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Applied Behavior Strategies is a proud sponsor of the Back-to-School: Special Education Parent Empowerment Conference on Saturday, October 5th in New Haven CT!  The conference is focused on trending special education issues and must-know advocacy skills to prepare for a successful school year. Parents and professionals should attend. You can learn more about this important event or buy tickets here: https://seekct.com/annual-conference  Online tickets $65. At the door $85. Don’t miss out!

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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.

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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 “Dennis”.

Dennis came to us just slightly before his third birthday. He carried a diagnosis of autism. Like many of our children, he also had a history of reflux. His reflux was so bad that his parents reported having to place a plastic covering on the floor under his crib to protect the flooring.

Dennis was non-verbal but he had no problem making his needs known. One way that he communicated his wants and needs was by vomiting. Initially, when a non-preferred food was presented to him, he vomited until it was removed. Over time, he began to control what his Mommy ate too. If he saw her eating something he didn’t like, he vomited. By the time he got to us, he had whittled his diet down to only 3 foods: a certain brand of potato chips, peanut butter, and a beverage. His poor Mom couldn’t eat in front of him and was limited to consuming Coca Cola only in his presence. Can you even try to imagine the family stress in that house?

Readers should know that Dennis was the most adorable picky eater. His chubby cheeks were just ripe for the squeezing. His toddler hands and feet were precious. He was the kind of child that you just want to pick up and hug and kiss over and over again. With a child that cute, you know behavioral feeding therapy is going to be a challenge! It is really hard to be firm with a cutie-pie.

Because of the seriousness of the behavior and the extreme food selectivity, we asked that the parents have a complete medical work up prior to starting feeding therapy. Dennis came back clean as a whistle–he had no major issues other than the reflux.

On the first day of feeding therapy, we realized that we needed help. We rushed out to the nearest store to purchase protective gear–plastic aprons. Dennis could vomit without any effort at all and our clothes were doomed without protection. (Dennis is the worst case of vomiting we have seen in our practice to date.) In the first three sessions alone, he vomited 13 times when a total of 30 bites had been presented! When Dennis vomited, we simply cleaned up the area and re-presented a clean but identical bite of food. Dennis tried to use gagging to replace vomiting. When he gagged, we simply closed his mouth by gently pressing his chin up.

Dennis did not give up his preferences willingly. He fought us for the first two days. In addition to vomiting and gagging, he used head turns, crying, spoon batting, and other disruptive behaviors to avoid new foods. We ultimately used physical prompting to encourage him to open his mouth and take a bite. Once he accepted the bite, he discovered that it didn’t taste quite so bad. Keep in mind that Dennis was also hungry for each session. His parents did not feed him before or after therapy so if he didn’t eat with us, he didn’t eat again until the next therapy session a few hours later.

Over time, he began to fight less and less and he began accepting bites willingly. By the third day of treatment (9 sessions) Dennis had stopped vomiting.  Across the last three sessions of treatment, Dennis gagged only 2 times out of 142 bites of food and he had no vomits.

On the fourth day of treatment, we transitioned Dennis’ parents in to replace the feeding therapists. On this day, Dennis had begun to feed himself and his parents were there to make sure that his bites were not too big. His parents also reminded him to take a bite if he slowed down or looked as if he might be trying to avoid a food. It was also on this day that we taught Dennis how to eat cake for his upcoming birthday party. We all cried tears of joy to see him willingly scoop up gluten-free (GF) and dairy/casein-free birthday (CF) cake (and yes, GFCF cake tastes delicious)!

Dennis was discharged after only 12 sessions of treatment (4 days)! A few days later, his parents sent us pictures from his 3rd birthday party where he was happily eating his real birthday cake.

This success story did not come without extremely hard work by the parents. It was emotionally draining for them to see their child put up such a fight to avoid foods. It is not easy watching your baby vomit repeatedly at the sight of new/non-preferred foods. It is not easy hearing him cry repeatedly for an entire session. But they stuck with it. They stood their ground and they supported our treatment by not feeding him between meals and by requiring him to participate in therapy 3 times each day despite his tears. Congratulations on your success! The hard work paid off!

We would love to hear from readers. Have any of you worked with children who vomit? Parents, are any of your children vomiting to avoid foods? Parents, teachers, and behavior analysts, would you be able to stick with it like the parents and the therapists did?

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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 an anonymous writer who recently learned about services under the Individuals with Disabilities Education Improvement Act (IDEIA). Individuals who are eligible for services under the IDEIA, may receive a variety of services including but not limited to:

  • Audiology
  • Counseling
  • Early Identification and Assessment
  • Medical Services
  • OT and PT
  • Orientation and Mobility
  • Parent Counseling and Training
  • Psychological
  • Recreation
  • Rehabilitation
  • School Health
  • Social Work
  • Speech Pathology
  • Transportation
  • Interpreters
  • Assistive Technology

The anonymous reader asked, “Parents can receive services under parent counseling and training? Do schools have to teach ABA to parents?”

The short answer to these questions: yes and yes.

The long answer is a bit more complicated.

The IEP and IFSP Drive Services

The document that is developed is incredibly important. The document, whether it is the Individualized Education Program (IEP) or the Individualized Family Service Plan (IFSP), determines what services are needed. Take extra care when developing your child’s IEP or IFSP.

Parent Counseling and Training Defined

The IDEIA has defined parent counseling and training. Specifically, parent counseling and training is for assisting parents in understanding the special needs of their child, providing parents with information about child development, and helping parents learn the skills that will help them carry out their child’s IEP or IFSP.

Thus, if you need to learn ABA in order to carry out your child’s IEP or IFSP, then by all means, the agency must provide you with training on ABA.

Treat the IEP and IFSP as a Contract

We cannot stress enough the importance of carefully developing your child’s IEP or IFSP. Read over every single detail before agreeing to its implementation. The signed document is your child’s contract with the agency until the next IEP or IFSP is developed.

If you have questions about behavior, email Missy at askmissy at appliedbehavioralstrategies dot com.

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