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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 post is about a 4-year-old little girl named Nahir who carries a dual diagnosis of Down syndrome and autism. Nahir began receiving early intervention services early in life. She began receiving ABA services shortly after she was diagnosed with autism. She began receiving ABA services from us last year.

Nahir’s parents wanted Nahir to be a community member in her neighborhood and they wanted her to learn alongside other children her age without disabilities. We designed an ABA program that consisted of about 10 hours per week of supported inclusion and 10-15 hours per week of 1:1 ABA instruction. Nahir responded to the intervention and began showing an interest in her peers at school and she began learning many skills at home. She even began using the toilet!

After several months, Nahir’s parents wanted to increase the amount of time in inclusive settings to 20 hours per week combined with 10-15 hours of 1:1 ABA. Nahir began engaging in non-compliant behavior and her rapid learning tapered off. We discussed our concerns about this change in learning with the parents and we encouraged them to consider making a change.

As a result, the family agreed to decrease inclusion time and increase 1:1 ABA time. Watch out! Nahir’s learning took off. She began imitating, her non-compliance decreased, and she started to communicate using her new iPad and Proloquo2go.

You see, inclusion is not all or nothing. Decisions about inclusion should be made individually for each child based on his or her unique situation.

We would love to hear from readers! Share your successful ABA and inclusion stories!

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Apps on the iPad can be an invaluable resource.  The great thing about apps is that they can be implemented by family members, and don’t require professional support (and the associated fees!).

Most of our readers know that we both have family members who are or who have been affected by autism. We are well-aware of the cost burdens on families, and the need to find cost-effective resources. Goodness knows we buy educational materials all the time, and we know how expensive they can be.

The good news about apps are several:  they are convenient, usually fun, usually effective (at least for the generalization of skills),  mostly decently price, and can be a helpful/practical addition to your toolbox.

Here is our current list of apps that we have used.  If you have any that you would like to share with us, please post in the comments! We are always looking for new apps that can help our kids. We are especially interested in scheduling applications and sequencing applications so please share your knowledge.

Reading and Reading Readiness

  • Smiley Sight Words
  • Teach Me Toddler
  • Teach Me Kindergarten
  • Teach Me 1st Grade
  • Super Why
  • ABC Match Ups
  • Intro to Letters (by Montessorium)
  • Bob Books
  • Elmo’s ABCs
  • See Touch Learn
  • Zoo Train
  • Feed Me
  • Monkey Preschool Lunchbox

Vocabulary and Language Builders

  • Kindergarten dot com Flash Cards (there are many! actions, alphabet, zoo, fruits, toys, instruments)
  • Speech with Milo (sequencing, verbs, prepositions, adjectives)
  • First Words Deluxe
  • Preschool Animals
  • Story builder
  • Sentence builder
  • Language Builder
  • Question Builder
  • Zombie Grammar Force
  • Grammar App
  • SAT Grammar

Speech and Articulation

  • Phono Pix Full
  • Artic Pix

AAC and Visual Planners

  • Proloquo2go
  • iPrompts
  • Going Places
  • Timer
  • Alarmed
  • Tap to Talk
  • Vu Meter

Social Skills

  • QuickCues
  • Stories2Learn
  • What are They Thinking?
  • HiddenCurriculum Kids
  • Stories2Learn
  • Conversation Builder
  • iTopics

Interactive Food Games (Thank you Maverick Software)

  • More Grillin
  • More Cookies
  • More Buffet
  • Cupcakes
  • More Pizza
  • More Salad
  • Little Match Ups Fruits

Interactive Echo Games

  • Talking Gugi
  • Talking Tom
  • Talking Babies
  • Talking Gina
  • Talking John
  • Talking Roby
  • Talking Larry

Interactive Books

  • Misty Island (Thomas the Train complete with puzzles, coloring, and dot to dot)
  • 5 Little Monkeys
  • Green Eggs and Ham
  • Me and Mom Go to the City
  • Toy Story (with reading and painting)
  • On The Farm
  • Ronki
  • Speech with Milo
  • Mickey Mouse Puzzle Book

Books

  • Read me Stories (a library with one free book each day)
  • Mee Genius (a library)
  • Reading Bug
  • Food Fight
  • Christmas Tale
  • The Ugly Duckling
  • Three Pigs
  • Sesame Books
  • Elmo’s Birthday

General Knowledge

  • Brain Pop
  • Weet Woo

Math

  • Bert’s Bag
  • Intro to Math (by Montessorium)
  • Free Multiplication Tables
  • Grasshopper
  • Ace Math Flash Cards
  • Pattern Recognition
  • Analogies for Kids
  • Analogies Practice
  • Tally Tots

Puzzles

  • Children’s Wooden Puzzles
  • Wooden Puzzles (these are not all good but the good ones are great. Sadly, the developers did not advertise on their app so we can’t tell you the exact name or developer)

Strategy and Problem Solving

  • Zentonimo
  • Cogs
  • Scrabble
  • Numulus
  • Logigrid
  • Conquist2
  • TicTacToe
  • Memory Game
  • Checkers Plus
  • Sudoku
  • Dots Free
  • Spider Free
  • Understanding inferences

Scanning

  • Pictureka
  • Waldo
  • I Spy

Adaptive Skills

  • I Love Potty
  • Everyday Skills

Motor Skills

  • Dexteria (developed by an OT and teaches fine motor skills)

Interactive Games

  • Bowling
  • Mini Cooper Liquid Assets
  • Monkey Flight (by Donut Games)
  • Sunday Lawn (by Donut Games)
  • Skee Ball
  • Flashlight
  • Spin the Coke Bottle
  • Spinning Plates
  • More Cowbell
  • Angry Birds
  • Doodle Jump
  • Cut the Rope
  • Where’s My Water
  • Rat on a Skateboard

Interactive Songs and Music

  • Wheels on the Bus (Duck Duck Moose developers)
  • Old MacDonald (Duck Duck Moose)
  • Wheels on the Bus (Duck Duck Moose)
  • Itsy Bitsy Spider (Duck Duck Moose)
  • Kid’s Songs
  • Virtuosa Piano
  • Piano Free

Art Tools

  • Drawing Pad
  • Draw Free
  • Kid Paint
  • Whiteboard

Halloween Applications

  • Carve a Pumpkin (to make the cute Jack-O-Lantern)
  • Pumpkin Lite
  • PumpknXplod
  • Pumpkin Plus
  • Skeleton (interactive and imitative)
  • Halloween Coloring Book
  • Carve It
  • Halloween Heat

Data Collection and Other ABA Tools

  • DT Data
  • ABC Logbook
  • ABC Data Pro
  • Touch Trainer
  • Smart White Board

 Parent Tools

  • IEP Checklist

 

Websites with Application Reviews

Let's BEE Friends

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It never occurred to us that we could take our existing knowledge about the iPad and applications and write an informative blog post for readers. So, thanks @PaulCBrady for asking us for a list!

The picture to the left comes from a wonderful (and free) application for Halloween. Children may carve by hand, carve by facial feature, carve by various faces, or use stickers to decorate. When the decorating is complete, a picture may be saved to your photo files. So, given that it is so close to Halloween, we’ll start with Halloween applications.

Halloween Applications

  • Carve a Pumpkin (to make the cute Jack-O-Lantern)
  • Pumpkin Lite
  • PumpknXplod
  • Pumpkin Plus
  • Skeleton (interactive and imitative)
  • Halloween Coloring Book
  • Carve It
  • Halloween Heat

Interactive Food Games (Thank you Maverick Software)

  • More Grillin
  • More Cookies
  • More Buffet
  • Cupcakes
  • More Pizza
  • More Cowbell
  • More Salad
  • Little Match Ups Fruits

Interactive Echo Games

  • Talking Gugi
  • Talking Tom
  • Talking Babies
  • Talking Gina
  • Talking John
  • Talking Roby
  • Talking Larry

Reading and Reading Readiness

  • Smiley Sight Words
  • Teach Me Toddler
  • Teach Me Kindergarten
  • Teach Me 1st Grade
  • Super Why
  • ABC Match Ups
  • Intro to Letters (by Montessorium)
  • Bob Books
  • Elmo’s ABCs (amazing and worth every penny)

Interactive Books

  • Misty Island (Thomas the Train complete with puzzles, coloring, and dot to dot)
  • 5 Little Monkys
  • Green Eggs and Ham
  • Me and Mom Go to the City
  • Toy Story (with reading and painting)
  • On The Farm
  • Ronki

Books

  • Read me Stories (a library with one free book each day)
  • Mee Genius (a library)
  • Reading Bug
  • Food Fight
  • Christmas Tale
  • The Ugly Duckling
  • Three Pigs
  • Sesame Books
  • Elmo’s Birthday

Vocabulary Builders

  • Kindergarten dot com Flash Cards (there are many! actions, alphabet, zoo, fruits, toys, instruments)
  • Verbs with Milo
  • First Words Deluxe

Math

  • Bert’s Bag
  • Intro to Math (by Montessorium)
  • Free Multiplication Tables
  • Grasshopper
  • Ace Math Flash Cards

Interactive Games

  • Bowling
  • Mini Cooper Liquid Assests
  • Monkey Flight (by Donut Games)
  • Sunday Lawn (by Donut Games)
  • Skee Ball
  • Flashlight
  • Spin the Coke Bottle
  • Spinning Plates

Interactive Songs and Music

  • Wheels on the Bus (Duck Duck Moose developers)
  • Old MacDonald (Duck Duck Moose)
  • Wheels on the Bus (Duck Duck Moose)
  • Itsy Bitsy Spider (Duck Duck Moose)
  • Kid’s Songs
  • Virtuosa Piano

Art Tools

  • Drawing Pad
  • Draw Free
  • Kid Paint
  • Whiteboard

Puzzles

  • Children’s Wooden Puzzles
  • Wooden Puzzles (these are not all good but the good ones are great. Sadly, the developers did not advertise on their app so we can’t tell you the exact name or developer)

Data Collection (I don’t think any of these are worth the money)

  • DT Data
  • ABC Logbook
  • ABC Data Pro

Applications for Autism

  • Proloquo2go–we love it.
  • Dexteria (developed by an OT and teaches fine motor skills)
  • iPrompts (thanks for the reminder Kristen!). iPrompts may be used to make schedules, choice boards, and a countdown timer. We LOVE this one.

Websites with Application Reviews

Parents of children with special needs will find the application called IEP Checklist very helpful.

We should clarify that we are not application developers and we have not been paid by any app developer to list their product. Missy is friends with Glenda, owner of Maverick software. Missy and Rebecca have both been given complimentary copies of Proloquo2go so that children may test out the software before making the purchase.

Finally, while these applications have been helpful for us in our therapy sessions, your child may no necessarily enjoy them. Before purchasing, read the ratings and comments. Check out the sample pages to make sure you know what you are purchasing.

Have fun with your applications. We sure do!

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Hi and welcome to Ask Missy Mondays where I respond to email questions from parents who are having difficulty with their child’s behavior. Today’s question comes from no one in particular but from many parents. Every time we show a parent how effective the iPad is for their child with autism, they instantly want to know how to get one for their child.

While some of our readers may not understand why a family cannot just run out and buy one (we know some families with 3 and 4 iPads!), many of the families with whom we work are struggling financially. So, if you have the finances, then definitely purchase an iPad for your child (and make a donation to the Holly Rod Foundation so more children can have iPads). If you do not have the finances, please read on.

There are several ways to get your device funded so I will carefully review each.

School Funding

First, under the Individuals with Disabilities Education Improvement Act (IDEIA), every child with a communication impairment has the right to an assistive technology (AT) evaluation. Only children with an IEP are eligible for this benefit. If the AT assessment result shows that the child would benefit from services, then the child should receive the device and services at no cost to the family. Training for family members, teachers, and all school staff who interact with your child is also included.

When purchased this way, the device belongs to the school district. Thus, when your child graduates or leaves the school district, the device does not necessarily remain with your child. The IEP team decides TOGETHER if the device should go home with the child each day. Obviously, if a child needs a device at school to communicate, he most likely needs it at home too. However, in some instances, the team may decide against this, especially if your child is prone to throw his device out the school bus window or if you frequently “forget” to send the device back to school.

Your child’s school district is also responsible for the care, maintenance, and repairs of your child’s device. Because the device belongs to the school, they are also ultimately responsible for any apps that are purchased and placed on the device. This means that your child’s app selection may be somewhat limited.

If you already had your IEP meeting, do not fret. Simply write a note to your child’s teacher requesting an additional IEP meeting to discuss AT (and any other thing you would like to talk about). The district must schedule the IEP meeting within a reasonable amount of time. You may have as many IEP meetings each year that are necessary to meet your child’s needs.

If you received an AT assessment and the results suggested that AT was not appropriate for your child, then you need to disagree with the assessment report and ask for an Individualized Educational AT Evaluation. This is known as an IEE and your child may have one IEE at no cost to you if you disagree with the evaluation that was completed by the school team. When your IEE is approved, carefully select an evaluator that will consider the use of an iPad for your child. If a second evaluator decides that an AT device is not necessary then your child will not be eligible for a device from the school district.

Insurance Funding

Your child’s insurance may cover the cost of a device. Coverage for devices varies based on your state of residence, your child’s insurance type, and other factors. Some insurance companies (e.g., Blue Cross and Blue Shield of Illinois) have gone so far as to state that devices like the iPad are not augmentative and alternative communication devices. If this happens to you, connect with your state health care advocate and file an appeal.

If you are lucky enough to have the right type of insurance, you will have to work closely with your child’s speech and language pathologist as well as your child’s primary care physician in order to get a device approved. The process will be time-consuming but when you use this option, the device belongs to your child. You will be responsible for its care, maintenance, and repairs. You will be responsible for purchasing any new applications.

When the device is purchased with insurance funds, the device is serving as a mode of communication. It should not be used as a toy.

Grants

There are many non-profits and foundations out there that are focused on helping provide iPads to children with autism and other disabilities. My favorite is the Holly Rod Foundation. My brother was a recipient of one of their iPads and he uses it to Skype our Dad and to Face Time me. One of my clients also received an iPad from the Holly Rod Foundation. We cannot thank the Foundation enough. Get on their mailing list so you will know when the next round of iPads will be given away.

If you live in Texas, the state has a program called STAP grants that are available to individuals who need to be able to communicate with others. Your child’s speech and language pathologist must complete the application on your behalf. Similar to insurance funding, the device must be used for communication purposes and not for games. This device will belong to your child and you will be responsible for its care and maintenance.

We have recently been made aware of other groups that are giving away iPads. We have not had any experience with these groups so use caution before providing them with information such as your social security number.

Babies with iPads is hoping to give away 4 iPads per year. Their website is here: http://babieswithipads.blogspot.com/

Snapps4kids is also giving away iPads. They recently merged with Easter Seals. Their website is here: http://www.snapps4kids.com/funding-sources-directory/

Have you had success getting a device for your child? Please share so that we may celebrate with you.

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Lately, I have begun paying attention to the ways people parent when they are on community outings. Many times, I see toddler tantrums that make me laugh. Why do I laugh? Well, if the parent is laughing, then the parent understands why the toddler is throwing such a fit.

You see, many parents understand that toddlers are going to tantrum. Many parents also know why their toddlers throw tantrums. Toddler tantrums are really just words that the toddler has not yet acquired.

“I want _______”

“I don’t want __________”

“_______ is mine”

This is true and there is even a shirt about it. This is a shirt showing the toddler tantrum yoga poses. See? Parents know their children’s tantrums!

You know what else? Pet owners often understand what their pets are trying to tell them.

“I’m hungry”

“Let’s play fetch”

“Let’s go outside”

“I have to potty”

“I’m tired and can’t walk anymore. Carry me.”

Pet owners know what their dog is saying, even though they cannot speak.

What I have never understood, however, is why people don’t understand (or don’t even try to understand) the tantrums exhibited by individuals with autism. Individuals with autism who are non-verbal have tantrums because they, too, have not yet acquired the words. Yet, when they have a tantrum, people are not laughing. Whey they have a tantrum, people get mad. When they have a tantrum, they get restrained, punished, or yelled at.

What we, as behavior analysts have learned over the years, is that individuals with autism are using their behaviors to communicate. A behavior analyst’s job is to assess what the individual with autism is trying to say with his tantrum.

“I want ________”

“I don’t want ______”

“I need help ________”

“I am all done”

That assessment is called a functional behavioral assessment. After the assessment, the behavior analyst designs a communication intervention program to teach the individual to communicate instead of tantrumming. You’ve heard the old saying, “Use your words”. When an individual is non-verbal, she does not have words. So, behavior analysts teach augmentative and alternative communication strategies or AAC. Individuals can learn to sign. They can learn to use pictures to express their wants. Or they can use an iPad equipped with proloquo2go. The options are endless.

So, next time you are out in public and you see an individual with autism throwing a tantrum, think about your toddler and her tantrums. Know that the individual is trying to tell us something. We just need to stop and listen.

Addendum

This is one of our favorite posts. We are hoping to share it with others today as we link up with Ado over at the Momalog as she celebrates her blog’s first birthday. Hop on over there and check out the other bloggers’ favorite posts.
Blog Bash

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Dear Steve,

You left us too soon. You left us before you could possibly know what your work has done for us. The iPad combined with many, many different applications, including the Proloquo2go software has helped us and our loved ones tremendously. Children have learned to communicate that they want to eat, children have learned to communicate when they are upset, children have learned to communicate when they are scared.

Thank you for being brave enough to think differently. Thank you for making a difference for our children with autism who also think differently.

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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 success story is about Mary Lea, a sweet little peanut who had just turned 3 prior to coming to feeding clinic. In addition to being diagnosed with autism, Mary Lea had experienced some medical issues in her young life. However, her Mother’s biggest concern was Mary Lea’s eating. Mary Lea only ate with her fingers and she refused to use utensils. Mary Lea also drank out of one cup and she showed no interest in drinking from any other container.

Mary Lea loved to drink apple juice and almond milk. She consumed Lays Stax chips, mini muffins, McDonald’s french fries, and chocolate pop tarts. Mary Lea also had an affinity for Sonic Grilled Cheese. Her mother bought a sandwich maker, special bread, and Sonic wrappers so she could make them at home. Mary Lea wanted nothing to do with her mother’s grilled cheese. She cried and refused to eat until her mother bought her a Sonic grilled cheese.

Mary Lea and her mother packed their bags and made the trek to Austin, Texas where we were offering a week of intensive feeding therapy. Mary Lea and her mother attended sessions 3 times each day (breakfast, lunch, and dinner). It is hard work for the parents because they have to take off from work to bring their child to the clinic. The parents have to prepare all the food and bring it to clinic for each meal. Finally, parents watch all sessions for the first day or two so they can learn the strategies that we use.

In the initial stages of intervention, we target an easy skill to ensure that the child will get access to preferred items or activities (also known as reinforcers). For Mary Lea, we quickly learned that she loved the new coconut milk yogurt we offered her. We were able to use the new yogurt to get her to try other new foods. Within the first day, Mary Lea was taking food from our hand and placing it in her mouth. Our next goal was to teach her to eat from a utensil.

Mary Lea was not happy about this change in feeding expectations. Since she refused to eat from the utensil in one session, she did not get access to the yogurt. After one session with no access to yogurt, Mary Lea realized that the only way she could have the yogurt was to try new foods. Soon, she was self-feeding with the utensils. After this, we transitioned her mother in to sit next to her and her eating continued to improve.

Once Mary Lea mastered eating in the clinic, we moved therapy to a local restaurant. Mary Lea’s mom brought the yogurt in to the restaurant to use as a reinforcer. Mary Lea does not handle change well so she was initially unhappy about eating in a new place with new plates and new utensils. However, she quickly realized that the restaurant also had good food to eat. (As a side note, most restaurants are ok with families bringing in special food, you just need to clear it with them first. In our experience, restaurant staff are very understanding of the issues associated with autism including eating challenges. Restaurant staff have been most accommodating.)

Not only did Mary Lea learn to eat within the 5 days of intervention, she stopped using her pacifier and  she started walking everywhere instead of being carried! Finally, on the last day, we introduced the iPad2 equipped with Proloquo2go software. We offered dairy-free pudding as dessert at the end of the meal. Mary Lea was prompted to touch the “I want pudding” button after which she received one bite of pudding. On the third try, Mary Lea touched the “I want pudding” button on her own.

Congratulations Mary Lea on your success. You could not have done it without your mom. She rocks!

Happy eating!

.

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