Back to basics

Recently I received a request to provide some technical support.  Without knowing much, this was my message.
'______ just called and I’d be glad to help as much as I can.

I don’t know if you ever got this book; but if not, I’d recommend getting it.
Functional Behavioral Assessment, Diagnosis, and Treatment by Cipani and Schock
You can find it on line and wherever best books are sold :-)
If you have it, or when you get it. Study it closely and apply the information and tools.
I realize I am an unusual person in many ways; however, I found it fascinating…seriously.
Once you have the book and begin the read, the first thing you will be directed to do is to look at antecedents and other setting events. It may be that much of the issue can be solved there. After you have done that, you’ll want to do more of an assessment to look at reinforcements; however, not knowing the person but just hearing a little…
I understand that s/he is an adult who can do what you want him/her to do but just isn’t motivated.
That’s about all I know.
This raises a few questions.
1. Is it really something s/he HAS to do?
2. If yes, what are the reasons s/he has to do it?
3. Are there any times when s/he does it? If yes, what are the differences and “I don’t know” or “there aren’t any” is not an acceptable answer. There are ALWAYS differences. (I suggest you get a copy of and read: Becoming Solution-Focused in Brief Therapy by Walter and Peller, not exactly the same situation; but totally applicable and another fascinating read.)
4. If there are times when s/he does it, replicate those times, situations, antecedents, and reinforcements. This may rely most heavily on antecedents to include setting events.
5. Look at the reinforcement s/he gets for NOT doing it (whatever it is)
6. Look at potential reinforcements for doing it, if it is REALLY something s/he needs to do.
If you get stuck in the process let me know and I’d be glad to sit down with you.
(In the case of the reader, I'd be glad to discuss the situation through the comments.  Be sure and do not include any personally identifying information.)
Hope that helped.'

Videos By Topic

Videos By Topic: "Videos and audio are now exclusively available in the new UC Davis MIND Institute Media Player. Adobe Flash and Javascript are needed to play back all media on the MIND Institute website. Chances are that Flash and Javascript are already a part of your browser as they are installed on almost all computers connected to the Internet. However, if you are having difficulty playing any media on this site, Adobe Flash can be downloaded from Adobe's website and instructions for enabling Javascript in your browser are available here." To watch the videos, click here.

These are excellent videos.  A bit technical; but not too bad if this is something you are very interested and are even nominally abreast of the research.

'It's important to remember that the amount of service is not what's important, because all of the child's learning occurs between sessions." McWilliam

Click "enter" to progress through the slides.

https://www.azdes.gov/uploadedFiles/Arizona_Early_Intervention_Program/evidence_based_pratice.pdf

Natural Reinforcement: Parenting that Lasts

Most parents want to teach their children skills, behaviors, and character traits which will last and even be improved upon well into adulthood. One of the keys to teaching that lasts is using natural reinforcement.


Natural reinforcement: A way to improve education

Journal of Applied Behavior Analysis 1992 Spring; 25(1): 71–75.

Direct versus indirect response-reinforcer relationships in teaching autistic children

Journal of Abnormal Child Psychology Volume 8, Number 4, 537-547

Too often we use contrived reinforcements (bribes) without teaching the natural connections to natural reinforcement. Natural reinforcement is a simple but powerful concept lost to many in our world. Sometimes we use contrived reinforcement to teach a child to do something and sometimes this is appropriate because it is more immediate. For example: you MAY need to use small candies to initially teach your child to use the toilet; however, the natural reinforcement is consistent success and toileting hygiene (with all the natural rewards of being potty trained). Another example of a contrived reinforcement is something I have too often seen in my work. Here’s an example: A therapists will want to teach a child to appropriately ask for a hug before just grabbing and hugging. The contrived reward for an appropriate request may be something like a “good job” from the therapist or a few M & Ms. Another example is teaching someone how to make a sandwich or breakfast. While you may have to reinforce the more immediate steps towards the ultimate goal (such as a “good job” for getting the bread out to make the sandwich) the natural reinforcement for making a sandwich is eating the sandwich. The natural reinforcement for making breakfast is eating and perhaps even sharing breakfast, and of course the natural reinforcement for appropriately asking for a hug is (when appropriate) getting a hug. Most of you reading this will think ‘how silly.’ But many parents do similar things with their own children.

Here is just one example: how many parents pay their child to help in the garden? Natural reinforcers for working in the garden include those which come from working together, seeing a well maintained garden grow, and yes, eating what you have grown. Wouldn’t it be great if more people understood the natural connection between working in a garden and eating?

Natural Reinforcement: Parenting that Lasts

Best Practice (less expensive) Treatment for Autism

Fortunately we have learned a great deal about Autism (including PDD NOS and Aspergers) treatment over the last 20 years. While there is a wide variety of ineffective and expensive treatment being practiced around the world to include hundreds of interventions. We now know enough to be prescriptive and even know which children are most likely to benefit from which treatment. This information is especially crucial now as policy makers are determining where to expend limited funds and resources. One intervention which; while currently considered an “emerging practice” has shown significant positive results for some children and costs less than $3000.00 per year on average.


Can Chidlren with Autism Recover? If So, How? Neurophysiology Review (2008) Volume 18: Number 4, 339-336
Evidence-Based Practice and Autism in the Schools: A Guide To Providing Appropriate Interventions To Students With Autism Spectrum Disorders National Autism Center 2009
Pilot study of a parent training program for young children with autism: The PLAY Project Home Consultation program
SAGE Publications and The National Autistic Society Vol 11(3) 205–224
Can one hour per week of therapy lead to lasting changes in young children with autism?
Autism January 2009 vol. 13 no. 1 93-115

While not all children are likely to make the gains in skills exhibited in some best practice models such as evidenced in a recent study of the Early Start Denver Model, most children with autism, as well as other behavioral concerns, can make significant behavioral progress if the right intervention is provided under the right conditions.

Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model
PEDIATRICS Vol. 125 No. 1 January 2010, pp. e17-e23

Most of the best practice and less expensive interventions have some common threads which are essential to success.
1. They are specific to the age, diagnoses, and functioning level of the child.
2. They contain goals and objectives which are clearly and well written contextually mediated to the natural routines of both the child and family.
3. They include extensive parental, and at times other caregiver involvement which, occurs during the natural routines of the child and parent. (This does not mean that a parent must drastically change their schedule and devote all of their excess time to providing direct intervention for their child. It does mean that they way they interact with and support their child during both the parents and child’s natural routines in adjusted for therapeutic value for the child.
4. They often incorporate more natural (logical) reinforcers and fewer (artificial) contrived reinforcers.
5. The service provider is expert in both the model of delivery and in effectively working with families according to the basic values and norms of the family.

Working with Families of Young Children with Special Needs (What Works for Special-Needs Learners) R. A. McWilliam PhD (Editor)
The Entry Into Natural Communities of Reinforcement Control of Human Behavior (Vol.2, pp. 319-324)
Contextualized Behavioral Support in Early Intervention for Children with Autism and Their Families Journal of Autism and Developmental Disorders
Volume 32, Number 6, 519-533
Coaching Families and Colleagues in Early Childhood Brookes Publishing

Early Start Denver Model for Young Children with Autism: Promoting Language, Learning, and Engagement

The following was not written by myself; but by:
Sally J. Rogers, PhD & Geraldine Dawson, PhD
“This book marks a very significant milestone in the development of appropriate interventions for young children with autism spectrum disorders. The integration of goals and teaching strategies from developmental, behavioral, and context-oriented approaches is unique. The chapters on theory will press even experienced interventionists to think about what they are attempting and why, and the detailed descriptions of activities show exactly how theory meets practice. With multisite research underway to test the encouraging results of early studies, this manual will enable interventionists to think more broadly; choose
concrete, measurable, and useful goals for each child; and collaborate across disciplines within a comprehensive intervention framework.”

Working Paper #9: Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development

Working Paper #9: Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: "Ensuring that young children have safe, secure environments in which to grow, learn, and develop healthy brains and bodies is not only good for the children themselves but also builds a strong foundation for a thriving, prosperous society. Science shows that early exposure to circumstances that produce persistent fear and chronic anxiety can have lifelong consequences by disrupting the developing architecture of the brain. Unfortunately, many young children are exposed to such circumstances. This report from the National Scientific Council on the Developing Child summarizes in clear language why, while some of these experiences are one-time events and others may reoccur or persist over time, all of them have the potential to affect how children learn, solve problems, and relate to others."

This is excellent but is not my work.  Please click on the link to read the whole article.

Better and more effective intervention for much less money, commonly as little as 20% of what is often currently being spent.

Evidence Based Family Centered Practice, sometimes called Coaching and sometimes provided through P.L.A.Y.; but which comes in many effective and proven forms and models which include contextualized routine based interventions is very often the most effective and cost efficient intervention for children with developmental disabilities and/or mental health concerns. All of these variations require extensive family involvement and responsibility; but generally speaking only minor alterations in environment and schedule, especially for parents who normally wish to spend both quality and quantity time with their children. The biggest difference isn’t so much what you do; but how you do it, and how you interact to enhance your child’s best behavior, functional skills, and relationships.


Frequently the best intervention to accomplish these outcomes is through consultation and education with limited direct interaction between the therapist and the child and more interaction between the parent and child with some observation, consultation, and even demonstration on the part of the therapist.

Family-Focused Interventions for Promoting Social-Emotional Development in Infants and Toddlers with or at Risk for Disabilities

The following article was not written by myself.  It is excellent and I have included a part of it here; however to read the entire article you will need to click on the link at the end.

"The reproduction of this document is encouraged. Permission to copy is not required.


Th is publication was produced by the Technical Assistance Center on Social Emotional Intervention for Young

Children funded by the Offi ce of Special Education Programs, U. S. Department of Education (H326B070002).

Th e views expressed in this document do not necessarily represent the positions or policies of the Department of

Education. No offi cial endorsement by the U.S. Department of Education of any product, commodity, service or

enterprise mentioned in this publication is intended or should be inferred.

Suggested Citation:

Powell, D. and Dunlap, G. (2010). Family-Focused Interventions for Promoting Social-Emotional Development in

Infants and Toddlers with or at Risk for Disabilities. Roadmap to Eff ective Intervention Practices #5. Tampa, Florida:

University of South Florida, Technical Assistance Center on Social Emotional Intervention for Young Children.

http://www.challengingbehavior.org/

Roadmap to Effective Intervention Practices


Family-Focused Interventions for Promoting Social-Emotional Development in Infants and Toddlers with or at Risk for Disabilities

Diane Powell and Glen Dunlap, September 2010

INTRODUCTION

This document is one in a series of syntheses intended to provide summaries of existing evidence related to assessment and intervention for social-emotional challenges of young children and for promoting the social-emotional competence of all young children. The purpose of the syntheses is to offer consumers (professionals, other practitioners, administrators, families, etc.) practical information in a useful, concise format and to provide references to more complete descriptions of validated assessment and intervention practices. The syntheses are produced and disseminated by the OSEP Technical Assistance

Center on Social-Emotional Interventions (TACSEI).

This synthesis considers family-focused services and practices

for promoting social-emotional development of children served in Part C. Its specific focus is on interventions that influence parenting practices for infants and toddlers with or at risk for disabilities.

The general effectiveness of early intervention services in promoting the well-being and development of children and their families has been well established through what Guralnick (1997) has termed “first-generation” research. This includes many strategies including procedures that seek to enhance child development through parent mediated interventions.
The field has now moved on to more specific “second-generation”


research questions: what works for which families and children, under what conditions? Answers to these questions can provide practitioners with specific guidance in the selection,

design and implementation of interventions and practices that produce optimal outcomes for infants and toddlers and their families. A substantial knowledge base exists regarding: 1) the role of positive interactional and parenting practices in shaping social emotional development of infants and toddlers, and 2) specific family-focused strategies and interventions that are effective in addressing social emotional competencies and challenging behavior in young children. The results of this research form the basis for this synthesis.

The development of behavioral/emotional self-regulation and the ability to establish secure attachments and positive relationships

with others during infancy and toddlerhood form the foundation for later social emotional competence and well-being (National Scientific Council on the Developing Child, 2004a). It is through interactions with others, and especially with primary caregivers, that these foundational capacities and competencies emerge. This is true for all children, both typically developing and those with or at risk of disabilities (National Scientific Council on the Developing Child, 2004b, 2008; National Research Council and Institute of Medicine, 2000). Many young children at risk for disabilities or with
identified disabilities develop social emotional competencies on an age-appropriate timeline. For others, deficits in physical, cognitive or communicative abilities may interfere with social emotional development, making early intervention to support effective caregiving practices even more critical.


The important role of family-mediated

strategies in early intervention

is well accepted as evidenced by the inclusion of parenting competencies in early intervention

theories of practice (Odom & Wolery, 2003), the recommended practices of the Division of Early Childhood of the Council for Exceptional Children (Trivette & Dunst, 2005) and in recommendations

for family outcomes in early intervenion (Bailey et al., 2006). In fact, some have argued that ensuring parent involvement and responsiveness is a necessary

component of early intervention without which child directed intervention services are unlikely to be effective (Mahoney, 2009).

The need for early intervention systems to develop the capacity to provide effective parenting interventions to families they serve has taken on heightened importance with the advent of the CAPTA and IDEA mandates for referral to Part C of children involved with the child welfare system. The developmental

and early intervention needs of infants and toddlers served by the child welfare system are well documented (Barth, et al., 2008; Rosenberg & Smith, 2008; Wiggins, Fenichel & Mann, 2007). It is estimated that these new mandates will result in large increases in referrals and enrollment of infants and toddlers with substantiated maltreatment in early intervention

systems (Derrington & Lippitt, 2008).

The teaching of nurturing, responsive interactions and effective parenting practices is central to many interventions that have demonstrated effectiveness in preventing and intervening with parents who are at-risk for child maltreatment (Baggett, Carta, et al., 2010; Chaffin & Friedrich, 2004; Geeraert, Van den Noortgate, Grietens & Onghena, 2004; Hammond, 2008). However, providing such interventions to families involved in child welfare presents new and complex challenges for early intervention systems. These challenges include engaging and serving families with severe and multiple risks; the voluntary

nature of early intervention services in contrast to the mandates and court orders that typically govern family involvement

with child welfare systems; continuity of programming for children who may experience frequent changes of placements

and caregivers; and coordinating with multiple service providers from different systems (Derrington & Lippitt, 2008; Dicker & Gordon, 2006; Rosenberg, Smith & Levinson, 2007; Stahmer, Thorp Sutton, Fox & Leslie, 2008).
While this synthesis does not focus specifically on interventions for maltreatment, it does note when an intervention has been evaluated with children experiencing trauma or maltreatment or with parents for whom child maltreatment is a concern.


PURPOSE, SCOPE AND ORGANIZATION OF THE SYNTHESIS

The purpose of this synthesis is to present summary information

on family-centered practices, and on interventions aimed at promoting positive parenting practices, teaching parenting skills, and influencing parent child interactions that have demonstrated associations with positive social emotional development

for children aged 0-3 years. The synthesis is intended to provide guidance to early intervention personnel, both those providing services to families and children within the Part C system and those working within other service frameworks.

The synthesis does not include interventions aimed primarily at communication and language outcomes for children unless the practices have also been demonstrated to enhance social emotional outcomes. It also does not include large scale, multi-component service delivery models such as Early Head Start, Healthy Families, SafeCare and Nurse-Family Partnership although it should be noted that there is a substantial literature

documenting the efficacy and effectiveness of such models in supporting multi-risk families (Chaffin & Friedrich, 2004; Geeraert et al., 2004; Love et al., 2005). Rather, the focus of this synthesis is on the parenting knowledge, skill sets and practices that have proven effectiveness and can serve as the content of parenting education delivered through these service models.

The synthesis first reviews the evidence for family-centered approaches and practices. Next it examines the literature concerning parent-child interactions and parenting behavior including knowledge gleaned from existing meta-analyses and reviews of the pertinent empirical literature. This includes both content (parenting/caregiving behaviors that impact infant/toddler social emotional outcomes) and methods (practices effective in supporting and changing caregiver behavior). This is followed by a consideration of some of the relevant intervention materials, packages, curricula and models for families of infants and toddlers that are available. Finally, factors to consider in selecting family-focused interventions are discussed.

REVIEW OF THE EVIDENCE

Family-Centered Approach and Practices

Family-centeredness refers to a philosophy of service delivery—an approach to the delivery of services based on values and beliefs regarding how professionals interact with and relate to the families they serve. While there are variations


in how family-centeredness is defined and characterized,

it typically includes: 1) treating families with dignity and respect; 2) practices that are individualized, flexible, and responsive to the expressed needs of families; 3) information sharing that enables families to make informed choices; 4) family choice regarding program practices and intervention options; 5) parent-professional collaboration and partnerships;

and 6) active involvement of family members in the mobilization of services and supports (Dempsey and Keen, 2008; Dunst, Trivette & Hamby, 2008). Similar conceptualizations

emphasizing the primary role of families and family strengths and assets-based practices can be found in DEC’s recommendations for family-based practices (Trivette & Dunst, 2005).

A family-centered approach has been well accepted in the field of early intervention from a philosophical and values-based perspective. Recent reviews and meta-analyses have provided documentation that when service delivery incorporates family-centered practices, outcomes for family and children are improved including parenting capabilities and positive child behavior and functioning (Dempsey & Keen, 2008; Dunst, Trivette and Hamby, 2006, 2007, 2008). Dunst, Trivette and Hamby (2006, 2007, 2008) classified family-centered practices as relational (clinical skills such as active listening, compassion, empathy, respect and beliefs regarding family member strengths and capabilities) or participatory (individualized,

flexible, responsive to family priorities, providing informed choices and family involvement in achieving goals and outcomes) and found in their meta-analyses that participatory

practices were most strongly linked with child outcomes including behavioral outcomes.

We now turn to a consideration of the role of parent responsiveness

and parenting behaviors in the social emotional development of infants and toddlers. Parents or other primary care providers are the key mediators of experience for infants and toddlers, and thus their influence is critical during this period of rapid development

of foundational skills and competencies."

To read or make a copy of the entire article, go to: http://www.challengingbehavior.org/do/resources/documents/roadmap_5.pdf

Autism: The right intervention for the right child

Fortunately we now know enough about Autism to know which children are most likely to benefit from intensive interventions and which types of interventions provide the most benefit for the child, considering: age of child, specific Autism Spectrum diagnosis, functioning level of the child, and willingness of the parent(s) to be active participants in treatment.

In many cases intervention can be provided for even less than $10,000.00 per year. Sometimes significantly less. If the right intervention is provided for three years to the child best suited to benefit from that intervention by a well qualified therapist properly implementing the intervention with active and continuing participation by the parent, government will literally save hundreds of thousands and in some cases even millions of dollars over the life of the child; plus it’s the right thing to do for the child and family. It’s the right thing to do fiscally, therapeutically, and humanely.
If it is the wrong intervention provided by poorly qualified interventionists without active parental(guardian) participation and without well written contextually mediated objectives, it is a disservice to the child, family, and taxpayer.
Depending on the type of intervention, the time spent by the parent can be either time set aside to specifically work on the intervention, a part of the parent and child’s typical routines, or a combination of both.
The right intervention for the right child, correctly implemented, will provide significant improvement in both functioning level and behavior.
More specific detailed information, references, and resources can be found at: http://www.bestoutcomes.blogspot.com/ and some additional linked websites.

Mental Health and Developmental Objectives Treatment Goals and Objectives PowerPoint

For those of you looking for a PowerPoint, I do have one; however, I would need to send it to you. If you wish to leave your name and e-mail address with the request in the comments section I can send you a power point; however, if you start at the beginning of the blog and work forward, that is, for the most part, the same information as is in the PowerPoint. You can bring it on line, start with the first posting and then just continue to click newer post. That will take you through the basics of the PowerPoint. Of course, additional explanation, examples, and activities, with the slides is always helpful.

Specific example of mental health or developmental disability goals and objectives

People often find this site by doing a search using the above words or something similar.

The best way to have a thorough understanding of this process is to start at the very earliest posting in this blog and move forward. The first set of postings review the basics of a training I have presented a number of times on how to write measurable behavioral objectives, goals, and plans. That is the best way to understand this very technical professional process, along with practice and ongoing feedback. You simply are not going to get what you want unless you know where you’re starting from (assessment and data) and have a very specific and clear plan (measurable behavioral objectives, goals, and plans) on how to get there.

With that said, I also realize that our world today often wants quick answers, and while sometimes the answers are simply not quick if you want the best outcomes, I’ll attempt to respond the best I am able.

While there are examples of poorly written objectives as well as well written objectives and a large example of great goals specific to young children with autism, it is impossibly to provide examples of goals and/or objectives for every situation and every child; however, it is possible to ask questions which will bring you to the right goals and objectives. If you want feedback, just write them in the comments without personally identifying information (you can make up a name) and I will respond.

Here are the questions:
What do you want the person to do? (in specific measurable terms)
How will the person know, or what cue will tell him or her it’s time to do what you want done?
How will you know it has been accomplished? (What are the specific criteria for success? {Never average over a long period of time})
That, with the name of the person will give you the basics of the objective.

The goal can be more broad and general and does not have to be quite as measurable.

For example:
Goal: John will come to school clean.
Objective: When John’s alarm rings in the morning at 6:30 A.M. , he will go directly to his drawer and pick out clean clothes, then go to the bathroom, take his shower, and put on deodorant, then the clean clothes he has chosen from his drawer. He will do this five days in a row for two consecutive weeks.

There are a number of assumptions in this goal and objective. John is obviously high functioning and has mastered the basic steps. If not, a more specific objective would have to be written for the steps. Sometimes we might include and reference a chart showing the steps for some functions such as taking a shower; however, this too would still imply that John has basically mastered the process.

The plan would detail others involved in the process to include arranging for clean clothing in the drawer and appropriate reinforcement.

This all starts though; from what you want John to do and then build from there. If you clearly know what you want the person to do. When the person will do it, to include what trigger or cue will tell the person it’s time to do…whatever it is you want the person to do. And if you have a clear and reasonable criteria for success, you have the basic information for your objective. The goal is simply the overarching, umbrella, behavior or skill you are looking for.

Any rote, prewritten, more generic objectives, are simply a terribly disservice to the child (or adult).

MEASURABLE BEHAVIORAL OBJECTIVE TEMPLATE

Please feel free to use the linked templates to create your measurable behavioral objectives and plans. If you have any questions, after completing this, you can click comments below. 

EVIDENCE BASED FAMILY CENTERED PRACTICE

PARENTS/FAMILY, THE CORE AND FOUNDATION OF A CHILD’S CONSISTENT AND LASTING PROGRESS

No matter what the condition, disability, or diagnosis of your child, while outside expertise can have a significant impact, except in some cases of severe medical need, the most significant impact will come from parents, family, and natural supports. Experts can help your child achieve his or her highest potential; but in order to make the most progress, and improve behavior when needed, any intervention must be incorporated into the natural routines of the child and family.

Typically this does not require significant or intrusive changes in family schedule; but instead requires only subtle adjustments in routines and interactions.

The result of this type of intervention is better functional outcomes for your child and increased freedom for the family to do the types of activities they would like to do with their child.



KEY PRINCIPLES of EVIDENCE BASED FAMILY CENTERED PRACTICE

1. Children of all ages learn best through natural routines and everyday learning opportunities.
Key Concepts

* Learning activities and opportunities must be functional, based on child and family interest and enjoyment

* Learning is relationship-based

* Learning should provide opportunities to practice and build upon previously mastered skills

Learning occurs through participation in a variety of enjoyable activities

2. All families, with the necessary supports and resources, can enhance their children’s learning and development.
Key Concepts

* All means ALL (income levels, racial and cultural backgrounds, educational levels, skill levels, living with varied levels of stress and resources)

* The consistent adults in a child’s life have the greatest influence on learning and development-not providers

* All families have strengths and capabilities that can be used to help their child

* All families have resources and assets, but all families do not have equal access to resources

* Supports (informal and formal, natural and paid) can and need to build on strengths and reduce stressors so families are able to engage with their children in mutually enjoyable interactions and activities

3. The primary role of the service provider (Action Plan Manager) is to work with and support family members and caregivers in children’s lives.
Key Concepts

* Providers engage with the significant adults in a child’s life to enhance confidence and competence in their inherent role as the people who teach and foster the child’s development

* Families are valued partners in the relationship with service providers

* Mutual trust, respect, honesty and open communication characterize the family-provider relationship

4. Evidence Based Family Centered Practice, from initial contacts through transition must fit the individual needs of the family and child while honoring family members’ learning styles, values, and beliefs.
Key Concepts

* Families are active participants in all aspects of services

* Families are the ultimate decision makers in the amount, type of assistance and the support they receive, within the confines of rule, law, and budget.

* Child and family needs, interests, and skills change; the child’s plan must be fluid, and revised accordingly

* The adults in a child’s life each have their own preferred learning styles; interactions must be sensitive and responsive to individuals

* Each family’s culture, spiritual beliefs and activities, values and traditions will be different from the service provider’s (even if from a seemingly similar culture); service providers must respect the family and seek to understand, not judge

* Family “ways” are more important than provider comfort and beliefs (with the exception of concerns about abuse/neglect)

5. Children’s and families’ needs and priorities determine functional outcomes, natural reinforcement, contextually mediated objectives, and appropriate supports and services, and appropriate supports and services,

Key Concepts

* Functional outcomes improve participation in meaningful activities

* Natural, logically related reinforcement, improves outcomes for families and children

* Functional outcomes build on natural motivations to learn and do; fit what’s important to families; strengthen naturally occurring routines; incorporate natural reinforcement; enhance natural learning opportunities

* The family understands that strategies are worth working on because they lead to practical improvements in child &; family life

* Functional outcomes keep the team focused on what’s meaningful to the family in their day to day activities

* Contextually mediated objectives provide better outcomes for families and children, that are the direct result of those services.

6. The family’s priorities, needs, and interests are addressed most appropriately by a primary provider who represents and receives team and community supports.

Key Concepts

* The team can include friends, relatives, and community support people, as well as specialized service providers.

* Good teaming practices are used

* One consistent person needs to understand and keep abreast of the changing circumstances, needs, interests, strengths, and demands in a family’s life

* The primary provider brings in other services and supports as needed, assuring outcomes, activities and advice are compatible with family life and won’t overwhelm or confuse family members

7. Interventions must be based on Key Principles of Evidence Based Family Centered Practice, validated practices, best available research, and relevant laws and regulations.

Key Concepts

* Practices are based on and consistent with Key Principles of Evidence Based Family Centered Practice

* Providers should be able to provide a rationale based on research specific to the child’s age, diagnosis, and functioning level, for practice decisions

* Programs use current research to guide practices

* Practice decisions must be data-based and ongoing evaluation is essential

* Practices must fit with relevant laws and regulations

* As research and practice evolve, policies must be amended accordingly

(The Key Principles are based on the Key Principles of practice of the Idaho Infant Toddler Program, which in tern are based on the national: AGREED UPON MISSION AND KEY PRINCIPLES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS
Developed by the Workgroup on Principles and Practices in Natural Environments, and found at:
http://www.nectac.org/~pdfs/topics/families/Finalmissionandprinciples3_11_08.pdf


Natural and artificial reinforcement

http://en.wikipedia.org/wiki/Reinforcement#Natural_and_artificial_reinforcement

Natural Reinforcement: A Way to Improve Education.

http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ448619&ERICExtSearch_SearchType_0=no&accno=EJ448619



CURRENT BEST PRACTICE IN AUTISM TREATMENT

The National Autism Center’s

National Standards Project

Findings and Conclusions

2009


Please see: http://www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf

Important note: This does not include the research on the Denver Model; which to date, has perhaps demonstrated the best results for a wider range of young children with Autism, using the most rigorous research methodology. Or P.L.A.Y. which is in the process of completing it’s current research project and which has shown great promise in preliminary study.

Supporting Materials and Research for

Evidence Based Family Centered Practice

Can Children with Autism Recover? If So, How?
http://www.springerlink.com/content/f080797r4t45jm16/

Abstract Although Autism Spectrum Disorders (ASD) are generally assumed to be lifelong, we review evidence that between 3% and 25% of children reportedly lose their ASD diagnosis and enter the normal range of cognitive, adaptive and social skills. Predictors of recovery include relatively high intelligence, receptive language, verbal and motor imitation, and motor development, but not overall symptom severity. Earlier age of diagnosis and treatment, and a diagnosis of Pervasive Developmental Disorder-Not Otherwise Specified are also favorable signs. The presence of seizures, mental retardation and genetic syndromes are unfavorable signs, whereas head growth does not predict outcome. Controlled studies that report the most recovery came about after the use of behavioral techniques. Residual vulnerabilities affect higher-order communication and attention. Tics, depression and phobias are frequent residual co-morbidities after recovery. Possible mechanisms of recovery include: normalizing input by forcing attention outward or enriching the environment; promoting the reinforcement value of social stimuli; preventing interfering behaviors; mass practice of weak skills; reducing stress and stabilizing arousal. Improving nutrition and sleep quality is non-specifically beneficial.

Relationship Focused Intervention (RFI): Enhancing the Role of Parents in Children’s Developmental Intervention (2009)
http://en.scientificcommons.org/52625021

Abstract
This article describes Relationship Focused Intervention (RFI) which attempts to promote the development of young children with developmental delays and disabilities by encouraging parents to engage in highly responsive interactions during daily routines with their children. This approach to intervention is based upon the Parenting Model of child development and was derived from research on parent-child interaction. Evidence is presented that RFI can be effective both at helping parents to learn how to interact more responsively with their children as well as at promoting children’s development and social emotional function. The argument is made, that although there is no research comparing the effectiveness of RFI to interventions derived from the Educational model of child development which places less emphasis on parent involvement and stresses direct instructional activities, still the effectiveness of all interventions appears to be related to the degree to which parents are involved in and become more responsive with their children. As such RFI may not simple be an alternative model for early intervention, but may reflect a paradigm shift pointing to the effectiveness of parent involvement and responsive interaction as key elements of early intervention practice.

Parent training: A review of methods for children with autism spectrum disorders
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B83X1-4VVN510-1&_user=10&_coverDate=12%2F31%2F2009&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1506906194&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5b2923bd37e3ee737cc7d3de0cf5acfc&searchtype=a

Abstract
Autism Spectrum Disorders (ASD) are common in the general childhood population, and are both serious and lifelong. Tremendous strides have been made in the treatment of these ASD in recent years, particularly with respect to psychological interventions. Given the considerable amount of time and cost involved in providing these interventions, parent training and involvement is a particularly appealing intervention option. This paper is a review and status report on evidence based methods that are available for training parents of children with ASD as therapists. Current trends and future directions are discussed.

Can one hour per week of therapy lead to lasting changes in young children with autism?
http://aut.sagepub.com/cgi/content/abstract/13/1/93

Deficits in attention, communication, imitation, and play skills reduce opportunities for children with autism to learn from natural interactive experiences that occur throughout the day. These developmental delays are already present by the time these children reach the toddler period. The current study provided a brief 12 week, 1 hour per week, individualized parent—child education program to eight toddlers newly diagnosed with autism. Parents learned to implement naturalistic therapeutic techniques from the Early Start Denver Model, which fuses developmental- and relationship-based approaches with Applied Behavior Analysis into their ongoing family routines and parent—child play activities. Results demonstrated that parents acquired the strategies by the fifth to sixth hour and children demonstrated sustained change and growth in social communication behaviors. Findings are discussed in relation to providing parents with the necessary tools to engage, communicate with, and teach their young children with autism beginning immediately after the diagnosis.

Effectiveness of a Home Program Intervention for Young Children with Autism
http://www.springerlink.com/content/w522865070k20373/

Abstract This project evaluated the effectiveness of a TEACCH-based home program intervention for young children with autism. Parents were taught how to work with their preschool autistic child in the home setting, focusing on cognitive, academic, and prevocational skills essential to later school success. To evaluate the efficacy of the program, two matched groups of children were compared, a treatment group and a no-treatment control group, each consisting of 11 subjects. The treatment group was provided with approximately 4 months of home programming and was tested before and after the intervention with the Psychoeducational Profile-Revised (PEP-R). The control group did not receive the treatment but was tested at the same 4-month interval. The groups were matched on age, pretest PEP-R scores, severity of autism, and time to follow-up. Results demonstrated that children in the treatment group improved significantly more than those in the control group on the PEP-R subtests of imitation, fine motor, gross motor, and nonverbal conceptual skills, as well as in overall PEP-R scores. Progress in the treatment group was three to four times greater than that in the control group on all outcome tests. This suggests that the home program intervention was effective in enhancing development in young children with autism.

Parent training: A review of methods for children with developmental disabilities
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VDN-4VPCVH0-1&_user=10&_coverDate=10%2F31%2F2009&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1506906710&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2f5e98d220fda0e9ae7a45d6478013b3&searchtype=a

Abstract
Great strides have been made in the development of skills and procedures to aid children with developmental disabilities to establish maximum independence and quality of life. Paramount among the treatment methods that have empirical support are treatments based on applied behavior analysis. These methods are often very labor intensive. Thus, parent involvement in treatment implementation is advisable. A substantial literature on parent training for children has therefore emerged. This article reviews recent advances and current trends with respect to this topic.

Pilot study of a parent training program for young children with autism
http://aut.sagepub.com/cgi/content/abstract/11/3/205

The PLAY Project Home Consultation (PPHC) program trains parents of children with autistic spectrum disorders using the DIR/Floortime model of Stanley Greenspan MD. Sixty-eight children completed the 8—12 month program. Parents were encouraged to deliver 15 hours per week of 1:1 interaction. Pre/post ratings of videotapes by blind raters using the Functional Emotional Assessment Scale (FEAS) showed significant increases (p 0.0001) in child subscale scores. Translated clinically, 45.5 percent of children made good to very good functional developmental progress. There were no significant differences between parents in the FEAS subscale scores at either pre-or post-intervention and all parents scored at levels suggesting they would be effective in working with their children. Overall satisfaction with PPHC was 90 percent. Average cost of intervention was $2500/ year. Despite important limitations, this pilot study of The PLAY Project Home Consulting model suggests that the model has potential to be a cost-effective intervention for young children with autism.

Using Family Context to Inform Intervention Planning for the Treatment of a Child with Autism
http://pbi.sagepub.com/content/2/1/40.abstract

Abstract:
Children with autism often engage in problem behavior that can be highly disruptive to ongoing family practices and routines. This case study demonstrated child and family outcomes related to two distinct treatment approaches for challenging behavior (prescriptive vs. contextualized) in a family raising a child with autism. The processes of behavior change directed either solely by the interventionist (prescriptive) and in collaboration with the family (contextualized) were compared. The family-directed intervention involved an assessment of family context (i.e., via discussion of daily routines) to inform the design of a behavioral support plan. Information gathered from the assessment of family routines was used to (a) help select specific behavioral strategies that were compatible with family characteristics and preferences, and (b) construct teaching methods that fit with the family's ongoing practices, routines, and interaction goals. More favorable results (i.e., reductions in challenging behavior, an increase in on-task behavior) were observed within the contextualized treatment-planning phase than were observed within the prescriptive treatment-planning phase. The procedures and results are discussed in relation to the emerging literature documenting the importance of contextualizing behavioral supports applied within

Benefits to Down's syndrome children through training their mothers.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1544420/

Abstract: This study investigated the hypothesis that training of mothers with Down's syndrome children would be beneficial both to the child and parents. The mothers were taught behaviour modification techniques based on learning theory and were given group discussions on dealing with their family or personal problems. The subjects were 16 mothers with a Down's syndrome child, divided into two groups on the basis of their child's sex and chronological and mental ages. The Griffiths Scale was used for assessment. The mothers in the treatment group received 12 sessions of training and group counseling over a 6-month period, whereas the control mothers received no additional attention except the usual routine from the general practitioner and health visitor. The result show clear gains to both the child and mother in the treatment group. The child improved, especially in language development as well as in the other areas, and the mother-gained more confidence and competence in her daily management of the child.

Natural Learning Environment Practices
http://www.coachinginearlychildhood.org/nlepractices.php

Common Mispercep­tions about Coaching in Early Intervention
http://www.fippcase.org/caseinpoint/caseinpoint_vol4_no1.pdf

Natural Supports

This represents only a very small sample of the vast research available on the subject of Evidence Based Family Centered Practice

Assessment: Targeting the treatment towards all the issues, not just the child.

When a child presents with Autism, or almost any developmental disability or social emotional issue, the tendency is often to immediately provide intervention to the child.

First, you must have a good standard assessment for diagnosis and treatment. So many developmental disabilities and mental illnesses today have well researched prescriptive treatment that it is often a huge waste of time and money when the wrong intervention is used for the child; however, just because you have the completed the right assessments for diagnosis, does not mean you have completed all the needed assessment for treatment.

In any situation where the issue/behavior is a significant issue, you must also complete a Functional Analysis of Behavior. Often, the most important intervention is not targeted directly at the child; but at the environment and setting events.

The following information is as applicable to the home as it is to the classroom.
http://www.challengingbehavior.org/do/pyramid_model.htm
http://www.challengingbehavior.org/do/resources/documents/yc_article_7_2003.pdf

For additional information see postings on this website on Functional Analyses of Behavior (Functional Behavioral Assessments) and Setting Events.

More progress for less money. Best practice, affordable therapy/intervention for Mental Health or Developmental Disabilities. Economic, Best Practice for Government Agencies and Schools: Coaching

Many states are considering making significant cuts to the amount of money they spend on therapy/intervention for children and teens with developmental disabilities or mental health diagnoses.


There is a cost effective way to help children and families; however, it requires parental responsibility. Some have argued that some families can’t be active participants in their children’s therapy. That argument is bogus and has been proven false by research. Almost ANY family can actively participate in their child’s therapy/intervention.

For children with Autism, one solution is P.L.A.Y. therapy. http://www.playproject.org/media/pdfs/PilotStudy_PLAYProject.pdf

The cost per child is approximately $2,500.00 per year as of 2008. Another option is Coaching.
P.L.A.Y. is a form of coaching; however, there are many forms of coaching in therapy and intervention.

While most of the research revolves around early childhood, there is supportive literature for this practice with older children, teens, and even adults. In fact, if you go to the bottom of: http://responsiblepracticalparenting.blogspot.com/ and use the Google Parenting and Google Scholar search engines, using key words such as: coaching, intervention, early, childhood, teens, therapy, you will find a wealth of information and research.

If you are currently spending $25,000.00 to $100,000.00 per year per child and getting poor results, consider coaching through one of the established research based models. Typically for $10,000.00 per year per child or less, you can actually get better results.

As mentioned, there are other ways of doing coaching; but the bottom line is, it is significantly more effective and significantly less expensive.

Full family centered involvement with contextualized routine based interventions in the environments natural to the child and family is the most effective way to significantly improve behaviors in the home and other natural environments and make significant progress based on the natural routines of the child and family.

If your state, school, or government entity is considering significant cut-backs in services, encourage those who make these decisions to consider a coaching model.

If we do not do something effective, the unintended consequences are going to be even more expensive.

Supplemental Materials:
http://www.coachinginearlychildhood.org/nleconcepts.php
http://www2.ku.edu/~kskits/ta/Packets/UsingPrimaryService/References.pdf
http://www.fippcase.org/caseinpoint/caseinpoint_vol4_no1.pdf
http://www.fippcase.org/


See: http://qualitytreatmentforchildren.blogspot.com/ & http://currentautismresearchhopeforautism.blogspot.com/ for additional information.

More on contextually mediated behavior from an unusual source.

The book, Working with Families of Young Children with Special Needs (referenced in the previous posting), talks a great deal about Contextually Mediated Behavior. While there is nothing new to this concept, (it is what we have desired in plans, goals, and objectives, for years) this book adds some additional clarification to the issue. The article, as you will see, is from an unusual source. The focus is on Artificial Intelligence; however, it provides some further clarification and additional reasoning to argue the importance of providing the context for the behavior, if we are to expect the behavior to occur in a natural environment.


“The context in which an intelligent agent operates profoundly affects how it behaves. Not only is this intuitive, it has been shown to be the case by psychological and sociological studies.”

The above statement is profoundly logical and has been well researched and yet it is often missed in writing plans or objectives for either children or adults with developmental disabilities and/or mental health issues. If you are going to teach new behaviors, it simply must be, at least in the end, within the natural environment where you want the behavior to occur. While you may start in a contrived setting, you must move to the natural environment within the natural routines as quickly as is possible and safe. This natural environment must include the individuals who are typically in that environment with the systematic reduction of any individuals who are not natural to the environment. For example: if the behavior you are attempting to change typically occurs in the home; while the therapist may, if absolutely necessary, start in a clinical setting, the therapist must move into the home with the child (or adult client) and family or other persons naturally living in that environment. The interventions must be taught to the parents and/or other individuals naturally in that environment and the therapist must systematically and gradually discharge him or herself from that environment while empowering the parent and/or other individuals natural to the environment to assume the responsibilities of the intervention with the therapist returning on occasion as required on a consultation basis.

“The result is that these AI applications cannot capitalize on knowing what context they are in and how to behave in that context. To the extent they do so at all, they are forced to do situation assessment, without any clear notion of what the space of possible situations (contexts) might be. … Instead, it must waste effort constantly deciding if behavioral knowledge is appropriate for the situation (e.g., by checking antecedent clauses of potential rules, goals/preconditions of potential operators, etc.) An application cannot easily learn important information about how to behave in a context, since it doesn’t have any clear notion about what it means to be in the context.”

While an individual may have some or a great deal of understanding of what it means to be in their natural context, if you do not teach, and naturally reinforce, the new replacement behaviors, they may never learn the new skill in practical way as to make it useful and contextually mediated within the natural routines of their natural environment.

http://www.aaai.org/Papers/Workshops/1999/WS-99-14/WS99-14-017.pdf

Writing an objective, goal, or plan, for safety concerns.

Consider the following objective:

Upon arrival at a street corner, Joey will cross the street safely 4 out of 5 trials for four consecutive weeks.

Hopefully the most significant problem with this objective jumped out at you immediately. Safety is ALWAYS 100%. Every time.

When working with either a child or adult with developmental or mental health disabilities, you can never leave safety to chance. You much include and incorporate into your plan how you are going to assure safety 100% of the time.

Let’s say for example you want Joey to stop at the stop sign, look both ways before starting to cross and only crossing when there is no oncoming traffic and the street is safe. There are a number of critical issues you must consider.

1. Is this a practical objective for Joey? Is Joey ever going to be able to traverse the streets on his own? And if not…

2. Is there a practical reason to work on this objective in a way to make it safer for Joey, while a responsible and capable family member or friend accompanies him on walks? If not, perhaps this isn’t an appropriate objective in the first place.

3. If it is determined that this is a practical and reasonable objective, what is the crisis/safety plan to assure that Joey remains safe? Is someone able to walk and stay right beside Joey and if he starts to cross before he should or in a place where he shouldn’t, is this person able to quickly and easily stop Joey from crossing or doing something unsafe? Safety is and must be 100% when working with individuals with disabilities.

CHILD BEHAVIOR: Why does s/he do that? and What can I do about it?

For years the battle has raged between nature and nurture, between genetics and environment; but the bottom line is that, the answer is both.

Humans have few behaviors which are absolutely instinctive. Sucking is one. Most, the vast majority, of our behaviors come from an interaction between what we brought with us from before birth and our environment, including our interaction with that environment. Some of the information provided below will differ to a degree because it comes from different sources which do not always agree. That’s ok, you’ll get a slightly different viewpoint on some of the subjects.

The following is rather long and I expect that there will be both questions and discussion; however, it is worth including.  It is from: Functional Behavioral Assessment, Diagnosis, and Treatment: Ennio Cipani &; Keven M. Schock pages 1-3



“Why does he do that? This is the age-old question. People ask this question when they see a child throw a “fit” in the store. Why does he behave like that? To date, an often-cited explanation of such undesirable behavior involves a hypothesis about the brain’s development in the child “afflicted” with such behavior. The underpinning of the undesirable tantrum behavior is hypothesized to be the result of some abnormality or underdevelopment of some part(s) of the brain. As further evidence of brain involvement, in some cases, such behavior along with other behaviors forms the basis for a mental disorder. Below is an excerpt from a hypothetical lecture in a Child Psychology class.

Student: Dr. Trait. I have a question. Why do some children have tantrums that are clearly inappropriate for their age?

Dr. Trait: The child throws the tantrum because he is immature for his age; his brain has not fully developed (in some hypothesized fashion). Once his brain matures, particularly the frontal lobe that is responsible for executive functioning, he will not respond to social situations in that manner. Until that point, we can expect this child to continue behaving in such a fashion because of his inability to process events adequately. Teenagers have a similar problem with brain immaturity when they behave impulsively. Their brain is not like the adult brain; hence, they too cannot be fully responsible for their impulsivity.

There are variations and extensions of this immature brain explanation. The following is the same conversation in a class in developmental psychology, with a slightly different explanation.

Student: In Dr. Trait’s class, we were told that children who have severe tantrums that are clearly inappropriate for their age do so because their brain is not fully developed. Is there any experimental cause-and-effect evidence for such an assertion?

Dr. Stager: Well, I believe there is more to it than just the brain’s development, although I would concur that neurological issues are part of the problem. Children behave in a certain manner because they have not proceeded through certain invariant developmental stages. I would say that these children have not progressed past the egocentric stage. Of course once the brain has developed, it is more likely that these children will interpret the actions of others as reasonable and not view everything from a “me first” perspective. When this happens, s/he will not react in such a manner, but will respond to conflict in a more age-appropriate manner.

Suppose we believe that the child throws a tantrum because his brain is not yet fully developed. What are the ramifications for dealing with such behavior when the supposed cause is brain malfunction? Do we wait until his brain becomes more fully developed? For clients who have continued such “immature” behaviors throughout their adolescence, and into adulthood, do we still continue to wait? What can be done in the interim to reduce tantrums and/or develop a more acceptable manner of dealing with his social environment?

What is wrong with those interpretations about tantrum behavior? The role of the environmental response to such behavior is trivialized! If the brain has not developed, apparently what people do in response to the child’s behavior, whatever the form, is insignificant and, therefore, irrelevant. One can only hope that the child’s brain becomes more fully developed. We believe there is a better conceptualization of why tantrum behavior occurs.

Instead of saying that the child throws a tantrum because he is immature, we would possibly ascribe such an incident to the purpose or function such tantrum behavior serves in that child’s environment. That conceptualization would generate an examination of observable events in the social environment. In the case of a child’s tantrum behavior, one would examine what the social environment does when the child has a “fit” in the store. What is the antecedent context for such tantrum behavior? How does the social environment react to these tantrums in the short and long term? The examination of temporally ordered environmental events can reveal the purpose of this behavior in this context.

This approach is termed a functional behavior-analytic approach to understanding human behavior (Baily & Pyles. 1989; Cipani, 1990; Cipani & Trotter, 1990; Iwata, Vollmer, & Zarcone, 1990; LaVigna, Willis, & Donnellan, 1989; Lennox & Miltenberger, 1989). In a functional behavior-analytic approach, all behavior is viewed as serving an environmental function, either to access something or terminate/avoid something (not withstanding genetic influences for some behaviors). Although other psychological explanations invoke hypothesized traits or developmental stages to explain behavior, a functional behavior-analytic viewpoint examines the role of the social and physical context. It deals with events that are observable to us and measurable.

For example, to say that a seven-year-old child named Oskar, diagnosed with oppositional defiant disorder (see DSM-IV-R manual) is aggressive is sufficient for many mental health professionals. When asked why this child is aggressive, their response would be, “It is a symptom of his underlying disorder, that being oppositional defiant disorder. He acts aggressively because he has this disorder.” As you can see this is a trial lawyer’s dream. People do things because they have a disorder. If they have this disorder, they cannot help it.

Whenever the behavior occurs, it is the disorder that made them do it. One should expect that they will engage in this behavior from time to time. It further presumes that such a behavior will occur irrespective of context and consequences. The child engaged in the aggressive behavior because of his malfunctioning brain. Such brain malfunctions are not predicted on any environmental context being present. One never knows when the neurons misfire! When they misfire, aggressive behavior results!

In contrast, a functional behavior-analytic view would explain such behavior more from the social context of the behavior. One would examine Oskar’s history of aggressive behavior and how it alters his existing social environment when exhibited. An understanding of why the behavior occurs is accomplished through an analysis of the behavior’s ability to produce desired events or terminate undesirable events.

For example, we may find out that Oskar often engages in aggressive behavior when he comes home from school. Oskar’s mother wants him to stay in the house for a while and either do his homework or finish cleaning up his room, Oskar, of course, wants to go outside, and play with his friends. He sometimes will complain and whine. His mother will respond to such complaining with the following retort: “You need to finish your homework. How do you expect to pass third grade? Once you are done with your homework, then you can go outside.” This parental response to his behavior incurs more arguing from him, with retractions for each of his assertions from his mother. When Oskar sees that this arguing with his mother is not helping his cause (i.e. getting to go outside) he tries another tact. He states, “I’m going to leave and you can’t stop me.” When he begins to exit the house she grabs him. At this point, he yells at her, calls her names, and hits her. After a struggle, Oskar pulls away and heads out the door. The mother, tired of fighting with her son, lets him go, complaining he is just like his father.

With the above information, what is a more plausible explanation for this child’s behavior during these circumstances? Does he do this because he is disordered? Or does the explanation lie in an understanding of how such a behavior impacts his environment? Does arguing with his mother result in him going outside? Or does he get to go outside when he becomes assertive (walking to the door) and combative (when he hits his mother as she tries to get him to stay inside)? What is the best explanation for his aggressive behavior in the afternoon? He does it because it “works” for him when he wants to go outside, and other behaviors such as complaining are less effective.

Why Is Traditional Counseling Not effective With Many Clients With Severe Problem Behaviors?

In 2006 (year this book was written), many people believe that sending children or clients with sever problem behaviors to counseling is the best method for changing these behaviors. This is despite a lack of empirical evidence demonstrating that severe behavior problems of clients or children are effectively treated with such an approach. But let’s look at the nature of this intervention and what we now know about client behavior. Perhaps we can determine why such an approach may be doomed for many children and clients with problem behaviors.

Can anyone (through counseling) convince Oskar that crying or later property destruction is not in his best interest? What is in the child’s best short-term interest when he is placed in time out? It is getting out of time out. What behaviors are most effective at producing such? Crying and property destruction. As a reader of these materials, do you believe that any adult, no matter how many degrees s/he may posses, can talk to Oskar once or twice a week and convince him not to throw shoes at the wall when in time out?

What will work is to alter the maintaining contingency? This translates to what? How will the child’s behavior change when he is placed in time out? Through insight or self-awareness developed by seeing a professional? Or by changing, the manner in which the parent reacts to the behavior? The answer should not be obvious. Ultimately, it is up to the care providers/parents to change their behavior in order to change the child’s behavior! If the adults continue to handle this child’s behavior in the same manner, we cannot see where anyone who talks to this child for 1, 2, or 3 hours a week is going to convince him to “straighten up” when he is in time out. The problem is not just with the child! It is also with the way the child’s environment responds to his/her behavior.

You change child behavior by changing the behavior of the adults who deal with that child. Pure and simple!”

Functional Behavioral Assessment, Diagnosis, and Treatment: Ennio Cipani & KIeven M. Schock pages 1-3



If you are a therapist concerned with behavior, this book is a must read; however there is more to environment than just the behaviors of the adults and as the above authors acknowledge, there is more to behavior than just the environment. We’ll talk about a few important elements.

Relationships are always the foundation for all of our interactions with each other. Before doing anything and while you are doing everything, build relationships…then:

First, look at the Environment: this includes the physical environment, smell and sound. (Safety and immediate health concerns always take president and if present should be addressed before anything else.)

Second, consider setting events, this includes: schedule, sleep, diet, stressors (including medical)

Third, consider interactions with others: does the behavior get the child something or get the child out of something.

Fourth and last, after looking at all else, even if the child has an obvious disability, even when the answer seems to be apparent…that this child has a problem, only after all of that, and making adjustments that may help, look at the child.

First, look at the environment.

Are their lights, sounds, colors, smells, that may increase stress or the likelihood of problem behaviors? Are there lots of distractions? Is the child too warm or too cold? Is the environment conducive to the child being able to effective communicate wants, needs, and feelings? Are there safe boundaries, i.e. safe and fenced yard and/or a partitioned off part of the home or center? If there are partitions, is there a clear view of all children? Sometimes designating different areas for different activities can be very helpful. Using appropriate music for a transition (see m. under stress management) can be helpful. Is there a consistent and full schedule for children with developmentally appropriate activities and engagement with adults (watching televison does not count)? Is the area safe, clean and engaging for a child? Are there different environments for different activities, even in a home environment this is possible and helps children to learn to regulate themselves according to the environment. Remember you can create a different environment with a different space, colors, temperature, pictures, toys, stuffed animals, or other items, with sound and with smells. This does not have to be expensive, with a little creativity this can be done cheaply and still be safe and appropriate.

You may be interesting in the following videos.

How to Create a Classroom Checklist

How to Modify a Classroom to Teach Behavior

There are many simple ways to manipulate an environment and have a significant impact on behavior. For example: when you want a young child to leave a room and come out with you, particularly in the evening, after asking the child to come, just turn off the light. The child will typically and naturally move toward the light where you are. This doesn’t mean that you need to make a big deal out of it and create a fear of the dark. Another example is simply removing objects which are a distraction or temptation. For a toddler it makes a lot more sense to remove an object you don’t want him or her to touch than to repeatedly try to teach the toddler not to touch the item...something that may be developmentally very difficult or even impossible to do.

Second, look at setting events. When in a child care center, these can be things that happen outside of your direct influence. As a parent you do have direct influence on these things. Does the child have a regular sleeping schedule and does s/he get enough sleep? Are there any medical problems? Are there other stressors in the child’s life? Does the child have consistency or is s/he passed around among many different care takers? Does the child eat regularly and did s/he eat last night and this morning? Are the meals healthy and enough? Is the child’s environment clean and is the child clean? How much positive interaction does the child get with adults? How much television and video games does s/he watch and or play? How many of the Developmental Assets does the child have in his or her life? Also remember skill buiding, which is important for all children. Some children need additional assistance or different teaching methods for skill building which should almost always be done in an inclusive environment.

Third, consider interactions with others: does the behavior get the child something or get the child out of something? Make appropriate changes to the way you and others interact with the child and teach skills to this child and when the child is in a group, teach and practice the same skills as a group.

There are many misunderstandings about the cause and affect of behavior. Over the years, I’ve often heard that someone has tried this and that and it just hasn’t worked. When this occurs I like to tell the following story. Many years ago there was a speaker in church who was going on and on and was rather dry. After what probably seemed like an eternity to one particular child, this child turned to his father and pleaded “dad, please take me outside and spank me.” I share this story for a couple of reasons. Lots of times we think that something is a punishment and while it may be to some extent, there is something else out there that is even more punishing or more rewarding. In this story, the boy, even though he was young, figured that a spanking would be less punishing than sitting and listening to the speaker. Children, even adults at times, will choose what may appear to be a punishment because they get an even more important reward i.e., physical touch (even painful touch can be acceptable when it is missing and craved) or attention. People often do things because it either gets them something they want or gets them out of something they don’t want. The other reason I mention the above story is that I’m really not a fan of spanking or corporal punishment in general. I and many of you have heard the term: “Spare the rod, spoil the child”. There are a number of alterations of this adage in the Old Testament and people for generations have used it as an excuse to beat children. About 20 years ago I was in a child abuse seminar presented by a Jewish Doctor, who was a student of the Tanakh, and who was also an expert on the subject of child abuse. He brought this statement up and said that in this context, the word “rod” did not refer to a physical rod but something quite different. When he said and explained it, I thought to myself…of course.

There are so many things that could be said here that it would take a chapter or two to even touch the surface of this part of the discussion.

Consider also that an inappropriate behavior may be reinforced in another environment, if this is the case; you need to be crystal clear that it will not be reinforced in your environment, while helping the child to learn that there are more appropriate ways to get their needs met, however; be gentle, loving, patient and understand the confusion. For example, a child that hits for attention and touch needs to not only learn that this is not acceptable in your environment but also that it will not work in your environment AND that they can get this same need met in other more appropriate ways.

Communication is key, often what we see as bad behavior is an attempt to communicate a want, need, or feeling. If children are behind in communication, help them get the help they need. (Communication problems often lead to behavior problems.)

When children come to you from another environment that may be less than ideal and exhibit behavior as a result, help then to transition each time to your environment and let go of the one they left. Sometimes children will be so frustrated from their other experiences that they will act out aggressively in yours because it is the only safe place for them to do so. If you have good reason to expect abuse, it must be reported to your local child protection agency or law enforcement. If it is just a chaotic and frustrating environment, then help them to change their physiology (see stress management for kids especially h. i. j. k. and m.) and transition to your environment. Be clear in your communication. Tell children what you expect of them. Listen. Even infants have a lot to tell you if you know how to listen.

Strong positive loving relationships with solid attachment are essential.

Some additional videos are linked below.

How to Approach Understanding Child Behavior

More Than Just Saying "No": Guiding Your Child to Positive Behaviors

Here are a number of additional short videos. They are very good and cover a number of topics. By Dr. Michelle Borba.



http://video.kaboose.com/behavior-expert.html



One common mistake I see from adults is when they laugh when a young child does something very inappropriate. Please stop and ask yourself this question, 'will this still be funny when the child is 16 and directing the behavior towards me'.

There is more about reinforcing appropriate behavior below.

One last point here, never forget the power of example.

Next I want to talk a little more about reinforcement. Remember the story about the child in church above. Reinforcement is not the same for every adult and it is not the same for every child.

There are basically two different kinds of reinforcers. It's kind of complicated but basically when you get something you want or when you avoid something you don't want, both are called reinforcers, one positive and the other negative. Either type of reinforcer increases the chance that the person will do again, whatever it was that got them the desired result.

Punishment on the otherhand decreases the chances that someone will do the thing (whatever the thing is) again. In the case of the child in the church, the spanking was not a punishment, or at least it was not as powerful of a punishment as the removal from church was powerful as a negative reinforcer.

There is one more thing to consider and that is, extinction. Extinction is the complete removal of a reinforcer. Extinction is kind of tricky though because you have to be pretty consistant for it to work, and you need to pair it with another reinforcer that achieves the same result. For example if a young child has learned that the best way to get attention is to hit, and if you start to ignore the hitting, then the child needs to learn at the same time, a more appropriate way to get attention. (S/he) needs to be rewarded with attention when s/he does the more appropriate behavior (i.e.), mom, dad, will you play with me. (Figure out ways to answer "yes." See additional information about "yes" below.)

(Note: when there are genuine safety concerns or significant property damage, you can not ignore the behavior.)

Natural reinforcers are those that will be received in almost any setting from almost any person. Natural reinforcers are almost always better than contrived and should be used whenever possible. For example, in many (hopefully it is most) situations, politeness and good manners receive a natural reinforcer.

Temperament can be exhibited in a child as young as three weeks and that it is firmly in place by six weeks. Temperament is defined as the combination of mental and emotional traits of a person. It is a natural predisposition toward a unique behavioral style. Remember that we have all kinds of predispositions; however, we still have choice. While many of our initial temperaments come with us from before birth, both environment and choice play an ever increasing part in who we are as we grow older. There are many stories of people who remade themselves. Gandhi is a great example. When I left home for college for the first time, I made some hard decisions to remake myself in many ways. These decisions and the changes I made have had a profound affect on my own life.

Understanding temperaments can be useful; however, be careful to never diminish or excuse a child because of a temperament.

There are several dimensions of temperament. Thomas and Chess identified nine dimensions of temperament. Other researchers describe them a little differently. If this is something that particularly interests you, go to http://www.collaboration.me.uk/Therapy_Search_Engine.php and do a search of the various types listed below. Just copy and paste the whole line into the search engine.

Greenspan classifies children’s temperaments into five basic types.
The first type is the highly sensitive child.
The second type is the self-absorbed child.
The third type is the defiant child.
The fourth type is the inattentive child.
The last type of temperament is called the Active/Aggressive child.

Remember, catch kids doing good. Praise them, reward them for doing good, and connect natural reinforcers with doing good. If you can, when a child asks, say "yes" as much as possible. It may be, "yes after you have done..." or "yes, after I have finished..." Sometimes you can not say yes, when this is the case, explain on the level the child can understand. We all have to learn to understand "no." When they have to wait, try to make it a reasonable amount of time for the developmental level of the child.

Kaboose Family and Parenting Videos- Kids Crafts, Travel, Parenting Issues, Health and More! - Kaboose.com

Kaboose Family and Parenting Videos- Kids Crafts, Travel, Parenting Issues, Health and More! - Kaboose.com: "Parenting"

More Than Just Saying "No": Guiding Your Child to Positive Behaviors | Child Care Aware®

More Than Just Saying "No": Guiding Your Child to Positive Behaviors Child Care Aware®: "You may hear the terms discipline, punishment, and guidance when it comes to addressing children's behavior. Debates and discussions are sparked continuously over what is the best way to discipline children. Are timeouts useful? Just how can I get my three-yearold to behave? All parents want their children to show positive behaviors and at the very least not be disruptive, or hurt anyone, including themselves."

How to Approach Understanding Child Behavior: How to Teach & Understand Child Behavior | eHow.com

How to Approach Understanding Child Behavior: How to Teach & Understand Child Behavior eHow.com: "How to Approach Understanding Child Behavior"

How to Modify a Classroom to Teach Behavior: How to Teach & Understand Child Behavior | eHow.com

How to Modify a Classroom to Teach Behavior: How to Teach & Understand Child Behavior eHow.com: "How to Modify a Classroom to Teach Behavior"

How to Create a Classroom Checklist: How to Teach & Understand Child Behavior | eHow.com

How to Create a Classroom Checklist: How to Teach & Understand Child Behavior eHow.com: "How to Create a Classroom Checklist"

How to write Contextually Mediated Objectives

What is a contextually mediated objective?
Context: 2. The set of circumstances or facts that surround a particular even, situation, etc.

http://dictionary.reference.com/browse/Context;

Mediated: 2. To bring about (an agreement, accord, truce, peace, etc.) as an intermediary between parties by compromise, reconciliation, removal of misunderstanding, etc.
http://dictionary.reference.com/browse/Mediated;

A contextually mediated objective will address needs within the every day activities of a child, within the child’s natural environment. It will contain all of the essentials previously discussed about quality measurable behavioral objectives.

The best contextually mediated objectives will use natural reinforcers.

http://bestoutcomes.blogspot.com/2009/03/reinforcement.html

Examples of contextually mediated objectives:

1) While taking a shower in the morning, Susie will apply shampoo and scrub her hair without assistance or prompt 4 out of seven days for two consecutive weeks.

Note: This may be written as is, or in some cases where more information is required as is often the case, may require further information regarding how Susie will apply the shampoo, how much shampoo is required and an operational definition of “scrub her hair.” This additional information can be included in the plan under operational definitions with a reference right under the objective to see applicable operational definitions and where they can be found.

2) Immediately (within 10 minutes) upon placing his bowl in the sink, after breakfast, Don will fill (will have completed filling) the dog dish (within one inch of the top) with dog food, with one or less prompt 5 out of seven days for three consecutive weeks.

This assumes Don knows where the dish and dog food are and that he is capable of doing this chore. If he is not, the objective would need to address more basic and detailed skills, such as walking to the hall closet, opening the door, retrieving the bag of dog food, etc. Note: short operational definitions are included within this objective.

Please see and read: Working with Families of Young Children with Special Needs Chapter 3 Community-Based Everyday Child Learning Opportunities



Additional Supplemental Material:

The Effectiveness of Contextually Supported Play Date Interactions Between Children With Autism and Typically Developing Peers