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Posts Tagged ‘challenging behavior’

It’s Fridaaaaaaaaaaaaay! I don’t know about you all but Friday was a long time coming. We look forward to Fridays around here for many reasons:boy hitting

  1. Friday happy hours
  2. Sleep in on Saturday
  3. Pizza night (doesn’t everyone do pizza night on Friday?)
  4. And Friday Funnies on the ABS Blog!

So we have been writing down all the funny things our kids say. We will share some of them with our readers. For today:

“John” was having a difficult morning in his class. He engaged in a few aggressive behaviors towards the behavior therapist (BT). The BT suggested that John step in the hall so as not to disrupt his peers. At that time, the supervising BCBA walked down the hall and saw John aggressing toward the BT. When John saw the BCBA, he began aggressing to the BCBA. The BCBA blocked the behaviors as planned. After a great deal of blocking, John stopped his aggression, looked at the BCBA and said, “You’ve got nice moves!”

Do you have any funny Kid Quotes to share?

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Last week, I (Missy) shared information about the Congressional Hearings on autism and I questioned why the news media had not picked up on the story. Clearly, they had more important things to talk about:

  • Lindsey Lohan getting arrested again
  • The lucky winners of the Powerball

Clearly, relying on television news media is not the best

Image representing Google Alerts as depicted i...

Image via CrunchBase

way to keep current on all things autism. For those of you who want to be in the know but who lack endless hours in front of the computer, I will share a few of my tricks with you.

RSS Feeds

One way to keep current, is to find your favorite webpages and set up RSS feeds so that you are alerted each time there is a change. I like to set up my RSS feeds right in my Outlook calendar so they appear like emails. You can also use Google to help you.

Google Alerts

I have several Google alerts set up including alerts for autism and applied behavior analysis. This is super easy! Visit this website and enter the term or terms that you are interested in. You will then receive alerts when those news items appear. Please note that you can set up weekly alerts and daily alerts and so forth.

Twitter Feeds

Several Twitter programs are available to assist you with information on Twitter. I tend to lean towards TweetDeck. I can set up columns on topics such as Step Parenting, Parenting, Autism, and behavior analysis. Within those columns I can read the twitter feed on that topic. You can also set up lists so that you organize your Tweeps by topic or content. I have a list on autism, GFCF, and behavior analysts. I have also written more in depth on Twitter and you can read about that here.

So, don’t feel overwhelmed as you try to keep up with the latest on your favorite topic. Many resources are available at your fingertips!

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Today marks one year for our blog. On September 19th, 2011, we started blogging regularly. The first blog appeared in August of 2011 but we didn’t become regular until September. Of course, we paused for life here and there along the way.

We want to take today to thank all of our readers and followers. We appreciate your support, your criticisms, and your suggestions.

Our all time busiest day so far was April 3, 2012 when we posted about free apps for Autism Awareness

And here are our top 10 posts based on total number of views.

10. Help! My Child Has ADHD

9. Peanut Butter Bread: Battle It Out?

8. My Child Won’t Poop in the Toilet: HELP!

7. Inclusion is an Individualized Decision

6. What Inclusion Teaches Us

5. Updated iPad Application List

4. Homework Habits That Work

3. Autism Awareness Free Apps

2. Using ABA to Teach Math

And the number one post of all time? Do You Use Visual Schedules?

Readers, we love hearing from you. Please let us know if you have any questions to answer about behavior or if you have a topic that you want us to write about. And most importantly, thanks for hanging around.

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Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question comes from Gwen who writes:

“My high functioning 7-year-old is in mainstream 1st grade with an aide. Her biggest problem is laughing and saying, “No!” as an attempt to avoid working. She is not disruptive enough to be sent to the resource room, yet she is non-compliant which is not appropriate for general education. Our ABA team has tried token systems and they did not work.They tried PEC cards for “quiet time” and “stop talking” but those strategies did not work.

At home, I simply say in a firm voice,  “It’s time to work” and she does it. She may giggle and say repeatedly, “all done!” but the work is completed and it is usually correct!

Do you have any tips for us? She is simply running over them”

Hi Gwen! thanks for coming back to visit. We are sorry to hear that you are having troubles with your daughter’s behavior. Let’s talk about a few things.

Function of Behavior not Form

First, so many times teachers and other professionals fall in to the trap of treating a behavior based on its form (how it looks–or what behavior analysts call topography of the behavior). However, we should not attend to the form of the behavior as much as we should attend to its function (the result of the behavior).

Functional Behavior Assessment (FBA)

We cannot effectively address a behavior without first knowing it’s function (why is your daughter doing this?). We typically understand the function by taking careful ABC data. We could also do some manipulations if necessary to prove why she is doing the behavior.

Your Daughter

Based on what you’ve told me, it seems that she is getting an awful lot of attention for her behavior (e.g., “no talking” and “quiet time” contingent on the behavior). If that is the case, a simple intervention of attending to her for good behavior (i.e., attending and working) and ignoring the junk behavior (i.e., work refusal and laughing) should be effective. Both techniques should be used in combination to ensure effectiveness of the intervention.

Example:

Seat work time. Your daughter laughs and says, “no”.

The teacher and aide should immediately turn their backs to her and instead give all of their attention to the other kids in class who are working quietly. The adults should say “I like how Johnny is working quietly” and “Suzie, you are doing great quiet work”

When your daughter is quiet and working, the teacher or the aide should immediately turn to her and give her praise for working quietly.

Class-Wide Reinforcement

The teacher may want to consider a class-wide reinforcement system so that all the children can be rewarded for staying on task and completing work

Keep me posted on how things go!!

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Technically, Jackson met our requirements for graduation at breakfast on the 4th day. He successfully ate breakfast with his mom and his brother and he engaged in almost no challenging behavior. However, before we discharge, we like to make sure that our clients can generalize their behaviors to school or to a community restaurant (or both!). So, we used Friday to work on generalization.

Pretzel’s at the Mall

Kendall told us that one of the most difficult times had been when they went to the mall and Jackson tried to get pretzels. Since starting the gluten-free diet, he would not be able to eat those pretzels and she worried that he would have a tantrum if she told him no. So, we agreed to meet her at the mall to work on an intervention.

Jackson walked right past the pretzels to meet us in the middle of the mall. However, when we arrived, he took off walking. He was a man on a mission! He went straight for the pretzels. We told him “no pretzels today, we are going to eat lunch”. He grabbed his communication device and typed out “PRETZEL”. We affirmed his request and simply restated that we would not be having a pretzel but instead we would go to lunch and he could eat pizza (we had already selected a gluten-free pizza place). We showed him the picture of a pizza.

Jackson took off walking through the mall. He had one things on his mind: Pretzels! After circling the mall and arriving at the pretzels again, he walked over to the display and pointed. We reminded him again that we would not be having pretzel and that we were going to lunch. With that, he decided it was time to leave and he proceeded to his car.

Well that seemed a little too easy.

Planet Pizza

 

When we arrived at Planet Pizza, the manager was restocking the chips. Yes, you remembered correctly. Jackson has a thing for Lay’s potato chips. He was super excited! He went over, picked up a bag of chips and appeared happy as a clam. We reminded him that he was here for pizza and not for chips. We asked him to put the chips back. At first he was reluctant but we remained firm. Please put the chips away, we are going to eat pizza. Jackson put the chips away and we asked him to pick out a drink.

Prior to starting feeding therapy, Jackson only drank water. He drank water out of a faucet and out of the Long Island Sound. Wherever he could find water, Jackson drank it! We told him, “No water today, pick something else.” He told us no but we held up two types of juice and he picked one.

Then we escorted him to find a table while the pizza cooked.

  1. Note: Kendall brought her own dairy free cheese and the staff cooked the gluten-free crust with the special cheese.
  2. Note: Bring things to do in restaurants while you wait!

While we are great at helping kids in the community, we have so much knowledge and training that we have a hard time remembering to teach the parents all that we know. We forgot to prep Kendall for the things that Jackson would need to keep himself busy. Luckily, we had iPhones so he tried to watch YouTube while waiting.

Jackson made a few noises during his wait. Unfortunately, restaurant patrons stared at us. The staring makes all parents uncomfortable. We let Kendall know that bringing Jackson out actually helps to educate others. Plus, Jackson has every right to be there too!

Success

The pizza arrived after only a 15-minute wait but then we had to wait for it to cool. Finally, Jackson could try pizza for the first time in many, many years. He loved it! He didn’t mind the spinach or the broccoli. He even picked up his fork and stabbed a few pieces on his own. He ate the entire piece that Kendall had prepared for him. He did this without aggression and without any expels!

Jackson still has some skills to work on:

  • cutting his own food
  • stabbing his own food using the fork
  • scooping his own food with a spoon
  • learning to wait quietly at restaurants
  • wiping his mouth with a napkin without reminders

However, he has come a tremendous distance in only 5 short days. Congratulations Kendall on all of your hard work. Jackson is a champion eater and you are a champion mom!

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Needless to say, Rebecca and I were running on fumes at this point in our week. We started the day hoping that 3 of 5 clients would graduate if all goes well. Because of his great success, Jackson was scheduled for only 2 meals: Breakfast with his brother and dinner with his father watching.

Breakfast with Brother

For breakfast, Kendall brought bananas, yogurt (coconut milk), gluten-free hot cereal, and raspberries. Jackson engaged in quite a few behaviors today which is common each time we change the conditions. He engaged in 20 verbal/vocal refusals, 6 physical refusals, and he cried two times. His brother, on the other hand, gagged a few times and had to leave the room several times. Hmmmm, maybe we should enroll another client in feeding therapy!

Dinner with Dad

Jackson was ready to show off his mad skills to his dad. Kendall brought sauerkraut and wieners, quinoa, beets, pears, and dried cranberries. What a champion! Jackson ate everything and he had only 2 gags! (beets would make us gag as well!) Throughout the meal, Jackson engaged in only 5 instances of verbal/vocal refusal. Dad was floored! He could not believe how much progress his son had made in just 4 days.

We also taught Jackson how to eat potato chips without making a mess. In the past, he ate them like a wood chipper with chip crumbs flying around. We taught him how to place the entire chip in his mouth without making crumbs.

Be sure to tune in tomorrow to see how Jackson handles going to the mall when he cannot eat his favorite Auntie Annie pretzels!

 

 

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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 a follow up to a previous clinical case. Do you remember Little Cherub? She first came to us over a year ago. Little Cherub’s dad attended a presentation we did in Atlanta. He desperately wanted help because she had very restricted eating. After listening to dad talk about her symptoms, we suggested that Little Cherub be seen by a specialist to determine if she had celiac, an autoimmune condition that leaves the body unable to digest gluten, a type of protein found in bread, pasta, and cakes.

Sure enough, Little Cherub had celiac. After putting her on a gluten-free (GF) diet, she further restricted her eating. After 5 of the toughest days imaginable, we finally helped Little Cherub learn that new foods are not scary and that, in fact, new foods can actually taste good. Little Cherub’s parents were amazed to see her chasing them down to get more cantaloupe!

In addition to her eating behaviors, Little Cherub has a fear of many new things. Take toileting for example. Little Cherub wanted to continue using her pull up for toileting. Urinating on the toilet was not painful for her. But from the look on her face and the behaviors she exhibited, one would think she felt extreme pain on the toilet. In the same week we taught her to eat, we taught her to use the toilet for urinating and defecating. We made a simple visual schedule to show her that “pee” goes in the toilet.

Within 2 days, Little Cherub overcame her fears of using the toilet. We reserved her very favorite jalapeno corn chips as a treat and she learned to associate positive things with the toilet.

Less than 10 months after overcoming her fears of new foods and toilets, Little Cherub began showing fear-like behaviors in public places such as Target and grocery stores. Little Cherub’s dad reached out to us again for assistance.

Public places can be very scary for children on the spectrum. Public places are loud, they have strange lighting, and things are not always predictable. However, once you teach children the routine, and associate the public place with something positive, children learn that public places are not scary after all.

Little Cherub’s parents used the same intensive model we used with feeding. They began taking her to public places two times per day, every day, for a week. Little Cherub’s dad writes,

She went from cowering to smiling when we went twice a day for a week and explained to her what everything was she was seeing and hearing.

Congrats again to Little Cherub and her parents for working so hard on overcoming these fears. The work parents do is never easy but with success stories like this, it makes all the work worthwhile!

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Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question comes from a parent of a previous client. We wrote about the client in our What Works Wednesdays post a few months ago. Little Cherub’s dad writes,

Little Cherub is doing great with her feeding. But the hurdle we are facing now is going out in public. Little Cherub literally acts and looks terrified.  Our main goal right now is to commit to getting her through this just like we did with ABA, school, eating, and potty training. Do you have any suggestions?

Hi Little Cherub’s dad! It is great to hear from you again. However, I’m sorry that she is giving you this trouble. Just remember, it is another behavior that she is using to “control” her environment. Think about what we did for food. We did not let her escape the bites, no matter how much she fussed. You will have to do the same thing for this new behavior. I like to add a few strategies before and after the behavior.

BEFORE

Before you head out to a public place tell her where you are going. Be sure to use a picture to help her understand. We have written about the importance of visual schedules before. Tell her that she is going in and that she needs to behave. Tell her she will get X treat when you guys finish your task there and leave the store. Be sure to show her a picture of the item as well.

DURING

When you are in the public place, do not give attention to any junk behaviors that she uses. If she drops to the floor, pick her up and put her in the basket. If she screams or cries, simply look away. If she swats at you, move to the side without looking or responding.

You will have to work through these behaviors just like you did for her behaviors around food.

AFTER

As soon as you have finished your shopping (or whatever you were supposed to do), immediately tell her good job and immediately give her the treat you promised her.

TIPS

My recommendation is to initially go when it is less crowded so you get fewer stares from people. Using pictures will really help her understand where you are going and what she gets when it is over.

If you have a behavioral question for me email me directly at askmissy at applied behavioral strategies dot com. Thanks!

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Hi and welcome to Ask Missy Mondays where I respond to a question from readers regarding a behavioral problem. Today’s question comes from a speech and language pathologist who works in a center for individuals with autism. The question is:

“The question I have is regarding a 3-year-old boy who has been diagnosed with autism. He started therapy with us and progressed very well. He is now able to follow commands. He imitates well and he is starting to vocalize single word utterances. He was able to focus for approximately 20 min with a reward and he really cooperated well. However, in the last 3 weeks, all of this positive behavior has changed. He now throws tantrums throughout the session. He bites if his needs are not met  and this is particularly if he does not get what he wants. We have tried rewards with the child but he cries and throws a tantrum for the reward if we only give him a part of it. In the session, we ignore the tantrums. It is unclear if the parents are ignoring the behavior at home or if they are giving in to the behaviors.”

Thank you so much for contacting me. Any time a child’s behavior changes suddenly, the adults should stop and ask “what has changed in his life”?

Any Changes in Home/School?

  • is he in a new classroom?
  • has his home environment changed?
  • has his feeding routine changed?
  • has a new therapy program been added/changed?

Any Medical Conditions or Medical Changes?

The other question to ask is about his medical condition. Medical conditions can impact behavior.

  • is the child constipated?
  • was he recently vaccinated?
  • was he recently sick?
  • is he teething?
  • is he tugging at his ear or are there signs of a sinus or infection?

Functional Behavioral Assessment

Once you have run through those questions, the next step is to complete an FBA. You have to document what is happening before and after the behavior to find out what might be causing the behavior or what might be maintaining the behavior. Typically, children use their tantrums to try to get things they like:

  • get attention
  • get favorite toy
  • get favorite activity
  • get favorite sensory

Sometimes, children use tantrums to avoid things they do not like:

  • avoid non-preferred person (e.g., therapist who makes me work)
  • avoid a non-preferred toy
  • avoid a non-preferred activity (e.g., work)
  • avoid sensory

Additionally, the child may engage in tantrums for any of the reasons combined (e.g., avoid work and then obtain favorite toy while on break).

Behavior Intervention Plan

Following a good assessment, then the team will need to develop a solid behavior intervention plan.

  • Staff and parents will learn how to prevent the behaviors
  • Staff and parents will learn how to teach replacement behaviors
  • Staff and parents will learn what to do after behaviors if they happen.
  • Staff and parents will learn how to reinforce the new replacement behaviors to that they continue to occur.

Please keep me posted on the outcome!

Thanks again for writing. Readers, if you have a behavioral question, email me at askmissy at applied behavioral strategies dot com.

I would appreciate any advice you can provide us in trying to help this child. As you might be aware services and facilities for children with autism are limited so any information you give us will be very useful.

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Here at Applied Behavioral Strategies, our mission is to improve the quality of life through effective intervention. One way we hope to do that is by reviewing research articles for our readers. Today’s article is titled, “Evolution of Research on Interventions for Individuals with Autism Spectrum Disorder: Implications for Behavior Analysts”. Dr. Tristram Smith (Tris) authored the article and he recently presented the paper at the Annual Conference of the Association for Behavior Analysts in Seattle.

This article is somewhat different from the other articles we have reviewed. In the past, we have reviewed research studies where authors gather data, analyze the data, and present the results. This article is a summary of the autism research that is ongoing today.

Historical Review

Over the past half-century, hundreds of papers have been published on the effectiveness of Applied Behavior Analysis (ABA) for individuals with autism spectrum disorders. Those interventions have been used to teach communication skills, play skills, self-help and those interventions have successfully addressed challenging behaviors such as self-injurious behaviors and tantrums.

Current Transformation

Today, scientists in fields other than Behavior Analysis are conducting studies related to autism. The Combating Autism Act  of 2006 and reauthorized again in 2011 was a declaration of the war on autism. This act resulted in hundreds of millions of dollars for research on autism with a large percentage of it focused on intervention efforts. Scientists can now apply for specific autism research money through Autism Speaks, the National Institute of Mental Health, the Institute for Education Sciences, the Maternal and Child Health Bureau, and the Department of Defense.

Priorities for this research focused on randomized clinical trials (RCTs) where participants are randomly assigned to treatments in order to determine which treatment is more effective. This means that some participants will be assigned to the “no treatment” or the waiting list control group. (I don’t know about you, but if my child had autism, I would not wait one minute to begin treatment.)

Types of Funded Studies

A number of studies have been funded. For example, two studies on psychotropic medication have been completed. Those studies resulted in the approval of the use of abilify and resperidone for treatment of children on the spectrum.

Several studies on ABA packaged interventions have been funded. However, the treatment is brief and often implemented by non-behavior analysts.

Studies on clinical behavior therapy and cognitive behavior therapy (CBT) have also resulted. Researchers examined social skills interventions, anxiety reduction strategies, and interventions for individuals with high functioning autism.

Implications for Behavior Analysis

Dr. Smith notably discusses the relevance of this to behavior analysts. Essentially, the money is available for research. If behavior analysts do not seek out the funding, other scientists will. He goes on to list areas of work where behavior analysts should focus.

Framework for Autism Research

  1. Dr. Smith encourages researchers to conduct careful tests of individual intervention packages before moving on to RCT research.
  2. Dr. Smith notes that some areas of ABA are ripe for RCT research, specifically comprehensive ABA interventions for school age children, youth, and adults.
  3. Dr. Smith suggests that we refine the defining features of autism through behavior research.
  4. Behavior analysts have long been successful in reducing stereotyped behaviors. This should be studied using RCT.
  5. Behavior analysts need to study intervention packages for behavioral feeding therapy.
  6. Dr. Smith encourages behavior analysts to develop thorough treatment manuals so that procedures may be replicated successfully.

In summary, we have a duty to ensure that research in autism interventions continues. If we want to continue demonstrating that ABA is effective, we must seek out this funding, design studies to demonstrate effective techniques, and disseminate our work so that others can implement successfully.

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