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Feeding Clinic

Check out this really cool video from our colleagues at the Munroe-Myer Institute Pediatric Feeding Disorders Program.

Video Link

Other Feeding Related Posts

We reviewed this study in our July 2019 Journal Club meeting. The full citation is: Jang, J., Dixon, D. R., Tarbox, J., Granpeesheh, D., Kornack, J., & de Nocker, Y. (2012). Randomized trial of an eLearning program for training family members of children with autism in the principles and procedures of applied behavior analysis. Research in Autism Spectrum Disorders, 6, 852-856.

For some background info…. staff at CARD in the R&D department as well as some of the staff in the Training Department (now known as the Institute for Behavioral Training) conducted this study on E-Learning. In full disclosure, I worked at CARD when staff conducted these studies.

We know that training parents to implement ABA is possible. (See some of Dr. Hancock (now Blackmon) and Dr. Kaiser’s vast work in the area of training parents to implement EMT and other language interventions).

I love this excerpt from the National Research Council’s book on educating children with autism (National Research Council 2001. Educating Children with Autism. Washington, DC: The National Academies Press. https://doi.org/10.17226/10017.)

The committee recommends that families’ participation should be
supported in education through consistent presentation of information
by local school systems, through ongoing consultation and individualized
problem solving, and through the opportunity to learn techniques
for teaching their children new skills and reducing behavioral problems.
Although families should not be expected to provide the majority of educational programming for their child, the parents’ concerns and perspectives should actively help shape educational planning.

The introduction section of this paper builds the case for parent training. For example, see this statement, “Thus, it has become the consensus that all treatment for children with autism spectrum disorders (ASD) should
include substantial parent and family training (Brookman-Frazee, Stahmer, Baker-Ericzen, & Tsai, 2006; Matson, Mahan, &​ ​Maton, 2009; McConachie & Diggle, 2007).​
“​ And while we have little data on the amount of parent training provided to parents as part of on-going ABA programs, we do know that insurance companies reimburse ABA providers for the service of parent training and for group parent training (when fewer than 8 parents participate)​​. Additionally, we know that E-Learning is an effective tool for teaching fact based knowledge regarding ABA concepts. Thus, the purpose of the study is logical: “evaluate the effectiveness of an eLearning program for training family​ ​members of children with ASD in the principles and procedures of ABA treatment​”​

The authors recruited 28 family members (mostly moms) to participate in this study. The majority of participants held a bachelor’s degree or higher.​ All participants spoke English and had access to high speed internet. 25 of the participants reported that their children currently received ABA services. The combination of these factors would suggest that the results of the study might not be generalizable to all populations but rather to those with higher education and SES.

The authors utilized a group design study and randomly assigned participants to one of two groups: treatment and waitlist. This design removed any ethical concerns regarding a no treatment group. Thus, the participants who were assigned to the no treatment group would ultimately receive training, just at a later date. In our online meeting, we discussed the limitation regarding the wait. Participants only had to wait one week after taking the pre-test before receiving access to E-Learning. We felt that a longer waiting period may have been better because participants may have been tested too much, too close together. Specifically, participants in the waitlist group took a pre-test, waited a week, took the pre-test, then started training and took the pre-test again.

The authors reported that the E-Learning resulted in improved performance on the test with the treatment group improving, on average, from 63% to 90% correct and the control group improving from 51% to 92% but only after they received training.

I think we can all agree that E-Learning is a viable option for teaching concepts. As the authors noted, having this technology available for parents is helpful to reach parents who live in rural areas. Using E-learning also allows families to proceed at their own pace. And finally, neither clinicians or parents have to travel to provide/receive the training.

​And while of these are advantages for E-Learning, our bigger struggle is the next p​​hase of training: application of principles.

If you enjoyed this article, you may also enjoy reading this article where the authors used the same E-Learning Program to train therapists. Here is the full reference: Granpeesheh, D., Tarbox, J., Dixon, D. R., Peters, C. A., Thompson, K., & Kenzer, A. (2010). Evaluation of an eLearning tool for training behavioral therapists in academic knowledge of applied behavior analysis. Research in Autism Spectrum Disorders, 4(1), 11-17.

Behavior analysts need 4 continuing education credits in Ethics every 2 years. This results in ethics credits being one of the highly sought out types of continuing education.

If you have found yourself in need of those ethics credits, we offer several opportunities through our online live webinars which we will now be recording and making available following each course.

Online continuing education offers some benefits but it also lacks one of my favorite things which is the socialization opportunities that go hand in hand with conferences. So, if you are needing some social time AND those ethics credits, you should check out the 7th Annual Ethics in Professional Practice Conference at Endicott College in Beverly, Massachusetts. And if you register BEFORE 7/15, you will receive the lower registration price.

Hope to see you there!

Related Posts on Ethics

Our FREE journal club met on Monday night. We discussed Fallagant & Pence 2017. You may access the article here or here.

The introduction to the paper consisted of a nice review of some of the work done to date in this area. The authors discussed why the Preschool Life Skills are so essential. 

The authors also discussed using a Response to Intervention (RTI) model for teaching these skills. You can learn more about RTI here or here. Essentially, in Tier 1, skills would be taught to a larger group or entire class. In Tier 2, small group instruction would be provided to the students who didn’t acquire the skills in Tier 1. Then in Tier 3, 1:1 instruction would occur for the students who didn’t learn the skills in Tier 1 or Tier 2.

The research was scientifically sound in terms of demonstrating experimental control. The authors used a multiple baseline across behaviors and then replicated that over 6 students. Like most research, a few flaws existed. For example, by using a multiple baseline across behaviors, experimenters lose a little bit of experimental control when the student demonstrates response generalization to an untrained behavior.

The participants in the study may have come from a convenience sample which was most likely a university affiliated preschool program. Each of the special education teachers in the school held master’s degrees in special education. The assistant teachers all held bachelor degrees.

The data in the study consisted of measuring the life skills being taught: responding to name, requesting/manding adult attention, requesting/manding adult assistance, delay tolerance, denial tolerance, and independent versus prompted responses. The authors indicated they also collected data on challenging behaviors but those data were not presented in the paper. The authors also reported high IOA data as well as high fidelity data (which is not always reported).

The authors provided a great description of the modifications provided to students who did not acquire the skills in Tier 1, 2, or 3. For these students, this included the use of an AAC device (i.e., proloquo).

One of our big discussion points occured around the author’s use of least to most prompting during Tier 1. We discussed if the results would have been different had they used most to least prompting and decided this should be a point of focus in a future study!

Another area of discussion for us revolved around the authors’ use of only 8 trials per session. This hardly seemed like enough practice for a preschooler, let alone a pre-k student with disabilities (the children had autism, Down syndrome, or DD).

We discussed, and the authors mentioned, the use of AAC and whether the students would have acquired the skills in Tier 1 had the AAC been available during that phase of instruction.

We also discussed the lack of preference assessments and whether the authors’ use of social reinforcement may have been potent enough to reinforce skill acquisition.

And finally, we discussed the limited generalization observed to peers. Some of the kids generalized skills to the adults who are obviously more skilled than the peers. But we also discussed the fact that with such few learning trials (N=8), that the kids may not have developed fluency in the skills thereby limiting their ability to readily generalize the skills. And of course, the authors mentioned that they did not program for generalization so this may have impacted generalization as well.

Bottom line, these seem to be some essential skills that we could easily teach in classrooms to increase the social skills of students.

I have identified a few extra resources. First because of all the tolerance discussion, we should look at some of the original tolerance studies. The following studies utilized FCT combined with Tolerance training.

  1. Bird, F., Dores, A. P, Moniz, D., Robinson, J. (1989). Reducing severe aggressive and self-injurious behaviors with functional communication training. American Journal on Mental Retardation, 94, 37-48.
  2. Brown, K. A., Wacker, D. P., Derby, K. M., Peck, S. M., Richman, D. M., Sasso, G. M., Knutson, C. L., & Harding, J. W. (2000). Evaluating the effects of functional communication training on brief functional analyses of aberrant behavior. Journal of Applied Behavior Analysis, 33, 53-71.
  3. Carr, E. G., & Carlson, J. I. (1993). Reduction of severe behavior problems in the community using a multicomponent treatment approach. Journal of Applied Behavior Analysis, 26, 157-172. 
  4. Day, M. H., Horner, R. H., O’Neil, R. E. (1994). Multiple functions of problem behaviors: Assessment and intervention. Journal of Applied Behavior Analysis, 27, 279-289.
  5. Fisher, W. W., Thompson, R. H., Hagopian, L. P., Bowman, L. G., & Krug, A. (2000).  Facilitating toleraance of delayed reinforcement during functional communication training. Behavior Modification, 24(1), 3-29.
  6. Hagopian, L. P., Wilson, D., & Wilder, D. (2001). Assessment and treatment of problem behavior maintained by escape from attention and access to tangibles. Journal of Applied Behavior Analysis, 34, 229-232.
  7. Harding, J., Wacker, D. P., Berg, W. K., Barretto, A., & Ringdahl, J. (2005).  Evaluation of relations between specific antecedent stimuli and self-injury during functional analysis conditions.  American Journal on Mental Retardation, 110(3), 205-215.
  8. McConnachie, G., & Carr, E. G. (1997). The effects of child behavior problems on the maintenance of intervention fidelity. Behavior Modification, 21, 123-158.
  9. Symons, F. J., Fox, N. D., & Thompson, T. (1998). Functional communication training and naltrexone treatment of self-injurious behavior: An experimental case report. Journal of Applied Research in Intellectual Disabilities, 11, 273-292.

And here are some extra resources on Preschool Life Skills

  1. Hanley et al 2007
  2. Luczynksi & Hanly (2013)
  3. Luczynski, Hanley, & Rodriguez (2014)
  4. Beaulieu, Hanley, & Roberson 2012
  5. Beaulieu, Hanley, & Roberson 2013
  6. Hanley, Fahmie, & Heal 2014 (in headstart)
  7. Francisco & Hanley (2012)
  8. Robison, Mann, & Ingvarsson (in press)
  9. Dogan et al 2017 (training parents)
  10. Halfdanardottier, Sveinbjornsdottir & Ingvarsson (in process but looking at life skills in older students)
  11. Ala’i-Rosales et al 2018
  12. Fahmie & Luczynski 2018 (review of studies)

We have updated webinars in the future covering the training you need! Flyers and syllabi are available for each webinar!

Make sure to visit our web page to get all the information and details on each one, so you don’t miss out! Check for dates that work for you and times they occur in the day.

Cost may vary, along with the credits they provided.

Don’t stress! These webinars can be learned from the comfort of your very home or office space! There are reduced rates available for groups of three!

Upcoming Webinars:

July 11th– Ethical Issues in Supervising and Training (Part 1)

July 12th– Supervision (Part 2) Skill Demonstration

August 22nd– Ethical Issues in Conducting FBAs and BIP Development

September 12th– SPED Law and Ethical Issues for Behavior Analysts

(Make sure to visit our website to get all the information you need to make learning easy for you!)

Contact: 203-903-9363 for any questions.

To Register: http://www.appliedbehavorialstrategies.com/workshops

What is Autism Recovery?

If you know anything about me, you know that I am passionate about providing quality services for children with autism as early as possible to ensure that every child has the opportunity to progress as far as possible and to potentially recover from autism. I’ve written about this topic here, here, and here.

If you think I’ve already had a few too many to drink today, please check out this professional video from the University of Connecticut. The researcher in this video is a Licensed Clinical Psychologist. Her name is Deb Fein and she is really good at diagnosing children. She realized she needed to study this further when a child she had previously diagnosed returned to her several years later and did not meet the criteria for autism.

So she began researching this very topic. While recovery from autism describes what she sees, Dr. Fein has chosen to use the words Optimal Outcome to describe the children who ultimately obtained optimal outcome and no longer met the criteria for autism.

In our journal club meeting on Monday, we read and discussed the following article:

Moulton, E., Barton, M. Robins, D. L., Abrams, D. N., & Fein, D. (2016). Earlycharacteristics of children with ASD who demonstrate optimal progress between age two and four. Journal of Autism and Developmental Disorders, 46, 2160-2173. You may access a free copy of the article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860351/pdf/nihms761908.pdf

We were a little disappointed in this paper in that it didn’t address treatment and optimal outcome but rather predictors of optimal outcome. 190 children participated in the study with 19 of them achieving optimal outcome.

At the beginning of the study, researchers classified all children into 4 groups: PDD-NOS; Asperger’s; ASD; and ASD Low MA (mental age less than 12 months). On average, all children were diagnosed around 26 months of age. Re-assessment occurred around 48 months.

Before we go further, it is important to note that the children in this study were Caucasian and far above the poverty line. Also, the study didn’t control for early intervention so it’s hard to really say other than the obvious:

  1. Children who were originally diagnosed with PDD-NOS were more likely to lose their diagnosis at re-evaluation.
  2. No children with ASD-Low MA met the criteria for optimal progress (OP) at follow up assessment. 
  3. Children in the OP group showed less severe symptoms in the area of social skills, stereotypies, and sensory abnormalities
  4. Children in the OP group showed fewer DSM-V symptoms at initial diagnosis
  5. Children in the OP group showed stronger adaptive abilities
  6. Lesser symptoms of restricted interests and  repetitive behaviors predicted OP.

​It is super important that we not think of this as mis-diagnosis but rather, the earlier the diagnosis, the earlier the intervention, the more quantity of intervention, and thus, better outcomes that result in losing the autism diagnosis.

If you are in the Fort Pierce area, stop by to see us! Scenes from this morning.

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