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Posts Tagged ‘Autism’

It was incredibly awesome to meet so many behavior analysts at the National Autism Conference! If you have never been to this conference, you should add it to your “to do” list. I got to meet my hero, Dr. Perry Zirkel. He presents there every year so if you go for no other reason, go to see him! The other perk about this conference (besides seeing AMAZING behavior analysts such as Tim Vollmer, Nikki Dickens, Tom Zane, Bill Heward, & Janet Twyman present) is that you get to access all the handouts online. So if you are having conference FOMO, you can still see some of the posted content here. Click on the speaker and then access their handouts.

My session on SPED Law and Ethical Issues for Behavior Analysts was full of engaging participants with many questions. I really appreciate how everyone participated with my questions and case studies! Thank you all!!!

While we made it through all of our planned content, we did not get through all of the questions that BCBAs posted in our Menti.com interactive software. So I promised participants that I would work through the questions here on our blog.

Q1. If a student needs a positive behavior support plan (PBSP or BIP) based on the FBA, does a behavior IEP goal have to be developed or is implementation of the PBSP/BIP (with data, consult, fidelity) enough?

This is a good question. To my knowledge, there are no laws/regulations on this. Be sure to check in your state for certainty. With that said, it would make logical sense that goals in the BIP would align/feed into the goals in the IEP. I would include replacement behaviors, positive behaviors, and targeted challenging behaviors. Beware: it has been my experience that as a more severe behavior is addressed, the topography may change. So the IEP goal would be met (i.e., zero aggression) but another goal would be added to target the new behavior (e.g., verbal threats).

Q2. When writing IEP goals after an FBA has been conducted, is it required to develop goals for both increasing a replacement behavior and decreasing the problem behavior?

To my knowledge, there is no requirement for this. Be sure to check your state law/regulations. However, it is good practice to ensure that staff focus on appropriate/replacement behaviors.

Q3. When a student is being placed out of district, does the referring district need to conduct the FBA before the placement occurs? Sometimes we (placement) receive an FBA but it is very outdated.

Again, to my knowledge, there is no requirement for this. Be sure to check your state law/regulations. It would be best practice under the LRE to ensure that all supports and services have been attempted before moving the student to a more segregated setting. An FBA and appropriate BIP would be one such example of supports/services.

Q4. I work for an Intermediate Unit. Districts contract a specific number of hours that they will need for me to consult in their districts. To be clear, consent for all consults/observations?

Who is your client? Who is the PRIMARY beneficiary of your services? If you are observing in a CLASS and you are providing consultation to the teacher, the teacher is your primary beneficiary of services. Your contract is with the district and the teacher is giving assent/consent to your services. The second you begin focusing on Johnny’s behavior or Suzy’s behavior, the individual child becomes your PRIMARY beneficiary of services. The teacher and paras are the secondary beneficiary of services. That child is a MINOR. His parents deserve to consent to your services. Under your BACB Code of Ethics, you need to have a contract for services (the IEP serves as a contract. Without an IEP or 504, you have no contract). You also need written consent to assess Johnny or Suzy. What is an observation of Johnny and Johnny’s behavior if it is not an assessment? And you need to work with the parents as part of the assessment process.

Q5. I work with a funding stream that contracts for services after an FBA has been completed and does not want us to complete them at re-eval. What should we do if there are no consents to re-eval?

Well, we all know that under IDEIA and the BACB Code of Ethics that an FBA (or assessment of any kind) may NOT be conducted without written consent from the parents. If you feel that an updated FBA is needed, then it is your clinical responsibility to document the need for an updated FBA and request it from the parents and the district.

Q6. As a parent, what can I do when I walk into an IEP meeting that has been written already? As a professional consulting, what can I do in the same situation?

This is a great question. There are a couple of ways you can handle it. 1) You could be a total jerk, rip it up, throw it in the trash and announce that you are exercising your right to be an EQUAL team member. 2) Another, more socially appropriate response would be to reach out to the teacher BEFORE the IEP is due and ask to meet to plan/discuss the upcoming IEP. 3) Finally, you could thank them for supplying you with a draft for review but add that you have some additions/corrections/changes that you would like to be made. I like option 2 as it lends itself to be more collaborative. If you are a consulting professional, you have no rights. So……when asked, add your input that would be backed with a written report full of data and data-based recommendations.

Q7. How many possible meeting dates must the team extend to parents if they cannot make the first date(s) given for an IEP?

This is one of my favorite questions! In case you do not know, the parents are an equal team member AND meetings must be held on dates AND times that are convenient to all the team members. The law and the regs fail to stipulate how many attempts must be made to get these meetings scheduled. However, the regs are clear that MULTIPLE attempts must be made. These attempts must include different modes of correspondence (e.g, phone, mail, etc.) These days, we have technology that allows us to schedule among many busy people. I highly recommend using Doodle for families who are tech saavy. I recommend face to face visits with families to nail down a time to ensure attendance and participation. I also recommend telehealth to allow families to participate right from work. The federal government recently indicated that attending IEP meetings falls under the FMLA act! wooo hoo for families!

Q8. As a parent, I don’t feel that “teacher notes” are data that accurately reflect my child’s progress. What can I do?

You are 100% correct that teacher anecdotal notes are insufficient to reflect a child’s progress. Can you imagine a parent of a child in general education, where the child received a C and the parent went in to inquire about the C. How do you think the teacher could possibly use her notes to justify the C? She cannot. She must use class assignments that are GRADED correct and incorrect. She must use test scores (GRADED correct and incorrect). She must use a rubric on projects with points assigned to various components on the project. All of these things are also required in special education. Simply ask for measurable data outcomes.

Q9. Public school refuses to provide copies of raw data. Claim that data in that form can be misinterpreted. What can parent do?

In general education do you get to see your child’s spelling test? Do you see the individual items that led to the 50% score? Yes! you can do an item analysis to find out why your child is failing spelling. For reading, do you get to see the reading tests so you can better understand why your child is not progressing in reading? Yes! Why would you NOT be allowed to see the data for your child in special education? ANALYZING is an important part of what we do (that is the second A in ABA). Item analysis, response analysis, data analysis should be allowed—especially if a child is not progressing.

Q10. I’m a teacher. We contracted a BCBA to help in the class. When paras and staff asked clarification or why something is done. The response was always I have the certification that’s why. What do I do?

These are the things that we do not want to hear about fellow colleagues. I’m sad for a BCBA who responds in this way. He/she clearly learned this behavior from somewhere else and should be reminded that this is not in alignment with our BACB Code of Professional and Ethical Code of Conduct. Please have him/her read this! The BCBA should work with you (and the parent) to develop a plan that is understandable. The plan should be explained to you in detail. You should be given time to ask questions AND to receive training on the plan. Here are a few quotes from our code: For example, under 3.04 Explaining Assessment Results. Behavior analysts explain assessment results using language and graphic displays of data that are reasonably understandable to the client. Also under 4.02 Involving Clients in Planning and Consent. Behavior analysts involve the client in the planning of and consent for behavior-change programs. And under 4.05 Describing Behavior-Change Program Objectives. Behavior analysts describe, in writing, the objectives of the behavior-change program to the client before attempting to implement the program. As a teacher who is benefitting from the services provided to the client, you are also the client of the BCBA. Additionally, in the same 4.05 code, The description of program objectives and the means by which they will be accomplished is an ongoing process throughout the duration of the client-practitioner relationship. And finally, 7.0 Behavior Analysts’ Ethical Responsibility to Colleagues. Behavior analysts work with colleagues within the profession of behavior analysis and from other professions and must be aware of these ethical obligations in all situations. So, please help this BCBA understand his/her responsibilities to you and your paras.

Q11. You shouldn’t say you are doing Social Thinking if you aren’t doing it as prescribed though. So we should be saying ‘modified ST’.

So is Social Thinking a curriculum or an intervention? It sounds as if you view it as an intervention. Should we be doing this practice as BCBAs? As behavior analysts under the BACB Professional and Ethical Compliance Code, 1.01 Reliance on Scientific Knowledge. Behavior analysts rely on professionally derived knowledge based on science and behavior analysis when making scientific or professional judgments in human service provision, or when engaging in scholarly or professional endeavors. And also under 4.01 Conceptual Consistency. Behavior analysts design behavior-change programs that are conceptually consistent with behavior analytic principles.

Q12. If you are part of a child study (pre-eval) team, and parents were invited but do not show or answer calls, can we still not discuss the student with the team cause there is no consent?

This is a good question. First, cheers for your team for inviting parents to the pre-evaluation/pre-referral process. This is the first step in acknowledging that the parents know their child better than anyone. As a BCBA, you should not be making any recommendations about ANY child without first conducting an assessment (see your assessment code 3.01). Additionally, you cannot start the assessment without written consent (see your assessment code 3.03). And finally, you should only provide services as part of a defined, professional, or scientific relationship or role (see your code 1.05). Without an IEP or other contract for services, it would NOT be advisable to act as that child’s professional.

As you can see we had a very lively session! Thank you again to the NAC for inviting me to speak and thank you to everyone who participated in the session.

Check out some of our related posts on SPED Law:

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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.

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

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We are pleased to announce the opening of our Florida WCity_Hallest Coast (AKA Cultural Coast) office!

We have no wait for ABA services! We accept most forms of insurance. We provide services in your home, in your child’s school, in your child’s daycare, and other community locations.

 

Please contact our office if you are interested in obtaining services.

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You know, I like to be positive. But today on this International Autism Day (AKA Light It Up Blue #LIUB), I’m not getting the feeling that we have the “awareness” we need. And it makes me ANGRY.LIUB

Yes, I’m happy that thanks to Autism Speaks we have 45+ states with insurance mandates!

 

But I’m boiling red mad because “awareness” is not enough! 😡

We need:

  1. Children identified EARLY. Pediatricians should lose their license when they send a family away and tell them to wait. REFER! A licensed clinician, with expertise in early identification, can determine if it’s autism.
  2. When the child is diagnosed, early intervention happens IMMEDIATELY without waiting lists or delays.
  3. Every child should be able to receive applied behavior analysis (ABA) therapy at the intensity recommended by the professional and based on assessment. This should be without regard to race, native language, socio-economic status, or type of insurance coverage. If you want to know more about ABA, read here.
  4. Every child with symptoms should be screened for appropriate medical treatment of any GI problems such as reflux, constipation, diarrhea, or food allergies/insensitivities.
  5. Every child should have access to quality behavioral feeding intervention if assessment indicates it is warranted.

Until these things happen, I will stay mad or “I mad” as one of my clients told me recently (when he found out he couldn’t have chocolate ice cream.) Go ahead, light it up blue but let’s turn awareness to ACTION!

 

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We are pleased to announce the launch of our new website! It is the same URL address, just new updatesgraph to make it easier for mobile users to stay in touch.

Our applied behavior analysis (ABA) team has worked hard to complete professional photos, update bios, and introduce our new behavioral feeding page!

Don’t miss our upcoming webinars for 2017. We offer group rates for 3 or more individuals from the same agency who are taking the course from separate computers. Our best discount is for groups who will share a computer during the webinar! Register 1 person at full price and all others are only $10! That’s right, $10 for the whole course when you share a computer. To register, simply visit our website here, scroll to the very bottom, enter your name and other pertinent information, enter an abbreviated title, and follow the link to PayPal where you may pay with your account or with any credit card. We also accept purchase orders from school districts!

Did you know that ABS has a monthly journal club where you earn 1 CE each month? Did I mention that the  Journal Club is FREE? All you have to do is join the club, read the article, and be present for the discussion. Email the info line at: info at applied behavioral strategies dot com to join the journal club.

If you haven’t been to our page in a while, hop over for a visit to meet our amazing team of BCBAs. (As an aside, we are currently hiring full- and part-time BCBAs.  If you are bi-lingual Spanish, we would be thrilled. We are also hiring part-time behavior therapists.) Come join our awesome team!

And finally, if you just want to stay in touch, join our mailing list here.

If you like what you see, say so! Like this post, like our facebook page, or follow us on LinkedIn,

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We are registered to do business in Tennessee! We are so thrilled to be expanding and to soon be offering services to children with behavioral challenges and their families.doing-business-in-tn

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