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Posts Tagged ‘ADHD’

In light of all the discussions this week regarding ADHD and medication, Using ABA to Address ADHD, and a research study on Addressing ADHD in Classrooms, this cartoon seems relevant!

Thank you Hank Ketcham for your brilliance all these years!

Dennis and Impulsivity

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English: A child not paying attention in class.

After yesterday‘s post regarding the use of ABA to treat ADHD, readers expressed interest in learning more. So today, one intervention to address ADHD behaviors will be discussed.

Reinforcement

Readers should not be surprised to hear that reinforcement is a recommended intervention. Reinforcement is a key topic in almost every single post on this blog. The important thing to remember is that reinforcement must be individually designed and administered in order to obtain maximum results. Individualization is not easy for teachers or parents. However, if appropriate reinforcers and correct schedules of reinforcement are utilized, great changes in behavior will be observed.

Differential Reinforcement

There are many types of differential reinforcement:

  • differential reinforcement of other behavior (DRO)
  • differential reinforcement of incompatible behavior (DRI)
  • differential reinforcement of alternative behavior (DRA)
  • differential reinforcement of higher rates of behavior (DRH; designed to increase desirable behaviors!)
  • differential reinforcement of lower rates of behavior (DRL)

Essentially, differential reinforcement is the use of reinforcement for one behavior and not for others. Differential reinforcement requires implementors to reinforce one behavior while withholding reinforcement for another.

Differential Reinforcement of Alternative Behavior (DRA)

In this intervention, reinforcement is provided when an alternative behavior is observed but not when inappropriate behaviors are observed. Specifically, if a child is engaging in off task and distractable behaviors, alternative behaviors would be identified. It is important to know why (e.g., to get out of work, to get teacher attention, etc). An assessment must first be conducted to know why a behavior is occurring. To read more on assessment, check here, here, and here. Once the assessment has been completed, then alternative behaviors to obtain the same reinforcers are identified.

If a child is trying to get out of work, an alternative behavior is to work faster so that play and non-work time may be accessed. If a child is trying to gain teacher attention, then the child is taught to use appropriate behaviors to get teacher attention.

The next step is to reinforce the new/alternative behavior. If the child is working quickly, she needs to be reinforced with a nice long work break or play time. If the child appropriately recruits teacher attention, the teacher needs to come over quickly to give attention.

Thin Reinforcement

As with any intervention, the goal is to get appropriate behavior then to thin or reduce reinforcement so that the child may function like the rest of children in the class or home. It is important to thin reinforcement at a pace that will prevent the ADHD-type behaviors from escalating.

I hope this helps readers better understand one way that ABA may be used to address ADHD.

Related articles

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Ginger rated her behavior during carpet time

Hi! and welcome to What Works Wednesdays where a success story from clinical files is shared. Today’s story is about a little girl named Ginger who happens to be a typically developing 3rd grade. Ginger’s teacher contacted Applied Behavioral Strategies to assist her with Ginger’s behavior because Ginger had difficulty paying attention during morning meeting, sitting quietly during group instruction, and staying on task during independent seat work.

Record Review

A review of Ginger’s academic records indicated that she was performing at grade level in all areas. While she had some struggles learning to read, with focused intervention, she has remained on a 3rd grade reading level. Ginger is also very active and has difficulty keeping her hands, arms, and legs still. Finally, Ginger is highly distractable. Her focus is disrupted by butterflies, peers walking by, and particles on the floor.

Ginger’s teacher felt overwhelmed because she had tried verbal reminders, notes home to parents, and seating arrangements. She felt that none of these strategies worked effectively.

Student Interview

The behavior analyst asked Ginger why she had difficulty sitting quietly, completing her seat work, and listening to teacher instruction. She responded that, “I try to sit still and listen but my friend talks to me” and “I try to do my work but I have to sharpen my pencil” and “I sit away from my friend but she comes to sit next to me”.

ABC Observation and Analysis

Direct observation revealed that a variety of consequences followed these target behaviors. Sometimes Ginger received a verbal warning, sometimes the class received a reminder, and some times, no consequence occurred at all.

Self-Management

The behavior analyst needed more time to complete the assessment

so she developed a brief self-monitoring plan for Ginger to use until the assessment and behavior intervention plan could be completed. The self-monitoring plan consisted of Ginger evaluating her own behavior following each instructional activity. Her teacher reviewed the evaluation and confirmed if the evaluation matched reality. Ginger received praise and positive feedback for desired behaviors and her parents provided additional positive attention each day when Ginger shared her rating at home.

Additional Tips

The form was printed and put onto Ginger’s favorite color of construction paper. Then it was laminated so that one side showed the seat work and the other side showed the carpet time. Using a dry erase marker, Ginger could self-rate each day and then the chart could be wiped clean for the next day.

Ginger rated her behavior during seat work

Success

After 2 weeks, the assessment had to be put on hold because Ginger’s behavior improved. As with any student, Ginger continues to have difficulty when substitute teachers are present. However, this simple intervention worked to focus on Ginger’s strengths by reinforcing desirable behaviors.

Readers, have any of you tried self-management? What worked? Parents, have any of your children been placed on self-management plans? Did you like it? Did your child?

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Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about behavior. Today’s question comes from Erin who asks

Last week, my four-year old son was just diagnosed with autism by a neurologist. However, at the IEP (Individualized Education Program) meeting back in March, the school told us our child was “fine” and that he no longer needed services. We moved to a new school district a few months ago. So when we received the autism diagnosis, we went to the new school to ask what to do. They told us that since we had our IEP meeting back in March at the other district, that whatever happened in that meeting determined what services would be available to us now.

Our child needs help! He has been kicked out of several day cares because of his behaviors. He is hyper, biting, loud, and wiggly. I cannot take him in public. Where can I get medication to make this all better? Can’t someone help us?

Wow Erin, I’m speechless. First, I am sorry that your child’s behaviors feel so out of control for you. It sounds like he definitely needs some help  in that area. But also, let’s not forget that he was also given an autism diagnosis and thus, he is going to need help in the three main areas related to autism: speech and language, social interactions, and other behaviors such as stereotypical behaviors and/or adaptive behaviors.

Request an IEP Meeting

I am going to back you up and have you start over with your new school district. Go to the district and bring copies of the new diagnosis and that person’s recommendations. Bring a letter that you have hand-written and dated (and saved a copy of at home) requesting an IEP meeting as soon as possible–preferably before the holiday break. While the IEP meeting in March resulted in your child being dismissed from services, new information is available suggesting that your child does, in fact, need services. The school must arrange an IEP meeting to be held within a reasonable amount of time.

At this new IEP meeting, the new team will determine if your child is eligible for services. According to federal guidelines, two things are required for him to be eligible for services. The first is that he must have 1 of the 14 disability categories identified in the Individuals with Disabilities Education Improvement Act (IDEIA). Autism is one of those 14 categories , so you are in luck there. The second requirement is that he needs special education in order to benefit from education. Your child cannot possibly benefit from education because he has been kicked out of an educational setting due to his behavior. Thus, he needs special education services to address his behavior so that he will benefit from the education available to him.

Develop a Behavior Intervention Plan

This brings me to another point. Under federal guidelines, if a child’s behavior interferes with his learning, then the team must consider positive behavior supports. By definition, in order for a child to receive positive behavior supports, he must first have a Functional Behavioral Assessment to determine why his behaviors are occurring. The assessment is then used to develop the Behavior Intervention Plan (BIP). All people involved in your child’s program must be trained on the plan and they must implement the plan. This includes you, your husband, the bus driver, the teacher, the speech teacher, and so forth.

Design a Program

Throughout the meeting, the team, including you and your husband, should develop a program that will address each and every one of your child’s needs. This is in addition to the BIP that should be developed. During the program development, it will be important to identify a number of goals and objectives that your child needs to master throughout the course of the year.

Particular attention should be paid to the three main areas of autism: communication, social skills, and behaviors. Additionally, the school is required to use evidence based methodology to teach your child. Currently, instruction based on principles of Applied Behavior Analysis (ABA), is widely recognized as one successful method for teaching children with autism. Any ABA program should be overseen by a Board Certified Behavior Analyst (BCBA) or someone with training and experience equivalent to a BCBA.

To Medicate or Not

I can certainly relate to your desires to medicate your child to control his behaviors. However, before you go down that route, might I suggest that you try other proven strategies first. For example, we know that certain foods may cause an increase in behaviors. You may read a bit more about that here and here.

Additionally, the BIP and comprehensive IEP, should be designed to teach your child to better control his behaviors. Multiple strategies, including the use of self-management, should be a part of his program.

If, after 6-12 months of following all of these techniques, your child’s impulsivity and hyperactivity has not improved, then perhaps you should visit an appropriately trained health care practitioner to discuss medication options.

You have a long road ahead of you. However, research has shown that an autism diagnosis is not the end of the road. Children can recover from autism and go on to function independently and indistinguishable from their peers. Get to work! And please send me updates!

If you have a behavior question that you need assistance on, please email: askmissy at appliedbehavioralstrategies dot com.

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Here at Applied Behavioral Strategies, we are concerned with helping children who have behavior challenges using Applied Behavior Analysis (ABA) as the treatment. While most people think of ABA as a strategy for children with autism, we serve a variety of clientele, including children without disabilities. Thus, we are frequently contacted by parents who need help with their child’s behavior.

At times, parents will contact us because they think their child has Attention Deficit Hyperactive Disorder  (ADHD) and they do not know what to do. Our first recommendation is to have the child properly assessed and diagnosed by a licensed professional. In our practice, we conduct behavioral observations and assessments, we do not diagnose children.

School Evaluation

Parents may seek assistance for assessment in three different ways. First, parents may request an evaluation by school personnel. This full and initial evaluation is completed at no cost to the family. The assessment is completed by a licensed school psychologist or licensed psychologist with the assistance of other school personnel including a general education teacher, special education teacher, and possibly a speech and language pathologist.

The entire process could take up to 60 days from start to finish as the assessment includes observations of your child in his/her classroom, individualized assessment time, and parent and teacher interviews. For additional information about the initial evaluation process for children with ADHD, Wright’s Law is a great resource.

Licensed Psychologist

The second source for assessment comes from a licensed psychologist. Finding the right psychologist to assist you may take some time as you should check their background to ensure that they have extensive training and experience with this population. Speak to other parents who have utilized the person’s services. Interview the psychologist to make sure he/she is a good fit for you and your child.

Once you identify the psychologist, he or she will schedule several appointments with you and your child. Just like the process used by the school personnel, the psychologist will administer formal assessments with your child, observe your child in his/her classroom, and conduct interviews with you and the child’s teacher. The entire process could take anywhere from 2 to 6 weeks. Receiving the written report and recommendations could take additional time depending on the detail provided by the psychologist.

Medical Professional

The last resource for a diagnosis of ADHD comes from medical professionals. Some family physicians who have training and expertise in ADHD may be available to assist with a diagnosis. Psychiatrists may also be available. The primary difference between medical professionals and licensed psychologists is that psychologists have been trained specifically to administer assessments to evaluate your child formally. Medical professionals, on the other hand, have been trained to treat conditions using medications. If you choose to use a medical professional, take extra precaution to ensure that you select someone with specific training and experience in ADHD.

If you think your child has ADHD, we advise you to read and become informed about the condition as you will be your child’s best ally throughout the process.

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Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about behavior. Today’s question comes from Shannon and Gary who write:

“This feels like an odd question because we know there are many families who work hard to help their child(ren) learn to maintain appropriate eye contact when communicating. Our child has decent eye contact while requesting things, but when we speak to him, not only is his eye contact very poor, but he won’t stand still! He’s constantly rocking back and forth from one foot to the other (sort of like walking in place) or walking away. Sometimes he will maintain some eye contact while moving around, but we would prefer to have him stand still and look around the room than to have proper eye contact and have him wiggling.

Is it appropriate for us to expect a six-year-old to stand still while we give him directions? If so, how can we target that behavior? Should it be targeted separate from maintaining eye contact and listening to directions? Eventually we would like him to be doing all three at once.”

Thanks for writing Shannon and Gary! This is a great question  and it is not unrealistic to expect your child to stand still. However, it may be impossible for his body to be still. One of the things we have learned as behaviorists is that the foods we eat may affect our bodies and behaviors. So, the first thing you need to do is get a good nutritionist to take a look at your child’s dietary habits. We know that artificial food coloring causes big wiggle problems. This includes dyes of blues, reds, oranges, and yellows. It is fairly easy to cut out the artificial colors when you cut out artificial foods. So the next step is to move to a whole foods diet. While the store Whole Foods is helpful for this, you will find it more affordable to shop locally. Aim for foods that are grown or killed (fruits, vegetables, meats and fish).

Once you rid your child’s body of harmful ingredients that may be causing all of the movement, then the next step is to teach him step by step how to stand and attend. You do this by working on his focus and attention using principles of Applied Behavior Analysis (ABA). We usually start by having your child focus on something for a very short period. We use a simple laser pointer and shine it on the wall. When your child stands still for 5 seconds (you may need to start even shorter–at 3 seconds), then reinforce his behavior by providing him access to a preferred item or activity.

When your child can successfully focus for 5 seconds, then increase the goal time to 10 seconds and so on.  When your child can stand still and focus for one minute, then you add distractors like noise, music, and people. When your child can focus for a minute with distractors, then you start adding information for your child to remember while remaining focused.

There is a great game on the Wii for this under the balance games. It is called the Lotus Flame. It requires the child to sit but that may also be effective at teaching your child to focus. Good luck! Please let us know how it goes.

If you have a question about behavior, please email me at askmissy at appliedbehavioralstrategies dot-com.

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