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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 “How and Why Parents Choose Early Intensive Behavioral Intervention” and it appears in the latest issue of Education and Training in Autism and Developmental Disabilities (Volume 47, Number 1) a peer reviewed research journal. Several researchers authored the study, including Richard Hastings, one of our favorite research scientists. The full citation for the authors is Tzanakaki, P., Grindle, C., Hastings, R. P., Hughes, J. C., Kovshoff, H., and Remington, B. (2012).

Study Purpose

The authors stated that the study had several purposes.

  1. What intervention options were available to parents when their child was diagnosed with autism?
  2. What other interventions did parents try before trying early intensive behavioral intervention (EIBI)? (NOTE: ABA is the intervention that is used during EIBI)
  3. How did parents first hear about EIBI and what were their initial impressions?
  4. What were the main reasons parents chose EIBI for their child’s intervention?
  5. What did parents understand about EIBI?
  6. How did parents access and fund EIBI?

Participants

Twenty-three mothers participated in the study. It is important to note that they had all participated in a previous study about EIBI. Sixteen of the mothers received free EIBI for their children through a university program while 14 received services from private providers. The mothers did not receive any compensation for participating in the study. At the time of the study, their children ranged in age from 49 months to 82 months and they all lived at home. Twenty-six of the mothers had additional children in the home. For five families, the fathers lived in a different home. At the time of the study, children had been receiving EIBI on average for 25 months.

Interviews

Each mother came in for a private interview with a researcher. Prior to coming in for the interview, the mothers were informed about the study purpose and they consented to participate. The researcher asked a series of planned, open-ended questions and recorded the entire interview. Later researchers transcribed the interviews and coded transcripts for themes and categories. A second person separately coded 25% of the transcripts to check for agreement (88% overall across all categories) and to demonstrate study integrity.

Results-At Diagnosis

  • 15 mothers (50% of the sample) reported that they were given no information or advice at the time of diagnosis.
  • 4 mothers were told that “nothing can be done” for their child.
  • For the mothers who were given treatment recommendations, only 16% were informed about ABA.
  • 8 mothers were already aware of ABA at the time of diagnosis and were seeking enrollment in a program.

Results-Interventions Before EIBI

  • 21 mothers (70% of the sample) tried at least one other intervention before starting EIBI (speech and language therapy was the most common).
  • 23 mothers (76% of the sample) implemented a dietary intervention for their child and 10 mothers (30% of the sample) reported trying nutritional supplements. Half of each group reported positive outcomes.

Results- How Did Mothers Learn About EIBI?

  • 11 mothers learned about EIBI from another parent of a child with autism.
  • 5 mothers reported learning about it from books.
  • 5 mothers reported learning about it from the internet.

Results-First Impression of EIBI

  • 20 mothers reported that their first impression of EIBI was a positive one.
  • 5 mothers reported an initial negative reaction to it.

Results-How to Learn More about EIBI

  • Once the mothers learned about EIBI, to learn more about it, 21 mothers turned to the internet.
  • Many of the mothers also read a popular book called “Let Me Hear Your Voice” by Catherine Maurice.

Results-Why Choose EIBI

  • Most of the mothers reported that the empirical data and anecdotal evidence served as the main reason for choosing EIBI.
  • EIBI is a logical intervention.
  • EIBI is available so let’s try it.

Results-Anticipated Benefits of EIBI

  • Language improvement (56% of mothers)
  • Child learning new skills (43% of mothers)
  • Child being cured (40% of mothers)
  • Child attending mainstream school (36% of mothers)

Results-Anticipated Pitfalls of EIBI

  • Intrusion on family life (56% of mothers)
  • Siblings receiving less attention (23% of mothers)
  • High cost (23% of mothers)
  • Difficult to organize (16% of mothers)

We found this study to be informative but clearly, more work is needed. How do parents want to be involved? Do parents want to participate in therapy or do they want to just be the caregiver? Readers who are parents and who are doing or who have done EIBI/ABA, what are your thoughts on this?

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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 Amanda who is employed as a behavior analyst in a school district. Amanda’s question actually came in following a webinar that Rebecca and I provided on Special Education Law and Ethics for Behavior Analysts.

During the webinar, we discussed the importance of acquiring parent permission before conducting any assessment on a child with an Individualized Education Program (IEP). Of course, this also includes obtaining written permission for conducting a Functional Behavioral Assessment (FBA).

As a result, Amanda asked this question:

“First of all, our district completes FBA’s as well as something we refer to as Behavior Observations. Let me explain how we are distinguishing the difference between the two.

Behavior observations are completed by the BCBAs. They consist of multiple observations and data collection using tools such as an ABC form, frequency data collection, and/or momentary time sampling. Based on the data we collect, we hypothesize a function of the behavior and develop written recommendations.

When an FBA is completed it incorporates more parts such as the observations, interviews, and questionnaires such as the MAS and the FAST. Once all this data is summarized a function is hypothesized and written recommendations are made.

I am wondering if what we are considering to be a behavior observation is actually a shortened FBA?”

Amanda, first, thank you for taking the time to write. Many parents and behavior analysts alike do not realize that an FBA requires written parental consent PRIOR to its commencement. Under the Individuals with Disabilities Education Improvement Act, school personnel must obtain written permission before conducting any assessment or evaluation on a child with disabilities (including behavior disorders or autism).

Second, you are absolutely correct in guessing that both steps you have described above (behavioral observations and the FBA) are in fact, FBAs. Had you merely observed a child and made verbal recommendations to the teacher about how to respond to certain behaviors, then a behavioral observation is probably appropriate without parental consent. However, since you collected data, analyzed the data, and formed a written opinion about why the behavior was occurring, regardless of what your district calls it, the procedure was still a functional behavioral assessment and required written parental permission prior to its commencement.

We want to hear from readers. Does your district obtain your written consent prior to completing an FBA? Has your child’s district ever completed an FBA on your child?

If you have questions about behavior that you would like assistance on, please email Missy at askmissy at appliedbehavioralstrategies dot com.

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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 we want to introduce you to Jack. Jack was an adorable little guy about 6 years old. When we say he was little, we mean it. He did not even register on the weight chart for children his age. That means that 99% of all children his age weighed more than he did. Jack did, however, love Dora more than any other child we have met! He loved Dora so much that he was willing to do anything to get more Dora, especially after his mother took Dora videos away for a lifetime an entire week while preparing for feeding therapy.

Jack came to us because his mother was concerned about his height and weight. He showed signs of extreme food selectivity. He loved chocolate chip cookies, chips, and pepperoni. He was not interested in eating too much else. Jack also had food allergies. He was intolerant to gluten and dairy/casein which meant that his mother had to make special cookies for him to eat.

Jack received feeding therapy from Missy in 2007 while she was employed at CARD. Jack’s story is interesting because if it were not for him and his mother, we would have never developed our short-term, intensive feeding program that is so successful today. You see, Jack’s mother lived over an hour away from the office where feeding therapy was provided. She could not fathom the thought of driving back and forth for therapy each week for up to 6 months. So she challenged Missy. She said,

“Missy, you told me that intensive ABA is better for my child when it is provided at higher frequencies. Would the same thing hold true for feeding therapy? You told me feeding therapy is ABA to address feeding? So why wouldn’t intensity matter?”

So, thanks to Jack’s mom, we thought outside of the box to develop a model that works. Our sessions have changed a great deal since then, but the basic format remains. We started with 3 sessions each day; one session for each meal of the day. We also started using a simple shaping strategy. In behavior analysis, shaping is reinforcing successive approximations of the desired behavior. Initially, we didn’t ask Jack to eat the bite, we simply wanted him to pick it up the bite and touch it to his lips.

Sweet little Jack was, quite honestly, not happy about any of it. In fact, he refused to eat pepperoni and chips (his favorites!) for Missy. But Dora, oh that little Dora talked him in to it. For just 30 seconds of Dora, Jack decided that he would try the food. You see, Jack had not seen Dora for over a week (Thank you Mom!!!). This made Dora more appealing to Jack. So it did not take long for Jack to realize that the only way he was going to get Dora was to try it our way. Soon, Jack warmed to the idea of trying new foods, not just the chips and pepperoni slices.

Jack was funny in other ways too. I think the best part of the feeding therapy was when he picked up the bite, ate it, and then popped Missy on the mouth as if to say “There! That’s for you making me eat this yucky food!”

Jack went on to make great strides. He met the criteria for graduation in 5 days. On the 5th day, he was eating foods while his mother supervised. He tried to go back to his old ways but his Mom was too smart for that. She had observed every single session. She knew he could eat the new foods so she dug her heels in. She told him that he could not have Dora until he ate his food.

It is important for readers to know that ALL children, regardless of age, ability, or trait, have battles over food. When given the choice, many children would choose processed foods such as chips, crackers, and fast food, over health foods such as whole fruits, vegetables, grains, and proteins. So, even after feeding therapy is over for the picky eater or selective eater, work will still be required from time to time. Does that mean that former picky eaters should be denied access to tasty processed foods? No, not at all. The answer for follow-up to feeding therapy is moderation. Once the intensity of feeding therapy is over, the process of moderation begins. It is fine to allow your child to have chips. However, chips should be available 1-3 times per week rather than 1-3 times per day.

Thank you Jack and thanks to your mom for pushing us (and you) to new heights–literally (Now, Jack registers on the height and weight chart for children his age!)

Happy Eating!

P.S. Now that back pack song is stuck in my head!I will forever associate that song with you, Jack.

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Addressing challenging behaviors is one of the most talked about topics among educators and parents alike. Here at Applied Behavioral Strategies, we are often asked for advice about how to deal with hitting, biting, self-injury (e.g., self-hitting, self-biting), and tantrums. While we would love to give a quick-fix, one-size approach answer to everyone, we have learned over the years that behavior simply does not work that way.

“What?!?!” you ask. “There are no quick-fixes for behavior problems?!?!”. Sadly, we must tell you that there are no quick-fixes. Short of locking your child in the closet (which we would never advise you to do), there is no fast way to make bad behaviors disappear.

What we can tell you is that with persistent and predictable parenting, the behavior will subside. However, you need to know a few things before you decide to nip the behavior in the bud. First, all behavior is a form of communication. If your child is misbehaving, she is trying to tell you something.

Second, all behavior has a purpose. Children act out because, quite frankly, it works. What does your son get when he has a tantrum in Target? What does your daughter avoid when she takes all morning to get ready for school? How much of your attention is all the negative behavior demanding?

Finally, positive behaviors will replace negative behaviors if the positive behaviors are reinforced. If your child is trying to get candy at the check out lane at Target, go ahead and give him candy at the check out lane. However, promise him the candy if he can get through target without any tantrums. Do not give the candy if your child has a tantrum.

If your daughter moves at a snail’s pace each morning, perhaps she is trying to purposefully miss the bus. Instead, offer to take her to school but only if she is ready by a certain time.You may have to consider getting her up earlier or even helping her get dressed in order to make the bus. And, if your child must go to school in her pajamas, I can assure you she won’t be the first child to come to school in pj’s.

If your child is misbehaving in order to demand all of your attention, beef up the attention you provide but make sure you are attending to the positive behaviors. We call it “catch them being good”. When children see that good behavior gets attention, they will enjoy engaging in good behavior over bad behavior any day.

While we cannot solve your child’s problem in a blog post, we would like to direct you to some additional resources to help you in your time of need. First check out this great site called Technical Assistance Center on Social Emotional Intervention for Young Children.This site is full of resources, many of them free. Here you will find access to power point lectures and handouts, access to a newsletter, and information related to managing challenging behavior.

If you need assistance with older children, check out this great site called the Positive Behavior Intervention and Supports. This site has information for families, teachers, and community members. Information is available regarding research, training, and program evaluation. Find out who is available to help in your state!

I came across a nice parent- and teacher-friendly post regarding challenging behavior. The authors, Elizabeth Erwin and Leslie Soodak, provide some helpful information regarding why behaviors occur and how to address them.

Finally, you can always submit your question to receive help during our Ask Missy Monday blogs. Simply email: askmissy at applied behavioral strategies dot-com.

The bottom line is that the sooner you address the behavior problem, the better.

Happy Parenting and Happy Teaching!

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Happy Friday!

(Just kidding! I added that picture for emphasis.)

Today we are going to talk about the importance of just saying no. To those of you that know me or who have worked with me over the years, this piece of advice may come as a bit of a shock to you. For those of you who are just getting to know me, I’ll explain myself a bit more.

You see, I often advise parents, teachers, siblings, and peers to refrain from telling a child “no” in response to challenging behavior. As you can see from these images, my advice has been   well-heeded by many! NOT! Images have been made to tell children “no” in response to their behaviors despite my frequent recommendations.

I suggest that we refrain from saying no in response to challenging behaviors because saying no does not teach children what TO do. Additionally, if a child is biting for  attention or hitting for attention, telling the child “no” gives him the attention he is looking for. While many educators believe that a firm no gives the child feedback that what she is doing is wrong, I argue that the child already knows what she is doing is wrong. She does not care. She has learned that the challenging behavior gets her what she wants so she keeps using the behavior for her own benefit.

But this is not why we are here today. We are here today to talk about the importance of saying no to your children. I cannot stress the importance of teaching your child to learn to accept no. Children must learn they cannot have everything they want. Case in point: I was at Target (one of my favorite places to shop and watch parenting at its finest). I observed a mother and child in the check out line. The child asked for candy to which the parent replied, “oh honey, it is too close to dinner.” The child began crying and yelling about how much she loved the candy and how “mommy never lets me have what I want!” Because mommy did not want to hear her child cry, she caved and she bought the candy. The little girl learned that all she has to do is cry and yell and mommy will give her what she wants. The little girl also learned that when mommy says no, she does not really mean it. This little girl is the boss. See, here she is strutting her bad self.

I see this type of parenting over and over in various settings every day:

“Mommy, I’m full, I don’t want to eat my vegetables.”

“Daddy, I don’t want to put my dirty clothes in the hamper.”

“Mommy, I don’t want to do my homework. I want to go outside.”

One of our duties as parents, is to teach children to accept no. When children learn to accept no at an early age, they learn to handle bigger disappointments later in life (e.g., I want to be a cheerleader but the judges told me no.) Parents, on the other hand,  need to practice saying no and sticking to it–even when the going gets tough. Why? Because as children grow up, their tantrums grow up too. Soon, crying becomes ugly, hurtful words (“I hate you!” or “I want to go live with Daddy!”) Who wants that kind of interaction later in life?

You know the old saying, “practice makes perfect”….if you practice saying no to children when they are younger (and while their tantrums are short and cute), you will be an expert at saying no when the going gets really tough (“Mommy, I want to have a curfew at midnight”, “Dad, can I have $250 for a new pair of jeans?”). So, head off in to the weekend and practice saying no to your little angels. Come back on Monday and tell me how hard it was!

Happy Parenting!

P.S. Can I have a new Mini Countryman?

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