Tag: Autism Therapy

Managing Your Child’s Screen Time During COVID-19 with Katherine Johnson, BCBA

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The sudden disruption in routine due to COVID-19 is challenging for all individuals to manage as we adjust to a new, and hopefully short-lived, normal of staying at home and ceasing most of our regular activities. For families of individuals with autism and other disabilities, the disruption can be especially challenging.

Resources Discussed:

Cosmic Kids Yoga: https://www.youtube.com/CosmicKidsYoga

Raz Kids: https://www.raz-kids.com/

Epic: https://www.getepic.com/

Prodigy: https://www.prodigygame.com/

DreamBox: https://www.dreambox.com/

Out School: https://outschool.com/

Story Time from Space: https://storytimefromspace.com/library/

Bark: https://www.bark.us/

For more helpful tips and resources, sign up for our Parent Newsletter at learnbehavioral.com/parentresources.

All Autism Talk (allautismtalk.com) is sponsored by LEARN Behavioral (learnbehavioral.com).

Autism and Co-occurring Disorders with Susan W. White & Carla Mazefsky

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Dr. Carla Mazefsky is an Associate Professor of Psychiatry at the University of Pittsburgh School of Medicine, where she is Co-Director of the Center for Autism Research (CeFAR) and the Director of the Regulation of Emotion in ASD Adults, Children, & Teens (REAACT) Research Program. She is a past recipient of the INSAR Ritvo-Slifka Award for Innovation in Autism Research. Her current studies take a lifespan approach, with an emphasis on adolescence and the transition to adulthood.  Her research focuses primarily on emotion regulation and associated mental health and behavioral concerns in autism spectrum disorder (ASD), including the mechanisms underlying emotion dysregulation in ASD and the development of new assessment and treatment approaches. She is co-editor of the Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions, author of the Emotion Dysregulation Inventory, and co-author of the Emotion Awareness and Skills Enhancement (EASE) Program.   

Susan W. White is Professor and Doddridge Saxon Chair in Clinical Psychology at the University of Alabama. Her clinical and research interests include development and evaluation of psychosocial treatments that target transdiagnostic processes underlying psychopathology. She is associate editor for the Journal of Clinical Child and Adolescent Psychology and the Journal of Autism and Developmental Disorders, and she the Editor in Chief of the ABCT Series on Implementation of Clinical Approaches. Her research has been funded by the National Institutes of Health and the Department of Defense. She received her PhD from Florida State University.

All Autism Talk (allautismtalk.com) is sponsored by LEARN Behavioral (learnbehavioral.com).

Early Detection and Treatment for Autism with Dr. Geraldine Dawson

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Geraldine Dawson is the William Cleland Distinguished Professor of Psychiatry and Behavioral Sciences at Duke University, where she also is Professor of Pediatrics and Psychology & Neuroscience. Dawson is the Director of the Duke Institute for Brain Sciences whose mission is to promote interdisciplinary brain science and translate discoveries into solutions for health and society.  Dawson also is Director of the Duke Center for Autism and Brain Development, an NIH Autism Center of Excellence, which is an interdisciplinary research program and clinic, aimed to improve the lives of those with autism through research, education, clinical services, and policy. She has published several books on autism, including An Early Start for Your Child with Autism, A Parent’s Guide to High-Functioning Autism, and  What Science Tells Us about Autism Spectrum Disorder.  Dawson’s pioneering studies were among the first to describe the emergence of autism symptoms during infancy, leading to new screening tools. Dawson co-created the Early Start Denver Model, an early autism intervention shown to improve behavioral outcomes, which has been translated into 17 languages and is used worldwide. Her work showed for the first time that early intervention can normalize aspects of brain activity in children with autism, changing the field’s view of brain plasticity in autism, a finding recognized by TIME Magazine as one of the top 10 medical breakthroughs of 2012. A strong advocate for persons with autism, Dawson has testified a number of times before the US Congress in support of major autism legislation and was appointed by the U.S. Secretary for Health and Human Services for two terms to the DHHS IACC.

All Autism Talk (allautismtalk.com) is sponsored by LEARN Behavioral (learnbehavioral.com).

Our amazing daughter

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Autism is a diagnosis that can be emotional for parents and families to accept. In our case, the diagnosis needed to be accepted by our family. Our daughter is amazing. She is incredibly bright, sweet, and an absolute joy to be around. As a parent, one of the most gut-wrenching things we experienced was being told time after time, “Your child has challenges, but no one knows why.” In May of 2013, we finally got our answer. Our beautiful girl has a rare genetic condition called Cohen Syndrome that causes intellectual, medical, and physical disabilities. Receiving this diagnosis was bittersweet because we finally got an answer, but we still didn’t know how to help our daughter. With a rare genetic condition like this, there are several programs, specialists, and therapies available that we didn’t even know existed. There are people with resources who wanted to help but had never heard of our child’s condition. It was very alarming for us because even though we were thankful for their help, the process can be anxiety-inducing.

When our daughter was diagnosed with Autism a year ago, it wasn’t a bittersweet moment like when we received her original diagnosis of Cohen Syndrome. It was just sweet! Autism Awareness has been raised, and there are people in the education and medical field who have experience with Autism. I fully accept that our daughter has Autism, but the fact is that a lot of her challenges stem from her primary diagnosis that is rare. I asked myself how this “known” diagnosis could help when you have to take her “unknown” diagnosis into account? The answer was ABA therapy.

Although we have seen AMAZING progress through ABA therapy in our daughter over the last year, the truth is that it cannot be contributed fully to “just” ABA therapy. ABA therapy with the right team is the answer. What makes the right team? Compassion, humility, resource-connected, knowledgeable, and experienced team members. ABA is an evidence-based practice.

We know firsthand that having a team that is compassionate and humble will allow for success. Having a child with complex healthcare needs is overwhelming. We almost always feel like we aren’t doing enough (are we acting more like advocates instead of just being mom and dad? Is our child receiving the right therapies, too many or not enough? How can we balance comfortability for a child whose world is almost always uncomfortable, but also push her to reach her full potential?). Adding ABA therapy to our already crammed schedule brought apprehension. But having the right team, takes the stress out of the equation. We (parents, child and staff) work together on proper goals and time management.

ABA is an excellent tool that I highly recommend families consider, but it’s not the only tool. Especially when working with a child who has a rare genetic condition plus an Autism diagnosis. Other resources and tools may assist families in achieving their goals. For us this meant learning about the objectives as a family together while our daughter was mastering goals. ABA works best when it’s combined with your other resources; (i.e., current therapies in place, IEP teams, community support, etc.) as this helps generalize what is learned. We have seen our daughter transfer the skills she’s learned in her sessions into her everyday life. Our daughter, recently turned eight years old, received a skilled companion dog, and is transitioning to a general education classroom. This transition and the skills that her amazing ABA team teach her have been a blessing to her, and our family. Our daughter has been showing more affection to those she cares about. She’s able to master her goals outside of her sessions and into the community (which I am unable to express how HUGE this is). She is also able to complete her homework with modifications; additionally, she can share who she is with others instead of allowing her diagnoses to define her as others think it does.

From a logical perspective, ABA therapy is remarkable in how it allows children (no matter what the diagnosis is) to learn things that other children may more readily know. From a mom’s perspective, it’s beyond amazing. This process has provided my husband and me with the support needed so we can be her parents, instead of her providers. Partnering in this way gives us opportunities we wouldn’t be able to have without this kind of assistance. There’s a saying that it takes a village to raise a child. In the early days of our daughter’s life, my husband and I would jokingly say it takes a hospital to raise our child. As her health has become more stable, and we’ve been able to focus more on her education and life skills, we agree that in fact, it takes a village to raise a child — a properly equipped village. And we are so grateful that God blessed us with her ABA team as an addition to our village.

– by Nicole

The Value of an Assessment after an Autism Diagnosis

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By Chisato Komatsu, PhD, BCBA-D

When you have decided on a provider for ABA services, one of the first things a provider will do to better understand your child and family’s needs is conduct an assessment.  You may wonder, “Why is an assessment necessary? Why can’t we jump right into intervention and teach my child new skills?”  I’d like to clarify that the purpose of conducting an assessment is not to identify what is “wrong” with your child, but rather to identify your child’s needs and to help develop the most effective intervention possible to meet those needs. To develop an effective intervention program tailored for your child, the initial program goals need to be developed based on your child’s current skill level. The initial and ongoing assessment process, therefore, is critical in identifying the current skills and levels and the specific needs for your child.

The assessment process usually  consists of interviews with the client and/or caregivers, direct observations, and additional assessment tools and analyses depending on various factors (e.g., client’s engagement in challenging behaviors, requirement of the funding source, etc.). Through the assessment process, the assessor evaluates the client’s current skills and performance levels and also focuses on the environment and how it impacts the behavior.

Based on the assessment results, an intervention program is developed. Many factors, such as the client’s age, are taken into consideration when developing programs. For teenage clients, for example, the intervention may focus more on the client acquiring independent living skills, helping them be more independent in the community, whether that be completing the daily routine independently, going to college, or getting a job. Priorities of the family are often taken into consideration during the development of the intervention program.   For example, if the family travels across seas to visit other family members, successfully completing a long flight may be of high importance.

When starting an assessment process, be sure to ask questions. Ask questions to find out what is included in the assessment process, how it is going to be conducted, and how the intervention is developed based on the assessment results.

Watch our video on the value of an assessment.

A Response to “The Controversy Over Autism’s Most Common Therapy”

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By Andrea Ridgway, Ph.D., BCBA-D

When reading a recent article entitled, “The Controversy Over Autism’s Most Common Therapy” published on spectrumnews.org and republished in The Atlantic, I was taken aback by the description of applied behavior analysis (ABA).  As a behavior analyst who works with an organization that serves 1,500 families per year, it is not my experience that our programs are controversial rather that they are highly effective and enthusiastically received by families.  However, it would be irresponsible to simply dismiss negative perceptions as misinformed or outdated.  There is more to this conversation.

How do behavior analysts define ABA?  Applied behavior analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior (Baer, Wolf, & Risley, 1968; Sulzer-Azaroff & Mayer, 1991).

The use of ABA in persons with autism was popularized by Ivar Lovaas, Ph.D. at the University of California Los Angeles (UCLA) where the use of sterile clinic rooms, robotic repetition of learning trials, and highly artificial delivery of awards and punishments were reported.  Increasing social skills and decreasing repetitive behavior were among the goals of the UCLA Young Autism Project. Lovaas applied the principles of behavior in the treatment of individuals with autism.  However, the interventions he used have been criticized for their harshness and some goals to “normalize” or reduce “autism-like” behaviors have been criticized as inappropriate.

The application of ABA with persons with autism has changed tremendously since Lovaas’ initial research.  Effective interventions based on the science of behavior analysis are anything but “one size fits all”.  ABA provides a technology to address individual needs; it is not a manualized treatment package that is applied to every child in the same way.  Each individual with autism presents with different skill deficits and behavioral excesses, and the reason these behaviors occur varies across individuals.

Behaviors are assessed to determine what purpose (i.e., function) they serve for the individual.  Once a behavior analyst determines why a behavior occurs, an intervention plan is developed.  For example, one child’s aggressive behavior may be maintained by attention from his parents, and another child’s aggressive behavior may be maintained by escape from non-preferred activities.  Therefore, the intervention for aggressive behavior will be different for each child.  In order to be effective, intervention programs must be individualized to the needs of the child and the function(s) of the target behavior(s).

At Autism Spectrum Therapies, the design of an ABA program is centered on the individual child’s and family’s goals and the behavior changes necessary to achieve those goals.  The child’s and family’s strengths are identified and leveraged in order to achieve success.  Maladaptive behavior that is harmful or interferes with learning is replaced with socially appropriate replacement behaviors through reinforcement-based interventions rather than with aversive procedures.  Instead of treatment occurring in sterile clinic rooms where the child is drilled with flashcards, intervention is conducted in the natural environment during play and family routines, involving multiple people to ensure generalization of skills in a meaningful way.

Behavior analysts treat the specific behaviors associated with a diagnosis of autism spectrum disorder (ASD) through interventions based on the principles of behavior.  Autism is not a behavior; it is a label used to describe the numerous behaviors with varying functions that fall into the diagnostic criteria of ASD.  ABA is not a therapy; it is the application of the science of human behavior.  Given the countless combinations of behavior that may meet diagnostic criteria for ASD and the number of interventions used to treat these behaviors within applied behavior analysis, it is of little surprise that “there is no one study that proves ABA works”.  Intervention outcomes in applied behavior analysis are most commonly measured through single-case research designs where the effects of individualized interventions on one or more behaviors of social significance are evaluated.

Who determines what behaviors are socially significant, if the interventions applied are acceptable, and what degree of behavior change is meaningful?  In other words, who determines social validity (Wolf, 1978)?  The issue of social validity is at the heart of the controversy over the use of ABA in the treatment of individuals with autism.  Society, including clients, caregivers, and other consumers, determines the social validity of behaviors targeted for intervention, procedures used, and outcomes obtained. Behavior analysts merely serve as the vehicle.

Social validity is subjective and society’s perceptions are constantly evolving.  While Lovaas’ initial research was initially received as groundbreaking, “normalization” of children with autism and the use of aversive procedures are now viewed by many as unacceptable.  As behavior analysts, we need to continually evaluate our proposed treatment goals and procedures.  We need to critically evaluate whether or not the behaviors targeted for intervention will actually improve the lives of our clients and that the treatment goals are in line with the client’s and family’s goals.  As a field, there is a need to communicate with our clients and their caregivers about the goals, procedures, and results.  Most importantly, we need to listen to what they say.

Wolf (1978) predicted that by placing importance on social validity, behavior analysts “will bring the consumer, that is society, into our science, soften our image, and make more sure our pursuit of social relevance” (p.207).  It seems as though many behavior analysts have forgotten the importance of social validity.  Rather than listening to criticisms of ABA with curiosity and compassion, behavior analysts have publicly gone on the defensive and simply explained why and how critics’ perceptions of applied behavior analysis are wrong.  In doing so, we are missing the point.  If applications of behavioral principles are not aimed at improving behaviors that clients, caregivers, and consumers view as socially significant or do not improve behaviors in ways which are meaningful, by definition, applied behavior analysis is not being practiced.

I propose we view the controversy surrounding the use of ABA in the treatment of individuals with autism as progress.  Controversy can serve as a catalyst for change.  Baer, Wolf, and Risley (1968) hypothesized that the dissemination of the applications of behavior analysis “may well lead to the widespread examination of these applications, their refinement, and eventually their replacement by better applications.  Better applications, it is hoped, will lead to a better state of society” (p. 91).  We have an opportunity and responsibility to respond to our clients, their caregivers, and consumers and advance our field in a way that embraces the changing views that celebrate diversity and individual differences.  We can hope that these advancements “lead to a better state of society”, but only society can make that determination.

Baer, D.M., Wolf, M.M., & Risley, T.R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91-97.

Sulzer-Azaroff, B. & Mayer, R. (1991). Behavior analysis for lasting change. Fort Worth, TX: Holt, Reinhart & Winston, Inc.

Wolf, M.W. (1978). Social validity: The Case for Subjective Measurement or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11, 203-214.