
  • clean out your backpack
  • finish your Veteran’s Day Project

Play Time

Once all the chores and school work have been completed, then it’s time for fun. Your children may need some direction or assistance in this area depending on their ages. We prefer to pick games the children can play on their own so that we can get our work done.

  • Wii (we prefer Wii Fit to keep kids moving)
  • Board Games (Yahtzee, Monopoly, Clue)
  • Card Games (Uno, GoldFish)
  • Art (our kids made “fall” cards for their grandmother in Florida including some hurricane thrown leaves)

Play Date

Once your kids have entertained themselves for the morning (and kept themselves out of trouble), then you can arrange for their friends to come over and play. While it may not seem like such a good idea to add more children to the mix, when children have friends around, they are more likely to play and stay out of your hair. If you have a friend for each child, even better.

Hopefully power will be restored soon and all of you can return to your regular routines. In the meantime, try to get as much done as you can while your kids are home.

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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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Recovering from a series of seizures

Dear Dr. _________,

I am writing as a follow-up to our ER visit on Saturday. I am certain that you will remember me, the guardian who fired you from treating my brother. I wanted to take a minute and explain to you why I asked you to step aside and why another physician was needed in your place.

  1. You made a recommendation for medical care for my brother without assessing him. You did not even take 5 seconds to step in and say hello and yet, somehow you think your pedigree gives you the right to treat him, sight unseen.
  2. You made a recommendation for an invasive medical treatment without cause. Sure, go ahead and restrain my brother to the bed so that you can put an IV in him. I’ll just step aside and allow you and your staff to recklessly provide treatment that is not medically necessary. Your “little” hospital makes a profit off that IV doesn’t it? Your “little” hospital does not make any money off my brother when he is taking up a bed for observation does it?
  3. You had the audacity to ask where “his mother” was! How dare you? You do not know the first thing about him or his situation. If you had taken the time to even glance at his file, you would have seen that he was there with his sister and guardian–the person who has provided care for him for the past 20 years. That should have been a hint that his mother was not in the picture. Did it ever occur to you that his mother might have passed away at some point in his life? He is 33 after all. As humans age, the likelihood that our parents pass away increases. How cold and inconsiderate of you to ask such a question!
  4. How many grand mal seizures have you seen? Let’s be honest. You are, at best, 28 years old. I’m pretty sure you didn’t see any seizures in medical school, maybe 1 or 2 in your residency, maybe 1 or 2 more in your time in the ER. I’ll give you 5 and I think that is generous. How many of my brother’s seizures have you seen? Zero. That’s right–none. If you learned anything in medical school, it should have been that no two people have the same type of seizures. So don’t go taking your very minor seizure experience and try to act like you know anything about my brother’s seizures. By the way, I’ve been a witness and first responder to my brother for about 5 seizures per year. You do the math. I’m pretty certain that I know more than you do when it comes to his seizures.
  5. Before you go talking down your nose to me, you should know that I am not some uneducated homeless person off the street. I realize that at your fancy “little” hospital, most of your patients are homeless, uninsured, do not speak English as a first language, or are drunk/strung out on drugs. What you don’t know is that I have a doctorate myself. That degree came from a major Research-I institution (top 5 in my field if you want to get specific about it). Oh, and I have a master’s degree too–from an Ivy League school very similar to the one where you work now. So please, do not patronize me.
  6. Finally, I will remind you that you took the Hippocratic Oath at some point in your career. You remember it, don’t you? I especially want to highlight the parts about over-treatment and the importance of warmth and sympathy. I’m including a copy so you can review it in its entirety.

I hope that you learned something from your experience with my brother and me. You need to treat your patients and their family members with respect and care. Contrary to what you may have been taught in medical school, you do not know everything. You are not even close. Maybe after a few more years of experience, you will learn that. Or maybe you won’t.

Sincerely,

Missy (the sister, guardian, and eternal advocate for my brother)

Hippocratic Oath (Modern Version via Wikipedia)

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of over-treatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not”, nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, be respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

We are linking up again with Erica over at Yeah Write. Hop on over there and check out all the other blogs. Go back on Thursday to vote on your favorites!

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If you have stopped by because the title sounded enticing and you were really looking forward to some hearty discussion about evidence-based practices, you will have to come back another day. You know as readers that we are die-hard evidence-based girls. None the less, today’s topic is actually about parental responsibility of keeping teachers up to date on family matters.

Besides us, as parents, teachers spend more time with our children than any other person in our children’s life. Wow. That is a lot of time. Because of this, teachers may be the first to notice subtle changes in our children’s behaviors, emotions, learning, and friendships.

We, as parents, need to keep teachers informed about events in our children’s lives that may impact their performance at school. We are not suggesting that you air your dirty laundry with your child’s teacher. Instead, we are suggesting that you keep her apprised of serious events.

As adults, we process information differently than children. We have a series of life events, education, and experiences that have formed the way we process information. What may seem like an everyday activity, may be a source of stress for a young child who is still figuring out the world. Factor in hormonal changes that occur with adolescence and your child could have a serious case of the blues at school.

Serious Illness in the Family or Friendship Circle

Illnesses such as cancer are scary for all of us but it is especially scary for children. If you have a friend or family member who is fighting cancer, your child may fear that he/she will catch it. They may begin thinking about death and have questions about the future. Hopefully, you have held those discussions at home. Either way, your child is probably thinking about it.

Change of Living Conditions

As parents, we are good about telling school staff when we move. However, what if the conditions in the home change? What if a relative is moving in for an extended period of time due to a loss of a job? What if the children changed rooms? What if a parent is out of the home to go care for a sick family member? All of these things sound simple for us as adults, but children may not handle the change so easily.

Loss of a Relative

The loss of a cousin, great-aunt, or other distant relative may not result in a cross-country trip to the funeral. Thus, your child’s teacher is most likely unaware of the incident. However, your child is. With the invention of cell phones, many of us have adult conversations all day long when our children are within an earshot of us. They know when these events happen, even if we don’t directly share the information with them.

Loss of a Pet

You know that goldfish that you have been secretly wishing would die? Well even though your child hasn’t fed it, spoken to it, or even looked at it in months, she will fall apart when it’s gone. Endearment for pets is not just limited to living pets. Some children form close bonds with stuffed animals. If one gets a “boo-boo”, it could cause stress for your little one.

New Pregnancy

We get that you were not planning a pregnancy or that you don’t want the world to know until it is a safer time. However, your little one has probably already picked up on the vibes or even overheard conversations. Nothing is more confusing for children than the age-old question “where do babies come from?” So, while you may want to keep it a secret, it is probably best that your child’s teacher know that you are pregnant. That is far better than her assuming that you are “sick” from too many cocktails the previous night.

Pending Divorce or Separation

No parent wants the neighborhood that things on the home front have fallen apart. However, your child’s teacher needs to know that a separation or divorce is on the horizon. Your child may handle the news when you present it but she may show her feelings differently at school.

These topics are just a few of the things you should share with your child’s teacher. School staff, including your child’s teacher, have received training on how to handle confidential information. Privacy laws prevent your family’s issues from becoming fodder for school gossip. Additionally, schools have a number of different staff available who can assist your child in times of need (e.g., school psychologist, school social worker, and school counselor). However, these trained personnel cannot help if they do not know.

Thus, be sure to keep your child’s teacher in the know so he/she can help your child adjust to life events.

This post will be linked up over at Yeah Write. Go check out all the other posts that have linked up.

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I’m not sure if you’ve heard the saying, but rumor on the street is that behavior analysts make the worst parents as well as the worst pet owners.

Lucky for me, I am (Missy) neither. Rebecca, on the other hand, is both! I bring this point up because I am hoping that I will be able to use all of my best behavior analysis skills today. I am packing up my family and dragging them across the country to Austin, Texas to see Rebecca and her family, visit dear friends, and show the girls why I love Austin so much.

My wonderful family in Bar Harbor (with a couple of friends)

Our travel group today will include my other half and his two children ages almost 8 and 10 going on 16. Sadly, my brother is not going with us. He took off a week from his day program in January to go to Florida so he must stay behind. We will miss him. Well, actually, we may not miss him much when we are on the plane. He has autism and an intellectual disability and that makes travel difficult for us all.

Yesterday we wrote about how difficult travel is for families, particularly when traveling with a child with disabilities. I believe strongly that traveling with children is difficult, regardless of their abilities. As such, I know that I will be following our own advice for readers today as we make our trek.

I have a couple of strategies that I use with regularly our girls to help the travel go smoothly. I follow much of the advice from yesterday, minus the visuals. We count down the days, we review the schedule, and we definitely pack snacks. The other strategy that I use has worked well thus far.

We Pack Together

  • I sit down with the girls and we brainstorm all of the things that we think we will need on the trip.
  • I take notes using simple words in handwriting they can read.
  • I break the packing into categories (clothing, toiletries, backpack stuff, and other)
  • I make a copy of the notes so that each child has a list
  • I send the girls off to their rooms to lay it all out

Why This Works

  1. First, the girls now feel that this trip belongs to them (at least in part).
  2. The girls cannot complain about their outfits–they picked them!
  3. The girls cannot complain about being bored on the plane–they picked out their backpack items
  4. It keeps the girls out of our hair while we are packing
  5. All I have to do is check their work and put their items in the bag

See you in Austin!

For our readers in the Austin area, Rebecca and I will be at Central market for coffee and conversation on Wednesday, February 22 at 9am. We are looking forward to seeing old friends and making new ones.

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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.

Today’s success story is about Grace and Sophia, two school-aged girls (7 years an 10 years) who were giving their parents and after-school tutor headaches. The girls engaged in a screaming, tantrums, fighting, back-talk, and non-compliance. Their behaviors were so bad that the tutor had threatened to quit if something didn’t change fast.

A quick observation of the scene on two or three different days allowed us to see some antecedents and consequences that may have been contributing to the homework headaches. First, the girls came off the bus without any plan. Sometimes they played outside, sometimes they watched television, sometimes they had snack, and other times they started homework right away. Second, when the girls misbehaved, each of them received a great deal of attention from the tutor as she lectured them about how and why they needed to behave. When he behaviors escalated to a high enough point, one or both parents swept in to save the poor tutor. The parents intervened by threatening loss of consequences, yelling about how badly the children behaved, or simply instructing the children to “cut it out and get to work”.

Once we assessed the situation, we developed a plan. All good behavior plans consist of antecedent modifications (antecedents are the events that happen before the behavior), the identification of target or replacement behaviors, and modifications of consequences (the events that happen after the behavior).

Antecedent Modifications

Right away, we asked the parents to develop a consistent homework routine. Because of their ages and different needs, one child ate her snack first and then played for 30 minutes before starting homework. The older child ate her snack while organizing her homework. Both girls had the responsibility of putting backpacks, shoes, and lunch boxes away prior to commencing any other activity.

We asked the parents, if they were home and not on a conference call, to come in immediately after the bus and give lots of positive attention. We instructed the parents to remain out of the room during all outbursts, tantrums, an inappropriate behavior. We also asked the parents to come in and give the children praise for any good behavior they observed (sitting, working, staying on task, etc).

Target and Replacement Behaviors

Instead of focusing on how rotten or awful the children were, we asked the tutor to focus on how wonderful the girls were. We identified several behaviors that she wanted to see more of:

  • sitting during homework
  • attending during instruction
  • working when asked
  • working without yelling
  • asking for assistance without crying or yelling
  • putting personal items away without being asked

Changes to Consequences

We implemented a token system for the girls. Each girl had a sticker chart. When the sticker chart was full, the girls could trade it in for $.50 they could deposit in to their bank account. Stickers could be given out freely by either parent or the tutor. We asked that whoever awarded the sticker to take extra care and identify exactly which target behavior resulted in the sticker award.

  • “excellent Sophia. You started work without yelling.”
  • “wonderful Grace, you put your lunch box away.”

We implemented a brief time-out procedure for Grace, who loved television. We made 10-minute TV Time coupons. Each day at the beginning of homework, the parents identified how many minutes of TV time were available (30 minutes or 60 minutes). Each time that Grace involved in yelling, screaming, tantrumming, back-talking, or non-compliance, the tutor removed one of the coupons.

Within 2 days, the frequency of inappropriate behaviors decreased to zero! The behaviors have maintained for 6 weeks with no signs of reversing. Congratulations to Grace and Sophia for your homework progress. Congratulations to your parents and tutor for helping you do it.

Readers, please share. What strategies do you use during homework sessions? What works for your children? Behavior analysts, what strategies have you used? How well did they work?

 

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