Posts Tagged ‘assessment’

It was another great FABA! I’ve made so many friends and I keep meeting more each year.

Nikki’s presidential address was definitely my favorite. I really enjoyed hearing about big data for the closing session as well. It gives me food for thought.

I enjoyed my workshop and my panel but I seriously thought our talk on assessment rocked. Too bad we were competing against big names like Merrill. None the less, we need to get this published!

If you missed FABA this year, hopefully you will make it next year in Jacksonville.

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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 story is about a young man we call Boost (you will see why a bit later in this post).

Boost came to us with a long history of feeding difficulties and he was only 7. He was diagnosed with autism and he was also non-verbal. Boost had previously eaten food but only in wet ground form. By the time he got to us, he consumed only Boost and apple juice. Both liquids were consumed from a bottle with the top of the nipple cut off so the liquid would literally pour into his mouth.

Prior to any behavioral feeding therapy, we require a thorough record review and assessment to assess for any possible underlying issues. (Honestly, all intervention programs should be preceded by a thorough assessment to help with program planning. We have written about that previously here.) For Boost, we completed a record review to determine if any assessments were needed prior to therapy. Boost had a long history of gastrointestinal (GI) issues so we referred his family to a gastroenterologist for a thorough work up.

The gastroenterologist completed an endoscopy during which the gastroenterologist inserted a pill camera to complete an assessment of the entire small bowel. He discovered that Boost had serious inflammation in his GI tract. Specifically, Boost’s pylorus was so inflamed that even the pill camera would not pass. You heard us correctly. A tiny pill camera would not pass through his pylorus. And we all wondered why he had limited his calorie consumption to a pure liquid diet.

You see, Boost was non-verbal. He could not tell us that he had GI pain. He could not tell us that it hurt to eat. Had we started therapy without the GI Assessment, we could have caused Boost a great deal of pain. This case is an excellent example for demonstrating the importance of assessment prior to treatment.

The GI Doctor placed Boost on an elemental formula and anti-inflammatory medication so that Boost could obtain appropriate nutrition while allowing his GI tract to heal, a process that took 6 months.

Parents, if you have a picky eater, please make sure that you obtain assessment in all areas to rule out underlying issues. Behavior analysts, do due diligence in the assessment process to ensure that you do no harm in your behavioral feeding therapy.

We would love to hear from readers. Please share what types of information you have gained from the assessment process prior to behavioral feeding therapy.

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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 Tracy, who asks:

“My child is having his first ABA Assessment soon, what questions should I ask? What should I expect?”

Tracy, thanks for asking! You have been an amazing help to me on Twitter so helping you in this way is the least I could do. You have definitely opened a can of worms with this question but hopefully I can give you some insight.


Your first question to the provider should be, “Do you believe in and work towards recovery from autism?” I realize that this question may offend some readers with autism. Please understand that I would never suggest that any individual who is capable of self-advocating be treated without consent. However, for young children, we know that the symptoms of autism can be successfully treated so that the child can go on to function in school without special education. The child can go on to function in adulthood without supports. The recovery rate is not high (around 48% of treated children). However, even if children do not fully recover, early intervention can lead to great improvements in IQ, adaptive behavior, and communication. “Shoot for the moon. Even if you miss it, you will land among the stars.” -Les Brown.

Reinforcement and Punishment

The second question you should ask is, “What is your philosophy on reinforcement and punishment?” A good ABA team will use a variety of reinforcers to help your child learn. Over reliance on edible reinforcers can be problematic. We have written a little bit about reinforcement here. Check it out. Preference Assessments are a must. Read about them here.

A good ABA team should deflect the question on punishment and talk more specifically about using reinforcement to address challenging behavior. Do not get me wrong. Punishment strategies are important and warranted in many cases. However, in a comprehensive ABA program, the team should be modifying antecedents to prevent challenging behavior, teaching replacement behaviors for challenging behavior, and severing the association between reinforcement and challenging behavior. New, appropriate behaviors should be reinforced and challenging behaviors should not be reinforced.


The third question you should ask is, “What curriculum do you use?” My favorite response to this question is “We use a variety of resources to determine what to teach your child.” Any agency who relies on one tool to drive their programming for your is setting your child up for failure. Your child with autism needs a comprehensive program to address all areas of development including receptive and expressive communication, fine and gross motor, social and emotional skills, pre-academic and academic skills. As your child ages, other skills such as pragmatics, perspective taking, and theory of mind skills will be important.

An exception here is the SKILLS assessment and curriculum. Having worked for CARD for several years, I know that the SKILLS curriculum was developed using multiple resources. CARD also completed several research studies on reliability and validity of the measure. While the curriculum may appear to be one tool, it is actually quite comprehensive.


The fourth question you should ask is, “What is your philosophy on inclusion?” The research on ABA (and on inclusion) supports that children should be educated alongside their typically developing peers as soon as possible. Depending on the severity of your child’s autism, he/she may need initial instruction in a very small, distraction-free environment. Once your child learns how to learn, he/she will be transitioned to a larger room with distractions. Once your child is able to imitate and learn from watching others, he/she needs to start regularly scheduled play dates to practice skills with other children. Finally, your child should be transitioned to a preschool with support. The support should be systematically faded until your child is functioning in general education with no supports.


Finally, your last question should be, “What is your philosophy about assessment?” This is a loaded question but their response will be informative. We have written a little bit about assessment here. The bottom line is that an agency should either refer you to or assist you with a variety of assessments. Obviously, the first is the diagnostic assessment where your child received the autism label. After that, a comprehensive developmental assessment is needed so that your child’s current level of functioning is assessed compared to his/her peers. This assessment should be norm-referenced and it should occur about once per year so that you will see how your child is progressing.

The agency should complete informal preference assessments daily. This will help them better understand how to motivate your child to work. Formal preference assessments may also be needed initially and periodically throughout your child’s program.

The agency should collect on-going data to monitor your child’s progress towards his/her learning objectives. The data should be collected by each therapist for every therapy session. Data should be graphed following each therapy session. The graphs should be examined to ensure that your child is making adequate progress. Changes should be made to your child’s program if he/she is not making adequate progress.

Supervision and Clinical Team Meetings

Your child’s program should be supervised by a BCBA with extensive training and experience in autism. The supervisor should oversee and train all the therapists on your child’s team. The supervisor should hold clinical team meetings at least twice per month and those meetings should include every therapist and both parents. When possible, related therapy providers (SLP, OT, PT), and school staff should be invited to attend.

The supervisor should also conduct visits of your child during regularly scheduled therapy sessions to ensure that the program is being implemented as planned.

I realize that this was a long-winded answer. Hopefully, it will help you prepare for your meeting! I hope it goes well. We can also schedule some Skype time if you want to talk more.

Readers, if you have a question that you need help with, email me at askmissy at appliedbehavioralstrategies dot com.


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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 a team of professionals who provide feeding therapy to children who are struggling with eating. The team writes,

“Hi Missy, we run a feeding clinic and have recently been receiving calls from a number of parents with very young children. How young is too young to start feeding therapy?”

I thought this was a great question but I wasn’t sure that I had enough information. So, I emailed back and asked them to elaborate. Specifically, what ages are the children? The team responded,

“Well, one child is 11 months old and the other child just turned 2.”

I was stunned. It broke my heart to learn that a mom was struggling with such a very young baby. My first response was that 11 month old clients are still, technically, infants. Thus, my recommendation was for the mother to seek support from her pediatrician or even mid-wife. Of course, the team should recommend a good nutritional, gastrointestinal (GI), and allergy work up. If, after all of those referrals and support, the mother still struggled with feeding, perhaps the child and parent could attend behavioral feeding sessions. However, I would want to exhaust all support services for infants before starting services that are primarily targeted for preschoolers.

We have treated several two year olds in our clinic. However, each client approached or celebrated their third birthday during clinic. Additionally, we modify our intervention strategies slightly due to their young age. There is a big developmental difference between a 34 month old and a 24 month old. So, I urged the team to use caution.


First, teams should carefully assess all participants prior to commencement of feeding therapy. This is especially true for very young children. The assessment should include a thorough record review of the medical history including assessing for any history of reflux or other GI issue. Swallowing function should be assessed by an appropriate professional. Chewing function should be assessed to ensure that the child knows how to manipulate food appropriately in his/her mouth without choking.


Given the child’s young age, the team should first establish rapport with the child so that he/she feels comfortable with each therapist. Second, the child needs to feel safe in the therapy environment. Of course, his/her parents should be present at all times. Finally, be sure to include play time before and after therapy so the child maintains positive associations with the environment. We recommend providing services in the home if possible. However, if not possible, the clinic area should be modified to meet the needs of very young toddlers.


The team should take some time to teach the child some basic compliance skills like gross motor imitation, singing songs, or playing together on the iPad. Once the child has demonstrated an ability to follow basic instructions and he/she has learned that fun things happen following compliance, then it is safe to begin therapy.

Feeding Therapy

Staff should take care to utilize child-friendly approaches during feeding therapy. Staff should never trick the child to eat or sneak food in when he/she is not looking. Staff should, instead, focus on teaching the child to tolerate new foods and to pair new foods with reinforcers such as hugs, cheers, high 5s, and even songs or games on the iPad.

Good luck helping those very young children. We know that the sooner you start, the better the long-term outcome. Please keep us posted on their progress. We know they are in good hands!

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

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One day each week, we would like to review a research article on a topic related to our clinical practice. If you would like for us to review an article that you have heard about, please contact us at info at applied behavioral strategies dot com. As long as it is related to ABA, intervention for children with behavioral challenges, feeding intervention, and parent/teacher training, we will be happy to consider your suggestion.

The article that we are reviewing today is called, “Assessment of Feeding Problems in Children with Autism Spectrum Disorders”. The article appeared in 2010 the Journal of Developmental and Physical Disabilities volume 22 (pages 401-413). Laura Seiverling, Keith Williams, & Peter Sturmey authored the article.

Feeding difficulties among children with autism is not a new phenomenon. Kanner reported it in 1943 and many others have subsequently validated his findings. While children with autism may experience a wide range of feeding difficulties, the most commonly reported issue is “food selectivity”. Most people would call it picky eating. However, for children with autism, the issue is much more extreme than merely picky eating. Children with autism may limit their food consumption to just a few foods. We’ve described this in our own clinical practice here and here.

Despite the severity of feeding difficulties among children with autism, professionals have only recently been able to accurately assess feeding difficulties. Thus, the purpose of the paper was to review various assessments of feeding difficulties including recently developed measures. The authors organized the review into categories of assessments. These included Questionnaires, Direct Observations of mealtimes, functional assessment or functional analysis of mealtime behavior, and use of the Diagnostic and Statistical Manual (DSM).

The authors reviewed a total of 9 different measures or approaches and they concluded with strengths and weaknesses of each. Finally, the authors made recommendations for future directions in assessment.

Have any of you utilized these measures in your practice? Parents, have practitioners used these methods when assessing your child?

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