Treatment: Autism & Behavioral Disabilities/Disorders

Index

2013-01-01T07:45:00.000-08:00

Please let me know by making a comment, if any of the supplemental materials links are no longer working. Please feel free to ask questions.
The material is more understandable if you start at the beginning/earliest of the postings and work your way forward in time.

CURRENT AUTISM NEWS & RESEARCH: HOPE FOR AUTISM

Autism Intervention:General Research, Models, Moduals, Packages, & Information: Free PowerPoint

Joint Attention, Parenting and Treatment a free PowerPoint

Behaviorism and ABA a Free PowerPoint

Writing Measurable Behavioral Objectives Powerpoint

Low Cost Treatment for Autism

Behaviorism: What it is and what it isn’t.

“Story-based Intervention Package” (For children with autism)

Music as a part of intervention

Joint Attention: one of, if not the most critical skills for communication and any significant improvement in autism 2-14-11

Parent Implemented Intervention For Autism 1-27-11

General: Autism Research, Model, and Intervention Package, Information 1-27-11

What to look for in a consultant/coach 1-24-11

Good, even the best autism treatment doesn't have to cost a fortune. Research has proven this. Sometimes your child can get great treatment for 20% of what is commonly paid for treatment. 1-21-11

What's the PROOF intervention works and is worth the time, effort, and money 1-18-11

Parent Implemented Intervention (Autism Spectrum Disorders) 1/18/11

Intervention descriptions: Evidence Based Best Practice 1/13/11

Back to Basics 12-17-10

Videos By Topic (Autism Research and Treatment) 12-15-10

Natural Reinforcement: Parenting that Lasts 12-3-10

Best Practice (less expensive) Treatment for Autism 12/1/10

Autism Internet Modules 1/13/11

Early Start Denver Model for Young Children with Autism: Promoting Language, Learning, and Engagement 11-22-10

Working Paper #9: Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development
Report from the National Scientific Council on the Developing Child 11-16-10

Better and more effective intervention for much less money, commonly as little as 20% of what is often currently being spent 11/8/10

Family-Focused Interventions for Promoting Social-Emotional Development in Infants and Toddlers with or at Risk for Disabilities 10/26/10

Specific example of mental health or developmental disability goals and objectives 10/19/10

MEASURABLE BEHAVIORAL OBJECTIVE TEMPLATE 10/16/10

EVIDENCE BASED FAMILY CENTERED PRACTICE 10/16/10

Assessment: Targeting the treatment towards all the issues, not just the child. 10/9/10

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 10/5/10

Best Practice, Better Outcomes: How to write Measurable Behavioral Objectives, Goals & Plans 1-27-11

Additional information on writing measurable behavioral objectives 1-29-11

More on contextually mediated behavior from an unusual source. 9/21/10

CHILD BEHAVIOR: Why does s/he do that? and What can I do about it? 8/9/10

Writing an objective, goal, or plan, for safety concerns. 9/2/10

How to write Contextually Mediated Objectives 7/26/10

Another way to respond to (deal with) tantrums 9/1/09

Short exchange with Dr. Richard Solomon 7/31/09

Some additional resources for working with children with autism 6/27/09

Meaningful Functional Outcomes and Parental Involvement 5/29/09

Reinforcement 3/17/09

Desensitization 3/14/09

Chaining 3/14/09

ENCYCLOPEDIA OF PARENTING

Quality Treatment for Children 2/6/09

Transition plans 1/9/09

Functional Outcomes 12/17/08

Functional Behavioral Assessments or What’s causing the short? 12/1/08

What are some of the often overlooked independent variables? (sometimes referred to as Setting Events) 10/21/08

CLASSIFICATION OF (some) INTERVENTIONS FOR YOUNG CHILDREN WITH AUTISM SPECTRUM DISORDER * 6/11/08

IEP Goals for P.L.A.Y. for children with Autism 6/11/08

Writing Measurable Behavioral Objectives for P.L.A.Y. 5-2-08

Best Practice, Better Outcomes: How to write Measurable Behavioral Objectives, Goals & Plans 1-27-11

Fever during pregnancy, diabetes and obesity may raise autism risk - USATODAY.com

2011-05-16T11:22:00.000-07:00

Fever during pregnancy, diabetes and obesity may raise autism risk - USATODAY.com: "giving birth by Cesarean section isn't associated with autism in offspring, but having diabetes or high blood pressure or being obese while pregnant seems to be."

Autism: Children conceived in winter are up to 16% more likely to be autistic | Mail Online

2011-05-06T19:24:00.000-07:00

Autism: Children conceived in winter are up to 16% more likely to be autistic Mail Online: "Women who carefully plan their conceptions to avoid being heavily pregnant when the weather is at its hottest now have an extra reason to start trying for a baby in the summer."

Autism Intervention:General Research, Models, Moduals, Packages, & Information: Free PowerPoint

2011-04-22T16:37:00.000-07:00

Download the file below. While playing the PowerPoint, depress the space bar if you wish to skip the animations.

http://www.mediafire.com/?aha7j577asw590o

Behaviorism and ABA a Free PowerPoint

2011-04-19T18:53:00.001-07:00

Download the file below. While playing the PowerPoint, depress the space bar if you wish to skip the animations.

Feel free to share with others; but please keep the reference to this blog at the end.
Please ask questions, make comments, and suggestions here.

http://www.mediafire.com/?g829d9bia9ww071

Tobacco, Drugs, Alcohol, and Parenting

2011-03-22T18:29:00.000-07:00

Everyone knows, or should know that Tobacco, Alcohol, and other Drugs simply don’t mix with pregnancy. There can be adverse affects on the fetus as well as the mothers when any of these substances are consumed while pregnant. The actual affect varies not only with the amount consumed; but by the timing as well. For example: a small amount of alcohol can have a larger, more negative effect on the unborn child at one stage of the pregnancy than a little more alcohol would at another.

What many people do not know, is the negative effect these substances have both on parenting and the health and wellbeing of the child.

Generally people understand that these substances are not healthy for children; however, there are a number of reasons they are especially (“especially” because they are toxic for adults as well) toxic for children and teens. Young people’s bodies and BRAINS are still forming into young adulthood. Toxic substances have a lifelong negative effect on the bodies and brains of children, adolescents, and young adults.

Some substances (such as Meth) and substance abuse in general is absolutely and completely incompatible with even adequate parenting. Not only does it have an impact on the eventual use of the substance by the child; but seriously and negatively effects employment, school work, socialization, citizenship, morality…and the list goes on and on.

Supplemental Research Material

Parenting and Alcohol

Parenting and Drugs

Parenting and Tobacco

Pregnancy and Tobacco

Pregnancy and Alcohol

Pregnancy and Drugs

Fetal Alcohol Syndrome

Prenatal Alcohol Exposure and the Brain

Visualizing Addiction - Neuroscientists Show Kids Effects of Drugs on Brain

Mums who drink in pregnancy have unruly kids

Low Cost Treatment for Autism

2011-03-21T18:22:00.000-07:00

It should never be a matter of just LOW COST treatment for autism; but what is evidence based and what is effective.

There are three elements of effective low cost intervention for autism. You’ll find information about these throughout this site.
It will include:
Parental/caregiver involvement
Consultant/Coach
Evidence based interventions according to the individualized needs of the child

A brain protein 'linked to autism'

2011-03-21T18:10:00.000-07:00

A brain protein 'linked to autism': "“A single protein may trigger autistic spectrum disorders,”, BBC News has reported. According to the news, when mice were bred to lack a protein called Shank3, which normally aids the transfer of signals between brain cells, they showed classic autism-like behaviours, including social problems and repetitive behaviours."

Behaviorism: What it is and what it isn’t.

2011-03-03T18:23:00.000-08:00

A few years ago a relative of mine made what s/he believed to be an authoritative statement. ‘Behaviorism doesn’t work. (So and so) didn’t respond as predicted.’ That thought may be common for many; however, it is a representation of a lack of understanding of what behaviorism is and is not.

When I was young, there was a magazine which I read regularly and which contained true, short, humorous, stories.
The one story I remember best was about a young boy sitting next to his father in church listening to a lengthy and, at least for the boy, incredibly boring sermon. After what seemed to the boy like an interminable amount of time, the boy turned to his father, rather loudly and pleaded, “Dad, please take me out and spank me!”
That one story, for me, encapsulates what is most misunderstood about behaviorism by both professionals and the general public.
The basic concepts of reward (reinforcement) and punishment, antecedents (to include setting events) are absolutely individual. You simply cannot treat everyone the same and expect to get the same results. If someone was to make a meal for you, you may prefer steak to monkey brain, and may respond differently to the one offering than the other. You may also react differently to steak, even if it’s the best steak in the world and you absolutely LOVE steak, if you’ve been eating it every night for a month and have already had it twice today. There are technical terms for these concepts; but that’s not what’s important here. I often talk about how objectives must be individualized, it is the same for the plan as a whole and it is absolutely the same for altering antecedents, rewards and punishments.
Simply: think about it this way:
Behavior is anything a person does. If you are alive, you are always behaving in some way or another.
An Antecedent is anything which occurs before a behavior, it can be internal (within the individual like hunger, fatigue, or a renal infection, etc.) or external (cold, heat, bright lights, yelling, etc.)
A reward is anything which increases the chances that a particular behavior will reoccur. (By now, you should understand that this is individualized and changes)
A punishment is anything which decreases the chances that a particular behavior will reoccur. (This also changes over time and is individually different). In the case of the little boy, the spanking was not a punishment for speaking loudly in church. It was a relief. One of the techniques used by the US government for enhanced interrogations was repeated and loud “Barney” music. I can almost imagine someone pleading, please, water-board me, just no more of that stinkin purple dinosaur! On the other hand, my grandson would be just fine with repeated loud Barney music… for I have no idea how long…because I can’t stand it for long at all and have to put an end to it if I’m in the room (the Sponge Bob laugh fits into the same category). My intention is not to make light of enhanced interrogations; but to demonstrate how individual punishment can be.
The next essential concept to understand is natural reinforcement (reward). This is simply receiving what you would normally receive for doing the behavior. For example, if a child asks their parent for a hug, my hope is that they would typically receive a hug. If someone pops popcorn, unless they are doing it for someone else, they would typically get to eat it. Unfortunately this simple concept is lost on many so called professionals.
So where does Behaviorism come from?
Behaviorism as we know it today gets its beginning from people like BF Skinner < http://en.wikipedia.org/wiki/B.F._Skinner >, John Watson < http://en.wikipedia.org/wiki/John_B._Watson >, and even Ivan Pavlov < http://en.wikipedia.org/wiki/Ivan_Pavlov > (classical conditioning) who was famous for his experiments with salivating dogs. The basic concepts of behaviorism though are many thousands of years old and can be found in our earliest writings from Greek philosophers to early government and religious writings. In a nutshell it includes any change (based upon scientific observation and repeated experimentation) to environment, antecedents, rewards, punishments, and activities, for the purpose of changing behaviors or skills.
ABA
From behaviorism and the initial research of Ivar Lovaas < http://en.wikipedia.org/wiki/Ole_Ivar_Lovaas > (and many others) we get Applied Behavioral Analysis < http://en.wikipedia.org/wiki/Applied_behavior_analysis > ABA has application, in work with children, adults, and animals. It is not only used with children and adults with disabilities or behavioral problems; but also: in the family, school, organizations, and even the corporate world through negotiations, competition, employee programs, and advertising. Government uses it to adjust/manipulate the behavior of its citizens and military. ABA is NOT just working with young children with autism.
As is implied in its name, ABA requires a scientific analysis of behavior. When working with individuals with disabilities or behavioral problems, it requires an ongoing individualized analysis of behavior.
What is EIBI or Early Intensive Behavioral Intervention for Children with Autism Spectrum Disorders?
EIBI is the application of ABA for young children with autism. It is a very specific, though individualized intervention.

Additional Resources

2011-03-02T19:59:00.000-08:00

• The Gray Center

• http://www.thegraycenter.org/

• Special Minds

• http://www.specialminds.org/about.html

• Social Stories Therapy for Children with Autism

• http://autism.healingthresholds.com/therapy/social-stories

“Story-based Intervention Package” (For children with autism)

2011-03-02T19:46:00.000-08:00

• “Story based interventions are similar to written scripts and Self-management in that they involve written materials that are designed to increase independence. The most well-known story-based intervention is Social Stories™”

• Evidence-Based Practice and Autism in the Schools

• http://www.nationalautismcenter.org/pdf/NAC%20Ed%20Manual_FINAL.pdf

• Please watch the video at: Introduction to Teaching Through Social Stories ™

• http://www.talkautism.com/Components/Video/Video.aspx?v=56

To continue with this information click here

Music as a part of intervention

2011-02-26T07:00:00.000-08:00

Music can play a vital role in intervention for many children and adults. Music can help with stress reduction and as a cue to assist with transitions.

Please read #10 on the following page for additional information

http://responsiblepracticalparenting.blogspot.com/2010/08/stress-helping-your-children-and-you.html

Music, like many things is individualized. While there are general “rules of thumb” regarding what kind of music is most helpful, it is still individualized both to the person and to the situation. It always irritates me when people search the web for canned objectives and come across this website, expecting they will find an objective they can just plug into a plan for a particular child. It has to be individualized to the specific child and situation or it simply won't be very effective. It is the same with music and it is the same with intervention in general. What will work for a high functioning young child with autism is not the same as best practice for an older child with lower functioning autism.

Communication and Joint Attention

2011-02-14T09:16:00.001-08:00

• Joint attention is absolutely critical for the development of language

Joint Attention

• One of the, if not THE, most pivotal skill for children with Autism.

• ALL of the Best Practice, Evidence Based interventions, for young children with Autism now incorporate, train, coach, teach, and reinforce, this pivotal skill.

Supplemental information:

How to Improve Joint Attention Skills in Young Children with Autism

Joint Attention: one of, if not the most critical skills for communication and any significant improvement in autism

2011-02-14T08:22:00.000-08:00

Joint Attention

aka
Shared Attention

To continue with this information click here.

Nutrition: Prenatal, Child, Family

2011-02-08T12:40:00.000-08:00

Supplemental material:

Researchers Link Processed Food To Lower IQs In Kids

Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA young autism project model. 2008

2011-02-03T17:00:00.001-08:00

“Abstract

A 3-part comprehensive synthesis of the early intensive behavioral intervention (EIBI) for young children with autism based on the University of California at Los Angeles Young Autism Project method (Lovaas in Journal of Consulting and Clinical Psychology, 55, 3-9, 1987) is presented. The three components of the synthesis were: (a) descriptive analyses, (b) effect size analyses, and (c) a meta-analysis. The findings suggest EIBI is an effective treatment, on average, for children with autism. The conditions under which this finding applies and the limitations and cautions that must be taken when interpreting the results are discussed within the contextual findings of the moderator analyses conducted in the meta-analysis.”

“Recently, the Committee on Educational Interventions for Children with Autism of the National Research Council (NRC) reviewed ten comprehensive intervention programs for young children with autism (Lord et al. 2001). Some of these programs were based on applied behavior analysis, which is a method that has been used to treat children with autism for many years. Recent survey data suggest interventions based on applied behavior analysis are some of the most frequently used interventions in autism…

Many of the programs had supporting empirical evidence, but the NRC did not recommend a single program and cited a need for more research on them (Lord et al. 2001). Instead consensus guidelines were listed stating children with autism should receive a comprehensive intervention program beginning as soon as they are diagnosed. The program should (a.) address the individual’s unique deficit areas, (b) use low teacher to student ratios, (c) include a family component, (d) be provided for at least 20-25 h per week, and (e) conduct ongoing assessment and revision of intervention goals and objectives (Lord et al.). Similar guidelines have been recommended by others (Dawson and Osterling 1979; Iovannone et al. 2003; Bolkmar et al. 1999) and are generally consistent with recommended practices in early intervention (Sandall et al. 2005).”

http://www.ncbi.nlm.nih.gov/pubmed/18535894

Additional information on writing measurable behavioral objectives

2011-01-29T11:41:00.000-08:00

This series of postings will provide additional information on writing measurable behavioral objective.
Remember, the best objectives are individualized and written specifically for the individual and the situation. You will get much better outcomes by learning and following the process, even though it takes a little more time and effort, writing individualized objectives rather than using canned objectives (which typically do not meet rule).

Click here to continue with the information.

Parent Implemented Interventions for Autism (ASD)

2011-01-27T13:13:00.000-08:00

The best progress your child can make will in almost all situations involve your own involvement; however, this is not something you should do on your own. It is essential you enlist the expert help and support from an appropriate consultant/coach. The following will tell you want to look for AND provide you with links for additional information.

Please click "here" for more information.

Best Practice, Better Outcomes: How to write Measurable Behavioral Objectives, Goals & Plans: for Mental Health and Developmental Disabilities

2011-01-27T13:04:00.001-08:00

This will take you through the information on how to write measurable behavioral objectives. Please ask questions in the comment section.

This series of postings will provide you with the fundamental tools and skills to write individualized and effective measurable behavioral objectives for either mental health or developmental disabilities.

Click next to continue: Better Outcomes

Further autism treatment information:

2011-01-27T12:41:00.000-08:00

¨ Please watch the video presentations: Evidence Based Practices in Autism Spectrum Disorders Presenters: Patricia Schetter, M.A., BCBA & Aaron Stabel, M.A., BCBA &
¨ Psychosocial and Biological Markers of Stress in the Lives of Mothers of Adolescents and Adults with Autism: Mailick Seltzer, Ph.D. (Once you have clicked on the videos, wait for the picture and music to start. It will take a couple minutes. After the music starts, pause the video, do something else you have to do and then about a half hour later click the play button to watch the presentation uninterrupted.)
¨ at: http://www.ucdmc.ucdavis.edu/mindinstitute/videos/video_autism.html

¨ and

¨ Parent Implemented Intervention: http://www.autisminternetmodules.org/mod_intro.php?mod_id=94
(It’s free and easy to register.)

Click here for additional information on interventions.

Progress for children with autism continued

2011-01-27T12:38:00.000-08:00

¨ While a child MAY make progress in a school or center…

¨ Without significant, Parental/Primary Care Provider, involvement in the consistent implementation of therapy…

¨ Most if not all gains in behavior are likely to be of only short duration

Click "next" to continue with this information.

Progress for children with autism continued

2011-01-27T12:36:00.000-08:00

¨ There is evidence of significant improvement in behavior for almost all children if:

¨ the right (EBP) intervention is provided at the right time

¨ by a well qualified interventionist, and

¨ Intervention is consistent across environments and settings

Click "next" to continue with this information.

Progress for children with autism continued

2011-01-27T12:33:00.001-08:00

¨ While the “Passive” children, on average, do not tend to demonstrate outcomes as good as the “Active But Odd” children,

¨ “Passive” children tend to do better in more tightly structured interventions. (New research coming out over the next two years may change this)

It may be that P.L.A.Y. will demonstrate positive outcomes for children in all three categories. The research completed so far is promising.

Click "next" to continue with this information.

Progress for children with autism continued

2011-01-27T12:31:00.000-08:00

¨ If we divide children with ASD into three subgroups:

¨ Aloof

¨ Passive

¨ Active But Odd (note: this nomenclature is not the fault or responsibility of the person preparing this information)

¨ The “Active But Odd” group tends to have better outcomes.

Please click "next" to continue with the information.

Progress for children with autism continued

2011-01-27T12:28:00.000-08:00

¨ There is no (peer reviewed and broadly accepted) evidence of significant skill improvement from any of the models for children with an IQ less than 35 or below 40% in chronological age according to a functional assessment.

Click "next" to continue with this information.

Progress for Children With Autism

2011-01-27T12:26:00.000-08:00

¨ To my knowledge and as verified by a number of the experts in the field:

¨ There is no (peer reviewed and broadly accepted) evidence of significant efficacy in intensive (one on one delivered by a professional) intervention beyond 36 months. (Little evidence much beyond 24 months. If the child is not making significant gains in the first year…make a change. * Significant in this case would mean a measurable improvement in SIB-R BI, and/or GMI, and/or IQ score)

¨ There is no (peer reviewed and broadly accepted) evidence of significant efficacy in intensive intervention for children older than eight years old.

Click "next" to continue with the information.

Recommended Autism Interventions According to Diagnosis

2011-01-27T12:22:00.000-08:00

¨ As you review the information presented through these training modules and the handouts for parents, please understand:

¨ The Diagnostic Criteria for Aspergers is not very precise and is often interchangeable with “High Functioning Autism”
¨ (There is a movement to remove the separate diagnoses of Autism, PDD NOS, and Aspergers and simply replace it with ASD or Autism Spectrum Disorder)

Click "next" to continue with the information.

General: Autism Research, Model, and Intervention Package, Information

2011-01-27T12:18:00.000-08:00

The following information provides a very brief overview of research and intervention in Autism. You will find additional links to some very good supplemental information.

Click "Next" to continue through the information.

Basic information including evidence based practice, stress and parenting a child with autism, and parental involvement in therapy

2011-01-27T12:17:00.000-08:00

This information is primarily targeted towards:

¨ Children diagnosed with ASD (Autism Spectrum Disorder)
¨ However; can be generalized to some extent to other children with developmental disabilities with more limited applicability to children with degenerative disabilities.

Consistency
¨ All of the recommended models (contained elsewhere on the site) contain elements of many of the EBP (Evidence Based Practice) intervention packages.

Click "next" to continue with this information.

What to look for in a consultant/coach

2011-01-24T17:20:00.001-08:00

Whether you have a child with autism spectrum disorder, another developmental disability, and/or mental health or behavioral health needs the criteria for an effective consultant/coach is very similar.

First, why do you want a consultant/coach?

1. Children make the most progress when the intervention is consistent across all environments and research has repeatedly demonstrated that parents can be effective interventionists for their own child and quite often are the most effective interventionists for their own child.

2. Even the very best therapists/interventionists use their own consultant/coach. You might even say that the best do and the worst don’t and that’s one of the reasons for the difference.

3. At times, even the very best parents loose objectivity and need another outside expert to take a look and give feedback for difficult, unusual, disabilities, disorders, and circumstances.

4. Not all children are the same. Just like not all adults are the same. Some children respond better to one type of intervention over another and sometime it changes over time.

5. Some children need very specialized and specific types of intervention.

What can you expect from a good consultant/coach?

1. This person will be an expert in working with families and children.

2. This person will have at their disposal additional consultant/coaches to help them help you in areas where your direct consultant/coach is not an expert

3. They will be an expert in the assessment of not only your child; but will be able to assess your resources to better help your child through your child’s and your natural supports. This assessment will include a functional analysis of behavior if there are behavioral issues.

4. They will provide and help you provide ongoing assessment, theirs being more formal and yours being more informal.

5. They will be an expert in providing intervention for the disability, condition, or behaviors your child is exhibiting.

6. They will provide both you and your child with pertinent, applicable, and valuable instruction related to your child’s disability and/or condition and how you can adjust your interactions to better help your child.

7. They will carefully and lovingly provide you with feedback regarding your interactions, and your child’s environment, even when some of it is difficult for you to hear.

8. They will provide directly or in conjunction with another consultant/coach, consultation and/or direct assistance with assistive technology when needed. (This can at times be very low cost and creative uses for common items found around your home.)

9. They will provide you with direct examples and demonstration of the techniques or interventions they are describing. This includes working directly with your child, while you are observing in person, and/or through a two way mirror, and/or by video, and providing feedback as they observe your work with your child. (This can be through ,direct in person interaction, two way mirror, and/or through viewing video of you working with your child. This video may be shared with other consultant/coaches as needed)

10. They will provide ongoing reassessment and adjustment as needed.

11. They will be respectful of your values

12. They will help you integrate intervention into yours and your child’s natural routines, usually eliminating the need to make drastic changes or additions to your schedule.

13. They will work with other educators and/or care providers to assure intervention is consistent across environments.

Supplemental material:

http://www.autisminternetmodules.org/mod_list.php#layout_content_box

http://www.coachinginearlychildhood.org/

http://www.fippcase.org/caseinpoint/caseinpoint_vol4_no1.pdf

Evidence-Based Practice: Parent-Implemented Intervention

There are many free tools.
Parent Implemented Interventions
Registration is free and easy.

Good, even the best autism treatment doesn't have to cost a fortune. Research has proven this. Sometimes your child can get great treatment for 20% of what is commonly paid for treatment.

2011-01-22T10:16:00.000-08:00

Good, even the best autism treatment doesn't have to cost a fortune. Research has proven this. Sometimes your child can get great treatment for 20% of what is commonly paid for treatment.

There are three keys:

1. Use Evidence Based Best Practice.

2. Consistency across all environments and throughout the day.

3. Parent/Caregiver participation. NOTE: This does not mean spending your whole life doing therapy with your child. What it does mean is altering all of your interactions with your child so therapy will occur during the natural routines for you, your family, and your child. You will find the tools and link to tools you need here. A good clinical/theraputic (routine based) consultant is a must…but must less expensive than full time therapy and often more beneficial to your child as long as all the interventions are contextualized within the natural routines of your child emphasizing natural reinforcers.

What's the PROOF intervention works and is worth the time, effort, and money

2011-01-18T17:34:00.000-08:00

Too often many people in the helping professions have the attitude that they are doing a good thing which should not require documentation or accountability, let alone measurable outcomes. Too often and too easily
data is manipulated, just as it often is in advertising, with the intent of selling a product or service being a higher priority than objective information on what works, what doesn't, and what really IS the cost
benefit ratio. These times are hopefully coming to an end. It is a disservice to the intended beneficiaries of the intervention and it is a disservice to those who are paying the bill...and really, it is a disservice to the intervention provider who isn't required to hone his or her skills and provide the right therapy at the right time.

It is too easy to write objectives in such a way as to show goals and objectives being met. It is too easy to say progress is being made; but withholding or simply not gathering crucial information that might give an indication if that progress has been a result of the intervention or perhaps other variables such as maturation or...(?).

One of the only ways to have a clear indication that real progress is being made is to compare against truly objective scores resulting from objective norm referenced assessments determined from direct observation and testing. These include assessments such as a Battelle, or Bayley, or an IQ score. There are many other assessments which can and will give you a standard deviation and Z score which will provide you with a better understanding of REAL progress. There are also other assessments which approach this level of integrity, validity, and reliability. There are also some assessments that while on the surface and through research, demonstrate a fairly high level of validity and reliability, unfortunately when in the hands of or reported by individuals with a high motivation to skew the results, they often lack good integrity. This can include the assessments previously mentioned.

Another fairly concrete way to look at progress is to look at real outcomes, outcomes based upon specific criteria, such as recidivism and employment; however, there are common misrepresentations in this data as well such as low recidivism back into a juvenile justice system while the same youth end up on an adult system (hardly a real success) or low unemployment rates but high underemployment and many people who have simply stopped looking for work or by statistical manipulation have been removed from the data.

So what to do? Assure the best assessments possible, and verify results on a random basis. Provide and pay for services which provide the best average results and the best average cost benefit ratio.

Parent Implemented Intervention (Autism Spectrum Disorders)

2011-01-18T17:15:00.000-08:00

In many parts of the world parent implemented intervention is the only intervention available for children with autism and due to the economic downturn may soon be the only intervention available in increasing sectors of the globe. For this reason and also because of the efficacy of (benefit from) parent implemented intervention (in most cases where the parent is provided with good consultation to better help their own child and where the parent is willing to adjust their interaction with a child of special needs) providers must learn to be more adept at working with families and providing needed consultation.

As you see here, as in all three of the closely associated websites: Best Practice, Better Outcomes/How to write Measurable Behavioral Objectives, Goals & Plans http://bestoutcomes.blogspot.com/ ; Current Autism News & Research or Hope for Autism http://currentautismresearchhopeforautism.blogspot.com/ ; and ENCYCLOPEDIA OF PARENTING: A RESEARCH BASED RESOURCE GUIDE http://responsiblepracticalparenting.blogspot.com/

There is a great deal of evidence from research which clearly demonstrates that parents can, with help of qualified consultants, provide therapeutic intervention for their own children. As mentioned previously, this may require learning to interact with their child with special needs in ways which must be adjusted from how they may interact with a typically developing child. While the adjustments may be; they are not always substantial.

Please see the following presentation for additional information and links to even more information. (All three of the websites listed above also provide a great deal of information on the subject as well as the ability to ask questions and discuss with others.) http://www.autisminternetmodules.org/mod_intro.php?mod_id=94
Registration is free and easy

Autism Internet Modules | Welcome

2011-01-13T10:31:00.000-08:00

Autism Internet Modules Welcome: "The Autism Internet Modules were developed with one aim in mind: to make comprehensive, up-to-date, and usable information on autism accessible and applicable to educators, other professionals, and families who support individuals with autism spectrum disorders (ASD). Written by experts from across the U.S., all online modules are free, and are designed to promote understanding of, respect for, and equality of persons with ASD."

Best Practice for Children diagnosed with Aspergers ages 15-18

2011-01-13T10:16:00.001-08:00

The following types of intervention have been found to be most effective; (but does not preclude some use of other interventions mentioned depending upon the individual needs of the child and family):

• Modeling …

Based on information from: The National Autism Center’s National Standards Project Findings and Conclusions: 2009

When interviewing potential providers, you may want to ask the following questions:

4) How has the agency and the individual therapist/staff gained expertise/certification in the above intervention?

5) What is the average (12 month) improvement in skills (BI score) and behavior (GMI score) for a child (age 15-18) diagnosed with aspergers, using their agency and the above intervention?

6) Ask them to fully explain how they will implement the above intervention in collaboration with other therapies your child is receiving.

Best Practice for Children diagnosed with PDD NOS ages 15-18

2011-01-13T10:14:00.001-08:00

The following types of intervention have been found to be most effective; (but does not preclude some use of other interventions mentioned depending upon the individual needs of the child and family):

• Behavioral Package …

• Modeling …

Based on information from: The National Autism Center’s National Standards Project Findings and Conclusions: 2009

When interviewing potential providers, you may want to ask the following questions:

1) How has the agency and the individual therapist/staff gained expertise/certification in the above intervention(s) you have chosen?

2) What is the average (12 month) improvement in skills (BI score) and behavior (GMI score) for a child (age 15-18) diagnosed with PDD NOS, using their agency and the above intervention? You may also further ask what the average improvement is for children whose functioning level is above 50% and the average improvement for children whose functioning level is below 50%.

3) Ask them to fully explain how they will implement the above intervention (or combination) you have chosen in collaboration with other therapies your child is receiving.

When multiple interventions are mentioned it is usually most helpful to use more than one or even all which are mentioned according to the specific needs and strengths of the child and family.

Best Practice for Children diagnosed with Autism ages 15-18

2011-01-13T10:13:00.000-08:00

The following types of intervention have been found to be most effective; (but does not preclude some use of other interventions mentioned depending upon the individual needs of the child and family):

• Antecedent Package …

• Behavioral Package …

• Modeling …

• Self-management …

Based on information from: The National Autism Center’s National Standards Project Findings and Conclusions: 2009

When interviewing potential providers, you may want to ask the following questions:

1) How has the agency and the individual therapist/staff gained expertise/certification in the above intervention(s) you have chosen?

2) What is the average (12 month) improvement in skills (BI score) and behavior (GMI score) for a child (age 15-18) diagnosed with Autism, using their agency and the above intervention? You may also further ask what the average improvement is for children whose functioning level is above 50% and the average improvement for children whose functioning level is below 50%.

3) Ask them to fully explain how they will implement the above intervention (or combination) you have chosen in collaboration with other therapies your child is receiving.

When multiple interventions are mentioned it is usually most helpful to use more than one or even all which are mentioned according to the specific needs and strengths of the child and family.

Best Practice for Children diagnosed with PDD NOS ages 10-14

2011-01-13T10:06:00.000-08:00

The following types of intervention have been found to be most effective; (but does not preclude some use of other interventions mentioned depending upon the individual needs of the child and family):

• Behavioral Package …

• Modeling …

• Peer Training Package …

Based on information from: The National Autism Center’s National Standards Project Findings and Conclusions: 2009

When interviewing potential providers, you may want to ask the following questions:

1) How has the agency and the individual therapist/staff gained expertise/certification in the above intervention(s) you have chosen?

2) What is the average (12 month) improvement in skills (BI score) and behavior (GMI score) for a child (age 10-14) diagnosed with PDD NOS, using their agency and the above intervention? You may also further ask what the average improvement is for children whose functioning level is above 50% and the average improvement for children whose functioning level is below 50%.

3) Ask them to fully explain how they will implement the above intervention (or combination) you have chosen in collaboration with other therapies your child is receiving.

When multiple interventions are mentioned it is usually most helpful to use more than one or even all which are mentioned according to the specific needs and strengths of the child and family.

Best Practice for Children with Aspergers ages 10-14

2011-01-13T10:04:00.000-08:00

The following types of intervention have been found to be most effective; (but does not preclude some use of other interventions mentioned depending upon the individual needs of the child and family):

• Modeling …

Based on information from: The National Autism Center’s National Standards Project Findings and Conclusions: 2009

When interviewing potential providers, you may want to ask the following questions:

1) How has the agency and the individual therapist/staff gained expertise/certification in this intervention?

2) What is the average (12 month) improvement in skills (BI score) and behavior (GMI score) for a child (age 10-14) with Aspergers, using their agency and the above intervention?

3) Ask them to fully explain how they will implement the above intervention in collaboration with other therapies your child is receiving.

Best Practice for Children with Autism ages 10-14

2011-01-13T10:02:00.001-08:00

The following types of intervention have been found to be most effective; (but does not preclude some use of other interventions mentioned depending upon the individual needs of the child and family):

• Antecedent Package …

• Behavioral Package …

• Modeling …

• Peer Training Package …

• Schedules …

• Self-management …

• Story-based Intervention Package …

Based on information from: The National Autism Center’s National Standards Project Findings and Conclusions: 2009

When interviewing potential providers, you may want to ask the following questions:

1) How has the agency and the individual therapist/staff gained expertise/certification in the above intervention(s) you have chosen?

2) What is the average (12 month) improvement in skills (BI score) and behavior (GMI score) for a child (age 10-14) with Autism, using their agency and the above intervention? You may also further ask what the average improvement is for children whose functioning level is above 50% and the average improvement for children whose functioning level is below 50%.

3) Ask them to fully explain how they will implement the above intervention (or combination) you have chosen in collaboration with other therapies your child is receiving.

When multiple interventions are mentioned it is usually most helpful to use more than one or even all which are mentioned according to the specific needs and strengths of the child and family.

Best Practice for Children with PDD NOS ages 6-9

2011-01-13T09:59:00.001-08:00

The following types of intervention have been found to be most effective; (but does not preclude some use of other interventions mentioned depending upon the individual needs of the child and family):

• Behavioral Package …

• Comprehensive Behavioral Treatment for Young Children …

• Modeling …

• Naturalistic Teaching Strategies …

• Peer Training Package …

Based on information from: The National Autism Center’s National Standards Project Findings and Conclusions: 2009

When interviewing potential providers, you may want to ask the following questions:

1) How has the agency and the individual therapist/staff gained expertise/certification in the above intervention(s) you have chosen?

2) What is the average (12 month) improvement in skills (BI score) and behavior (GMI score) for a child (age 6-9) with a diagnosis of PDD NOS, using their agency and the above intervention? You may also further ask what the average improvement is for children whose functioning level is above 50% and the average improvement for children whose functioning level is below 50%.

3) Ask them to fully explain how they will implement the above intervention (or combination) you have chosen in collaboration with other therapies your child is receiving.

When multiple interventions are mentioned it is usually most helpful to use more than one or even all which are mentioned according to the specific needs and strengths of the child and family.

Best Practice for Children with Aspergers ages 6-9

2011-01-13T09:57:00.000-08:00

The following types of intervention have been found to be most effective; (but does not preclude some use of other interventions mentioned depending upon the individual needs of the child and family):

• Modeling …

• Story-based Intervention Package …

Based on information from: The National Autism Center’s National Standards Project Findings and Conclusions: 2009

When interviewing potential providers, you may want to ask the following questions:

1) How has the agency and the individual therapist/staff gained expertise/certification in the above intervention(s) you have chosen?

2) What is the average (12 month) improvement in skills (BI score) and behavior (GMI score) for a child (age 6-9) with aspergers, using their agency and the above intervention?

3) Ask them to fully explain how they will implement the above intervention (or combination) you have chosen in collaboration with other therapies your child is receiving.

When multiple interventions are mentioned it is usually most helpful to use more than one or even all which are mentioned according to the specific needs and strengths of the child and family.

Best Practice for Children with Autism, ages 6-9

2011-01-13T09:55:00.000-08:00

The following types of intervention have been found to be most effective; (but does not preclude some use of other interventions mentioned depending upon the individual needs of the child and family):

• Antecedent Package …

• Behavioral Package …

• Comprehensive Behavioral Treatment for Young Children …

• Modeling …

• Naturalistic Teaching Strategies …

• Peer Training Package …

• Schedules …

• Self-management …

• Story-based Intervention Package …

Based on information from: The National Autism Center’s National Standards Project Findings and Conclusions: 2009

When interviewing potential providers, you may want to ask the following questions:

1) How has the agency and the individual therapist/staff gained expertise/certification in the above intervention(s) you have chosen?

2) What is the average (12 month) improvement in skills (BI score) and behavior (GMI score) for a child (age 6-9) with autism, using their agency and the above intervention? You may also further ask what the average improvement is for children whose functioning level is above 50% and the average improvement for children whose functioning level is below 50%.

3) Ask them to fully explain how they will implement the above intervention (or combination) you have chosen in collaboration with other therapies your child is receiving.

When multiple interventions are mentioned it is usually most helpful to use more than one or even all which are mentioned according to the specific needs and strengths of the child and family.

Reccommended Models for Young Children with Autism

2011-01-13T09:52:00.000-08:00

Recommended interventions:

ABA: Behavior Analysis is the scientific study of behavior. Applied Behavior Analysis is the application of the principles of learning and motivation from Behavior Analysis, and the procedures and technology derived from those principles, to the solution of problems of social significance. Many decades of research have validated treatments based on ABA.
http://www.centerforautism.com/getting_started/aba.asp ~ http://www.abainternational.org/

The Denver Model
Also known as the Early Start Denver Model is a well researched combination of behavioral and developmental therapy. It has produced very good results with children who’s IQ is as low as 35 (the lowest or one of the lowest of any of the well researched established models providing excellent outcomes).
http://www.ucdmc.ucdavis.edu/mindinstitute/research/esdm/ ~ http://www.autismspeaks.org/docs/d_200911_ESDM.pdf

DIR®/Floortime™ The Developmental, Individual Difference, Relationship-based The objectives of the DIR®/Floortime™ Model are to build healthy foundations for social, emotional, and intellectual capacities rather than focusing on skills and isolated behaviors. http://www.icdl.com/dirFloortime/overview/index.shtml

The P.L.A.Y. Project® is (an) … early intervention program dedicated to empowering parents and professionals to implement intensive, developmental interventions for young children with autism in the most effective and efficient way.
http://www.playproject.org/

PRT: Pivotal Response Treatment … Pivotal Response Teaching, and Pivotal Response Training, PRT focuses on targeting “pivotal” behavioral and skill areas.
http://education.ucsb.edu/autism/ http://www.autismnetwork.org/modules/behavior/pri/index.html http://www.blogger.com/goog_1943166904

TEACCH: Treatment and Education of Autistic and Related Communication Handicapped Children
The foundation of this structured teaching intervention is the modification of the environment to assist the child in the learning process. The focus of this intervention is on organizing the child’s physical environment to facilitate overall task success, capitalizing on visual strengths typically displayed by students with ASD and minimizing reliance on auditory processing/verbal expression. http://www.teacch.com/

If your child is functioning close to 50% of chronological age or above or above a 35 IQ, you should see significant gain in both skills (BI) on the SIB-R AND improvements in behavior (GMI) on the SIB-R. Most children should make significant improvements in behavior.

When you interview potential providers, ask these questions.

1) How have they as an agency, and how have the individual therapists/specialists who will be working with your child, gained specific expertise/certification in the above intervention you have chosen?

2) What is the average (12 month) improvement in BI and GMI for a child (age 3-6) with autism, using their agency and the above intervention? You may also further ask what the average improvement is for children whose functioning level is above 50% and the average improvement for children whose functioning level is below 50%.

No matter which intervention you choose, best practice for best outcomes will include close collaboration with a Speech Therapist (SLP) and very possibly other therapists. This close collaboration should assure that all of the intervention for your child is closely aligned, and that everyone is supporting other interventions received by your child. Parental involvement is essential in any of these interventions.

Intervention descriptions: Evidence Based Best Practice

2011-01-13T09:43:00.000-08:00

Intervention descriptions

Please see: Evidence-Based Practice and Autism in the Schools from the National Autism Center.

You can find a copy at: http://www.nationalautismcenter.org/pdf/NAC%20Ed%20Manual_FINAL.pdf

This guide can be downloaded on the internet and will provide you with additional information and resources for the various interventions; however, the information is not sufficient to make you an expert on any of the interventions. Expertise comes from specific and extensive study, training, and supervised experience. Be leery of anyone, and possibly any agency, who says they are an expert in everything.

While the referenced paper is geared specifically to the school, the same concepts and specific interventions can be used in multiple settings including the home.

Collaboration between these therapies and intervention provided by SLPs, OTs, PTs, and the child’s physician, is strongly supported in this paper and research. In addition, collaboration with and the additional intervention provided by parents and other natural care providers (supported by consultation and modeling from the therapist) during the child and caregiver’s natural routines, significantly extend, enhance, and strengthen, the child’s learning opportunities. For best outcomes, all intervention and supports, natural and otherwise, must be closely integrated.

• Antecedent Package … These interventions adjust the environment and interactions before the behavior and are meant to either increase or decrease a subsequent behavior. This includes understanding and adjusting “setting events” as well as the more immediate stimulus right before a behavior. Additional, extensive, and excellent information can be found at: http://www.autisminternetmodules.org/mod_intro.php?mod_id=83 ¨ Registration is free and easy. See Antecedent-Based Interventions (ABI)
¨ Please note that while you can learn a great deal from online modules and reading research, this alone does not qualify anyone to deliver the intervention.

• Behavioral Package … These interventions include traditional behavioral conditioning and rely heavily on positive and negative reinforcement.

• Comprehensive Behavioral Treatment for Young Children … This treatment is eclectic in nature with many aspects of ABA and related interventions.

• Joint Attention … These interventions help to develop the foundational skills required for focusing or paying attention to the same object or person, and at the same time, as another person. This essential skill is often difficult for children with autism.

• Modeling … These interventions use either video or live modeling of appropriate behaviors/skills to help individuals develop those same behaviors or skills. It is often used with other interventions which incorporate reinforcement. Supplemental Material:

¨ http://www.ucdmc.ucdavis.edu/mindinstitute/videos/video_autism.html

• Making SENSE of Autism Through Peers, Play, and Performance • Lecturer: Blythe Corbett, Ph.D.• Affiliation: UC Davis MIND Institute • Date: June 4, 2010 • Length: 1:21:51 • Synopsis: Blythe Corbett, Ph.D. discusses her work at the MIND Institute regarding video modeling, cortisol and stress, and a unique therapeutic intervention -- SENSE Theatre -- that allows children with autism to participate with age-matched peers in theatrical musical performance. Recorded Fri, 4 June 2010.

• Naturalistic Teaching Strategies … These interventions concentrate on natural reinforcement and natural consequences in the natural environment, training, support, and behavioral objectives contextualized in the natural routines and environment for the child. Supplemental Material: • Additional, extensive, and excellent information can be found at: http://www.blogger.com/goog_672379774

• Registration is free and easy. See Naturalistic Intervention
• Please note that while you can learn a great deal from online modules and reading research, this alone does not qualify someone to deliver the intervention.
• Peer Training Package … These interventions use specifically selected and trained peers to work with and help the child develop appropriate skills and behaviors through structured settings and learning opportunities.

• Pivotal Response Treatment … This intervention focuses on pivotal behaviors in the natural setting.

• Schedules … The use of schedules, charts, picture directions or schedules, etc., often with reinforcement to include natural reinforcers. (Music and other sounds can be used as triggers and cues for schedules when helpful.) Supplemental Materials: • Schedules
• It is easy to create your own effective schedules; however, here are some possible resources.
• Autism Therapy: visual schedules • http://www.blogger.com/goog_1975106661
• Picture Schedule Samples • http://www.blogger.com/goog_1975106665
• Visual Schedules for Autistic Children • http://www.blogger.com/goog_1975106668
• Visual Schedules • http://www.specialed.us/autism/structure/str11.htm
• Visual Schedule for Autism • http://www.lucasworks.org/visual-schedule-autism.html

• Story-based Intervention Package … The use of stories specifically designed to teach skills to children. Social Stories™ is an example. Supplemental Materials: • Please watch the video at: Introduction to Teaching Through Social Stories ™
http://www.talkautism.com/Components/Video/Video.aspx?v=56
• The Gray Center • http://www.thegraycenter.org/
• Special Minds • http://www.specialminds.org/about.html
• Social Stories Therapy for Children with Autism • http://autism.healingthresholds.com/therapy/social-stories

Currently there are two similar projects establishing national standards for the treatment of autism in children and adolescents. One is referenced frequently in these pages and the other is the National Professional Development Center for Autism. While the criterion is slightly different for the two projects there is considerable overlap and many of the same professionals worked on both projects. The results are and will be modified as additional research is completed, published, and validated against rigorous standards. Most of the recommendations in these pages are based on evidence based best practice; however, some is better described as emerging practice with close association with evidence based practice (EBP). Recommendations for disabilities other than Autism Spectrum Disorders (ASDs) are based on best practice research regarding routine based intervention in the natural environment for a wide variety of disabilities. Much of the research on treatment for ASDs is also applicable to children with other disabilities as well as more typically developing children. To better understand how to implement EBPs, please watch the video presentation: Evidence Based Practices in Autism Spectrum Disorders Presenters: Patricia Schetter, M.A., BCBA & Aaron Stabel, M.A., BCBA at: http://www.ucdmc.ucdavis.edu/mindinstitute/videos/video_autism.html

Additional Resources: http://www.nichd.nih.gov/health/topics/developmental_disabilities.cfm

INDEX ACCORDING TO AGE AND DIAGNOSIS

Recommended Models for Young Children with Autism

Best Practice for Children with Autism, ages 6-9

Best Practice for Children with Aspergers ages 6-9

Best Practice for Children with PDD NOS ages 6-9

Best Practice for Children with Autism ages 10-14

Best Practice for Children with Aspergers ages 10-14

Best Practice for Children diagnosed with PDD NOS ages 10-14

Best Practice for Children diagnosed with Autism ages 15-18

Best Practice for Children diagnosed with PDD NOS ages 15-18

Best Practice for Children diagnosed with Aspergers ages 15-18

Back to basics

2010-12-17T15:49:00.000-08:00

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

2010-12-15T14:31:00.000-08:00

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

2010-12-03T21:39:00.000-08:00

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

2010-12-03T16:56:00.001-08:00

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

2010-12-01T14:23:00.000-08:00

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

2010-11-22T17:24:00.000-08:00

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

2010-11-16T16:46:00.000-08:00

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.

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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

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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

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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

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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

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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

2010-10-16T10:58:00.000-07:00

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

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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.

2010-10-09T07:00:00.000-07:00

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

2010-10-05T17:03:00.000-07:00

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.

2010-09-21T15:27:00.000-07:00

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.

2010-09-02T16:26:00.001-07:00

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?

2010-08-09T17:00:00.000-07:00

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

2010-08-09T16:59:00.000-07:00

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®

2010-08-09T16:58:00.001-07:00

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

2010-08-09T16:58:00.000-07:00

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

2010-08-09T16:56:00.001-07:00

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

2010-08-09T16:56:00.000-07:00

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

2010-07-26T17:54:00.000-07:00

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

Another way to respond to (deal with) tantrums

2009-09-01T16:47:00.000-07:00

The typical and recommended response to a tantrum is to ignore it whenever possible. This can be very effective when consistent. There are two potential problems with ignoring tantrums.

1. It can be difficult to be consistent across all settings and with all people.

2. There are times when there are safety concerns and it can not be ignored.

There are other ways to respond to tantrums which in some situations can be more effective and produce quicker positive results. With this said, one intervention does not work best for either all parents or interventionists or with all children or clients.

Many years ago I worked in an institution. During that time I spent some time working with a group of young adult men with sever developmental and behavioral problems. There was one young man who, when he would get upset and throw a tantrum, he would tear his clothes, throw beds and at times even tear sinks off the wall.

One day he started into a tantrum, I do not remember why, and he started screaming and tearing his shirt. I’m not sure what caused me to respond in this way, but I started yelling and also tearing his shirt. He immediately stopped with a shocked look on his face and mumbled the question “are you crazy?” That was the end of the tantrum.

Another time I was with a young man (about 10 years old) who was very upset because he wasn’t able to go on an outing (this was a consequence for his behavior). He was swearing and complaining about one particular staff member. I listened and then suggested that we write it all down. He just responded “naw” and that was the end of the tantrum. We of course discussed what got him to that point and on a long term basis worked on skills that would help to avoid the same problem. On another occasion a young girl (about 6 or 7) started throwing a tantrum in a clinic setting (screaming, kicking). I told her that she wasn’t doing a very good job of throwing a tantrum and that I could throw a better one. Which I did. There were two or three other adults in the room with us who joined in on the act, each trying to out do the other. She never threw a tantrum in front of me again.

My grandson is another example. He is almost four years old and had started throwing tantrums. The first time he did it I responded by saying “that’s just not working for me, why don’t you try….” I would then suggest different things like hitting the couch or stomping his feet a little harder and lying down and kicking his legs. Each time I would respond and say, “nope, that’s still not doing it for me” and suggest something else. Before very long at all he had given up. I believe I did it with him one other time and that has been it. More recently he thought screaming might work on me so I took him to a room, there were some other interesting things in the room but I wouldn’t let him play with them because our purpose was to scream REALLY loud and long. I told him we were here to scream and to go head, he said “no thank you.” He did not get to play with the things in the room but returned to what we had been doing instead.

Here’s the point for tantrums, another possible alternative. Ratchet it up, take it to the next step, perhaps even a challenge, and participate in the tantrum without becoming overly anxious. Make sure the person is safe. (Generally the head is where I am most concerned. You do not want to allow something that may cause damage to the child such as banging a head against the wall. There can also be other areas of concerns.) You can also redirect to safer ways to tantrum. Instead of ignoring, turn it into a game, such as a stomping contest.

Address what brought the child or person to this point in an appropriate and positive manner.

I wanted to add one thing to our tantrum discussion, it's not just that the child may be worn out, but children are smart, even children with disabilities are smarter than we often give them credit and they quickly learn that there's just no leverage in the tantrum, with adults who react in this way. It's more like, "hey this adult just doesn't get it, no use trying it on him or her any more."

It's similar to some of Milton Erickson's techniques where he just wouldn't get flustered and would actually jump right into the drama with the client. He believed that it wasn't his job to turn people around, just move them out of their entrenched trance by a degree or two and then allow them to figure it out and "right" themselves.

Short exchange with Dr. Richard Solomon

2009-07-31T20:26:00.000-07:00

Dr. Rick,A few days ago I was reviewing a web presentation on attachment. Nothing new but a nice refresher. This morning I was reviewing a comprehensive assessment on a child diagnosed with PDD NOS. I was also thinking about some thoughts a co-worker had recently shared, about co-occurring dd and cmh disabilities and it struck me that the diagnosis of autism or something in the spectrum almost requires an attachment issue. I also thought about the LOVAAS approach and autism treatment in the clinical or community setting with non family members who sometimes change frequently. Where there has been some corroboration of positive outcomes with LOVAAS in IQ, those positive outcomes have not generally included behavior. The best overall outcomes must include family participation and even LOVAAS/ABA has now acknowledged the importance of joint attention. Yesterday I also read an article about the longing that many if not most children in the spectrum have, in spite of inappropriate or ineffectual attempts, for relationships. (Hope that wasn't too long of a segue.)If most children with autism also have attachment issues, is center based or even community based treatment ultimately counter productive for the overall and long term benefit of the child and family? From a mental health perspective you would NEVER prescribe a child with an attachment disorder, especially a young one, with 30, 20, or even 10 hours per week in a center or community setting with strangers and without a family or caregiver present. That would be almost unfathomable. Your thoughts, please?Pete

Hi Pete,I fully agree. Drilling a young child 30-40 hours per week is developmentally inappropriate and can interfere with multiple developmental processes including attachment, affect, initiation, and autonomy. ABA is good for cognitive gains but depends on naturalistic settings for generalization and attainment of true social abilities. The fundamental relationship in ABA type interventions is: 'Do this. Good job' which is a very impoverished form of relationship. The adult leads. Child led interventions promote affect, initiation and autonomy--three very high values for me. Joint attention is just the beginning. I'm afraid we've let the tail wag the dog. By using empirical approaches only without a respect for what we know to be developmentally necessary, we've been able to teach discrete skills at the cost of developmental integrity. You can quote me on this. Hope this helps.Take care,
Rick
Richard Solomon MD
Medical Director
Ann Arbor Center for Developmentaland Behavioral Pediatrics

Added note from Pete: This does not mean that children with Autism have an attachment disorder. Children with Autism generally do development strong attachments: however it is often an irregular and sometimes difficult attachment. The developmental needs of the child as well as the relationship and what is called "joint attention" are central to the needs of the child and family.

Some additional resources for working with children with autism

2009-06-27T07:26:00.000-07:00

These were recommended in a class I recently attended and I am passing on the recommendations to you.

Verbal Behavior Therapy

Social Thinking

Social Stories

Social Stories and Comic Book Conversations

The Grey Center

Relationship Development Intervention with Young Children: Social and Emotional Development Activities for Asperger Syndrome, Autism, PDD and NLD

Relationship Development Intervention with Children, Adolescents and Adults

A Work in Progress: Behavior Management Strategies & A Curriculum for Intensive Behavioral Treatment of Autism

Behavioral Intervention for Young Children With Autism

Meaningful Functional Outcomes and Parental Involvement

2009-05-29T18:26:00.000-07:00

As many know, one of the problems with the SIB-R is how much it lends itself to malingering. Sometimes this malingering comes from coaching by the provider and other times it is just a parent's rationalization due to a feeling of desperation. This desperation comes from a number of sources, sometimes it is out of a hope that something will be better for their child and sometimes it comes from the need to have someone watch their child and their fear that there is no one except someone from an agency who will watch their child. Often times they have given up on the possibility that their young child with a disability might be accepted by a typical day care or that their older child with a disability might be able to be included in typical programs. While there are always going to be some children who will need specialized supports in order to participate in some type of child care or other activities including family based, for the majority of children we work with there is real hope for significant improvement. Unfortunately there are two primary obstacles, with numerous ancillary obstacles.
#1 Meaningful Functional Outcomes.
If we do not start with the end in mind, we will not know where we want to go. If the end is not meaningful to the parent, the parent will not feel vested and involved and will be less willing to participate. If the path or route taken towards the end does not involve the parent, let alone make sense to the parent, then the parent will disengage further. On the other hand, if the outcome is meaningful to the parent and it's practical functionality is obvious to the parent (because it originated from the parent), the parent will be more likely to be invested in the intervention especially when the parent has been taught both the essentiality of their involvement and been assured that they will be given the requisite skills and supports.
#2 Parent involvement. It is no wonder that SIB-R Maladaptive scores often get worse while the child is making progress in the center or even community with the therapist or tech when there is little or no parental involvement in the actual intervention for the child. There are three primary reason for parental involvement in the actual intervention with the child. 1. It provides more and more consistent intervention for the child. 2. It provides better outcomes for the child. and 3. The parents perception of their ability to help the child, handle the child during difficult times, interact and communicate with the child are heightened. This last issue has become so important in the research that for early intervention there has even been developed The Early Intervention Parenting Self-Efficacy Scale (EIPSES) which you can find on my page at: http://www.collaboration.me.uk/q.php
When used correctly, the SIB-R Maladaptive score is actually reflective of two things, one is the actual behavior of the child and the other is the parent's perception of that behavior, which includes their perception of their personal self-efficacy in relation to those behaviors.

Of course and as is well known, any research about the efficacy of intervention or even any kind of extended additional hours clearly demonstrates that parental involvement is essential.

Reinforcement

2009-03-17T18:30:00.001-07:00

There are many types of reinforcement. For our purposes here we will talk about natural reinforcers and contrived (or artificial) reinforcers.A natural reinforcer is any reinforcer that would occur out in the natural environment without therapeutic intervention. They are either spontaneous or come after time with delayed gratification. For example, you work you get paid. There is a natural connection between the behavior and the reinforcement. Any child in a healthy environment would likely receive the reinforcement. Generally speaking, when you are nice to people, they are nice to you. Generally speaking, when you say please and thank you, you get a more reinforcing response. You learn to make a PB&;J sandwich and you get to eat it. You appropriately ask an appropriate person for a hug in an appropriate manner and you get a hug. If you are a child and you appropriately ask for a glass of milk in the right place and time from the right person, you get a glass of milk. You put together a model airplane or a car, you get to keep it and feel good about what you have accomplished. As a child, you ask for what you want that is appropriate, in an appropriate way from the right person and at the appropriate time and you get it if possible. You learn to do something for yourself and you develop independence and feel good about that. You play "nice" (I know that has to be defined) and other children want to play with you. You do things that are appropriate and people say thank you and I'm proud of you. (This one is kind of in-between)
Contrived reinforcers are those provided by or arranged by the therapist and in some cases the parent or teacher. "High fives" (plus some additional strange behaviors usually only seen in football players and avid fans) are also in-between. You ask for a hug and get an m&m. You complete a task or step and get a sticker. You are quiet in class and you get a star while other children who are quiet do not get stars.You do something appropriate and get points and eventually get to buy something with those points. The "point" here is that there is an artificial connection created between the behavior and a reinforcement that would not typically occur for a child not in therapy, or an artificial reinforcement that would not typically occur.

Supplimental Information:
Artificial and Natural Reinforcement

Desensitization

2009-03-14T11:21:00.000-07:00

Desensitization is also a fairly simple concept; however it requires the coordination of a number of interventions. As you help someone to desensitize you build self efficacy. You do this by first helping them to relax, this can be through play and doing an activity they both enjoy and for which they already have high self efficacy. Using successive approximations you then gently introduce the concept or activity that you and/or they want to build self efficacy for and be desensitized to. For example, you may help someone to relax with music and relaxation techniques or through play and/or an enjoyable activity, without making a bid deal about it and perhaps even a little in the distance, uncover the picture of a spider. Over time and a few sessions you would hand them a picture of a spider then have a toy spider and eventually have a real (safe) spider in a jar and continue this to the point needed. It would probably never be needed that they actually hold the spider. It is the same thing with almost anything else. If it is fear of flying this would continue until they actually took a short flight with someone they trusted and who would help them to relax. They may carry relaxing music with them or even a relaxing and enjoyable video to watch. This of course is all individualized. If someone does not have a problem with pictures of spiders but is afraid of spiders, you would not need to start by uncovering a picture of a spider. Starting with a toy spider may be more appropriate.

Chaining

2009-03-14T10:41:00.000-07:00

Chaining is a simple concept. You can do both backwards and forwards chaining. It is simply teaching one step at a time. For example if you are teaching someone to use a computer, if you are doing forward chaining you first teach them to turn it on. If you are doing backwards chaining you first teach them to turn it off. If you are teaching someone to get dressed, you may first teach them to put on their underpants (it could be broken down even more basic if needed teaching them to first pick up the underpants in a certain way and then teaching them to put one leg in and then the other and then pulling them up. That is forward chaining. If you were training doing backwards chaining you may put most of the top on and put their head through and one arm through and teach them to put the other arm through on their own. The next step would be to teach them to put both arms through on their own. With either forwards or backwards chaining you continue to redo the steps already learned.

Quality Treatment for Children

2009-02-06T12:33:00.000-08:00

An evaluation treatment matrix for parents of children with developmental disabilities, mental health and/or behavioral issues.

How do you tell what is good quality therapy for a child with a disability, mental illness, and/or behavior problems? This system is not perfect; however, it is based on extensive research and can be used as a GUIDE for evaluating treatment options as well as evaluating the quality of treatment being provided.

The program will be strength based. While this does not mean that the program ignores deficits or problems, the primary focus will be strengths. Safety should always come first; however, is the long term and clear emphasis on increasing appropriate behavior?
Providing a best practice, research documented and peer verified approach that matches the disability, disorder, issue, and individual situation for your child i.e. PLAY, Lovaas, ABA. Does the provider provide a well researched, developmentally appropriate, and best practice intervention that is known to provide best outcomes for a child of (age of your child) and (disability, condition, or diagnosis of your child)? They should be able to tell you exactly what intervention they are providing and provide you with the research to back it up. If they can not, they should have a very good explanation of why they can not.
When therapy is integrated into yours and the child's typical routines, more really is better. Are you an integral part of the therapy, are you being taught things that you can do to support therapy and is there follow-up to see how well you are doing and what you might do differently to adjust for better results for your child? Are you listened to as a partner and an expert on your child? Does therapy support and promote inclusion in typical healthy productive routines that your child's peers are involved with i.e. 4-H, scouting, school activities, church activities etc.?
I.E. Speech, Physical Therapy, Occupational Therapy, or other type of specialist. Is there a global approach to your child? This does not mean that the other therapists have to be providing direct therapy. Sometimes this can be only for consultation and evaluation. This is not essential for every child but the need should be explored through the Functional Analysis or Behavior. Is this occurring or has it been thoroughly explored?

Is there both communication and an integration or support of services being provided by other professionals. Does the therapist working with your child, collaborate with and integrate suggestions provided by other therapists?

Evidence that the child is making significant progress with the existing therapies. (May include maintenance for certain degenerative syndromes.) Can you easily recognize significant achievements made by your child, that were written as specific goals or objectives on your child's plan.

Quality and appropriate (including developmentally) Measurable Behavioral Objectives. Does your child's plan contain objectives that are so clear and concise that you know exactly what your child is to do and when your child is to do it? Do you also clearly understand when your child will have achieved this objective?

Quality and appropriate (including developmentally) Functional Outcomes.
Are the outcomes and goals on your child's plan something that s/he will be able to use as a part of his or her normal routine? Is this a skill that you would teach a typically developing child? Is s/he learning something that s/he could possibly use if s/he were living on his or her own?

For some interventions and disabilities this would include the first three years of life; however if Best Practice is provided can extend through age 8 or 9. (This does not mean that treatment is not important for older children, it is. It does mean that early intervention is crucial if at all possible. This is partially because of what we know about brain development.
Some other crucial times can be times of transition, including between schools, moving, family transitions, puberty etc.
Is therapy being provided at a crucial time period and if not, does the therapist acknowledge and understand the importance of these periods and is s/he prepared with a transition plan for these periods?

Medication is not needed for most children. If it is being used, has it been prescribed by an expert. A children’s psychiatrist is recommenced if at all possible. If there is medication is there close collaboration between the therapist and the physician?

Existence of a functional behavioral analysis. (Also called a functional analysis of behavior.) (Must include, environment, setting events, sleep, diet, medical, communication etc.) Was a functional analysis of behavior conducted, especially for a child three years or older?

Does your child have a positive caring relationship with the therapist or do you believe that they will be able to develop one. (Knowing that the therapist personally cares about the individual is important for any therapy.)

View additional information by clicking here.

Transition plans

2009-01-09T18:37:00.000-08:00

There are all kinds of transition plans. So many that it would be impossible to talk about all of them. If you have a question, please ask and we’ll talk about it. A transition can be from one place to another, from one activity to another, from one program to another and from one life stage to another. They sometimes cover; gathering information, looking at options, and a list of who will do what when. For a transition from one activity to another or from one place to another, it would depend on how difficult the transition may be for the individual. This may include a regular predictable schedule, cues to indicate that the transition is coming up (music can be helpful for this as noted in: http://www.collaboration.me.uk/Stress_Reduction.php see letter m., or charts can also be used), a very specific and safe process for the transition and something to relax into the transition. For some individuals, environmental structure can both be very important and helpful. It just depends on the needs of the individual.

Functional Outcomes

2008-12-17T18:02:00.000-08:00

In context of any type of therapy, functional outcomes must be Measurable, Behavioral, Observable and Repeatable. For the purpose of our discussion I’ll define functional as: being able to complete a personally practical, purposeful task or behavior.

Just writing a good measurable behavioral objective is a difficult task for many therapists; however, good measurable behavioral objectives should never be your final goal. Outcomes should be functional, while it may take numerous steps to reach that goal, it should be the end you have in mind and even incrementally you should get there as soon as possible.

A very simple example of a functional outcome would be: "When Joey comes home from school he will make him self a peanut butter and jelly sandwich". This would be an example where Joey has basically mastered this skill and has a need for a snack on arrival home from school. Something better for an emerging skill would be: "When Joey arrives home from school, after removing his coat and back pack and within 10 minutes of entering the house, he will go to the kitchen and remove the bread from the bread basket, 4 out of 5 times for 5 consequtive weeks".

When you think about functional objectives, ask the question, what would a person, or a child in this family, typically do if there wasn’t a disability involved?

For example, a child who lives on a farm may typically have chores out on the farm. Perhaps for an older child this may mean something as simple as some kind of assistive accommodation. Some people might think, well this kid just doesn’t need to be going out around the animals, but today, there is a strong belief (and frankly for many, they have had this strong belief for a very long time) that kids and people in general need to be able to participate in life as fully as possible. This is really what functional outcomes are all about, not just on the farm but in the home and school and wherever a typical child might be found. For the same child on the farm at a younger age, perhaps the outcome would have the child in a little wagon, scooping food from a bucket into the feeder. This sort of outcome provides all kinds of therapeutic opportunities, communicating with mom or dad or an older sibling who are pulling the wagon, working on both fine and possibly gross motor therapeutic needs, building self-efficacy (see letter e.) and subsequently self-esteem and being a part of regular life.
Two things you need to remember about a functional objective. It will almost always be in the natural environment for the child, or adult, and it still must be measurable and behavioral.

For additional information on Natural Learning Environment Practices click here.

Functional Behavioral Assessments or What’s causing the short?

2008-12-01T18:05:00.000-08:00

Many years ago, early in my marriage, my wife and I owned a Ford Escort. It was a good car for our very young family. After about a year, we started having electrical problems. We took it back to the shop over and over again. A number of different things were replaced but the problem kept recurring. One day, someone discovered that we kept a spare key in the ash tray. That key was causing the short. As soon as we stopped keeping the spare key in the ash tray, the problem stopped, no more shorts.
Sometimes behavior problems are really that simple, sometimes they are not; however, diagnostics, until you find the problem, are essential. The more experienced I become, the more I believe that good upfront and ongoing assessments, to include functional behavioral assessments are absolutely essential. It is better to spend the time and resources finding the problem and the right solution than to skip this step and spend thousands and tens of thousands of dollars address the wrong problem or using the wrong solution (which of course, is usually not a solution at all). (A Functional Behavioral Assessment is also called a Functional Analysis of Behavior.)

Additional Resources:
Functional Behavior Assessment (FBA) and Behavior Intervention Plans (BIP)
Functional Behavioral Assessment Generator
Example of a Functional Analysis Assessment Report
FUNCTIONAL ANALYSIS OF PROBLEM BEHAVIOR: A REVIEW
Teaching Children with Autism: Functional Behavior Analysis
Free tools for Functional Behavioral Assessments, as well as other therapy tools.
Functional Behavioral Assessment
multimodal functional behavioral assessment
Functional Behavioral Assessment
An IEP Team's Introduction To Functional Behavioral Assessment And Behavior Intervention Plans (2nd edition)
Functional Behavioral Assessments: What, Why, When, Where, and Who?
Functional Behavioral Assessment

What are some of the often overlooked independent variables? (sometimes referred to as Setting Events)

2008-10-21T11:47:00.000-07:00

Medications
Medical or physical problems
Sleep cycles
Eating routines and diet
Daily schedule
Staffing patterns
Density of people (too many people present)
Stimulation (is the environment overly stimulating, this can change over time where initially it is not overly stimulating but becomes so as the person reaches and goes beyond capacity).

What are intervening variables ie motivation, fatigue, hunger, intelligence, expectations?

Additional resources and links:
Dependent and independent variables
http://msxml.excite.com/excite/ws/results/Web/independent%20variables/1/417/TopNavigation/Relevance/iq=true/zoom=off/_iceUrlFlag=7?_IceUrl=true

Intervening variable
http://en.wikipedia.org/wiki/Intervening_variable

Variable
http://en.wikipedia.org/wiki/Variable

Supplemental Material:
Setting Events
Setting Events Checklist

Manipulating (and understanding) Variables: Getting an idea of what might and what might not work.

2008-10-18T17:43:00.001-07:00

Sometimes you have to poke around a little, turn over a few rocks. You have to test some hypothesis. Sometimes this may be a part of the functional behavioral analysis; sometimes it may be part of the ongoing assessment you are (or at least should always be) conducting. Taking everything at face value is usually not good enough. Is a hug always reinforcing? Just with certain people? Are there times when it is more reinforcing than another? Is it possible to reach the point of satiation?
Sometimes this is called in-situational hypothesis testing. Sometimes simply: hypothesis testing by manipulating the independent variables.
I remember many years ago as a mental health counselor working with a family of children who had been severely and ritualistically sexually abused. One of the older children who had become very sexualized was also working one on one with a tall gorgeous blond therapist in her late 20’s. The therapist once commented to me that every time the boy would get out of control, have bursts or anger, or become non-compliant she would hold him tightly (he was about 10) and he would almost immediately calm down. Upon hearing this I immediately thought of many variables including some possibly unintended consequences and reinforcing that might be going on. The important point though is that I did not know for sure. This was an opportunity to test a lot of different variables before adhering to a specific plan of intervention for any extended period of time.
Testing variables can be quite tricky. If you manipulate more than one variable at a time, how do you know which variable is influencing any change that may occur? Is it possible that the change is caused by a compounding of the two variables?
In the case mentioned above, there are a number of ways we could test some of the variables. First, collect detailed data about when and where behaviors occur and with whom. If there is an increase in certain behaviors in the presence of the therapist, then there is a possibility that the holding by the therapist is reinforcing and actually having the effect of increasing the behavior. Note, while this is a possibility, we still don’t know for sure. What are some of the other variables that could influence this behavior at this time? Sometimes children will display aggressive behaviors in the presence of the therapist or another outside authority figure because it’s safe. They understand at some level that while they may have a consequence, they are not going to get knocked around…at least at that time. It becomes a safe place to blow up. Sometimes victims of domestic violence display violent behavior against their perpetrator when the police show up. This can take place because they have so much emotion and anger built up that when the police show up, they realize there is safety and they explode. They may then get hauled away and charged, but in the immediate situation that too may be the lesser of two evils. The bottom line here is that you still don’t know the cause of the behavior.
Even after you develop a good working hypothesis; it is always a “working hypothesis.” This is why you continually take data and periodically adjust your plan as needed. So what else can we do to further assess the behavior (manipulate the variables)? Here are a few possibilities:
1. Teach the child that it’s ok to ask for a hug and that he can get one when he appropriately requests one. (Stop using holding as a consequence.)
2. Change to a male therapist.
3. Keep the same therapist but use a different consequence.
4. Teach and help the child to implement more appropriate ways to release frustrations and/or get his needs and appropriate wants met.

These are just a few possibilities.

Before you write a plan, it is critical to review existing data, gather data and try out your hypotheses to the extent possible. Once the plan is written, take the time to manipulate one variable at a time and find out what happens if???? Allow an appropriate amount of time to find out if a manipulated variable is actually helping or making the situation worse.

Additional resources:

Functional Assessment and Program Development for Problem Behavior: A Practical Handbook O'Neill, Horner et al &
Functional Behavioral Assessment, Diagnosis, and Treatment: A Complete System for Education and Mental Health Settings Cipani & Schock

Click here for additonal information on writing measurable behavioral objectives

When teaching calming or de-escalation skills.

2008-09-12T08:18:00.000-07:00

When teaching calming activities and de-escalation skills, it is important to include a program to teach those skills when the child/individual is already relatively calm. Some activities to focus on are aerobic activities (within the safety range that the child/individual's physician will approve), such as walking, and big bubble blowing activities (I say big bubbles because big bubbles require slow deep breathing), deep breathing, and sometimes just taking a safe break away from things/people. When these things are taught as a part of the overall program it makes it easier to access these skills in an emerging crisis situation if needed.

Click here for additional information on writing measurable behavioral objectives

Getting what they want

2008-09-05T11:33:00.000-07:00

One of the simplest but often overlooked concepts is helping an individual in therapy get what they want. Therapists have actually taught kids how to request a hug and then given them a “high five” or a “thumbs up” or another reinforcement other than a hug. Sometimes therapists try to teach a frustrated client who wants/needs something, how to identify their feelings or deescalate without actually dealing with what they want/need.
Your priorities should be, (after safety, because safety is always first):
1. Help clients identify what they want.
2. Help clients request what they want in a socially appropriate manner.
Once this is done, there are three options.
1. They get what they want. No need for further reinforcement.
2. They get what they want at a more appropriate time/place. In this case it may be helpful to teach de-escalation/coping techniques and/or feeling identification (may need some reinforcement). The appropriate time and place must be made clear as well as what they need to do (if anything further needs to be done) in order to get what they want. When the person finally gets what they want, there is no further need for reinforcement.
3. They do not and can not get what they want. In this case, there are two things to consider and do. Teach coping techniques (may need reinforcement) and discover underlying needs/wants and teach alternative ways to get underlying needs/wants met (no need for further reinforcement when they get their underlying needs/wants met).

Click here for more information on writing measurable behavioral objectives

When you have to decrease a behavior for safety reasons.

2008-06-20T12:40:00.000-07:00

I believe and overwhelming research confirms that it is better to focus on increasing a behavior than decreasing one; but sometimes, there are behaviors that can not be totally ignored and must be addressed for safety reasons. (Please see What is an Asset? http://communitycollaboration.blogspot.com/2007/11/what-is-asset.html for additional information on assets vs deficits.) Sometimes you may want to do this, not because it is a particular focus, but because you want to gather valid and reliable data regarding the behavior.
Remember:
Conduct a functional assessment (see functional assessment under Writing a Plan for Problem Behaviors http://bestoutcomes.blogspot.com/2008/05/writing-plan-for-problem-behaviors.html ) to determine, as much as possible, and continually adjusting with additional information, what the functional purpose is of the problem behavior. Sometimes, a problem behavior becomes the most efficient way for a person to get their needs met.

Write a program/plan to provide an alternative and more appropriate way to achieve the same and underlying appropriate outcomes. If you look deep enough, there will be a basic and underlying reason for the behavior that can be fulfilled through another behavior.
Spend as much time as possible working on increasing positive behaviors. Ideally you should spend at least three times as much of the program time on increasing behaviors as on decreasing behaviors.

Click here for more information on writing measurable behavioral objectives

Additional Resources for Measurable Behavioral Objective writing

2008-06-16T16:34:00.000-07:00

Benjamin Bloom's Taxonomy of Behavioral Objectives
Applying Bloom's Taxonomy
Learning Domains or Bloom's Taxonomy
Rubric: Guidelines for Evaluating Behavioral Objectives

Click here for more information on writing measurable behavioral objectives

CLASSIFICATION OF INTERVENTIONS FOR YOUNG CHILDREN WITH AUTISM SPECTRUM DISORDER *

2008-06-11T11:59:00.000-07:00

Excerpts from:
AUTISM SPECTRUM DISORDER WORKGROUP
CLASSIFICATION OF INTERVENTIONS FOR YOUNG CHILDREN WITH AUTISM SPECTRUM DISORDER *
January 2007
Provided by Dr. Richard Solomon (P.L.A.Y. Project)

Early Intensive Behavioral Intervention (EIBI)
Comprehensive behavioral programming that aims to improve socially important behavior by using interventions that are based upon principles of learning theory (i.e., Applied Behavior Analysis) and that have been evaluated in experiments using reliable and objective measurement. EIBI methods are intended to increase behaviors (e.g. on-task behaviors, social interactions) teach new skills (e.g., life skills, communication skills, or social skills), maintain existing behaviors, generalize or transfer behavior across situations or responses, and to restrict or narrow conditions under which interfering behaviors occur and reduce interfering behaviors. (e.g., self injury or stereotypy). Individual curricula and teaching approaches may vary but commonly used approaches include the UCLA model (Discrete Trial Training, Applied Behavior Analysis) and Applied Verbal Behavior (VB).

http://www.behavior.org/autism/index.cfm?page=http%3A//
http://www.cofeat.org/data/201/documents/ParentsPacket2005January.pdf

Learning experiences: An Alternative Program for Preschoolers and Parents (LEAP)
LEAP was originally established as a federal demonstration program in 1982 at the University of Colorado School of Education. LEAP includes a Preschool component and a behavioral skill-training program for parents. The Preschool curriculum provides opportunities for learning related to social, emotional, language, adaptive behavior, cognitive, and physical development. The preschool setting includes typically developing children and peers with autism. This program has been shown to be effective for students with and without disabilities. The research suggests that this program produces improvements in social and language skills.

Pivotal Response Training (PRT)
PRT is a behavioral treatment intervention based on the principles of applied behavior analysis (ABA). Researchers have identified two pivotal behaviors that affect a wide range of behaviors in children with autism: motivation and responsivity to multiple cues. These behaviors are central to a wide area of functioning, so positive changes in these behaviors should have widespread effects on other behaviors. Thus PRT is able to increase the generalization of new skills while increasing the motivation of children to perform. PRT works to increase attempts and interspersing maintenance tasks. PRT has been used to target language skills, play skills and social behaviors in children with autism.
http://psy.ucsd.edu/autism/prttraining.html
http://www.dbpeds.org/articles/index.cfm

Positive Behavior Supports (PBS)
Positive behavior support (PBS) is the application of behavior analysis in the assessment and reengineering of environments so people with challenging behaviors: Experience reductions in their problem behaviors; learn how to replace inappropriate behaviors with acceptable appropriate behaviors; and increase social, personal, and professional qualities in their lives.

PBS emphasizes the development and implementation of individually tailored support plans that focus on proactive and educative approaches.

The PBS process involves engineering the environment to prevent problems from occurring; teaching individually acceptable alternative behaviors to replace problem behaviors; and consistently providing for positive consequences that encourage appropriate behavior outcomes over time.

Pyramid Approach: includes using Picture Exchange Communication System (PECS)
One of the methods used under an ABA approach, PECS uses pictures and other symbols to develop a functional communication system. PECS teaches students to exchange a picture of a desired item for the actual items (e.g., requisting). The application of ABA methods to teach PECS is an appropriate intervention for children with ASD who have limited or no communication skills. To increase the utility of this intervention, an important area for future research is to investigate PECS procedures for promoting initiation of communication and acquisition of complex, flexible language.

http://www.pecs.com/

Hanen Program/More Than Words
Integrates more traditional behavioral approaches with developmental, social-pragmatic approaches into a single program.
Does not replace the need for an intensive intervention program, rather it provides parents with practical tools for facilitating social and communication skills in their young child with ASD; parent training is considered an effective practice for early intervention.
Parents are extensively involved in their child’s intervention program, which can be more appropriate and effective, and less expensive than direct speech/language therapy for very young children.

Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH)
The foundation of this structured teaching intervention is the modification of the environment to assist the child in the learning process. The focus of this intervention is on organizing the child’s physical environment to facilitate overall task success, capitalizing on visual strengths typically displayed by students with ASD and minimizing reliance on auditory processing/verbal expression. Visual schedules are used to describe sequence of activities, work systems are used to teach students to work independently and task organization provides information regarding how to perform task.

http://www.teacch.com/

Denver Model
Denver Model is a developmentally oriented approach for preschool age children. Focus of intervention is on intensive teaching and developing social-communicative skills. Provided in home setting, inclusive preschool programs & in one-to-one direct instruction. The skills to be targeted are determined by the family in collaboration with the intervention team.

Developmental, Individual difference, Relationship based (DIR) Including Floortime, Play Project & Responsive Teaching
Social Pragmatic Interventions (SPI). Focus on reciprocal, contingent interactions. Play-based, child led and structured by developmental level of child.
Well-structured parent training approaches. Manual includes extensive training materials.

P.L.A.Y. Project
http://www.playproject.org/

ECO/Communication Partners
Emphasizes importance of parent education and involvement – parent child interactions are viewed as the primary opportunity for teaching young children to talk.
Aims to prevent speech and language delays by treating infants and preverbal children to ensure healthy development of socialization and communication.
Focuses on social-pragmatic language skills rather than simply building the size of the child’s vocabulary.
Targets children who are considered to be at high risk for speech and language problems.

http://jamesdmacdonald.org/Articles/MacDonaldStart.html

Gentle Teaching
Gentle Teaching is a philosophical approach that addresses how caregivers interact with individuals with disabilities. This approach can be used with persons of all ages and with various disabilities. The focus of Gentle Teaching is to create a bond between the person with a disability and their caregiver as a means to promote positive changes. This method is opposed to the use of punishment and physical restraint.

http://www.gentleteaching.nl/

Music Therapy
Refers to the application of music with the intent to enhance functioning. It consists of using music therapeutically to address behavioral, social, psychological, communicative, physical, sensory-motor, and/or cognitive functioning. The music therapist involves clients in sensing, listening, moving, playing instruments, and creative activities in a systematic, prescribed manner to influence change in targeted responses or behaviors and help clients meet individual goals and objectives. Musical activities may also be highly preferred for an individual with autism (e.g., listening to music, dancing, playing an instrument). Access to such activities may be used as a reward; this is different from music therapy, in which the musical activities themselves are viewed as therapeutic.

http://www.musictherapy.org/
http://www.autism.org/music.html

Prompt
Seeks to understand sensory-motor systems and how these systems function in typical and delayed/disordered child development.
PROMPT therapists do not use oral-motor exercises, speech drills, or traditional speech development hierarchy.
PROMPT therapists do utilize tactile-kinesthetic information to improve motor control, and facilitate the development of functional cognitive, social, and communication skills.
PROMPT provides treatment individualized to each person’s specific needs.

http://www.promptinstitute.com/

Relationship Development Intervention
Relationship Development Intervention is an ongoing program of clinical development and research begun in 1996. The primary goal of RDI is to remediate the recognized core deficits of ASD. RDI provides individuals with ASD the cognitive, emotional, communicative and social tools that are geared towards remediation rather than compensation. Recognized deficits of individuals with ASD include emotional referencing, social co-regulation, experienced based communication, autobiographical or episodic memory, executive functioning and dynamic thinking. RDI is a family centered treatment program that prepares parents to act as ‘participant guides’, creating daily opportunities to remediate the developmental deficits of ASD. The provider undergoes an eighteen month internship in the program in order to become certified.

http://www.rdiconnect.com/

Sensory Integration (SI) Therapy
SI refers to how an individual’s nervous system, including the five senses of pain, vision, taste, smell and hearing, receives and organizes input from the body and the environment. SI therapy was developed based on the belief that some individuals with disabilities experience dysfunction in their nervous systems capacity to organize sensory input and, as a result, their responses to sensory input are non-adaptive. SI therapy seeks to restructure the way the nervous system responds to input so the child can better make sense of the world around them and, consequently, increase their adaptive responses. SI therapy programs are highly individualized. However, generally the therapy is focused on correcting deficits in the proprioceptive (muscles and joints), vestibular (gravity) or tactile (touch) sensory systems. Activities used to address these deficits include the use of weighted vests or blankets, swings, jumping on trampolines and deep brushing.

http://www.autism.org/temple/visual.html

Social Communication Emotional Regulation Transactional Supports (SCERTS)
Early identification and intervention that targets children who are developmentally from 8 months to 10 years of age. Multidisciplinary team collaboration, ongoing staff training, professional development, and administrative support. Adherence to all components of the SCERTS model with a sequential, logical procession from assessment to educational programming and less complex to more complex goals. Child-and family-centered approach with emphasis on family involvement and support. Transactional Supports should be implemented in a variety of settings (home, school, and community) to address Social Communication and Emotional Regulation objectives and promote generalization of learning within natural contexts. Promotes learning opportunities in inclusive settings. Promotes learning opportunities in inclusive setting. Supports low child to adult ration (2:1 for many or most children with ASD).

http://www.scerts.com/

Facilitated Communication
Facilitated Communication (FC) is an augmentative communication method that uses a facilitator as a physical support to aide the child in communication through pointing, writing or typing. The facilitator helps the child to isolate the index finger and to stabilize the hand, wrist, forearm or arm during typing. The facilitator also helps the child maintain focus on the process by encouraging the child to remain on task and redirecting the child back to task.

IEP Goals for P.L.A.Y. for children with Autism

2008-06-11T11:57:00.000-07:00

Provided by Dr. Richard Solomon (Note: these are Goals, not measurable behavioral objectives)
ATTENTION AND BASIC SOCIAL RELATEDNESS
• Child will respond to the overtures of familiar/preferred adults with smile, frown, reach, vocalization or other intentional behavior.
• Child will respond to the overtures of familiar/preferred adults with obvious pleasure.
• Child will demonstrate affection towards others.
• Child will seek comfort when hurt.
• Child will stay engaged with familiar adult for increasing lengths of time.
• Child will become displeased when preferred adult is unresponsive during play for 30 seconds or more.
• Child will spontaneously seek the company of his/her family members when family is not attempting to engage him/her.
• Episodes of aimless behavior will decrease. .
• Child will stay focused on shared conversation with caregivers, instead of lapsing into private reference.
• When engaged with a family member/trusted adult, frequency of subvocalizations will diminish.
• Child will acknowledge the comings and goings of familiar people.
• Child will demonstrate awareness of others by seeking proximity.
• Child will demonstrate awareness of others by showing some simple imitation.
• Child will call family members by name.
• Child will call family members and other familiar people by name. -
• Child will focus attention on a directed activity for _______ minutes.
• Child will respond to first requests.
• Child will predictably attend to speech, normal in tone and volume.
IMITATION
• Child will imitate with object after demonstration of use of object.
• Child will simultaneously imitate with objects.
• Child will imitate hand movements.
• Child will imitate body movements.
• Child will imitate mouth movements. . ^
• Child will imitate sounds.
• Child will imitate words. .
AFFECT
• Child will look up to caregiver using smile as a way of securing adult attention.
• Child will show positive emotional expressions in response to praise.
• Child will independently solicit praise upon the completion of a task.
• Child will label feeling states (begin with happy, sad, angry/mad, scared) in self..
• Child will identify emotions in family members/familiar adults/peers.
• Child will respond appropriately to emotions in family members/familiar adults/peers.

· Child will offer comfort to others in distress.
· Child will accurately identify the feelings she/he has in a variety of settings and will
be able to explain the relationship of events to her/his feelings.
• Child will match spoken expressions of sadness, happiness, anger and surprise with facial expressions of the same emotions.
• Child will tolerate negative emotions in literature and play.
• Child will use pretend play scenarios to explore negative affect and practice appropriate responses.
• Child will be tolerant of own mistakes and performances that were not perfect.
• To express precision and subtlety in the expression of emotion, child will use qualifiers to describe gradation of emotional experience (e.g. really disappointed, a little disappointed).
SELF-REGULATION
• Child will recover from distress within minutes with help from familiaradult. . .
• Child will tolerate the proximity of other children.
• Child will communicate through language when upset, rather than tantrum.
• Child will learn different strategies for self-calming during times of frustration, anxiety, anger or disappointment.
• Child will use appropriate strategies for controlling his/her body when excited, anxious or angry.
• Child will maintain a polite and/or tactful style of communication when letting others know that something is bothering them.
• Child will productively reflect upon the advantages and disadvantage of own behavior.
PLAY ,
• Child will look at familiar adults when they attempt to engage the child in play.
• Child will joyfully participate in sensory-motor play with a familiar adult.
• Child will participate in songs, finger-plays and rhymes with familiar adults.
• Child will engage in parallel play.
• Child will engage in simple motor games with rules.
• Child will participate in turn taking activities.
• Child will appropriately look at books with caregivers.
• Child will expand his/her play repertoire to include manipulation, sensory-motor, art experiences, music experiences, building/construction, and early cognitive (sorting, matching, puzzles).
• Child participates in physical games with rules (e.g. duck, duck, goose).
• Child participates in non-physical games with rules (e.g. board games) (5-6 yrs).

Play with toys:
• Child will look at face of person activating toy or game.
• Child will imitate toy action.
• Child will engage in functional action with a toy with adult participation.
• Child will independently engage in functional action with a toy.
Pretend Plav:
• Child will develop interest in the content of pretend play as opposed to the simple mechanics (i.e. interest will move from how the bottle fits in baby's mouth to helping hungrybaby).
• Child will participate in pretend play involving concrete and familiar themes such as self-care, daily activities, cars and animals with adult/peers.
• Child will develop nurturing play with baby dolls.
• Child will arrange doll furniture into meaningful groups and uses doll figures to act out simple themes from own experience (2-2 ¥2 yrs).
• Child will participate in increasingly elaborate make-believe, moving from early concrete (episodes of eating/feeding, driving cars with noise, putting farm animals in barn) to more complex concrete (simple familiar stories) with adult/peers.
• Child will participate in more elaborate play themes, moving from concrete themes (involving everyday, common experience) to abstract themes (involving everyday, common experience) to abstract themes (involving material never directly experienced) with adult/peers. . • Child will assume the role of another person (dress-up) (3 J/2 - 4 yrs).
• Child will engage in role-playing using figures and puppets (4 — 4 */z yrs).
Drawing:
• Child will scribble with crayon (1 -1 ½ yrs). ' .
• Child will imitate drawing of vertical line (2-2 J/2 yrs).
• Child will imitate drawing of circle (2 ¥2 - 3 yrs).
• Child will add 3 parts to incomplete human drawing (5 ¥2 - 4 yrs).
• Child will copy drawing of-square (4 - 4 '/2 yrs).
• Child will draw unmistakable human with body, arms, legs, feet, nose, eyes and mouth (4 ¥2 - 5 yrs).
COMMUNICATION
Receptive (understanding language):
• Child will respond to his/her name.
• Child will look for family members when asked "Where is Mommy?" or "Where is Daddy?"
• Child will stop action in response to "No!"
• Child will appropriately respond to the command, "Stop!" • •
• Child will move body in response to a one-step direction.
Child will get familiar object or food that is requested.
Child will take object or food to someone when requested.
Child will follow two-step directions involving two different actions.
• Child will indicate approval when asked a "Do you want" question.
• Child will appropriately respond to simple and familiar WHERE questions with searching movements.
• Child points to eyes, nose and mouth in self and others upon request.
• Child identifies all large body parts upon request (2 - 2 !/2 yrs).
• Child will point to pictures in a book or familiar objects as they are named.
• Child will follow a series of 2-3 simple related commands with the same object.
• Child will identify smaller body parts upon request (i.e. chin, knee, elbow, fingers, toes).
• Child will follow a series of three unrelated commands.
• Child will comply with strategically posted STOP signs.
Eye Gaze:
• Child will look at person when given something.
• Child will look at person when giving them something.
• Child will follow someone's point when object is in close proximity and can be touched.
• Child will point to desired object when object can be touched/over distance.
• Child will follow someone's point when object is distant.
• Child points to direct someone to look at object or event to share enjoyment while looking back and forth to make sure adult sees what child sees.
• Child will look towards adult to make sense of an ambiguous situation (social referencing).
• Child will reference adult expression to guide own behavior.
• Child will look at person who is speaking to communicate interest/attention.
• Child will look at person to whom he/she is speaking to make sure person is listening/attending.
Expressive communication (body language and affect):
• Child will respond to gestures with intentional gestures of his/her own (e.g. reaches out in response to outstretched arms).
• Child will initiate interactions (e.g. reaches for toy).
• Child will look when name is called. .
• Child will wave goodbye.
• Child will express desire for food using gestures and body language.
• Child will express desire for activity using gestures and body language.
• Child will express wishes, intentions and feelings using multiple gestures in a row.
• Child will indicate disapproval using gestures and body language.
• Child will choose from two options using gestures and body language.
• Child will find appropriate and effective ways to get attention.
• Child will participate in 4 reciprocal social interactions.
• Child will participate in 8 reciprocal social interactions.
• Child will participate in 12 reciprocal social interactions.
Expressive communication fthe use of symbols for communication'):
• Child will learn fill-in-the-blanks of familiar songs, rhymes and or familiar verbal routines (e.g. ready, set, go).
• Child will use word/sign/picture for "more".
• Child will make choice using real objects. .
• Child will use word/sign/picture for mommy and daddy.
• Child will express desire for food using PECS/signs/words.
• Child will express desire for activity using PECS/signs/words.
• Child will express desire for toy/object using PECS/signs/words.
• Child will develop consistent vocabulary of _____ symbols used in the absence of concrete gestures (for example, child will come into the dining room and say "apple" to mother to request apple juice without needing to take mother to refrigerator and touch the apple juice bottle).
• Child will indicate disapproval using PECS/signs/words.
• Child will choose from two options using PECS/signs/words.
• Child will indicate that he is done with an activity by saying or signing, "All done".
• Child will respond to question, "What's this?"
• Child will ask question, "What's this?"
• Child will spontaneously add words to play, narrating play actions.
• Child will use two-word combinations (18-36 month skill).
• Child will use "MY" to indicate ownership (18-24 month skill).
• Child will refer to self by name.
• Child will ask questions by raising pitch at end of word or phrase.
• Child will ask for help (2-3 year skill).
• Child will say first and last name when asked. . '
• Child will use pronouns I, ME, MINE and YOU.
• Child will talk about an event that has just happened. . -> Child will respond to WHAT and WHO questions.> Child will respond to WHERE and WHEN questions.> Child will respond to WHY questions.
• Child will spontaneously ask WH questions (3-4 year skill). > Child will use language in imaginative play to narrate actions.
• Child will use prepositions IN, ON and UNDER. .Child will describe objects according to size, color and shape (4-5 yrs).Child will use pronouns HE, SHE, THEY, HIS, HER, OUR and THEIR.Child will use the following deictic terms: HERE, THERE, THIS, THAT.Child will ask meaning of new words.Child will retell a brief story (5+ year skill). • •
• Child will tell home address.
• Child will talk about the future using "will".
• Child will use pronounds "himself and "herself.
• Child will compare objects using "-er" and "-est" endings.
Conversational Skills/Pragmatics: •
• Child will use attention-getting words such as "Hey!" (2-3 years)
• Child will use appropriate volume with conversational partner.
• Child will use meaningful inflection with conversational partner.
• Child will use appropriate distance between self and conversational partner.
• Child will make appropriate adjustments when initiating conversation in order to gain and keep partner's attention (i.e. raising her voice, adding a gesture):
• Child will attend to peers when they address her/him, responding appropriately.
• Child will say "What?" or "Excuse me, could you say it again?" or a similar phrase when she/he doesn't understand question posed by an adult.
• When others initiate conversation, child will respond in appropriate, multi-wordphrases. • '
• Child will use eye contact to signal turn taking.
• Child will be able to engage in conversation over a broad range of topics.
• Child will add new, relevant information to previous comments in conversation.
• Child will ask questions that are related to topic to maintain conversational flow.
• Child will make transition statements to signify a change in conversational topic.
• Child will put her/his thoughts on pause so adult/peer can add to, or comment on, the conversation.
• Child will initiate conversation that is of interest to social partner.
• Child will change style of interaction when speaking with very young children (3-4
years). » Child will change style of interaction when speaking with peers as opposed to adults.
• Child will use names of adults/siblings/peers when addressing them.
• Child will ask how, why and when questions in order to obtain information.
• Child will provide relevant'information to adult when it is requested.
· Child will provide relevant information to peers/sibling when it is requested. » Child will share experiences through narration (describing connection between settings, characters behavioral and emotional responses, and consequences).
SENSORY ISSUES
Child will eat a greater variety of foods.
The frequency of the startle response will decrease.
Child will gain comfort with activities in which his/her feet are off the ground.
Child will become sensitized to, and appropriately label, hot, cold and pain.
Child will walk around toys, pets and people on floor. .
Child will successfully avoid bumping into people.
• Child will develop compensatory strategies for feeling comfort while in large, open spaces.
• Child will employ appropriate strategies to reduce overwhelming stimuli in new environments.
• Child will become more comfortable with activities designed to decrease tactile defensiveness on hands and face.
• Child will remain socially engaged, as is typical for Child, in the midst of a group of children.
• Child will remain socially engaged, as is typical for Child, in new environments.
RESTRICTED INTERESTS/PERSEVERATIVE BEHAVIORS
• Instances of perseveration (specify types) will be successfully redirected.
• Instances of idiosyncratic motor behaviors will decrease.
• Playing with toys or objects in atypical/repetitive ways will decrease.
• Reciting passages from books, videos, TV and/or radio will decrease.
• Instances of perseveration around rules, when child appears bossy, will decrease.
• Child will tolerate changes in routines.
• Child will demonstrate interest and pleasure in a range of developmentally appropriate play activities. .•
• Child will expand repertoire of social play activities.
CONCEPT DEVELOPMENT
• Child will label self by name.
• Child will use the words "me" and "mine".
• Child will demonstrate understanding of function of familiar objects by selecting correct item or insisting on correct item when 'mistakenly' given wrong item.
• Child will demonstrate knowledge of the spatial concepts IN, ON and UNDER.
• Child will demonstrate understanding of quantity concepts ONE, MORE and ALL.
• Child will demonstrate knowledge of gender by pointing to boy/girl upon request (2Yi-Syrs). . '
• Child will demonstrate an understanding of the spatial concepts FRONT and BACK by moving his/her body or moving objects.
• Child will demonstrate knowledge of FRONT and BACK of clothes (3 ¥2 - 4 yrs).
• Child will demonstrate spatial concepts ABOVE/BELOW and TOP/BOTTOM (4-4 ft yrs).
• Child will demonstrate understanding of same/different.
• Child will demonstrate understanding of first/middle/last.
• Child will develop a better conceptual understanding of causality as demonstrated by appropriately answering WHY questions.
• To demonstrate a growing understanding of time and sequence, child will
spontaneously use time markers in conversation (in the following order: now, later,, soon, before, after, breakfast time, lunch time, dinnertime, morning, afternoon, night,yesterday, today, tomorrow, along time ago, days of the week, months of the year).
• Child will recall recent/familiar events with logical sequence.
• To demonstrate an understanding of locative state and prepositions, child will be able to answer WHERE questions.
• Child will be able to use the word NOT in sentences, such as "Which car is not in theline?" . .
• Child, will be able to group items into the following categories: color, size, shape, function, texture, taste and temperature.
• Child will practice sorting by one attribute.
• Child will practice sorting by more than one attribute at a time.
• Child will accurately answer questions that connect actions to adjectives, such as "What do you do when you are hungry?"
• Child will accurately describe the relationship of both immediate and extended family members using the appropriate labels for relatives.
• Child will draw accurate inferences from auditory information, answering questions such as "What do you think will happen next?" or "How do you think so-and-so might be feeling?"
• Child will demonstrate an understanding of graduated size by stacking and nesting blocks.
• Child will use the prefix "-est" to demonstrate knowledge of relative size.
• Child will demonstrate the ability to guess, speculate, estimate and imagine to come up with an answer or to solve a problem.
SOCIAL AWARENESS/THEORY OF MIND
• Child will acknowledge the comings and goings of familiar people.
• Child will use eye gaze to bring attention to self (as if to say, "Look at me!").
• Child will note what others are doing and shape his/her behaviors accordingly.
• Child will demonstrate an awareness of the needs of others by spontaneously offering help.
• Child will receive a daily compliment for being considerate.
• Child will demonstrate concept that his/her actions have an effect on the way other .people feel.
• Child will demonstrate the ability to teach another person how to do something, figuring out just what that other person needs to know.
Theory of Mind:
• Child will be able to identify what another person is experiencing.
• Child will identify what another person knows.
• Child will predict what others might see or hear in a given situation.
• Child will predict what others might think or feel in a given situation.
• Child will demonstrate the knowledge that other people do not know what child isthinking or feeling. . . •
SOCIAL SKILLS
'i?
• Child will successfully initiate conversation/play with peer.
• When someone does not want to play with Child, she/he will be able to fonnulate a new plan of action.
• Child will appropriately respond to peers when they make social overtures.
• Child will decline an invitation to play or converse using appropriate communication.
• Child will develop tactful responses to describe dislikes and disagreements.
• Child will sustain interaction with peers.
• Child will be able to join others already engaged in a play activity (as opposed to having a peer join them in their activity).
• Child will tolerate and stay engaged in play with peer even when not in charge.
• Child will communicate with peers when ready to change activities.
• Child will demonstrate flexibility and the ability to adapt in social settings by accommodating play suggestions from familiar caregivers or therapists.
• Child will demonstrate flexibility and the ability to adapt in social settings by accommodating play suggestions from peers.
• Child will sustain interaction on a playdate.
• Child will share toys when appropriate with adult/sibling/peer (3 —3 ¥2 yrs).
• Child will successfully negotiate over toys.
• Child will demonstrate appropriate responses to children who are mean or hurtful. \ • Child will learn to talk on the phone in a developmentally appropriate manner. « Child will apologize if and when he/she bumps into someone.
• Child will apologize if and when he/she hurts someone's feelings or body.
-'^ - SOCIAL NORMS
• In an age appropriate manner, child will wait for her/his turn to talk.
• Child will refrain from interrupting parents while on the phone.
• Child will demonstrate an understanding of modesty and/or privacy by being fully clothed when leaving the bathroom in public places.
• Child will refrain from publicly touching private body parts. .
• Child will wipe nose on tissue and throw tissue away.
• Child will demonstrate an understanding of ownership by refraining from takingsomeone else's food or belongings. .
• Child will demonstrate age-appropriate modesty.
• Child will demonstrate age-appropriate tact.
• Child will refrain from asking embarrassing or intrusive question of conversational partner.
SCHOOL/CAMP SKILLS
•» In an age appropriate fashion, child will follow teacher's instructions.
• Child will attend to verbal instructions, using compensatory strategies when
necessary.

Parsimony

2008-06-09T16:38:00.000-07:00

One of the four assumptions of science is that it is parsimonious. Therapeutic plans should also be parsimonious.
The purpose of the information found throughout this site is to help you keep not only the measurable behavioral objective but the entire plan as simple, clear, concise and parsimonious as possible.
In other words and as much as possible, Keep it Simple!

Shaping Compliance

2008-06-02T11:51:00.000-07:00

Therapist often turn in plans that focus on getting a person to be compliant. I must confess that this idea is also not mine but makes perfect sense. Instead of working so hard to get someone to do something that s/he does not want to do, try getting them to do something that they do want to do. After a while, start throwing in something here and there that they may not be as motivated to do, always going back to including things that they do want to do. Over time you can include requests that are increasingly objectionable or difficult, continuing to include reinforcement. Before long they may be much more compliant in all appropriate areas.

Remember:
Almost no one is compliant 100% of the time, (and we worry a little about those who are). [For example, if you are working with a kid with special needs in a classroom and it is almost the end of the day or perhaps even the end of the school year and the rest of the class is off task, why in the world would you be trying to make the kid with special needs stay on task?]
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If you are trying to get a kid to do something, make sure that it is within his or her capabilities. [Sometimes we even see plans trying to get a kid to do something that a typical kid of the same age would be unlikely to do, especially on their own and without help.]
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Make sure you ask a child/kid to do easy and or preferred activities at least some of the time and on a regular basis. Even as adults, most of us don’t want to do something hard or unpleasant all the time. It’s good to learn and to stretch but not all the time. [You don’t ever want to be seen by the child as that person who only wants me to do things that are either extremely difficult or unpleasant all the time.]

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The DEAD MAN (or WOMAN) test

2008-06-02T11:43:00.000-07:00

Recently I attended a training/meeting where the DEAD Man test was mentioned. It’s the same concept as I have written about previously under the heading, “nature abhors a vacuum.” The concept here, though the same as previously discussed, is presented in a very different way and may strike a chord of understanding for some.
This is the idea. If your objective is to begin or increase a behavior that a “dead man or woman” could do, then you probably have a poor or even dead objective.
For example: Any time that your objective is that someone NOT do something, then that is something a dead man could do and is almost always a very poor objective.
There are some exceptions to this rule. There may be a time that you need someone to sit quietly for a brief period. Well a dead man could do that but it still may be appropriate.

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Writing a Plan for Problem Behaviors

2008-05-31T09:33:00.000-07:00

When writing an ABA (Applied Behavioral Analysis) or similar plan, the following worksheet may be helpful. (This is specific for children; however, it would be similar for adults.)
Plan Writing Work Sheet
Complete all that apply. In most cases all will apply.

What is the problem behavior? ________________________

What is the function of the problem behavior? What benefit is the child getting from this? Remember that the same problem behavior may derive different benefit in different settings. ____________________

Measurable Behavioral Objective:

1. Whose behavior is being modified? (name of child) _____________________________________________

2. What behavior do you want to increase or initiate? ______________________________________________

3. What is the cue that will tell the child that it is time to do the behavior? _____________________________

4. How will you know that the objective has been met? _____________________________________________

How will you show (data) that this has been met? _________________________________________________

What is the current baseline for the desired behavior? (Don’t know, is unacceptable. Trials should be run

during the comprehensive, functional assessment or previous therapy) _____________________________________________

What is the reinforcement for the child if the child completes the desired behavior as prescribed? _________________________________

What will be the reaction of the therapist (or parent) if the child does not do the desired behavior within the

prescribed time? ____________________________

What additionally will be done to prevent the problem behavior? _____________________________________

What will be done to minimize aversives in this interaction? _________________________________________

What will be the next steps in this objective? _____________________________________________________

How will this skill (behavior) be generalized? ____________________________________________________

Could any therapist or the parent pick up the plan, carry it out and collect data as required without any additional background or discussion? Yes ____ No ____

Additional resources for a Functional Behavioral Analysis:
http://cecp.air.org/fba/default.asp
http://www.teach-nology.com/currenttrends/functional_behavior/
http://cie.asu.edu/fall98/miller_tansy_hughes/index.html
http://www.cde.state.co.us/cdesped/fbaguidelines.asp
http://specialchildren.about.com/od/fba/g/FBA.htm
Functional Behavioral assessment FAQ

To continue with this information click here: The DEAD MAN (or WOMAN) test

Writing Measurable Behavioral Objectives for P.L.A.Y.

2008-05-02T18:50:00.000-07:00

“The P.L.A.Y. (Play and Language for Autistic Youngsters) Project is a community based/regional autism training and early intervention program dedicated to empowering parents and professionals to implement intensive, developmental interventions for young children with autism in the most effective and efficient way”.
“Created by Richard Solomon MD and based on the DIR® (Developmental, Individualized, Relationship-based) theory of Stanley Greenspan MD”
(Additional information about P.L.A.Y. can be found at: http://www.playproject.org/ )
I am very impressed with P.L.A.Y. and want therapists to understand that it is completely compatible with the components of a good plan as prescribed in this blog. I also want therapists to understand that writing good goals and measurable behavioral objectives is compatible with and supportive of P.L.A.Y.
Ok, now for a measurable behavioral objective:
When therapist (or mom) initiates a preferred activity with Sally and in Sally’s (child) comfort zone, Sally will sign or gesture to the therapist for the activity to be repeated within 5 seconds of completing the first activity at least one time 50% of the time that a preferred activity is initiated over a one month period.
Operational definition of gesture: This can include Sally; taking the hand of the therapist and moving it towards the activity, sally signing “more” or “again,” or moving the activity towards the therapist.
Data clarification: When Sally gestures that she wants the activity repeated just one time, within 5 seconds) after the activity has been initiated, that counts as having been accomplished. The objective is met when she can do this 50% of the time over a one month period.
Response: When Sally indicates, as mentioned above, that she would like the activity to be repeated, the therapist will sign “more” or “again” and say the word and repeat the activity.
Additional note about the objective: It may be counter productive to repeat the same activity over a long period of time (more than 15 minutes). After completing a good assessment of Sally you will have a better idea about preferred activities and when they are most preferred. Start with preferred activities at a time that she is most likely to want to repeat them.
This is only one way that this objective might be written. Notice that it includes:
When; when the therapist initiates a preferred activity with Sally
Who; Sally
What; sign or gesture to the therapist to repeat the activity
How (will we know that it has been achieved); by gesturing to the therapist at least one time after the initiation 50% of the time.

Measurable Behavioral Objectives are the Foundation of a Good Plan

2008-01-31T09:51:00.000-08:00

Measurable Behavioral Objectives are the foundation of a good plan. They do not come first. Assessment/Evaluation or a study come before, goals come before but Measurable Behavioral Objectives are the foundation. Colleges and Universities do a disservice to Social Workers and Therapists if they do not teach this skill. Government, organizations, agencies and even businesses do a disservice to customers, taxpayers, participants and the organization itself if they do not demand Measurable Behavioral Objectives.
When written well, additional instructions are much easier to write in a clear and concise fashion. When written well, data collection is easier to conceptualize and clearly define. When written well, the rest of the plan can be parsimonious. When written poorly, in order to be understood and consistent, more verbiage is required and at times even ongoing and continuous explanations and clarifications are required.
This is a tough skill for some people to acquire. It takes time and effort; however this time and effort pale in comparison to the waist of time and money when there is not a clear and mutual understanding of what you and others are doing and how it will be measured.

Click here to continue with this information: Writing a Plan for Problem Behaviors

Additional resources for the theraputic setting, the home, the classroom, or the boardroom.

2008-01-22T13:32:00.000-08:00

Here are a few additional resources to help you in writing Measurable Behavioral Objectives in a variety of settings. From the therapeutic setting, to the classroom, to the board room.

The Dreaded Behavioral Objective
http://www1.appstate.edu/~mamlinnl/behavior.htm

How to Write Learning Objectives that Meet Demanding Behavioral Criteria
http://www.adprima.com/objectives.htm

Topic 4 : Developing Goals and Objectives Instructor’s Notes
http://www.roundworldmedia.com/cvc/module4/notes4.html

Rubric: Guidelines for Evaluating Behavioral Objectives
http://pixel.fhda.edu/id/Goals/goals_rubric.html

Clinical Resources: Writing Behavioral Objectives
http://home.hvc.rr.com/wmbrooks/Clinical%20Resources.htm

ABC's of Behavioral Objectives--Putting Them to Work for Evaluation http://www.joe.org/joe/2005october/tt3.shtml

Information About Behavioral Objectives and How to Write Them
http://med.fsu.edu/education/FacultyDevelopment/objectives.asp

Writing Behavioral Objectives for the Clinical Presentation Curriculum
http://www.oucom.ohiou.edu/fd/objectivesforcpc.htm

Click here to continue with this information: Measurable Behavioral Objectives are the Foundation of a Good Plan

Crisis Plans

2008-01-22T11:02:00.000-08:00

Crisis Plans

The best crisis plan is the one that you prepare for but never implement. It incorporates all the things already talked about. It focuses on behaviors that you want to increase, rather than the ones that you want to eliminate. Sometimes though, people go into crisis and sometimes they take you with them. When this happens there are a few things to prepare for and keep in mind.
1. Someone else may be better at helping with the de-escalation than you. A team approach is often, though not always, helpful.
2. When someone is going into crisis there is usually a physiological change. In order to help them reduce their own stress levels, they may need another physiological change. Aerobic exercise (to include a fairly brisk walk) may be a helpful component to the plan. (Sometimes a quiet/relaxing break with low stimulation is all that is needed or can be a great follow-up to something more aerobic.)
3. Choices (when possible, I like three) can be very helpful to relieve the stress, de-escalate the crisis and help people to return to a more thoughtful place.
4. After the crisis, when all seems calm, can be a dangerous place particularly if the crisis erupted fully. The calm after the crisis can sometimes turn into depression.

Additional notes:
I have found music to be very helpful when applied correctly and the pace is gradually used to help people to relax. (It’s sort of like driving at 70 mph then turning into a town where the speed limit is 25. Kind of drives you crazy for a while. It can be the same with music. You usually can not relax someone who is super hyper with super relaxed music. You have to start some place in between then move to more and more relaxed music.
For children and some adults blowing REALLY big bubbles can be very helpful. It changes the breathing patterns without the other person knowing what’s going on. Slow, deep breathing is helpful for relaxation. Adding good music can be helpful.
If this is a significant concern for you and in your situation, I recommend four resources:
One is the MANDT system http://www.mandtsystem.com/
Another is an excellent book by Joan Borysenko, Minding the Body Mending the Mind. (Don’t do the neck exercise, research after the book’s publication has questioned the efficacy of this particular exercise)
The third is Crucial Conversations by VitalSmarts http://www.vitalsmarts.com/
Each may have some applications across situations and some that may be more applicable to some situation than others.
The last little resource that I recommend is baroque music (for REALLY relaxed) and my very favorite is Timeless Motion by Daniel Kobialka. He also has some additonal music that may be more appropriate for other situations. http://www.danielkobialka.com/

Click here to continue with this information: Additional resources for the theraputic setting, the home, the classroom, or the boardroom.

Continuous Evaluation and Adjustment

2008-01-15T10:53:00.000-08:00

Continuous evaluation; of a plan, the implementation of the plan, data collection and progress or lack of progress are essential. In depth periodic evaluation is also essential.
Very simply...
You need to ask yourself "What worked?", "What didn't work?" ( or what could have made it better?) and Why? All three questions are essential for best outcomes even when everything seems to be working well or fairly well. It is a disciplined thought process that helps bring about better outcomes for clients/participants and helps to improve you as a therapist/interventionist. This process requires good "Critical Thinking" http://en.wikipedia.org/wiki/Critical_thinking
You need to ask these questions for all aspects of the intervention but especially about:
The environment;
The antecedents and reinforcers;
The plan;
Plan implementation; and
Data collection. Of course you must always take into consideration what is going on internally as well and how that is impacting everything else. IE. illness, reactions to medications, hormones, etc.
When you have gone through this process, adjust for better outcomes.

To continue with this information click here: Crisis Plans

Transition Plans

2008-01-09T08:35:00.000-08:00

Think of a transition plan as a “to do” list.
It still must be measurable, but does not usually need the same strict formula (there are exceptions which shall be explained below).
The plan may need to be adjusted as you move forward. That’s ok, all plans need to be flexible.
The first part of the transition plan consists of specific tasks that need to be done, when they will be done, and who will do them.
For a child moving into an adult system there are usually specific eligibility issues that need to be taken care of. Some times guardianship and living arrangements need to be made.
If there are partners working with the same child and the partner is taking care of some of the specifics, reference the partner’s plan and attach it. For example if you are a Developmental Disability Agency and there is a Service Coordinator from another agency who is taking care of specific tasks, reference the Service Coordination plan and attach.
The next part of the transition plan consists of specific activities that will help the individual acclimate and become comfortable in any new setting.
The last part of the plan (and it doesn’t have to be in this order) should address any specific skills/behaviors that will need to be increased in order to help the individual be successful in the new environment. This part should follow the strict criteria for a measurable behavioral objective. This could also be contained in another part of the overall plan and just referenced in the transition plan and attached; however, where ever this part is located, it needs to address the specific skills/behaviors that will help the individual in the new situation.

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Nature abhors a vacuum

2007-11-30T14:58:00.000-08:00

Recently, just this morning, I was visiting with an excellent young therapist. We started talking about data collection and about making it simpler to which she responded how difficult it was to simplify data collection on the aggressive behaviors she was observing and which she was at times on the receiving end. (It is important to note that the therapist is not in any danger of harm in this situation.)

This brought me back to my tired old record, which I play quite often, about finding the reason for aggressive or harmful behaviors and finding and teaching a replacement behavior.
It is important to do a thorough assessment of current levels of behaviors of the person that you are working with.
Occasionally it is important to reassess the level of those behaviors, especially if there is danger; you can not totally ignore them. Safety comes first.

Our conversation thought, brought me to talking about the Hawthorne Effect. A good therapist should have a good understanding of a number of different effects including Hawthorne, Pygmalion and Halo. See: http://www.psy.gla.ac.uk/~steve/hawth.html#pyg & http://en.wikipedia.org/wiki/Halo_effect . You must ask yourself what the effect has been, is and/or will be of continually and frequently measuring an inappropriate behavior.

I know this therapist and her husband fairly well and I asked her what the result would be if she started taking data on how many times her husband left the toilet seat up. While this may decrease the behavior there may be some additional consequences. (Frankly, while I know them fairly well, I don’t know them well enough to even know if this is an issue.) Anyway, since in a situation like this, the goal should not be to not have the toilet seat left up but to have it put down, a simple reinforcement (perhaps even a simple request) of putting the seat down is likely to be more productive all around. For a better example, if someone needs physical touch and is filling this needs in a socially inappropriate fashion, then trying to eliminate all touch is probably not reasonable. If flinging feces provides needed attention, then perhaps it would be beneficial to teach and reinforce another more appropriate way to get attention. Remember that whenever you are trying to decrease a behavior, you need to be increasing another more appropriate behavior that still fills the needs met by the less or inappropriate behavior. If you do not, the person will find another, perhaps even less appropriate way to meet their needs. As Spock astutely said in The Wrath of Kahn “Nature abhors a vacuum.”

Please also visit http://www.childrenofthecode.org/interviews/shonkoff.htm#Adaptation:

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